Dr. David Koehn is a psychologist practicing in Fort Myers, FL. Dr. Koehn specializes in the treatment of mental health problems and helps people to cope with their mental illnesses. As a psychologist, Dr. Koehn evaluates and treats patients through a variety of methods, most typically being psychotherapy or talk therapy.... more
My Substance Abuse – Dual Diagnosis Life
Not an Oxymoron But What a “Casino” (Italian for FU)”
I spent about a year working the roles of program director, clinical director and training director in a residential inpatient/outpatient, dual diagnosis, substance abuse, treatment center. The amount of suspiciously unethical practices that occurred in this environment was unbelievable. The organizational practices of this center made the series “The House of Cards” on Netflix look like a child’s game.
Originally I was hired to be the training director for the facility owned by a firm that was not located in the state where I worked. My primary role was making sure all mental health professionals were up to date with “state of the art” practices associated with treating dual diagnosis and “pure” mental health clients. I was also responsible for developing an Association of Psychology Postdoctoral and Internship Center (APPIC) program for pre-doctoral and post-doctoral internships in psychology. This was accomplished in record time and became the model for other centers owned by the firm across the country. Because of the center’s bad practices, which will be discussed later, most of those hired to be in the clinical director role or program director role left the organization. At least two program directors and two clinical directors left during my tenure. Regardless, I ended up taking on these roles until corporate was able to stabilize this chaotic disruption. Their solution was to hire the current operations manager into the program manager position – the worst decision corporate could have made, as will be revealed.
To provide an example of the bad practices previously mentioned, one of the program managers, a psychologist, prior to his leaving, shared a posting on the website concerning the owner of the business for whom we were working. What he shared with me was shocking. This individual was disbarred as a psychiatrist in Britain for fabricating his credentials and doing unethical research. Here in the United States, he was allowed to set up multiple treatment centers for substance abuse clients. Even though I was previously informed of his lack of credentials, at the time, I did not know him. Eventually I did get to know him quite well. Diagnostically, he operated a lot like a bipolar person who was up and down like a roller coaster, to the extent that he could not be trusted for what he said or did. Again, this will become obvious as the onion is peeled back to this story.
The center opened in a residential community, but it was not vetted with the members of community. It was erroneously and purposefully presented with a disguised intent and subsequently approved by the board of the city. When the true purpose and intent was made evident to the community, the board fined the firm and was told to cease and desist. The firm, however, sued the city and won and began operating with licenses from the state to provide substance abuse (dual diagnosis) and mental health services on both an inpatient and outpatient basis. Things eventually settled down, but the owner and some of his centers on the west coast were handed warrants and evidence was taken – a finished story yet to unfold.
The operations manager, brilliant in her knowledge and treatise associated with state regulations, was successful in getting the center accredited despite major flaws in operations and practice. She was awarded by corporate for her efforts by being promoted to the program manager position. Prior to this success, she conducted herself much like a good anti-social personality disorder person that has an uncanny ability to con the world. She was extremely gifted at making things up and getting everyone to believe as though others were at fault. Many rumors were abound – just how many were true I am not sure, but many appeared valid. For instance, she had control of the corporate credit card and used it to purchase personal items and took residential furniture and accessories, to include plasma TVs, for her home use. She gave work contracts to her personal friends to include drug dose distribution, which were typically over filled and over paid. She misrepresented her academic credentials, claiming she graduated from a college in PA, which no longer existed at the time she said she had attended. She would get the chef at the center to make gourmet food for dinner parties she held at her home. She manipulated and maneuvered until she got rid of everyone, including me, without even batting an eye. She worked on the side for a competing firm – this incident was against the rules of engagement and a major conflict of interest violation. When this was brought to the attention of corporate she only received slap on the hand – they needed her. What she did not see coming was that corporate would let her go after the center received its accreditation saying they no longer could afford her. They replaced her with an unqualified protégée, the previous project manager groomed who was also a con artist and had no compunction lying to get whatever she wanted. All this was just the tip of the iceberg!
The clients hardly ever stayed more than thirty days primarily because their insurance ran out. Most of our program was set up for ninety days with a follow-on transition program back into the community. Many clients had a difficult time getting insurance. The firm set up a side insurance company to pay for them to attend the program. After a month their insurance ran out and they were discharged even though they needed services – highly suspected of being unethical and bordering on fraud. For lack of services, most clients were unsuccessful in their return to the community. As if this were not enough, the clients were further taken advantage of by having their credit cards compromised and used without their knowledge – no one admitted as to how this happened. Many clients who came to the center were falsely informed as to what services they were going to receive or misguided as to their treatment program by regional placement personnel.
The process employed during the stay at the center by those seeking treatment was barbaric and violated all ethical, psychological and reinforcement principles. Clinical staff and program/operations staff were constantly at battle over doing the right thing or doing the wrong thing. Clientele were misled from the beginning regarding the potential services and privileges they would receive once they came to the center by the outreach people, hired by corporate. The outreach people were paid based on the clientele coming to the center, not whether they were good candidates. Often the clientele were poor candidates, but the staff was pressured into taking them regardless of their opinion. During the intake at the center, the clientele were finally given the truth about their services and more often than not became very upset over the dishonesty of the original presentation.
All residents, whether classified as pure addiction, dual diagnosis (mental health and addiction) or pure mental health, were placed on the same programmatic phases for obtaining benefits and privileges. In Phase 1, they were not to see or talk to anyone from the outside for the first fifteen days, including turning in their cell phones. If they had no disciplinary actions against them, such as failure to attend activities, classes or therapy, they would be approved to move on to Phase 2 by the program director. During Phase 2 (sixteen through thirty days), they could have controlled phone calls and weekly visits by family, but no access to their cell phones. During this phase, they also had staff-supervised visits off campus. If they were in compliance they were approved by the program director for Phase 3 (beyond thirty days). In this phase they had access to their cell phones, off campus visits with their family and weekend leaves unsupervised. If a problem did occur they would be dropped down to a lower phase based on the extent of the grievance. The major issue, besides the program director’s lack of comprehension of treating the clientele, was that she used her power of approval or denial to manipulate the clientele according to her will. The firm backed the program director’s decisions, which both exasperated and disgusted the clinical staff.
The work environment was extremely toxic due to the operational approach and actions taken by the operations/program director. She was instrumental in having a well-known psychiatrist fired; who she had previous run-ins with at other jobs, claiming he should not prescribe for bipolar and/or ADHD issues while clientele undergo detox. She had a close relationship with a Physician Assistant (PA) who could prescribe medications and treat substance abuse and who also worked with the aforementioned psychiatrist. The program director, with the PA’s cooperation, colluded against the psychiatrist which ultimately led to his dismissal. This PA had a negative work history of having lost his board license to practice nursing for stealing medication from the place he worked prior to his attaining his PA license. He was suspected of taking drugs himself and drank excessively, all of which was known by corporate, but they let him practice anyway. (Postscript – he died this last year from a suspected heart attack.)
None of the pre-doc or post-doc interns, as well as the professionally licensed mental health counselors, was treated with respect by the previous operations manager, now program manager. They were constantly demeaned and told to do things that they knew were unethical. In fact, one of my post-docs was fired by the program director and the current clinical director (a retired chaplain who had his own anger management and impulsivity issues) for a fabricated accusation. I intervened, but she maneuvered around me. Although, I thought I had the ear of the owner who said he “had my back” and was my closest “buddy.” He ultimately reneged on his promises and commitments and basically offered me up as a sacrificial lamb. A complaint was filed against the facility with the health commission as well as the accrediting bodies - I assume by some of the staff. While weakly investigated, nothing came of the complaints; however the malfeasances continued and were never further explored by the state.
There was a lunacy to policies and procedures (which were contrary to good psychology practices and reinforcement principles) and a caustic culture that prevailed at the center and corporate. Even so, the mental health staff were competent, passionate and committed to give the best quality of care and continuity of care as possible. They worked tirelessly with the residential and nursing staff and provided great communication, coordination, collaboration, and cooperation. All this was done in an atmosphere where the program director, and to a degree corporate, did not want this positive interaction between residential-nursing staff and mental health staff. Most of the residential and operations personnel were recovered addicts themselves, including the promoted program director. It was as though, she, the program director, had to be the dominant, powerful alpha dog and in control of everything.
The residential center was located along the river bank and provided a beautiful, picturesque landscape. Housing units usually were set up for two persons, with the exception of the detox units where only one person resided. Separate units were set up to meet the standards for mental health. Male units were separated from female units, but the doors could not be locked per policy. There was a central unit that provided a dining room, recreation area and television room. Food was reasonable but nutrition and dietary needs were not a consideration. We had excellent programs to include equine therapy, garden therapy, music therapy, art therapy, fishing therapy and an exercise/running club. Meditation and yoga were supported and reinforced. Group and individual therapy were conducted by credentialed mental health professionals daily at our outpatient clinic, located about ten miles off campus.
Training of all staff was provided, and for interns specific requirements were mandated by APPIC. Weekly sessions were held, covering state of the art practices in the field of substance abuse and mental health. Individual and team meetings occurred regarding their counseling sessions with clients. Documentation standards were reviewed and assessed for quality. There was an open door policy for staff to come in and discuss anything that was on their mind.
One of the things I implemented across all staff were team building exercises – we used the Meyers Briggs Type Indicator and Life Styles Inventory to leverage understanding and interaction. Over my forty plus year career, I have used these instruments as well as others to help teams without issue. Towards the end of my tenure, we hired another clinical psychologist to take on the role of being the clinical supervisor. For whatever reason, this psychologist felt these team building exercises were a personal violation of privacy, on which she and I disagreed. She must have reported her feelings to corporate because they used this as ammunition to compel me to leave my position. I was so fed up with their falsifications and manipulative management practices that I did not fight them and removed myself from the company. My major regret is that the pre-docs and post-docs were left without any support to complete their program. As a side note, the night before I left I discussed with the owner his impression of an envisioned strategy and program for interactive multi-media training across sites that I put together for him. He said it was brilliant and they would be looking into it. Any concerns related to the above-mentioned administration assessments, policy procedures or lack thereof were never mentioned. The never-ending saga of this firm and center continues – for how long, who knows...
(PostScript – Center was closed down by DCF for numerous infractions to include nonpayment to employees and contractors.)