Pennsylvania has allowed addiction treatment providers to continue operating despite repeated violations of state regulations and harm to clients, a Spotlight PA/KHN investigation has found.

More than 80 interviews and a review of thousands of pages of government and court records revealed that the state Department of Drug and Alcohol Programs lacks resources and regulatory power, uses an inherently flawed oversight system that does little to ensure high-quality or effective care, and rarely takes strong disciplinary action against facilities when so many Pennsylvanians need services.

Among the investigation's findings: 

• The department has no standard criteria for when it should force facilities to serve fewer patients and, as of early April, had revoked just one treatment provider’s license in nearly a decade.
• It doesn’t regularly compare facilities to see if any stand out for an unusual number of violations or the most client deaths.
• And since state inspections focus heavily on records, they can be tricked with fraudulent paperwork, former employees in the treatment field said.

This leaves Pennsylvanians in the dark about which treatment facilities have troubling track records.

THE CONTEXT: Even though the department provides the licenses that allow addiction treatment facilities to operate, Secretary Jennifer Smith said it has limited responsibility for them.

Smith said people should pick treatment facilities the same way they do primary care doctors, based on publicly available information, personal recommendations, and discussions with insurers.

But public information is limited, and many employees and clients in the treatment field are skeptical of any long-term improvement.

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