With few detox beds available, state health department removes portion of license from Spokane provider

One of Spokane’s largest drug treatment centers has lost its certification to operate a secure withdrawal management and stabilization facility.

The move follows a state Department of Health investigation into patient care practices at the American Behavioral Health Services facility in north Spokane.

ABHS and the health department in August entered into an agreement that resulted in the loss of the withdrawal services. ABHS, which operates behavioral health facilities statewide including two in Spokane, can reapply for certification for the withdrawal services in three years.

The services located at ABHS Cozza, 44 E. Cozza Drive, closed last December due to staffing shortages and the COVID-19 pandemic, not the ongoing Department of Health investigation, said Tony Prentice, ABHS chief operating officer. The Cozza facility still operates as a behavioral health agency with an active license but no longer provides withdrawal management services. ABHS still provides withdrawal services at its Chehalis and Wenatchee locations.

The closure of the 24-bed facility leaves the Spokane area with fewer beds for patients in withdrawal. Spokane Treatment and Recovery Services (STARS) has five beds for women and eight for men in their withdrawal management program that takes Medicaid. Sequoia Detox Centers in Spokane Valley has 12 beds for patients using private insurance or paying out of pocket.

People addicted to alcohol, benzodiazepine and opioids have painful withdrawal symptoms when they stop taking the drug. Not only is withdrawal mentally taxing but those symptoms can lead to medical issues, making withdrawal, also commonly referred to as detox, best done under some level of supervision.

Service providers from other treatment programs often use detox facilities for their clients as a preadmission step. But with the shortage of beds, it’s difficult to refer their patients, said Hallie Burchinal, executive director of Compassionate Addiction Treatment.

“Withdrawal is incredibly uncomfortable so a detox facility allows for at least your basic needs to be met and support from a peer counselor,” Burchinal said. “You have someone there to remind you why this is so important to you and to help you keep going.”

The investigation

In the summer of 2018, ABHS began offering withdrawal management and stabilization services at their north Spokane facility, according to the agreement between the health department and ABHS.

The facility filled a critical need in the community where few withdrawal programs are available. Often, people seeking treatment first need to go through withdrawal and an evaluation before they can be admitted to inpatient or outpatient treatment.

In August 2018, the health department began an investigation into complaints against the Cozza facility’s withdrawal management program. The facility also provides other behavioral health services.

The next spring, investigators reviewed records of 12 patients at the facility. Staff was unable to produce a policy or procedure for admitting people into the withdrawal management program. The facility also didn’t ensure at least daily contact between patients and a substance use disorder professional, according to the agreement.

In all the cases investigators looked at, the facility didn’t use American Society of Addiction Medicine’s criteria when admitting patients or create treatment plans for the patients.

Investigators also found dayslong delays between when a patient was admitted and when they were evaluated or examined by staff, according to the agreement. Some patients were admitted and stayed for days at the facility, despite showing no withdrawal symptoms, investigators found.

In May 2019, the facility submitted a plan of correction for the issues found by the Department of Health. That plan was unacceptable, according to the health department. Officials asked for revisions, which were made by July 2019.

The withdrawal management program was new in Washington with new laws governing the program. Prentice said there was little guidance on the new law or how to interpret it.

Investigators made an unannounced follow-up visit to the facility in February 2020 and examined seven more patient files and found similar issues to the first visit.

After that visit in December 2020, the Department of Health issued an intent to suspend ABHS’s license to operate a secure withdrawal facility at that location. ABHS initially fought the suspension, Prentice said, but ultimately entered into an agreed order in August to remove that portion of their license for at least the next three years.

The program closed because ABHS was unable to staff the facility “safely and consistently due to the pandemic, rising costs and shortages of nursing care,” Prentice wrote in an email.

Staffing is an issue across all of ABHS’s programs statewide, Prentice said.

Prentice also noted ABHS continues to run two secure withdrawal facilities with health department approval.

The Cozza withdrawal center accepted Medicaid and Washington state insurance. A large portion of the patients – about 65 to 70% – were involuntary holds sent from designated crisis responders at area hospitals, Prentice said.

After detox, those involuntary hold patients would be recommended or required to enter another type of care, often inpatient or outpatient substance abuse treatment, Prentice said.

Prentice disagreed with much of the Department of Health’s characterization of the flaws in the Cozza program but said ultimately ABHS and its legal team decided it was best to enter into the agreed order to resolve the Department of Health’s complaint.

Lack of withdrawal support

STAR in central Spokane offers withdrawal management to men and women with inpatient stays of three to five days, said Joe St. John, executive director. During their withdrawal stay, staff administer medications, offer emotional support and complete a substance-use disorder assessment.

After detox, those patients are recommended for further treatment based on their assessment while in the withdrawal program. The assessments are a key to getting into further treatment programs, St. John said.

“Our mission at STAR is to really continue to provide substance use disorder treatment and to get more people into treatment and really the withdrawal management is the way we get people into treatment,” St. John said.

STAR mainly gets patients from Providence hospital emergency departments, St. John said. They also get referrals form the Spokane Fire Department. The facility accepts Medicaid along with private insurance.

The program is not a medical detox, meaning if someone in withdrawal needs significant medical care or has a medical episode, they’ll be taken back to the hospital. The STAR withdrawal program is almost always full but with such short stays there are discharges nearly daily, St. John said.

After an upcoming remodel, STAR plans to add beds to the withdrawal program but those won’t be available for at least a year, St. John said.

Homeless people are often struggling with drug addiction and withdrawal support is often a key part of getting them into treatment and stabilized, St. John said. The region could use significantly more withdrawal beds, he said.

Sequoia Detox Centers in Spokane Valley opened in late 2021 but had several pauses in service while restructuring care. The program has 12 beds available for five- to 10 -day stays, said Director Tracy Dantzler.

The program only takes private insurance or out-of-pocket payments but is working toward approval to take Medicare, Medicaid and Apple Health insurance, Dantzler said.

Like at STAR, patients who are discharged from Sequoia are then referred to other treatment programs.

What we really try and do is work with the individual to find what their needs are and try to find a program that is ideal to meeting their individual needs,” Dantzler said.

Sequoia strongly encourages patients to continue with another type of care, whether that be self -help meetings, counseling or inpatient treatment.

Other treatment providers like Compassionate Addiction Treatment have struggled to get their patients into detox.

“The need is so high that we almost never have been able to get someone into that detox,” Burchinal said.

Once detoxed, CAT clients qualify for housing in shelters with barriers, like the Way Out Shelter. Being housed is a huge part of creating a stable recovery environment, Burchinal said.

“We need a solid detox facility in our city,” Burchinal said. “It’s a grave need.”