Cities would share power to probe addiction treatment complaints under Umberg bill

Used meth pipes in the trash can, drug stashes beneath the stairs, prone bodies in the middle of the street. “My kids are growing up with people overdosing and doing drugs right in front of their eyes,” said a South Laguna dad with a state-licensed detox center across the street.

The city of Beverly Hills sued one rehab, saying it ran an illegal facility that was “a haven for drug abuse and criminal conduct.” One resident described it as “a place to crash and smoke fentanyl,” where the owner provided black tar heroin and methamphetamines to residents at “significantly reduced prices.”

In November, insurance giant Aetna sued that same rehab — and a slew of related operations in Los Angeles, Orange and Riverside counties — alleging they lured patients with kickbacks, “weaponized addiction and pushed relapse to prevent recovery. Far from performing services for their patients, (they) actively worked to harm their patients,” the suit says.

While these horror stories are well-known to folks on Southern California’s Rehab Riviera, some legislators in Sacramento haven’t gotten the memo. So there was Sen. Tom Umberg, D-Santa Ana, nimbly deflecting the profound skepticism oozing from Senate Health Committee Chair Richard Roth, D-Riverside, at a hearing on Senate Bill 913 on Thursday, April 10, in Sacramento. We were on high alert that this bill was sure to die.

Umberg’s 913 is simple: It would extend the state’s exclusive power to respond to complaints about state-licensed addiction treatment centers to local officials, like city attorneys.

Why? Because cities get swamped with complaints about wayward facilities (which are usually six-bed operations in tract homes in residential neighborhoods, which is a weird place to provide life-or-death health care), but can do precious little about it. The California Department of Health Care Services — and only the California Department of Health Care Services — has the power to investigate complaints, but, you know, has trouble keeping up.

We think Roth was trying to defend DHCS, not denigrate it, when he pointed out that the average time for closing complaints has shrunk from eight months (245 days) to just shy of four months (115 days).

Phantom inspectors?

DHCS got some $5 million over the past few years to beef up enforcement in O.C. and SoCal, Roth pointed out, unconvinced this bill is necessary.

Some of that money was to pay for three inspectors right here in Santa Ana, rather than in Sacramento with all the others. The idea was to swiftly respond to and resolve problems in America’s addiction fraud capital, but legislators said they haven’t seen improvement. They questioned how many analysts there were, and whether they’re really in O.C. at all, as folks couldn’t find an office address or business permit.

We asked DHCS about this, and officials assured us that the analysts really do exist. The new licensing and certification staff is stationed in DHCS’ Orange County office on MacArthur Boulevard, spokesman Anthony Cava said. There are now four people on duty — three analysts and one manager — and DHCS is currently in the process of hiring another analyst, he said.

Still, SoCal needs more help. An impassioned plea came from Sen. Janet Nguyen, R-Huntington Beach, vice chair of the Senate Health Committee.

“This has been the No. 1 issue in my district — coastal, inland, it doesn’t matter,” she said. “We cannot get the department to listen to us, hear from us, they’re not coming out. We can complain, even the fact that we’re talking about 1502a (the law prohibiting overconcentration of facilities in neighborhoods) — that’s not even been looked at. This issue has been ongoing for almost 20 years, not just in Orange County, but a full discussion has never happened in Sacramento.”

Her question to Umberg was: “What happens when a city files a complaint to the department?”

There was a short but dramatic pause. “I realize this sounds facile,” Umberg said, “but pretty much nothing.”

“I don’t think anyone would dispute that there’s been virtually no enforcement,” he said. “I think the department would agree their resources are inadequate. In our part of the state, there are virtually no site visits.”

Nguyen cited some stats for a quickly growing segment of mental health facilities not subject to DHCS regulations but her larger point was spot on: The overwhelming majority of state-licensed and/or certified addiction treatment facilities governed by DHCS — 1,235 out of 1,799 — are right here in Southern California.

It breaks down like this: 600 in Los Angeles County, 330 in Orange County, 151 in San Diego County, 105 in Riverside County and 49 in San Bernardino County, according to DHCS’s latest stats.

Compromise

The original version of Umberg’s bill included sober living homes, which don’t have to be licensed by anyone and are thus a different beast. Umberg dropped them from SB 913 over concerns about discrimination against the disabled, the sword and shield protecting people in recovery (which, Aetna and Beverly Hills might argue, pad the pockets of providers but don’t protect vulnerable people at all).

Roth had a problem with local governments taking over state authority to enforce state laws.

“It is not the intent for cities to take over the responsibility,” Umberg said. “The department has the responsibility. To the extent the department does not have adequate capacity and provides consent to a city attorney to conduct a site visit — that’s the intent.”

The state would essentially deputize a city to do site visits, allowing local officials to respond in much realer time to complaints about patient brokering, drug use, overcrowding and other serious issues. The state would have to develop a process for that, and it could deny local governments that authority on a case-by-case basis.

“This bill aims to establish a robust framework for oversight and enforcement, ensuring that these entities operate with integrity and provide evidence-based care,” Umberg said in a Senate analysis of the bill.

“By empowering cities with the authority to conduct site visits and additional enforcement mechanisms for existing laws preventing patient brokering, this bill strives to create a safe and dignified recovery environment. This legislation is a crucial step in safeguarding individuals in recovery from exploitation and in promoting high standards of care.”

Support

The League of California Cities is the muscle behind this bill. Its Caroline Grinder painted it as a partnership between state and local governments to protect public health and safety, and a much-needed opportunity for the state to leverage local resources.

“Cities are well-positioned to respond promptly to emerging issues in their communities,” she said. SB 913 “would establish a process for cities to work with the department to ensure compliance, and would require the department’s approval prior to any inspection or enforcement action.”

DHCS clearly faces major hurdles in being able to monitor and regulate these facilities, and cities can be valuable partners in ensuring that DHCS is aware of violations and that swift action is taken.

“I think we share the same goal of ensuring that bad actors aren’t able to subvert state oversight to take advantage of vulnerable populations,” she said. “It’s critical that their needs are prioritized over profits.”

In addition to the League of California Cities, the county of Orange has signed on as a supporter, as well as the cities of Cypress and Fountain Valley.

Opposition

The muscle behind the opposition is the California Consortium of Addiction Programs and Professionals.

“What they want is to appease NIMBYS in Orange County who have raised illegal and public relations battles against recovery residences for over 10 years,” Sherry Daley of CCAPP told the committee.

This bill is the equivalent of a “no-knock warrant” on peoples’ homes and is antithetical to the Constitution, common sense, and basic human dignity, its opposition statement said.

“These local governments throughout Orange County continue to harass citizens and thumb their noses at state laws and the Constitution,” Daley said. “Their track record on this issue proves that these entitles would ignore any rules presented to them and continue on a path of discrimination, but with the state’s blessing.”

SB 913 is meant to appease disgruntled League of Cities members who are leaving the fold over the League’s support of  Proposition 1 — the $6.4 billion revamp of mental health and addiction treatment services. Some cities fear it will make things worse, not better, for struggling people and their neighbors.

“To create a law that would allow any local government official to enter persons’ private property for any reason, other than the urgent health and safety needs of the public, is simply unacceptable,” CCAPP said. “There is no need to subjugate state enforcement to local entities as required in this bill.”

Stunning consensus

So, we’ve seen a lot of sausage-making over the years. It’s not every day that a committee “respectfully” ignores the chair’s disapproval.

But it happened here.

Sen.Shannon Grove, R-Bakersfield, made it clear that this is not an O.C.-specific issue. She has gotten calls from rattled constituents saying, “They’re in my front yard, it’s 3 a.m., what can I do?” she told her fellow committee members.

“There’s not a lot that can be done,” she told Umberg. “I get what you’re trying to do.”

Sen. Caroline Menjivar, D-San Fernando Valley, worried that this power would be “weaponized” and “NIMBYS are going to come out even more,” she said. “‘We don’t want these in our neighborhoods but we don’t want homelessness.’” Facilities would wind up concentrated in communities of color.

When votes were finally recorded, though, the ayes were 10 and the nays were zero. Chair Roth did not record a vote.

No one may be more surprised by this little victory than Umberg himself.

“I’m obviously grateful that the bill is continuing to move along,” he said. “It’s so important that we have effective — really, any — enforcement of the laws that pertain to recovery centers.”

But this is just a first step in a very long process, and the bill’s survival is anything but certain. Its next stop is in the Senate judiciary committee, which Umberg chairs, on April 23.

Cities all over SoCal yearn for this bill. If enforcing state law, and protecting vulnerable people from horrid exploitation in real time, seems important, Umberg urges you to contact your legislators and urge them to support the bill. Find your reps at https://findyourrep.legislature.ca.gov/.

Source: Orange County Register