Hoquiam opioid addiction treatment service dispute will not deprive patients of treatment

A dispute between an opioid addiction clinic in Hoquiam and the government body that provides the funding for it has many area addicts asking if they will be able to continue their treatment if a dispute over funding is not resolved soon.

“The answer is a resounding yes, they will continue to get the services they need,” said Molly Carney, Executive Director of Evergreen Treatment Centers, which contracts to operate the clinic in Hoquiam.

“The county and the (Great Rivers) Behavioral Health Organization have no desire to see this service terminated, to just stop,” said Grays Harbor County Commissioner Vickie Raines.Raines also sits on the board of Great Rivers, which oversees state and federal funds distributed for the treatment of mental health and substance abuse disorders for people with Medicaid insurance in Grays Harbor, Pacific, Cowlitz, Lewis and Wahkiakum counties.

Since Great Rivers took over administration of the region’s mental health and opioid addiction funding April 1, 2016, Carney said the Hoquiam treatment facility has not received any of the more than $500,000 owed the clinic for services rendered.

“From our perspective our contract clearly states Great Rivers is obligated to pay us for all patients,” she said. “We have never been paid for our services.”

While Evergreen Treatment is accusing the five-county Great Rivers body of dragging its feet, Raines said the reason payment has not been rendered in more than a year is there were holes in Evergreen’s record keeping that, until fixed, would keep them from getting the funding owed them.

“We found that there were inconsistent treatment plan notes,” she said. “There were missing components of the treatment plans.”

Great Rivers requires detailed records of each patient treated at the clinic that outline every step of their recovery from their initial assessment through follow-up counseling and the number of times they are given Methadone or buprenorphine, two drugs used to ease withdrawals from opioids like heroin and other narcotic pain relievers. Raines said some of the records from the Hoquiam clinic failed to detail any follow-up visits.

A difference in the software programs used for records between Great Rivers and Evergreen was partially to blame, at least initially.

“Part if it is the difference in the records keeping system that we use and they use, part of it is interpretation of the rules, some of that was because of the transition from working with the state to working with the Behavioral Health Organization,” said Bill Benham, Evergreen Treatment’s Director of Clinical Service.

Carney said that isn’t the root of the real problem.

“(Raines) called a meeting early in June that focused exclusively on the software situation, which wasn’t the problem from where I sat,” she said. “The problem was they weren’t paying us at all.”

Raines did offer a 70 percent good-faith payment, but Evergreen Treatment hasn’t seen it, said Carney.

“If we have received that it would have helped significantly, but it never came through and I’ve had no follow-up on that,” she said. “Meanwhile, both Evergreen Treatment and Great Rivers were working seriously to get through the data communications piece of this, and each time we provided a piece of what they’d ask for, they’d ask for something else.”

Raines said the June meeting over the communications problem was productive, with representatives from Great Rivers, Evergreen Treatment and Grays Harbor County Health and Human Services discovering some of the issues causing the incomplete records. One was as simple as a form that was called one thing at Great Rivers, another at Evergreen Treatment.

“We kind of worked through some of that and were supposed to all circle back and meet June 30,” said Raines. “Then on Thursday the 29th I get an email that the meeting had been cancelled by Carney, with no explanation. I reached out, sent her a text, and got no response.”

Evergreen Treatment’s contract with Great Rivers expired June 30, the day of the scheduled meeting. Carney said she had to focus on doing what was best for her patients and the employees at the Hoquiam clinic.

“By June 30 I had lost all faith in Great Rivers and was trying to figure out what to do, since the contract was ending,” she said. “The only safe port was to give a notice of closure, which guarantees we will get paid for those services rendered during those 90 days. I waited until the last possible minute to file the 90-day closure, then had to figure out how to tell the staff and patients without instilling panic in either.”

She presented the staff a letter of explanation dated June 29, saying if Evergreen Treatment is forced to sell the Hoquiam clinic and they do so before Dec. 31, or if Evergreen Treatment is able to sign a new contract, either way any employee who chooses to stay on through this uncertain period will receive a bonus payment of four weeks’ pay.

The next day, patients attending the clinic were given a letter from Evergreen Treatment, detailing the situation and telling them, “Whatever happens, treatment with methadone or buprenorphine will continue uninterrupted.”

Patients were also given pre-addressed, postage-paid cards designed to be sent to County Commissioners, Hoquiam Mayor Jasmine Dickhoff and Aberdeen Mayor Erik Larson. Patients were encouraged to tell each recipient their desire to continue their treatment with Evergreen Treatment and encourage Great Rivers to pay the amount owed and negotiate a new contract, something Carney said she is not willing to do unless payment is made.

Raines said the cards starting coming into the commissioners’ office July 3. She said only a few contained names and she could not verify the validity of most of them.

“I advocated for Evergreen. I said let’s be patient, let’s help them walk through this, and then this thing with sending out these postcards,” said Raines. “So now I’m in a quandary.”

Raines contends it was irresponsible for Carney to give these postcards and letters to their patients.

“When I met with both groups a few weeks ago – as a County Commissioner, not a Great Rivers board member – I told both groups I’m not concerned with Great Rivers or Evergreen Treatment Center,” she said. “I’m concerned we continue these services to the citizens in Grays Harbor County.”

Raines said since she first came onto the commission the number of people treated for heroin addition has been increased from 50 or 60 to around 600 annually.

“And those people are wanting to lead a normal life and be clean and sober from heroin deserve to have treatment provided to them and not be told this service is going away,” she said. “It is a game I am not willing to play, and it frustrates me.”

Carney defended the letters and cards.

“When I went down to speak to the staff and patients I didn’t have time to go into all the details so I had to think of a really quick way to explain the situation and also give patients a way to channel their reaction in a positive manner. So I stood outside and gave every patient a pamphlet and five pre-addressed and stamped envelopes,” she said.

Carney continued, “The top priority is our patients. This is not about winning and losing. My only beef is we have not been paid and (Great Rivers) has managed the situation in a way that has been less than helpful. Our agency works with three other Behavioral Health Organizations – there are only nine in the state – and this one (Great Rivers) operates extremely differently from the others in the state.”

Raines maintains it’s Carney’s unwillingness to work with the county and Great Rivers that is making things more difficult.

“There’s a lot of animosity there and I’m not sure where it actually stems from, but the result has culminated in the nonpayment of their fees,” she said.

Carney said she felt Great Rivers was trying to muscle Evergreen Treatment out of the county.

“If there’s one person running (the Behavioral Health Organization) and he wants us to go, if that’s it, then there’s not much we can do,” she said, adding, “It’s important that the community understand we have deep connections with law enforcement, medical providers, the hospital and our patients and have every desire to continue offering services here.”

Both sides agree treatment will not stop. Carney has said if a contract cannot be reached, Evergreen Treatment will actively assist the county and Great Rivers to get another similar operation on the Hoquiam site.