Somerville Hospital loses detox unit

6/30/09The Somerville Hospital detox unit shut its doors last week, and will now begin referring those in need out to locations spanning from Jamaica Plain to Worcester.

It is a move that was due, according to Cambridge Health Alliance spokesman Doug Bailey, to steadily decreasing numbers of patients over the last six years, and lack of funds from the State. "We're just not paid for those services. The costs remain the same and we have to staff it like it's full."

In a transcript of her testimony before the Department of Mental Health (DMH) in April, Chief Operating Officer Allison Bayer said the Cambridge Health Alliance "incurs significant financial losses from the combination of reduced reimbursement [...] and the higher cost of providing [services]."

The unit had a 67 percent occupancy rate average in the last fiscal year, but the loss of occupants doesn't signify that substance abuse among Somerville residents has gone down.

"There is still a need," Bailey said.

Part of the problem is that hospital detox treatment requires a certain level of medical urgency, said Gail Enman, executive director of community-based treatment center CASPAR. Many of Somerville's patients were uninsured, but now that Massachusetts requires health insurance, the pool of funds from the state for uninsured programs has "dried up."

Another problem is the nature of addictive personalities. According to Enman, "[People with substance abuse problems] will make appointments and not keep them. If they're under the influence, they're not reliable." Subsequently, a lot of substance abusers get dropped from Commonwealth Care's insurance package and find themselves, now, unable to take a bed in the hospital unit.

To complicate matters, Enman said that a large number of Somerville's detox's unit has been homeless. Without an address, it's hard to get an insurance card.

On April Fool's Day, 2003, during what was comparatively a minor recession, CASPAR also had to close its detox unit due to state funding cuts.

"This community has already taken a big hit," said Enman, who is also on the executive team of Mental Health Substance Abuse Corporations, which meets with the commissioner of Public Health. "I had to look these clients in the eyes who said, 'I'm gonna be dead.' Well, we're gonna go under if we continue to offer this service. There's no sugar coating what the consequences were. The whole detox system lost half of their beds across the state. So they were cut from almost 980 beds to 400-some."

A study released in May from Columbia University's Center for Addiction and Substance Abuse (CASA)--"Shoveling Up II: The Impact of Substance Abuse on Fed, State and Local Budgets"--found after three years of research that "of $373.9b in federal and state spending, 95.6 percent ($357.4b) went to shovel up the consequences and human wreckage of substance abuse and addiction; only 1.9 percent went to prevention and treatment, 0.4 percent to research, 1.4 percent to taxation and regulation, and 0.7 percent to interdiction."

When programs are cut, Enman said, people end up detoxing in hospital emergency rooms, or in jail, neither of which is as effective.

The Health Alliance's "Plan for Continued Access Service," provided by Bailey, acknowledges that "patients will not necessarily be able to rely on public transportation to reach these sites and will need access to motor vehicle transport."

"To say it's okay and we're taking care of their needs, it's a fallacy," Enman said.

System-wide, CHA has cut 300 jobs in their three hospitals and clinics throughout the area. CHA has said they will discontinue services only after they have finished treating, and have discharged, patients who were there prior to June 30.

"This is like the poem ['The Hollow Men'] by T.S. Eliot," Enman said. "'This is the way the world ends/ This is the way the world ends / This is the way the world ends/ Not with a bang but a whimper.' That's the way I feel about the closure and the response. It's just... not there."

Attempts to reach the state Department of Public Health for comment were unsuccessful.