(Update, May 22: On Wednesday, Commissioners Josh Parsons and Ray D’Agostino voted 2-0 to approve the allocations; Commissioner Alice Yoder was absent.)
Previously reported:
The Lancaster County commissioners are scheduled to vote Wednesday morning on allocating a little under $450,000 from the county’s opioid settlement.
The money, totaling $447, 373, would go to four programs, as follows:
- Drug & Alcohol Commission ($125,000): Funding to pay for individuals in recovery to reside at licensed recovery houses;
- Reentry Coalition / Donegal Substance Abuse Alliance ($81,800): Addition of two reentry case managers to assist individuals in recovery after their release from prison;
- County Prison ($205,573): Medication Assisted Treatment (MAT) for substance use disorder.
- Lancaster County ($35,000): Hiring of a project manager to oversee the opioid settlement and the programs it supports. Initial funding is for six months.
The money comes from the second opioid settlement payment made to the county, which it received last year. The county must allocate it by June 15 and allocations must conform with “Schedule E,” a list of approved uses developed as part of the nationwide settlement agreement.
The allocations were recommended by the steering committee of Joining Forces, the countywide coalition of organizations battling the opioid epidemic. The commissioners had decided in March to seek Joining Forces’ input.
It makes sense for the county to draw on Joining Forces’ expertise rather than starting from scratch on its own, said Commissioner Alice Yoder, who previously served as one of Joining Forces’ co-chairs.
The organization represents a broad cross-section of stakeholders in the opioid fight, she noted, as well as the views of three related organizations: the South Central PA Opioid Awareness Coalition, which is a network of physicians; Joining Forces for Children, which serves children affected by a family member’s substance use; and the county’s Overdose Fatality Review Team, which is led by Penn Medicine Lancaster General Health.
About the projects
The $125,000 proposed for the Drug & Alcohol Commission would support roughly 100 clients at recovery houses, assuming stays of 50 nights on average at $25 per night, commission Executive Director Rick Kastner said. The program would complement an existing one for Medicaid enrollees that supports 30 to 40 clients a year. Kastner said he would like to get the new one up and running for July 1, the start of the commission’s fiscal year.
The $205,573 proposed for the County Prison would allow its MAT program to continue at full capacity, Deputy Warden Joe Shiffer said. There are currently 85 participants; the program is budgeted for up to 120. The program is currently supported by a state grant that is due to expire at the end of September; providing the settlement funding in its stead will assure continuity, Shiffer and Commissioner Yoder said.
As for the reentry case managers, Donegal Substance Abuse Alliance already has two on site, but their workload is daunting, the alliance’s and Reentry Coalition’s representative Scott Theurer said. Adding two more will bring capacity more in line with the need: Each case manager typically handles about 45 to 50 active cases at a time, he said.
Lastly, the project manager is needed to oversee the various programs and ensure compliance with Schedule E and other regulations, Kastner said. He or she will be able to oversee other programs as well, allocating administrative hours to their funding streams accordingly.
The county is expecting 15 years of opioid settlement funding. It is currently receiving about $900,000 a year from two settlements, Kastner said, and that could eventually increase to $2 million to $3 million. Hence the need for a program manager: There’s already considerable administrative complexity and more on the way.
County Chief Clerk Larry George said it’s not clear how quickly the county will be able to hire for the role. It intends to move quickly, he said, but there are a number of steps involved, including bringing the position to the county Salary Board for review and approval.
Commissioner Josh Parsons noted that other elements of the plan will likewise require further Board of Commissioner action to approve provider contracts.
Process transparency
Gail Groves Scott, an opioid researcher and policy advocate and founder of Health Policy Network, has criticized the county’s opioid allocations. In an email to the commissioners that she shared with One United Lancaster, she said she supports the proposals for recovery housing and case management; but said funding for the prison’s MAT program should come with strings — namely, bringing in third-party monitors and changing how meds are administered.
Currently, the prison handcuffs inmates before administering the medications. Scott has pushed for an end to that, calling it unusual, inhumane and stigmatizing; prison officials say less restrictive protocols were ineffective in preventing inmates from secreting their meds and using them as contraband, potentially leading to safety problems such as fights or overdoses.
Scott also said the Joining Forces steering committee should have followed Pennsylvania’s Sunshine Act, advertising its meeting or meetings on the settlement funds and allowing public attendance and comment. “It’s a transparency fail,” she said.
Melissa Melewsky, media law counsel for the Pennsylvania NewsMedia Association, agreed. The Sunshine Act applies to public bodies and “all committees thereof” that render advice, and she said Joining Forces’ steering committee was acting de facto in that latter capacity.
“If you exclude the public from the committee process, you also exclude them from most of the decision-making process,” Melewsky said. “The Sunshine Act guarantees the public’s right to witness and participate during all stages of decision-making.”
That analysis misinterprets Joining Forces’ role, Commissioner Yoder said. The steering committee provided input to the commissioners, as any organization or individual is entitled to do, and nothing more.
“The Board of Commissioners did not appoint individuals to a review committee, nor did they vote to authorize Joining Forces as the sole decision maker in this process,” she said. Therefore, “the authority remains with the Board of Commissioners to determine allocation,” and it’s the board to which the Sunshine Act applies.
The board’s deliberations are in full compliance with the act. Tuesday’s work session and Wednesday’s regular meeting were advertised and their agendas posted; they are open to the public and there is opportunity for community members to comment.
“That is the appropriate venue for the public to participate,” Yoder said.
United Way of Lancaster County was formerly a Joining Forces steering committee member organization, but it does not currently participate. Joining Forces’ current co-chairs are Dr. Mitch Crawford, a psychiatrist with WellSpan Health, and Commissioner Parsons. Parsons said he did not take part in the steering commission’s discussion of the opioid settlement. Crawford did not immediately return an email soliciting comment.
