Some addiction treatment programs may not be adequately prepared in an emergency to prevent gaps in care, which could compromise patient progress or safety, according to a new audit released today by New York State Comptroller Thomas P. DiNapoli. The audit, which covered the period from 2019 to 2022, found the state’s Office of Addiction Services and Supports (OASAS) must improve its oversight and monitoring of nearly 400 certified providers that offer vital programs to thousands of New Yorkers battling substance use disorders or gambling addiction.

“The COVID-19 pandemic led to significant disruptions in addiction care and services, leaving many vulnerable New Yorkers susceptible to relapse,” DiNapoli said. “The state’s Office of Addiction Services and Supports should work to improve its oversight over its providers’ programs to ensure gaps in potentially life-saving care do not occur during emergencies and crisis situations.”

Opioid deaths skyrocketed by 44% in 2020 over the prior year, while the number of inpatients decreased 33%. Providers believed less people were getting help for the following reasons: the possibility of catching COVID-19, limited admission of visitors to treatment facilities, court closures and adjusted enrollment to accommodate social distancing.

Emergency Preparedness Plans

Auditors found that OASAS needs to improve its guidance for the emergency plans for residential or inpatient programs for substance use disorders. Though not required in the plans, in the aftermath of the pandemic, just 14 of the 27 plans reviewed included procedures to address infection control. OASAS also did not review providers’ plans after a program’s initial certification, leaving it up to providers to update them. Auditors reviewed a sample of regional office site visits and recertification records and found 10 of 14 programs (71%) had no records to support that OASAS verified the existence or content of emergency plans or procedures.

Locating Patients

The audit also found 12% of OASAS’ inpatient or residential programs may not be able to locate a missing patient in the event of an emergency because they are not utilizing a required barcode scanning system. Patients in programs typically wear a wristband with a unique barcode that can be scanned to determine a patient’s location and hospital records. During an emergency, the New York State Evacuation of Facilities in Disasters System, or eFINDS system, can help track a patient’s location in real-time and help to determine, for example, if a patient is transferred to another facility, is evacuated, or leaves to go home. The eFINDS system was created after Superstorm Sandy because of the number of patients who had to be evacuated. However, the audit determined 35 of 287 programs were not properly set up to use the system. OASAS cited the significant loss of health care workers during the pandemic and the ongoing struggle to find replacement staff as a contributing factor.

Waiting Lists

OASAS has not tried to improve the accuracy of its wait list data for certified substance use disorder programs. As a result, OASAS doesn’t have a clear picture if patients in need of care or who should be prioritized are getting services due to unknown openings. For example, pregnant women or opioid users are prioritized on wait lists. Auditors concluded some providers are either not sending needed information to OASAS for its central waiting list directory or are sending inaccurate information. If incorrect data is used to determine program capacity or gaps in care, it could jeopardize OASAS’ allocation of resources or skew public data. In response, OASAS emphasized the current state of the waiting list data does not hinder its decision making or appropriate oversight of its residential programs.

DiNapoli offered the following recommendations for OASAS:

• Review and revise guidance to providers, to:
  • Incorporate provisions that address providers’ plans to manage and mitigate disruptions in service.
  • Clearly describe the responsibilities of both providers and OASAS personnel related to the emergency plans, eFINDS readiness, and waiting list data.
• Review emergency plans subsequent to initial program certification.
• Verify providers have access to eFINDS, including verifying that staff assignments to key roles are current.
• Improve the use of waiting list data submitted by providers to better support OASAS’ decision making and oversight.

In response to the audit, OASAS said it will direct all providers to incorporate any newly issued guidance and recommendations into their operations and emergency plans. However, the office maintained its guidance to providers throughout the pandemic was clear. OASAS acknowledged the audit identified some gaps among some providers related to access to eFINDS and inputting waiting list data and agreed to undertake a review of all such guidance to ensure instructions are clear and to promote compliance.

Audit
Addiction Support Services During Emergencies

Related Audit
Oversight of Chemical Dependence Residential Services

Related Report
Continuing Crisis: Drug Overdose Deaths in New York