Audit blasts state system
No question: Idaho’s substance abuse system needs an overhaul. That much was clear from a scathing state audit released in December, a Sandpoint lawmaker said this week.
But Republican Sen. Shawn Keough said state officials shouldn’t move too quickly to create a special commission to tackle the problem. More time and more information are needed, she said, to understand the implications of the 117-page report that detailed failings of a system aimed at helping people addicted to drugs and alcohol.
“It’s such a serious subject and we didn’t want to rush anything,” Keough said.
Prepared by the state’s nonpartisan Office of Performance Evaluations, the audit concluded that the substance abuse services are too fragmented to provide even basic answers to questions about need, scope and service.
The report called for creation of an independent agency to monitor services now provided by seven state entities at a collective cost of about $27.5 million a year.
State evaluators expected the commission to be approved during the current legislative session and put in place by July 1. So far, however, no bill has addressed the issue.
But Keough, a member of the Joint Legislative Oversight Committee that called for the audit, said it’s not clear that creating a new state commission is the right approach.
“I think that’s part of the struggle,” she said. “We’re reluctant to set up yet another agency. … What is the true problem, and does another layer of bureaucracy correct that?”
Problems outlined in the audit included inadequate monitoring and licensure of contractors and providers, unreliable data about clients and services, and insufficient information about program results.
Information as basic as the number of clients served varied widely in state accounts. For example, the number of outpatient treatment clients in fiscal year 2004 ranged from 4,472 to 8,151, state Department of Health and Welfare records show.
The department, responsible for the bulk of state substance abuse services, mismanaged federal substance abuse funds, leading to a $1.6 million shortfall in fiscal year 2005, the audit concluded.
At the same time, the agency’s treatment completion rate ranged from 19 percent to 24 percent, far below the national rate of 39 percent, the audit showed.
Health and Welfare Director Karl Kurtz said the audit unfairly criticizes his department for failing to achieve statewide coordination and that the agency is addressing many of the concerns raised.
“While DHW concedes that some improvements in its data collection and management practice are necessary, such advances by DHW alone are insufficient to effect interagency coordination,” Kurtz wrote.
Issued just before the start of the legislative session, the audit surprised many lawmakers and agency representatives.
“It took a lot of people’s breath away,” said Kara Schallock, a community resource development specialist for DHW.
Still, the audit wasn’t on the agenda Tuesday when a Coeur d’Alene judge was among seven people honored for outstanding work in substance abuse at a Boise ceremony led by Gov. Dirk Kempthorne’s wife. And its conclusions were disputed by Sen. Joe Stegner, R-Lewiston, who received the third annual Patricia Kempthorne Award for his dedication to improving treatment of mental illness and substance abuse.
“The regional approach to substance abuse is the best model Idaho can work toward,” said Stegner, who added he hadn’t spent much time thinking about the audit and didn’t want to dwell on differences with its authors.
“I have less confidence that the state can operate a Boise-down system that is more effective than a regional approach,” he said.
Coeur d’Alene Magistrate Judge Eugene Marano also was honored for his role in creating and maintaining Kootenai County’s Drug Court, which has been hailed as a model for the state. Marano said he was only vaguely aware of the audit’s critical findings. In general, though, he said he had confidence in regional solutions to the issues raised in the report.
A statewide substance abuse commission could still be formed, said Rakesh Mohan, director of the Office of Performance Evaluations, which produced the audit.
It could depend on the results of an audit of the management of Idaho’s Health and Welfare Department, to be released Feb. 28. Also, the state Board of Health and Welfare is expected to give a formal response to the substance abuse audit in early March.
“This issue is not dead yet,” Mohan said.
Nor should it be, added Keough.
“We’re still finding all of the information on which to make a sound decision,” she said. “There’s obviously too much at stake, both in terms of people’s lives and taxpayer dollars.”