He Had a Heroin Addiction, West Nile Virus, and Endocarditis. The Healthcare System Failed Him; A Certified Recovery Specialist Empowered Him.
Feb 25, 2019
Living on the streets in Boston, Mass., Peter Mulroney struggled with an addiction to heroin.
One day, he woke up in his homeless encampment and knew something was wrong. A friend gave him a ride to Boston Medical Center, where he was diagnosed with endocarditis, an inflammation of the inner layer of the heart.
On his fourth day at the hospital, Peter fell into a coma. The nurses called his parents to obtain permission to perform a spinal tap on Peter.
When they did, the doctors discovered another deadly infection: West Nile Virus.
Peter was in a coma for seven days. He was in the ICU for two months.
His diagnosis was grim. Doctors told Jake?s parents that he would never walk or talk again.
Somehow, Peter defied the odds. After a few weeks, he began talking. Eventually, he even began walking with a cane.
But while recovering from his deadly infections, Peter still had to sustain the recovery path for his other disease: opioid use disorder (OUD). All while being treated with opioid pain medication.
While at Boston Medical, Peter was treated with methadone. When he was discharged to a long-term rehabilitation facility, Peter was started on Suboxone with a two week bridge prescription until he could receive ongoing medication-assisted treatment (MAT).
At the rehab, Peter would need ongoing physical therapy and IV antibiotics while he continued his recovery from West Nile Virus and endocarditis.
For his addiction treatment, the hospital staff connected Peter with CleanSlate’s East Boston addiction treatment center, a national medical group that operates outpatient centers for MAT. Suboxone reduced Peter?s withdrawal symptoms, but he also needed the support that CleanSlate provided for the other parts of his recovery.
Recovery from addiction during the physical rehabilitation Peter was facing would be a challenge.
Fortunately, CleanSlate had a Certified Recovery Specialist (CRS) on staff, Heather Burke. She visited Peter at the hospital and rehab to help him through his addiction treatment.
In the coming months, Peter would need Heather more than anyone realized.
What are Certified Recovery Specialists?
A CRS works with drug and alcohol clients in a hands-on fashion, doing whatever is necessary to advocate for necessary services and help individuals overcome barriers to recovery. These specialists have personal experience with recovery and work with clients on a peer-to-peer basis, helping people feel comfortable so that they connect and stick with recovery treatment.
?There is no cookie cutter formula to apply to people with addiction,? says Heather. ?We need to be able to meet people where they?re at.?
?Where they?re at? might be in a homeless shelter. Or without insurance. Or in the contemplation stage about whether they even want to recover. Or needing help navigating the process of getting started with treatment.
In Massachusetts, hospital ER staff are now mandated to offer addiction patients one of three FDA-approved medications: buprenorphine, naltrexone or methadone. ER staff then coordinate with a CRS to bridge a patient?s medication treatment so that there is no gap in that patient?s addiction treatment.
Related Blog: Emergency Rooms Are Starting To Treat Addiction Patients Like They Have A Disease. Because They Do.
?I don?t just hand people a flyer, I will set up the appointment with them and walk them through the process,? says Heather. ?People feel comfortable talking to me because they see me in the community, working with anyone who wants help. I never judge people, no matter their circumstances.?
Skilled nursing facility unskilled with addiction
Peter?s rehab facility was not licensed to treat people with Substance Use Disorder (SUD).
That alone wasn?t the main challenge.
This was: the rehab staff had little interest in dealing with the patients who suffered from addiction.
Those patients were relegated to their own floor, a veritable dumping ground of neglect, manned by nurses and staff who were incapable of handling all of the different needs of addiction.
The stigma against these patients impacted their recovery from the physical conditions for which they had been admitted.
?It went beyond ineptitude,? says Peter?s father, Jim. ?Nobody was communicating with anyone at all.?
At the rehab facility in Worcester, patients with addiction have the same rights as any other patient to come and go as they pleased. That means that patients leave to pick up illicit drugs, bringing them back and using them at the facility. For someone going through addiction treatment, like Peter, this ?wild west? atmosphere created even more challenges for recovery.
Institutional inertia compounded the problem. While the rehab facility was limited by its lack of license to treat patients for SUD, staff also showed no interest in creating solutions to the clear problem in their midst.
A person who has high medical needs can?t qualify for a traditional detoxification program, so the obstacles are steep for patients to begin most addiction treatments in this kind of a setting. The exception would be MAT, which is why Heather was able to continue to work with Peter on his treatment program as he recovered in the rehab.
?The strength that Peter has is unbelievable,? Heather says. ?Somehow, he remained substance-free while he was in that facility. I can?t say that was true for anyone else there. The population there is actively using.?
Related Blog: Stigma Against Addiction Medication Fading, Ringing In Hopeful Signs For Opioid Epidemic In 2019
Heather believes that Peter?s ability to maintain his recovery was because of the level of support that CleanSlate provided before and during his ordeal with West Nile Virus.
?We try to develop those close relationships with our patients,? she notes, ?encouraging them every step of the way, and helping them show others that there really is hope. There is a way out of addiction.?
Good morning, now leave
Heather and Peter?s family were frustrated by the unstable environment for Peter. But their feelings grew from dissatisfied to outraged when administrators at the rehab announced to Peter that he was being suddenly discharged. He needed to vacate the premises by 4pm that day. No warning, no case management, no plans for transition – just a swift kick out the door.
Peter called Heather. ?Can you please come down here?? he said. ?I need help.?
This was unacceptable to Heather. Other patients may not have had an experienced advocate to fight for them, but Peter did.
She knew Peter?s rights. The rehab staff were flagrantly violating his treatment plan, failing to provide him with a plan or other supports for his discharge. He was being set up for failure
The rehab officials explained that Peter didn?t require a high level of care anymore. He wouldn?t make any further improvements and they couldn?t justify continued care to the insurance providers.
?Peter had already beat most of the odds,? Heather fumed. ?We were told he would never walk or talk again. How could these people say that he couldn?t continue to recover??
(Pictured: Heather Burke and Peter Mulroney.)
Administrators also claimed that they didn?t have enough documentation in Peter?s medical records to prove that he needed any further care.
?These people didn?t have documentation because they never met with him,? Jim says. ?They betrayed my son.?
Jim gets heated when he recalls Peter?s shoddy treatment. Words like ?wicked,? ?liars,? ?delusional,? and ?medically criminal? pervade his conversation.
?They never did one thing they promised,? he says. ?They never even filed the paperwork. The case manager didn?t even try to find another treatment facility for him. The few he suggested don?t allow MAT, which they knew was mandatory for Peter. They didn?t care what happened to Peter; they just kicked him to the curb like he was garbage.?
Never giving up hope
Heather stepped in and made sure that Peter wasn?t released without a place to go that would help him recover from both of his diseases.
After doing work that should have been performed by Peter?s case manager, she was able to place him in a residential facility where he currently benefits from care for rehabilitation and sober living. Peter receives intensive therapy for his SUD, and is able to go to appointments with the infectious disease doctors who are helping him with his West Nile Virus.
All while still continuing to receive MAT and intensive substance use counseling every week at CleanSlate.
Jim credits CleanSlate with saving his his son?s life. ?With the level of addiction that Peter had,? he says, ?if he had fallen through the cracks, if CleanSlate wasn?t fighting for him the way that they did, he would have had an 85% chance of relapse. I heard this directly from an expert.?
A practicing minister, Jim believes that the traditional healthcare system is overwhelmed by the opioid epidemic and often ill-equipped to respond. He saw how Heather?s forceful advocacy had an effect on everyone around Peter, including the patient advocate assigned to Peter, who had become discouraged by the neglect of the rehab facility.
?My bible says to ?fight the good fight,?? he says. ?Heather never gave up on Peter. She came to us straight from heaven. CleanSlate as a company has a level of integrity and goodwill that creates success for its patients.?
Today, Jim tells everyone about CleanSlate. ?I am in commitment and prayer and awe for CleanSlate,? he says. This company is the only thing that I?ve heard of in the last two to three years that has worked for my son. When people decide to care, all of God shows up. CleanSlate is the vehicle of God?s grace.” See more about being thankful in recovery.
?I have my whole church praying for CleanSlate.?