Future of local recovery center unclear

Terry Murray, director of the county Community Services Department, said he felt there was a need for such a center in the county and that Koochiching has “consistently shown to be in high need of chemical dependency (treatment).”

County commissioners agreed. The group voted unanimously to contract chemical dependency service assessments on a full-time basis with Sharon Frank, one of the current contracted assessors, with the stipulation that local referrals will be made when necessary.

The motion included language that after a six-week period, the action will be reviewed.

Decrease in patients

Many referrals to treatment centers like Pineview are based off the results of a Rule 25 chemical dependency (CD) assessment. The assessment refers to the administrative rule that addresses chemical-use assessment, administrative requirements and appeal and fair hearing rights of the client. All 87 Minnesota counties, 11 American Indian Tribes, and nine state-contracted Managed Care Organizations are mandated to provide this Rule 25 assessment to anyone who requests one, or for whom a chemical-use assessment is requested. Use of a standardized, uniform, state-developed assessment tool was implemented in July 2008, according to the Minnesota Department of Human Services website. A 0-4 score from the assessment determines the level of care a patient needs, and what kind of risks are involved.

Under Minnesota law, the county is required to provide and pay for chemical dependency assessment services.

Before Tuesday, Murray said his office contracted with two Rule 25 assessors – Frank and Gus Christianson, director of Rainy River Recovery. Murray said his office alternated between the two when an assessment was needed.

“There are times when we have to use one over the other...but that is very rare,” he said. Murray noted Tuesday that Rainy River Recovery had previously requested to no longer be contracted for Rule 25 assessments.

“It has to do with them concentrating on other outpatient services,” Murray said of Rainy River Recovery. “We are in the process of ending that contract.”

Kimberly Perkins, CEO of Littlefork Medical Center, of which Pineview is affiliated, told the board she felt the client intake to the center is low because of lack of referrals to the facility.

“Minimal to no referrals from local providers, assessors or counties have made the operation of the Pineview Recovery Center strained,” Perkins said in a March 8 letter to Murray. “As more chemical dependency services are outsourced or referred to outpatient facilities, the Pineview Recovery Center will continue struggling into nonexistence.”

After reading Perkins' letter, Murray said he did a “thorough investigation” as to resources the Rule 25 assessors are referring clients and “realized they have been sending a large number of clients than I was aware of almost exclusively to out-of-county providers."

“There are times we have to use an out-of-town facility...but we want to make sure that when at all possible, we use a local facility for a lot of reasons,” he said.

Murray added that when sending patients out of the county, the price tag can quickly add up.

“We contract for volunteer drivers, and it's a high cost for us,” he said. “It is about 90 cents per mile. If I took that into calculation, (the cost) would probably be about $40,000.”

Questioning conflicts

More than once during Tuesday's meeting, Perkins said she felt the lack of referrals stemmed from an assessor's conflict of interest.

“Since August of 2012, out of 49 possible referrals, we kept one of those locally,” she said. “I don't believe every single one of them could have been referred to Pineview...but it's very disheartening for me to have to tell my (LMC) board that out of all these possible referrals, Pineview was only given one.”

In a letter to the board before Tuesday's meeting, Murray said he learned the LMC Board had given Pineview three months to “turn things around.”

Perkins said Tuesday that Pineview's director, Chris Jonson, in November completed training to be a Rule 25 assessor. The board agreed that Jonson could act as a backup assessor if Frank was unable, for whatever reason, to do the assessment.

Perkins continued that there have been many discussions in the past eight months about the lack of referrals and she said, “I will make it very clear that I truly believer there was a conflict of interest with the previous (Rule) 25 assessor.”

In a telephone interview Thursday, Perkins confirmed it was Christianson with whom she felt the conflict was coming. 

When contacted by The Journal earlier the same day, Christianson said many of his patients required involvement of a counselor in their addiction treatment or recovery.

“Pineview spent a lot of time looking for a counselor,” he said. “I can't refer someone to a facility unless they've got a counselor in place.”

In February, Pineview hired Kale Tippit as a chemical dependency counselor, which Christianson said prompted an immediate referral by him to the facility.

And although Perkins disagreed that he made recent referrals to Pineview, Christianson continued, “Since (Tippit's hire), I've referred five people down there. I'm excited for Pineview and its new opportunity. I hope Pineview lets people know they've got an exciting new guy down there.”

Murray explained that his review of the matter was never intended to say a conflict existed with any of the contracted assessors.

“In general, there wasn't the best working relationship with Pineview and the assessors and I'm not going to blame either side,” Murray told The Journal Thursday. “There is a lot of people involved (with the issue). I took all the information I received, and hopefully, the county board's end result will satisfy everybody. Our main concern is that each (assessed) person gets the best service they can.”

Murray said he is confident the board's decision Tuesday will allow Pineview to stay open in the community and he will more closely monitor the entire situation.

“If referrals aren't where they should be, we'll look into it again,” he said.