Mind and Body

BHDDH cuts more than $2 million in funding for recovery programs

Who ordered the cuts – and whether or not the Governor approved slashing of funds for recovery programs – have yet to be answered

Photo by Richard Asinof, file photo

M. Teresa Paiva Weed, president of the Hospital Association of Rhode Island, with Tom Coderre, at a past Rally4Recovery.

By Richard Asinof
Posted 9/6/21
The move by R.I. BHDDH to cut more than $2 million in funds for ongoing recovery programs in Rhode Island was made without public notice, and who was responsible for the ordering the cuts remains a mystery, as the state celebrates September as recovery month.
Have the financial shortfalls created by the apparent mismanagement at Eleanor Slater Hospital led to the decision by R.I. BHDDH to slash funds to recovery programs in the state? What will it take for R.I. BHDDH to be forthright and identify who were the decision-makers who authored the budget cuts for recovery programs? Was Gov. McKee briefed about the budget cuts? Why has R.I. Medicaid decided not to reimburse for peer recovery coach services? In searching for an alternative source of Narcan, are there any considerations needed about whether the alternative sources are being produced by Sackler-family controlled drug companies?
As the Rhode Island Foundation prepares to announce its suggested transformative big ideas to invest $1.1 billion in federal American Rescue Plan Act funds, with some certainty that one or two of the ideas will focus on housing creation and affordability, where does the opioid epidemic fit into the equation when it comes to investment?
The research and data analyses has shown, since sociologist Shannon Monnat first published her studies in 2016, using CDC statistics, that the demographic group with the highest mortality rate in Rhode Island was for people ages 25-34. Some five years late, the most recent data from the R.I. Department of Health confirms Monnat’s findings. Is this news?
Last week, in federal bankruptcy court, the judge approved the reorganization plan offered by the Sackler family, the owners of Purdue Pharma, allowing them to pay some $4 billion in order to escape future liability claims for the ways in which their product, OxyContin, spurred the opioid epidemic. Some states are planning to challenge the decision, including Washington State and Connecticut. Rhode Island Attorney General Peter Neronha may also decide to challenge the decision.
What the Sackler saga demonstrates is the old line from Lenny Bruce, about how “the only justice in the halls of justice is in the halls.”
The overdose epidemic was driven in large part by the greed of one family to game the system in how drugs were marketed, at the same time using its wealth to name museums and medical institutions. The data show that those most vulnerable to die from the opioid epidemic in Rhode Island were young people between the ages of 25-34. In making investments in Rhode Island’s future, how will those investments improve the economic future of young adults, and not just the powerful elite bent on preserving wealth and the status quo of power.

PROVIDENCE – September is “Recovery Month,” with numerous events being planned, including the Rally4Recovery, scheduled for Sept. 18 from 11 a.m. to 4 p.m. at the Temple To Music at Roger Williams Park, an annual recovery community event that has been held every year since 2006.

The message this year is straightforward: “Recovery is for everyone – every person, every family, every community.”

“Recovery is about hope and awareness that anybody can find recovery,” said Linda Mahoney, an administrator with R.I. Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals, in a Sept. 1 interview with WJAR Channel 10’s Alison Bologna, entitled “State agencies work around the clock to prevent overdose deaths.”

“We do see people in recovery, and they’re getting jobs,” Mahoney continued. “They’ve been in hell and they find a way out. There’s not enough money. I love what I do, and I love the people who fight the good fight.”

The operative phrase in Mahoney’s interview, it seems, should be: There is not enough money.

Because in the last month, agencies that are working to deliver recovery services on the ground in Rhode Island have been hit with severe funding cuts by R.I. BHDDH. The agency has wielded a blunt hatchet, eviscerating and eliminating funding to numerous ongoing recovery programs, several recovery community advocates told ConvergenceRI.

Putting people’s lives at risk?
The cuts occurred with little warning, with no justification offered in data or in results to support any rationale for the funding cuts, several recovery advocates told ConvergenceRI.

Worse, the cuts in funding have occurred at a time when overdoses in Rhode Island are at an all-time high, and when there is a dramatic shortage of Narcan, highlighted by a die-in staged in front of R.I. EOHHS offices last week [See link below to the interview with Michelle McKenzie by WPRO’s Steve Klamkin].

Among the agencies whose funding was slashed, potentially putting people’s lives at risk, included:

• CODAC, which is slated to lose more than $1.3 million beginning Oct. 1, including $755,791 to provide medication-assisted treatment “induction” opportunities at BH/Link on a 24/7 basis.

CODAC, the largest nonprofit outpatient provider for opioid treatment in Rhode Island, also received a $333,313 cut in funding for its efforts to develop its mobile treatment capacity.

The program was first developed as a shared mobile treatment unit for the opioid epidemic. It was then redeployed as a mobile COVID testing unit during the coronavirus pandemic. [See link below to the ConvergenceRI story, “A report from the front lines of telehealth.”]

Because of the challenges created in sharing the mobile unit, CODAC applied and received funding from the Champlin Foundation to purchase its own mobile unit. Now, just as the mobile unit was about to be deployed, CODAC lost the funding for staffing through the cuts in state opioid response dollars from R.I. BHDDH.

R.I. BHDDH had also eliminated funding for CODAC’s work in providing prisoners with access to medication-assisted treatment, but the R.I. Department of Corrections has since found money in its budget to cover those costs.

• All of the recovery centers in Rhode Island, including Anchor, Hope, East Bay, and Serenity, have had their budgets cut substantially with little notice, according to one long-time member of the recovery community. Agencies were given three weeks to revamp their budgets to deal with the budget cuts, including more than $500,000 at Anchor.

• The AnchorED program, an innovative initiative that placed peer recovery coaches at hospital emergency departments, developed in large part by Jim Gillen, is being “dismantled,” according to one source. Instead, the source warned, the plan is to put untrained individuals into the state’s emergency rooms. “People are going to die,” the source warned.

An innovative ride-along program with police departments, featuring peer recovery coaches, had also been slashed by R.I. BHDDH, but those funds apparently are in the process of being restored, after a behind-the-scenes outcry.

Who authored the cuts?
Who authored the cuts remains a mystery. R.I. BHDDH workers responsible for informing agencies of the cuts said that the decision to make the cuts was allegedly coming from the “higher ups.”

Was it Richard Charest, the director at R.I. BHDDH, who authored the cuts? Were the cuts then approved by Secretary Womazetta Jones, at the R.I. Executive Office of Health and Human Services? Was Gov. Dan McKee aware of the cuts and did he approve of them?

On Friday morning, ConvergenceRI emailed Yvette Mendez, chief of staff to Secretary Jones, asking: “There are apparently serious budget cuts being made by BHDDH to ongoing recovery and medication assisted treatment programs, effective Oct. 1. Who is responsible for authorizing those cuts? Did Secretary Jones approve those cuts? Is the Governor aware of those cuts and did he sign off on them.”

Mendez looped Randall Edgar, the communications spokesperson at R.I. BHDDH, into the conversation. He responded Friday afternoon – but without answering the questions about who had authored and authorized the cuts.

Edgar wrote: “The funding streams for the programs under discussion—expanding recovery community centers and some other peer-based recovery support services – came from time-limited discretionary grants. These grants aren’t guaranteed to come to Rhode Island, year after year, and they’re only eligible for use in a limited, specified period. When BHDDH makes awards under these grants, we cannot and do not guarantee to provide funding beyond the length of that grant.”

Edgar continued: “We are continuing to fund peers through some available federal funds. We are using COVID-related federal funds to support peer recovery programs after September, and we will continue to keep looking for other sources of funding for peer recovery support services.”

In response, ConvergenceRI wrote back: “In my initial email, I talked about cuts to MAT programs, too, which were not addressed in your response, specifically, $755,000 in cuts to CODAC at BH/Link, which provided access 24/7; given the severity of the current opioid crisis, cutting this program when ODs are at an all-time high, seems short-sighted.”

ConvergenceRI then repeated the questions: “Who authorized these cuts? What was the reasoning? Was the Governor briefed? Thanks!” No response has yet been received from Edgar.

ConvergenceRI also reached out to the Governor’s office, in an email to Alana O’Hare, the Governor’s press secretary, on Friday afternoon, after getting the response from Edgar that did not answer the questions about who had authorized the funding cuts: “I am working on a story about budget cuts by BHDDH, including more than $755,000 to provide medication assisted treatment at BH/Link on a 24/7 basis; given the severity of the current opioid epidemic, these are services that save lives; my questions are: who, specifically, authorized those cuts? Was the Governor aware of those cuts and did he authorize them?”

O’Hare wrote back on Saturday morning: “Thanks Richard! When are you writing for?” ConvergenceRI responded: “Story to publish early Monday morning,” suggesting that a response by Sunday at noon would work best.

The inside story
R.I. BHDDH, it seems, has decided to change its model of delivery in how it funds recovery centers, moving to what is known as a “hub and spoke” model, a move not publicly shared by any BHDDH officials. Further, recovery advocates in the field have reported that: “Medicaid billable services have been completely dismantled. Previously, Medicaid allowed billing for peer support services.”

Translated, the budget cuts appear to be an attempt to limit financial costs for both Medicaid in Rhode Island and for recovery program funding by R.I. BHDDH.

The larger question is: How have the ongoing crises at R.I. BHDDH – including the ongoing scandal at Eleanor Slater Hospital related to its delivery of services and the pending potential penalties for failure by the state to follow its federal mandate in developmental disabilities, each with its own set of major financial consequences – caused the agency to make unannounced cuts in its operating budgets for recovery programs?

Would that be a good question for the House Oversight Committee to explore, Rep. Patricia Serpa?

A further wrinkle when it comes to context around the funding cuts to recovery programs has been the decision by R.I. BHDDH to launch the new faith-based Imani Recovery project, at a cost of approximately $877,000, using federal funds.

Critics of the Imani program, speaking off the record, told ConvergenceRI that the program contradicts two key components that the state has maintained as requirements for funding: evidence-based practice [very little research was done on this project, critics said]; and state certification of workers to be peer recovery specialists [apparently there are folks with “lived experience” doing the Imani work that have not received state certification as peer recovery specialists.]

What the data do not tell us
The recovery community advocates tell ConvergenceRI that Rhode Island’s treatment landscape is as bad as it has ever been. They say that there is no published data on treatment outcomes. Medication-assisted treatments are actually down in the first quarter of 2021, compared to the fourth quarter of 2020, even as overdoses have risen by 38 percent in the past 24 months.

One recovery advocate told ConvergenceRI about an alleged spike in overdoses occurring in mid-August in Woonsocket, with 13 overdoses and four deaths, following a conversation with a hospital health care worker.

A spokesman for the R.I. Department of Health said that they had no record of the alleged spike in overdoses, when ConvergenceRI inquired.

Carolyn Kyle, the communications spokesperson at Landmark Medical Center, said she forwarded my question about an alleged spike in overdoses occurring in mid-August to the Emergency Department medical director for a response. Kyle indicated that the hospital data is reported to the R.I. Department of Health and, in turn, the agency provides the hospital and community partners with the report.

Further, Kyle said, in Woonsocket, the local Health Equity Zone’s Overdose Prevention Group convenes to review and discuss the data and related initiatives.

In addition, Kyle included a link to the newly launched Overdose Surveillance Data Hub, which ConvergenceRI reviewed to try and find the data regarding the alleged spike in overdoses and deaths in Woonsocket. However, much of the data tabulated only covered the first two quarters of 2021.

Translated, despite the new data tools launched to provide a better analysis of trends regarding overdoses and deaths in Rhode Island, it is still difficult to find results in real time, in ConvergenceRI’s experience. The story related by a health care worker at a hospital in Woonsocket to a recovery community advocate proved difficult if not impossible to confirm.

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