Scrapping state license for teen drug, alcohol facilities in Idaho is a bad idea
By all accounts, the Good Samaritan Rehabilitation center in Coeur d’Alene is a tremendous success and a much-needed drug and alcohol treatment facility for adults.
In tracking 3,100 clients over a five-year period, 2,400 clients were successful in their treatment for a 78% success rate, Idaho Rep. Ron Mendive, R-Coeur d’Alene, told the House Health and Welfare Committee on Jan. 28.
Good Samaritan has saved the state an estimated $50 million in costs associated with drug and alcohol use, in the form of law enforcement, incarceration and social services, Mendive told the committee. And it costs only $3,000 for a four-month stay.
“There’s no state agency that could even begin to approach these numbers,” Mendive said. “They’re totally impressive.”
Meanwhile, teen drug and alcohol use and suicide are on the rise, according to Sen. Mary Souza, R-Coeur d’Alene.
So Souza and Mendive are proposing a bill that would allow Good Samaritan to expand to also treat teenagers, 13-17, by adding an exemption in state law from licensing requirements for temporary alcohol-drug use residential treatment facilities.
This is a bad way to make policy. We should not create laws for the benefit of one specific organization. Further, getting rid of state licensing for facilities that treat our most vulnerable populations is a horrible idea. Some regulations, particularly those that protect children, shield society from the vagaries of the free market.
Souza and Mendive are clear that their bill, House bill 340, is specifically to allow Good Samaritan to expand.
The nonprofit center was started by “Pastor Tim” Remington, whose name may sound familiar from a few years back when he was shot six times at his church, Altar Church, and survived. Remington was appointed last month to fill the House seat of John Green, who was removed from the Legislature after Green was convicted of a federal conspiracy to defraud charge.
Good Samaritan had been treating teenagers for about 10 years until a grandmother of a girl in the program realized Good Samaritan was not licensed by the state, Souza said. The state Department of Health and Welfare stepped in and told Remington he couldn’t operate without a license from the state, Souza told the Health and Welfare Committee.
“Pastor Tim said, ‘If you make me license, I will close the doors of my program,’” Souza said. “And that’s what happened. He closed the doors voluntarily, because he does not want government to be telling him what he can and cannot do in his program. He’s worried about ... the government coming in and saying you can’t use faith, you can’t talk about Jesus, because he feels that’s the essentially successful element of his program.”
Mendive said he attends the church that runs Good Samaritan.
“They actually were the ones that requested this legislation,” Mendive told the committee. “And it’s primarily so they could do something for the teens.”
Idaho bill moves forward
The Health and Welfare Committee listened to nearly two hours of testimony, and all who spoke testified against the bill. Speakers came from the Idaho Federation of Families for Children’s Mental Health, the Idaho chapter of the National Alliance on Mental Illness, the Idaho Council on Developmental Disabilities, and included a clinical psychologist, a former teen drug user who is now a youth counselor, parents and mental health advocates.
Opponents raised concerns about eliminating the safeguards that come with state licensing for our most vulnerable populations, opening up the possibility for abuse. They also expressed concerns about bringing bad actors into the state and creating a blanket exemption for the benefit of one private entity. They were concerned about adults and children being placed in the same facility and questioned the ability for state oversight, reporting and shutting down a problem facility.
Supporters, meanwhile, said the state is in crisis with teens in need now. The state can’t wait and needs to find solutions that will be responsive to the free market.
After some competing motions to either hold the bill in committee or send it to the House floor with a do-pass recommendation, a motion from Rep. Megan Blanksma, R-Hammett, to report it out of committee with an opportunity for amendments won the party-line vote, with the Democrats on the committee voting against it.
“It’s a crisis situation, and something needs to be done, and it needs to be done now,” Rep. John Vander Woude, R-Nampa, said during the committee hearing, his already-booming voice rising. “While we sit here and wait, there’s going to be more teenagers that commit suicide, that drop off or are not getting the treatment they need. While we sit here twiddling our thumbs, waiting for our bureaucracy to create a licensed program and with all the sideboards and everything else, we’re still going to be losing teenagers.”
I get and appreciate the sense of urgency and the strong desire to help kids, but the answer isn’t to throw away oversight just so we can get kids placed in a program — any program. And it’s clear oversight is needed.
Adults and children together
One of the biggest concerns that held the bill back for amendments, as expressed by Blanksma and Rep. Jarom Wagoner, R-Caldwell, was about ensuring children and adults are kept separate.
“My gut kind of clenches on that one,” Blanksma conceded.
Rep. Laurie Lickley, R-Jerome, asked Souza and Mendive about whether there would be separate facilities for children and adults in the Good Samaritan program, which already has a residential treatment program for about 100 adults.
“It is my understanding that there are separate areas of facilities for teenagers and adults and certainly separate bedroom facilities and separate bathroom facilities,” Souza said. “But we are not calling that out in this bill, because if we say that there must be completely separate facilities, we will be doing exactly what we’ve done with our crisis centers and our adult rehab programs and so many other things that we are increasing the costs.”
“So we feel that each program will find its own way,” Souza said.
That’s my biggest fear, that programs, including bad actors, will find their own way to abuse and neglect, especially if we’re even entertaining the idea of letting adults and children share a facility.
Opening up the state
Opening the door to anyone and everyone was a common concern expressed by those who testified against the bill and by some of the members of the Health and Welfare Committee.
“My worst concern is that we are just opening up the state for who knows what in the future,” said Rep. Fred Wood, R-Burley, chairman of the committee. “My concerns aren’t so much about what’s going on today up north. ... That’s not the issue. The issue is that we’re just opening up the state of Idaho carte blanche to anybody who wants to come.”
That sentiment was echoed several times among those who testified against the bill.
“This is not about one facility,” said Howard Belodoff, a Boise attorney for the past 41 years who has done extensive work in youth protection cases. “This opens the state of Idaho to any facility. … It’s not about the facility in Coeur d’Alene. It isn’t. It’s about every other one that can come into the state of Idaho, rent a place and put up a sign on the door and say, ‘I will help your kid.’”
Ruth York, executive director of the Idaho Federation of Families, who testified against the bill said there are examples all over the country of treatment centers that are motivated solely by profit in states that do not have the same protections that Idaho has.
“Let us not be one of those states with horror stories in the national news because we made it easy for the bad players to move in and create harm where healing is needed,” York said.
Jennifer Griffis, a parent and the family engagement director for the Idaho Federation of Families, shared that same concern.
“It doesn’t seem like this is seeking to solve a problem as it is seeking to provide an opportunity for a facility that’s currently treating adults,” Griffis told me by phone after the hearing.
Concerns over not licensing
The bill does have safeguards, Souza pointed out. The bill mandates that such facilities must:
- notify local law enforcement of the presence of the facility
- be within 50 miles of an emergency medical care facility
- conduct background checks on all staff, volunteers and others with direct access to children
- verify a child has a prescription from a doctor and the child’s school counselor or court-appointed advocate has been notified that the child has entered the facility
- undergo a review by the child protection legislative review panel after two and five years, including a report from local law enforcement on any child-abuse complaints.
Souza said this is a “community-based” approach, with members of the child’s community, including police, counselors and doctors are involved in ensuring proper care.
But those who testified during the hearing said those safeguards don’t even come close to what you get with state licensing.
“The safeguards in this bill are not truly safeguarding Idaho families,” York said.
Licensing makes sure facilities maintain specific clinically based standards of care, including quality, expertise, training and monitoring of staff and staffing levels.
Belodoff said without licensing, there would be no direction, oversight or reporting on whether a facility practices such things as the use of restraints, seclusion, corporal punishment. There are no guidelines over parental rights and visitation, and there is no requirement for liability insurance. Licensing establishes a uniform system of reporting.
Concerns were raised whether law enforcement would be able to shut down a facility and what action a facility would have to take with background checks. All of that oversight and regulation would come with state licensure and would be lost without it.
Belodoff said self-reporting only works with the threat of a loss of license and that licensing promotes prevention of abuse, not discovering it after the fact.
Jim Baugh, a retired disability rights advocate, testified against the bill as a concerned resident.
“I’ve seen over the years how very important licensing is in discovering abuse and neglect,” Baugh said. “If there’s no licensing, there’s no mechanism to shut down a program that’s not providing the necessary level of service.”
Griffis, who is also formerly chairwoman of the Idaho Behavioral Health State Planning Council and has done extensive work with the state on mental health treatment reforms, pointed out that this bill lumps substance use treatment facilities in with camps and schools. The bill would not require these facilities to follow the same guidelines as even day care, substance use treatment or behavioral health facilities.
Licensing intended to help parents
Supporters say the bill allows parents to make these decisions for themselves in a free-market, private transaction.
Rep. Bryan Zollinger, R-Idaho Falls, who made a motion to send the bill to the House floor with a “do-pass” recommendation, argued that parents, not the government, should make decisions about what treatment is best for their children. This bill allows that, and if there’s a bad program, the free market will shut it down.
Opponents, though, argued that parents who are in a crisis situation, such as when their child is struggling with substance use disorder, need backstops like state licensing to make sure their child is protected and being placed in a well-managed facility.
“These parents are in crisis,” Griffis said. “When you take your child to the emergency room, you don’t question whether the doctor there is licensed or qualified to give medical treatment.”
Too much burden would be placed on parents to do the research into whether proper pre-screening is taking place, whether background checks have been completed, whether there has been a history of complaints or issues or even know that there are different levels of care for children dealing with substance use disorder.
“If a program is failing, what’s the mechanism to monitor that, if not licensing?” Linda Miller, a parent of a child in a mental health residential treatment program, told the committee. “As a parent, I wouldn’t be able to tell whether the program were failing.”
Keith York testified against the bill as “just a dad” whose son was diagnosed with substance use disorder when he was 13.
“It is a devastating time; it’s heartbreaking,” he said. “As parents, we had no idea what questions to ask, how to determine where we were going to put our kid. … We have so many regrets, so many questions that we wish we would have asked, but we didn’t. The idea that I could go to a facility here in Idaho and it not be licensed, not have the confidence that people who are taking care of my kid have not undergone some degree of education, know what they’re doing, are staying current with the ever-changing understanding of how this brain works, is unfathomable to me. … We’re dependent on the state to provide those facilities for us.”
I get that Idaho prides itself on getting rid of regulations, but can we all agree that there are some regulations that are absolutely necessary?
When it comes to our kids, this is not a regulation we should get rid of.
This story was originally published February 10, 2020 at 6:00 AM.
