Pubdate: Tue, 13 Jun 2000
Source: Honolulu Advertiser (HI)
Copyright: 2000 The Honolulu Advertiser, a division of Gannett Co. Inc.
Contact:  P.O. Box 3110 Honolulu, HI 96802
Fax: (808) 525-8037
Website: http://www.honoluluadvertiser.com/
Author: Lynda Arakawa, Advertiser Capitol Bureau

DELAYS BLAMED FOR DRUG RELAPSE

Recovery advocates criticize QUEST

Inmates released from prison often must wait for substance abuse treatment
through the state's QUEST program for the poor, which hurts their chances of
staying out of jail.

Drug treatment providers and advocates say people who apply for QUEST
sometimes have to wait as long as two months to receive health care
coverage. New members may then be subjected to a 30-day waiting period for
substance abuse treatment if the service is not considered urgent.

Officials with QUEST health plan providers claim patients don't need to be
active drug users to get help. But drug treatment advocates describe a
system that essentially requires people who have been clean to use drugs
again to qualify for treatment.

Drug addicts, advocates and state officials have emphasized the need for
released inmates to continue receiving treatment when they re-enter the
community. Without such programs, prison officials say, addicts likely will
fall into old habits and wind up in prison again.

"It's kind of a vicious cycle," said Larry Williams, executive director of
the Salvation Army Addiction Treatment Facility. "If you wait until they use
drugs, they're violating the law. It's a Catch 22."

While all health insurers have been pressured by advocates and some
legislators to increase benefits for substance abuse treatment, QUEST is the
target of complaints. As the state's health insurance program for the poor,
QUEST is the likely insurer for those who are leaving prison.

Charles Duarte, administrator of the state's Med-Quest program, said inmates
must wait until they are released to apply for QUEST, because federal law
prohibits anyone living in an institution from being a QUEST beneficiary.

Duarte attributes the wait to receive benefits - which he estimated at five
to seven weeks - to a shortage of staff. QUEST does provide coverage to
anyone who has been waiting for more than 45 days, he said.

However, QUEST allows health care plans to impose a one-month waiting period
on new adult members for services not considered urgent, he said. Substance
abuse treatment is considered a nonemergency, but a plan may make exceptions
if it determines such treatment is medically necessary.

"Surely someone who comes out and has been clean and sober for six months
may not have as urgent a need for substance abuse treatment - although I do
understand the need for continued treatment," Duarte said. "Quite frankly,
the problem we have is we're underfunded and always have been for substance
abuse treatment."

Not all forced to wait

Some plans, such as Queen's Hawaii Care and Straub-Care Quantum, don't
impose a 30-day waiting period on new QUEST members, company officials say.
The Hawaii Medical Service Association has a 30-day waiting period for new
QUEST members, but case managers can waive it if necessary, said HMSA
spokesman Cliff Cisco.

Social service advocates and state officials argue that even inmates who
have been drug-free in prison face a tougher challenge staying clean and
sober on the outside.

"You're doing everything at one time: You have to find a place to live, you
have to find a job, many people coming out have anger management and
psychological problems. It's a critical time," Williams said. "And the
resources are so limited. If you can't get timely treatment, you're kind of
doomed from the start."

Hawaii Paroling Authority administrator Max Otani agreed that people
released from prison need continued support, because they will likely face
additional stress in adjusting to the community.

"We've seen where these guys would be the ideal prisoners - no positive drug
tests, completed their programming - and they come out and all of a sudden
they fall apart," Otani said. "It's not unusual to see that."

Drug abuse prevalent

About half of the parolees who are returned to prison have a substance abuse
problem, Otani said. Prison officials have estimated that 85 percent of the
roughly 4,800 prison inmates in Hawaii have a history of drug or alcohol
abuse.

A former inmate who agreed to be identified only as "Jay" criticized the
system, even drug treatment facilities, for failing to give addicts enough
help when they need it.

A 35-year-old Windward man who has been in and out of jail, primarily on
drug charges, said he went to a drug treatment facility for help recently
and was told he needed insurance.

"I wanted treatment," he said. "I know what (the drug addiction) does to
me-you get sick of everything that's happening around you. Everything starts
falling down.

"A person should be able to walk into a program and get help. It shouldn't
be all about money or insurance, because you're talking about a person's
life," he said.

State officials say they are working to address the problem, and acknowledge
it is still far from meeting the need.

The Department of Health provides treatment to those waiting for insurance
on a space-available basis, but its main priority is pregnant women and
intravenous drug users. The paroling authority's Otani said QUEST workers
have sometimes expedited his agency's request to get parolees enrolled inthe
health plan within two to three weeks.

In addition, the paroling authority is receiving $100,000 in forfeiture
money from the Honolulu

Police Department to pay for substance abuse outpatient treatment for
parolees who don't have insurance and cannot afford treatment, Otani said.
And the state Department of Health last year gave the Salvation Army a
$63,000 grant for a pilot program to treat drug addicts immediately after
they leave prison.

Money also an issue

Duarte said problems stem from not only waiting for insurance, but a
shortage of treatment facilities and resources. "It requires more than just
an insurance benefit to take care of the problem," he said. "We need dollars
for a whole continuum of care so these folks don't fall back into the same
trap."

Anita Swanson, Department of Health deputy director with the Behavioral
Health Administration, agreed.

"If you don't have the `clean and sober' housing, and you send them back to
the house with ice addicts nearby, no treatment is going to work," she said.
"I think the bigger question is we have to look at substance abuse,
alcoholism and mental illness as no different than any other physical health
ailment."
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