I am an addictions counselor. I have my Master’s in Social Work. I worked for an inpatient style facility that took in mostly out of state patients. These patients would be flown in from other states and the staff at this agency would go pick them up. There was a nurse and Doctor that worked for this agency, but they were not available 24/7. If struggling, patients would have to wait to see the Doctor the one day a week he was there. I had never worked for this type of treatment facility prior to coming to this agency. What I found once there was less than desirable and I ended up not staying long. The staff were all very undereducated for the responsibilities they were given. There was only one other therapist there when I got there. The clinical director directed from another state, which I thought was obscure. I was responsible for seeing clients in group, individually, and doing their initial assessments. When I started seeing clients, I quickly learned of many discrepancies. One major discrepancy was that folks were coming in for detox level of care and they were coming off substances that did not require detox such as methamphetamines. However, their intake notes stated they were drinking “a fifth a day” and doing methamphetamines. When I would ask the patients when they had their last drink most would say they never drink or have not drank in years. This was a red flag for me. I told the patients that their intake application shows alcohol use. The patient would tell me they did not know where the person doing their intake got that information. I asked the case manager about this. I was told that this was for insurance purposes and not to worry about it. I told him that it was highly illegal to lie to insurance companies to get coverage. He told me just to continue seeing the patient and not to worry about that part. These patients were in detox for a lot longer than I clinically deemed necessary. I was told that detox paid more money and that we would be keeping them in detox for as long as the patient’s insurance would cover it. This concerned me as well. There were more instances of discrepancies. Case management notes would be made, by one case manager in particular, that did not fit with the client indicating they were struggling more than what they were in my clinical observation. When I questioned this I was told it was to get more treatment time from the person’s insurance and for me not to worry about it. I brought this to the clinical director’s attention who told me she would handle it and she did not. I brought it to the owner’s attention and I was told that maybe I just had not seen the client struggling.
Another major concern was that the patient’s transitions of care were not dictated by myself, the other clinical therapist, or the clinical director as I was told they would be, and they should have been. Folks would be moved randomly from detox and PHP levels of care to the owner’s local sober living houses and IOP never to be seen again. This was an issue because most of these clients were not ready for this move and if they were, they still should have been coming to IOP (Intensive Outpatient Program). However, we were told they had to work to pay their sober living rent and would not be able to make the IOP hours. This was a concern because for a bit they were still on the therapist’s caseloads. If something happened to them, we could be ethically and legally responsible. When this was brought to the owner’s attention, he stated that the sober living program was separate from the recovery center’s and for me not to worry about it. I told him that the patient needed to be closed then. When I brought this concern to the clinical director’s attention, she stated that should not be happening, it should be a clinical decision, and she would handle it. Again, I did not hear another thing about this.
Another concern was how many times these patients would come back to treatment. I was there for only seven months. In that time several patients came back to the 2–4-week program more than once. I brought this up as a concern and simply stated that we need to figure out how to better set these folks up for success. I was shut down again saying relapses happen (mostly by that same case manager) and they will take them back as often as needed. I told them that I understand relapses happen, but this seems extreme in such a short time frame. I was simply trying to make the best program possible. I figured that these patient’s insurance companies would get aggravated about paying for inpatient treatment so often with no good results.
I was also concerned about when patients wanted to leave, they were told they could not and if they left it would be considered “against medical advice” and they would get no belongings, meds, phones, wallets, purses, etc. They were told to sit still and almost bullied into doing so. In my opinion, where they got care should have been the
In my opinion, where they got care should have been their decision. They should not have felt forced to stay somewhere they did not feel comfortable. And when they left, they should have at least been given personal belongings such as their phones to call someone, meds, ID, and clothes. I understood not giving them money as they could buy drugs and overdose once they left. We even had a cop one time force the owner to give a patient his stuff because he was stuck here from out of state. These folks were mostly from out of state and if they left AMA would be left without a way to contact their loved ones, take care of themselves, take their meds, and get home safely. This was against my ethical standards.
The above were some of the major illegal and unethical things I saw while working for this agency. Beyond this, there were many boundary and unprofessional issues I witnessed. The case manager in question throughout much of this explanation would cuss out and yell at patients. Patients would be hired to be techs right out of the inpatient house. Folks with little experience and sober time were hired. Techs were patients sponsors which I feel was a conflict of interest. Any time I brought up issues I was shut down by the owner. I was cussed out and belittled by the case manager who was the culprit throughout many of these troubling experiences. I could no longer stay with this agency and gave my notice. The fact that this owner and his staff are held in such high esteem by the recovering folks locally is very concerning. I feel that he is manipulative and deceitful. Once someone catches on to his nonsense or goes against what he says he throws them out on their tails literally. Knowing these folks are mostly from out of town and survived by his “good graces.”
Postscript from anonymous author: This center pays for the client’s airfare and they do NOT sign promissory notes.