Veterans Village of San Diego will not appeal a state decision to revoke its license to operate a residential substance use treatment center on its campus, the Board of Directors announced following its Friday afternoon meeting.

The move ends VVSD’s service to non-veterans at its Mission Hills campus.

The California Department of Health Care Services on Sept. 5 notified the nonprofit that it was suspending the program and would revoke its license, and VVSD had 15 days to appeal. The suspension of the Drug Medi-Cal Organized Delivery System program, which provides substance use disorder treatment for eligible Medi-Cal members, went into effect Monday.

The program had been at VVSD since 2019, and most of the 76 clients were non-veterans who had been referred by San Diego County Behavioral Health Services.

“We embarked on the DMC (Drug Medi-Cal) program with a bold vision: to extend our world-renowned treatment approach to civilians in need,” the VVSD board said in a statement released Friday. “We undertook this mission amidst an unprecedented surge in fentanyl use, reaching out to the most vulnerable members of our community with crucial support. As we move forward, we proudly refocus our efforts on our core mission — dedicated service to our nation’s heroes.”

Tessa Outhyse, information officer for the California Department of Health Care Services, said the state has revoked the license or certification of five other residential substance use disorder facilities in the past three years.

The California Department of Health Care Services had cited “serious concerns about client safety” and the deaths of seven clients in its notice to VVSD and its program.

VVSD President and CEO Akilah Templeton said the news was devastating to staff members who had worked with clients and now fear they may relapse or return to the street. County staff members were on hand Monday to place people in new programs, but VVSD counselors said they are in the dark about what happened to them.

“I know that on that first day, so many of our residents just left and went back out to the street, just going back to using,” said Meghan Ripley, a program manager who worked with clients.

“And it just breaks my heart, because they were doing so well here,” she continued, fighting back tears as she remembered the program’s last day. “It was so sad. I had clients coming up to me crying, begging me to let them stay, like I had any control over it. Begging, saying that they would come up with the money to be able to pay out of pocket just to be able to stay here because they were safe here. And then they just lost all hope and left.”

“It was so swift, the way they came down,” said clinical associate Isaac Salas, also in tears. “It was so traumatic for everyone involved. It was just devastating. The population we work with, they’re already a bunch of traumatized people. They already have a lot going on. And the way that they handled this, it was inhumane.”

Founded in 1981 to serve veterans facing a variety of challenges, VVSD offers programs to overcome unemployment, addiction, barriers to health and mental health care and other challenges. It created the annual Stand Down event to connect veterans with homeless services, and the program has inspired similar events throughout the country.

A perfect storm

Templeton said several things aligned to lead to the license revocation, beginning with complaints within the organization itself from people who objected to VVSD expanding its programs to include non-veterans, a move she said involved many factors, including a need for additional funding.

VVSD also was restricted from expelling disruptive people from the program during the pandemic, and critics went public with accusations that the environment was unsafe, she said.

And then there was the overall increase in fentanyl use among addicts. All of the overdose deaths cited by the state involved the drug, which is considered more lethal than other street drugs.

“And so this was all the perfect storm,” Templeton said.

Restrictions on the program prohibit clients from being searched, and Templeton said an investigation into one death revealed the fentanyl involved had been brought onto the campus by another client who hid it in a body cavity.

“We can’t do everything,” she said, adding that drugs were rarely found on campus. “We can’t even pat someone down. We can’t say with absolute certainty that substances won’t make their way into the environment.”

“If you have drugs on campus, you are discharged,” said counselor Teresa Najera, who had worked in the program. “No exception. You’re putting the rest of the clients at risk of relapsing.”

Templeton also acknowledged there were deficiencies in the program, but said they had been corrected and none were related to the deaths, which included one from apparent natural causes and others outside the campus.

On-, off-campus deaths

The state cited seven deaths in its notice, with four in 2022, two in 2023 and one last March. Four were on campus, including two that were drug-related.

One client died of a heart attack on campus in February 2022. That same month, another person who had been ill died on campus after he returned from a hospital that had cleared him for discharge.

A third person died in April 2022 of a drug overdose on campus. Templeton said that man had been referred from the County Probation Department and was on campus just two weeks when he died. After his death, Templeton said they learned he had 20 prior drug overdoses and other issues that might have disqualified him from the VVSD program.

In September 2022, a client who was not responding to treatment, relapsing and not complying with urine testing was off campus and supposedly looking for a sober living home when he died of a drug overdose.

Because he was still technically enrolled in the VVSD program, his death was considered to have happened on their watch. The state put VVSD on an 18-month probation because of the deaths in 2022, and the probation was set to end Sept. 9.

In May 2023, a man in the program created a fraudulent pass to leave the campus and died of a drug overdose at his brother’s house, although he was considered still enrolled in VVSD.

In September of that year, another client who was off campus died when he was struck by a train while riding a bicycle.

Last March, two clients overdosed on campus, and one died.

The closing of the program affected 36 employees; Templeton said 19 were furloughed and 17 were assigned other positions.

VVSD still has 199 beds funded for residential treatment, but the action leaves an additional 123 beds without funding.

The nonprofit had submitted $87,136 to the state to renew its license last March, and Templeton said the money is not refundable.

Originally Published: September 13, 2024 at 7:30 p.m.