NO DETOX: What's the cost?
To see the cost of not having a detox facility in Brainerd, one only needs to spend a Saturday night in the emergency room.
That’s what Dr. Peter Henry told Crow Wing County officials in a meeting Wednesday. Crow Wing County has been transporting people out of the area for detox services since the facility in Brainerd closed in 2011. Crow Wing County Administrator Tim Houle said the issue is whether a provider can cash flow a detox facility and run it as a business.
Henry, emergency physician with Essentia Health St. Joseph’s Medical Center, said the total cost may be difficult to come up with in dollars and cents. It comes, he said, in the cost as doctors are distracted from caring for someone’s mother having a stroke or someone’s brother with a heart attack as they deal with a belligerent, aggressive and potentially dangerous intoxicated man in the ER during a six-hour stretch.
“There is a huge cost of care there and it’s not quantifiable,” Henry said. Chemical dependency, with an increase in methamphetamine use and prescription drugs, along with alcohol abuse are huge issues in Crow Wing County, Henry said.
The county has been without a detox facility since June 1, 2011, when its previous provider, Dakota County Receiving Center, stated it was unable to find an alternate site after the Brainerd Regional Human Services Center in east Brainerd was no longer available. The county worked with Dakota County, which continues to run the facility in Hastings, to help the private nonprofit find an alternative site.
Currently, the county uses a private contractor to transport people to detox facilities, such as Hastings, Nevis or St. Cloud. Henry, and Dr. Peter Neifert, psychiatrist from the hospital’s Grace Unit, said there are barriers to transporting people to detox, too. The transport service wants detox patients to be placed on a hold order for the trip. Otherwise the individual could demand to be let out in Little Falls while on the way to St. Cloud and there would be no legal way to detain them. But the unlocked detox facilities, which are the ones often available and willing to take people under the influence of meth or other drugs, do not want patients on hold orders.
Essentia Health reported there were at least 20 patients needing detox services in the ER between April 27 and May 14.
“The need is there,” Henry said. “I don’t anticipate that going away.”
People who are intoxicated or under the influence of drugs may wait in a busy weekend ER for hours as doctors try to find a detox facility with open beds or arrange transport. One individual was there for eight hours, Henry reported. Neifert said some people stayed in the hospital’s intensive care unit to detox at a cost of thousands of dollars a night, which the hospital absorbs.
“It’s an incredible waste of resources when it happens,” Neifert said. “Overall, it would be much more cost effective to have a detox in our county. I don’t know how to make it happen. I just know there is a need.”
When the hospital has had to use an ambulance for transport, the cost is $1,500 per ride and write off the expense.
Commissioners Rachel Reabe Nystrom, Rosemary Franzen and Paul Thiede met with Essentia Health representatives, including Jani Weibolt, president of Essentia Health St. Joseph’s Medical Center.
Weibolt said when the detox center closed there seemed to be no question in anyone’s mind that a new facility would reopen in the area. She asked what had changed.
Thiede said when Northern Pines responded to the county’s request for proposals to provide detox services, the assumption was the base line of area county customers would continue. But since the facility was no longer available, Houle said other counties began using alternate detox services and business began peeling away. Houle said the county needed data it could measure beyond anecdotal information to be able to evaluate the most cost effective way to provide the service.
The county budgeted $350,000 for detox in 2012 down from $388,000. Since the detox facility closed, the county reported average monthly costs were down significantly even with cost of transport taken into consideration. Houle said one of the issues is at what level is the public expense to provide the service locally.
Nystrom said after law enforcement was no longer vocal about concerns for detox services here and with declining use, it seemed the county’s solution of transport was working.
“This has been a very enlightening conversation,” Nystrom said. “We thought it was a great solution.”
Nystrom said they weren’t hearing anything urgent about the detox center until Wednesday.
Any downward trend in use of detox services will be short-lived, Henry said. He suggested talking to the ER directors from hospitals in Aitkin, Crosby, Little Falls and Staples. Franzen quoted statistics measure a 50 percent drop in detox use. But Neifert said that may be more about barriers to the service than a lack of need.
Houle told the group there was no lack of desire for a local detox service but the county has stopped short of taking the responsibility to make the business cash flow. But Houle asked what steps they should take next to advance the dialog.
Essentia Health was asked to send a representative to serve on the task force looking at the detox issue.
Franzen said the task force has talked a lot but hasn’t come up with a solution.
“This hasn’t been dropped but it hasn’t come to a conclusion either,” Franzen said.
For the hospital, Weibolt said they’ve felt out of the loop.
The county is required to offer detox services with licensing and strict medical criteria required, including 24-hour access to a doctor and nurse because alcohol withdrawal can have serious, even life-threatening side effects. Northern Pines Mental Health Center was selected to provide detox services after requests for proposals were sent out for a new provider.
The Crow Wing County Sheriff’s office is typically making the judgment calls on when people should be transported to a detox facility. Henry reported about half the people needing detox services come in with law enforcement and half arrive by ambulance or private vehicles.
The question remains whether use is down because there isn’t a facility. People who may have gone to detox may now be left in the care of family, friends or even acquaintances. Essentia Health staff said it’s hard to use something that no longer exists here.
The county and Essentia Health agreed to work with the task force to compile information.