Mendocino County has the highest per capita number of overdose deaths in the state, with 54.7 per 100,000 in 2021. And there’s not always enough treatment, according to Clover Martin, the Treatment Services Director at the Ford Street Project in Ukiah. This week, she said, “We do not have any female beds available. Probably the next available female bed is three weeks away. So if you can imagine being a mother or a grandmother or a father and calling to try and get your family member in and you have to be told no, or I don’t know when the bed is going to be available or we need to put you on a wait list, that’s tough. And our male status for beds, we have two.”
Since November of last year, the county has received $1.4 million from opioid settlement agreements. This week, Aneri Pattani of the Kaiser Family Foundation reported that last year the Board of Supervisors approved the use of over $63,000 of settlement money to balance the county’s budget. That includes backfilling a portion of the multi-million dollar hole in the health care plan.
Erica Valdovinos is an ER doctor at Adventist Health Ukiah Valley. She also works for California Bridge, an organization dedicated to using evidence-based treatments for patients with substance use disorder. “As a physician who takes care of patients with opioid use disorder every day,” including people who have overdosed, she said, “I am very eager to find out what is going to become of the opioid settlement funds in this county. In fact, I have been trying for months to learn more about the process by which these funds are going to be distributed. And I haven’t gotten any answers. So I was alarmed to see that reporting yesterday that seems to indicate that the county is going to use a portion of those funds to plug a hole in the budget.”
Supervisor Glenn McGourty, chair of the Board of Supervisors, wrote in a statement that, “The $63,000 referenced in the December 2022 budget status report, was a portion of the Plaintiff Subdivision Fund, and appropriately approved for offsetting healthcare expenses, given the County has incurred damages for past harms including increased healthcare costs as a result of the opioid crisis.”
He wrote that $1,125,000 of the settlement funds received so far have been set aside in an abatement fund, “to address future remediation such as treatment programs for our community.” The other $275,000 is in the subdivision fund, which political subdivisions like cities and counties can use for purposes other than direct opioid remediation. McGourty wrote that this portion of the settlement, “provides for our direct damages, such as reimbursing past County incurred opioid related expenses and costs of bringing the litigation” against the manufacturers and distributors of opioids.
It’s not the first time money from a public health crisis has gone into the health care plan deficit.
Last year, over $4.5 million of the county’s allotment from the American Rescue Plan Act, or ARPA, went towards backfilling the shortfall. The Executive Office estimated it would have been over $10 million without the infusion. Another $370,000 from the same covid relief fund went towards remodeling the Board of Supervisors chambers, including a mechanical podium where members of the public stand to address the Board. The podium moves up and down to accommodate speakers of various heights.
ARPA guidelines were loose. And according to data compiled by Christine Minhee of OpioidsettlementTracker.com, only thirteen states have declared in writing that they’ll report 100% of their opioid settlement expenditures to the public.
California is not one of them. Minhee’s analysis, first shared with Kaiser Health News, shows that while many states have not committed to reporting any of their settlement expenditures, California has only committed to reporting 15%.
The state is participating in seven settlements with distributors, drug makers, and individual pharmacies. Two years ago, opioid manufacturer Janssen Pharmaceuticals and three distributors, McKesson, AmericsourceBergen, and Cardinal Health, settled over 3,000 lawsuits for $26 billion. California will get regular payments from a little over $2 billion from those settlements through the year 2038. Settlements with five other drugmakers and pharmacies are pending.
Some addiction treatment providers in Mendocino County are frustrated by the lack of transparency about how the local funds are going to be distributed. Jacque Williams is the Executive Director of the Ford Street Project, which offers residential and outpatient treatment as well as state-licensed detox therapy. She’s gotten a state grant to expand, and is applying for $4.1 million in Measure B funds to increase her offerings. She wants to understand what the strategy is going to be for community input. “Is there going to be an oversight of decision-making body or an oversight committee that ensures the implementation or approval of requests?” she asked. “This deserves a structured approach because there are several opportunities for investment of that money. And that's going to require people who understand the broad impact within our community. I’d love to see some first responders, people from the ER’s, just educators, be our thinkers about how we get after this going forward.”
Though the opioid litigation has been wending through the courts for years, many municipalities, including Mendocino County, have not yet formulated a plan for how to distribute the funds. McGourty wrote that, “Dr. Jenine Miller, the Director of Behavioral Health and Recovery Services, and member of the National Association of Counties Opioid Solutions Leadership Network, will be working with the Board of Supervisors in the near future to determine the highest and best use of the Abatement Funds for opioid remediation activities in our County.”
Valdovinos said that, while she is “just an emergency doctor,” who doesn’t know what the details of the of a transparent process will be, “I am really looking forward to seeing what the county has planned to address this epidemic in our community, and I remain standing by to support with any guidance or feedback that they might like. I also have plenty of colleagues who also have lots of experience taking care of patients in our community with substance use disorder, and all of us are here and willing to help.”