Rainforest Recovery Center is remaining closed and Gastineau Human Services is aggressively challenging critics who earlier this week said the nonprofit’s lower level of substance abuse care presents a “clinically dangerous” situation for people needing the higher level of treatment at the now-closed hospital facility.
The accusations resulted in a meeting at Bartlett Regional Hospital on Thursday afternoon between officials from the hospital, GHS, Juneau Assembly and the city manager’s office. Participants said the existing plan remains in place for GHS to expand its 19-bed facility by eight beds, currently scheduled to happen by Oct. 14, with assistance from a Bartlett employee and possible help from a $500,000 allocation being considered by the Assembly.
“I have complete confidence in GHS,” Mayor Beth Weldon wrote in a text message to the Empire after the meeting “BRH and GHS will have to work together as medical issues/treatment is needed. We just needed to have all the players in the same room to hear (and) get the same message.”
The dispute essentially comes down to Rainforest Recovery providing “high-intensity” residential care at its 16-bed facility versus the “low-intensity” residential care offered by GHS.
Among those voicing public criticism of the consequences of Rainforest Recovery’s closure earlier this week was Lindy Jones, a Bartlett board member and emergency room doctor, who during a board meeting Tuesday said the board had passed a resolution stating a closure of the facility would be considered in November if funding to support it wasn’t found. Instead, it was closed by the hospital’s CEO on short notice as of Tuesday, creating what Jones called a perilous situation.
“We have no plan what to do with people in the future and then we shut it down,” he said during the meeting. “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.”
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Harsh criticism was also voiced at the meeting by Tina Pleasants, Rainforest Recovery’s admitting and attending provider, who said it created a “dangerous and medically irresponsible” situation. Both Jones and Pleasants appeared to temper their remarks Thursday, with Jones stating in an interview he wasn’t criticizing GHS’ recovery program and Bartlett issuing a statement that Pleasants offered a “retraction in today’s meeting.”
In a strongly-worded response to the criticisms, GHS leaders stated Thursday key points of critics are based on treatment guidelines that are outdated and an elevated level of “low-intensity” care is offered by the nonprofit at the 19-bed Mount Juneau Counseling and Recovery facility that opened last year. Which means while the facility can’t accommodate all addicts Rainforest Recovery was able to treat, it can handle a larger percentage than critics indicted.
The errant criticisms are “harmful to many in the community who now may not now seek services or referrals from the only currently operating residential substance use treatment program in our community,” GHS Executive Director Jonathan Swinton and Behavioral Health Director Fred Sweetski wrote in a four-page letter to Bartlett Regional Hospital and its board of directors.
However, there are still significant differences in low-intensity and high-intensity care in the four-level system updated last year by the American Society for Addiction Medicine. Also, Swinton said in an interview Thursday the Alaska Department of Health has not yet officially adopted the updated ASAA recommendations — meaning criticism voiced earlier this week would apply to the state’s standard for low-intensity residential treatment, even if GHS is operating under the newer recommendations.
The updated definitions, as presented to Assembly members earlier this month during a discussion about Rainforest Recovery’s future, 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 addiction 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.”
Among the differences in the older versus the newer guidelines is treatment in low-intensity care “is only required to be five hours per week” under the old guidelines, while the newer recommendations call for nine to 19 hours per week. GHS provides 18 hours of treatment a week, according to materials provided to the Assembly. High-intensity care calls for 20 or more hours of treatment a week.
Also highlighted in the letter by Swinton and Sweetski is “that only clients experiencing severe acute withdrawal or those with high-complexity medical issues” require high-intensity residential care.
“GHS embraces the ‘no wrong door’ approach to treatment, which encourages individuals to seek help from any available resource,” the letter states. “This approach is widely supported by the Substance Abuse and Mental Health Services Administration (SAMHSA), ASAM, and current research. Misinformation implying that individuals should limit their search for help to specific providers or programs might deter them from reaching out to other available care.”
Rainforest Recovery Center treated 316 people during the past three years, about half of whom were Juneau residents, according to the hospital. Swinton said he doesn’t know how many patients will require the high-intensity care the GHS facility can’t provide, but “I would bet we’re talking about somewhere in the neighborhood of 5% to 10% of the typical referrals that comes into us need to have a higher level of care than we can figure out how to manage.”
Swinton has previously said his facility generally operates at full capacity and the expansion is meant to accommodate the volume of local residents who were seeking treatment at Rainforest Recovery. While the expansion was originally scheduled to be completed Jan. 6, Swinton said Thursday the target date was changed to Oct. 14 after Rainforest Recovery’s closure was announced.
“We’ve had to speed up hiring of additional personnel and we’ve had to be creative with the space that we have for offices,” he said. “We’ve doubled up some people in offices, for example, to free up the space we needed to add more beds.”
A statement issued by Bartlett on Thursday asserts “today’s meeting reinforced the hospital’s positive relationship with GHS.”
“To be clear, the hospital’s case management team ensured a safe discharge for exiting RRC patients,” the statement notes. “It’s unfortunate that the hardworking professionals at both the hospital and GHS became causalities in this matter. We are hopeful for a collaborative process moving forward with all parties involved.”
The statement also expresses appreciation for “Ms. Pleasant’s retraction in today’s meeting,” without specifying what remarks that applies to. Attempts by the Empire to contact Pleasants to confirm if she has retracted some or all of her public statements to the board Tuesday were not successful. Swinton, describing the meeting, said Pleasants “was very cooperative in the discussion to try to help facilitate proper treatment for the patients.”
Jones — who during Tuesday’s board meeting was harshly criticized by Bartlett Interim CEO Ian Worden for his recent comments as well as controversial statements last year about shortcomings in the hospital’s behavioral health services — said in an interview after Thursday’s meeting “I’m 100% supportive of Gastineau Human Services.”
“They provide excellent service to our community,” he said, emphasizing his previous remarks were not a criticism of the nonprofit. “I think at this time the way to move forward is for us all to support them and their mission.”
However, that transition still leaves a gap in local care for people needing high-intensity treatment, Jones said.
“I still believe that there’s going to be some people that are going to be really challenging to place and I guess time will see how our community will deal with them,” he said.
• Contact Mark Sabbatini at mark.sabbatini@juneauempire.com or (907) 957-2306.
Rainforest Recovery Center at Bartlett Regional Hospital closed on Tuesday. (Laurie Craig / Juneau Empire file photo)
