Next Step Healthcare, an operator of 21 skilled nursing facilities in Massachusetts, has settled with the state’s U.S. Attorney’s Office over allegations that it turned away hundreds of patients because they were taking medications to treat their opioid use disorder.
Over a period of two years, from September 2017 to August 2019, Next Step allegedly denied admission to 548 patients who told the provider they were being treated for addiction, even though all of those patients were looking to be admitted to facilities for unrelated health issues.
“This is awful,” Dr. Andrew Kolodny, the medical director at Brandeis University’s Opioid Policy Research Collaborative, told GBH News. “There would have been no medical reason — no justification for denying them treatment — other than stigma or misunderstandings about opioid use disorder.”
Next Step did not respond to a request for comment from GBH News.
People who use medication to treat substance use disorder are protected under the Americans with Disabilities Act. The federal government has been going after institutions that discriminate against this population — the latest settlement is the 10th the Massachusetts U.S. Attorney’s Office has made with a skilled nursing facility.
Kolodny said he thinks bias against medication-based treatment for the disorder were likely at play in Next Step’s denial of admission to so many people.
“This is a systemic problem rooted largely in a misunderstanding about both the disease of opioid addiction and its treatment,” Kolodny said. “With effective treatment, people can be productive members of their community. They can be good parents, good citizens.”
Kolodny said many people have opioid use disorder because of physicians’ prescribing practices, and not because they sought out opioids. But, he added, regardless of how someone develops an addiction, experts agree that the best treatment option is medication to decrease cravings.
“Opioid addiction is most effectively treated with medication. Without medication, people are at very high risk for an overdose death,” he said. “The likelihood of a good outcome with an abstinence-based approach is slim.”
Next Step agreed to adopt a nondiscrimination policy toward people with disabilities, to train their admissions personnel on disability discrimination and to pay a nearly $100,000 civil penalty to the federal government under the settlement. It will only have to pay $10,000 if the company complies with the agreement.
In a statement, Massachusetts U.S. Attorney Rachael Rollins said, “When people finally find the strength and courage to be open to entering recovery, they should be met with support and understanding, not discrimination and barriers to healthcare. ... We appreciate Next Step’s cooperation in modifying its policies and practices to come into compliance with the ADA, and we strongly encourage other skilled nursing facilities to proactively do the same.”
Harry Weissman, the director of advocacy for the Boston-based Disability Policy Consortium, said Next Step’s alleged discrimination devalued and endangered the lives of people with disabilities. He added that people who have mental health disabilities often suffer from discrimination rooted in stigma, which he also thinks was behind the treatment of those with opioid use disorder by Next Step.
“People who are dealing with those things should never be turned away,” Weissman said, “whether because they’re seeking treatment for that issue or for something else, they are people just like the rest of us. And, you know, disabled lives are just as worth living as a non-disabled life.”
The Disability Policy Consortium is continuing a push to get legislation passed on Beacon Hill that would improve protections from discrimination for people with disabilities in health care settings. Weissman said they are backing a proposed bill in the state Legislature, which reached the Ways and Means Committee but stalled there in the formal legislative session that ended over the summer.
Weissman said the bill would be a big help to Massachusetts residents who are lower-income or people of color, who are more likely to have disabilities.
“To deny treatment to somebody on this basis is discriminatory. ... It’s racist, it’s ableist, it’s classist,” he said. “Everybody has a right to health care and shouldn’t be denied that health care for any reason.”
