City, county discussing plans for opioid settlement funds
Cascade County and City of Great Falls officials are discussing how to use funds they’re receiving in opioid lawsuit settlements.
Both local governments pursued legal action related to opioids and now have a say in how the settlement funds are used.
Some of those funds are coming directly to the city and county, while a large chunk will go to a regional trust over which the city and county have to create a governing structure. The use of those funds will be application based.
Cascade County officials discussed potential uses of the funding during an April 29 meeting. They’re looking at multiple settlements with different amounts over different time frames and working to determine those specifics.
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Carey Ann Haight, deputy county attorney, said she’s meeting with Ben Snipes, the local private attorney who litigated the opioid cases for both the city and the county, to work through those details.
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“Before we get serious about how to use this money, we need to be clear on how much for how long,” County Commissioner Joe Briggs said.
The county has been using some of the funds toward the salary of the civilian coroner housed within the Cascade County Sheriff’s Office, as well as naloxone, lab supplies and body bags.
Trista Besich, county finance director, said she’s been working with CCSO staff and the County Attorney’s Office to determine the eligible uses for the opioid settlement funds.
Undersheriff Scott Van Dyken said opioid issues touch the civilian coroner in that she handles death investigations related to controlled substances, collects those substances for destruction, oversees the medication/drug turn-in program for destruction, is a certified Narcan instructor and trains deputies.
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Besich said some of the settlement funds were used by CCSO but they’ve since determined they need to have a formal plan for use of funds coming directly to the county.
During an April 15 meeting, City Commissioners adopted a resolution to establish a governing body for the administration, management and use of their opioid settlement funds.
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The city is part of an opioid settlement agreement with the state, which was signed in November 2021 and amended in 2022.
To comply with the agreement, commissioners voted during their April 15 meeting to appoint City Commissioners Rick Tryon and Shannon Wilson to the governing body and assign Melissa Kinzler, the city finance director, as the fiscal agent.
The resolution doesn’t allocate funding to specific programs and those options will be presented to commissioners as separate agenda items for consideration, according to the staff report.
It’s an action the Cascade County Commission took in October 2023.
The county named Commissioner Joe Briggs as their representative and fiscal agent.
The state agreements allocate some of the settlement funds directly to participating local governments such as Cascade County and the City of Great Falls. The agreements also established regions that will receive additional settlement allocations into regional trusts that local governments have input and equitable representation as to the use of those funds, according to a 2023 county staff report.
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Cascade County and the City of Great Falls are included in the local metro regional trust.
Ben Snipes, attorney for both the county and city in the opioid litigation, told the City Commission during their April 15 work session that there’s a “substantial amount of money coming into both the state and local governments.”
He said that a portion of the funds go to the state, a portion to local governments that participated directly and a portion to the Montana Opioid Abatement Trust.
Snipes said the city would be getting about $230,000.
He said the Cascade County metro region would receive an estimated $743,000 this year and about another $400,000 annually for about the next decade.
The city and county have sole authority over their direct allocations and shared authority over the regional trust funds through an interlocal agreement, according to Snipes and city officials.
Agencies can submit grants to the Montana Opioid Abatement Trust, Snipes said.
During the meeting, Commissioner Susan Wolff said she had concerns about the consistency of the governing body since city commission term limits were shorter than county term limits.
She said she didn’t understand how it was determined to set up the representatives.
David Dennis, city attorney, said that it was “critical” to get the governing body set up to be able to establish the governance structure for the regional trust.
He said his thought was to establish the city’s governing body now and could then appoint commissioners in sync with their term cycles.
During their April 29 meeting, county officials said that to access the $743,000 in the regional trust, a governance structure is required.
Haight, the deputy county attorney, said that governance structure wasn’t yet established and the county was waiting on the city to take the step the county had taken in 2023.
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She said they’ll have to work with the city to develop an interlocal agreement.
“That’ll take five years, Briggs said. “We gotta get this worked out on what the governance is.”
He said some government entities sued separately from the state and there’s a number of moving parts.
“Quite frankly, how this pool works, I am confused,” Briggs said.
Haight said that in talks with Snipes, her impression was the funds were intended for broad uses that opiates touched.
Van Dyken, CCSO undersheriff, said as an example of their office using the funds was the coroner, who had investigated an overdose death that occurred in the hospital that week.
The coroner works with the drug task force and through the investigation can sometimes figure out where the drugs came from.
Van Dyken said that in some cases, they’ve been able to charge the people who provided the fentanyl, or other drugs, in relation to a death.
He said his concern with the money in the regional trust is that various agencies would come out of the woodwork requesting money, falsely claiming to work with CCSO, the jail and local medical providers.
Van Dyken said they were seeing that already in some state grant programs.
“They’re saying they’re doing all this and they aren’t,” he said. “I worry about them going to something and alleging they’re associated with us and they’re not.”
County Commissioner Eric Hinebauch said that it seemed the money was being cut up in so many ways it won’t be effective.
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Briggs said since it’s one time money, he was concerned about how to use it effectively. There’s been discussions of mental health and crisis stabilization beds, but if it’s not recurring funding, Briggs said, “I’m not sure how to deploy it and do good work with it.”
Besich suggested that they draft a resolution formalizing how they’ve already been using the funds.
In late April, the Montana Department of Public Health and Human Services announced it was accepting proposals for a $6.5 million one-time grant program aimed at building sustainable capacity for community-based forensic stabilization services throughout Montana’s local detention centers.
The one-time-only, 24-month pilot grants are funded through the Community-Based Court-Ordered Evaluations and Stabilization Near-Term Initiative approved by Gov. Greg Gianforte and recommended by the Behavioral Health System for Future Generations Commission. Community-based court-ordered evaluations currently funded through the first phase of the NTI will continue to be funded, according to the DPHHS release.
In Cascade County, there’s been a significant backlog of court-ordered mental health evaluations and the Cascade County Attorney’s Office has paid for those evaluations in some cases in an effort to ensure criminal cases proceed.
Van Dyken said they were looking to apply for the funds in some fashion.
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Briggs asked what kind of addiction issues exist in the jail currently since the funding could be used for inmate treatment.
“Almost all of them have a nexus to that some way,” Van Dyken said of addiction.
The county is using an existing state grant, the Healing and Ending Addiction through Recovery and Treatment (HEART) Fund, to help address addiction and mental health in the jail.
One of those tactics is the use of long-lasting injectables for mental health medications.
Some last 30 days, some two to three months, depending on the medication, but they cost about $6,000 per shot, Van Dyken said.
The shots help those inmates function, sometimes in their criminal proceedings, other times so they can be released.
Briggs asked if the jail sees those individuals once the shots wear off.
Van Dyken said sometimes, but there’s a local mental health council that is working to provide case management of those in the jail with mental health conditions in an effort to coordinate their care. Local providers look for their clients around town when their injectables have worn off to provide a new dose. It’s labor intensive, but helps those individuals remain functioning members of the community and out of jail, they said.
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They also coordinate payment of those medications, since they aren’t eligible for Medicare reimbursements while incarcerated, but some local agencies can get those reimbursements to help treat those in the community.
Van Dyken said they handle people coming into the jail while on opiates or other drugs.
The most dangerous, he said, is alcohol.
Alcohol withdrawal can kill someone quickly, Van Dyken said.
Besich said that withdrawal for alcoholics can cause psychosis, seizures and they can mimic a full psychiatric break.
An example, Haight said, is ongoing litigation in the state over the 2009 death of Allen Longsoldier, Jr. in the custody of Hill County. He died of alcohol withdrawal, according to multiple news reports and court documents.
Van Dyken said that inmates are screened during booking for substance use and potential withdrawals. He said most know they’ll get sick during withdrawals and notify jail staff so medical staff can monitor.
The county’s mental health roundtable, comprised of local law enforcement agencies and healthcare providers, tracks inmates with major mental health issues in an effort to connect them with resources and prevent serious problems.
Van Dyken said without similar programs, inmates may come in and say they’re suicidal due to withdrawal, at that point, they have to be stripped because of hanging potential and placed on suicide watch in isolation where they further deteriorate and some assault corrections officers, adding felonies to their criminal charges.
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Van Dyken and CCSO staff are working to establish a crisis diversion center and a mobile response team in an effort to respond to those in a mental health crisis that don’t necessarily need to be in the jail or hospital.
That plan was discussed during the county opioid settlement planning meeting on April 29.
Typically the mobile response teams include a clinician and an EMT who can only bill Medicaid for response times and Van Dyken said it’s possible they could use some of the opioid settlement funds to pay wages for those providers when on call.
Van Dyken said his staff is researching how other counties with successful mobile response teams are funding their programs.
Besich said some of the larger counties have voted levies to help support those programs.
They’re also working on a crisis diversion facility that would be staffed with appropriate personnel where people in crisis could go to stabilize rather than sit in jail or the hospital.
The county received a $1.49 million DPHHS grant earlier this year toward the project and they’re working with the Indian Family Health Clinic in Great Falls to convert a floor of their building into the crisis diversion center.
IFHC also received a grant toward the project, which they’ll operate with county support, and Sletten is working on the plans, Van Dyken said.
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He said they’d done abatement work in the facility, but needed a fire inspection since certain fire systems are required for a residential facility but not an outpatient facility, so they’re working through those details.
“We’re kinda playing catch up,” Van Dyken said in terms of crisis diversion and mobile response.
He said the crisis diversion grant is currently a three-year program but the state has indicated it will be extended.
The Montana State Hospital isn’t functioning properly, he said, and lawmakers have been pushing for community based programs, but many communities lack the resources to be able to provide such services.
The community based treatment model, Van Dyken said, it’s sustainable for all counties in Montana, particularly the smaller counties and essentially only the big seven counties have the infrastructure to attempt such a model.
That means, he said, “everybody from Shelby to Malta is coming to Great Falls and they’re gonna stay.”
Reimbursements for those treatment programs are also not sustainable, Besich said.
But the Montana State Hospital struggles with capacity and can’t get enough staffing, Van Dyken said, which has been evident in several local cases that have slowed criminal proceedings while waiting on the state hospital or been dismissed entirely due to those delays.
Van Dyken said there’s a woman currently in the Cascade County Adult Detention Center for 387 days as of April 29 who had just hit No. 2 to get to Warm Springs.
Briggs said he’s also not sure the local model is sustainable.
Mobile response has been attempted locally several times and failed, so Van Dyken said the county’s coordinator is visiting communities that are doing it well to gather information and develop a workable program here.
“We can’t keep failing at this,” Van Dyken said. “We’re trying to go slow to be successful. We can’t fail again.”
The state grant won’t cover operations at the crisis diversion center, but they can bill Medicaid for the services, which means they’ll need an employee to handle that workload.
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Haight said the county can’t bill for services when a person is incarcerated.
Van Dyken said they have a code in their records system, which is shared with the city, for mental health calls allowing them to track those numbers. He said the highest volume for those calls has been between 11 a.m. and so they’d start the mobile response team operations during those hours.
He said Missoula County can’t sustain 24-hour operations and “they’re miles ahead of us.”
Not everyone has to go to the crisis diversion center, Van Dyken said, as the mobile response team can often address the issue or connect the person with appropriate resources.
Briggs said the mobile response had “failed at least three times,” and they didn’t respond outside the city limits previously, causing problems and frustration for the county. He asked what had changed to make this more palatable to the county.
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Van Dyken said now it’s being operated and funded by the county and they planned to respond to calls fairly.
The previous problems were, in part, due to the team not responding out of the city or taking too long, so deputies would have calls stacking up and instead take the person to jail to solve the problem in less time.
As of now, the city is not contributing to the program, he said, and some local mental health providers and EMTs could participate as contractors to respond when they’re on call.
Hinebauch said it seems a more sustainable model.
Besich said a potential issue is if large agencies again put non-compete clauses in their contracts, essentially barring their providers from participating in the mobile response team, which had happened in the past.
“Part of me feels like we’re going down the same blind alley we’ve done three times before,” Briggs said, so thought it was a wise precaution that CCSO was learning from successful programs.
Besich said that in most cases, the successful models were tied to local governments.
