FARGO -- Six recovering drug addicts were abruptly discharged from a state-funded residential treatment program late last month -- a decision that baffled some former staff who claim it was a breach of ethics.
A day after leaving the Sharehouse facility in south Fargo, one of the six patients was found dead from an apparent overdose. He was considered mentally unstable and was one of two men deemed a high-risk to dangerously relapse, according to accounts of former employees laid off last month.
Despite repeated emotional pleas from staff asking for more time to smooth the transition, a supervisor told the patients on a Thursday that they would have to leave by the following Monday, though plenty of beds were available, the former employees said.
The two high-risk patients bolted soon after learning the news. They procured some drugs and ended up at a Moorhead, Minn., motel where the mentally unstable man was found dead on Feb. 26, the former employees said.
The man who died was Shawn Randall Hansen, his family and friends said.
Hansen's sister, Barbara Olheiser, said she hasn't received an explanation as to why Sharehouse officials decided to put her 42-year-old brother on the street.
"I want some accountability because these people were supposed to be taking care of him," said Olheiser, who lives in a Phoenix suburb. "I'm going to find an attorney, and I'm going to go after them."
The exact reason for the discharges is elusive. But they seem linked to changes at Sharehouse that have significantly reduced the average length of stay for patients, like the six discharged, who receive residential treatment paid for by the state of North Dakota.
The shorter stays come amid hard financial times at Sharehouse, a nonprofit group, which recently laid off 25 employees and saw its state funding for residential care cut.
Pam Sagness, director of North Dakota's Behavioral Health Division, said she was not aware of the situation involving Hansen and the five other patients until The Forum brought it to her attention. She said her division will conduct a review of what happened.
Asked about the discharges of Hansen and the others, Sharehouse CEO Nate Medhus said federal privacy laws prevent him from confirming or denying any details about a patient's care. He said the same laws bar him from addressing the question of whether Sharehouse bears any responsibility for Hansen's death.
Why the rush?
CEO Medhus said he could only speak in generalities. "There are circumstances occasionally when a client doesn't feel that they're ready to leave," he said. "Sometimes clients leave against our staff advice before the entire discharge plan can be communicated."
The former Sharehouse employees said when they asked why the discharges were happening so quickly, their supervisor, residential treatment director David Collins, told them the reason was "the state," and did not elaborate.
Sagness, the state official, said she doesn't know what Collins meant by that comment, adding that the state exerted no pressure on Sharehouse to discharge the patients. Multiple phone messages left for Collins at Sharehouse were not returned.
The Forum learned of the discharges and Hansen's subsequent death from four former Sharehouse employees, who requested anonymity for fear of negative effects on their careers. The four were among 25 employees laid off on Feb. 29, the same day the discharged patients had to leave. Medhus said the layoffs were not related to the discharges.
Hansen and the others discharged from Sharehouse were part of the Robinson Recovery program, which serves North Dakotans who can't pay for residential treatment out of pocket and don't have insurance to cover the cost. Sharehouse holds the state contract to run the publicly funded program, which mostly treats those with severe addictions to meth or opiates, including heroin.
Sharehouse closed its Robinson Recovery Center in the fall, but the program has continued with Robinson patients being housed by gender in the Sharehouse men's and women's buildings, alongside patients who have private insurance and Minnesota state vouchers. What's now the men's building was previously the Robinson Recovery Center, where all Robinson patients were housed, Medhus said.
Over the years, the Robinson Recovery Center was known as a long-term residential treatment program, where stays lasted four months up to a year or more. The length of stay now averages 45 days, Medhus said.
Sagness said the state does not have a minimum or maximum requirement regarding a Robinson patient's length of stay. How long a patient remains in residential treatment is up to Sharehouse, she said.
Medhus said there's no set timeline for a patient's stay in the Robinson program. He said the recent move toward shorter stays brings the program in line with how Sharehouse treats residents who pay with private insurance or have a Minnesota voucher.
The new approach came as a result of the Robinson program's limited funding and the need for Sharehouse to prove that patients have a medical need to be admitted into residential treatment and are meeting the criteria to continue receiving it, Medhus said.
"The goal isn't to turn people away, but we do have a responsibility to make sure that we have the right people in our facilities at all times," he said. "Just because we have bed availability doesn't mean we can just cram the beds full of people that really are clinically appropriate to be at outpatient services."
The former employees say the changes in the Robinson program that have led to shorter stays do not justify or explain the abrupt discharges, which they believe went against a promise Medhus made months ago.
Hansen and the five others were part of a group of about 30 Robinson patients who in the fall, when the future of the program was in question, were told by Medhus that they would be able to stay "as long as clinically appropriate" regardless of the cost, the former staff members said.
Medhus confirmed he made this promise, and he maintains he's kept it. The former employees and Hansen's sister disagree.
"Broken promises can lead to broken dreams, and broken dreams can lead to loss of hope," Olheiser said.
Hansen and the other discharged patients had been in the Robinson program for varying lengths of time. Some had started treatment in late summer or early fall, while others had been there longer.
Hansen had been a Robinson patient for about 11 months, and while the former employees acknowledge he was reaching the end of his treatment stay, they say his discharge happened too soon.
"He was preparing for four weeks. He wasn't preparing to be dropped on his butt with nothing around him," his sister said. "He was trying to make preparations because he knew his treatment was coming up. He wasn't given the chance. He was just kicked out."
'Punch to the gut'
On the afternoon of Feb. 25, two of the former employees, both social workers, said they received a strange and sudden request from Collins, their supervisor. He wanted them to evaluate the files of the six patients and determine whether it was a medical necessity that they stay in residential treatment.
The social workers said that because they're not licensed addiction counselors, they're not qualified to make such findings. They had contributed to team discussions about past discharges, but they had never before been asked to make hasty recommendations about patients' futures on their own.
They said the patients' addiction counselors should have been involved. But as it turned out, just one patient of the six had a counselor there that day; the other counselors were not at work.
When the two social workers later met with Collins, they both made tearful defenses of why Hansen and the other high-risk patient needed to be in residential treatment. But Collins, who holds an addiction counselor's license, quickly overruled them, and they came away with the sense that the discharging decisions had been made ahead of time.
"It felt like a big punch to the gut because I felt that what was going on wasn't right," one social worker said, noting that all six patients wanted to stay in residential treatment. "In the abruptness of what they did, a life was lost."
The other social worker said Hansen had a mental health crisis earlier that day and a psychologist told her she had to figuratively "talk him off the ledge."
That social worker said that after Hansen died, the patient who left with him returned to Sharehouse where he told her that they had used drugs.
She said she felt that some of the patients on the list were ready to move on, but she disagreed with the speed with which Sharehouse was discharging them. She said discharges are usually done gradually, giving patients a week to two weeks of notice before they're discharged with a place to live, a job, transportation and community support.
However, the short notice in this case did not allow staff enough time to even make housing arrangements for everyone, including Hansen, she said.
It's unknown what became of the five other patients after they were discharged. Attempts to reach them were unsuccessful.
"We were setting them up to fail in an unsafe environment," she said.
Bobbi Griffin-Stinson, Sharehouse's director of policy and quality assurance, had a different answer to the question of how much notice patients receive before they're discharged. She said it varies, but it's usually less than a week.
Bill Sparke retired in November as director of the Robinson program. He said he doesn't know the details of what led to the six discharges. But he believes that what happened can be traced back to decisions Sharehouse made as a result of funding shortages.
"This guy overdosing, I think we can go back to not receiving enough funding from the state to even break even providing treatment," he said.
Ever since 2005, when the North Dakota Legislature passed a bill that set aside money to create the Robinson Recovery Center, the program has been underfunded, Sparke said.
There's always been state money to run Robinson, Sparke said. But it wasn't enough to cover Sharehouse's expenses, so the organization subsidized the program.
Medhus, who became CEO in 2013, says Sharehouse's rising costs and flat revenues mean the days of subsidizing Robinson are over. "As a nonprofit, we're not here to have a big, fat bottom line, but we do need to have a responsible business plan," he said.
In the 2013-2015 biennium, Sharehouse received about $65 per day per bed to run the Robinson program, with a requirement of having 45 beds. Under a renegotiated contract, Sharehouse now gets $190 per day per patient, with no set number of beds.
This higher rate came after the state requested bids for the Robinson Recovery contract last summer, and no one, including Sharehouse, bid on the contract, the terms of which Medhus viewed as a losing proposition for his organization.
In the last legislative session, the pool of state money for the Robinson program was increased, but that money went away -- a 10 percent cut -- after Gov. Jack Dalrymple ordered most state agencies in February to slash their budgets by just over 4 percent in the face of a $1 billion revenue shortfall blamed on slumping oil and farm commodity prices.
So while Sharehouse can now bill the state at a significantly higher rate for Robinson patients, its funding level is roughly the same as the last biennium. This means the program can't accept as many patients as before.
Medhus said there's no target number of patients. But if Robinson takes on too many, the money could run out before the contract ends, he said.
As of last week, there were 19 patients in the program. Medhus said there are beds available, so more people could be admitted right away.
'We all feel it'
Behind Shawn Hansen's infectious smile was a man who struggled with drug addiction and depression for much of his life, moving in and out of halfway houses and treatment centers.
In spite of all this, he was known as a guy who was always joking around, trying to make others laugh.
"He was hilarious," his sister said. "When you were walking around with him, you were with the cool people."
Hansen, who grew up in Phoenix, was single and had no children. In 2009, he moved from Ohio to Bismarck where his sister's family was living at the time. He later moved to the Fargo area where he worked as a welder, his sister said.
Dylan Kerr, 27, said he became close with Hansen while they were in treatment together in the Robinson program. Kerr said they would pick each other up on difficult days.
"We stuck together, and we helped each other out," said Kerr, who completed treatment in December.
While in treatment, Kerr and Hansen would sometimes enjoy a cigar as they drove around listening to hip hop and rapping freestyle. "It was a way for us to verbalize and express exactly what was going on with us," Kerr said.
Brian Dean, 42, also spent time in the Robinson program with Hansen. Dean, who finished treatment last summer, said Hansen's deep religious faith was a constant as he battled to get clean. "He fought for a long time," Dean said. "He's not at war anymore."
Hansen's death was reported to Moorhead police at about 9 p.m. on Feb. 26. An acquaintance had discovered him dead in a room at the Grand Inn Motel, Lt. Tory Jacobson said.
Hansen's sister said police told her that her brother was found dead in bed. The only thing on him was his wallet. His truck was impounded. And his body was taken to St. Paul for an autopsy.
Jacobson said no foul play is suspected. As police await the results of a toxicology test, they are investigating Hansen's death as a possible overdose, the lieutenant said.
Joe Moran, a 38-year-old who befriended Hansen through a 12-step program, said his death has touched the entire community of recovering addicts.
"When one of us dies, we all feel it," Moran said, "because we all know that could be us."