Detox deaths rattle rehabs
Patient pleaded for hospital before collapsing, dying at Arizona facility
During her nearly three days at an Arizona drug detox center, law enforcement reports show, an Ohio mother repeated the same request to multiple staff members: Take me to the hospital.
Madison Cross, 22, traveled from her home outside Columbus, Ohio, last Oct. 7 to check into Serenity Care Center, a state-licensed drug detoxification center in suburban Phoenix. Her family said she wanted to kick her addiction to opioids and other drugs for her 2-year-old daughter.
Once at the center, she showed escalating signs of distress.
She had trouble breathing. Her pulse raced. She was wheezing, and her lungs sounded “crackly,” staff members told investigators.
She appeared lethargic and ill. One technician told investigators her complexion was jaundiced, and her lips were purple. Another said she went from pale to yellow to blue.
Technicians reported her vital signs to nurses, who consulted with medical staff about her care, according to medical records from the Maricopa County Sheriff ’s Office obtained by USA TODAY under a public records request. She was ordered several medications.
But she was not sent to the full-service hospital less than a mile away. She collapsed in her room at Serenity and was soon pronounced dead.
The Maricopa County medical examiner concluded Cross’ death was an accident caused by “septic complications of acute bronchopneumonia in the setting of heroin toxicity.”
An attorney representing the young woman’s family called the center’s treatment of Cross “outrageous.”
“This woman was basically begging for them to save her life by sending her to the hospital, and they refused,” attorney John Wrona told USA TODAY.
He plans to file a lawsuit on behalf of the family.
A spokesman for Serenity said the center provided appropriate care and monitoring for Cross.
The center performs regular room checks, vital signs readings and intervenes when required, spokesman George Haj said.
Patients who are undergoing withdrawal and trying to stay clean are particularly vulnerable to medical emergencies. As the opioid epidemic causes demand for addiction treatment to surge, industry veterans said tougher standards, better screening and greater oversight are needed to improve patient safety.
Treating addiction
More than 1.4 million people sought treatment for alcohol or drug addiction from inpatient, outpatient and residential treatment programs in 2015, according to the Substance Abuse and Mental Health Services Administration. The federal agency recorded 3,362 deaths.
States separately report death investigations at residential treatment centers. In California alone, state regulators have investigated more than 150 deaths at treatment facilities since 2014. That includes 44 during the fiscal year that ended June 30.
Industry officials said the for-profit centers that have flooded the growing market for addiction treatment are in some cases providing aggressive marketing and substandard care.
“This is a huge issue for the industry,” said Marvin Ventrell, executive director of the National Association of Addiction Treatment Providers. “It is a critical time where we can get this right or we can get this wrong.”
Ventrell was speaking generally. He was not addressing Cross’ death, Serenity or any particular center.
His organization, which represents about 850 facilities in the USA, tightened its policies this year to require members to adhere to an updated code of ethics that prohibits such practices as “patient brokering” – paying recruiters to bring in patients who can generate lucrative insurance payments for services that must be covered under the Affordable Care Act.
The association is cracking down on websites that deceive consumers about treatment and offer inducements to get people in treatment.
Unscrupulous providers try to sell a service to a prospective patient, industry leaders said, rather than assessing individual medical needs. Many patients, leaders said, might fare better if they received medications such as suboxone or methadone from a doctor rather than checking into a facility and detoxing.
“The key is not to be assessed by a marketer on a website but by a clinical provider at a reputable center,” Ventrell said.
The burgeoning industry has attracted the attention of congressional investigators. The House Energy and Commerce Subcommittee on Oversight and Investigations called industry leaders to a hearing in July on advertising and marketing practices.
Longtime treatment organizations said they welcome tighter regulations for an industry flooded with newcomers seeking to profit off the addiction crisis.
Advocates said for-profit treatment centers provide Americans much-needed access to care. They said it’s inaccurate to say bad business practices have led to poor care at for-profit centers.
Mark Covall is CEO of the National Association of Behavioral Healthcare, an industry organization that represents about 1,000 nonprofit and for- profit members that provide inpatient, outpatient and residential treatment for mental health and substance abuse.
Covall said association members adhere to state licensing requirements and often are scrutinized by third-party accrediting organizations such as the Joint Commission and the Commission on Accreditation of Rehabilitation Facilities.
“For-profit or nonprofit is a tax status,” Covall said. “That doesn’t necessarily give any indication of how well or not well a provider is doing.”
Signs of struggle
Video footage taken in Cross’ small detox room during the early morning hours of Oct. 10, 2017, shows her struggling.
She attempted to open a restroom door, but seemed confused. Legs wobbling, she stumbled away from her bed and fell to her knees. She grabbed a shelf and held on for several seconds. Her right arm dangled to her side. She collapsed to the floor and lay still.
Six minutes and 25 seconds passed before a Serenity employee entered the room. The technician took her pulse – there was none, medical and sheriff ’s reports showed – rolled her on her back and began chest compressions.
Paramedics arrived minutes later and took her to Banner Del E. Webb Hospital, blocks away on the same street.
Efforts to revive her were unsuccessful. She was pronounced dead at the hospital.
Joshua Michael Kennedy, the technician who discovered Cross’ body, was interviewed by sheriff ’s investigators that morning.
Kennedy said Cross asked to be sent to the hospital because she didn’t think she was getting the medication she needed. She worried she might have contracted strep throat from her daughter, investigators wrote.
Kennedy took her vital signs at 3 a.m. He noted an elevated pulse rate and less-than-ideal blood pressure, investigators wrote. He reported this to nurses at Serenity, but he “felt as if their response to him was as if he were being a nuisance,” the investigators said.
Wrona, the family’s attorney, argued that Serenity’s nurses failed to recognize the seriousness of Cross’ condition soon enough. He said the problem was compounded by a policy that limits communication from family members during detox.
“There is a difference between someone who is going through a garden-variety detox and one who has a lifethreatening medical condition,” Wrona told USA TODAY. “If they had spoken to her family, they would have been able to advocate for her in some way.”
Haj, the Serenity spokesman, said privacy laws prohibit the center from discussing the details of Cross’ case.
“Our policy is that medical personnel constantly monitor a patient’s condition ... including regular in-person monitoring of vital signs and in-person room checks,” he said.
Staff members “do not rely solely on the video feed,” he said.
“Patients undergoing withdrawal frequently request transfers to hospitals in the hopes of relieving anxiety or in the hopes of obtaining drugs,” Haj said. “If all requests are satisfied, a patient’s substance use disorder treatment can be severely hampered. Patients are monitored to see if medical intervention is required.”