Finances, staffing and licensing issues plagued treatment center

ELLSWORTH — It’s been nearly five months since Open Door, a substance use disorder treatment center that operated in Ellsworth for nearly 40 years, abruptly shut its doors.

Now, as a new board works to revive at least some of Open Door’s services in the future, questions remain about the nonprofit’s past.

Why did an organization whose services appear to be badly needed suddenly close last summer? Why had documented deficiencies gone unaddressed despite repeated state warnings?

And why was the executive director paid $141,440 in a year Open Door posted an operating loss of more than $160,000?

Prior to the July closure, the Maine Department of Health and Human Services decided not to renew the facility’s license after regulators documented “numerous regulatory deficiencies.” At the time, former Board President Carla Magoon cited financial issues, a perennial problem for the nonprofit, as being partially responsible for the licensing issues and eventual closure.

Open Door had struggled to recruit and retain qualified staff, Magoon said in a recent email. As a result, she said, Executive Director Barbara Royal was overworked and unable to dedicate enough time to paperwork.

Royal resigned shortly before the closure.

A regulatory history obtained by The Ellsworth American shows that the licensing issues go back to at least October 2016, when Open Door operated without a license for several months after staff failed to renew it. And financial records show that in 2017 and 2018, years the organization either lost money or was barely in the black, Royal took home more than $100,000 in compensation — a figure far higher than the annual median salary for a nonprofit executive director in Downeast Maine, which was $73,000 in 2018, according to the Maine Association of Nonprofits.

Royal received a salary as executive director of Open Door (Magoon did not recall how much) and additional compensation for work at Hills House, a residential program for pregnant women and mothers. She received hourly payment of $30 “for duties like overnights and transportation, and babysitting,” Magoon said.

Royal worked roughly 16 to 20 hours per day in the two years before Open Door closed, said Magoon, and was on-call 24-7.

“It was not even close to an ideal solution.”

Royal, said Magoon, “was consumed with trying to find a way to keep the Hills House open and didn’t give the charting issues the state brought to the staff’s attention due diligence.”

Royal, who has been praised by many community leaders for her work, was with Open Door for decades. Most years, according to federal tax filings dating back to 2002, she took home between $38,000 and $62,000 in her role as executive director.

In the fiscal year ending in June 2017, Royal took home $110,530 in compensation, a figure accounting for roughly 15 percent of the organization’s overall expenses. The next year, fiscal year 2018, she received $141,440 in pay, the same year the nonprofit recorded a loss of more than $160,000.

“The compensation was disproportionate relative to other positions of similar authority and accountability,” said Bob Worrell, a volunteer consultant who is working to help revive the organization, particularly Hills House.

“When we get ourselves back on our feet our executive director will be compensated in a manner that’s not at the top, by any means, of the range for that kind of functionality. It’ll be considerably less than what it was prior,” Worrell said.

Former Board President Magoon said she wasn’t sure who was tracking Royal’s hours but that her compensation had been approved by the board.

“I know personally she was there [at Hills House] a great deal of time,” said Magoon, “but I am not sure who was responsible for tracking the time.”

Magoon said in an email: “It was not that her salary was that high,” but that “we could not find employees to work at the satellite program, The Hills House. What Barbara did was sacrifice time with her family and friends to do double and sometimes triple duty.”

Royal said her hourly compensation was reduced to $18 an hour in the last year. Magoon said that as funding dwindled, Royal donated some of her paycheck back to the organization in order to pay other employees.

“She was not doing it because she desired more money, she was doing it because she felt strongly that we needed to keep the house open for the women and especially children who needed a safe place where they could recover from a near hopeless situation,” Magoon said.

Royal’s health eventually began to suffer, said Magoon, and the board “made it a priority to hire the people we needed to stop the need for this.”

“So, she did make more money during that time period, but she was doing at least two distinctly different jobs. In our accounting, we kept the Hills House budget separate from the Open Door.”

Once the board became aware of the licensing problems, Magoon wrote in a follow-up email, “We increased prospective wages to be competitive and put all our energy and directed Barbara to put all her energy into hiring staff.”

A drop in patient referrals had also been an issue, Magoon said.

“The inpatient was really hard to maintain and the intensive outpatient wasn’t working because of the competition.” Magoon said other area programs offer outpatient services that demanded less time than the four-hour, three-day-per-week sessions at Open Door.

A potential donor for Hills House fell through.

“The board tried really hard to come up with fundraising,” said Royal, “but it was very difficult.”

The financial issues were compounded by regulatory problems: Maine Department of Health and Human Services records show that the nonprofit had been having difficulty complying with licensing requirements beginning in 2016, when it operated without a substance abuse treatment license for several months after staff failed to renew it.

Between October 2016 and the center’s closing this past July, regulators from DHHS visited Open Door more than a dozen times, occasionally unannounced, issued six deficiency statements, and met with Royal and her staff on numerous occasions to discuss action plans.

The problems were ongoing, according to the state. In a report issued on June 21, DHHS officials documented several deficiencies that it said hadn’t been addressed.

Some of the issues were related to governance. The board did not provide evidence that it was meeting at least quarterly (a state requirement) and that it was discussing treatment services and client satisfaction, according to state records.

State officials also noted problems with staff training and supervision. Personnel records for the organization failed to show that staff members were meeting ongoing clinical education requirements. “The agency also did not present documented evidence of supervision occurring for the year 2018-2019,” officials wrote.

Some background checks of employees were incomplete or missing documentation, according to the state, and Open Door was unable to provide evidence that staff had received performance evaluations within six months of hire and annually thereafter.

Open Door also had problems with client treatment plans, including missing progress notes, “a repeat deficiency,” according to state regulators. It had also been repeatedly cited for having an “arbitrary” admission requirement that Hills House clients abstain from substance use, including prescription medications such as Suboxone, a medication used to treat addiction.

Royal acknowledges the organization fell behind on paperwork, but says the state should have done more to help.

The board, which initially met only quarterly, wasn’t aware of licensing issues with the facility “until it was too late,” said Magoon.

“I will say the board felt a little blindsided by the state issue.”

Communications about licensing issues were sent to Royal, said DHHS spokeswoman Jackie Farwell, per department protocol.

“It is the responsibility of the primary agency contact person to inform board members or other individuals at the organization of such issues,” Farwell said.

At the time of Royal’s resignation, Magoon said Royal needed to devote more time to the care of her aging parents. In a recent interview, Royal said state officials asked her to step down.

In an emailed statement, Maine Opioid Response Director Gordon Smith said: “As opioid response director, I am not in a position to make licensing decisions affecting substance use treatment providers. That is the purview of the Maine Department of Health and Human Services’ Division of Licensing and Certification. I communicated to Barbara Royal my opinion that the facility’s future prospects would improve with her resignation and the opportunity for new leadership.”

After more than two years of back and forth, regulators issued the facility a conditional license that was set to expire on July 1, 2019.

When officials visited in June, said Farwell, they “determined that the facility had not resolved these regulatory deficiencies as required under the conditional license,” and declined to renew it. Open Door closed shortly after.

Four women and two children who were living in Hills House at the time were relocated to facilities in Cumberland and Penobscot counties and more than 10 employees were out of work.

“This is a very, very sad situation,” said Hancock County Commissioner Bill Clark in an interview shortly after its closing. “They have counseled thousands over the last 30 years. There’s nobody out there in this area that’s going to take up that void.”

But some are trying: a new board is working to reinstate Open Door’s substance abuse license. Members are particularly interested in reviving Hills House.

“We have a tall building to construct and we don’t even have the first floor built yet,” said consultant Worrell, speaking metaphorically.

“The upper parts of the building are going to have to do with fundraising, have to do with expansion, have to do with dealing with public perception,” he continued. “Compliance is going to be one of our most important things.”

Kate Cough

Kate Cough

Kate covers the city of Ellsworth, including the Ellsworth School Department and the city police beat, as well as the towns of Amherst, Aurora, Eastbrook, Great Pond, Mariaville, Osborn, Otis and Waltham. She lives in Bar Harbor and welcomes story tips and ideas. She can be reached at [email protected]

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