Marion County: At the crossroads of drug rehabilitation

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Posted March 21, 2024 | By Jennifer Hunt Murty

Editor’s Note: This report will be supplemented as more information becomes available. 

When it comes to providing residential treatment for those fighting drug addiction, Marion County is punching well above its weight. Despite being ranked No. 19 in population among Florida’s 67 counties, Marion County is No. 6 in the number of treatment beds available for recovering drug users.

With seven facilities totaling 532 licensed residential drug rehabilitation beds, Marion has more capacity than powerhouse counties including Orange, Duval, Polk and Brevard, according to the state Department of Children and Families. 

But that capacity does not necessarily translate into better treatment services for Marion residents. A closer look reveals the numbers are inflated by patients from well beyond Marion’s borders, which is leading to a litany of challenges for mental health advocates and county officials.

Being in north central Florida, Marion County is uniquely situated to take in people from around the state as the demand for drug addiction treatment services continues to exceed the supply of available beds. Under a contract from the state Department of Corrections, the Phoenix House receives hundreds of such patients from around the state each year.  

The Phoenix House is the largest center of its kind in Marion County. The facility opened in Citra in 1994 and is run by the nonprofit organization Phoenix Programs of Florida, Inc. 

In recent months, the “Gazette” started digging after hearing some in the community express concern about the number of out-of-county patients who are brought here, and what happens to them when they leave the facility; the ratio of staffers to patients and the problems associated with a high caseload; and the type of rehabilitation services that are or are not being provided at the facility.

In a Jan. 27 letter signed by 65 female patients at Phoenix House and sent to the “Gazette,” the facility was described as disorganized and not providing enough treatment. Included among the complaints, were vulnerable women “wandering away” from the center and getting hurt because of a new policy that prohibits them from having cell phones and that the food was not safe to eat. 

In addition to the DOC contract, the Phoenix House also receives a steady stream of patients under a contract with Hillsborough County government, nearly two hours away. Hillsborough County has 15 facilities with a total of 772 licensed beds, according to the state Department of Children and Family Services, but a Hillsborough spokesperson told the “Gazette” that there is not enough space, which is why patients are being sent to Citra. 

A numbers game at Phoenix House

Phoenix House is licensed by for 300 beds: 200 for residential level 2 care and 100 for residential level 4 care. As of 2017, however, Phoenix House reported providing services to 527 patients. In 2021, that number nearly doubled to 918 patients.

The dramatic increase in patients has led to staffing problems at Phoenix House. Over the past two years, the DCF has granted requests for variances from Phoenix House to the state mandate requiring no primary counselor may “have a caseload that exceeds 15 currently participating individuals.”

Maria Alvarez, CEO for the Phoenix House, said the variance was needed because the ratio of staff to patients was unworkable.

“We continue to experience tremendous workforce challenges debilitating our ability to meet the demands of our community hindered by attaining counselors needed to meet our current funded contracts,’’ she said. “Our current census is 195; (105) less than licensed. We cannot bear the financial hardship that this brings, approximately $1.8 million, let alone the inability to meet the rising need for substance use treatment in our communities as overdoses are at an all-time high.”

Alvarez indicated with the increased caseload, each primary counselor would be able to see every one of their clients individually weekly for at least an hour, provide daily groups, and be available for additional contacts.

Under the DOC contract, quarterly reports are to be submitted and if the patient discharge rate falls below 51%, Phoenix House officials are to file a Quality Enhancement Study outlining how they plan to improve in this area. The DOC has not responded to requests by the “Gazette” for copies of those reports.

The pressure is already on the Phoenix House to increase its number of patients. In a letter dated Oct. 13, 2023, the DOC indicated to the Phoenix House that it would “monitor expenses and utilization rates on a quarterly basis. In the event you are not utilizing your allocated annualized bed days on a consistent basis, the Department reserves the right to reduce your allocation and provide those dollars to Contractors who are maximizing their program’s capacity.”

The 2023-2024 DOC budget for Phoenix House is about $5.5 million. The per-diem rate ranged from $50.15 in 2021 to $77.02 this budget year. If the patient had a co-occurring mental disorder in addition to drug rehabilitation, the daily rate jumped to $88.70. 

According to the Substance Abuse and Mental Health Services Administration, a branch of the U.S. Department of Health and Human Services, the facility offers medication-assisted treatment. The contract says DOC agrees to compensate the Phoenix House at $690 per offender per dose of Naltrexone, a monthly shot. That amount would include Phoenix House administrative oversight lab work and education of the patient. 

Additionally, the facility was offered the rate of $1,590.22 per offender, per service for a single dose medication like Vivitrol, which is a monthly shot that helps addicts fight cravings. The drug is more expensive but requires less manpower to manage.

Phoenix House does not seem to be billing for medication assisted rehabilitation despite the DOC contract’s provision which may mean they are not currently offering it. The “Gazette” could not find anywhere in the DOC contract where the facility was required to provide it to DOC patients and the Phoenix House would not respond to the “Gazette’s” repeated emails or telephone calls.

Patients raising concerns

After receiving the letter from the female patients at Phoenix House, the “Gazette” attempted unsuccessfully to speak with them. The mother of one patient who signed the letter told the “Gazette” she had visited her daughter, who was at Phoenix House under a DOC contract, and she felt her daughter was doing better. The mother indicated that she knew of the recent policy change that prohibited patients from having cell phones; however, she reported that her daughter was able to call her regularly from the facility.  

Another former patient, Devon Frazer, 31, recently sought treatment at Phoenix House following a three-day detox stay at a different facility. He said he checked himself into Phoenix House only to leave a few hours later after finding drugs in a bathroom. 

Frazer’s mother, Sherry Jackson, indicated when she arrived with her son the place seemed short-staffed and people were waiting for hours to be admitted. According to Jackson, Devon called her hours later asking her to come pick him up. 

Frazer said Phoenix House staffers were apologetic about drugs being found in their facility, but he was later admitted to SMA Healthcare. Frazer, who was uninsured at the time, said Lutheran Services agreed to pay for his treatment. “This community is very supportive of those seeking treatment for addiction,” he said. 

Taking in Hillsborough County’s patients

Hillsborough County began its arrangement with Phoenix House in 2018 and, according to records, approximately $2 million has been spent primarily for services at the Citra site since then. The county’s rate for residential services is $96.97 for behavioral therapy, room and board per day. The “Gazette” could not find any evidence that medication-assisted treatment was either reimbursed or billed to the county. 

According to a Hillsborough County official, transportation for the patients back and forth is handled by the Phoenix House. Public records indicate, however, that not all patients continue with treatment and some leave against medical advice to stay.

What happens to those patients who leave? Do they stay in Marion County, and avail themselves of local services, or find some other place to go? Agencies that support this at-risk population–including the Salvation Army, Interfaith Emergency Services, Marion County Hospital District, and the city of Ocala’s Office of Homeless Prevention–all indicate there seem to be very few patients transitioning from Phoenix House to community agencies. 

Community resources to support rehabilitation efforts

Marion County contributes significant resources to helping the patients at the Phoenix House. Charities and businesses offer support to people trying to enter the workforce, a requirement for some under the DOC contract with the Phoenix House. Area hospitals treat the medical issues that arise with the patients Emergency call records indicate that some of the medical issues could be related to drug use.

Marion County Fire Rescue provided the “Gazette” the following call history to the Phoenix House: (see Marion County Fire Rescue call history graph)

Medical calls to the facility have considerably jumped. In 2023 alone, MCFR transported 198 patients to area hospitals from the Phoenix House. Who returns them to the Phoenix House after their hospital visit? It’s not MCFR. Phoenix House may pick them up, but they haven’t responded to our interview requests and no one else has been able to confirm.

Opioid Settlement

Florida is in the process of figuring out how to spend its $1.6 billion share of a legal settlement involving 14 states against three pharmaceutical distributors and one drug manufacturer stemming from the opioid epidemic. 

The distributors were AmerisourceBergen, Cardinal Health and McKesson and the manufacturer was Johnson & Johnson. Together they will pay over $26 billion in the coming years. 

States will receive a portion of the distribution and then counties and municipalities will receive a share. 

The money must be used to treat opioid addiction, and so communities around the state are creating task forces to develop plans to implement and spend the settlement money. Advocates hope that some of the funding will lead to increased capacity throughout the state, making it possible for those seeking treatment to find it closer to home.

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