The Problem: ‘A Big Waiting Game’

PHOTO BY BRIANNA SPAUSE
An unknown woman sits on the steps of Girard Medical Center, located at 8th Street and Girard Avenue. Girard Medical Center, which is owned by the North Philadelphia Health System, provides mental health and substance use treatment. 

CHAPTER I: On the inside

Girard Medical Center is decorated on the outside. 

The center, which is on the corner of 8th Street and Girard Avenue, provides mental health and substance use treatment, including detoxification and residential services.

A colorful mural is painted on one side of the building, featuring a collage of smiling faces and sceneries. The mural’s name? “A Journey to Resilience.”

Perhaps resilience was the most important attribute for individuals who sought treatment at Girard Medical Center’s behavioral assessment center (BAC) before it closed last fall.

In the city, BACs are a point of entry for individuals seeking treatment for mental health and substance use disorder. When patients visit a BAC, they are assessed by workers from the BAC, who then reach out to Community Behavioral Health (CBH), which can either approve or reject patients for treatment. As a part of the city’s Department of Behavioral Health and Intellectual disAbility Services (DBHIDS), CBH authorizes care for patients on Medicaid.

When the BAC at 8th and Girard closed, it left only two facilities designated as BACs open in Philadelphia. This lack of resources leads to overcrowding and long wait times for patients seeking treatment.

“It’s really just a big waiting game, but they have to stick it out if they want treatment,” said Tyler Hurst, a Philadelphia social worker who is in long-term recovery.

According to a former employee of several addiction treatment facilities who would like to remain anonymous but has knowledge of GMC, waiting room deaths were not uncommon at the center at 8th and Girard.

Wait times for treatment in Philadelphia are often long, and in many cases patients are in active withdrawal or on the cusp of overdose. The nature of medical care dictates that sometimes — against the best efforts of medical professionals — people will die.

But something uncommon happened late last year: a man who was approved for treatment by CBH died while withdrawing from alcohol inside the BAC at 8th and Girard, Hurst said.

“They never moved that client,” the anonymous source confirmed. “They got the authorization, but never moved him into a detox bed. They let him stay in one of the beds in the BAC, and he ended up dying overnight.”

While Roland Lamb, the deputy commissioner of DBHIDS, said he couldn’t confirm the patient was authorized for care by CBH, he said the BAC was responsible for the patient’s care at the time of his death.

CBH’s Chief Medical Officer Dr. Geoffrey Neimark also confirmed that the patient died, but said he can’t “give the particulars from any case.”

Laura Jones is the senior vice president of behavioral health at North Philadelphia Health System (NPHS) — the agency that oversees GMC. She said she could not confirm or deny that a patient died at the BAC because she is not authorized to speak on individual patient care.

So was this man’s death preventable? Neimark said when a patient is withdrawing from alcohol, they are typically given medication to prevent further complications — the most serious being death.

The anonymous source said they aren’t sure exactly why the man never received treatment, but they have their theories: perhaps the BAC staff thought a bed was about to open up, but it never did. Perhaps when the BAC staff approached the man to move him to treatment, he had fallen asleep.

“What I do know is that once [patients] get to the detox unit, they’re monitored 24/7, especially because he was in there for alcohol,” the anonymous source said. “But in the BAC, they’re just kind of there in beds waiting, so there’s not a lot of medical attention.”

CHAPTER II: Understaffed and overworked

In a city with more than 1.5 million permanent residents, there are seven total crisis response centers (CRCs) and BACs where people can access referrals for addiction treatment. This lack of resources forces people seeking recovery to spend hours — sometimes days — waiting to be assessed.

“I’m a person who’s in long-term recovery, so I’m able to look at this from a perspective of what it would be like for a person who wants to get help and feels like they can’t,” Hurst said. “It takes me a minute to get high. Why would I wait days?”

Hurst interns at a CRC — a type of facility that is open 24/7 to treat people experiencing emergency behavioral health crises. He said many of the patients who would’ve sought treatment at the BAC on 8th and Girard are now using CRCs.

“All the CRCs are overworked,” Hurst added. “They don’t have enough staff. They have more than enough patients in a very small area that are all going through crisis.”

“If you don’t have a BAC, you’re going to see an increase in services to other providers,” Lamb said.

Since the closed BAC was part of the larger GMC health campus, Lamb said it was “connected” to other medical services, like detox and a methadone clinic.

“We are very much concerned about the need for services in that area of the city and the continuity of care,” Lamb added. “We don’t have a facility that has comprehensive … services. We’re going to have to figure out ways to accommodate that.”

Lamb said DBHIDS is planning to open a “stabilization center” this summer. He said the details of the center, like cost, treatment and location, haven’t yet been nailed down. He could not elaborate on whether the stabilization center would be assessed differently than the closed BAC.

So how are GMC’s services — such as those that were provided at the closed BAC — assessed? According to Jones, NPHS uses patient satisfaction surveys every month to evaluate GMC’s services. She added that the city has a consumer satisfaction team that visits GMC to interview patients and measure quality of care.

CBH also monitors all of the centers regularly, Neimark said. He added that CBH’s qualitative assessments of GMC are for internal review and not public information.

“I think it’s imperative we have good services readily available and that they’re evidence-based and that they’re high quality and that the DBHIDS, including CBH, are really committed to making sure that that’s the case,” Neimark said.

 

CHAPTER III: Finding peace

On New Year’s Eve in 2008, Michael Worthy reached the end of the road. For him, that was at Temple University Hospital’s Episcopal Campus — which has a BAC and CRC on site. He had walked more than a mile from his home on 11th and Cumberland streets to reach the hospital on Lehigh Avenue near B Street, where he would first access treatment for his substance use disorder. He used drugs the whole way there.

When he arrived, there were too many people waiting for medical care and too few beds.

“Since it was a holiday weekend, and plus there was a whole lot of other people, I had to lay on the floor in intake … for a day and a half before they could find me a bed,” Worthy said.

Worthy has remained sober since Jan. 2, 2009, but for others in Philadelphia, the crowding of resources — or the complete lack thereof — can be more challenging to overcome. Lamb reported more than 900 fatal overdoses in the city in 2016. That marked a 30 percent increase from the year before.

Over the course of five days in December 2016, 35 people died from opioid overdoses. On one day that same month, 12 fatal overdoses were reported to the Philadelphia Medical Examiner’s Office — the most ever recorded in one day in the city. These fatalities were concentrated in North Philadelphia and Kensington.

As overdose deaths surge in Philadelphia, resources remain limited. In January 2017, NPHS filed for bankruptcy. The NPHS-owned St. Joseph’s Hospital closed in March 2016 — a symptom of the system’s financial troubles.

Hurst added that it’s common knowledge among behavioral health professionals that there is a lack of resources for treatment, and the problem extends beyond Philadelphia.

The Substance Abuse and Mental Health Services Administration’s most recent National Survey on Drug Use and Health reported that 22.7 million Americans needed treatment for a problem related to substance use in 2013. Of those who needed treatment, about 11 percent received it.

Devin Reaves, a social worker who specializes in behavioral health disorders and recovery, thinks addiction is a social justice issue. He wants to tear down the proverbial “fence” blocking the less fortunate from treatment for their substance use disorders.

“If you have access to resources, if you have access to things like treatment, money to afford a lawyer, you’re not going to go to jail when you get arrested for having heroin,” said Reaves, a person in long-term recovery. “But if you are a poor, young Black man from North Philadelphia … it’s a really big problem.”

Although there’s a city-wide lack of resources, individuals like Worthy are still making on-the-ground efforts to help people enter and maintain recovery.

Worthy founded his own Christian 12-step fellowship out of the Greater Church of Philadelphia in Kensington, where he attended his first 12-step meeting more than eight years ago.

He currently sponsors five people. In his spare time, he practices the bass three days a week in the church. He said he “lost his skill” during his addiction, but since he entered recovery, he now plays in the church’s band every Friday night.

“I’m at peace,” Worthy said. “I am finally at complete peace with myself.”