Discussion: Source

A dodgy clinic. A reality TV crew. AWOL state regulators.

How a t wentysomething alcoholic’s last

best hope took a fatal turn.

BY JOHN HILL I L L U S T R A T I O N B Y M A X O M A T I C

O n D e c e m b e r 3 0 , 2 0 1 2 , as part o f a series called Drugged, the N ational Geographic C hannel aired an hourlong docum entary ab o u t a 28-year-old nam ed Ryan Rogers. It appeared to be a classic tale o f a drunk trying against the odds to sober up, albeit with espe­ cially harrowing footage and an unusually charismatic protagonist, often shown with a radiant smile on his handsom e face. In one scene, Ryan, in the m idst o f an o th er day o f drinking vodka straight o u t o f the bottle, vomits into the trash can next to his armchair as his distraught grandfather looks on. In another, he roils aro u n d the passenger seat while badgering the elderly m an to drive him to the liquor store.

“I apologize, you guys,” Ryan says to the camera crew in the backseat. W ith o u t a drink, “I can’t even focus o r th in k o r even understand anything.”

T h ese scenes o f crav in g an d self-ruin u n fo ld along th e idyllic shores o f R yan’s h o m e n ear Lake T ah o e , w ith a ch eerfu l, late-sp rin g alp in e lig h t d an c in g in th e p ines. D u rin g th e rare m o m e n ts o f relative calm , R y an ’s w arm th an d a loving, i f fraught, relatio n sh ip w ith his fam ily reveal som e­ o n e w ho m ig h t have a sh o t at kicking addiction.

This episode o f Drugged focused o n the medical

consequences o f alcoholism, so the British produc­ tion com pany, Pioneer Productions, followed Ryan until he entered a recovery program, which the com ­ pany arranged in exchange for his willingness to lay bare his inner turmoil. Ryan’s first stop was a Texas medical clinic, where he underw ent a comprehensive evaluation. After palpating his pancreas and liver, the doctor told Ryan th at parts o f his body were “scream­ ing and dying” as a result o f all the alcohol. T he hip he broke w hen he fell o ff his bike, drunk, while pedaling to the liquor store never healed, leaving him with a rolling limp and in constant pain. A t one p o in t Ryan h ad perm ission from a psychiatrist to alleviate his withdrawal with some vodka, which he knocked back with an orange soda chaser in the m en’s room . Then came the pivotal m om ent, a staple o f addiction reality shows: the interview when the psychiatrist asked if he was willing to go into rehab.

Ryan said he was terrified, b u t vow ed, “I w an t to am aze p eo p le, to let th e m know : I was gone, b u t here I am .”

The next day, Ryan arrived at Bay Recovery, a luxu­ rious San D iego center where treatm ent ran about $1,800 a day. In a baggy white T-shirt, sagging jeans,

H U N G O U T T O D R Y

and a blue bandanna, he earned his navy- blue duffel bag from a taxi to the front door o f his new residence, one o f several Bay Re­ covery houses in a neighborhood overlook­ ing M ission Bay and SeaW orld. His room was in a tree-shaded four-bedroom house, set back from the road.

Ryan looked at the ocean and the verdant lawn. “I m ight n o t w ant to leave,” he said. The frame froze o n his smiling face.

“Ryan to o k a courageous step,” the nar­ rator intoned. “But 17 days into rehab, he died. H e was only 28 years old.”

But things w eren’t quite th a t simple. A look at the government records surrounding Ryan’s case—and the rest o f the poorly regu­ lated rehab industry-suggests th at it m ight n o t have been just the drinking th at killed him: It was the treatment, as well.

The docum entary to u c h ed a ch o rd w ith viewers. “I’m sitting here just fucking devas­ tated,” one wrote o n Reddit after the film was posted on the site. “G ood G od, that was absolutely crushing,” another wrote. “I was rooting so hard for him .”

Ryan’s story is a very specific tale o f addic­ tion and loss. But it’s also a case study o f the fragmented, expensive, and poorly regulated rehab system. Desperate families struggle to find affordable treatment. Those w ho do all too often discover facilities subject to m ini­ mal standards, with regulators who do little to track w hat happens to patients o r to as­ sure th a t programs are following evidence- based best practices.

At the time o f Ryan’s death, California’s medical board had opened the latest o f four cases against Bay Recovery’s executive direc­ tor, D r. Jerry Rand. A m ong the concerns that they cited was the death o f another pa­ tient several years before. A nd yet the center had been allowed to stay in business, leav­ ing Rand responsible for Ryan and scores o f other vulnerable addicts.

O f America’s estimated 18.7 m illion al­ coholics, only 1.7 m illion—8.8 percent—are treated in specialized facilities, according to a 2012 report by C olum bia’s N ational C en­ ter o n Addiction and Substance Abuse. That five-year study reviewed m ore th an 7,000 publications, analyzed five national data­ sets, co nducted focus groups and surveys o f addicts and treatm ent professionals, and investigated how rehab centers are licensed. Its conclusion: “Despite the prevalence o f these conditions, the enorm ity o f the conse­

quences that result from them , and the avail­ ability o f effective solutions, screening and early intervention for risky substance use is rare, and the vast majority o f people in need o f treatm ent do no t receive anything th at ap­ proximates evidence-based care.” N ine o u t o f 10 people with alcohol o r drug addiction, it said, get n o treatm ent at all.

C o m p o u n d in g the p ro b lem is the fact th a t tre a tm e n t is o fte n n o t co v ered b y in s u ra n c e , b u t p a id o u t o f p o c k e t by a d d icts an d fam ilies. T ra d itio n ally , p ri­ vate insurance has covered 54 p ercen t o f A m ericans’ health care costs, b u t o nly 15 p e rc e n t o f a lco h o l a d d ictio n trea tm e n t. O b a m a c a re —w h ich requires m a n y gov­ ernm ent-subsidized health plans to cover trea tm e n t-stan d s to im prove matters, b u t quality o f care rem ains a serious problem . W hile residential treatm ent programs m ust be licensed at the state level, standards vary w idely. “For n o o th e r h ea lth c o n d itio n

A major study of the rehab industry

found that in many states,

clinics are barely regulated and

offer “unproven therapies” at

“astronomical prices.”

are such exem ptions from routine govern­ m e n ta l oversig h t co n sid ered acceptable practice,” the C o lu m b ia report concluded.

A great deal o f research supports m odem evidence-based approaches to addiction, often involving medically supervised w ith­ drawal, medication to help with withdrawal sym ptom s, sup p o rt groups, and cognitive behavioral therapy. But because there are no national standards, the C olum bia study notes, “patients face a patchw ork o f treat­ m e n t program s w ith vastly different ap­ proaches; m any offer u n proven therapies and litde medical supervision,” even at cen­ ters pushing “posh residential treatm ent at astronomical prices.”

Part o f the problem is th a t alcohol and drug abuse have been seen less as medical co n d itio n s th a n m oral failings requiring self-discipline, according to Scott Walters, a

University o f N o rth Texas psychologist w ho has studied addiction treatment. The model p o p u larized by A lcoholics A n o n y m o u s, though effective in m any cases, is n o t based o n m o d e rn science o r m edical research. O n e result are clinics staffed by “counsel­ ors” w ho in m any states are required to have only m inim al training in responding to the serious m edical problem s th a t addicts like Ryan often face.

“T h ere’s really n o quality co n tro l,” Dr. M ark W illen b rin g , a fo rm er d irecto r o f tre a tm e n t a n d recovery research a t th e N atio n al Institute o n A lcohol A buse and A lcoholism , to ld me. “T h e co n su m er is hard-pressed to know w hat’s w hat.”

Ryan’s mother, Genene Thomas, and his fa­ ther, Tim, m et w hen she was 16, he was 18, and they were bo th working at restaurants in the casinos th at line the southern shore o f Lake Tahoe. W h en she was 20, they married, and went o n to have four sons.

N ow 51, long divorced and rem arried, Genene welcomed me into the living room o f her cozy ranch house, filled with W estern memorabilia and sepia-toned photos o f her family wearing cowboy outfits. Genene has a tendency to smile when other people might cry. Some viewers o f the docum entary said she came across as cold, b u t she confesses th a t she just shuts dow n w hen confronted with overwhelming em otions. Since Ryan’s death, she’s filled stacks o f notebooks with thoughts about her son.

W h e n Ryan was growing up, the family m oved a do zen times, across the country: T ahoe to New Jersey, back to California, C o lo ra d o , an d even Hawaii. “Everyone w ould ask i f we were in the military,” she said. “But Tim was just resdess.”

H e was also dangerously unpredictable and seriously m entally ill: D iagnosed with paranoid schizophrenia, he drank and heard voices. Some days he organized scavenger hunts for his kids; others, he’d smack them around. O nce T im h it Genene for refusing to give him the bullets he w anted to use to co m m it suicide. W h e n Ryan was 10, Ge­ nene h ad had enough and took the children to live in a safe house. After about two years o f moving around, she took the boys to Las Vegas, where her parents lived.

Ryan grew into a cheerful teen, so skilled o n a skateboard th a t a local dealership of­ fered to sponsor him. Like m any kids in his high school, he drank an d experim ented

4 6 M O T H E R J O N E S I MAY/JUNE 2015

InNeed of a Fix: The grim state of the rehab industry — S a m a n th a M ic h a e ls

1 8 * 7 m illion A m ericans needed alcohol treatment in 2010.

million received it.

R easons a d d ic ts g iv e f o r n o t g e t t i n g h elp :

4 5 .5 % I C an ’t a ffo rd it /in a d e q u a t e h e a lth cov e rag e

W o rr ie d a b o u t t h e ir jo b

c w Clinics T h e re a r e 14,148 a d d ic tio n t r e a t m e n t fa c ilitie s

in A m e ric a . V e r y f e w in c lu d e in p a t ie n t services:

High Prices P o o r ^

8 1 % O u t p a t ie n t

R e s id e n tia l2 6 % ____

6 % ■ H o s p ita l in p a tie n t

o f t h e costs o f alcohol a d d ic tio n tre a tm e n t.

T h is is w h o ru n s t h e m :

Local g o v e r n m e n t

S t a t e g o v e r n m e n t

F e d e ra l g o v e r n m e n t

W h ile i t ’s possible t o g e t fre e t r e a t m e n t a t c h a ritie s like th e S alvatio n A rm y, a m o n th o f re s id e n tia l care can c o s t as li t t le as $ 1 ,8 0 0 a t a g o v e rn m e n t-s u b s id iz e d c e n te r an d up t o $ 6 0 , 0 0 0 a t th e k in d o f f a c ilit y t h a t h e lp s c e le b ritie s like Lindsay Lohan.

2 0 states req uire e ith e r no degree o r o n ly a high school d ip lo m a t o becom e a c e rtifie d a d d ic tio n counselor.

O n ly 10 states re q u ire re s id e n tia l t r e a tm e n t p r o g r a m s to h a v e a physician on s ta ff.

O n ly 8 s t a t e s r e q u ir e t h e sam e o f o u tp a tie n t tre a tm e n t program s.

O n ly 21 states req uire th e tra c k in g o f p a tie n t o u tc o m e s .

S o u rc e s : N a t io n a l C e n te r o n A d d ic t io n a n d S u b s ta n c e A b u s e , C o lu m b ia U n iv e r s ity ; S u b s ta n c e A b u s e a n d M e n t a l H e a lth S e rv ic e s A d m in is t r a t io n ; C e n te rs f o r D is e a s e C o n tr o l a n d P re v e n tio n

Cost to Society A lcohol a d d ic tio n costs

$230 billion each year. 1 percent ($28 b illio n ) o f to ta l he alth care costs in 2010 w e n t t o tre a tin g d ru g and alcohol a d d ic tio n .

For every d o lla rfe d e ra l and sta te go ve rn m e n ts spent,

95.6 cents w e n t t o pay fo r t h e consequences o f s u b stance use; o n ly 1.9 cents w e re s p e n t on any ty p e o f p re v e n tio n or tre a tm e n t.

N o t re a d y t o s to p using2 4 .5 %

| D o n ’t k n o w w h e r e t o go

N o t r a n s p o r ta tio n /in c o n v e n ie n c e

T r e a t m e n t b e d s p e r c a p ita

with marijuana. He even dabbled with meth, but it didn’t seem out o f control. W hen he was 19, his paternal grandparents asked if he wanted to live with them to help care for his grandmother, who’d always doted on him.

There, in South Lake Tahoe, Ryan met Shaken Miller, an outspoken 28-year-old single m other with a Bettie Page vibe. Her interests ranged from the British occult­ ist Aleister Crowley to ribald jokes, and it was love at first sight. “There was just something about Ryan,” she said. “Anyone

who met him loved him. He had this light to him I’d never seen before.” Shaleen’s two daughters adored him, and they would make up stories together. Soon Shaleen and Ryan were engaged.

But when Ryan’s grandm other passed away, he began drinking more heavily. A year and a half later, in 2008, his fath er- who had sobered up and reengaged in the lives o f his sons—died o f a blood clot at age 47. Ryan helped his grandfather clear out Tim ’s room in a Carson City hotel and

soon spiraled further out o f control. These two deaths marked a turning point in Ryan’s life. Genene grasped the scope o f the prob­ lem when she found him unconscious on his filthy bed, surrounded by more than 50 empty vodka bottles o f all shapes and sizes. She couldn’t wake him up.

In 2009, Ryan secured a free charity bed at a 30-day treatm ent program in South Lake Tahoe. He liked it, b u t once he re­ turned to his familiar surroundings, he started drinking again. (The National In-

M A V / J U N E 2015 | M O T H E R J O N E S 4 7

stitute on Alcohol Abuse and Alcoholism notes that 90 percent o f alcoholics will ex­ perience at least one relapse during their first four years o f sobriety.) Over the following two years, he was hospitalized several times for alcohol poisoning, including a stint last­ ing more than a month in intensive care.

In an attempt to jolt Ryan from his ad­ diction, Shaken broke off their engagement, but she remained determined to try to save him from himself. The average wait for sub­ sidized treatment was six months, she and Genene were told, and Ryan would have to call every morning until a spot opened up. This was what he had done to get into the South Lake Tahoe program, but now he was too far gone to pick up the phone.

Desperate, Genene talked to a police of­ ficer she knew, and learned that her best shot might be to get Ryan arrested to force him into treatment. It was reasonably well- founded advice: The 2012 Columbia report found that 44 percent of addicts in publicly funded treatm ent programs are referred by the criminal-justice system, but only 6 percent come in via health care providers. W hen Genene heard that Ryan had tried heroin, she called the police. But his grand­ father bailed him out, and the case stalled.

Then Shaken stumbled upon a Craigslist ad from Pioneer Productions, a London tele­ vision production company that was look­ ing for severe alcoholics willing to be filmed in return for free treatment. Shaken wrote an email and got a call the next day.

Pioneer declined to answer questions about the case, but Ryan’s family says the crew told them that they chose Bay Recov­ ery because the clinic treated chronic pain as well as addiction, making it a good fit for Ryan’s twin straggles with alcoholism and his damaged hip. The clinic’s website boast­ ed o f its association with reality television producers like Lifetime and A&E and of the “unequaled” care provided by its medical di­ rector, Jerry Rand. Genene never found out who covered the cost o f Ryan’s treatment.

S haken and one o f the Pioneer crew dropped Ryan off in San Diego. “I just lost it,” she told me. For two years, she’d been emotionally preparing for him to die. Now, she allowed herself to take heart.

“Hope can be a bastard,” she said.

Even as R yan arrived at Bay Recovery, Rand was fighting for his professional life. In 1988, when he was a general practitioner in H un­

tington Beach, the Orange C ounty Supe­ rior Court had temporarily ordered him to stop practicing. The case came about after a woman whose daughter he was treating for a possible ear infection bolted out o f Rand’s office and told a state medical board inves- tigator-who happened to be sitting in the waiting ro o m -th a t Rand was so impaired that his speech was slurred, his eyes were bloodshot, and he couldn’t even stand up straight. Though Rand sought treatment for his addiction to the pain pills he’d been prescribed after a back injury, the state medi­ cal board moved ahead and put his license on probation for seven years. By 1990, he had found work at a recovery center, and in 1992, he launched his own. By 2002, he was an associate director at Bay Recovery.

In 2003, Rand was barred from practic­ ing for 60 days and put on seven years’ pro­ bation for what the medical board deemed gross negligence and incom petent treat­ m ent o f a homeless patient. The board’s report does n ot detail what ended up hap­ pening to the patient, b ut in 2 0 0 9 -th e same year Rand became Bay Recovery’s ex­ ecutive director—the medical board moved to revoke his license entirely. This time, the accusations included gross negligence in treating a 29-year-old woman who drowned in the bathtub at Bay Recovery. Rand had engaged in “extreme polypharmacy,” the board alleged, prescribing drugs to m ul­ tiple patients with little regard for their in­ teractions. Bay Recovery’s operations were unaffected. The California Department o f Alcohol and Drag Programs (dadp) investi­ gated the drowning and ordered immedi­ ate steps to secure medications, but it did n ot issue any citations for 16 months.

W hat transpired at Bay Recovery is one example o f why the rehab regulatory sys­

C lo c k w is e f r o m le f t : R y a n , as a c h ild , in o n e o f his

m a n y h o m e s ; t e e n a g e R y a n h a p p y in Las V e g a s ; a d u lt

R ya n w i t h his o n e t i m e f ia n c e e , S h a le e n M il le r

tem is so often described as fragmented. dadp was responsible for licensing the facility, b u t it’s unclear w hether it knew ab o u t R an d ’s earlier p ro b atio n s. And while the medical board had charged that Rand was admitting patients who were too medically and psychologically unstable to be treated at his facility, dadp never ad­ dressed this issue while Ryan was alive.

In 2012, as a nonpartisan investigator for the California Senate, I wrote a report that exposed problems in drag and alcohol treatment facilities, including deaths that occurred when programs failed to monitor medically fragile clients or accepted addicts too sick to be in a nonmedical setting. My report found that dadp failed to pursue evi­ dence o f violations after deaths, and took as long as a year and a half to investigate the serious charges. At the time o f Ryan’s death, I had been asking the agency for several months why it was allowing Bay Recovery to continue treating clients. I also interviewed Rand about Bay Recovery’s troubles for my report, but he was dismissive. The woman who died had hoarded drags, he said, and had previously overdosed. He refused to talk about Ryan’s death. I was not able to reach him for this story.

R y an d id n o t have a cellphone with him, but he borrowed other residents’ phones to update Shaken. He told her that detox—the first 72 hours without a drink—was n ot as bad as he had feared. He said he was “eating

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like a pig,” putting on weight, and could not remember when he’d felt so well. He joked that he was having a tough time sitting in a hot tub overlooking the ocean. And he was making friends with staff and fellow patients. “Everybody loved him,” Kanika Swafford, a residential technician at Bay Recovery, told me. “He never felt sorry for himself. He nev­ er blamed anyone for the choices he made.”

O n May 30, 10 days after Ryan arrived, Rand started him on buprenorphine, or “bupe,” which is often used to treat opiate addicts and may also help those who suffer from chronic pain. But it is not for everyone, and it came on top o f a whole cocktail of other medications.

The day after starting on bupe, Ryan be­ gan to feel sick, according to a later report by the San Diego medical examiner, and in the following days he rapidly deteriorated. Sweaty and disoriented, he now could not hold a conversation. He urinated on the floor and tried to set things on fire. He grabbed at objects that were out o f reach and tried to light a nonexistent cigarette. He told a staff member, “Thank you for the sandwiches; my ride is here.” One resident filed a complaint to Bay Recovery’s manage­ ment, stating that Ryan was “hallucinating, talking to himself, stumbling about and al­ most falling down the stairs” and had turned a “gray-white color.” A residential technician told a counselor and one o f the managers that Ryan needed medical attention.

The evening o f June 5, a 20-year-old m edical assistant nam ed Giselle Jones heard banging from Ryan’s bedroom and found him on the floor o f his closet, dig­ ging frantically through his things. She and a resident named Robert tried to put him back in bed, but he kept falling out, get­ ting so agitated that he tried to crawl out a window. Jones tried to reach Rand and his brother Mitch, who was a manager o f Bay Recovery, several times.

W hen Rand finally responded to the call, he prescribed more Ativan, an anti-anxiety medication, and Risperdal, an antipsychot­ ic. Jones hesitated. The charts noted he’d already had two prior doses o f both drags earlier that evening. Was Rand certain she should give Ryan more? Even after he said yes, she called her manager, who told her to follow the doctor’s orders. She did, and 20 minutes later Ryan became listless. Jones tried to get him into bed, but every time she managed to move him, he collapsed. She

watched as Ryan’s breathing became more labored. His pulse stopped for five minutes. Jones tried to reach Rand again, but there was no answer. Then she called her manag­ er. Finally, at 3 a.m., she called 911. Robert, the other patient, performed cpr on Ryan. They waited for an ambulance.

At 3:40 a.m., Ryan was pronounced dead.

L a te r t h a t m o r n in g , Shaleen tried to text Ryan via one o f the other residents’ phones and eventually she got a response: “I’ll have the director call you back.” She left more messages, one more urgent than the next. She finally got a call back. “I could get in trouble if they knew I had contacted you,” the person said. “But we all loved Ryan so much.”

“I heard ‘loved’ and I just collapsed,” Shaleen said. She dropped the phone. Soon after, a police officer, whom authorities in San Diego had asked to contact the family, appeared at Genene’s door.

The San Diego medical examiner found that Ryan had died o f acute respiratory distress syndrome, in which damage to the lungs prevents oxygen from reaching the blood. The deterioration apparently began around the time Rand started him on bupe, which—along with some o f the other medi­ cations he’d prescribed Ryan—can depress breathing. While the evidence was not con­ clusive, “the suggestion is somehow that the treatment played a role in the development o f the condition,” Dr. Jonathan Lucas, who certified the cause o f death, told me.

Twenty days after Ryan’s death, officials from the D rag Enforcement Administra­ tion, the medical board, and the state licens­ ing agency raided Bay Recovery and Rand’s home. They had already found that Rand had had employees illegally call in prescrip­ tions for him under the name o f another doctor. The state suspended Bay Recovery’s licenses in July 2012.

O n September 6, 2012, the California medical board ordered Rand to surrender his medical license and “lose all rights and privileges as a Physician and Surgeon in C alifornia.” Police investigated Ryan’s death, and while no charges were filed against Rand, the state did find Bay Re­ covery “deficient” for failing to get Ryan to a hospital. Residents told state inves­ tigators that Rand excessively prescribed drugs with little regard for their interac­ tions. O ne patient said he hadn’t been on

any medications when he arrived, but now was taking at least 10. The state finally re­ voked Bay Recovery’s licenses and closed the facility in late 2012.

Pioneer Productions sent flowers and paid to have Ryan’s body cremated. It also gave Genene $1,020—money it had raised to help pay for Ryan to get his hip replaced. Pioneer wanted to arrange a memorial service, and a few weeks later family and friends gathered at Monitor Pass, an open slope south o f Lake Tahoe with a dizzying view o f Nevada’s ba­ sins and ranges, to scatter Ryan’s ashes. The crew filmed one last scene.

About a m onth after the memorial ser­ vice, Pioneer told Genene that the company was sending someone from London to show her the film. A lawyer appeared a few days later and left Genene alone to watch the doc­ umentary on his laptop. She did-twice. The lawyer returned with a form for her to sign that stated she had seen the film and wanted it to ran. Genene, feeling strong-armed so soon after losing her son, refused, but when the lawyer called from London a few days later to say that Pioneer had decided not to air the film on the National Geographic Channel, she was heartbroken. Genene and Ryan’s other relatives and friends saw the documentary as his legacy.

Eventually, things were resolved and Ryan’s documentary aired. Many viewers re­ sponded, expressing grief as well as concern. “I find this very strange, folks,” one posted online comment said. “The danger zone for any addict is the first 5 days at most. 17 days in he should have been feeling great and refreshed...I don’t think this documentary is telling the honest truth about what really happened to poor Ryan.”

To this day, Shaleen still gets Facebook messages from all over the world, and the shared grief has helped her cope. “That’s just an amazing thing to be able to hold on to,” she said. “Knowing his story made it out there. It gave some kind o f purpose to it.”

But Genene continues to write in her notebooks the questions that plague her. Did Pioneer really want to help Ryan, or was it just about ratings? How could the state have allowed Bay Recovery to stay open after the death in the bathtub and the medi­ cal board’s case against Rand? Someone was bound to die there, she believes: “If it wasn’t Ryan, it would have been somebody else. And my son had to pay the ultimate price for trying to do the right thing.” ■

M A Y / J U N E 2015 | M O T H E R J O N E S 49

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