With Riverside Hospital Shut Down, Patients Scramble for a Place in Houston's Recovery Care System

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It's a late morning in August as Verenice Lopez leans against the passenger seat window of her boyfriend's pickup truck, watching the leafy residential streets of Houston's Fifth Ward speed by. They're on their way to Riverside General Hospital's drug treatment center on Lyons Avenue, which had been Verenice's home for the past three months. She isn't talking much, so her boyfriend cranks up the radio to Country Legends 97.1.

Verenice's mind is on the certificate waiting for her at the hospital, proof of all the work she's put into an intensive 30-hour-a-week drug treatment program to kick her crack addiction. She's proud of that, but she's also worried about where to go next. What she needs is just a little more help, this time to find a halfway house that will ease her into living alone.

A part of her is afraid that if she returns home to old friends and falls back into an old grind, she'll want to use again. Detox and rehabilitation were only the first steps on the road to recovery. It's like what a tech told her when she graduated from Riverside just the day before: "Get ready for your new life to be uncomfortable."

The recovery campus looms up around the corner, a four-story, 100,000-square-foot facility tucked behind a metal wire fence that runs the length of the block. As they pull into the parking lot, maneuvering around potholes cratering the gravel, Verenice sits up. There's a thin cluster of patients gathered outside, arms full of their personal things.

Verenice tells her boyfriend to wait as she climbs out of the truck, and asks one of the patients what's going on and why the parking lot is half empty. The patient explains -- the recovery campus shut down overnight and most of the staff had already gone. State health department agents were inside helping everyone relocate. Some homeless went to Star of Hope, women with children left to Santa Maria Hostel, single men to Cheyenne House, adolescents to Volunteers of America. Verenice doesn't believe it. The patient says no one expected the center to close so suddenly.

Riverside General Hospital, which once operated three medical campuses, now treats patients at its 3204 Ennis Street detox and psychiatric center only. The August closure of the Barbara Jordan Healthcare Center displaced all of Riverside's long-term residential patients, the majority of whom were discharged into the surrounding community without a plan for continuing treatment.

Verenice, 23, checked herself into Riverside's drug rehab program in March. Police had just busted her crack-addicted ex-boyfriend in a stolen truck, and she was eight months pregnant with her second daughter. She had an expensive addiction of her own, no income and the option of either staying with her ex's mother or fending for herself on the streets. In those days, she cried until her head ached. "I was just tired of living that life, still in that mentality," Verenice recalled. "When my ex went to jail, I didn't have nothing, so I went to get some help."

She needed a free drug program that would provide long-term residency for women staying with their children, and she found Riverside. With a one-year-old in day care and an infant in the nursery, Verenice attended classes and counseling Monday through Friday for 90 days. She never forgot what the intake secretary said to her as they worked through paperwork together -- Riverside couldn't force her to stick to its program, but if she did, they would take care of her. If she left, no one would know how to help her and in the worst-case scenario, she could lose her daughters.

Like the other women with children, Verenice had her own room, but when the air conditioners broke, her babies would stay up crying for hours. One sweltering summer night in the women's ward, the heat grew to be unbearable. Verenice called a friend begging him to bring her a fan, but he wasn't able to until the next day, so she stripped her baby naked and nursed her until she drifted off to sleep. At 6 a.m. the next day, she got up to pump, dress her daughters and deliver them to day care. Breakfast was toast and a side of grits. Verenice was always hungry and tired for morning meetings, but if she nodded off, she would get written up.

"The way that she would get attached to me...she was too attached to me," Verenice says of her baby, who she'd pick up from the nursery. "When I got her, she would just look at me with some sad eyes and she would start crying. But then I would tickle her stomach and she'd laugh. Everybody was in love with her."

Verenice remembers interviewing with regulators from the state health department as she neared the end of her treatment. They wanted to know if the program was helping and if she had any complaints, so she told them about the air conditioning and the food. Other than that, she said, everything was comfortable. The other patients had become her friends and the counselors were open about their own recovery stories. The staff never complained when she needed the kitchen unlocked after hours to store bottles in the fridge.

Fire marshal reports in the recovery campus's last months indicate the building had fallen into serious disrepair: Fire alarms were useless and the sprinkler system was obsolete. Elevators were inoperable, gas-pipe pressure tests were long overdue, windows were cracked in the children's wards and lights were out in more than half the building.

Renovations would cost millions of dollars that Riverside General Hospital didn't have. Its top administrators had been indicted for fraud as part of a nationwide Medicare sweep in 2012, and three conservators were appointed to make good on debts. The slow flow of FEMA relief funds, promised to Riverside after Hurricane Ike ravaged surgical suites, stopped altogether. The state health department rescinded $3 million in contracts. Staff paychecks bounced. Patients complained doctors weren't available when they needed them. The hospital hadn't been in the proper condition to treat anyone for a long time, but it tried to keep clients in residence up until the day the state wrested them away.

Riverside's problems exploded in February 2012, when the FBI raided the hospital's corporate offices for a truckload of files. Evidence linked the hospital's assistant administrator, Mohammad Khan, to a $158 million scam in which he bribed recruiters to steer patients to Riverside's clinics. Khan pleaded guilty to charges of fraud, but not before naming others -- including Riverside head Earnest Gibson III -- as accomplices. Gibson had written grants worth millions of dollars over 30 years as chief executive, and the conservators who were suddenly left to oversee the hospital's continued existence asked the court to let them consult him on finances. Prosecutors objected vehemently, and Gibson was ordered to leave Riverside business alone.

Things only got worse after that. When the Centers for Medicare & Medicaid Services suspended Riverside's funding, the hospital struggled to retain staff, maintain its properties and treat as many patients as it once did. The hospital seemed unable to secure alternative sources to fund its debts.

On July 9 of this year, Third and Fifth Ward residents gathered before Riverside's iconic green awnings, surrounded by news cameras, and demanded the release of federal funds to the hospital. They were afraid that Riverside's financial and legal problems meant it could close any day. Among them were former addicts and hospital employees, ministers and homegrown activists such as Quanell X, whose mother checked in and out of the recovery campus about eight times over the years. She referred to the outpatient program as her "90 in 90" -- 90 Cocaine Anonymous and Alcoholics Anonymous meetings in 90 days.

Quanell X, 43, later told the Houston Press that he was ten years old the first time he caught the bus with his mother to attend drug treatment classes at Riverside. In addition to addiction, his mother had a severe mental health problem, Quanell X said. When she relapsed and his grandmother couldn't find any place to take her, Riverside never turned her down.

"It was very difficult because it was almost like we were raising our own mother, but I learned so much from Riverside Hospital as a young man," he said. "I told everybody this -- once Riverside's gone, there's going to be a lack. It would get real bad because the only place that African Americans really could go, without a penny in their pocket, who had hit rock bottom and needed help, was Riverside Hospital."

There are other community organizations in the Third Ward that provide support for addiction, such as SHAPE Center, Third Ward Community Cloth and Change Happens. Yet they all referred patients to Riverside, and Riverside would then connect with recovery houses like Santa Maria Hostel and Star of Hope to help patients who had completed rehab to become financially independent.

Most patients' families lived close enough to the hospital's campuses in the Third and Fifth wards that they could easily visit, and clients who were reluctant to seek help in the first place were more open to Riverside because the staff there looked like them and understood where they came from, a former employee says.

James Walker, who asked us not to use his real name, lost his tech job in August along with about 70 other recovery staff. He says that in the men's ward where he worked, some patients were ex-offenders fresh out of prison and desperate for rehab so they could hold down a job. "Half of them got families, half of them got babies," Walker says. "With that program being shut down, where can they get help now? Are you gonna starve, you not gonna eat?" He says he expects his patients to return to crime.

Other protestors were preservationists intent on protecting a historic black institution. Protest organizer Georgia Provost's late husband had been Riverside's events photographer decades ago, and he used to tell her the history of the hospital while they processed negatives together in the darkroom. Once known as Houston Negro Hospital, 96-year-old Riverside was the only hospital in the city that hired black physicians and treated black patients, and today remains one of two historically African-American hospitals still in operation in the country. (The other is Howard University Hospital, once known as Freedmen's Hospital.)

Over the years, Provost saw her neighborhood transformed around her photo studio, one of a dwindling number of black-owned and operated small businesses. She says the community fears losing Riverside the way it fears school closures in the Third Ward and the loss of its post offices, fresh-food markets and single-family homes to the monolithic condos and townhouses that developers have already built throughout the west side.

"We had everything we needed right here, but integration killed the black community," Provost says. "We have all sorts of people in our community who don't look like us, don't support us, and you can't even get them to take out an ad in the school paper to support students."

On August 21, Riverside conservator Gerry Hilliard received a call from the executive commissioner of the state health and human services commission, Dr. Kyle Janek. Janek was already en route from Austin, and he wanted to meet at noon. Hilliard cleared his schedule and conference-called the two other conservators, former state representative Ron Wilson and the Rev. Manson Johnson of Holman Street Baptist Church. As they listened in, Janek advised Hilliard to shutter Riverside's recovery campus.

Hilliard says he argued that some of the state's findings were erroneous and that patients were progressing daily, but the commissioner maintained the building itself was a health risk. Negotiations dragged on for three hours. Eventually, Hilliard gave in. As he broke the news to staff, state health department agents moved in to interview patients about how to relocate them.

Of the 81 residential patients kicked out of Riverside, doctors determined 34 were well enough to go home, but ten were discharged against medical advice, according to the state health department. The remainder were transferred to other area residential programs. Two youth from North Texas returned to that area. At the time, Riverside also ceased treating about 75 outpatients.

Riverside's recovery campus used to be one of the largest drug treatment centers in the state of Texas, though the Harris County Jail remains No. 1. County Judge Ed Emmett's new diversion program gave $10 million to area nonprofits for treating would-be prisoners, and advocates won $2.6 billion for additional funding in the last legislative session, but Texas is nowhere near catching up to other states in mental health and rehab spending.

The two are often tied, as in the case of Crystal Williams, 20. She also asked that we not use her real name because she's currently staying in a secret recovery house. Williams checked herself into Riverside two years ago to placate a concerned friend. At the time she didn't think of herself as an addict, though she had been drinking since the age of ten and popping a mixture of over-the-counter cough and cold medicine, Xanax and Valium since 14. Molested as a child, Williams was also a chronic self-mutilator.

When her brother came home from jail, Williams overdosed twice in one week. She finally agreed to enter rehab, still thinking she was somehow different from the other women of Riverside, who marveled at how young she was. She wouldn't listen to counselors with their textbook 12-step coping tactics.

It wasn't until halfway through treatment that Williams actually began to accept it. The friend who convinced her to get help in the first place had been murdered in the apartment complex where they used to live. Counselors and other clients comforted her then, and she chose to stay at Riverside because there was support there and none at home. "When I first got there, I had a real dark, morbid mind. By the time I left, you could see the hope on paper," Williams says.

Houston's remaining drug treatment centers say they've had an influx of patients coming off the street in search of care since the Riverside recovery campus shut down. Referral agencies like the Council on Alcohol and Drugs and the Association for the Advancement of Mexican Americans say they're overwhelmed. Patrick Asuquo, an addiction counselor at Star of Hope, took in 15 Riverside patients after their relocation and continues to interview others.

A former Riverside volunteer, Asuquo says a hospital shouldn't be allowed to operate if it can't be accountable to its patients. He's also a firm believer that because chemical dependency doesn't discriminate, there's little reason behind protestors' notion that Riverside provides an essential "cultural sensitivity." At one point, Asuquo recalls, he cared for more white patients than black patients at the recovery campus.

"I don't know why they make it a race thing," Asuquo says, emphasizing that historic preservation should come only after progress. If Riverside is in fact as indispensable to the Third Ward as residents say, then the assistant administrator should never have broken the law, he says. "If I had something like that in my neighborhood, I would do my best to make sure that its reputation remains aboveboard."

Star of Hope was where Verenice hoped to transition, but seeing Riverside close its doors on patients convinced her to stay out of the system entirely. Counselors used to tell the women to avoid certain relationships that could create dependency -- she chose to make an exception for new boyfriend Rudy Lopez.

The two met a couple of years ago when Verenice still worked as a prostitute and Rudy picked her up off the street. It's no fairy tale, but Rudy reminisces about locking that initial eye contact like there was magic to it. When Verenice and Rudy drove by the place where they first met, he'd always tease her by nodding the way he once did to catch her eye. She says she hates that.

Over time Verenice and Rudy stayed friends, growing closer when he visited her while she was in treatment at Riverside. He would drive her to doctor appointments and join her at church, those few opportunities to see each other doubling as dates.

"I know how I met her and the circumstances, but I have no regrets. I'm very proud of her," Rudy says. He's a Vietnam veteran who went to rehab for alcoholism decades ago and has been sober for eight years. "She hung in there. Making that choice to get treatment, she did that on her own."

After Riverside, the couple moved from motel to motel, looking for a way out of their old neighborhood. In late September, Rudy secured a one-year lease on an apartment in Katy.

When asked about her long-term goals, Verenice pauses as if she hasn't decided. She thinks she might earn a GED, but then she admits she doesn't actually have a lot of goals. She says she wants to work. Looking back, there's no doubt she's had some bad relationships, but she wouldn't blame the crack addiction on anyone else.

Now and then, Verenice dreams about using crack, but when that happened, she'd wake Rudy up and they'd talk it through. She moves past the cravings.

For her older daughter's second birthday party on September 27, Verenice wanted a cake, a dress, decorations, invitations and little candy bags tied up with ribbon for the guests to take home. Her mother, Maria Lopez, helped to sort it all out. Though the two women never had a close relationship in the past, Rudy says watching them reconnect over ordinary things like buying groceries and tailoring the baby is real proof of how far Verenice has come. "It's like I'm getting the chance to get back together with my family like the way it should be," Verenice says.

Riverside's relocated patients are continuing with whatever treatment regimen the new agencies provide, which varies from what they're used to but keeps those who are determined to get better on task. Some Riverside counselors have kept in contact with their patients. Verenice texts her old sponsor whenever she's afraid she'll relapse or if she just needs extra clothes.

Williams still calls her sponsor at least once a week, though she's been in solid recovery for months as she works toward a psychology degree.

Williams says although it broke her heart to hear what happened at Riverside, she doesn't think it's the end of the road for anybody. Those who want to get clean will just have to become more disciplined, she says. She knows people who have recovered from addiction on their own, without receiving any kind of professional treatment, she says.

Local Cocaine Anonymous groups are another option. Lilly Grove Baptist Church in Third Ward hosts a Friday night meeting that used to be a regular stop on Riverside patients' schedules. The church would bus in about 40 men and women at a time to sit with its resident recovery coach, Anita Edens, but since the recovery campus closed and patients scattered throughout Houston, Lilly Grove hasn't been able to provide transportation for them all. Verenice was one of the few who returned every Friday because Child Protective Services requires that she continue her recovery through outpatient meetings. The deacon in charge of the program, Darrell Washington, says he's unsure where others have gone and whether they're getting help.

On September 20, Third Ward residents concerned about the future of Riverside invited hospital representatives to a community forum at Trinity United Methodist Church. About 75 people crowded a back conference room for the dual discussion on schools and health care. As HISD board member Paula Harris and her host of 15 principals fielded questions from angry parents for two straight hours, Hilliard's seat on the panel sat empty.

The other conservators, Ron Wilson and Manson Johnson, have been nearly silent since they were appointed. Residents say the conservators haven't been communicating with them and the hospital has lost its neighborhood feel. Provost suspects administrators are just careful to avoid hampering litigation, but all she wants is updates about Riverside's debt and the chance to get involved somehow in funding it. Hilliard told the Houston Press that community members have not reached out to include him, and instead of protesting, they should have organized a charitable drive.

Hilliard says if people had bothered to ask him directly about the state of the hospital, he could have told them that he recently contracted for $3 million worth of renovations on the recovery campus. Spinning the voluntary suspension of Riverside's drug treatment license as an opportunity to focus on upgrades, Hilliard says fixing the plumbing, rewiring the electricity and installing flood barriers, new ceilings and elevators within three months will allow him to reapply for the license and hire back employees.

He's funding the remodeling with out-of-state private lenders, which means Riverside is going deeper into debt, but Hilliard says Janek, the health commissioner, has promised to prioritize Riverside's recovery. Janek, of course, doesn't actually get the final say in whether the Texas Department of State Health Services relicenses the hospital. Riverside still needs to comply with a long list of state regulations, and DSHS spokesman Chris Van Deusen says the agency is looking to channel the hospital's contracts to other providers in the Houston area, such as those that have stepped up to care for displaced patients.

On Monday, a jury convicted former CEO Gibson and his son of health-care fraud, two years after they were taken away from Riverside in handcuffs. Despite the lack of direct evidence linking administrators, federal prosecutors argued that Riverside had charged Medicare and Medicaid for so many imaginary doctor visits that there was no way Gibson could not have known.

Hilliard had hoped for Gibson's acquittal to reinstate him as a financial adviser, even approving the use of hospital funds to hire an -independent law firm to investigate the likelihood that he was guilty. Now, as Gibson awaits sentencing, Riverside conservators are on their own.

Shortly after her daughter's birthday, Verenice called Edens, the recovery coach at Lilly Grove Baptist Church, in a panic. Rudy had cheated on her, she said, so she broke up with him and moved back in with her former pimp. Rudy says only that Verenice went back to her ex as soon as he got out of jail. The problem was that Rudy had been the one to drive her to Cocaine Anonymous meetings at the church, and now she has no way of making the trip downtown on her own. When she tried to enroll for treatment through the county Mental Health and Mental Retardation Authority, the best they could do was put her on a waiting list. Child Protective Services took her baby.

Verenice's on-again, off-again boyfriend Andrew Nelson, 20, is fresh out of prison and living with his parents in Pearland. He works odd jobs around the neighborhood to buy baby food for Verenice to deliver to her mother, who is temporarily taking care of both girls. Neither is his biological child, but Nelson insists he's ready to be a father. He says he's through with pimping and drugs, and he's beaten Verenice only once since they got back together.

"I used to be aggressive. I used to put hands on her. We had our arguments, but as far as leaving marks on her? Nah," Nelson says. The last time they scuffled, he'd been trying to end an argument by pushing her away. She kicked him twice in the side where his ribs had previously gotten broken in a prison fight, and "it was just a reflex," he says. "I regret that."

Nelson isn't allowed to visit the girls at their grandmother's house, so Verenice takes the bus home on her own. October 8 is the first time she goes to see her children in nearly two weeks. That morning, as she picks her way through a front yard littered with soda cans and spare car parts, Nelson calls after her to drive safely. She turns around and shows him the finger.

On the way up, Verenice points out a restaurant where Rudy once treated her to dinner and the thrift store where he bought her a baby walker. He spoiled her, she says wistfully, admitting she would go back to him if he'd only answer her calls. She isn't sure if she actually loves either man -- she'd been with Nelson longer, but these days she's constantly thinking about what Rudy is doing and who he's with, so that has to count for something.

Maria Lopez lives in a quiet neighborhood near Harrisburg in a house with a neatly trimmed lawn and a fat cat that lies sunning in the driveway. She feeds the two-year-old in the kitchen beside a tidy mountain of Fisher-Price toys while the baby sleeps in the next room underneath a crucifix. The house is decorated for Halloween, and it smells like baby powder and coffee brewed on the stove.

As she takes the grocery bag full of baby food Nelson purchased and checks each container for cracks or dents, Maria explains Verenice is welcome to move back home as long as she can follow the rules: Take care of the children, go to school or get a job.

"I don't like this situation. I don't like it at all," Maria says. "I just want to make sure the kids are at home. It's not like I don't want them, because you know they are my grandkids." At 60, she hadn't expected to become the primary caretaker of two young girls, but she's adamant that Nelson have as little to do with them as possible.

"I know for a fact you don't eat," she tells Verenice. "You don't take care of yourself. There is no end of the road here with this one you have...He has whored her out for his convenience to buy beer, cigarettes and drugs. It's no secret that this is where her hardcore drug use comes from."

For his part, Nelson blames Riverside. He's convinced that if Verenice had only stayed at home with his mother while he served his time, she would still have the baby. He says it all went downhill when she ran off for treatment -- and Rudy.

Verenice stays about an hour at her mother's house, gently bouncing her five-month-old baby in her arms nearly the entire time. When it's time to leave, she takes away trash bags stuffed with clothes and other personal things, including a polka-dotted suitcase marked with her name on a plastic tag. She says Riverside gave it to her when she graduated.

On the drive back to Pearland, Verenice complains that finding a job isn't easy with six counts of prostitution on her rap sheet. She says she needs to get Child Protective Services on the phone about getting her children back. It's plain to see her mother is taking good care of the girls, but that's not the point -- she wants them with her.

"If Riverside reopens, I'd go back in a heartbeat," she says.

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