The REDC ... Impropriety, Avarice or Corruption?

To attract a reader’s attention, I ordinarily begin articles with a quote from a great work of literature.

Not this time. Not with this topic.

The possible ramifications are potentially too ominous and far reaching.

And if the trail of facts and logic are followed to their logical conclusion, the end destination could touch the very halls of Congress and involve conflicts of interest if not corruption in the eating disorder industry at the highest level.

The Eating Disorder Industry is Unregulated and Cannot Survive the Appearance of Impropriety, Conflicts Of  Interest nor Corruption

Currently and for the foreseeable future, there will be no governmental oversight or regulations, either federal or state over the eating disorder industry. Residential treatment centers, IOP programs, counselors, doctors, and academic centers are allowed to market themselves in whatever form or fashion they desire. They can engage in outlandish puffery and make representations pertaining to their treatment modules that are not supported by any scientifically based evidence. Treatment centers can generate whatever statistics they wish in order to support their business. (99% satisfaction rate? Yeah, right! Why not?) They can define “evidence based treatment” however they wish and use it freely on their websites for the sole purpose of seducing families to utilize their services.

There is neither uniformity nor clarity in the manner in which insurance providers evaluate claims. Private equity investors, without fear of retribution or accountability, can come into the industry, engender a take over of treatment centers and ipso facto participate in medical treatment decisions which could be life and death decisions for our loved ones.

There is no enforcement agency on the federal or state level and there is no fear of being caught engaging in unethical, unscrupulous or criminal conduct. One may think that Congressional oversight of the industry, implementing objective universal standards to allow parents to make rational and informed decisions regarding the care needed by their loved ones would be of the highest priority for legislators in our state capitals and on the Hill. One may also think that fair and focused enforcement over an out-of-control industry would be of an equally high priority. One would be justified in thinking that all of those concerns are taking place at the highest levels. And, if one embraced those thoughts, they would be mistaken. Those issues are not even being addressed with Congress. To characterize the lack of action on these issues as "reprehensible" would be charitable. 

The Eating Disorders Coalition

The Eating Disorders Coalition (“Coalition”) was formed to advance the recognition of eating disorders as a public health priority by purportedly building relationships with Congress, federal agencies and national and local organizations dedicated to health issues. It was designed to be the liaison with state and federal agencies, administrators, lobbyists and legislators. It was designed to be the voice of the eating disorder industry, inclusive of all, excluding no one.

The Coalition is a 501(c)(4) organization. A 501(c)(4) organization is considered a social welfare organization. The IRS mandates that in order to be recognized as a legitimate 501(c)(4) entity, the organization must be operated exclusively for the promotion of social welfare primarily engaged in promoting the common good and general welfare of the people of the community.

As a 501(c)(4) organization, the Coalition can spend an unlimited amount of money on politics without having to disclose its donations. The organization can engage in some political activity so long as that activity is not the primary purpose. However, earnings cannot benefit any individual member of the organization. If that becomes the primary purpose, those expenses could be subject to taxation. Finally, 501(c)(4) organizations can engage in lobbying efforts if the causes coincide with the organization’s purpose.

The Coalition should be the “White Knight,” it should be the voice for the millions of people who suffer from this disease who do not have a voice. It was certainly not designed to favor one part of the eating disorder industry over another. And yet, the facts indicate that exclusionary favoritism is beginning to infect the Coalition.

This favoritism is shown not just by examining the results obtained by the lobbying efforts paid for by the Coalition but by the Residential Eating Disorder Treatment Consortium (“REDC or Consortium”) as well. It is also shown by reviewing that which was not obtained by those lobbying efforts let alone even not pursued.

The Coalition’s Lobbyists, Amounts Paid and Legislative Agenda

Between March 3, 2012 and July 20, 2012, the Coalition employed the lobbyist firm, Hogan Lovels US, LLP. Before it filed its Notice of Termination, Hogan Lovels was paid approximately $30,000 by the Coalition.

From March 1, 2012 through December 31, 2017, the Coalition employed the lobbyist firm, Guide Consulting Services, Inc. Before it filed its Notice of Termination, Guide Consulting Services was paid approximately $310,000 by the Coalition.

From January 1, 2018 through the current date, the Coalition employed Center Road Solutions, LLC. The Coalition has already paid Center Road approximately $60,000 and it is believed the Coalition has a contract providing for quarterly payments of approximately $30,000 to Center Road.

Those numbers are correct. $400,000 paid to lobbyists with an additional $30,000 paid every quarter.

The Consortium’s Lobbyists, Amounts Paid and Legislative Agenda

Just as the Coalition was engaged in lobbying ostensibly on behalf of the eating disorder industry, it was inevitable that the Consortium jumped into the game of politics to further its own financial interests.

In 2016, the Consortium employed the lobbyist firm, Capitol Decisions, Inc. It paid this lobbyist approximately $30,000. The 21^st Century Cures Act was signed into law by President Obama in mid December of 2016. As a registered lobbyist, Capitol Decisions, Inc. must identify the specific bills and the issues upon which it lobbies on behalf of its clients.

In the fourth quarter of 2016, with regard to the Consortium, Capitol Decisions reported that it was employed to pursue the following specific lobbying issues:

Public Law 110-343, Emergency Economic Stabilization Act of 2008, Implementation of parity issues

Public Law 111-148, Patient Protection and Affordable Care Act, Implementation of parity issues

S.2680, Mental Health Reform Act of 2016, Parity issues

H.R.4276, To strengthen parity in mental health and substance use disorder benefits, Parity issues

H.R.2646, Helping Families in Mental Health Crisis Act of 2015, Parity issues

Public Law 114-255, 21st Century Cures Act, Parity issues

In the third quarter of 2016, with regard to the Consortium, Capitol Decisions reported it was employed to pursue these specific lobbying issues:

Public Law 110-343, Emergency Economic Stabilization Act of 2008, Implementation of parity issues

Public Law 111-148, Patient Protection and Affordable Care Act, Implementation of parity issues

S.2680, Mental Health Reform Act of 2016, Parity issues

H.R.4276, To strengthen parity in mental health and substance use disorder benefits, Parity issues

H.R.2646, Helping Families in Mental Health Crisis Act of 2015, Parity issues

In the second quarter of 2016, with regard to the Consortium, and for its first reporting, Capitol Decisions reported it was employed to pursue the following specific lobbying issues:

Public Law 110-343, Emergency Economic Stabilization Act of 2008, Implementation of parity issues

Public Law 111-148, Patient Protection and Affordable Care Act, Implementation of parity issues

S.2680, Mental Health Reform Act of 2016, Parity issues

H.R.4276, To strengthen parity in mental health and substance use disorder benefits, Parity issues

H.R.2646, Helping Families in Mental Health Crisis Act of 2015, Parity issues

The language used on the specific lobbying issues above is the exact wording used by Capitol Decisions when it made its annual reporting. With regard to the specific lobbying issues, no information was omitted or changed (with the exception of the underlining and bolding).

As can be readily ascertained, the exact language used by Capitol Decisions conclusively establishes that the only concern of the Consortium, that its sole purpose in paying its lobbyist was to ensure that residential treatment care would be included in language incorporated into the 21^st Century Cures Act. This included each and every house bill, senate bill or public law in which residential treatment could be at issue ... and not just in the eating disorder industry but the entirety of the mental health industry. It did not concern itself with educating the public or educators nor of additional training of medical professionals.

Only after it had accomplished its goal, then beginning in 2017, the Consortium began to use the same lobbyists utilized by the Coalition. In 2017, the Consortium employed the lobbyist firm, Guide Consulting Services, Inc. The Consortium paid Guide Consulting Services $70,000. As previously stated, Guide Consulting had been utilized by the Coalition since 2012.

From January 1, 2018 through the current date, the Consortium employed Center Road Solutions, LLC. The Consortium has already paid Center Road approximately $60,000 and it is believed the Consortium has a contract providing for quarterly payments of approximately $30,000 to Center Road. Not coincidentally, this is the same amount paid by the Coalition.

But wait. If the Coalition was instituted for the purpose of being the liaison with state and federal agencies, administrators, lobbyists and legislators on behalf of the eating disorder industry, why would the Consortium even need to retain, let alone, make separate payments in excess of $160,000 to a lobbyist?

The Consortium’s Lobbyist is on Staff at … the Coalition

For the last two years, both the Consortium and the Coalition have utilized the same lobbyist. Their current lobbyist, Center Road Solutions lists as its managing principal, Katrina Velasquez. Ms. Velasquez is also listed on the Staff of the Coalition employed in the capacity of Policy Director.

Since Ms. Velasquez is listed on the Staff of the Coalition, and is being paid by both the Coalition and Consortium, in order to avoid even the slightest appearance of impropriety, there cannot be any conflict between the legislative agendas being pursued by both the Consortium and the Coalition. That legislative agenda must be the same. If it was not, after disclosing the potential conflict, Ms. Velasquez would be forced to either resign her position with the Coalition or return all funds paid to her by the Consortium. She should also ethically be required to advise both the Consortium and the Coalition when potential conflicts of interest arise since she cannot accept payments from these entities to argue opposing or contradictory sides of the same issue.

It is important to note that in no manner is it being suggested that Ms. Velasquez is engaged in any unethical or illegal conduct. Ms. Velasquez is a registered lobbyist and is recognized for her excellence in representing her clients. Ms. Velasquez received the AED Meehan/Hartley Award for Public Service and Advocacy at the 2017 International Conference on Eating Disorders, which was held in Prague. Any suggestion of impropriety on the part of Ms. Velasquez is inaccurate.

So, can we conclude that the Consortium and the Coalition are pursuing the same political and legislative agenda? If that is the case, doesn’t it necessarily follow that the Coalition is necessarily pursuing the agenda the PE firms dictate since those PE firms control the Consortium?

If the Coalition was instituted for the purpose of being the liaison with state and federal agencies, administrators, lobbyists and legislators on behalf of the eating disorder industry, and the Consortium and Coalition were pursuing the same agenda, why would the Consortium even need to retain, let alone, make separate payments in excess of $160,000 to a lobbyist?

What you get for $560,000

As part of its services, Guide Consulting helped lobby for passage of  the 21^st Century Cures Act which was signed into law on December 13, 2016.  The 21^st Century Cures Act takes up 355 pages. The eating disorder portion of this Act takes up one page.

Those provisions which were included in the Act in essence had two main provisions: (1). Expanded training and education for health care and medical professionals with a proposal that the increased training be paid by existing federal agency funds, and; (2). Clarifying language that if a group health plan or health insurance provider included coverage for eating disorder benefits, then residential treatment for eating disorders should also be covered in accordance with the Mental Health Parity Act of 2008.  [emphasis added]

The Coalition and Consortium combined paid over $560,000 to lobbyists on the Hill and still had sufficient revenue to run their daily operations. And for this  $560,000, the Coalition and Consortium obtained increased training for health care professionals paid by existing federal funds and … language stating that residential treatment centers for eating disorders should be paid by insurance providers.

When one studies the specific lobbying issues pursued by the Consortium in 2016, one cannot help but wonder who stands to financially benefit by having the provision about residential eating disorder treatment included in the 21^st Century Cures Act. To provide a more definite answer to this puzzle, we must look back at the original Anna Westin Act.

The Original Anna Westin Act

The original Anna Westin Act bill was designated H.R. 2515 and was introduced in the House of Representatives on May 21, 2015. As introduced, its goals were:

1.             To reinstate the Bodywise Handbook and related fact sheets on the National Women’s Health Information Center website;

2.       To award grants to increase and improve training and education of eating disorders to primary care physicians and other health professionals;

3.           To award grants to conduct educational seminars for school personnel on eating disorders early identification, intervention, and prevention of behaviors that are often associated with the development of eating disordered behaviors;

4.          To have the Director of the National Institute of Mental Health  conduct a program of public service announcements to educate the public on the types of eating disorders and their serious nature;

5.            To have clarifying language that if a group health plan or health insurance issuer included coverage for eating disorder benefits, then residential treatment for eating disorders should also be covered in accordance with the Mental Health Parity Act of 2008. 

So, which one of these is not like the others? Four of the five provisions pertain to furthering and increasing education of the public and training medical professionals and school personnel. One of the provisions pertains to increasing profits for private entities.

And which of these provisions ended up on that one page of the 355 pages of the 21^st Century Care Act? Of those five (5) issues, which is the only issue the Consortium paid its lobbyist, Capitol Decisions to pursue in 2016?

The Consortium is inextricably intertwined with the Coalition

Consortium membership is reserved for residential eating disorder treatment programs offering residential eating disorders treatment which meet the Consortium’s established standards. If you are a residential treatment program, especially if you are owned by a PE firm, and if you can afford the annual dues (which are apparently based in part upon the number of residential beds you have), and promise to comply with their guidelines, then you are welcome to become a member of the Consortium.

The Consortium from its inception was not designed to be all inclusive. It excludes non-profit treatment facilities, university based treatment facilities, other academic based treatment facilities, IOP treatment programs, and PHP programs. It excludes organizations like the Academy for Eating Disorders, the Alliance  for Eating Disorder Awareness, iaedp, ANAD, NEDA, BEDA and a host of other concerned, involved organizations. It does not include the many foundations, projects and programs designed to help the millions of people suffering from eating disorders.

In actuality, the Consortium is a very small minority of treatment professionals in the United States and yet, has taken over and is monopolizing the eating disorder industry. The Consortium represents to federal agencies that their members constitute 90% of the residential treatment providers in the United States.

Private equity owned RTCs have proliferated and are deeply imbedded in every aspect of the eating disorder industry save and except for the academic and research entities. Its reach encompasses the Coalition and its ability to spend a combined $560,000 for lobbyists to protect those PE owned residential treatment programs and to insure that the revenue stream which is their lifeblood continues unabated.

With regard to the Coalition, its 2017 – 2018 officers are :

President – Bryn Austin – President-Elect, Academy for Eating Disorders

Vice President – Chase Bannister – Bannister Consultancy

Treasurer – Jillian Lampert – The Emily Program

Secretary – Millie Plotkin – Eating Recovery Center

Currently, three of the four Coalition officer positions are held by Consortium members or advisors. It is widely believed that Mr. Bannister will be the next President of the Coalition.

With the Consortium having control over the Coalition, one can readily determine the entities which set the agenda and legislative priorities for the Coalition and as a result, the eating disorder industry in general. 

One can also speculate that legislation which could help the eating disorder industry, the academic community and the disenfranchised as a whole is not being pursued since it would financially harm the Consortium and would financially cripple their PE Overlords. And yet, it is incredulous to believe that the Coalition would have the same agenda as the Consortium.

But the puzzling question still exists. If the Coalition was instituted for the purpose of being the liaison with state and federal agencies, administrators, lobbyists and legislators on behalf of the eating disorder industry, why would the Consortium even need to retain, let alone, make separate payments in excess of $160,000 to a lobbyist?

Unless …

The Coalition was formed in 2000. The Consortium came into existence in December 2011 after Private Equity Firms began to acquire residential treatment centers. Between 2011 and 2016, there were at least ten (10) major acquisitions of residential treatment centers by PE firms.

The Consortium first began to pay a lobbyist in 2016, the year in which the 21^st Century Cures Act was being heavily debated and the language addressing residential treatment was being debated in Congress. Four of the five provisions in the original Anna Westin Act pertained to education and training of professionals. One provision pertained to increasing the profits for residential treatment centers. That is the only provision upon which the Consortium demanded its lobbyist focus on in 2016. And that provision was incorporated into the bill signed by President Obama.

The Question

The question repeatedly posed was: If the Coalition was instituted for the purpose of being the liaison with state and federal agencies, administrators, lobbyists and legislators on behalf of the eating disorder industry, why would the Consortium even need to retain, let alone, make separate payments in excess of $160,000 to a lobbyist? Logic leads us to few conclusive answers. And in this instance, the application of Occam’s Razor is most appropriate: All things being equal, the simpler solution is usually the best one.

So, the possible logical answers must be:

1.    The Coalition does not represent all aspects of the eating disorder industry and thus the Consortium was required to occupy this void;

2.   In order to consolidate its hold on the eating disorder industry, and to ensure that it could continue to increase its profits, the Consortium was required to control the Coalition from the inside so that it could dictate its legislative agenda. This would entail utilizing the same lobbyist and eventually gaining control over the offices of the Coalition;

3.   The Consortium has a very different agenda than the Coalition and its primary goal is to not just preserve, but to increase the profit margins for the private equity firms which own the vast majority of the Consortium at the expense of the rest of the eating disorder industry and in derogation of the objective, scientifically based research which exists.

Answers two and three are intertwined. And it follows that if answers two and three are accurate, then the first answer must necessarily be true as well.

Specific lobbying agendas. Financial control over the industry. Billions of dollars being invested only in residential treatment centers. No oversight. These facts are indisputable. When these facts are revealed in an orderly manner, logic leads to inescapable conclusions.

Conclusion and Call for Action

Private equity firms have invested multi-billion dollars in residential treatment centers and not out of the kindness of their hearts. They must protect their investments at all costs. The Consortium is about to assume control over the Coalition, and currently has the ability to dictate the types of legislation proposed, the number of patients seen and treated (through expansion of treatment centers or abandoning patients in IOP programs) the non-enforcement of corporate practice of medicine doctrines, the exclusion of all government funded payment plans and the direction and course of the industry.

There is no federal oversight and state-by-state involvement is sporadic, inconsistent or non-existent. The Consortium has the liberty, or arrogance, of believing it can make any representations and statements to the general public without fear of exposure.

When it makes its representations to the public and federal agencies, the Consortium does not even reference the objective, third party research studies indicating family based, outpatient therapy is the most effective treatment module for treating this insidious disease  These scientifically based studies would reveal that  the Consortium and the PE owned residential treatment centers are pimping voodoo based treatment which is dependent on confirmation biased studies which in turn allows treatment centers to crow about an alleged 99% satisfaction rate.

Parents, medical professionals, legislators and society in general have a right to clear, honest answers to pointed and direct questions. Both the Consortium and Coalition should:

1. Identify their financial donors, the amount donated and applied toward the $560,000 paid to lobbyists. 

2. Identify the entities which mandated inclusion of the provision pertaining to residential treatment centers into the original Anna Westin Act and subsequently thereto, the 21^st Century Cures Act.

3. Disclose the studies undertaken which calculated the financial benefit which would be bestowed upon the PE owned residential treatment centers by including that provision in the 21^st Century Cures Act.

Our children are dying from this insidious disease. We cannot expect any assistance any time soon from the government or federal agencies. The Consortium, up until now, has been allowed to put a fair face on foul heart.

If ever there was a time to embrace the courage of one’s convictions and demand answers to questions, that time is now.

A Final Perspective

October 30, 2018 will mark the 2 year date upon which death took my beloved daughter, Morgan. It is not time to dwell on that in this missive so as to derail the message.

But, on that last horrible day, when Morgan’s body was wracked with pain, as one by one her organs were shutting down, when the very last words I heard from her were “Daddy I love you,” when “Code Blue” was blared out and you feel like your heart too has stopped, when you watch doctors trying frantically to restart your beloved daughter’s heart, when you bow your head, holding your daughter’s hand and you hear the physician’s voice quietly say, “She’s gone,” and you know … you absolutely know that your world was just sent spinning into the deepest depths of despair … at a time when you know a part of you had died as well… perhaps the very best part … the Consortium and their PE Firm owners were spending thousands of dollars and pushing, lobbying to have a law passed which was designed to only protect their profit margin, their 13X EBIDTA, their financial situation and their bottom line.

So, for those whose voices have been taken … for that Army of Warrior Angels … for those who have been left behind in bitter anguish and despair …

We will have answers.