People who want treatment for their addictions in Santa Clara County often have to wait for the help they need—or resort to an emergency room.
A new audit of the county Department of Alcohol and Drug Services (DADS) shows that people calling into a hotline for substance use and mental health problems will spend up to six hours on hold. Those looking for a detox bed will wait 12 days on average—not for a lack of space, but because of the way the county reserves beds for patients who don’t use them right away.
This means people who need immediate help may turn to emergency rooms—a quick, exorbitant fix for a chronic problem. In 2011, more than 5.1 million people in the US were admitted to emergency rooms for drug-related causes, in lieu of rehab.
The report by Harvey M. Rose Associates, an auditing firm hired by the county, also made recommendations that could save taxpayers $1.2 million a year.
Perhaps the biggest issue, because it marks the front line for people who need help, is the call center. Of the eight people who work for the Gateway Call Center, only four to five field more than 50,000 calls a year. But so many employees don’t show up to work that it compromises countless calls, inflating wait times and prompting more than 25 percent of callers to just hang up.
“In addition to its very limited staff, the division has an absenteeism rate that is nearly double the department’s overall … rate,” the audit states. “In FY 2012-13, eight full-time-equivalent staff used 222 leave days, including sick, personal and unpaid leave. The vast majority of these days were used by four of the eight staff.”
The audit suggests checking staff morale to find out why so many people aren’t coming in to work when they should.
In terms of public access, the beds presented another huge problem. Because of bureaucratic rules around how the county reserves spots for people detoxing from drugs and alcohol, it spends around $358,000 a year for empty beds.
Despite 12-day-long wait lists for a spot at a county detox clinic, an average of 14 beds a day remained empty. That’s because of a department policy that requires providers to reserve them for clients who may not come until days later. The county pays a flat rate for bed space, not matter how much use its gets. Annually, that amounts to $24,467 per residential bed and $44,305 per detox bed, or more than $6.1 million annually for 237 beds.
The audit says the county should come up with a new way to contract bed space that bases payments on actual use. It should also improve coordination with these clinics and require patients to report in for detox within 24 hours of doctor’s orders—72 hours for people coming out of jail who need more time to pick up their meds and reach the clinic.
The department could also see $704,000 a year in savings if it closed its adult outpatient clinic and outsourced the service. The county clinic costs seven times more than those run by subcontractors. Contracting out the youth and perinatal clinic would save even more, the audit says, and should be considered. DADS Director Bruce Copley disagreed with this finding, arguing that the county services cost more because of its justifiably more generous salaries.
Outside contractors provide many of the agency’s services, the audit says, but have little oversight, which means the county has no consistent way to tell if they’ve met their commitments. The department administers $17.4 million a year in contracts to 25 organizations, but fails to measure outcomes.
“The lack of tracking outcome measures prevents the Department from assessing, over time, how the provided services are meeting the needs of individuals and the community,” the audit says. “Inability to assess the effectiveness of programs means that funds may be expended on ineffective programs.”
The department isn’t able to assess the effectiveness of the 180 employees on staff, either. The audit says employees don’t have to undergo regular performance reviews, which leaves management with little idea of how well its staffers are living up to their obligations.
Another program proven inefficient by auditors is the department’s Children, Family and Community Services Division, which treats substance-addicted youth. It lacks policies and procedures, a website and uniform workloads for its caseworkers.
Copley agreed with the audit, for the most part. The report is expected to come up for review at a Board of Supervisors meeting in the next month.