Nation

Behind the luxury: Turmoil and shoddy care inside five-star addiction treatment centers

The Recovery Centers of America’s facility in Danvers.
Keith Bedford/Globe Staff
The Recovery Centers of America facility in Danvers.

The advertisements are everywhere. On television, a sleek black sedan pulls up to a sprawling estate with a rolling green lawn as a mother recounts how Recovery Centers of America saved her child from drugs. On Facebook, radio, highway billboards, and commuter trains, people are urged to call the company’s instantly memorable hot line: 1-800-RECOVERY.

The marketing blitz and an infusion of private equity money have helped make Recovery Centers of America into the self-described fastest-growing addiction treatment provider in the country. Launched less than three years ago by a high-end real estate developer, it’s part of a rush of entrepreneurs who see opportunity in the treatment business as the opioid crisis sweeps the country.

But an investigation by STAT and The Boston Globe has uncovered evidence of shoddy care and turmoil inside the walls of the company’s two Massachusetts treatment centers. This report is based on interviews with more than a dozen former and current employees, internal RCA documents, and state investigative reports — depicting a company that spends lavishly on facilities and marketing while skimping on giving patients basic care.

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At a company that promotes itself as the new frontier of addiction treatment and charges an average of $24,000 a month, some patients were not getting basic counseling. They were often unsupervised. The staff has complained repeatedly to management and the state that they weren’t able to keep the patients safe. And patients were found to be having sex.

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RCA operates luxury residential and outpatient facilities in five Northeastern states, featuring original artwork, custom furniture, and manicured gardens. In Massachusetts alone, the company has spent nearly $50 million to buy and renovate a country inn in the rolling hills of Westminster and the former Hunt Hospital in Danvers.

“RCA is 100 percent committed to our patients and their paths to recovery,” according to a statement from the company. “At the very core of our facilities and mission is a steadfast dedication to the highest standards and regulations, and the care and safety of every individual we treat and employ.”

In Westminster, patients sleep on Serta Prestige Suite II Pillow Top mattresses selected after company executives tested more than 30 brands. Each day, fresh linens are carefully folded and placed on the end of patient beds. Every room has a flat-screen television and private bathroom.

But when state regulators inspected the facility in February, they found that essential services like individual counseling and group therapy sessions were not regularly being provided, worker training was lacking, the facility was understaffed, and patients were not properly supervised.

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One staff member complained to the state that patients were trading their medications for financial and physical favors. Staff members grew so incensed about conditions inside the facility that one wrote an inflammatory e-mail to management.

“Our patient to staff ratio is exhausting for us and nontherapeutic for the patients,” wrote one employee in a January e-mail to management at Westminster obtained by STAT and the Globe. “The patients who should in no way even still be with us are taking advantage of our lack of staff by turning us into a drug hotel and brothel rather than a recovery center and the ones who are with us to make an attempt at meaningful recovery are feeling ignored, stressed, and unprepared for after their stay.”

The state report did not indicate that investigators found drugs inside the facility. In a statement, RCA said of the e-mail, “We will not respond to accusations that are unfounded.”

RCA also said it conducted its own investigation and determined the state findings of staff shortages and lack of programming were wrong, and that, in fact, RCA had more staffing and treatment services than required. The records that the state viewed were incomplete, RCA said.

At Danvers, which state investigators visited once in May and again in July, the state found an understaffed facility where patients wandered freely, taking the elevators to the roof and other floors to smoke and have sex — and where RCA consistently failed to notify the state about incidents within the facility. In one case, according to a police report attached to the state complaint, a patient drank hand sanitizer — which contains alcohol — and RCA staff attempted to wave off an ambulance called for him.

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The company said it prohibits sex between patients. Regarding the finding that patients were allowed to walk freely within the building, RCA said that “patient freedom is beneficial to patients’ recovery,” because it prepares them for responsible life in the “real world.” However, the company said it did add staff to comply with the state’s concerns about staffing. RCA declined to comment on the patient who drank hand sanitizer, citing privacy.

On Friday night, hours after the Globe and STAT published this story on their websites, the state Department of Public Health shut down admissions to the Danvers RCA facility, citing “concerns regarding patient care and safety.” The action was prompted by the Aug. 18 death of a patient, the second such incident this year.

Earlier, in response to questions from STAT and the Globe, state regulators said in a statement that they found “troubling lapses in the company’s policies and procedures” and have yet to issue full operating licenses to the two Massachusetts centers. The state is currently investigating the deaths of two Danvers patients, one in February and one this month. RCA also operates in New Jersey, Maryland, Delaware, and Pennsylvania.

***

A guest room at the Recovery Center of America's facility in Danvers.
Keith Bedford/Globe Staff
A guest room at the Recovery Centers of America facility in Danvers.

One patient in particular concerned staff: Charles, a 47-year-old from Georgia who sought treatment first in Westminster and then in Danvers. STAT and the Globe are identifying him using only his middle name at his family’s request. RCA said it could not discuss his care because of patient privacy laws.

Charles’s care was overseen directly by the facility’s medical director, John Halpern — a doctor with a sterling resume, but a past that includes a role in allegedly helping to launder money for a massive LSD-trafficking operation. He was never charged in the case.

A relative of Charles said he was placed at RCA because “in an under-addressed epidemic, we were fortunate to find RCA to help in a unique situation.”

But workers repeatedly raised concerns about Charles’s treatment to the company and the state, according to state reports.

“At times it was observed that he was nodding out and appeared over-medicated,” wrote one fired staff member in a letter to the state on Feb. 15. “We were told that he and his family had an endless supply of money and we were to do whatever we had to to keep him in the facility.”

By then, Charles had been moved to Danvers. Seven days later, he was dead.

***

When state investigators showed up to inspect Westminster last February, one employee who had repeatedly complained about conditions there was told by management to “hide,” according to a state complaint.

In a message exchange cited in a lawsuit against RCA, the employee texted a manager on the second day of the state’s review, asking why.

“hahaha,” came the response. “bc what we do isn’t legal.”

The February inspection was one of three by the Massachusetts Department of Public Health conducted at Westminster and Danvers this year — all finding that RCA has failed to meet basic requirements. Westminster opened in October with 48 beds, and Danvers, called the Boston Center for Addiction Treatment, opened in January and now has 72 beds. Both are in the midst of expansions.

Detailed letters from staff members contained in two of the state files show employees who are by turns disgusted, angry, and anguished over the care their patients are receiving.

“I felt as though there was good to be done here and that we would be helping those truly in need. This was obviously my naivety taking over,” wrote one former Westminster staff member. “Many of the practices and decisions I have seen implemented at RCA has been motivated by, no surprise here, MONEY.”

Short-staffing meant that employees couldn’t properly watch patients, staffers wrote, and some patients rarely saw their therapists. The state found that RCA had one case manager and two therapists or counselors providing services for both detox and its longer-term inpatient unit.

Three people said they had been fired after raising red flags to management about conditions inside the facility, though the state did not address the alleged firings in its final report.

“Talk too much or know too much and termination is imminent and swift,” wrote one employee to state inspectors, adding they were fired after reporting “many, many” infractions to management.

RCA denied the allegations contained in the employee letters, calling the writers “a limited number of disgruntled employees who acted in a coordinated manner by writing letters of accusation to [the state] within the same 24 hour period.”

Payroll records and surveillance video showed the facility was not understaffed and that services were provided, RCA said. The company disputed the allegation that an employee was told to “hide,” saying that in fact she was invited to meet with state inspectors and declined. RCA did not offer an explanation for the text message. The state did not address whether employees were told to hide.

Danvers, MA - 8/10/2017 - Paintings of celebrities with alleged addictions hang in the lobby at the Recovery Center for America's facility in Danvers, MA, August 10, 2017. (Keith Bedford/Globe Staff)
Keith Bedford/Globe Staff
Paintings of celebrities who struggled with addiction hang in the lobby in Danvers.

In Danvers, an employee who was dismissed in July wrote to the state with a detailed list of safety concerns, including that staff would be absent “for several hours” at a time; that responses to patient emergencies were slow; and that patients “routinely” drank Purell hand sanitizer from the nurses station.

On June 27, the employee wrote, a patient who was stumbling and smelled of alcohol confessed to drinking Purell. Nursing staff called 911, but according to a police report, someone canceled the ambulance. Police arrived and recalled the ambulance and described the patient as “intoxicated and belligerent,” according to the police report.

RCA said in a statement about the second Danvers investigation simply that it was closed, and declined to comment on the Purell allegations, citing patient privacy.

RCA boasts that it is “transforming the way treatment is delivered in an industry in desperate need of change.”

There is no single treatment standard for drug addiction, and regulations on acceptable staff and patient ratios vary from state to state. Among the dozens of treatment approaches are abstinence-only, 12-step programs; cognitive behavioral therapy; and medication-assisted therapies like methadone and Suboxone. Some centers use a combination of approaches. Facilities can seek voluntary national accreditation offered by two private companies, but only about half do so.

The Westminster facility is accredited, and Danvers is seeking accreditation. Specific staffing ratios the state found at the two facilities were not included in the state reports.

In a statement, a spokesman for the Department of Public Health said the agency “has investigated complaints from former employees of Recovery Centers of America (RCA) about staffing, safety and the care delivered at RCA’s facilities in Westminster and Danvers. We validated many of those concerns and found troubling lapses in the company’s policies and procedures designed to ensure that patients are safely assessed, treated and monitored during their program of care.”

The company has made improvements, state officials said, but is being closely monitored.

***

Internal RCA e-mails obtained by STAT and the Globe detail complaints from patients about poor care in Westminster.

“I chose RCA Westminster because of the holistic approach that is stressed on the website. I knew that farm-to-table dining, equine therapy, acupuncture, martial arts, yoga, massage therapy, and state of the art exercise equipment as well as a spiritual atmosphere would help me begin my recovery,” wrote one patient in an e-mail in January. “There are no horses, acupuncture, martial arts, or sufficient exercise equipment and I’m not sure if Sysco food deliveries really count as ‘farm-to-table.’”

Westminster, MA - 8/10/2017 - The massage room at the Recovery Center for America's facility in Westminster, MA, August 10, 2017. (Keith Bedford/Globe Staff)
Keith Bedford/Globe Staff
The massage room at the Recovery Centers of America's facility in Westminster.

The patient said that during her six-day stay, she met only once with her therapist and twice with her case manager, and no meeting lasted more than 15 minutes.

RCA said it offers “patients double the amount of counseling then is required by the state” and that patient satisfaction at its facilities is high. As for the promised programs that were never offered, such as equine therapy, RCA blamed that on a failure to update the facility’s website. The company said it does offer farm-to-table food through a vendor.

In March, Westminster’s former quality assurance manager filed a wrongful termination lawsuit in Worcester Superior Court, which echoed the complaints of many other Westminster employees about inadequate staffing and patient safety. Nabil Georges alleged that RCA Westminster falsified state documents, operated a facility where patients had sex, did drugs, and went without therapy, and where employees — including himself — were fired for complaining.

In August, after STAT and the Globe had begun investigating RCA, the company sued Georges in federal court in Pennsylvania. The lawsuit seeks to bar Georges from divulging “confidential information” relating to his employment at RCA to the press.

“Mr. Georges has come forward with these complaints and taken great personal risk to protect future patients at these facilities,” said Georges’s attorney, John T. Martin.

“These are the perfect victims, because when they are in addiction treatment, they usually have criminal histories, they usually have a history of relapse, and when they claim that nobody helped them, no one believes them.”

RCA said the allegations contained in Georges’s complaint were “without merit.”

For all the difficulties, there are those who credit RCA with saving their lives, and the company has energetically promoted those successes stories. RCA cites its internal data showing that 70 percent of RCA’s patients are still off drugs a month after their discharge. The company also provided STAT and the Globe with scores of written testimonials from employees, patients, and other treatment specialists that provide examples of success stories at RCA.

The company has highlighted the case of Jason Amaral, 31, who was featured in a CBS News series that tracked his recovery from addiction at an RCA facility. In the opening scenes filmed last spring, Amaral was haggard and using heroin in Boston City Hall. Now, off drugs for 19 months, he works at the Danvers facility, where he met reporters in the lobby during a recent tour arranged for STAT and the Globe.

“The big thing is, I’m happy, clean, not miserable,” he said.

As reporters toured Westminster with RCA executives, a patient rushed into the hallway.

“I want to tell you, when I walked in the door 30 days ago, I was literally a shadow,” the man said. “Whatever you’ve done, you’ve done a great job.”

***

The opulence of the Recovery Centers of America would not surprise anyone who has followed the career of its creator: J. Brian O’Neill.

His early success in commercial real estate allowed him to buy luxury yachts, a private jet, and homes across the country. He once gave a ride to the Dalai Lama on his airplane. He purchased a country club and mansion in Newport, R.I., and became a fixture on the social scene in that summer resort.

O’Neill said in an interview that one motivation for him to enter the drug treatment business was his frustration with the lack of quality treatment centers. His only experience with addiction treatment was personal: He had helped friends get clean, he said, and conducted interventions.

The idea to open his own treatment centers came to him after the financial crisis of 2008 — a crisis that he said “creamed” the real estate business, including his own. His Philadelphia-based company, O’Neill Properties Group, was “in horrible shape,” he said.

Owner J. Brian O'Neill stood at a nurses station at the Recovery Centers for America's facility in Westminster.
Keith Bedford/Globe Staff
Owner J. Brian O'Neill stood at a nurses station at the Recovery Centers of America facility in Westminster.

It was a humbling time for O’Neill, a high-school dropout who made a fortune developing high-end residential, retail, and office properties. As he dug his way out financially, O’Neill became involved in a successful effort to have 17 Catholic high schools in Philadelphia – four of which were slated for closure – managed by a private foundation. The endeavor brought him to tears as he recounted it in a recent interview.

Then, he set his sights on the world of addiction treatment.

He took two years to create a 400-page business plan for what would become RCA. He found a deep-pocketed financial partner in New York City investment firm Deerfield Management Company, which has committed $331.5 million to help RCA develop its treatment centers. A spokesman from Deerfield declined to comment.

RCA is one of several well-funded, for-profit players expanding into the addiction treatment business. One competitor, American Addictions Centers, went public in 2014 and Deerfield is a major investor. Addiction treatment provider Summit Behavioral Healthcare has partnered with private equity firm Flexpoint Ford LLC “to accelerate its strategic growth.”

In getting RCA off the ground, O’Neill did what he knows best: He snapped up a former estate, a country resort, and health care facilities in New Jersey, Maryland, Massachusetts, and Pennsylvania, sinking tens of millions of dollars into renovations.

The facilities are designed to create a luxury resort ambience. Fruit-infused water is set out in the lobbies. RCA’s Maryland facility, which is featured in its television ads, is a 24,000-square-foot replica of an English country house on 557 acres of land that rolls up to tributaries of the Chesapeake Bay. Patients in need of transportation are shuttled around in Mercedes-Benz 550 series sedans by full-time drivers.

“We are a big believer in creature comforts,” O’Neill said during an interview at his company headquarters in King of Prussia, Pa.

Westminster, MA - 8/10/2017 - The pool at the Recovery Center for America's facility in Westminster, MA, August 10, 2017. (Keith Bedford/Globe Staff)
Keith Bedford/Globe Staff
The pool at the facility in Westminster.

As he led a tour of RCA’s Danvers facility earlier this month, O’Neill complained about the quality of the coffee and a railing in need of paint, and promised to dispatch a longtime employee to fix things.

RCA’s focus on five-star amenities is matched by an aggressive marketing operation that features ubiquitous television ads where it operates. The company spent nearly $2 million on television spots last year and is on pace to double that amount this year, according to Kantar Media, an independent company that monitors media buys.

O’Neill’s real estate company offices have been largely taken over by RCA. On one floor is a call center — named the “Mission Center” — that takes 13,000 calls a month through the heavily promoted 1-800-RECOVERY number.

RCA ends up referring many callers to competitors, O’Neill said, because its own beds are often full — one reason he is aggressively pushing to expand. This month, he opened a center in suburban Philadelphia that he said will be the largest facility of its kind in the country, with up to 280 beds.

O’Neill’s goal is ambitious: to treat 1 million people in the next decade. When asked how he came up with that number, he said the initial figure was 50,000 but that was not “bold enough.” He then compared his efforts to those of Michael Milken, a symbol of 1980s Wall Street excesses nicknamed “The Junk Bond King,” who subsequently helped raise hundreds of millions of dollars to find new treatments for prostate cancer.

“We are going to take a king-sized bat to this industry and change the way addiction is treated in this country,” he said.

***

Belmont 4/13/06 A portrait of Dr. John Halpern(cq) at McLean Hospital, on Friday, April 13, 2006 Belmont MA. Dr. Halpern is a lead researcher in a study giving advanced cancer patients the drug Ecstacy to help with their anxieties.(Dominic Chavez/Globe Staff) section: Health/Science slug: 16ecstacy reporter: Scott E. Allen Library Tag 05152006 Health/Science
Dominic Chavez/Globe Staff
Dr. John Halpern at McLean Hospital in Belmont in 2006.

One of the medical professionals O’Neill brought in to carry out his vision is Dr. John Halpern, a psychiatrist who allegedly played a key role in helping an LSD trafficker launder money in Russia.

It was Halpern who supervised the care of Charles, the patient from Georgia who died in February.

Last year, Halpern was hired by RCA to be the medical director at its Westminster facility. After the larger Danvers facility opened in January, Halpern left Westminster for the same job there.

For most of his career, Halpern was a researcher at the highly regarded, Harvard-affiliated McLean Hospital, studying the effects and potential medicinal value of hallucinogenic drugs. He has received awards and grants, published extensively, invented treatments for headaches, and testifies as an expert witness regarding hallucinogenic drugs.

He shifted his focus to clinical care more recently.

On the RCA website, Halpern’s Harvard and McLean pedigrees are highlighted. But grand jury records buried in federal court filings in California and Kansas reveal the doctor’s alleged role in laundering money for what the US Drug Enforcement Agency in 2003 said was the largest LSD laboratory ever seized by the agency.

Halpern was never charged in the case. He did testify about his role to a grand jury in 2004 and a DEA agent called him a “co-conspirator” in court proceedings.

The LSD lab was operated out of an abandoned missile silo in Kansas by two men, one of them named William Leonard Pickard. Halpern testified he met Pickard in 1995 through a mutual acquaintance. Both men were studying at Harvard at the time.

The bond between the men became stronger following a strange encounter in New Mexico. Halpern testified that he ingested a combination of plants that mimic the effects of ayahuasca, a tropical vine known for its hallucinogenic properties. The concoction caused Halpern to curl up into a ball in a bed and sob.

Halpern said Pickard showed up unannounced and started to comfort him. Pickard “starts massaging my feet, telling me that everything is fine.” Halpern said Pickard was “treating me in a way like a baby. If I burped, he would go, ‘Mmm, yeah. Oh, yeah.’ Just to try to make it humorous.”

After that, Halpern testified, he considered Pickard a “brother from another planet.”

Pickard had money, which Halpern testified he believed came from the sale and production of LSD.

“I’ve never met anybody in my life who would have hundreds of thousands of dollars in cash just laying about,” Halpern testified. “Never in a safe, just it’s in a shoe box, you know.”

Which made Pickard a prime candidate for an introduction to another of Halpern’s friends, a man he grew up with, who now lived in Russia investing money in an environment Halpern described as “anything goes.”

Halpern initially told his childhood friend that Pickard was wealthy from an inheritance, but said he eventually decided to tell him the true origins of the funds. Halpern said his friend “could tolerate accepting money from ill-gotten gains, that this would be illegal money.”

Pickard allegedly ended up laundering as much as $3 million of drug money through Halpern’s friend — and for his role in connecting the men Halpern was to be paid a 10 percent commission, according to court records.

Pickard is serving two life terms for conspiracy to manufacture and distribute LSD.

RCA said it conducts background checks on employees and was “aware of Dr. Halpern’s acquaintance with Mr. Pickard.” The company added that “what is more relevant to RCA is Dr. Halpern’s outstanding academic and professional achievements, as both a clinician and researcher in the field of Addiction Treatment.”

***

The death early this year of Charles was a shock to staff at Westminster. They had warned the company and the state about Charles. He died anyway.

RCA, in a statement, said it “cannot and will not comment on protected health information or any other details that may be related to a patient’s stay or treatment.”

Charles came from a prosperous Atlanta family, but his life had been marked by tragedy. As a young man, he lost both his arms after he accidentally grabbed a power line. Later, he survived cancer. He struggled with chronic pain.

He was brilliant, well-read, and doggedly independent. He used hooks to replace his hands, and was so nimble with them that he could type and drive a car. He was gifted with computers, and came to Boston about four years ago to audit courses at the Massachusetts Institute of Technology. Here, he lived in a luxury apartment, and began associating with people who abused crack cocaine.

Charles also had a history of abusing alcohol and prescription painkillers. In Massachusetts, he sought help from Halpern before he was hired by RCA. Charles followed Halpern to Westminster when RCA hired Halpern to be the medical director there. He arrived in late fall of 2016, and his family paid cash.

The placement was unusual from the start. Halpern personally oversaw his care. “John Halpern did nothing but help us,’’ said the relative of Charles. “He was a light in darkness for us.’’

Charles left the facility at least twice, according to records obtained by STAT and the Globe, and private nurses were hired from an outside company to be with him 24 hours a day — an arrangement the state determined in its February investigation was evidence of a patient that was “inappropriate for that level of care.”

Staff were told Charles had a history of abusing crack cocaine, according to a state complaint. He was awaiting surgery he hoped would relieve some of his pain. The job of getting him well enough for the surgery was largely left to Halpern, according to state documents.

“We were told not to provide any case management as the doctor at the facility was in charge of him as he was a private patient of his,” wrote one fired staff member in a letter to the state regulators in February. The staffer said that “numerous” warnings that the patient was not “clinical appropriate” went unheeded.

The staff member also told the state that Charles appeared to be overmedicated.

“It was brought to attention that he was being prescribed a large dose of Suboxone up to 4 times daily for pain,” the staff member wrote. The primary ingredient in Suboxone is buprenorphine.

Sometime around late January or early February, according to internal documents obtained by the Globe and STAT, Charles moved from the Westminster facility to Danvers. He was again following Halpern.

On Feb. 21, Charles was rushed from the Danvers RCA to the hospital.

In his body, according to his death certificate, was a toxic combination of cocaine and buprenorphine. He died a day later.

For O’Neill, the troubles at RCA are a distraction from what he describes as his company’s noble purpose to help people get sober in areas of the country in desperate need of treatment options.

“When this is all said and done, you have to decide the following,” O’Neill told reporters in a phone call to discuss questions about the quality of care in his facilities. “Are we the good guys or the bad guys?”

Correction: Because of a reporting error, an earlier version of this story misidentified the company that partnered with Flexpoint Ford LLC. The company is Summit Behavioral Healthcare.

Evan Allen can be reached at evan.allen@globe.com. Follow her on Twitter @evanmallen. David Armstrong can be reached at david.armstrong@statnews.com. Follow him on Twitter @davidarmstrongx.