Patti Singer, @PattiSingerRoc Published 4:33 p.m. ET March 12, 2018 | Updated 9:28 a.m. ET March 13, 2018
Maryann Marshall said she prays that a decision by the state to allow hospitals to use more of their beds for detox, at least temporarily, will make a difference for families fighting opioid addiction.
“Keep them and detox them,” the Greece woman said. Marshall said her son Jonathan was never offered a bed all the times she took him to Unity Hospital because of opioids.
“They never kept him more than a few hours,” she said. “They’d hydrate him and send him off on his way.”
Marshall said it’s crucial that people addicted to drugs get help when they want it. “You’ve got to move quickly.” Her son survived but is now incarcerated.
The state Office of Alcoholism and Substance Abuse Services earlier in March freed hospitals from a regulation governing the number of beds that can be used for detox services.
“It opens up hospitals to be responsive to the needs of their communities,” said Robert A. Kent, general counsel for OASAS. “We know in Rochester, like other communities, there are a lot of people who show up in the emergency department, reversed on Narcan, clearly with addiction issues. We want the hospital to have the full range of options available without any interference from state regulators.”
But the waiver may not matter in Monroe County, according to one person in the recovery field.
“The hospital beds are full,” said Carl Hatch-Feir, president and chief executive officer of Delphi Drug & Alcohol Council. “There are parts of the state where it will make a significant difference. Monroe County is not one of those parts.”
However, Hatch-Feir said there could be a ripple effect — hospitals in outlying areas taking advantage of the waiver could free up resources in Monroe County.
The state Department of Health operating certificate allows hospitals to treat people for addiction, Kent said. However, hospitals that do not have a specific license from OASAS are limited in the number of beds they can use for that purpose. OASAS is allowing hospitals to get a waiver so they can use five or more medical/surgical beds for a person needing treatment for addiction. The waiver runs through 2018 and will be revisited for 2019.
Hospitals in the UR Medicine and Rochester Regional Health systems routinely run at or over capacity. Early in January, both systems reported that some patients who needed to be admitted from the emergency department were temporarily boarded in hallways.
Kent said he would not comment about how hospitals manage their beds. “I think there’s always beds available for them to be detoxing people. Local hospitals can dispute that and talk about what their patient flow is. My sense is, if there’s need, they find a way to help people.”
Kent said he’s had inquiries from Rochester-area hospitals, but he declined to say which ones.
What will UR, RRH do?
UR Medicine officials said that given capacity constraints, they do not envision adding beds dedicated to detox services at Strong or Highland hospitals. However, other hospitals in the UR Medicine system may be exploring the option.
A statement from B. Chip Partner, director of external communications at UR Medicine, said officials at Strong Memorial Hospital are working with Monroe County Commissioner of Public Health Dr. Michael Mendoza to determine how the OASAS waiver may help the hospital expand and accelerate its link to outpatient recovery services for hospital patients.
Strong and other UR Medicine hospitals provide inpatient detox services also to opioid-addicted patients who are admitted for other medical needs. The length of stay for detoxification is usually two to four days.
UR Medicine provides comprehensive outpatient addiction recovery services, Partner wrote.
Rochester Regional Health is working on a plan based on the OASAS memo sent earlier in the month, said Kathy McGuire, senior vice president for behavioral health.
"There are still some unanswered questions from OASAS and when they are addressed, we hope to have a better idea of the direction we will be headed to continue to fight the opioid crisis," she wrote in an email.
RRH provides limited detox services in a hospital when medically necessary for hospitalized patients, and the system has an outpatient program, she wrote.
Kent said the waiver is part of a bigger discussion about detox beds and connecting individuals to follow-up treatment.
“Almost everybody with an addiction issue, especially in this epidemic, ends up in an emergency department one way or the other in crisis,” he said. “Not everybody will be appropriate for detox in a hospital. If we create more community-based detox beds, they can go there.”
Kent said hospitals are taking a broader view of their role in treatment and making connections from the emergency department and detox bed to treatment so that people aren’t sent right home. “It’s not the right place to go when we're in the midst of what we’re in the midst of.”
Carol Struble of Hilton said she grew frustrated with New York City emergency departments that treated only the crisis her son Robert Giannotti was in before discharging him.
“They don’t give any follow-up,” said Struble, who lost her son to addiction. “Like a cancer patient or a diabetic or someone with a broken leg, they need follow-up. What’s the difference between a diabetic and an addict coming through? They still need help and direction.”
Kent also said OASAS is in discussion to increase the capacity for Syracuse Behavioral Health on University Avenue, which is licensed for 25 adult beds. OASAS recently awarded a grant to Villa of Hope for 18 beds that would serve people as young as 16.