The cost of detox increasing
WILLMAR - When an intoxicated person gets taken to detox to sober up, county taxpayers pay the price.
From 2001 to 2004, Kandiyohi County paid a total of $607,824 for detox services, or an average of $151,956 a year.
That bill will be higher this year, not because more people are using it, but because the daily cost of operating the local detox facility is increasing.
The daily, per-person fee Kandiyohi County is paying to Woodland Centers increased $141 in July of this year, raising the fee to $378. Woodland Centers operates a regional detox center at its Willmar facility.
Under the state detoxification law, the burden of paying for detox service is borne by the county where the individual is picked up. A person could be from out of town or out of state, but if he's picked up in Kandiyohi County and taken to a detox center, Kandiyohi County pays the bill.
With few options for collecting money to recoup the costs, counties have no choice but to pay for the mandated service.
When it comes to funding, paying for detox is "a pure loss to the county," said Larry Kleindl, director of Kandiyohi County Family Services.
In Kandiyohi County, about 1 or 2 percent of the detox costs are recovered from a third-party payer, like an insurance company, or direct payments from the people who use the service. Kleindl said nearly 99 percent of the cost comes from the county's family service budget.
Kleindl said the Minnesota Social Service Association and the Minnesota Association of County Social Service Administrators wants the legislature to provide full state funding for mandated detoxification services by creating a surcharge on liquor, or by expanding the liquor excise tax.
The liquor fee/tax proposal was one of the top five legislative positions the Minnesota Social Service association delegates approved at their convention last month, said Kleindl. The proposal went nowhere in the last legislative session, he said, but attempts will be made again this year.
Having a source of revenue to pay for detoxification services would make more money available for other uses in the county, like chemical dependency treatment, said Kleindl.
Sen. Dean Johnson, DFL-Willmar, said he wasn't aware of a proposal to charge a fee or tax on liquor for mandated detoxification programs, but said it would be worth considering.
"Someone, somehow has to pay for detoxification," said Johnson. "The bug that bites you should probably pay for it."
High risk program
Whether it's 2 a.m. or 2 p.m., operating a detox program is a "high risk and high maintenance" program, said Dr. Gene Bonynge, director of Woodland Center. It's also a money-loser.
Since 1993, Woodland Center has lost money by providing the detox service. In recent years the annual loss has been $120,000 to $140,000. Add to that the cost of repairing and replacing windows, chairs and TV's that get broken every year by unruly clients. There are also workers' comp claims from employees who are injured by clients that add to the overall cost of providing the service.
Earlier this year Woodland Centers asked for, and received a $141 increase to the per-person daily fee that counties pay to use the service.
The new rate will be in place through 2006, but will likely increase to about $400 a day in 2007 said Kleindl. Most clients stay in detox about two days. The maximum is 72 hours, not counting weekends.
Woodland Centers still probably won't make any money this year with the detox program, but if it only loses $5,000 a year, Bonynge said he'll be happy.
The detox service is a needed one, but Bonynge admits he wouldn't be sorry if someone else in the community would take it over. "Believe me, I've tried to get someone else to do detox," he said.
If Kandiyohi County expands its county jail in the future, the county may opt to develop its own detox program, said County Administrator Wayne Thompson.
"We'll definitely consider it if we do a jail expansion," said Thompson. He said, however, plans for an expansion are "pretty much on the back burner" and wouldn't be possible unless the county secured a 5-10 year contract to house state or federal prisoners. Thompson said extra county staff that would be needed for a jail expansion could be "cross trained" to work at a county detox unit.
Many counties have shut down their detox units because of the high costs and are transporting clients to other counties or private facilities. At Woodland Centers, about 60 percent of the clients come from Kandiyohi County. The remainder comes from neighboring counties.
There are detox units that charge far less than Woodland Centers, including Project Turnaround in Granite Falls, that charges $205. Bonynge said Project Turnabout can use detox as a "feeder program" for its residential chemical dependency treatment program. Woodland Centers does not have a residential chemical dependency treatment program.
Bonynge said Woodland Centers pays to have the detox facility and staff available 24 hours a day and seven days a week. Because some days there are no clients, the facility operates at about 30 percent capacity. The detox facility in St. Cloud, he said, operates at about 90 percent capacity and is able to charge a lower daily fee.
Kandiyohi County could take people to other towns to take advantage of lower-priced detox units, but that wouldn't necessarily save money.
If there wasn't a detox facility in Kandiyohi County, law enforcement officers would have to spend time transporting people to other counties. That would take officers off the streets in this county, said Thompson.
Leslie Kveene has worked at Woodland Centers for 18 years. For 17 of those years she's worked in the detox unit. She's currently the director of the detox and crisis intervention programs.
Chemical dependency is an illness, just like diabetes or any other disease and it needs to be treated, said Kveene. Woodland Center's detox unit can provide a safe place to receive emergency intervention.
There's a strict routine that's followed when someone is admitted to Woodland Centers' detox facility, which has small living room, kitchen and set of bedrooms.
Kveene said some clients have been there before and know the routine: empty the pockets, put on pajamas, do the breath test, meet with the detox technician to provide general information and get vitals signs taken by a nurse.
"With repeaters, we know their history," said Kveene.
The detox staff knows the predictable withdrawal symptoms intoxicated individuals experience and are there to help them through it. They've had clients with a blood-alcohol level as high as .55, which is incredible considering the new legal limit for intoxication is .08. Those with a blood-alcohol level greater than .44 receive medical care at Rice Hospital.
The detox staff's guard instantly goes up when they get a heads-up call from law enforcement that they're bringing in someone on methamphetamine, said Kveene. Not enough is known about how people act and what their needs are when they withdraw from meth, she said.
Clients need to be medically stable before they're allowed to leave detox, said Kveene.
"There's usually not a dull moment," said Kveene of her years working in the detox unit. Chairs being thrown across the room and smashed into windows are all taken in stride. "The TV has gone flying before," she said.
Kveene said she loves her job and clients and can't imagine working anywhere else. "This detox unit is close to my heart," she said.