The description of “3.1” and “3.5” care levels referenced in this story have been updated to match those provided earlier this month to the Juneau Assembly.

An acrimonious effort to reopen Rainforest Recovery Center due to what a staff member called a “dangerous and medically irresponsible” situation surfaced during a Bartlett Regional Hospital board of directors meeting Tuesday night, with hospital and city officials planning to meet Thursday to discuss options.

The clash occurred on the same day the residential substance abuse treatment program closed, one of multiple programs recently targeted for closure or cuts due to budget shortfalls. Hospital officials on Tuesday also noted specific eye and skin disorder care are among the services being halted, although for reasons going beyond Bartlett’s financial hardships.

The announcement of Rainforest Recovery’s closure caught Juneau Assembly members by surprise after they tentatively approved funding to keep the program operating until some services were transferred to a local nonprofit operator. But concerns were raised by hospital staff and board members at Tuesday’s meeting that the nonprofit’s low-intensity residential care isn’t adequate for patients needing Rainforest Recovery’s high-intensity care.

“It would be dangerous and medically irresponsible to refer our local individuals requiring high-intensity services to a lower level of care,” Tina Pleasants, Rainforest Recovery’s admitting and attending provider, told board members and hospital administrators. “Many of the local patients served at Rainforest Recovery Center are medically complex and are at serious risk of life-threatening complications without the expertise and licensed staff to safely care for these individuals.”

Her comments echoed criticism by Lindy Jones, a Bartlett board member and emergency room doctor, published Monday in the Empire. In official terminology, the dispute is about Bartlett’s level 3.5 (high-intensity) care versus the level 3.1 care (low-intensity) provided at the facility Gastineau Human Services opened last year and plans to expand.

The classifications, as defined within a four-level system by the American Society for Addiction Medicine, are:

• Level 3.1 (clinically managed low-intensity residential): “The primary goal of ASAM Level 3.1 is to promote responsibility and reintegration of the individual into the network systems of work, education, and family life. Activities are provided within a 24-hour structured program with available trained personnel. It is a clinically managed, low intensity residential program which provides individuals who need time and structure to practice and integrate their recovery and coping skills in a residential, supportive environment.”

• Level 3.5 (clinically managed high-intensity residential: “ASAM Level 3.5 is appropriate for individuals whose addition is so uncontrollable that they need 24-hour supportive, safe and structured treatment environment to initiate or continue a recovery process that has failed to progress. The programming promotes a variety of treatment approaches which may include harm reduction, abstinence, addresses additive and antisocial behavior, and effects change in lifestyle, attitudes, and values.”

Rainforest Recovery Center, operated by Bartlett since 2000, was the only facility in Southeast Alaska providing level 3.5 care. It cared for 316 people the past three years, but also saw wages and benefits exceed net revenue by $2.3 million during just the past two years and an additional loss of about $800,000 was forecast this year.

A transition to level 3.1 instead of level 3.5 care wouldn’t be a drastic adjustment for most local patients, Assembly members were told by Bartlett and GHS administrative leaders at meetings earlier this month. Also, a staff member from the former Rainforest program was going to work with the nonprofit center to ensure quality treatment.

Furthermore, while Rainforest Recovery had 16 beds and GHS planned to add only eight to its current 19-bed facility, Bartlett officials said only half of their patients are Juneau residents and thus they could be accommodated with the expansion. GHS Executive Director Jonathan Swinton has said the nonprofit’s facility is operating on a sustainable basis.

However, Mayor Beth Weldon stated in a text message to the Empire on Wednesday she requested Thursday’s meeting — which will include herself, other city leaders, and hospital and GHS personnel — after learning about the concerns raised by Jones and other stakeholders.

“We need some reassurances from BRH and GHS,” she wrote.

Among the criticisms expressed by Pleasants was being left out of the decision-making process about Rainforest Recovery’s future.

“I was never consulted or asked a single question about any plans moving forward or any transition process,” she said.

Bartlett Interim CEO Ian Worden, who rebutted numerous criticisms about the closure during Tuesday’s meeting, said discussions about the future of Rainforest Recovery and other programs have been ongoing for months at meetings involving staff, public board meetings and before the Juneau Assembly. He also noted that while there was an intention to keep Rainforest Recovery open during the coming months while the transition to GHS occurred, a shortage of staff that included recent resignations due to the uncertainty of the facility’s future meant that wasn’t feasible.

Pleasants told board members she doesn’t accept that explanation.

“Staffing at Rainforest Recovery was an issue, but there are still core staff employed at Rainforest who are willing to run the program, and we are still here and we are still employees of the hospital,” she said. “The staffing challenges are no different than any other department. Yes, there were resignations, but the majority of them happened when Rainforest was overstaffed.”

Pleasants said she believes “sustainability at Rainforest Recovery Center is achievable, even if it’s only reopened with a revised structure and limited timeline to allow other organizations in the community to safely develop 3.5-level services outside of Bartlett Regional Hospital.”

But most board members, other than Jones, said simply reopening the center doesn’t seem possible given Bartlett’s ongoing staffing shortages. Wade Bryson, the Assembly liaison to the hospital board, also said it’s highly questionable if there’s enough support on the Assembly to provide enough funding to allow the center’s reopening.

The Assembly last week gave initial approval to a $500,000 allocation to help GHS expand its treatment program more quickly than planned — money originally earmarked for Bartlett to continue Rainforest Recovery during the coming months. But reopening the center would cost considerably more, with an estimate of $1.5 million for the current fiscal year cited during Tuesday’s meeting.

As for other alternatives explored, SEARHC formerly operated a level 3.5 center in Sitka, but closed it because it wasn’t financial sustainable and the Alaska Native healthcare operator isn’t interested in offering such a facility in Juneau, Worden said.

Tuesday’s meeting was punctuated by some angry exchanges, primarily between Worden and Jones, including each questioning if the other was exceeding the bounds of their authority.

Jones said Worden exceeded his authority with the decision to close Rainforest Recovery since the board had passed a resolution this summer stating that if a funding solution wasn’t realized by Oct. 31 the board would meet in November to try to work out an arrangement with a third-party provider in a way not harmful to patients.

“We have no plan what to do with people in the future and then we shut it down,” Jones said. “And I’m sorry if I’m offending people and making them feel hurt, but this is clinically dangerous and people are going to get hurt. People are going to die. And we need to do this right.”

Worden, in turn, said Jones was stepping over the line as a board member with the claims he was making about the impacts of Rainforest Recovery’s closure, the alleged failings in the process of the decision, and how he was raising such matters with city leaders and the public.

The interim CEO also noted Jones helped trigger another controversy at the hospital last summer when he presented a letter to the board alleging “inhumane treatment” of behavioral health care patients. Then-CEO David Keith announced his resignation the day after a story about the allegations was published by the Empire, which led to Worden’s appointment as interim CEO a few months later.

“It’s so destructive what you’re doing last year and this year to the wonderful people that work in this hospital,” Worden told Jones. “I don’t understand why you would demoralize our people over a program that we can’t even afford, the city says it can’t afford and (when) we’re trying our best to be able to handle the patients that come to us.”

Tuesday’s meeting was Worden’s last as CEO, with current Chief Financial Officer Joe Wanner scheduled to become the new permanent CEO on Sunday.

Ophthalmology and dermatology services at Bartlett halted

Budget cuts at Bartlett this year have primarily focused on six “non-core” programs that, in addition to Rainforest Recovery, including crisis stabilization care that was halted in July, hospice and home health services that are getting financial support from the Juneau Assembly to continue operating, and a therapy program for people ages 2-21 diagnosed with autism now being provided by providers who left the hospital to start their own program.

At Tuesday’s board meeting two more services, both provided by staff from outside the hospital, also were discussed due to them being discontinued.

One is a monthly ophthalmology clinic by doctors from Anchorage who treat eye disorders such as retinal disease, macular degeneration and secondary cataracts. The most recent clinic occurred last month and one more is planned next month before they are halted.

Worden said the program was operating at an annual loss of $150,000 to $200,000 and, while there were discussions with visiting doctors about changing their rates, the drugs required are also costly. He said there are discussions about trying to have local ophthalmologists take over such care, but “our initial discussion with them is that they would not be ready to take on those until after Christmas.”

Dermatology was suspended as of June 30 due to the retirement of a physician who was sponsoring a physician assistant providing the services at Bartlett, and without such a sponsorship the assistant cannot continue such work, Worden said.

• Contact Mark Sabbatini at mark.sabbatini@juneauempire.com or (907) 957-2306.