Budget cuts eliminating beds for substance abuse treatment

MIDDLETOWN–So far, in his 25-year career as a state employee providing addiction treatment services, Ken Kroll has worked at two facilities that have since closed their substance abuse programs.

Connecticut Valley Hospital, where he works now, has also cut back. And on Sept. 1, it will eliminate 20 detoxification beds and 60 rehabilitation beds for men.

“It just keeps shrinking,” Kroll said Wednesday.

Ken Kroll CVH 7-20-11

Ken Kroll and other CVH workers rally outside Merritt Hall

The planned closure of two rehabilitation units at the Middletown hospital’s Merritt Hall, part of $1.6 billion in cuts announced last week, represents the elimination of more than 15 percent of the intensive substance abuse rehabilitation beds at facilities the state either operates or contracts with.

A ratified agreement between state employee unions and the administration of Gov. Dannel P. Malloy could avert the closures. But if the 60 rehabilitation beds are closed, the state will be left with 284 comparable beds, including 30 for women at CVH that will remain open, 21 beds at the state’s Blue Hills campus in Hartford, and 233 run by private nonprofits.

Private substance abuse treatment providers are working with the state Department of Mental Health and Addiction Services to try to absorb the demand. The private facilities also offer detox services, but not with the level of medical care that Merritt Hall has, so some patients will likely go to acute care hospitals for detox when the 20 Merritt Hall beds are closed.

“Eighty beds is a huge, huge reduction in capacity on the substance abuse side,” said Jeff Walter, President and CEO of Rushford, which provides substance abuse and mental health services. Rushford has 42 beds for intensive rehabilitation–comparable to the beds the state is cutting–and 16 detox beds.

Walter said he doesn’t think the existing providers can completely absorb the need created by the planned closures. The implications, he said, will be “pretty dire”: Instead of treatment, people will end up in jail, emergency rooms, or hospitals that cost more.

“I hope this can be averted,” said Walter, the longtime co-chair of the council that oversees the state’s Behavioral Health Partnership, which handles mental health and substance abuse care for people in Medicaid and other state programs.

Rushford has some beds available now–not uncommon in the summer–but Walter said it’s not clear how long that will last.

Bill Young, chief operating officer of Alcohol and Drug Recovery Centers, Inc., in Hartford, said his agency has “some small amount” of capacity in a program that’s comparable to the rehabilitation units being closed. Overall, ADRC has 28 intensive rehabilitation beds and 35 detox beds.

“From our perspective, we can help out a little,” Young said. “I guess the question becomes…when you add together all the small contributions that a bunch of providers within the system can make, is that enough?”

DMHAS is hoping that it will be. “Some providers currently have some unused capacity, which we will utilize,” department spokesman James Siemianowski said.

Going forward, substance abuse services at state facilities will be reserved for patients with no insurance who meet the medical necessity criteria for the services. “We are the payor of last resort,” Siemianowski said.

DMHAS closed admissions to the intensive residential programs for men on Wednesday, a move intended to give current patients enough time to receive treatment and get follow-up care in the community. Admissions to the detox program will be closed Aug. 15. Both dates were set based on customary lengths of stay, according to the department.

Siemianowski said the general hospitals in the state provide detox services at the level that Merritt Hall does now, and can adapt to demand. In addition, Blue Hills has 21 detox beds at a lower level of medical care, while community providers that contract with the department have 130.

Patty Charvat, a spokeswoman for the Connecticut Hospital Association, said hospitals are particularly concerned about the closure of detox beds, which she said will lead people to seek services in emergency departments that are already at or near capacity.

“We are definitely anticipating that we’ll be impacted by this closure, and it will start in the ED,” she said.

During a rally outside Merritt Hall Wednesday, addiction services workers, many of whom received layoff notices, said they hoped an agreement on a concessions deal would make the cuts and layoffs unnecessary. Their union, the New England Health Care Employees Union, District 1199, SEIU, voted for the concession package.

But workers warned that the closure of the substance abuse beds would mean some people would be shut out from care altogether, with potentially dangerous consequences.

“Many patients here have been turned away by private sector agencies because of their complex issues or inability to pay,” said Sarah Woolard-Raczka, an addiction counselor. She said the programs have at times had waiting lists of six weeks, and that the beds slated to be eliminated serve about 1,600 people a year.

“In the short term, it might look like money saved, but in the process, lives will be lost,” she said.

Others said that patients who can’t get into Merritt Hall could wind up in emergency departments, on the streets, or in jail.

“Or a community!” one worker shouted.

“A community near you!” someone else added.

“If they live!” a third called out.

Ann Marie Rankins, a mental health worker who has worked at CVH for about 12 years and received a layoff notice, said patients have learned about the planned closure through the media and have asked what they will do now, if they’ll just be left on the streets to die.

“At least we can find jobs,” she said. “But our patients need somewhere to go.”