This report is a result of an on-site complaint investigation conducted on July 25, 2007 with a follow-up meeting on July 31, 2007 by staff from the Division of Drug and Alcohol Program Licensure. Coatesville Treatment Center is approved to use a narcotic agent, specifically methadone, in the treatment of narcotic addiction. Based on the findings of the on-site complaint investigation, Coatesville Treatment Center was found not to be in compliance with the applicable chapters of 4 PA Code and 28 PA Code which pertain to the facility. The following deficiencies were identified during this investigation and a plan of correction is due on August 27, 2007.
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Plan of Correction
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Observations
The facility failed to restrict involuntary detoxification of patients to the reasons permitted by regulation. In three of four patient records that were reviewed, three patients were involuntarily terminated and detoxed from methadone maintenance for non-payment. The Coatesville Treatment Center financial responsibility intervention procedures states that a patient will be placed on a contract 8 days after the first non-payment. If the patient continues not to pay for the next 3 days, then a 21 day administrative detoxification will occur. The brevity of this timeframe does not allow for a clinical intervention nor for the lack of financial responsibility to be treated as a clinical issue. There is no opportunity for the patient and counselor to work together to develop treatment plans goals and interventions such as seeking employment, obtaining credit counseling, applying for public funding, etc. Since methadone is a life sustaining medication, an involuntary detoxification is permitted only as a last resort unless there is an immediate danger to the patients or staff. The issue of financial responsibility is a long term clinical issue that needs to be addressed on an individual therapeutic basis.
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Plan of Correction
The following progress will be implemented starting 9/4/07:
1)Patients with a balance will be notified by the office manager immediately.
a.Office Manager will put a note in the primary counselor's box, which will indicate the patient was informed of balance.
2)The primary counselor will schedule to meet with the patient within 7 days to discuss treatment plan goal.
3)The following questions will be addressed.
- How did this happen/ What is going on?
- Have you applied for Medical assistance if not provide the patient with the attached sheet
- Is the patient eligible for any county funding?
- How can we correct this?
- Indicate the plan established
- The primary counselor or supervisor will indicate to the patient the need for patient to move in compliance with treatment plan goal within 3 days to avoid being put on a contract.
4)If the patient needs to apply for Medical Assistance the patient has to continue to pay until Medical Assistance is approved. Applying for MA will be added to the treatment plan. The counselor will follow-up on Medical Assistance status with the patient at least once a week.
5)If a patient is unemployed the patient should actively seek employment and it must be added to the treatment plan. The following questions and issues will be addressed and placed on treatment plan.
- Are you eligible for unemployment benefits?
- If yes, give them information regarding this process.
- If no, What type of job is the patient seeking to obtain?
- Where will the patient look for employment opportunities such as the newspaper, DOL, Career Link in Coatesville?
- How many jobs a week will the patient apply for each week? Generally 3 is average.
- Does the patient need help developing a resume or improving interviewing techniques? Ask them how they dress for an interview? Give the patient unsolicited pointers on interviewing techniques.
The primary counselor will check employment status and process weekly.
6)The primary counselor will inquire as to whether any family members can help? The primary counselor will encourage scheduling a family meeting to discuss the problems occurring and place this intervention on the treatment plan.
7)If at anytime during this process the patient remotely indicates difficulty budgeting. The primary counselor will develop a budget sheet with the patient and add budgeting to the treatment plan. Compliance with budget plan will be changed weekly.
8)Patients are always placed on a payment plan as a monitoring tool and assist with accountablility. If the patient fails to follow agreement the primary counselor will meet with the patient and document interventions and make any changes if needed to the treatment plan
9)Non-compliance with financial responsibility will be reviewed weekly during treatment team and during management meetings.
10)The patient will begin a 21 day Administrative Taper only after all interventions have been exhausted. This timeframe will vary.
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