Malibu Beach Recovery Center

2011 may well be remembered as the year the nation finally ­­realized that it is not just celebrities who are dying from legally prescribed drugs, but tens of millions of ordinary folk – from children to adults to aging baby boomers, in every city and town.  Many of us already suspected what a recent analysis by the Los Angeles Times confirmed:  drug deaths now outnumber those killed in traffic accidents, and prescription drugs are largely to blame.

Law enforcement has begun to take note:  most daily on the organization’s facebook page, Members of the National Coalition Against Prescription Drug Abuse (“NCPDA”) post news about crack downs on local “pill mills” – doctors who make a living writing prescriptions for anyone who pays.  

Unscrupulous doctors operating out of store fronts, with cash counting machines, or via internet, create just part of the grisly statistics.  National and state legislators now need to regulate the practice of pain management – not just for those who specialize in this new field, but for the doctors who staff the Emergency Rooms and Urgent Cares, and also dentists.  Too many of these medical professionals write prescriptions for narcotics and benzodiazepines without a thought to the long-term consequences, or the history of the patient.

Earlier this year we interviewed Dr. Marc Mandel, MD, a Beverly Hills doctor who often serves as a medical expert in Workers' Comp cases involving pain.  Most often the doctors whose treatment he reviews are anesthesiologists. To become pain management specialists they study the pain management curriculum – there is no residency program -- and pass a board test which certifies them in the sub specialty.  

Treatment of pain, says Dr. Mandel, is often related to blocking different nerves, something anesthesiologists are quite adept at doing. 

Dr. Mandel goes on to say:  “The classical textbook on pain management was authored by Doctor Aronoff.  In the introductory chapter of the classic book, he states, 'too many visits to this office may be deleterious to your health'.  And what Doctor Aronoff was stating is that the goal of pain management is to help the patients cope with their pain.  It’s not to simply ply them with medications.  Because if you have an addictive personality, and probably 15 to 20 percent of us do, you’re gonna get hooked on the medications.  And consequently, you’re gonna need ever increasing amounts of drugs to allay the symptoms of pain.

“Now if someone has terminal cancer, I think it’s important to give them medications to make their life as comfortable as possible since the end is near.  But if you’re dealing with a young, adult otherwise healthy person, I think it’s not the best practice to ply them with an enormous number of addicting narcotics.”

Just last week a client, we will call her Lynda, had a very impacted wisdom tooth which needed to be pulled while she was still in treatment. Lynda was born addicted to cocaine. She has battled most of her young life with substance abuse, specifically opiates.  The dentist was told not to use narcotics and he did not, but a subsequent infection sent her to another dentist.  His staff was warned that Lynda was in early recovery when the appointment was made, and the counselor who accompanied her wrote a note to the dentist.  Nonetheless, he handed her a prescription for percoset, a Schedule II (controlled) narcotic whose main active ingredients include oxycodone -- basically synthetic morphine and highly addictive.   As an addict, Lynda was really tempted -- after all it was a dentist who wrote the prescription.  It took virtually the whole clinical team to talk her down.   Next morning I called the dentist, more to enlighten him then to complain.  I said that a Class II narcotic could “awake the sleeping dragon” in any addict and cause a relapse.  My comments were met with pure attitude.

A week before that Lynda’s roommate Anais managed a trip to the Emergency Room for “excruciating” back pain.   A chiropractor confirmed that years of living on the street had taken its toll and that now, off pain-numbing opiates, Anais was finally feeling the consequences.   He also said she could manage the pain with over the counter ibuprofen.  The paramedics told the ER staff Anais wa a patient at an alcohol and drug treatment center.  The counselor accompanying her told the doctor she was in early recovery.   Yet when Anais shooed the counselor out of the room, the ER doctor gave her a shot of morphine. 

Krissie Bergo, who we wrote about last June, came to us through Workers' Comp.  She spent 73 days at Malibu Beach Recovery Center and then 6  weeks at Oceanside Transitional Living.  It cost her insurance more than $100,000 to get her off $50,000/month of toxic opiates and benzodiazepines, all prescribed by a single Workers' Comp pain management doctor.  Incredibly the next Workers' Comp doctor she was assigned ordered her back on hydrocodone, another addictive Schedule II (controlled) narcotic.  She knew enough about addiction to refuse.  Then she went to the dentist and though she told him she was in recovery, he used a benzodiazepine to numb her gums.  I believe it was inadvertent, but warned that Krissie was an addict,  he need to be more vigilant.  She spiraled out of control and had to check back in to MBRC to avoid relapse.

Any addict looking for a quick fix, or a prescription on which to relapse, has to go no further than our local Urgent care.  The doctor told me he would rather give the patient demanding narcotics what he/she wants and out the front door than risk a bad internet write-up.  

ER doctors who want to do the right thing may be putting their jobs at risk said Douglas, a former drug and alcohol counselor who called in to the September 27, 2011 broadcast of “Talk of the Nation.” Douglas told Neil Conan, host of the award-winning  PBS news show, that two of his current clients are emergency room physicians,  He said doing the right thing is hard when you are graded on performance, which includes patient feedback.

Douglas (caller):  “So they'll get clients, patients coming in who are drug-addicted, on Oxycontin, other drugs like you've mentioned, and will press for the drugs...If they spend the time discouraging that patient, it ends up scoring negatively against them.”

In the United Kingdom doctors are being sued for creating prescription drug addicts amid claims they have failed to follow safety guidelines published more than 20 years ago.

Are frustrated Americans going to "occupy" the lobby of the AMA this year?  Stay tuned.

On July 20, 2010 I reported on the nightmare we went through trying to get Anthem Blue Cross to pay for treatment of a client whose stay was fully authorized.  Although we were ultimately successful, many executive hours were spent forcing Anthem to approve payment, cut and mail the check.

I was not as lucky getting reimbursement for another client who was treated in 2007-2008.  The claim had been rejected repeatedly because we were not Medicare Providers.  Of course not. Client is not on Medicare and alcohol and drug treatment is not even covered by Medicare.   

Finally I called the office of State Senator Fran Pavley who represents Malibu in the California legislature.  Her staff put me in touch with an Anthem lobbyist.  She directed me to someone who waived the Medicare requirement.  At that point, our alum who had paid for treatment in 2007-2008 was finally reimbursed for the benefit he had faithfully paid for month after month, year after year. Thank you Senator Pavley and your dedicated team.

So what about the 2010 clients who still needed their reimbursement?

By contrast with Blue Cross/Blue Shield of New York, Texas, New Jersey, Tennessee, Michigan. Washington, and several other states we know about, all of which have fair, even generous benefits for chemical dependency treatment, the standard Anthem Blue Cross of California coverage is worth less than $6,000.  And you have to fight to get it. 

Here are some examples:

Client John, a diagnosed schizophrenic, was on probation for having shot up his parent’s upper middle class neighborhood with a rifle while drunk.  When he opened the front door and started tossing beer cans into the street, the terrified neighbors called the police. 

Anthem refused to pay for his treatment.  Why?

1)      John can be “safely treated” in the community. 

2)      John does not have a severe medical disorder for which he needs constant supervision while receiving treatment. 

This brilliant determination was made by two Anthem Medical Reviewers who our lawyer insists we cannot name. They definitely deserve to have a schizophrenic like John move in next door and drive past their children every day to attend a community outpatient program.

Client George is legally blind. He came in addicted to opiates and benzodiazapines.    It took about 5 days to detox him from opiates, 30 days to get him off benzos.   For most of treatment a counselor had to be at his side, to makes sure he did not fall down or walk into a wall.   What did the wise Anthem doctors determine?

1)      George can be “safely treated” in the community. 

2)      George does not have a severe medical disorder for which he needs constant supervision while receiving treatment. 

Dear Anthem Doctors:  George actually saved Anthem money by going to residential treatment.  It would have cost Anthem much more to pay someone to drive George to and from outpatient treatment, and then remain at his side around the clock to make sure he did not slip and fall at home from the effects of getting off drugs.  Even a Certified Nursing Assistant costs $20/hour.  

Then we had a client we will call Sam.  Addicted to speed balls (a combination of heroin and cocaine), on arrival he tested positive for opiates, methamphetamine, amphetamine and benzodiazapines.  He reported having had hallucinations and hearing voices.  He had an abcess in his right forearm which was filled with gauze.  He could barely stand and complained of nausea.   His terrified parents paid for treatment.  We agreed to help them get reimbursement for the small amount of money their Anthem policy provided for chemical dependency treatment.

We called Anthem to get authorization for detox.  Impossible though it seems, this part of his chemical dependency benefit was denied.  We moved to Plan B: Residential Treatment (living at the center 24/7 and going to individual therapy, group therapy, family therapy, doing 12 Stepwork).   Also denied.   In the end, Anthem authorized 5 days of “Partial Hospitalization” (for which they pay even less than the pittance they allow for detox and residential treatment).  

This means that the Anthem clinical team determined that Sam, though almost comotose and craving drugs, was perfectly able to live at home and commute to treatment each day. When I called back after 5 days, additional days of "Partial Hospitalization" were denied because Sam was still detoxing.

I heard an even worse story from the director of a treatment facility in Northern California. An Anthem client completed residential treatment and was stepped down to an outpatient program.  Anthem refused to pay because they now knew the client had a "pre-existing condition."

With criminal lawyers like Michael Nasatir, Mary Masi, and Gilbert Geilim on his Board of Advisors, not to mention former Citibank CEO Michael S. Knapp, it’s clear John Tarasi came up with a winning concept when he created “Sober Guard.”   The new company provides services to clients facing legal issues because of substance abuse.

“We exist to make the job of the attorney easier, not to replace him or her” says John, a tall, lanky crew-cut Pittsburg native. “My goal is to fill a gap, to do what no lawyer has time to do.   I can help by appearing with the attorney and defendant in court and saying: ‘Your Honor, I vouch for the defendant.  This person is serious about changing his/her life and taking the steps to do it.’   It makes a very powerful impression on the judge.”  

John has been working in recovery for ten years.  He attributes the beginning of his own sobriety to an enlightened Santa Monica judge who sentenced him to drug court instead of jail.   John spent eight months at the non-profit Clare Foundation; while still a patient he began running the Clare Men’s Center.  After completing treatment, he worked as group facilitator for the City of Santa Monica’s inpatient program at Clare, and did individual counseling for both of Clare’s primary care programs.

One day while speaking at St. John’s Hospital he met David Milch, creator of the TV series NYPD Blue and segued to TV production for three years.  While working for Milch’s Red Board Productions, he co-wrote (uncredited) with Milch the pilot for the acclaimed HBO series “Deadwood.” 

He left the entertainment world to start Soba Sober Living in Malibu with Greg Hannley, which they eventually expanded to include a licensed treatment center.

“I saw people coming in with legal issues,” said John.  “Because of my personal experience with the law, I realized I could help them. “   

Sober Guard was officially launched several months ago.  One of the first clients was a well-known actor who had recently completed treatment at the Malibu Beach Recovery Center.  Once he graduated from our residential program, John kept him out of jail by making sure he attended all of the anger management classes and domestic violence counseling sessions the judge had mandated.  Additionally he convinced the judge to sentence the actor to a “creative” type of community service that John believes was a true service to Los Angeles – teaching acting to youngsters in the inner city.

 “I try to match talents of my client to community needs.  Judges like that and the communities benefit.   Picking up trash is more humbling but does not make someone feel he is ‘giving back.’”

John works all over the country, advocating for clients because he believes that treatment is better than jail and jail better than prison.

“I had a client with seven cases before the same judge,” he recalled.  “He came to California, I got him into treatment and 1-2 months later I flew back to New Jersey with him.  The judge with impressed.  He asked me:  ‘You came 3,000 miles to vouch for him and tell me the letter from this rehab is accurate?’  When I assured him this was indeed the case; the judge dismissed all seven misdemeanors and fined my client a mere $250.

“It happens frequently.  In fact, it happens all the time.  Every time we accompany a client and his or her lawyer to court, the sentencing goes better.  Judges tend to put more faith in the defendant because a Sober Guard representative is at their side.  Our clients get easier deals, less time, and stay out of jail.  Sometimes I can get judges to reduce a client’s probation time by half.”

Lawyers like him, he believes, because under John’s care their clients don’t re-offend.  Bondsmen like him because he makes sure the defendant shows up in court.  Judges like him because John gives them confidence that they won’t dismiss charges only to read in the newspaper the following day that the freed defendant blacked out while driving and killed an innocent party.

California State Senator Mark DeSaulnier is coming to visit the Malibu Beach Recovery Center at the end of July. We are honored and excited.

Senator DeSaulnier is a man after my own heart. Every year he holds a "There Ought to be a Law" contest," inviting members of his Northern California district to submit ideas for new state legislation. We got to know him this year because one of the 2009 winners was Danville resident Bob Pack, whose two children, Troy and Alana Pack, ages 10 and 7, were killed in 2003 when a woman high on prescription medication passed out while driving her car. The car crossed three lanes of traffic, killing Bob’s children and seriously injuring his wife. The driver had gotten 350 vicodin pills in the week before the accident from six different doctors, all of whom practiced at the same hospital. Each of them had no idea that she was getting medication from the others.

Working with the Department of Justice, Pack, an East Bay computer company owner, and advocate for curbing prescription drug abuse, turned the State's antiquated Controlled Substance Utilization Review and Evaluation System (CURES) into a real time online data base. Now doctors can have instant access to prescription drug histories of their patients- which helps prevent doctor shopping for highly addictive controlled substances such as oxycodone, xanax, vicodin, valium. Until now it took healthcare professionals weeks to obtain information on drug use by patients. That delay allowed patients like the driver who killed Pack's children to get large quantities of drugs from multiple doctors for personal use or sale.

With the State of California broke, Pack proposed the legislation that became SB 1071 (SB stands for Senate Bill). It was designed to make the CURES online database financially sustainable by taxing the pharmaceutical companies $0.0025 for each highly addictive narcotic prescribed in California. That’s less than 25 cents a prescription.

On May 5th I took some of our alumni to Sacramento, including prescription drug addicts now in recovery, to lobby for SB 1071.

To our surprise the bill did not get out of the Senate Health Committee. It lost by one vote. The Democrat who Senator DeSaulnier counted on to vote with him, voted against the bill because; according to his office staff, she was opposed to levying new taxes in the current economic climate. Given the amount of revenue the pharmaceutical industry reports each year (over $300 billion in 2007) this was surprising. Maybe not though, considering the number of lobbyists the pharmaceutical industry employs in Sacramento.

Senator DeSaulnier told me that he is committed to making sure the CURES system will remain funded so doctors can continue to find out in real time if their patients are doctor shopping and pharmacy hopping for narcotics. Can’t wait to hear what he has to say on his upcoming visit.