This investigation is a joint venture of KHN, a national newsroom that produces in-depth journalism about health points, and Highlight PA, an impartial, collaborative newsroom devoted to producing investigative journalism for all of Pennsylvania.
When Ian Kalinowski was at work, his mother normally texted him. So when he noticed her quantity present up as an incoming call round lunchtime one Tuesday, he figured it had to be vital.
Now, greater than seven years later, he remembers her screams, the shock and the questions she requested over and over once more.
“Why are they saying this to me? Why are they mendacity to me?” Ian recalled his mother asking. “They’re telling me Adam’s useless. Why would they do that to me?”
Adam was Ian’s older brother. Rising up, it appeared they spent each second collectively. Soccer, hockey and tag stuffed lengthy days outdoors their Pittsburgh residence. When Ian moved away for faculty, he and Adam turned to online poker to keep in contact. Adam served as finest man at Ian’s wedding ceremony, and Ian admired his brother’s inventive streak. Adam may flip any piece of paper into an origami swan. His mother’s residence continues to be full of swans.
Adam’s battle with opioid and alcohol addiction was painful for Ian to watch. The issues started, it appeared to Ian, after Adam dropped out of faculty and used drugs to deal with his depression. Adam sought treatment, and he relied on methadone for a few years, however his issues continued. When he was 32, he sometimes drank dozens of beers every day. On Feb. 3, 2014, he entered a treatment center run by Addiction Specialists Inc., in accordance to a lawsuit later filed by his family in opposition to the facility. The center, in a Fayette County strip mall, was about an hour’s drive south of Pittsburgh.
Lower than 24 hours after Adam made it to the facility, he was useless, in accordance to skilled studies from medical doctors in the family’s wrongful loss of life lawsuit. Ian couldn’t perceive what went incorrect, and neither may his mother, nonetheless in denial on the opposite finish of the cellphone call.
What his family didn’t know was that Addiction Specialists, usually often known as ASI, had a historical past of violating state guidelines. In a later federal investigation into the facility’s billing and drug distribution practices, a grand jury concluded {that a} litany of issues occurred at the enterprise many months earlier than and after Adam’s arrival.
Within the wrongful loss of life go well with, a lawyer for the Kalinowski family alleged Adam wasn’t evaluated by a doctor when he arrived at ASI, didn’t receive the medication or treatment he wanted, turned more and more uneasy and anxious all through the night time and killed himself. An Allegheny County choose in December 2019 stated the enterprise, two of its homeowners — Rosalind and Sean Sugarmann — and an ASI doctor had been negligent in caring for Adam. The choose ordered them to pay over $1.6 million in damages, though Ian doubts they ever will.
ASI finally shut down, two years after Adam died.
In current interviews with KHN-Highlight PA, the Sugarmanns denied accountability for Adam’s loss of life and maintained that ASI was a great facility. Rosalind stated it helped lots of people in a rural space with a excessive drug-overdose price.
Addiction treatment services in Pennsylvania, like ASI, are licensed and regulated by the state to guarantee they observe sure guidelines and maintain susceptible people struggling with addiction protected. Oversight used to fall to the Division of Health. However in 2012, the state created the Division of Drug and Alcohol Packages, a $125 million company arrange to give substance use the eye lawmakers felt it deserved.
On the time of Adam’s loss of life in 2014, the department had taken few disciplinary actions in opposition to ASI. It had issued citations and required the corporate to submit plans to right them. However the Sugarmanns informed KHN-Highlight PA that, at the time, they didn’t concern the state would shut them down.
Maybe for good purpose.
A KHN-Highlight PA investigation discovered that the department has allowed providers to proceed working regardless of repeated violations of state laws and hurt to purchasers. Greater than 80 interviews and a overview of 1000’s of pages of state authorities and court docket records revealed that the department lacks assets and regulatory energy, makes use of an inherently flawed oversight system that does little to guarantee high-quality or effective care, and not often takes sturdy disciplinary motion in opposition to services when so many Pennsylvanians want companies.
The department has no customary standards for when it ought to drive services to serve fewer patients and, as of early April, had revoked only one treatment provider’s license in practically a decade. It doesn’t, as an everyday follow, evaluate services to see if any stand out for an uncommon quantity of violations or essentially the most consumer deaths. And since state inspections focus closely on records, they are often tricked with fraudulent paperwork, former workers in the treatment discipline stated.
This leaves Pennsylvanians — who are suffering one of the highest drug overdose loss of life rates in the nation — in the darkish about which treatment services have troubling monitor records.
Some advocates level out that overregulating or closing services may depart people affected by addiction with out choices for care. However in the present system, state and judicial records present, some patients have acquired insufficient treatment or even died; sure services have fraudulently billed insurance corporations; and homeowners rake in federal and state tax {dollars}, in addition to non-public cash from victims of the opioid crisis.
“Many of these rehab services should not correctly run or supervised, and many are in it for the cash,” stated Peter Friday, an lawyer who represented Adam’s family in their lawsuit. “These locations have been unbridled.”
Who Polices the Providers?
Regardless that the Division of Drug and Alcohol Packages provides the licenses that permit addiction treatment services to function, Jennifer Smith, secretary of the department, stated it has restricted accountability for them. Regulation enforcement companies are sometimes higher positioned to take motion in opposition to troubled providers, she stated, and insurance corporations that pay for companies additionally provide oversight.
“It’s not our job to actually police the providers,” Smith stated in an interview. “Our operate is to actually strive to allow them to meet the [state’s] necessities, and by doing so, enabling them to provide high quality companies.”
But, because the regulating physique of these treatment services, the department collects some of essentially the most important information mandatory to correctly police them, together with studies of consumer deaths and bodily and sexual assaults.
Smith stated most providers try to do good work. She stated annual inspections guarantee services meet security requirements, like having sufficient staff members and a constructing that’s up to code. However inspections should not meant to consider high quality of care, she stated.
The KHN-Highlight PA investigation discovered the department makes little of what it is aware of about troubling services accessible to the general public. Its web site reveals if a facility at present has a provisional license — a designation indicating the provider failed to meet a number of state necessities and will probably be inspected extra continuously till it resolves these considerations — however not whether or not it ever acquired such a sanction in the previous, for what points, nor how they had been resolved.
The department doesn’t submit the studies it collects about deaths and assaults, which symbolize some of essentially the most regarding occasions at treatment services.
When KHN-Highlight PA filed a public records request for these studies, the department shared solely incidents that it determined didn’t warrant investigation. It stated it couldn’t provide the full quantity of such occasions at particular services because it doesn’t have mixture knowledge prior to September 2019, when it launched a new digital reporting system. Even the accessible knowledge from that new system provides an incomplete image, as lower than 1 / 4 of treatment services had enrolled in the voluntary system as of March 2021.
Smith stated people ought to choose services the identical manner they do primary care medical doctors, primarily based on publicly accessible information, private suggestions and discussions with insurers.
One of the principle public assets the department provides is an internet site with studies from its facility inspections. Inspectors write these studies after a web site go to, itemizing any violations of state laws they discovered. However these studies provide a restricted window into the each day actuality for purchasers, as there’s no indication of which violations are extra extreme than others, and many laws focus on constructing conditions and completion of records. One regulation, for instance, mandates the temperature at which refrigerated meals should be maintained.
In response to every violation inspectors discover, the facility submits a plan to handle it. If the facility fails to provide a plan or observe by on it, the department has two primary choices: drive the facility to cut back the quantity of purchasers it serves or subject a provisional license. If the department desires to completely revoke a facility’s license, it should undergo an administrative court docket process to get approval.
In practically a decade earlier than December 2020, the state issued provisional licenses to fewer than 80 services — lower than 10% of providers— and compelled solely three to cut back their capability, in accordance to knowledge from the department. In ASI’s case, regulators stated a number of occasions that the corporate failed to doc that it supplied required counseling and different companies. A department spokesperson stated it didn’t drive ASI to function beneath provisional licenses earlier than 2015 as a result of the enterprise submitted plans of correction the department discovered acceptable. Even when a facility has many violations, the department considers how cooperative it’s in working to repair them, Smith stated.
After a current reorganization, the department fashioned a top quality enchancment unit with three workers, Smith stated. The unit may go instantly with treatment services however is supposed to handle broader prevention efforts and different addiction-related programs as effectively. The department can be working with a national firm to provide an online platform the place purchasers can depart evaluations of services, beginning in spring 2022.
However many workers and purchasers in the treatment discipline are skeptical of any long-term enchancment. For years, they’ve seen troubled services make fixes, solely to have the identical deficiencies come up in later inspections.
The department’s personal records present the cycle can persist for years.
Years of Citations, Little Motion
At SOAR Corp methadone clinic in Philadelphia, inspectors from the state Division of Health first issued citations for unqualified workers in 2009, earlier than the Division of Drug and Alcohol Packages was created and took over inspections in 2012. Inspectors at the time additionally discovered one counselor who was accountable for 40 purchasers — above the state-mandated most of 35.
SOAR Corp responded by saying it had demoted an unqualified counselor, had employed one other counselor to decrease caseloads and would guarantee future hires met the state’s necessities.
However state records present that inside a 12 months of these 2009 citations, the facility was cited three extra occasions for related points: hiring an unqualified venture director, overloading counselor caseloads and missing sufficient medical personnel. 12 months after 12 months, state inspectors discovered the identical issues. But the state permitted SOAR to open extra locations in Lansdowne, Levittown and Warminster in 2010, 2016 and 2018, respectively.
In interviews with KHN-Highlight PA, a dozen former workers and practically a dozen present and former purchasers throughout a number of SOAR websites complained about poor hiring practices and power understaffing as simply two symptoms of their a lot bigger considerations. They believed the corporate relentlessly pursued earnings by getting as many consumers in the door as doable, with little care for the standard of treatment.
The Philadelphia location has acquired three provisional licenses from the state, in 2012, 2019 and 2020, placing it among the many 10 most frequent recipients of this sanction over practically the previous decade.
The previous counselors felt that expectations to maximize “billable hours” led to their burnout. They usually noticed excessive turnover amongst staffers. The previous and present purchasers stated they often went weeks with out therapy or had been switched from one overwhelmed counselor to one other each few months.
Nicole Tihansky was a consumer at SOAR’s Levittown location for about a 12 months till final fall. She stated she waited greater than a month earlier than getting her first counseling session, and then was assigned about 5 counselors, one after the opposite.
“It makes you simply need to get in and out of the session shortly, as a result of you already know you’ll get one other counselor in a month,” she stated.
Understaffing is an issue throughout the treatment trade, in accordance to workers in the sector. However former SOAR workers who’ve labored for a number of corporations stated SOAR stood out in their experiences for its excessive staff turnover and insufficient therapy.
“It’s not about therapy or addressing the wants of purchasers,” stated Esther Kirshenbaum, a counselor who labored at the Philadelphia location from 2017 to 2019. “The perspective is to simply get purchasers in right here and ensure we get paid.”
In an announcement, SOAR CEO Richard Mangano stated the corporate “makes each effort to comply with native, State, and Federal laws.”
KHN-Highlight PA shared with SOAR an in depth record of greater than a dozen allegations from their reporting, together with violations of state laws and placing earnings over patient care. Mangano didn’t handle them particularly.
“Soar Corp categorically denies any allegation or suggestion of wrongdoing. … Soar Corp has and will proceed to work with DDAP to enhance the vital companies it provides,” Mangano wrote, referring to the Division of Drug and Alcohol Packages.
In its responses to state citations in current years, SOAR defined that purchasers didn’t present up to scheduled counseling classes, and that companies like drug checks and doctor evaluations had been supplied however merely not documented correctly.
The Division of Drug and Alcohol Packages has by no means compelled SOAR to lower its capability, nor have state officers initiated the executive court docket process to completely revoke its license.
Former purchasers and workers stated state licensing inspections had been introduced forward of time, inflicting a rush by SOAR workers in the times earlier than a web site go to to full treatment plans, counseling notes and different required paperwork.
Nicholas Cucchiaro was a SOAR counselor from 2017 to 2018. He shared with KHN-Highlight PA what he reported to the Division of Drug and Alcohol Packages and the Pennsylvania Workplace of Lawyer Normal after he was fired. He informed the companies {that a} senior administrator at SOAR instructed him to make up counseling notes for purchasers who had gone weeks with out an assigned therapist.
“These are notes from therapy classes that by no means occurred,” he stated, including he knew it was incorrect however feared dropping his job if he didn’t comply.
A few dozen different former workers and purchasers described to KHN-Highlight PA their very own experiences of related practices, starting from thrusting months’ value of types upon purchasers in the times earlier than an inspection to backdating their paperwork.
The Division of Drug and Alcohol Packages and the lawyer common’s workplace each agreed to look into the allegations, Cucchiaro stated, however he didn’t hear of any penalties for SOAR.
The lawyer common’s workplace informed KHN-Highlight PA that it reviewed “a small quantity” of complaints concerning SOAR and referred the matter to the Division of Drug and Alcohol Packages.
Smith, the department head, stated that as a common matter it’s tough to prevent services from falsifying paperwork, as a result of state laws require advance discover of licensing inspections. But when the department receives a grievance, it could possibly conduct unannounced inspections, she stated, and different services have been cited for fraudulent paperwork.
Unannounced web site visits had been made in response to the complaints at SOAR, in accordance to a department spokesperson, and citations had been issued for violations that didn’t embody fraudulent paperwork. SOAR’s Philadelphia location acquired provisional licenses in 2019 and 2020, however as of mid-April all the corporate’s websites had been working on full licenses after remedying the cited points.
A Rising Trade
One vital limitation on the department’s oversight is its incapacity to impose financial penalties on treatment services.
In distinction, the state’s environmental safety and health departments can wonderful polluters and nursing houses for violations.
A 2017 report from the state auditor common’s workplace urged lawmakers to permit the department to cost licensing charges and assess financial penalties, pointing to different states that achieve this. Smith informed KHN-Highlight PA that fining services would help weed out repeat violators.
A invoice launched in the Pennsylvania legislature to permit the department to generate licensing charges went nowhere two years in the past. A related measure was just lately referred to the state Senate Health and Human Companies Committee.
“I hope that it’s thought of shortly as making certain drug treatment services are given acceptable oversight is of utmost significance,” the invoice’s sponsor, state Sen. Judy Schwank (D-Berks), stated in an announcement.
In the meantime, with tens of millions of {dollars} on the road, the treatment trade is rising in Pennsylvania. Over the previous 4 years, the state has seen a internet acquire of about 40 services, the department stated, bringing the full to greater than 800 treatment providers. State funds paperwork counsel the trade’s consumer capability has grown by about 5,000 over the same interval.
The Division of Drug and Alcohol Packages employed 82 people, together with two dozen who conduct facility inspections, as of April. That is about half the quantity of canine wardens employed by the state to examine kennels.
Smith stated there may be “satisfactory staff to carry out our present licensing obligations.”
In December 2018 — the identical 12 months the department stated it acquired complaints from former SOAR workers and purchasers — it permitted the corporate to open a location in Warminster. Inspection surveys at the facility since have discovered it violated state guidelines by offering a sure medication with out state approval and failing to provide the required hours of therapy to some patients.
A former SOAR supervisor who continues to be working in the treatment trade and requested not to be named doubts the state will ever take stronger motion in opposition to the corporate.
“The state is aware of the demand for treatment and the demand for medication-assisted treatment,” the previous supervisor stated. “In the event you took SOAR’s license in Northeast Philadelphia and didn’t give them a provisional, you might be displacing 500 purchasers.”
The Want for Treatment
The urgency of the opioid crisis places regulators in a troublesome place: In the event that they shut down a facility, the place will all the patients get treatment?
James McKay, a professor at the College of Pennsylvania’s medical school who researches the efficacy of addiction treatments, stated services which are committing insurance fraud or actively harming patients must be penalized. However the query turns into extra sophisticated when judging how effectively a facility is serving its purchasers.
In Philadelphia, the place there are lots of treatment programs, it’d make sense to shut one which has ineffective interventions, untrained counselors and many consumers dropping out, McKay stated.
“However in case you’re out in the center of the state and there’s just one treatment program in any cheap distance, so long as they don’t seem to be treating you badly, you’re at least going to get some assist and meet others in recovery,” he stated. “A lot of this relies on what the opposite alternate options are.”
In western Pennsylvania, an inpatient detox and rehab facility referred to as Clear Day Treatment of Westmoreland has acquired a number of provisional licenses because it opened in 2018. State inspectors have famous at least six incidents that concerned drugs on the premises and have cited the facility at least twice for understaffing, writing that the shortage of enough staff fails to guarantee “environment friendly and protected operation.”
Despite these considerations, the facility is the one one in the county that provides detox companies whereas permitting patients to keep on any of three medicines for opioid use disorder. Many patients in the world want that service, stated Colleen Hughes, govt director of the Westmoreland Drug and Alcohol Fee. (The fee is one of greater than 40 companies throughout the state that the Division of Drug and Alcohol Packages contracts with to coordinate substance use companies domestically.)
The fee decided in 2017 {that a} lack of residential rehabs in the county was one issue delaying people’s treatment. Clear Day responded to a request for proposals to meet that want from corporations that handle Medicaid-paid behavioral health for the state in that area. Clear Day has been awarded practically $750,000 in state Medicaid funds left over from earlier years to help with startup costs, in accordance to Southwest Behavioral Health Administration, one of the businesses that put out the request.
Stephen Devlin, govt director of Clear Day, stated in an announcement that Southwest Behavioral Health Administration intently monitored these funds, which helped the facility provide “a lot wanted” addiction treatment companies.
“State auditors have been diligent in making certain that Clear Day addressed all deficiencies which have been recognized throughout audits,” Devlin wrote, “and, additional, that Clear Day provides sturdy and effective treatment to the people in our care.”
Hughes stated her workplace has addressed the problems of understaffing and drugs on the premises with Clear Day by conferences and coaching classes.
Smith, head of the Division of Drug and Alcohol Packages, stated: “None of us need to see providers closing. We would like them to achieve success. We would like them to find a way to ship the companies for their profit and for ours.”
Ready for Penalties
In Fayette County, ASI got here beneath fireplace from state and federal authorities in 2015.
The FBI raided the facility that October. The next January, a federal grand jury indicted one of the homeowners, Rosalind Sugarmann, and an ASI physician on a number of counts of illegally distributing a medication to deal with opioid addiction.
Practically three months later, a counselor employed by ASI overdosed whereas staying at the facility, an lawyer for the state later stated in an administrative court docket submitting in opposition to ASI. In the end, a chapter case compelled the enterprise to shut.
In late 2016, Sugarmann pleaded responsible to unlawful drug distribution and health care fraud. However that hasn’t stored her and her family out of the recovery enterprise. Lower than a 12 months after she was launched from jail, Sugarmann — who has talked publicly about her personal substance use many years in the past — introduced she was opening a recovery residence.
“I’m not going to cease working with addicts ever. That’s my calling in life,” Sugarmann stated in an interview with KHN-Highlight PA. “Someone helped me, and I help anyone else.”
However two households stated Sugarmann failed their loved ones.
There’s Adam Kalinowski, who died at ASI in 2014, and there’s 37-year-old James Pschirer, who died of an overdose in a recovery residence Sugarmann’s family operates. These houses provide peer assist and usually have curfews and guidelines designed to help people avoid drugs after they’ve been discharged from inpatient treatment.
In Kalinowski’s case, Sugarmann stated ASI reported his loss of life to everybody it was required to. There’s no indication from department records that the state cited ASI in connection with his suicide.
(The Division of Drug and Alcohol Packages wouldn’t remark on Kalinowski’s case particularly however stated it labored with the FBI to examine issues at ASI.)
Neither Sugarmann nor her husband, Sean, mounted a protection in opposition to the Kalinowski family’s lawsuit in court docket. In a current interview with KHN-Highlight PA, Sean Sugarmann positioned the blame for Kalinowski’s loss of life elsewhere, saying that the facility was staffed accurately and that, given his eventual suicide, Kalinowski by no means ought to have been despatched to ASI.
Kalinowski’s family additionally sued UPMC Mercy, the Pittsburgh hospital the place he was handled earlier than going to ASI, and affiliated entities, however resolved the claims in opposition to them by a non-public settlement, in accordance to a family lawyer. UPMC denied accountability for Kalinowski’s loss of life. In a pretrial court docket submitting, an skilled witness for UPMC directed blame at ASI, saying Kalinowski was effectively sufficient to be safely discharged to a residential treatment facility. That he wasn’t evaluated by a health care provider, nurse or professional counselor when he arrived at ASI was a priority, the skilled wrote, and “maybe this tragedy may have been prevented” if ASI had supplied a better level of care.
Extra just lately, Rosalind Sugarmann has confronted criticism for her involvement with recovery houses.
In February 2019, whereas nonetheless beneath federal supervision, Sugarmann introduced on a weblog that she was “again in fee!!” and would open a males’s recovery residence referred to as The Second Act outdoors Pittsburgh.
A 2017 regulation gave the Division of Drug and Alcohol Packages new energy to regulate recovery houses in addition to treatment services. The state missed a June 2020 deadline to implement the voluntary licensing process however plans to roll out the program this 12 months.
James Pschirer turned to The Second Act for a spot to keep in the autumn of 2019. His mother, Andrea Zack, helped him with hire, writing out a $250 verify to Sugarmann, in accordance to a photocopy of the verify the family supplied.
Then, on Nov. 1, 2019, James died inside the house from a fentanyl and cocaine overdose, a photograph of the loss of life certificates supplied by his family confirmed.
Andrea and James’ sister, Amanda Pschirer, went to The Second Act to acquire his garments and private gadgets. Andrea stored the cash in his pockets, figuring out he had touched them.
It wasn’t till after James’ loss of life that his family came upon about Sugarmann’s prison conviction, they stated.
Amanda is aware of her brother selected to use drugs, however she thinks he may nonetheless be alive if he had stayed in one other residence with higher oversight. And she or he’s indignant that nothing stopped Sugarmann from being concerned with one.
“I’m nervous that another person will die beneath her care,” Amanda stated.
In interviews, Rosalind and Sean Sugarmann downplayed their involvement with The Second Act. “My children are concerned in the recovery houses,” Rosalind informed KHN-Highlight PA. “I’m not an proprietor there.” The enterprise is registered in their youngsters’s names, and Rosalind stated she’s lived in Los Angeles since early 2020.
Nonetheless, Sean Sugarmann acknowledged serving to his adult youngsters handle the enterprise, and stated in March he was living in the boys’s residence at that point. One of his daughters referred questions about The Second Act to Sean. Rosalind promotes the enterprise on social media accounts, encouraging people to transfer in. She informed KHN-Highlight PA, “I’m not gonna deny that I’m a guide.”
Sean stated an overdose loss of life “may have occurred anyplace, and I feel it occurs in every single place.”
Final fall, Amanda Pschirer reached out to state officers with considerations about recovery houses. However she stated she didn’t receive a response for 4 months. The department stated a pc glitch with an online type, found in January, prompted the delay in responding to her submission and about 260 others.
Ian Kalinowski, whose brother died at ASI seven years in the past, has adopted Rosalind’s posts online and noticed that she’s nonetheless concerned in the recovery enterprise. He’s outraged.
He and his family are nonetheless grieving Adam’s loss. Ian needs his younger youngsters had gotten to meet their uncle. He doubts the ASI defendants will ever provide the $1.6 million-plus that the choose stated they owe.
Ian acknowledges that ASI’s leaders confronted some penalties for issues at the enterprise.
“However there have nonetheless been no repercussions for what occurred to my brother,” he stated of the Sugarmanns.
He’s not optimistic there ever will probably be.
Methodology: How We Investigated Pennsylvania’s Addiction Treatment Trade and Discovered Weak Oversight of Providers
Pennsylvania is at the epicenter of the nation’s opioid crisis, rating among the many high 5 states for overdose loss of life rates and high 10 for quantity of adults affected by substance use disorder in current years, in accordance to national knowledge. And the addiction treatment trade there may be rising.
Federal grants, state initiatives and Medicaid pump tens of millions of taxpayer {dollars} into the sector yearly. The state has seen a internet acquire of about 40 licensed treatment services over the previous 4 years, bringing the full to greater than 800.
However an investigation by Highlight PA and KHN discovered the Pennsylvania Division of Drug and Alcohol Packages — which licenses these services — provides weak oversight and lacks the assets and regulatory energy to police them, permitting providers to proceed working regardless of repeated violations and hurt to purchasers. The department has no customary standards to decide when it ought to drive services to serve fewer patients and, in practically a decade, has revoked only one provider’s license.
Highlight PA, an impartial, collaborative newsroom reporting on the Pennsylvania state authorities and statewide points, started investigating the oversight of addiction treatment services shortly after its launch in late 2019. The newsroom later partnered with KHN, a national group that produces in-depth journalism about health points.
Our crew started by scraping 1000’s of facility inspection studies from the Division of Drug and Alcohol Packages’ web site. We then analyzed them to discover essentially the most egregious citations: ones that talked about a failure to report patient deaths and assault, that famous medication errors or that exposed unsafe staffing ratios.
We additionally requested from the department historic knowledge about which services had acquired provisional licenses — designations indicating that services have failed to meet a number of state necessities and will probably be inspected extra continuously till they resolve these considerations. The department didn’t have an automated system to collect this knowledge however agreed to compile it manually. It supplied the information with the next caveat: “Due to incorrect knowledge entered into the licensing database, the hooked up report could not embody all provisional licenses since 2012. It’s as shut to correct as we will decide base[d] on the accessible knowledge.”
Moreover, the crew filed an open records request for studies of uncommon incidents. These are sure critical occasions that the department requires services to report, together with consumer deaths and incidents of bodily and sexual abuse, amongst others. The department supplied studies of solely these incidents that it determined didn’t warrant investigation. It stated it couldn’t provide the full quantity of such occasions as a result of it doesn’t have facility-specific mixture knowledge prior to September 2019, when it launched a new digital reporting system. Even accessible knowledge from that new system provides an incomplete image, as lower than 1 / 4 of treatment services had enrolled in the voluntary system as of March 2021.
Reporters additionally reviewed the department’s administrative court docket historical past to see circumstances in which the state had initiated authorized motion in opposition to a facility.
To additional inform our reporting, Highlight PA launched a public callout for readers to ship in suggestions and considerations about services.
Utilizing a mixture of these sources — facility inspection surveys, provisional license historical past, administrative court docket circumstances, restricted studies of uncommon incidents and suggestions from the general public — we compiled a listing of 34 services that appeared to have essentially the most troubling monitor records.
From the brief record of services, Highlight PA and KHN reporters then reached out to present and former workers and purchasers at numerous locations. The interviews helped set up whether or not people’s firsthand experiences matched the considerations that arose in the information.
Our reporters additionally reviewed the licensing applications that these services had submitted to the state, in addition to lawsuits filed by purchasers and workers in opposition to the services. We interviewed former workers of the Division of Drug and Alcohol Packages to perceive the oversight system and challenges throughout the company.
The ultimate story was primarily based on interviews with greater than 80 people and a overview of 1000’s of pages of state authorities and court docket records.
Daniel Simmons-Ritchie contributed knowledge evaluation to this story.
Watch this Sept. 9, 2021, panel dialogue that includes Ed Mahon and Aneri Pattani, the reporters who labored on this story. Joined by a gaggle of consultants, they discover Pennsylvania’s efforts to preserve high quality and security at the state’s addiction treatment centers. The occasion was hosted by Highlight PA.
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