Rehab Riviera: Many recovery centers fail to deliver

The fight of Dillon DeRita’s life was etched into his flesh.

On his left forearm was a tattoo of the Serenity Prayer, with its plea for redemptive power:

“… To accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.”

On his right were needle tracks from years of injecting heroin.

Last year, that struggle brought DeRita 2,600 miles from his home in Florida to Pacific Coast Detox in Costa Mesa. The center was one of the 1,117 licensed drug and alcohol treatment facilities in Los Angeles, Orange, Riverside and San Bernardino counties, an area known in the industry as the Rehab Riviera.

DeRita put his faith – backed by an insurance policy that would have paid tens of thousands of dollars for his sobriety – in an industry that regulators, elected officials and some recovery experts say too often fails addicts in its care.

On June 26, just two days into his detox regime at Pacific Coast, DeRita spent the night in a chair on a patio. The next day he was found dead from a heart attack – at 21.

In California, one customer dies every 16 days in a licensed rehab center.

DeRita’s father, Rich, watched his son struggle with drugs for years and knew he’d gone to California for another shot at sobriety. But he still was shocked when a woman from Pacific Coast called to tell him about Dillon’s death.  “I was freaking out.”

The woman from the rehab center told Rich DeRita something else during that call – that Pacific Coast staff had checked on Dillon while he was on the patio and found him to be OK.
Later, a security video and other documents surfaced that contradicted her claim.

In their records, emergency responders in Costa Mesa wrote that when they arrived at Pacific Coast and got to Dillon DeRita, at exactly 12:07 p.m., he was unresponsive. Craig Harvey, former chief of investigations for the Los Angeles County Coroner, reviewed the incident report later and said that data on that report indicates DeRita had been dead for at least 35 minutes and possibly as long as two hours when the EMT squad showed up.

But records written by Pacific Coast made note of the same time, 12:07 p.m., and claimed something else – that rehab workers checked on DeRita and found him very much alive.
“Client observed on the patio … snoring,” the Pacific Coast log states.

A video also showed rehab workers checked on DeRita earlier in the morning, found him unresponsive and walked away. The video doesn’t show them calling for medical help or performing CPR.

Officials with the California Department of Health Care Services later focused on the discrepancies, and other problems, when investigating Pacific Coast. In a settlement with state regulators, the center agreed to surrender its license. Pacific Coast declined to discuss the death, but said the company cooperated with the state.

Rich DeRita, who is suing Pacific Coast, said simply: “They didn’t take care of my son the way they were supposed to.”

Concerns about care

It’s not an unusual lament.

From 2013 through 2016, the number of complaints filed each year against rehab centers nearly doubled, according to state regulators. During the same period, insurance companies investigated and, in some cases, sued specific centers and chains, alleging widespread billing fraud and poor care. At least three rehab centers surrendered their licenses after state regulators investigated in-patient deaths.

This month, a Los Angeles Superior Court judge ruled that one of the biggest rehab operators in Southern California, Christopher Bathum, must stand trial on charges of insurance fraud. Charges of sexual assault against clients still are pending. Bathum, a convicted felon, ran at least 15 centers in Los Angeles and Orange counties.

Rehab operators point out that drug- and alcohol-addicted patients aren’t a healthy or easy population to deal with. Many suffer chronic health conditions beyond their addictions. Some have mental health issues. Some are suicidal.

But the death rate inside centers, one dying every 16 days, doesn’t include hundreds of others who died after leaving rehab centers with their addictions still raging. And many critics, including some long-time rehab operators and drug counselors, say that reflects the poor care – sometimes nonexistent care – offered in many rehab centers. They add that substandard care, which can be more profitable than thorough treatment, is part of the business model for some centers.

Part of the problem inside rehab centers, critics add, is lack of oversight.

“There are many providers who are (cheating) the system because there’s no regulatory system in place,” said Deb Herzog, a former federal prosecutor and ex-investigator for insurance company Anthem.

“Anybody and their brother can open up one.”

There are few bars to getting a license to run a rehab center in California, regardless of academic or criminal background. Physicians who have had their medical licenses revoked by the state serve as chairmen or chief executives of some centers. And with some state prison systems offering classes in rehab center management, it’s not unusual for ex-cons to serve as hands-on operators.

Providing legitimate treatment services is expensive, and profit margins are low even with insurance paying the bills. As a result, long-time rehab owners describe their industry as a modern, medical version of the “Wild West,” saying it’s tough to stay in business while providing good medical care when a growing percentage of your competitors are profiteers.
What nobody can say for sure is what percentage of rehab operators are as interested in treatment as they are in profit.

“I’m not going to sit here and tell you the industry does not have bad players. It does,” said Stampp Corbin, president of the Addiction Treatment Advocacy Coalition, a Westlake Village-based organization that represents owners of rehab centers and drug-testing labs.

Still, Corbin added, the “bad players” don’t outweigh the good work provided by legitimate operators.

Centers are required to hire some credentialed counselors and, often, some medical personnel. But it’s also not uncommon for counselors in training to spend time working with people in life-or-death crises. By law, apprentice counselors can work with patients for up to five years, as long as they’re working toward their state certification.

Over the years, California’s loose regulations and lack of background screenings have allowed sex offenders and unethical staff members to work with addicts at their most vulnerable moments, according to a 2013 investigation by the state Senate.

“Many counselors draw from their own struggles with alcoholism and drug addiction to excel at a difficult job for not much pay,” state investigators wrote.

“But some come to the profession with serious criminal backgrounds that raise questions about their fitness to treat clients, who are often at one of the most vulnerable points in their lives.”

Health regulators say since 2013 the state has implemented a quality review system to weed out poor applicants, monitor routine licensing and improve investigations of rehab centers.
Some rehab owners say the state’s regulations – patient limits, requirements for security and food services, insurance and legal fees – actually encourage fraud by making it tough for legitimate operators to make a profit.

“The California model for addiction treatment is broken,” said Corbin, of the Addiction Treatment Advocacy Coalition. “At current rates you cannot run a facility appropriately or profitably.”

Other rehab operators agree.

“I would love to see a much more professionalized industry, but it’s going to take all of us to make that happen,” said Michael Cartwright, CEO of American Addiction Centers, a publicly traded treatment chain that operates centers in several states, including A Better Tomorrow, in Murrieta, where four patients died between 2008 and 2012.

“California has the most problems when it comes to licensing.”

In October, Cartwright’s company agreed to maintain compliance, internal audit and quality review programs for its California centers for three years as part of a settlement in one of the deaths at its Murrieta center.

Still, in many other ways, the industry doesn’t seem over-regulated.

The California Department of Health Care Services has just 16 investigators, all headquartered in Sacramento, looking into nearly 2,000 licensed rehab centers.

What’s more, the state lets rehab centers keep information away from consumers in ways it doesn’t allow for other licensed industries.

Paper records about rehab centers, and consumer complaints against them, are available to the public in Sacramento, or by filing a public records request and waiting weeks for electronic copies. Unlike information about restaurants or auto repair shops, the state doesn’t put consumer information about rehab centers or their operators online.

For many patients, the closest they get to consumer information about the entity from which they hope to attain life-changing sobriety comes from Yelp.

Such information might have been helpful to Sarah Hernandez and her husband, Anthony, in May 2016, when the Riverside couple checked in to West Coast Rehab in San Juan Capistrano.

Hernandez said she didn’t know that the center’s chief executive, Dan Case, learned the addiction counseling profession in 2014, while serving a two-year prison sentence in Arizona for using a stolen credit card and passing forged drug prescriptions, according to court records.

The Hernandezes are suing Case and West Coast Rehab, claiming fraud and negligence. As part of that lawsuit, Case testified in a deposition that the Hernandezes were too intoxicated to fill out an admittance sheet or sign a contract when they arrived at his facility.

He did accept a $65,000 personal check from Sarah Hernandez, who says the money came from an inheritance from her late mother.

Though the couple left the center after 36 hours, Hernandez claims Case tried to persuade her to invest in his business. The complaint also alleges the couple were given drugs that Case, in his deposition, said were prescribed by a doctor. The Hernandezes’ Escondido attorney, Mick  Meagher, claimed during Case’s deposition that the doctor denied writing such a prescription.

Case could not be reached for comment and his attorney declined to be interviewed. In court papers, Case and other defendants denied “the myriad of allegations set forth in the complaint.” West Coast Rehab has since closed down, according to state regulators.

Sarah Hernandez said she is living sober now, but she doesn’t credit that to her rehab stay in San Juan Capistrano.

“I thought I was going to die there.”

Desperate for help

While it’s hard to find detailed information from state regulators, it can be tough to avoid rehab centers’ rosy marketing pitches.

“This place did for me what I couldn’t do for myself. From the minute I walked in the door they took care of me,” says a man’s voice in an advertisement for American Addiction Centers, one of the nation’s largest for-profit treatment chains.

The words “Stay Clean & Sober – or return for 30 days treatment FREE” float on a backdrop of soothing water trickling into a placid creek.

“This place saved my life,” a 20-something man in a beanie says.

The ad – and others from myriad treatment providers – provides an 800 number to call and offers free insurance verification.

But rehab centers offer little objective, independent data on how well their programs work over the long haul. While that might be intentional deception by some unethical operators, it’s also an industry norm.  There is little hard data on recovery, and there are no industry-accepted standards for elastic terms such as  “sobriety” or “relapse” or “success.”

In a 2016 report on drug and alcohol rehabilitation, then-U.S. Surgeon General Vivek Murthy’s office noted the difficulty in quantifying addiction-related deaths. Instead, the report described addiction as a disease that should be “managed on a day-to-day basis,” as a lifelong illness, and that commercial promises of cures are “often empty.”

The report did emphasize that long-term sobriety requires dedication to follow-up treatment outside a rehab center and, above all, patience.

“By some estimates, it can take as long as 8 or 9 years after a person first seeks formal help to achieve sustained recovery.”

That hard message isn’t common in rehab advertising.

Robert Harris, a policy adviser for the California Society of Addictive Medicine, a physicians group that is seeking to increase the quality and availability of addiction treatment, said idyllic claims about rehab are part of the business model for many centers, luring people from around the country to California treatment programs.

“TV advertisements are a big problem,” Harris said.

“Besides the stuff that’s out-and-out fraud, there’s a lot of semi-fraud.”

Sober living?

While the state tracks licensed rehab centers, there is little oversight or regulation related to sober living homes. Experts say there are thousands of sober living homes in California, but nobody knows the exact number.

What these homes ostensibly provide sounds great – fellowship and support for people struggling to stay clean; housing for people who might otherwise be homeless; structure.

The living arrangement, in fact, is considered a family by law. And cities and counties can’t ban sober living houses because the residents – like patients in licensed rehab centers – are legally protected under the Americans With Disabilities Act.

But critics suggest sober living homes also are where some of the most egregious abuses of the rehab system take place.

Timmy Solomon repeatedly lapsed in sober living homes.

In 2013, Solomon, now 28, came from his hometown, Boston, to Dana Point, to get sober. Since then, the long-time addict has lived in rehab centers, sober living homes and on the streets.

Earlier this year, to get a glimpse of what happens inside rehab, the Southern California News Group followed Solomon for about 90 days. During that time he spent separate stints in a string of detox hospitals, residential rehabilitation centers and sober living homes in Los Angeles and Orange counties.

The pattern for Solomon was consistent and depressingly familiar – shooting up narcotics, entering rehab, relapsing and eviction.

Solomon’s journey revealed a key point – sober living homes can be places where recovery falls apart.

One of Solomon’s relapses came after Solomon claimed he’d been drug-free, in a sober living home, for more than a month. A friend at a San Juan Capistrano recovery center gave him a bag of methamphetamine, he said, and he used it.

During another meeting with reporters, at a Whittier-area sober living home, Solomon showed up saying he’d just knocked back three beers to ease the side-effects of detoxing cold turkey.

On St. Patrick’s Day, Solomon entered Mission Hospital in Laguna Beach for detox. He spent 10 days there before leaving for a sober living home in San Clemente.

In late April, on what was supposed to be his 40th day clean, Solomon escorted reporters into a bathroom in the San Clemente home, where he shut the door, locked it and turned on the shower. As the room steamed up, he dumped a baggie of new needles on the counter, along with a bottle of 75 hydrocodone pills he said a doctor had just prescribed him. “He’s trying to help me get off heroin,” Solomon said of the physician. “I haven’t slept in two nights.”

Solomon then crushed up six pills, mixed them with methamphetamine and water, and injected it all into his vein.

Sober living managers don’t need to be credentialed in any way. In some homes, they’re recovering addicts or former drug dealers. Critics say some rehab centers use sober living homes as way stations of sorts, places to store patients who can be given or encouraged to use drugs again so they can become candidates to return to lucrative in-patient rehab.

“The thing that’s causing the most problems is the sober living home environment,” said Harris, the policy adviser at the California Society of Addictive Medicine.

Congressman Darrell Issa, a Republican who represents south Orange County, said he’s pushing to undo what he views as overly bureaucratic protections for sober living homes.

“If you’re interested in getting (addicts) back into productive lives, (the current protections) don’t make sense.”

Another politician, California Assemblywoman Melissa A. Melendez, a Republican from Lake Elsinore, is sponsoring a bill (AB 285) that would require the state to regulate and monitor sober living homes for the first time.

She became interested in the rehab industry after a string of four deaths between 2008 and 2010 at a rehab center in Murrieta and other rehab deaths in Lake Arrowhead. She’s targeting sober living homes because they can provide a fallback for unscrupulous rehab center operators.

“What happens to these facilities when they shut down?” Melendez asked.

“Do (the operators) up and move into another California community with another name and another cast of characters doing the same thing?”

Melendez didn’t differentiate between licensed centers and sober living homes when she first learned about the industry.

Prosecutors sometimes don’t either.

Experts say the case against Los Angeles-based rehab operator Bathum offers a glimpse into how the industry can break down.

Bathum, whose empire included the Seasons rehab center in Malibu and who described himself as “The Rehab Mogul,” is accused of sexually assaulting nine female patients, sometimes providing them with drugs as they struggled to overcome their addictions. He denies those allegations.

Bathum also is accused of fraudulent billing to the tune of $176 million, prosecutors said. The alleged billing includes charges for services that prosecutors say were never provided.

Bathum has denied all of the fraud allegations as well, and his attorney declined to comment.

Still, regulators say the criminal case is also a case study.

The allegations against Bathum “illustrate the medical provider fraud that can and does occur,” California Insurance Commissioner Dave Jones said. “It’s egregious.”

‘He wanted to get through it’

For addicts like Dillon DeRita, the Florida man who died last year in Costa Mesa, getting inside a rehab center in California proved to be an ending, not a new start.

DeRita’s father said family members last year began seeking new treatment options for his drug-addicted son, who had relapsed several times. And even though they lived in a region that was ripe with rehab centers, South Florida, they believed California offered better facilities and more.

“It seemed a little more laid back,” Rich DeRita said.

After arriving in Southern California, Dillon DeRita tried one rehab center, in Orange, before moving to Pacific Coast Detox.

DeRita’s final hours at Pacific Coast were described in the state complaint against the treatment center and in internal company records obtained by the Southern California News Group.

The records include an email written by Lucy Weiss, former vice president of compliance for Sprout Health, the New Jersey-based parent firm of Pacific Coast. Weiss, who wrote the note to other managers, confirmed that the memo is authentic but did not  provide it to a reporter.

The company’s records say Pacific Coast employees performed welfare checks on DeRita at least every 30 minutes on the day DeRita died, observing him at various times asleep in his room and on a patio.

But Weiss, in her memo, wrote that a 12-hour security video showed DeRita never moved from the patio chair and that staff didn’t check on him.

“Throughout the video there are a few clients from time to time that come out to smoke but still no staff present. Per the video the client had never left the chair.”

“Some staff said they did checks and then later admitted to not to doing them,” Weiss added. “I am guessing they knew that this would be seen on the video.”

Company records describe DeRita sitting in a chair, smoking, during a final midday welfare check. But the state’s complaint against Pacific Coast says that record was hastily written after DeRita had been found unresponsive and emergency medical rescuers had been called.

The state says Pacific Coast’s log was fiction.

“Literally, as paramedics were en route to Pacific Coast Detox, two staff members made false entries,” the state complaint says.

Rich DeRita remembers a final phone call from Dillon two days earlier. Dillon told his father he was happy to be entering Pacific Coast and that he loved him.

He also recalls the hope his son brought with him to California.

“He didn’t want to be who he was,” he said. “He wanted to get through it.”

Part three: When addicts are curbed …

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