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Raymond G. Ferrero III, a Florida lawyer who helps families get loved ones into treatment via the Marchman Act, is taking on the A&E Network’s “Intervention” reality series for abusing patients. The Florida Marchman Act requires due process and begins with a petition to the court. An involuntary commitment statute, the Marchman Act was named after Hal Marchman, a pastor and treatment advocate who died in 2009.

Ferrero, who began handling Marchman Act cases under contract to the state in 1998, and whose boutique law firm Addiction Recovery Legal Services has provided Marchman Act services to family members of addicts since 2008, is criticizing episode 10 — “Courtney” — which aired March 5. In the show, interventionist Donna Chavous, who works for Intervention911 and is an “A&E interventionist,” performed an intervention on 20-year-old heroin addict Courtney.

Specifically, before the intervention, Chavous told Courtney’s family that she had the power under Florida’s Marchman Act to call the police and have her arrested if she refused to go to treatment that day. “This was a lie,” Ferrero told ADAW.

The intervention not only failed, but was also dangerous, with Courtney escaping in a truck driven by her boyfriend and a family member hanging from the open door of the vehicle, said Ferrero.

Ironically, Ferrero provided a Marchman Act seminar to Ken Seeley’s Intervention911 team in 2009. Seeley is an A&E interventionist and employs Chavous. He was unavailable for an interview with ADAW.

A&E role

Now, Ferrero’s anger has gone beyond Chavous to the inaction of A&E, which should have suspended Chavous from further interventions pending an investigation, pulled all episodes in which she appears and spent equal air time providing truthful information about the Florida Marchman Act, he said.

At first, he said, A&E seemed helpful about trying to fix the problems with the story. “But I’m a lawyer. I know what happened," Ferrero said. "The minute I provided them with the details, they ran it up the flagpole and somebody said, ‘We’ve got no liability here.’”

Ferrero used to be a fan of “Intervention,” he said. ‘It does give you insight into active addiction,” he said. But now, he thinks that it is more about “voyeurism” than educating. “This is their formula, showcasing the suffering,” Ferrero said.

A&E has removed Episode 10 from its website, but the show is still available for purchase from iTunes. A&E has also removed Ferrero’s criticisms from its discussion board. A&E did not respond to emails and telephone calls from ADAW.

The process

The Marchman Act is a completely civil statute, with specialty courts that handle Marchman Act cases only. All records can be sealed, and hearings are held within closed chambers by statute. There is no jail unless the patient is deemed by an independent assessment to need treatment, then refuses to be in treatment and then is proven to be in contempt of court.

The first step of a Marchman Act process involves petitioning the court for an assessment, explained Ferrero. “I represent the family, filing against the respondent, who is the addict,” he said. Then there is a court order for assessment and detoxification — these cases involve people who are using and in crisis, he said. After the assessment, the court is petitioned for a treatment order for a minimum of 60 days. At the end of treatment, the Marchman Act attorney can petition for additional extensions.

“What the interventionist said on A&E was a lie,” said Ferrero. “She doesn’t have any standing to bring the case, she never filed a petition and what she was telling the family was incorrect.”

Treatment facilities are not locked. If someone walks out of a treatment program against medical advice, and they are there under the Marchman Act, they would be in noncompliance with a court order. The Marchman Act attorney would file a secondary petition and have the person served, and he or she would have the right to come to court and show good cause why they should not be held in contempt. At that point, the judge makes a ruling -- for example, the person could be given a choice of 10 days in Broward County jail or going to treatment. 

Interventionist’s role

Ferrero thinks some interventionists are actually threatened by the Marchman Act, because they think it’s taking their business away. But what interventionists do is very different, he said. “I deal with the law, and just bring families in to provide testimony,” he said. “Interventionists are clinicians and use certain techniques.”

In fact, interventionists may think that Marchman Act attorneys can undercut their role; both get paid hefty fees by family members. The families pay Ferrero for the work on a flat-fee basis. “We realized that if we billed by the hour, the families would get very frustrated,” he said. “Some cases we get burnt on, especially in West Palm Beach.” The families are rich, and both sides — including the candidate for treatment — can afford steep legal fees.

Some cases can go on for months, with the proposed patient defending against going into treatment, said Ferrero. He would not name the fee he charges because based fees vary based on complexity. “We do hardship packages, and if families don’t have the funds, we have even let them pay $500 down and then we work out a payment plan,” he said.

Before opening his Marchman Act practice in 2008, Ferrero defended the patients under a civil contract with the state. “I have had interventionists reaching out to me who are extremely supportive,” said Ferrero. “This is not about bashing interventionists.”

Chavous not AIS

The Association of Intervention Specialists (AIS) likes "Intervention" because “it has made the word ‘intervention’ a household word,” said Becky Flood, president of the AIS board of directors, in an interview May 3 from Savannah, where the group was holding its biannual meeting. “Hundreds of people have gotten treatment who would never have gotten treatment had they not gone through that show.” She didn’t see the episode about the Marchman Act, and she has never done an intervention in Florida, so she didn’t want to comment on it.

That said, however, Flood, who is also executive director and CEO of New Directions for Women, said only AIS members should conduct interventions, and Chavous is not listed as an AIS member on the AIS website. “I tell every family member who wants an interventionist that they should only use one who is a full member of AIS — that means they’re board-registered and credentialed,” she said.

And Flood understands the concerns expressed by Ferrero. “You should never make idle threats to anybody who is an addict,” she said. “That’s putting a nail in someone’s coffin. It’s not fear that motivates them to get help, it’s love.”

For a list of AIS members, as well as its code of ethics, go to http://associationofinterventionspecialists.org/.

While most single state authorities (SSAs) view prescription drug abuse as a top priority, few have very much input into prescription drug monitoring programs (PDMPs), according to the National Association of State Alcohol and Drug Abuse Directors (NASADAD).

In an inquiry conducted by NASADAD research analyst Cliff Bersamira and presented by executive director Rob Morrison at the national prescription drug abuse summit held in Orlando last week, 48 states reported on their involvement with the PDMP.

“Only about half the states are actually involved at all with their PDMP,” Bersamira told ADAW in an interview with him, Morrison, and NASADAD research director Henrick Harwood immediately following the presentation. “We were surprised.” However, three-quarters of the states found the PDMP data to be useful. “They don’t create it, they don’t run it, but the data is useful to their mission,” he said.

Almost one-quarter (11) of the 47 states who responded said prescription drug abuse was their highest priority. Of the remainder, 27 said it was very important, 7 said it was important, and 2 said it was moderately important. None said it was of little importance or unimportant.

Asked what is driving the SSA interest in prescription drug abuse, Harwood cited media reports of overdose deaths. Last fall, the Los Angeles Times reported that federal data show drug overdoses kill more people than traffic accidents (see ADAW, Sept. 26). “Governors started paying attention,” said Harwood. Still, in most states, the governor is turning to law enforcement, not public health, for housing the PDMP.

The conference

There were more than 700 attendees at the conference, with presentations from treatment, enforcement, education, medicine and public policymakers. Gil Kerlikowske, director of the Office of National Drug Control Policy, was there, calling prescription drug abuse the country’s number-one public health problem, while flanked by Gov. Steve Beshear of Kentucky, Rep. Hal Rogers (R-Kentucky) and Rep. Nick Rahall (R-West Virginia). The conference was brought together by Unlawful Narcotics Investigations, Treatment and Education, Inc. (Operation UNITE). Founded in 2003 by Representative Hal Rogers, Operation UNITE is a nonprofit corporation with the mission to combat prescription drug abuse in Kentucky.

It’s significant that NASADAD, representing the SSAs with control over the Substance Abuse Prevention and Treatment block grant, presented at this high-powered meeting, which involved many groups not traditionally working shoulder to shoulder with treatment, such as law enforcement. “When there’s a discussion about something that has a link to addiction, which this does, we should be front and center to help shape the debate,” said Morrison.

‘Opening a door’ for other SSAs

NASADAD supports increased resources for PDMPs, wherever they come from, said Morrison. PDMPs can help law enforcement track down pill mills and unscrupulous prescribers and dispensers. But, when the SSA is involved, they can also help steer the people who are addicted to opioids into treatment. Only three states — Vermont, Maine and, most recently, Maryland — have the PDMP housed in the office of the SSA (see ADAW, Feb. 20). “We do know that Vermont and Maine feel that they can play a productive role, and Maryland sees that as well,” said Morrison.

Usually the pharmacy board in the state is in charge of the PDMP, with SSAs the advisors, said Harwood. “Literally only three of our members have the intimate management oversight of PDMPs,” he said. “This inquiry is opening a door” for SSAs in the states, because the message — that they are very concerned about prescription drug abuse, even if not part of the PDMP — is loud and clear.

NASADAD, whose members comprise all the states with their huge variations in SSA influence, does not have one single position on the role SSAs should be assigned in terms of PDMPs. “But to the extent that a state’s SSA can be involved in anything involving addiction, that person can infuse the PDMP into their own plan,” said Morrison. “For example, what can the data do for referrals?”

Treatment

Nationally, about 11.5 percent of the people who present for addiction treatment cite prescription opioids as their primary drug of abuse, said Harwood. This percentage represents a quadrupling from 1998 — about the time that OxyContin was introduced — and that has been the percentage since about 2003, he said.

But admission data don’t tell the whole story, noted Harwood. Data from the federal National Survey on Drug Use and Health shows a 40-percent increase in the number of people reporting they are dependent on prescription drugs, with 70 percent of these people saying they are dependent on painkillers.

Finally, national data are not representative of individual states, which in some cases can have much higher admission rates for prescription opioid addiction, noted Morrison. “That’s where the SSAs come in,” he said. “They know what the service needs are for their state.”

States spend 75 percent of their substance abuse budget on treatment, said Harwood. “Seeing the rates of treatment demand for prescription opioids quadrupling, they understand that it’s washing into their systems,” said Harwood. “They know their challenges. They know that methadone and buprenorphine are both very effective strategies. They want to promote access.”

Threshold event

Prescription drug abuse is not new — it has been obvious to SSAs for years, Harwood said. But sometimes, some “threshold event” is needed for policymakers to make changes, he said. Harwood recalled the crack epidemic of the 1980s, which only received attention after basketball player Len Bias died after a cocaine-induced heart attack.

“This was a wake-up call that was overdue, because the cocaine data in DAWN showed that cocaine emergency room admissions had been going up for some time,” he said. “It takes some kind of event to cross a threshold.” The overdoses may be the threshold for prescription drug abuse, he said.

“Our goal in doing this is to identify states that have good strong initiatives and practices and let other states know about that,” said Morrison. “We want to improve all of the state systems by exposing them to what’s working best.”


Sidebar

ONDCP Chief of Staff on prescription drug abuse

Last year, when Gil Kerlikowske, director of the Office of National Drug Control Policy (ONDCP), visited Kentucky, West Virginia and Georgia, Operation UNITE, the group launched in Kentucky to combat prescription drug abuse, discussed with him the idea of having a national drug abuse summit.

“They were very dynamic in putting together a comprehensive program with prevention, education, advocacy, treatment and law enforcement tracks,” said Regina Labelle, ONDCP chief of staff, in an interview with ADAW. “This was a wonderful opportunity to hear experts in the field talking about what can be done. I go to lots of summits and scientific conferences, but what is special about this one is you have parents who have lost their kids, members of the medical profession, policymakers coming together around what we put out in our strategy, the four pillars of education, monitoring, disposal and enforcement,” she said. “It’s great to see the energy and enthusiasm that is going to bear on this problem.”

LaBelle is particularly pleased that “everyone is committed to a wholistic approach — there is no one silver bullet,” she said. “A lot of science needs to go into tamper-resistant formulations. We need to get parents involved. There are steps we can take now.”

As for overdose deaths, most are occurring in white middle-aged men who have a substance use disorder who live in impoverished areas, said LaBelle. “The vast majority of the 20,000 or so fit into this cohort of older people who have had chronic substance abuse,” she said. “They would be candidates for drug treatment. But they are harder to treat because we haven’t intervened early.”

This month South Dakota Gov. Dennis Daugaard signed a $4 billion budget for the state that included some increases for Medicaid services that were cut last year to close a budget gap. The economy is doing well in the state, and Medicaid providers will get a 1.8-percent increase.

State employees get a raise — an average of 3 percent. Employee salaries in the Department of Social Services (DSS) will go up 7.3 percent, and employee benefits will go up 4.7 percent.

Grants and subsidies increase 3.5 percent. Overall, contributions from the general fund to DSS go up more than $3.3 million, from $55.7 million in fiscal year 2012 to more than $59 million in fiscal year 2013. Federal funding goes down by $56,000, staying basically level at $37 million. The total DSS budget for FY 2013 is $35 million for employees and $63 million for operating expenses.

But whether this good news translates into good news for the beleaguered substance abuse providers in the state is unclear. Last year they saw their hold on contracts threatened by mass firings of state officials with expertise in substance abuse (see ADAW August 8, November 11, 2011). Nobody who currently is funded by the state would talk to ADAW on the record about this because, they said, they were afraid of losing their funding in retaliation. Neither DSS nor the Governor’s budget office responded to queries about the FY 2013 budget — we obtained the information from the South Dakota Legislative Research Council.

Treatment providers weren’t encouraged by the report that South Dakota received an “F” in the State Integrity Investigation released last week. Governor Daugaard’s chief of staff Dusty Johnson told reporters that he doesn’t believe it — and then said that the state handles ethics issues by firing people. “Every year there are plenty of people in state government who get fired because they violate state policies, procedures or state law,” he told KSFY March 19. “And when you think about it, that's a pretty good way to handle it because if you break the law, you're in trouble and we don't need an ethics commission to tell us that, that's common sense and the South Dakota way,” Johnson told reporters.

For the state integrity investigation report, go to http://www.stateintegrity.org/state_integrity_invesitgation_overview_story.