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STAT

How addiction centers target, then trap, public workers

Molly Ferguson for STAT

They’d been promised a “spa for teachers,” but were brought to a rundown, low-slung building on an unremarkable stretch of road miles from the beach. Employees confiscated their cellphones, credit cards, and driver’s licenses.

One after another, New Jersey public school teachers arrived at the Recovery Institute of South Florida after asking their union to find them addiction or mental health treatment. Instead of getting the help they needed, many said they were essentially trapped at the facility while their health insurance was billed tens of thousands of dollars.

“I felt like a prisoner,” said Michael Barone, a special education aide in a New Jersey public school who spent two months at the institute last year. He said he was forced to stay longer than he felt necessary because he couldn’t go back to work without the center signing off on his return.

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The teachers’ experience is a stark example of what’s happening around the country to union members fighting addiction. Treatment center operators and middlemen who act as brokers for those facilities are targeting these workers because they usually have generous insurance benefits that pay for long stays in rehab. They also often need a health care provider’s clearance to return to work, handing the centers tremendous power over patients.

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“There are facilities definitely keeping people to make money,” said Ken Serviss, the executive director of the Allied Trades Assistance Program in Philadelphia, which oversees substance abuse treatment benefits for several unions. Serviss spoke generally, and not about the Recovery Institute. “They have that leverage to hold over them and keep them longer than they need. That is a big issue.”

STAT and The Boston Globe interviewed 10 people treated at the institute over the last five years — teachers, mostly from New Jersey, as well as school custodians and social workers or their relatives. Most said they were allowed only limited contact with family. They complained about inadequate and cookie-cutter treatment, consisting mostly of group counseling and 12-step meetings, massages at a local chiropractor’s office, and plenty of free time.

Several said the staff warned that their jobs would be at risk when they tried to leave before the treatment center deemed it appropriate. Although the patients were there voluntarily, many needed letters indicating they were fit to return to work.

There is no standard length of addiction treatment because people progress at various rates, according to guidelines from the National Institute on Drug Abuse. The longer someone stays in treatment, the guidelines say, the better the chance for a positive outcome — but that treatment can be either inpatient or outpatient. And family support and involvement are critical to success, as is combining individualized drug counseling with group sessions.

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Many of the New Jersey patients said they weren’t trying to stop treatment: They just wanted to continue it closer to home and with more involvement from family. Several of those with mental health issues said treatment at the Recovery Institute, also known as RISF, was not tailored to their problems.

Officials of RISF, which has facilities in Davie and Fort Lauderdale, Fla., declined to answer questions about Barone’s and the other former patients’ allegations.

Unscrupulous operators have flocked to the treatment industry, drawn by the growing number of people caught up in the nation’s opioid addiction crisis. The Globe and STAT have published a series of stories since May showing that patients are often recruited by “brokers” or “marketers” working for treatment centers that provide shoddy care, with enticements of free flights and health insurance, sunny beaches, and an endless supply of cigarettes.

In pursuit of union workers, treatment providers and brokers frequently wine and dine labor officials and those who work in union employee assistance programs, creating an environment where referrals can go to operators more interested in getting rich than helping workers get better. Brokers and consultants are also often paid to send union members to particular centers; and some treatment centers hire family members of union workers to ensure referrals.

“The main reason people want union members is strictly financial,” said John Christian, the chief executive of Modern Assistance Programs, a Massachusetts-based company that runs employee assistance programs for unions. “Unions have good health and welfare plans; they have good benefits.”

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The Recovery Institute treats patients from a number of unions, but many are public school employees. Many of the New Jersey teachers went to Florida after their union representatives put them in touch with a consultant who, they were told, helps members in need of treatment. That man is Terry Livorsi, a former union electrician who said in a 2007 deposition that he has been in recovery from substance abuse since 1982.

What many of the teachers weren’t told was that the smooth-talking consultant has a second business: He owns the Recovery Institute of South Florida.

‘I want to come home soon’

Ian Sandberg said he was relieved when his mother, Ruth, a Pennsylvania teacher’s aide, checked in to RISF for treatment of her alcoholism late last summer. Then the letters started arriving.

Ruth wrote one letter in a combination of English and French to disguise her concerns about the facility from staff, who she was convinced were reading outgoing mail. In English, she praised the food and referred to her roommate fondly. In French, she struck an ominous tone: “Sometimes, I am scared because something isn’t good,” she wrote to her family. “That’s the reason I want to come home soon.”

When a friend left treatment, Ruth, who asked to be referred to by her middle name to protect her privacy, smuggled another letter out with her — all in English.

“I am convinced that Terry has a racket going and tries to make everyone stay 90 days for the $,” she wrote. “Anyone who wants to leave early, which RISF deems to be any time before 90 days, is bullied verbally & all kinds of roadblocks are put in their way.”

Sandberg, an administrator in a public school district, was shocked by his mother’s letters. “It’s unbelievable to me that this exists,” he said. “There is something wrong with this, and all I can tell is, there seems to be a link with the unions.”

Ruth’s therapist, Maureen Nolan, who has treated her for years in Pennsylvania and is not affiliated with the Florida center, said the staff refused to allow her to speak with Ruth for the first two weeks she was there, despite a release Ruth had signed authorizing contact.

“That gave me a very bad feeling. Like they were trying to isolate her,” Nolan said in an interview. “I work with drug programs. Nobody gets shut off like that.”

Ruth, 63, said in an interview that she contemplated escaping out the window of her room. She was the only public school employee interviewed who wasn’t referred to RISF by her union. Nonetheless, soon after she was admitted, RISF staff asked her to sign a release allowing them to communicate with her school district bosses.

After a few weeks, they began telling her she would need to stay 90 days, or they would not sign a letter allowing her to return to her job — even though she had checked herself in and it was during summer vacation. Ruth insisted on leaving after about 30 days.

When she got home, she said, she found that RISF had sent a letter to her school saying she would not be returning for several more weeks.

“I’ve always been pretty trusting of my doctors, and people saying they were going to help me,” Ruth said. “And I have lost that.”

State documents obtained through a public records request show that when Florida regulators inspected RISF, in late 2014, they identified more than 100 deficient practices. They found problems with how the facility handled patients with mental health issues. Inspectors noted that staff were not always obtaining mental health treatment and sexual abuse histories from patients; it was “not evident” that treatment plans were being completed on each client; and staff were not always providing rationales for treatment decisions. That was the most recent inspection provided by the state.

The institute submitted a plan to correct the deficient practices.

Several other union employees treated at RISF told stories like Ruth’s, talking about feeling coerced to stay and describing the 28-bed detox and medical facility in Davie as moldy, cramped, and filthy. “When I went to wash sheets the first time, there were live bugs all coiled up in the foam bedding,” one New Jersey teacher wrote in a diary she kept during her stay last summer to treat alcoholism. There was dust all over the floor and ants in the cabinets, she wrote.

12stat - Excerpts from the diary of a New Jersey teacher, who was referred to RISF by her union late last summer. (Handout)
Handout
Excerpts from the diary of a New Jersey teacher.

State inspectors also found widespread dust in the facility during their 2014 visit, as well as ants in the bathroom and “a giant rat trap” on the kitchen floor.

The teacher, who asked not to be identified to protect her privacy, noted in her diary that she did not speak to an individual therapist for 13 days after she arrived, with the exception of one 15-minute meeting. She was scheduled for only two hours of group therapy plus an Alcoholics Anonymous meeting every day, and group was “sporadic/cut short,” she wrote. “I’ve learned and enjoyed from these groups but the remainder of the day is free time.”

Staff began to pressure her to stay for 90 days, telling her they “couldn’t give me a letter that said I was fit to go to work,” she added. “I strongly feel that I’m expected to stay just for insurance purposes. I was very upset/am upset that I was misled — lied to about the length of time in the program.”

Livorsi spoke briefly with STAT and the Globe but declined to answer specific questions about his businesses and allegations made by former patients about the quality of care at RISF. He twice hung up on reporters and did not answer several written requests sent via e-mail and text messages for responses to specific questions.

“You gotta do better research or something,” Livorsi said in one short phone call, about a detailed list of questions reporters sent him. “You know, there’s things in there categorically, absolutely not true.”

When asked what, specifically, was not true, Livorsi hung up.

A ‘beautiful place’ in Florida

The patients said Livorsi was more talkative with them, often speaking glowingly about RISF to union members before they headed south for treatment. Many teachers and other former patients said they found him to be empathetic and charming — “His voice dripped honey,” one said — but also insistent that they come right away.

For Michael Barone, treatment in Florida was a way to avoid a pending drug test he knew he would fail and might cost him his job as a special education aide in New Jersey. He said his union representative put him on the phone with Livorsi, who told Barone there was a “beautiful place” in Florida he could get him into for treatment. He arranged a flight that day. Barone said Livorsi never told him he owned the treatment center.

“I was used,” Barone said.

Many of the other former patients said they learned of Livorsi’s ownership only after spending time at the facility.

A former employee of Livorsi’s union consulting company, HealthCare Assistance with Member Support, or HCAMS, alleged in a lawsuit filed last year that Livorsi told her not to disclose his ownership of the Florida treatment center to clients of the consulting business. Former care services coordinator Kathleen Rodebaugh claimed she was actually paid by RISF and received a bonus of $100 for each person she placed into treatment there. She also said he chastised her when she suggested sending a union employee to a different facility.

Livorsi disputed the allegations in the lawsuit, which was settled in May for $17,000. The terms of the settlement state that Livorsi did not admit the validity of any of Rodebaugh’s claims.

Asked in one phone call whether he mentioned his ownership to people he was advising to check into RISF, Livorsi said that was “common knowledge.” He said he also sent people to other treatment centers.

The executive director of RISF, who is identified on the center website as a former New Jersey school superintendent, and two other officials at RISF and HCAMS did not respond to requests for comment.

Detox for patients who weren’t addicted

Union members said much of their care at RISF seemed designed to maximize the bill paid by insurers. Five patients said they went for mental health issues, not substance abuse, but were still made to go through a sometimes-weeks-long drug and alcohol detoxification program when they arrived.

One New Jersey teacher said she was admitted to RISF on three occasions for mental health issues, and each time was required to go through a four-to-five-week detox program. She was also drug tested twice a week and required to attend Narcotics Anonymous meetings most evenings, she said. She stayed two to three months each time.

“I wasn’t there for substance abuse,” she said. “I was there for mental, emotional problems.” She said it was difficult to get help for her issues because there was only one psychiatrist affiliated with the center, and patients had to request time with him.

During the 2014 inspection, state regulators identified one patient placed in detox even though there was a doctor’s order that “clearly states” she did not meet the criteria for that program. In addition, patients with mental health issues but no history of substance abuse did not get treatment for their mental illness, inspectors found.

The center billed insurers at a higher rate for detox services than other treatment, according to licensing documents RISF submitted to the state in September of this year. They list the per-day charge for inpatient detox as $2,325, compared with $2,090 or $1,980 per day that insurers were billed for “residential level 2” treatment, and a charge of $1,430 for day or night treatment with community housing. RISF also billed insurers separately for individual, group, and family therapy sessions.

The state documents also show that RISF charged insurers far more than it charged private pay patients without insurance — more than three times as much for detox.

After completing detox and residential level 2 treatment, patients were sent to group residences and transported by van each day to a building in Fort Lauderdale called “The White House.” There they would typically meet in group sessions in the morning, the former patients said. In the afternoon, they would meet individually with counselors on occasion or walk down the street to receive massages at the office of a chiropractor. Most nights they were required to attend Alcoholics Anonymous or Narcotics Anonymous meetings.

The trips to AA and NA were tremendously helpful, said another New Jersey teacher, who spoke on condition of anonymity. But he pointed out that Narcotics Anonymous is free. The institute was essentially charging his insurer thousands of dollars a week to bus him to meetings, he said.

“That’s what I mean by a New Jersey con. I’m a union member 25 years, and proud to be a union member,” he said. “But this to me — you know, is just wrong. It’s wrong for us to be connected to it.”

Wooing union business

Addiction treatment providers from across the United States packed expo booths, handing out pamphlets that advertised “privacy and tranquility” in the mountains and stays in one of the world’s “top ten most luxurious” programs. More than half the booths were occupied by a substance abuse treatment facility, and their targets were the hundreds of employee assistance professionals coursing through the Westin Bonaventure Hotel & Suites in Los Angeles during a conference last month.

These are the folks whose jobs include helping to find treatment for workers with emotional and substance abuse problems, and the sales reps eagerly offered them brochures and trinkets promoting their programs.

More than 14.5 million American workers belonged to unions in 2016, according to the Bureau of Labor Statistics. While addiction cuts across class and professional lines, some of the most heavily unionized professions — including police officers and firefighters — struggle with a combination of trauma, mental health, and substance abuse issues. It’s a niche that treatment providers have rushed to fill: at the conference, many facilities advertised programs specifically for first responders.

Libby Timmons, president-elect of the International Employee Assistance Professionals Association, which runs the conference, has noticed the proliferation of addiction treatment centers marketing to unions and employee assistance programs. “The business people — I’m going to get in trouble for saying this — but a lot of times they’re just chasing admissions, they’re not looking to help people,” she said. “People see something, they think they can make money, so they chase it.”

The chase for admissions goes beyond flashy brochures; some treatment centers pay for extravagant meals and other perks.

Timmons, a licensed independent substance abuse counselor, is the employee assistance and union specialist at Elements Behavioral Health, a chain of mental health and addiction treatment facilities. When union representatives come out to Utah to tour its first responder program, she said, Elements makes sure they aren’t offered any favors — no extra nights at the hotel or ski trips that other treatment providers offer.

“It costs us admissions,” she added. “But we’d rather not have admissions than do the unethical thing.”

Lyle Fried, cofounder and CEO of The Shores Treatment and Recovery in Florida, said some treatment centers hire marketers who have relatives high up in unions to steer business their way.

“That’s their only job, they massage that relationship,” Fried said. Fried said he knew one man who opened a treatment center with the hope that his mother, a top official for an Ohio company’s assistance program, would send him clients.

And the unethical behavior, Fried said, goes both ways: One of his employees recently told him about being approached by a man who said he was affiliated with a union. The man promised to deliver a certain number of union clients a month — for thousands of dollars in cash. Fried said they turned down the deal.

Some treatment centers advertise directly to union members on the Web, but most connections are made in person.

Livorsi’s consulting business is no exception. Rodebaugh alleged in her lawsuit that she was instructed by Livorsi “to use her sexuality” in dealing with two male union representatives because it would get her “anything she wanted.”

In addition, the firm’s director of member services is the former chief lobbyist of the New Jersey Education Association, according to the company website. HCAMS promotes itself as an “NJEA approved Employee Assistance Program offered at NO COST to you and your family.”

A spokesman for the NJEA, which is the largest public school employee union in the state with 200,000 members, said the organization does not have a formal or financial relationship with Livorsi’s consulting company and did not approve or endorse HCAMS.

Spokesman Steven Baker said the company markets to its members and officials by paying to set up booths at its events and advertise in its publications — in addition to offering free training on a variety of topics to union locals.

Baker said that prior to hearing from the Globe and STAT, the NJEA was “not aware of the particular situations described” by patients. The union is in the process of finalizing a contract with a different vendor who will provide addiction treatment referrals, he said, adding that HCAMS submitted a bid but didn’t meet the requirements.

He did not respond to questions about whether NJEA was aware that Livorsi owned HCAMS, or whether the union leadership believed that was an appropriate arrangement.

Massages, music, and dominoes

It was an opioid addiction that brought Megan Elizabeth to RISF in the spring of 2013. She was not a union member herself but was covered by the insurance plan of her mother, a New Jersey public school teacher, and her mother’s union connected her to Livorsi. She asked that her last name not be used to protect her privacy.

The night she arrived in Florida, she said, there was no bed available in detox, so she had to sleep on a common room couch.

Megan Elizabeth, now 32 and living in Eatontown, N.J., said she liked most of the technicians and nurses at RISF. But she said counselors spent a lot of time talking about their own addiction histories, rather than patient therapy. Patients spent much of their time outside, listening to music, smoking, and playing dominoes.

Once she moved out of detox, the groups improved and there was less free time, she said, but patients were given the option of visiting detox to relax in the afternoons. She received regular massages, which she said she enjoyed but did not have any apparent treatment purpose.

Her stay ended abruptly after two months, she said, when her insurance ran out. She came home and within 30 days, she overdosed on two bags of heroin in her bedroom. Her mother found her and called 911, and EMTs revived her with the overdose antidote naloxone.

It would be two more years before she finally got sober.

Evan Allen can be reached at evan.allen@globe.com. Follow her on Twitter @evanmallen. David Armstrong can be reached at david.armstrong@statnews.com. Follow him on Twitter @DavidArmstrongX.