Death of a Detox (June 25th, 2009)

The rumor had been circulating for more than a year that the detox might be closing. Ever since the state had been reforming the public healthcare system we understood that major changes were going to be implemented.

Our organization and primarily one other in the state had been divvying up the free care pool, of which detoxification beds had been a part.

Prior to the state healthcare reform, our detox had been receiving over two thousand dollars a day per bed. Since the reforms were enacted we had seen that amount dwindle to just over two hundred dollars a day. Something had to give; in this case it was our unit of twenty-six beds.

So on the morning of January 28th, 2009, the head of nursing for the organization, the nurse manager for our unit, a representative from HR, the medical director for our unit, and several mid-management people made their way onto our unit.

They gathered us into the back staff room like a herd of cattle and asked us to sit down they had an announcement to make (I chose instead to sit on a computer desk, staring at the floor). In my ‘gut’ I knew what was coming.

“Due to the financial crisis within our organization, we will be closing the detox on June 30th” (later revamped to June 25th). Most of the people in the room initially sat in stunned silence. My feelings went from rage to sadness. After all this time of “wondering” what was going to happen, we finally knew.

Not that we had ever been allowed to be a part of the process, or decision. This was probably the reason I had initially felt such rage when they made the announcement; we were just the peons that ran the unit, nothing more, and nothing less.

This was strictly a business decision on their part; at least this is how they presented it. For years the organization had essentially ‘raped’ the free-care pool, now that those monies were gone they were walking away from providing this inpatient service. No, “we have been developing a plan so that when the closure comes, patients in need of detoxification services will still be served.”

To some, it seemed amazing that DPH (substance abuse services for the state) would allow this. A few counselors felt that DPH would not consent to the final sign-off on the closing of the unit. “It’s not over yet!” was their credo. I knew better. They never would have made this announcement without already having discussed it with DPH

Wake up people. Do you really think that DPH would slash its’ own programs to fund a unit that had been outside of DPH looking in at them for years? Don’t be foolish, absurd.

Besides, the organization had more to gain financially if these patients were channeled into their DMH regulated beds; a higher rate of reimbursement and they would not have the DPH constraint of only 3-5 days for detox.

How could these patients in need of detoxification make their way onto the locked psych/addiction units? Quite simple my friends, it begins in the Emergency Department where the street smart addict/alcoholic will say they are suicidal. Next the assessor will ask them if they have a plan, they will answer “yes.” Next the assessor will ask them what the plan is and the addict/alcoholic will refuse to tell them. Viola! Now you can not let them go, they could pose a danger to themselves and/or others and they have a detox bed.

Psych is the bastard child of medicine, and addiction is the bastard child of psych.