ORANGE COUNTY REGISTER: Addiction treatment bills aim to change troubled industry – but it’s slow in coming

Friday, August 30, 2019

By Teri Sforza

His kids, ages 9 and 11, ran into the living room screaming. “There’s someone laying in front of our house in the middle of the street!”

Jeff Briney, a 20-year resident of Laguna Beach, ran to the window. Indeed, a young man was sprawled out, unconscious, on their narrow, winding South Laguna road.

That happened in late July. It was the fifth ambulance-sirens- and police-cars-crisis that Briney had witnessed since 2017, the year a licensed residential addiction treatment center moved in across the street. He doesn’t believe he’s seen all or even most of the center-related emergencies, saying there’s “no telling how many there actually have been, since we aren’t home 24/7.”

Over the past two years the Southern California News Group has chronicled disturbing reports of deaths, sexual assault, drug abuse and paying-for-patients inside California’s loosely regulated addiction treatment industry. Those reports have prompted federal probes, an Orange County task force, a sober living registry and new state laws meant to protect vulnerable people struggling with addiction.

But while activists are thrilled that several state bills may be bound for the governor’s desk aiming to tighten up regulation, increase inspections and raise standards at rehabs and sober living homes, changes are slow to percolate down to the neighborhood level.

“We’ve found used meth pipes in our trash cans,” Briney said. “My neighbor found a stash of heroin underneath his stairs. My kids are growing up with people overdosing and doing drugs right in front of their eyes.”

For Briney — and tens of thousands of Southern Californians who live near the region’s 1,000-plus licensed addiction treatment centers or the thousands of unregulated sober living homes — change can’t come soon enough.

Today, just as was the case two years ago, when one problem home shuts down another often pops up nearby, sometimes under the same ownership.

“It is very much (a game of) Whack-A-Mole,” said Sandy Genis, a councilwoman in Costa Mesa, which, along with places like Malibu and Lake Arrowhead and Hollywood, is among the Southern California cities hardest hit by unregulated sober living homes.

Clean-up

The rehab industry is getting more scrutiny from lawmakers. More than two dozen treatment- and recovery- related bills were introduced in Sacramento this session, proposing major reforms to what has been described as a “Wild Wild West” lack of regulation in California’s treatment industry. Most of those proposals ran into familiar brick walls.

“The advocacy groups for alcoholism and drug recovery, I think, view (most regulation) as a slippery slope,” said Assemblyman Tom Daly, D-Anaheim, whose Assembly Bill 1779 — which would set new standards and rules for some sober living homes — stalled in committee on Friday.

“Any type of state or local regulation makes them concerned it will be harder to open up new facilities,” Daly said. Operators have had an open field for a long time, he added, and they want that to continue.

Federal anti-discrimination laws categorizing addiction as a disability, on par with physical challenges, have also been used as a shield by some rehab operators to protect their industry from regulation. But an across-the-aisle team of lawmakers has banded together in Sacramento to push back.

The new Bi-Partisan Legislative Substance Abuse Treatment Working Group seeks to significantly expand state oversight, improve patient protections and ensure taxpayer dollars are spent on programs that work. Led by Assemblywoman Cottie Petrie-Norris, D-Laguna Beach, some say the new group is the reason more bills have progressed in this legislative session than ever before.

“It’s been a difficult nut to crack. (But) it’s starting to move,” said Assemblyman Bill Brough, R-Dana Point, and a member of the working group. “Cities are fighting back.”

While longtime rehab reform activist Ryan Hampton said the legislative process remains frustrating, he’s also seen progress.

“There are four major bills that are waiting to be funded and are literally one step away from the Governor’s desk,” said Hampton, who kicked a heroin habit and lost friends in wayward treatment residences and sober living homes.

“These bills address issues of serious concern such as recovery residences, unregulated outpatient treatment services, unscrupulous phishing of addiction patients on the internet, and curbing patients whose insurance benefits are stolen to provide housing and when the benefit runs out they are left homeless,” he said.

“Would we like to see more? Absolutely. However, we haven’t seen this level of progress ever from the California legislature. So I am hopeful that legislators are finally woke on this issue.”

Survivors

The legislators in the bipartisan working group — and neighbors like Briney — hope so, too.

Among the bills still in play as the Legislative session approaches its end on Sept. 13 are:

Senate Bill 589 by Sen. Pat Bates, R-Laguna Niguel, which would prohibit rehabs and sober homes from making false or misleading statements, and from hijacking the web traffic of another rehab;

AB 920, by Petrie-Norris, which proposes a working group to revamp California’s system, will be amended to require unlicensed outpatient treatment centers to adopt American Society of Addiction Medicine treatment criteria as the minimum standard of care. That’s the brainchild of Sen. Jerry Hill, D-San Mateo, whose bill requiring the same of live-in treatment centers was signed into law last year.

AB 919, also by Petrie-Norris, which would crack down on financial conflicts-of-interest between laboratories, treatment programs and housing providers, and require the Department of Health Care Services to provide enforcement.

AB 290, by Assemblymember Jim Wood, D-Santa Rosa, which would remove the financial incentive for treatment providers to bring people to California by promising “free” insurance coverage.

Bates’ marketing bill survived the Senate appropriations committee on Friday and will go to the floor. But it came with a major amendment: unlicensed sober living homes were removed from the restrictions. Legislators thought the homes would be hard to identify, since they are unregulated.

“It’s still significant in terms of the universe it is trying to rein in,” Bates said. “But there still is a ways to go. This is going to be incremental in moving the ball a little downfield. The sober living home is the one that appears elusive.”

Petrie-Norris is gratified that her bills have progressed so far, and plans to harness momentum to put together a legislative package for next year that’s even more ambitious.

“The opioid crisis is a very recent challenge. I don’t think our framework has caught up with… the ways in which some bad actors have been able to exploit loopholes in the laws,” she said.

“The big goal is to shine a spotlight and elevate the conversation in a bipartisan way… When we work together, we’re able to get things done.”

The Petrie-Norris/Hill bill would address the complete lack of standards in outpatient centers, where the vast majority of treatment is provided. Right now, outpatient centers don’t need to be licensed, aren’t regulated by the state and aren’t required to meet any standards.

The proposal for a working group to explore a major revamp of California’s approach to addiction treatment will be pursued in the next session, she said.

Casualties

Many bills seeking change will have to try again next year.

Daly’s  AB 1779 would have, for the first time, required quality standards for sober living homes receiving public funding. It also would have made officials keep track of complaints and report back to the Legislature in five years.

“That’s one of the problems. Because there’s been a lack of regulation in this area, there’s also a lack of data,” Daly said. “That’s one of the goals of my bill. Let’s get some real facts on the table. If there’s public money being spent, then the public has a right to expect the homes to be operated with quality standards.”

Daly is disappointed with the delay, but vowed to redouble his efforts to obtain standards in 2020.

Another bill that got stuck sought to ban sober living homes from paying “brokers” who bring them insured customers. Another would have required that rehab workers pass criminal background checks — something that’s mandatory for acupuncturists, dental hygienists, optometrists and veterinarians but not for those who work closely with people seeking addiction treatment.

Assemblyman Bill Brough, R-Dana Point, holds out hope for his AB 224, which would require treatment homes to have a plan for relocating clients whose insurance benefits have run out. Now, such people are often “curbed,” meaning that they get kicked out of the facility as soon as insurers stop paying, often ending up homeless. The bill is scheduled to go to the Assembly health committee in January.

Another Brough bill that didn’t make it through, AB 615, sought a $10,000 penalty to bolster a new prohibition on body brokering — the practice of licensed rehabs paying middlemen for new clients — which he called “toothless” for its lack of meaningful fines. Legislators, however, wanted to give the new ban a chance to succeed without high fines, he said.

It’s still hard to get reforms past those who favor the status quo, and even when reforms are passed, there’s the issue of enforcement, Brough said.

“That’s the hardest part of this job, getting the bureaucracies to do something,” he said.

Activist Laurie Girand of Advocates for Responsible Treatment in San Juan Capistrano, who has been pushing for stronger legislation for years, is wary but optimistic.

“This has been the best year we’ve had, in terms of Northern California and Southern California working together, support across the aisle, and support for change in both the Senate and Assembly health committees,” she said. “Where we really need to go is to state licensing for all businesses, and if they’re not businesses but living environments, the state should certify them.

“This is a very exciting time,” she said. “We hope for, and anticipate, progress that could save lives and improve the situation in communities.”

Street scene

Back in Laguna Beach, the rehab across the street from the Brineys has stunning ocean views, a pool, four bedrooms and 3.25 baths in 3,857 square feet of space. Zillow estimates the home in which the rehab operates is worth about $3.7 million.

Records show it’s licensed as a residential detox facility with six beds by the Department of Health Care Services. Its legal name is Laguna View Center, its program name is Laguna View Detox, and managers have included John Kovacs and Tracy Coveyou. No one answered the door to comment about the neighborhood conflicts. The person who answered the facility’s phone refused to speak to a reporter, but program director Riky Hanaumi responded by email.

“We opened our treatment facility to address known, and unfortunately growing, addiction problems in our society,” Hanaumi said. “Our aim is to reduce substance use in the community, improve the lives of our clients and thereby, eliminate the crime and drawbacks to society which often accompany lives plagued by addiction…. Our sole purpose is to improve lives and the community in which we serve.

“We do not allow crime, or even misconduct, in our facility. Although we are not permitted to police the behavior of individuals in the neighborhood, we do carefully control the conduct of our clients within our facility. We lament any criminal activity anywhere and encourage residents to contact law enforcement whenever they observe dangerous, or criminal behavior. This is especially so when in the neighborhood of our treatment facility. We are as interested in having a crime free environment as our neighbors are.  Perhaps more so.”

Briney, for his part,  is aggravated. Cars come and go at all hours, he said. Clouds of cigarette smoke waft up the hill. Property values have taken a hit.

“If anything good has come of this, it’s that we’ve had a lot of talks with the kids about the dangers of using drugs,” he said.

Lawmakers say they want to address such concerns.

“I certainly understand and sympathize with their frustration. The reality is, in our current framework, there is very little oversight for drug and alcohol facilities in California,” said Petrie-Norris.

“That’s bad for people who are struggling with addiction, for people who are in recovery and for people in our communities,” she added. “That’s why this is such an important issue, and why we must act.”

Costa Mesa, one of the cities that has struggled with the proliferation of sober living homes, is optimistic. The city has turned a corner when it comes to controlling the rehab industry within its borders, said Councilwoman Genis.

“For a long time, we felt the state and feds were throwing stumbling blocks in our way,” Genis said. “Now we finally have their attention.”