It Technology and 3) Managed Facilities. The Raleigh Hills Hospital of the Raleigh Hills Hospitals network, AHS became the largest B. Chemical Aversion Therapy, With Emetine, As An 1/ Raleigh Hills Hospitals employs a 19-step alcoholism treatment program. One of these 19 steps consists of conditioned aversion therapy using emetine as the chemical conditioning agent. Emetine is used solely as a conditioning agent to induce nausea and vomiting in order to associate those unpleasant phenomena with alcohol consumption. It is this single aspect of the entire multi-modality Raleigh Hills Hospitals treatment regimen for alcoholism that drew the attention of the Federal Government, specifically the Department of Health and Human Services (HHS). By way of background, chemical aversion therapy, with emetine, in the treatment of alcoholism uses a learning paradigm known in the psychological vernacular as respondent conditioning. Ivan Pavlov, a Noble Laureate and Professor of Physiology in 1/ In addition to chemical aversion therapy the following other modalities constitute the comprehensive multi-modality alcoholism program: (1) detoxification; (2) medical treatment of organic complications; (3) individual alcoholism counseling; (4) group alcoholism counseling; (5) family counseling; (6) individual education regarding alcoholism and complications; (7) daily medical evaluation; (8) psychological evaluations; (9) relaxation training; (10) bio-feedback training for symptom control; (11) goal planning; (14) (12) assertiveness training; (13) roleplaying, rehearsal; systematic sensitization; (15) identification of psychological illness; (16) depression treatment; (17) nutritional counseling; and (18) aftercare planning and counseling, which includes an introduction to Alcoholics Anonymous (AA) and lifetime aftercare therapy as long as the patient remains sober. the Military Medical Academy of St. Petersburg, reported on a variety of experiments between 1895 and 1924 which established the laws of respondent conditioning. His most famous experiment showed that repeatedly pairing a neutral stimulus with a stimulus that elicited salivation ultimately enabled the neutral stimulus itself to elicit salivation. In this research, Pavlov was simply revealing one of the most influential modes by which animals and humans acquire new response patterns in the face of changed environmental circumstances. As one aspect of the Raleigh Hills alcoholism treatment program, an originally neutral stimulus, beverage alcohol, is repeatedly paired with a stimulus, emetine, eliciting vomiting and nausea. This repeated pairing is necessary so that the neutral stimulus, beverage alcohol, itself acquires the nausea inducing properties of the emetine; when it does so, alcohol is then an aversive agent, one which the patient chooses to avoid ingesting. C. The HEW (HHS) Investigation of the Raleigh Hills Hospitals Program. Starting in 1975, certain officials within the Department of Health, Education and Welfare (now Health and Human Services) began an examination of the Raleigh Hills Hospitals alcoholism treatment program. This examination was a secret directed inquiry, as opposed to the represented inquiry involving broad issues of coverage for all alcoholism treatment programs. It was targeted specifically against Raleigh Hills Hospitals due to the use of emetine as an aversive conditioning agent. Without the use of the Freedom of Information Act, which constitutes the focus of your Congressional examination today, a most effective treatment method for chronic alcoholism might well have been irreparably and permanently harmed, and certainly professionally discredited by what appears to have been a cavalier and highly unprofessional government financed investi gation conducted by certain unfortunately prejudiced and myopic federal bureaucrats. Based upon the facts which I will set forth in my testimony today, AHS and RHH respectfully recommend to this Honorable Subcommittee that it not seriously entertain any proposals which would weaken the responsible use of this most powerful and essential tool as a truthseeking device for ferreting out the discovery of secret and arbitrary administrative actions by government against persons - be they corporate or private individuals. II. INFORMATION ACQUIRED BY ADVANCED HEALTH Medicare coverage has been continuously extended to the services provided by Raleigh Hills Hospitals since 1966, soon after the adoption of the Medicare program in 1965. It is in this connection, as a Medicare provider, that the safety and efficacy of chemical aversion therapy, using emetine, arose as an issue within the Department of Health and Human Services (HHS). Our law firm was retained in early 1980 to represent both Raleigh Hills Hospitals and Advanced Health Systems, Inc. in connection with an ongoing investigative proceeding involvi the Medicare coverage of the Raleigh Hills Hospitals' treatmen program for patients undergoing treatment for the disease of alcoholism. Although we assiduously endeavored to secure information regarding this rather unorthodox investigation directly from government officials involved, we found that their writter and oral responses left us with no alternative but to pursue discovery through the Freedom of Information Act since no viable alternative then existed, short of actual litigation. Con sequently, early in our representation of the client, we file multiple Freedom of Information Act requests with various HH! constituent agencies. Our reason for resorting to Freedom of we Information Act as a discovery tool was that our client, as well as Our law firm, was confronted by the reality that could not secure through traditional channels any information regarding the nature of the inquiry and the very existence of the then-protracted inquiry was having an adverse and dilatory impact not only upon patients and staff, but upon potential recipients of treatment since government officials informally were advising third parties that the treatment delivery system was of a questionable scientific and/or medical efficacy. The information discovered by the Freedom of Information Act requests was startling. Although every conceivable delaying tactic was used by several of the government agencies to preclude us from securing information that we had a statutory right to secure, we finally were able to piece together a most alarming and consistent pattern of government abuse. Much to Our amazement, we learned that the rights of Raleigh Hills Hospitals and Advanced Health Systems had been grossly violated through what appeared to be a furtive, prejudiced and pre-determined investigation of nearly five years' standing targeted solely at AHS and RHH by several officials within HHS. Although the investigation was clothed under an alleged inquiry into alcoholism treatment systems and, in particular, chemical aversion therapy, with emetine, it was, as the multiple documents revealed, a frontal assault upon Raleigh Hills Hospitals and an attempt by certain officials to bring them to their fiscal knees and ultimately to preclude reimbursement under Medicare. These officials clearly knew that a removal of Medicare coverage, although insubstantial in terms of the totality of the cash flow of the corporation, would arouse the spectre of questionable efficacy for the delivery system and thereby potentially cause other third party payors, i.e., the insurance companies, to fol of alcoholism. low the government's lead, thereby adversely affecting the fiscal viability of the Raleigh Hills Hospitals and Advanced Health Systems multi-modality service delivery system for the treatment What was perhaps even more startling was our discovery that no other provider of a similar service was involved in the inquiry and the key government officials who conducted such inquiry had never bothered to ask questions of the entities being investigated. Rather, the government bureaucrats conducting the investigations consistently refused to visit facilities or enter into a dialogue with the medical and scientific expert at the Raleigh Hills Hospitals and Advanced Health Systems facilities for a purpose which became quite obvious as our inquiry continued certain government officials wanted no facts or information which would allow for a disinterested and scientif ically responsible decision. In our judgment, not only did this investigation violate the Administrative Procedures Act, but it also contained several elements of substantive and procedural due process violations guaranteed to our clients under the Fifth Amendment to the Constitution of the United States. We were greatly disturbed to see emerging a pattern of prejudgment emanating from government officials, especially since such activity was not occurring within the context of a bona fide criminal investigation for fraud but rather was appearing under the innocuous banner of an alleged inquiry to determine the efficacy, both scientifically and fiscally, of an alcohol treatment delivery system. One would think that if in fact the government was conducting an efficacy inquiry, there would be some basis of comparison with other systems or there would be an attempt to seek out all of the facts from the principal provider of the system in order to determine whether those facts proffered by the provider and those facts ascertained by the government |