VICE editor Wilbert L. Cooper explores the peculiar and troubling side of the "for-profit" addiction-treatment industry.
Ted Jacques enrolled his son, Brandon, in what he thought was the "best treatment center money could buy"—A Sober Way Home in Prescott, Arizona—in February 2011, not long after Brandon's mother, Kim, discovered the 20-year-old sprawled out and unconscious on the bathroom floor. He had just sucked down a red Solo cup filled to the brim with Crown Royal, and the booze sent him reeling to the ground. It didn't help that Brandon's belly was likely empty from forced vomiting. Kim rapidly unlocked the door after hearing the sound of her son's body smack the linoleum. The shower was still running, Brandon's eyes had rolled into the back of his head, and blood was trickling out of his mouth. It was a horrifying wake-up call, but just one of the many wrenching episodes related to Brandon's years of bulimia and alcoholism.
For $14,500, A Sober Way Home assured the family that it could treat Brandon's dual disorders. His particular condition required a high level of care and monitoring because of the debilitating effects of purging, which can cause the body to have an imbalance of essential electrolytes that can impair the functions of the heart. Substance abuse like alcoholism, which affects about 50 percent of all people with eating disorders, and binging and purging can be a fatal combination.
Despite A Sober Way's assurance that it could care for Brandon, his vomiting continued, and his drinking was just barely kept at bay while he was in its care. After he spent a month at A Sober Way, the organization admitted to the Jacqueses that it could not properly treat their son's eating disorder. Instead of recommending that he get medical care at a hospital, A Sober Way officials beseeched the Jacques family to send their son to another residential rehab facility in Newport Beach, California.
The second facility, called Morningside Recovery, barred Brandon's parents from communicating with him. While Brandon was there, his binging and purging got even worse, and he was caught secretly drinking booze. Toward the end of his stay, and without his parents' knowledge or consent, Morningside officials moved him out of their inpatient facility and into a small nonmedical detox center on the other side of town called First House. Here, Brandon went into cardiac arrest on April 2, 2011, and died. Because of the lack of communication, his parents had no idea that he'd even been transferred to a different rehab center—much less that Morningside passed patients like Brandon to First House with the added bonus of kickback cash.
In the United States, more people between the ages of 25 and 64 die of complications from drugs than car crashes. According to a 2009 study published by the Substance Abuse and Mental Health Services Administration, 23.5 million people in this country over the age of 12 need treatment for drug and alcohol abuse, and only 2.6 million of these afflicted individuals actually receive it. In response, drug and alcohol rehab has blossomed in the past three decades into a $35 billion industry with nearly 15,000 facilities across the country. Although non-hospital residential treatment serves only about 10 percent of those in recovery in the US, the exorbitant cost of such care—as high as $75,000 a month—has made it extremely lucrative. And thanks to popular TV shows like Celebrity Rehab, which have installed the luxurious rehabilitation center in the popular consciousness, the national enrollment figures keep growing.
Yet in many states, the laws regulating the industry have been unable to catch up to this new breed of for-profit rehab facility. Despite their popularity, these centers operate in a gray zone somewhere between legitimate medicine and total quackery, offering things like horseback riding and meditation as solutions to addiction, and often promising medical care that they are unable to provide—sometimes with disastrous results.
Stricken with grief, it took a long time for the Jacques family to think that anything but an unavoidable tragedy had befallen their son. They didn't start asking questions until they got an email on January 6, 2012, from former Orange County Register reporter Jon Cassidy. Cassidy, who's now with the investigative site Watchdog.org, had acquired internal emails that spoke of the financial incentive the institutions had for transferring Brandon from facility to facility. These moves, one of the emails implied, were motivated by greed rather than medical need. In the email—which had allegedly been written by one of Brandon Jacques's caretakers—the author likened the way they treated the 20-year-old to a "piece of meat."
Ted Jacques at the 160-acre family farm he bought so he could spend quality time with his son, Brandon, hunting and riding motorcycles and ATVs. Ted sold the farm not long after Brandon passed away. Photos by Barrett Emke
Kearney, Missouri, is about 30 minutes outside Kansas City. Until he was sent to rehab, Brandon Jacques lived in his family's house in an upscale neighborhood there called Holmes Creek, attending the local Park University and working for his dad's contracting company. His parents still live there. Their McMansion occupies its own cul-de-sac, sitting atop a green knoll with an in-ground pool in the back. Out of the perfectly manicured lawn protrudes a 20-foot beam hoisting two fluttering flags. The top one is Old Glory. The bottom flag features a pixelated image of their late son in front of his shiny black pickup truck with the words see ya later.
Inside the house, Brandon's room is exactly as he left it: His black dresser is covered in dozens of dietary supplements, fat burners, and muscle builders in colorful powders and pills with names like Pro Complex, Xtend, and Mega Men. It looks as though someone robbed a GNC store or Mark McGwire's locker.
On his desk is a Bible and a card from his big sister, Heather, with a plaintive message for Brandon scrawled out in dark blue ink: "You don't need to worry about trying to live up to anybody's idea of what you should be."
Brandon was born in 1990 and was the family's only boy—a precious pigeonhole of a position in a family built on traditional values, with a roughneck father who wanted a son who could one day fill his work boots. As a kid, Brandon was doted on by his mother, and he constantly mimicked his dad. He would try to do anything and everything that Ted did—even working with him on the family farm when he was just barely able to stand up. Ted took him on site and let him operate the excavators when he was only ten.
"He was a risk taker from the very beginning," Heather says. "That's what I always admired about Brandon."
As a teenager, Brandon was probably the only male fashionista at Kearney High School. Friends remember the way he used to show up to overnight get-togethers in the town's backwoods, where kids would meet up, drink cheap beer, and sleep in the beds of their pickup trucks under the stars. Most of his pals would come to the parties in dirty boots, blue jeans, old T-shirts, and trucker caps. But Brandon would rock his signature green, pointy-toed Steve Madden alligator boots and Hollister button-down shirts. His senior year, there was even a full-page picture of him in the yearbook looking like a blond Marky Mark, exhibiting a fussiness not appreciated in a town where camo, ballistic black, and hunting orange are the preferred clothing colours for men.
"He didn't get it from me," Ted says.
"Brandon was always my first, and I was always his first for trying everything," says Brandon's closest friend, Ridge Quarles. "We never hid anything from each other." The boys first met at a friend's birthday party when they were in the fourth grade. "It was a pool party, so everybody was swimming. But both Brandon and I were overweight. We looked at each other and knew immediately there was no way either of us was going to get in the water without our shirts on."
Despite being overweight, Brandon was always popular, thanks to the legacy of his cool older sister and the swagger he'd inherited from his dad. But the extra weight he carried on his bones hung heavy over him—especially right after he would gorge himself on a whole box of pizza or chug an entire gallon of chocolate milk.
Early on, he had an awful revelation. "When we were in seventh grade," Quarles says, "he came to me and told me he'd discovered a new way to lose weight. He said, 'I just eat it and then throw it up, and it's like I never ate it.' When you're young and you don't know about that kind of thing, it seems like the perfect solution."
A memorial flag flies high near the Jacqueses' family home—one of the many reminders that their son is gone for good.
Brandon started rapidly losing weight around the age of 13, but his parents weren't suspicious. After all, he was active in sports, notably joining the wrestling team in his early teens. His new virile physique, however, hid a terrible secret. When his parents caught him in the act of vomiting one day in junior high, they confronted him. Ted and Kim were downstairs, and they could hear the sounds of Brandon heaving and retching in his second-floor bathroom. They came up the steps and swung open the door to find him bent over the porcelain seat. But he explained it away quickly—he said he was just puking to make weight for wrestling. After that incident, Brandon's battle with food fell out of sight and became unspoken, precisely because he looked like he was doing so well.
"He was very much the athletic, outgoing type of person in high school," remembers a former classmate. "He was a jock... all about working out. It was obvious that he cared about his body image."
By the tenth grade, Brandon had also started to hit the weights. Soon Brandon's arms were pumped up like a pair of Reebok sneakers, and his abs looked like two rows of hot cross buns. He was an only slightly smaller version of the chiseled and oiled men who posed on the covers of the Muscle & Fitness magazines that piled up next to the toilet he puked in after nearly every meal.
"We did everything together. So I even did it with him a few times," Quarles says. "But it was something I couldn't do consistently, 'cause it made my head ache and my throat hurt. Through our whole friendship, I stayed overweight while he kept losing."
According to Quarles, Brandon became so adept at puking that all he needed to do was bend over for half-eaten food and stomach bile to launch out of his mouth. On some of the afternoons his parents thought he was just going to Eagle Fitness, Brandon and Quarles would actually go across the street to LaMar's Donuts, order two dozen glazed, eat them all in one sitting, sneak behind the bakery to vomit them back up—and then go lift weights.
Few people but Quarles knew about Brandon's secret—or at least they didn't want to know. There are friends he had in school and around town who still have no idea he had an eating disorder—a problem most people usually associate with waify girls, not tough-looking dudes like Brandon. While only 10 percent of people with anorexia or bulimia are men, according to a study conducted by the International Journal of Eating Disorders, 7.5 percent of all men in the US have participated in some level of binge eating—one central facet of Brandon's behavioral disorders.
Brandon's cycle of binge eating and vomiting never reached a fever pitch—instead it bubbled under the surface. Nonetheless, some close friends of his explained what was going on to his counselor at Kearney High. When the counselor confronted him, Brandon had nothing to say. So she left it with the parents, hoping they would find some way to address the issue.
But in the Jacques family, everything was muted. The Jacqueses pulled Quarles aside one day, and he opened up about what Brandon was doing in toilet bowls, showers, and the parking lots of fast-food joints. But as Heather puts it, "I think there was something in me that didn't want to believe. I didn't want to let my mind wander down that path."
What cut through and put his pathologies at the feet of the Jacqueses was the booze. The bulimia had been going on for years and might have continued unfettered had it not been for the alcohol. As in many rural communities in America, the drinking culture is intense in Kearney.
"We're all from a very small town," remembers one of Brandon's classmates. "Field parties are what we did."
However, Brandon became a serious alcoholic after high school graduation, in 2010. He was living at home and attending Park University, a small school in Parkville, Missouri, where he was studying business so that, as his father says, he could one day run the family contracting company.
Things imploded fairly quickly. Brandon was caught driving drunk after a night out with friends and was arrested by the local Kearney police. It was his first of two DWI charges, and one of the first times he had ever been in any serious trouble.
After that, Brandon began drinking at home, alone—before eating to numb his hunger, or after overeating to numb the shame and disappointment, Kim says. When he was drunk, he wasn't himself. "He wasn't even being Brandon anymore," Quarles says. "He was no longer the guy I knew who was always a happy person and down to have fun." Instead, according to Heather, when he drank he was "internally angry and closed off."
Quarles remembers the night he realized Brandon was too far gone. He was visiting Kearney from his college in Louisville, Kentucky, in August 2009, and called Brandon to get together—they'd typically go kick it at the Sonic drive-through in their trucks until other friends showed up, and then they'd figure out something, if anything, to do.
"I was getting ready to pick him up at his house," Quarles says. "I called him, and he said he was just going to jump in the shower. I said, 'All right, I'll be over in ten minutes.' When I called him back to tell him I was going to leave my house, Kim picked up the phone and was frantic, saying, 'Ridge, I don't know what the hell just happened, but I found Brandon on the bathroom floor, throwing up blood, and his eyes were rolled in the back of his head."
The paramedics took Brandon to Liberty Hospital. "I remember sitting in the waiting room, holding hands with Kim, bobbing back and forth," Quarles says. "Then the doctor came out, and he looked at Kim and said, 'I need to talk to you.'"
While in the ER, Brandon was given an electrocardiograph that revealed abnormalities in his heart's electrical cycle, likely related to a lack of potassium created by his bulimia. At the time, his potassium level was 2.8—normal levels range between 3.7 and 5.2 milliequivalents per liter. The doctor recommended that he be admitted to a hospital because she was concerned he could develop life-threatening cardiac arrhythmia, which could lead to cardiac arrest.
After that, it wasn't long before Brandon dropped out of college, having completed only one semester. Brandon's parents pushed him to start taking steps to turn his life around, from hiring a psychologist to having him detox and do residential treatment at a small, local nonprofit addiction center in Kansas called Valley Hope in November 2010.
Private nonprofits like Valley Hope operate 71 percent of all addiction-treatment facilities in the US, while private for-profit programs, like the ones Brandon would go to later, operate only 21 percent-the government takes on the rest. Nonprofits tend to steer clear of the luxurious creature comforts that for-profit centres use to attract patients, and they are more likely to be operated by hospitals (though Valley Hope is not).
In Brandon's first 36 hours at Valley Hope, he suffered a seizure caused by alcohol withdrawal and had to be taken to an emergency room and hospitalised. This incident, along with the one-two punch of his dual diagnosis of alcohol abuse and bulimia, proved to be too much for the facility to feel like they could properly care for him. He hadn't even finished his planned monthlong stay there before they recommended that he get help somewhere else.
Brandon left Valley Hope and returned to his parent's house, where he spent the winter. In February 2011 he had an epiphany. He was sitting at the family's long wooden kitchen table in the middle of the night, streaming an episode of A&E's Intervention on his MacBook.
Brandon's parents joined him at the table to watch a few episodes of the show. They sat in silence, watching the cycle of forsaken addiction and redemption play out over and over again, episode after episode, streaming across the screen.
"We watched three or four episodes," Ted says, "and then my wife turned to Brandon and asked, 'Would you like to go to one of these places?'
"Brandon said, 'Yeah.'"
The images of hulking, glistening men that fill the pages of publications like MuscleMag International embodied everything that Brandon so desperately desired.
A Sober Way Home wasn't like Valley Hope. It was a for-profit facility. It had been on Oprah. And it was featured on several of the Intervention episodes the Jacques family had watched that morning. The moment Brandon said he was willing to give the place a try, his mother got up and made the call. After finding out there was a bed available for Brandon, the family flew from Missouri to Prescott, Arizona, the next day.
Typically, when a treatment facility like A Sober Way Home admits a new patient, it does what is known as an intake. An intake is supposed to consist of in-depth evaluations of the potential client's medical history to get a grasp on the kind of care he needs and whether the facility can actually treat him. Unfortunately, at for-profit facilities the in-take is often administered by staff counselors rather than medical professionals. And in the for-profit realm, there is a heavy emphasis on following the mantra of "keeping heads on beds"—a phrase rehab entrepreneurs actually use—and not turning away paying clients even though they may need a higher level of care than a facility can offer. As Dr. Akikur Mohammad, the owner of Inspire Malibu, a high-end Southern California rehab center that boasts a former salesman as its admissions director, says, "When you are in a business for profit, sales is involved. We have to sell the treatment—because of the competition."
After a short breakfast, a tour of the facilities, and a meeting with counselors, Brandon signed up for a 30-day stay at A Sober Way Home. The facility was opened in 1999 by Sandra Tillman, a former addict who's been sober for 26 years, and charges $14,500 a month.
The model of care practiced by rehab facilities like A Sober Way Home has its roots in Alcoholics Anonymous, the religion-tinged, 12-step group-therapy program for addicts that was developed in the 1930s. Today, an estimated 98 percent of all rehabs in the US are 12-step-oriented, and 78 percent actually use the 12-Step Facilitation model. This happened because the model had much better results than other methods of its era, like lobotomy and hallucinogenic drugs. So in the 1950s, at Hazelden Hospital in Minnesota, psychologist Daniel J. Anderson combined AA's 12 steps and group meetings with psychological counseling and laid down the blueprint for modern-day rehab treatment. Despite a lot of window dressing and posturing, not much has changed.
A Sober Way Home is composed of 16 different homes catering to about 85 addicts and employing 75 staff members, including one medical doctor and one psychiatrist. They offer a detox and inpatient program that, according to Tillman, involves AA meetings, an unproven practice called neurofeedback therapy (which aims to map out electric activity in the brain to help an addict control his impulses), and "equine therapy" (in which the patient plays with horses).
Although Brandon came there with an addiction to alcohol and an eating disorder, the Jacqueses claim A Sober Way insisted from the very beginning that they could provide all the necessary treatment to fight both issues. Their website boasts that they can take on patients with other disorders accompanying their addiction, ranging from mild depression to bipolar disorder.
"They said their main focus was getting the alcohol addiction stopped first and then working with the disorder," Ted says. "At that point, leaving my son that far away from home in a facility was the hardest thing I'd done in my life. But they really made us feel good. As we were leaving, they said, 'You can just take a big breath of fresh air—he's safe.'"
At first, Brandon did well at A Sober Way Home. "Over the phone," Ted says, "he made comments like, 'Gotta get going here and get registered back into college because otherwise I'm going to be thirty-five years old before I get my degree.'"
But progress started to stall during the second half of his monthlong stay. Brandon was caught eating the food of other clients. Then, on the 29th day—one day before he was scheduled to go home—counselors called the Jacqueses, saying that Brandon would have to continue inpatient treatment in order to get better. They strongly recommended a rehab center in Newport, California, called Morningside Recovery.
The Jacques family in Brandon's bedroom
According to a former employee of Morningside who spoke to me on the condition of anonymity, transfers like Brandon's were often steered by greed, not need.
"They were making referrals back and forth [between A Sober Way and Morningside]," the former employee says. "Morningside calls it 'consulting referrals.' You refer a client to Morningside, and they pay a ten percent fee of what they get paid... The majority of the time the cash is going to the owner [of the facility]... or to the director of admissions."
In the United States, kickbacks or "fee splitting" in medicine has long been seen as an unethical practice. A letter to the editor of the New York Times by A. S. Draper from Albany in 1912 discussed the subject, stating, "The patient is defrauded by the physician whom he trusts and robbed by the aid of a specialist, and both physician and specialist are corrupted."
On a federal level, there are key legislations—the Stark law and Anti-Kickback Statute—that make it illegal to engage in kickbacks when payment comes in the form of federally funded Medicaid and Medicare. Meanwhile, state laws protect citizens to varying degrees. In California, kickbacks like the "referrals" described by the informant are illegal. According to the state's Business and Professional code, Section 650, "Any rebate, refund, commission, preference, patronage dividend, discount, or other consideration, whether in the form of money or otherwise, as compensation or inducement for referring patients, clients, or customers to any person, irrespective of any membership, proprietary interest, or coownership in or with any person to whom these patients, clients, or customers are referred is unlawful." Arizona's state laws feature nearly identical language, with a section specifically targeting "behavioral health" businesses like A Sober Way Home.
I confronted A Sober Way Home founder Sandra Tillman about the former Morningside employee's allegations, outlining the individual's claim that a kickback for transferring Brandon from A Sober Way Home to Morningside had been set up between one of her employees and an employee of Morningside. Tillman seemed caught off guard. She claimed to have been unaware of the fee-splitting deal at the time it was made, but confirmed to me that a kickback had been discovered and had likely played a factor in Brandon's transfer. She also confirmed that the employee allegedly responsible still worked for her at the time of our interview.
Naturally, neither A Sober Way Home nor Morningside revealed the alleged kickback to Brandon or his parents. Instead, A Sober Way employees Pete Stewart and Lori Kidd told the Jacqueses they wanted to move Brandon because, they claimed, A Sober Way couldn't effectively treat his eating disorder—which raises the question, why did they accept him into their care in the first place, since they knew he was a bulimic from the very beginning? Now that things had gotten serious, they wanted to pass him off to another facility. But instead of recommending that the Jacqueses take Brandon to a hospital, his admitters referred him to a place they had a financial relationship with.
Morningside costs $25,000 a month, which is $10,500 more than A Sober Way. Based on information given to me by the informant, this transaction would have yielded a referrer at A Sober Way $2,500, an amount that could taint any recommendation.
Regardless of the price increase, as a concerned father Ted was glad to pay more if it was going to help Brandon get his life back on track.
"They wanted him to move in that day, so we had to lock down a flight," Ted says. They took Brandon to the airport, and he flew out. He landed at John Wayne Airport in Santa Ana, California, on March 14, and Morningside picked him up. It all happened so fast, but the Jacqueses were reassured that Morningside would be the right place for Brandon, not just by A Sober Way's referral but by Morningside's own testimonials.
"When we were looking at the website before we sent Brandon out there," Ted says, "it talked about a doctor, Theodore G. Williams, and a nurse practitioner, Jill Shelton. The website made it look like they were at that facility."
Little did the Jacqueses know that it's illegal for residential drug and alcohol programs like Morningside to provide any medical care in the State of California, because of an old, controversial law that is a vestige of the rehab industries' AA-based, nonmedical beginnings. Morningside, as many facilities do in the State of California, was operating on the fringes of the law by independently contracting work from physicians. Since these physicians are not legally allowed to be on staff, they are often employed at multiple facilities at a time. In Shelton's case, she was contracted to at least one other facility, a treatment center in Costa Mesa called the Pat Moore Foundation, at the time that she was working for Morningside.
Instead of being on site at least 40 hours a week, as one might expect from looking at the testimonials and websites, these physicians have select, designated days and times when they come in to see patients. A former Morningside employee who spoke to us on the condition of anonymity described a contracted physician like Shelton coming in a couple times a week from 9 AM to noon. In reality, much of the care in these facilities is actually offered by recovering drug addicts with little more than GEDs and counseling certificates from degree mills.
Because the State of California has done such a poor job of enforcing the ban on in-house professional medical care, facilities like Morningside get the best of both worlds—they can market themselves as medical facilities to attract more clients without fear of getting shut down, but they don't have to spend the money on medical care or jump through the regulatory hoops required of a facility practicing medicine.
Morningside is not the only California clinic with egregious violations. A comprehensive report compiled by the California Senate Office of Oversight and Outcomes in 2012 outlined numerous repeat-offending facilities that had multiple deaths on their watch, and several citations related to practicing medicine, yet were still allowed to operate. Among these was the Living Center in Modesto. In 2010, a former staff member of the Living Center told a state official that one client had been kept at the facility even though he needed to be sent to a hospital, just so the Living Center could make more money. A year after being reported to the state, the treatment center was still operating and admitted another client who was visibly in need of medical care far surpassing what they offered. At the client's intake, which was conducted by someone who was not a physician, his eyes and skin were yellow, and he was so dizzy he couldn't walk by himself. Eventually, they sent the sick man to a hospital, but at that point it was too late, and he died.
In addition to citing that death, the state revoked the Living Center's license to provide treatment in August 2013 for a variety of violations that included admitting suicidal and bipolar clients who needed hospital care, providing medical care it was not licensed to offer, employing people who've failed background checks, and admitting clients under the age of 14. The state issued the facility a cease-and-desist notice in June 2013, but it remains open.
Brandon inherited his motorcycle skills from his father, who let him bounce a Yamaha XR80 over dirt mounds around the family farm when he was only ten
The Jacqueses had virtually no contact with Brandon once he was transferred to Morningside. Like many rehab programs, Morningside allowed him no phone privileges during the first week of his stay. According to Ted, they also deny clients the use of the center's phones in order to keep the lines open for staff. Desperate to talk with his son about the transition and his health, Ted sent down a cell phone for Brandon to use. But Ted never received a call. Morningside said they denied Brandon access to the phone because he was caught with alcohol in his system.
"His counselor said, 'Well, evidently he gave somebody twenty dollars to go out and buy some alcohol and told him to keep the change.' I said, 'Where'd he get the twenty dollars? How did this happen?'"
The Jacqueses had planned to visit Brandon the second weekend in April. They would have visited sooner, but a Morningside counselor told them to hold off.
"At A Sober Way Home we talked to him quite often. But once he transferred to Morningside, I personally did not get to speak with him at all. And the communication was terrible."
On March 18, Morningside's lab tests revealed that Brandon's potassium level had fallen to 3.3, below the normal range. At that point, however, he was not prescribed anything to supplement his potassium. It wasn't until four days later that another nurse, who was contracted by Shelton, prescribed Brandon something for his decreasing potassium levels—some multivitamins.
On April 1, Ted got a rare call from one of Brandon's counselors at Morningside, saying they thought Brandon should be moved again. They said his potassium levels were low and that they had started to give him potassium pills. They thought it might be a good idea to send him to Reasons Eating Disorder Center, in Rosemead, California, for a more intense treatment for his binging and purging.
"I said, 'Wait, I thought you guys were supposed to be taking care of the eating disorder.' I told her, 'I want him to go to the best possible place. I don't care where it is.' She told me that Brandon was not in danger and that she was monitoring his levels."
Unfortunately, Brandon was in grave danger. According to Morningside's own records, the day before they called Ted, Brandon's potassium levels had sunk to a dangerous level of 2.9—only one tenth of a point higher than the night his mother found him unconscious on the bathroom floor.
As far as Ted and Kim knew on April 1, Brandon was OK and would likely get moved the following week to another facility, again with the promise that their son's dual disorders could be treated there. But Brandon had in fact been covertly moved the day before his father got that call from the counselor. Morningside hadn't transferred him to a local emergency room or an eating-disorder center in a hospital. Instead, they'd quietly shuttled him to a facility called First House Detox in Costa Mesa. While Brandon was at First House, his parents still didn't hear from him.
According to records kept by the facility's employees, Brandon frittered away his time at First House interacting with the other clients, reading, smoking cigarettes outside, and catching up on sleep. And according to a deposition given by owner Richard Perlin, Brandon received absolutely no counseling or treatment while he was in First House's care, which is puzzling considering his most recent lab work showed he was at risk of sudden death from cardiac arrest.
But the lack of treatment he received would be less surprising to anyone familiar with First House. The place was a well-known treatment center of disrepute when Morningside sent Brandon there. The business comprised three different detox houses, with one staff member and six beds per house. Its owner, Richard Perlin, is a former drug addict and convicted felon. In 2008, First House was cited for not checking often enough on a client who was going through withdrawal. Three months later, another client died in their care, and it was determined after the client's death that he hadn't been monitored in accordance with their stated policy. In 2011, a few days before Morningside secretly sent Brandon there, another client died on their watch. The First House employees checked on that guy at least three times before they finally realized he was dead.
The day after Ted's conversation with Brandon's counselor at Morningside, Brandon spent a good portion of his time relaxing in the living room of First House with fellow client David Falk, watching a movie on the television. In between 3 and 4 PM, true to his obsession with burning calories, Brandon hit the floor for a quick set of 30 push-ups. Then he rolled over on his back. It was there on the floor that he went into cardiac arrest and his lips turned blue.
David Falk shouted for help, and staff member Greg Epilone came into the room, saw Brandon on his back, and called 911. He then tried to give Brandon rescue breaths and the "cardiac thump," but all he could find was a weak pulse. They placed a pulse oximeter—a noninvasive oxygen monitor—on Brandon's hand to gauge his vitals, but the readings were coming in on a steep decline. The paramedics showed up three minutes after Greg had made the call. They tried CPR and then shocked him several times with the defibrillator. After ten minutes of efforts with IVs and the AEDs, the paramedics loaded his body onto a gurney and finally took him to the hospital, where he was pronounced dead at 5:20 PM.
That night, Ted was eating a tenderloin steak at the Landing Eatery & Pub in Kearney with Kim. The Missouri Tigers basketball team was playing. Ted and his wife's cell phones were blowing up with frantic calls, but the sound of the game coming from the big screens drowned out their rings. When the family got home from dinner, Kim and Ted saw they had several voicemails from an unfamiliar number on their house phone. The messages were all the same: "Call Hoag Hospital, in Newport Beach, California."
One of the many portraits of Brandon that rest on every mantle, hang on every wall, and clutter every shelf in the Jacqueses' home.
Ted and Kim flew to Los Angeles in a complete daze. It didn't feel real—they hadn't spoken with or seen their son in weeks thanks to Morningside's policies, and they had no idea what his living circumstances were like during the previous month.
"David Gates [the former CEO of Morningside] met us outside the hospital," Ted recalls, "and wanted to talk about giving us credit back. He just kept going on and on about it until I shut him down and said, 'Look, man, I don't want to talk about money.'"
(Officials from Morningside and First House would not respond to VICE's multiple requests for interviews.)
Once inside the hospital, Ted talked with the physician in the ER who had pronounced Brandon dead—Dr. William H. Cloud. According to Ted, Cloud said something that stuck in his mind, telling the family that Hoag Hospital gets kids from rehabs all the time who die or suffer serious health complications as a result of the lack of care in those facilities.
After seeing Brandon's body, the Jacqueses sat down with Gates, who insisted on having his attorney present. Ted hadn't seen Brandon in two months and hadn't heard his voice in one, so he understandably wanted to see where his son had been living and talk to the people who knew him in his last days.
"And then it finally came out. He wasn't at Morningside when he died. He was at some place called First House."
Ted says that Gates told him the reason Brandon was moved to a new facility without notifying his parents was something about other Morningside patients "needing more critical care."
First House lost it license after Brandon's death for reasons including falsifying medical records and providing medical services illegally.
Ten months after Brandon's death, the state ordered Morningside to shut down residential and detox services due to a multitude of violations, including operating beyond the scope of their license by providing medical treatment and carelessly administering prescriptions drugs. The state also cited Nurse Jill Shelton for running a pharmacy and ordering and distributing opiates like Subutex and Suboxone to clients at Morningside without a legal permit.
I spoke with former Morningside client Ilana Kekst, who claims she was at Morningside for six months between 2006 and 2007 for an opiate addiction. She told me, "There is no recovery there." Of her time there, she remembers things like drivers who were supposed to pick her up for AA meetings but never came.
At least nine former clients have also sued Morningside for never delivering promised treatment. City council initiatives chased the company's facilities out of Newport Beach, since locals didn't want rehab centers in their backyards. Morningside's main hub is now in Costa Mesa.
Despite the violations, Morningside Recovery still provides a wide range of treatment services in Southern California, even though several of their locations are listed on the California Department of Health Care Services site as "unlicensed facilities." The way they get around this, a former employee explains, is by providing "sober living" for all their clients—special housing for addicts that faces even fewer regulations than rehabs—and transporting them to a separate facility to do outpatient treatment.
"Every psychologist or doctor would say you need inpatient care if you called and said, 'I've been shooting heroin every single day for the past ten years.' But if you called Morningside today and said that, you'd find out one of two things," says the former Morningside employee. "Either they will lie and misrepresent themselves as an inpatient treatment center, even though there are now state regulations that say they can't provide that level of care. Or they're going to convince you that you don't need that level of care [even if you do]."
On October 15, 2014, the Jacques family settled a wrongful-death suit with Morningside and its parties for $3.7 million. Because the case never went to trial, the full extent of the clinic's practices remains unexplored. It's unclear how many other patients may have been, or continue to be, mistreated by Morningside.
Brandon was buried on April 11, 2011. On either side of Brandon's grave is a spot reserved for his parents.
First House lost its license five months after Brandon's death, in September 2011, for providing services beyond the limitations of its license, administering medication, falsifying medical records, using counseling services not recognized by the state, having more clients in a house than legally allowed, and giving new clients the meds of former clients.
Although First House is closed, Richard Perlin opened a new facility under the name of his girlfriend, Eddie Johnson, called Orange County Recovery. The new facility features several of the employees who worked at First House when Brandon was enrolled there.
Now that First House is closed, it has been revealed that the business also participated in secret kickbacks, paying Morningside. According to a deposition given by Richard Perlin, the company paid Morningside at least three times for "parking" clients at his facilities. Perlin says, "David Gates contacted me and said, 'Look, in order for us to utilize First House, Morningside would like to get $100 a day per person that we put in there.'"
The highest payout that he made on record for clients like Brandon was $3,000, which dates back to 2010. The three payments he disclosed in the deposition were made by check. No one knows how much may have been paid in cash, which is how the former Morningside employee said these transactions are typically made. The full scope of this relationship is unclear—as is the extent to which similar abuses are occurring at for-profit rehab centers all across America-but the way people like Perlin and his ilk look at their patients isn't unclear at all. In the deposition, he compared sick kids like Brandon to dirty clothes.
"[Morningside] runs a business there," he said. "They wanted to participate in the profit. There was a lot of intermediate precedence for different business that do that sort of thing. In other words... a dry cleaner sent a jacket out to have it cleaned elsewhere and then charged a premium on it."
Follow Wilbert L. Cooper on Twitter