As painful as it was for them, the Mosiers had made the right decision. But could justice be delivered another way?
I’d sent a third text to Kendall after leaving their home and had Brynn working behind the scenes to dig deeper into the business structure of Renacido and the attorney who’d used intimidation tactics against the Mosiers. At the very least, the Illinois Bar Association needed to hear about it, but I was more interested in why Renacido had felt compelled to go to those lengths.
I was standing outside a Gold Coast rehab center prepping for a loosely arranged meeting with Dr. Lecaros. He’d promised me a fifteen-minute block of time, provided I didn’t mind waiting around for him during a break between appointments. Annoying, but if he was willing to talk to me without the consult bill, I’d sit quietly and bow to his schedule. The psychologist had described Wykell as dangerous, and he certainly seemed it to me, but that didn’t mean we were working off the same definition. Given Lecaros’s area of expertise, I was speculating that there was either a patient or a practice at the heart of their rift
The red brick building I’d been directed to was elegant and discreet. Its Georgian architecture and rich green shutters blended seamlessly into the neighborhood. To anyone walking past, the purpose of the business establishment would have been unknown; the small brass plaque near the door was the only mark identifying it as one of the most highly regarded treatment centers in the Midwest—and then only if you happened to be familiar with the name. I’d walked past the facility myself many times and not given it a second thought.
Two young men stood outside, taking time out for a smoke near the iron fence as I approached. I nodded hello, then stepped toward the heavy green door. Immediately inside was a reception area, more parlor-like in feel than the clinical atmosphere I had expected. Traditional furniture, wingback chairs, even a small area fashioned into a library. Like the Renacido Center, this facility made an attempt at disguising its purpose. However, given the cameras and manned reception desk, it didn’t seem likely patients were wandering aimlessly out of this facility without supervision, certainly not those in physical distress.
If you had $30K to drop on treatment, I imagined the homey atmosphere took the sting out of the reality of being consigned to the facility.
I approached the woman at the desk and asked for Dr. Lecaros.
“Please have a seat. I’m sure he will be out shortly,” she said after putting in a call.
I settled into a chair and killed time by Googling Dr. Wykell, looking for any connection I could find to business associates, past or present. The intimidation tactics used on the Mosiers screamed big money or big risk. There was a lot to lose, or a lot to gain, if the tactic of choice was to hire a thug.
Zoe had died of a heart complication, as had Owen Mosier. If Paul’s life had ended for the same reason, it would be impossible for CPD not to explore the connections. It was unlikely that the ME had completed their work yet but I sent Michael a text asking anyway, before moving back to the internet to explore drugs with risk of heart-related side effects.
Dr. Lecaros poked his head out of the doorway and motioned me over. I tucked my phone into my bag and scurried after him as he moved down the hall.
He led me to a small room outfitted with a desk, a couple of upholstered chairs, and bookcases stacked to capacity. He settled into one of the chairs and I did the same.
“You’ll forgive me for the limited time. My schedule is such that I have to squeeze in meetings where I can, even if it means using facilities other than my own.” He flapped his hand at the room, which clearly didn’t meet his standards. “If I recall correctly, and I believe I do, you were interested in cutting-edge opioid treatment modalities,” he said.
“Before we get to that, you said something the other day that I’d like to follow up on. It was about Dr. Wykell. You cautioned me to stay away. Why was that?”
“You clearly mistook my intent. I simply meant that there are psychologists far more knowledgeable in this area. After all, why consult with the second string?”
“Then you’re familiar with his work. I got the impression that perhaps there was a conflict there. Was I mistaken?”
I had to be careful of how I approached the conversation, as I had yet to correct Dr. Lecaros’s assumption that I was still an attorney shopping for a hired gun. If I had to fess up to being a reporter, I’d have about two seconds to get out of the room.
“It’s nothing other than philosophical differences. So, you have questions on the newest treatments.”
As I suspected, Dr. Lecaros had recognized his moment of indiscretion and was dialing it back.
“Could we start with an overview of some of the practices in your world,” I said. “As a leader in the field, how would you define the gold standard of addiction treatment?”
May as well start with the suck-up. Admiration, real or not, was going to be the fastest way to get Lecaros to be talkative. If he disagreed with the current standard of care, he’d let me know just to show how smart he was.
“Flattery will get you everywhere.” He laughed, while I resisted an eye roll. “Although your question is like asking me to describe the gold standard in building a house. There is no one way. I happen to have strong opinions, opinions based on my years of work in the field, I might add, but the gold standard is more accurately thought of as a positive end result.”
“Fair enough. I can only imagine the patience and the compassion required to make addiction treatment your life’s work,” I said, continuing the unpleasant ego stroking. “Perhaps I need to rephrase the question. Would it be accurate to say that various methods of talk therapy are the primary methodology?”
“Yes, although talk therapy is an immensely generic term. We do utilize practices such as cognitive behavioral therapy, biofeedback therapy, and a whole host of other modalities that would fall into that category, but then there are also treatments such as EMDR, which access other mechanisms in the brain. Often it’s a combination of protocols that have been individualized for the needs of the patient.”
I had two primary lines of questioning in my mind, and I had to be careful how I layered them if I was going to keep Lecaros engaged. There was the concern about what might be going on financially that would heighten the risk of a PR black eye impacting the Renacido Center, and then there was the issue of experimental treatments. They weren’t mutually exclusive, but I had to be deliberate in my questioning so that I didn’t appear to be going after Wykell directly. Like in the law, it was out of bounds for one doc to publicly disparage another, and Lecaros was certainly aware that he had already toed up to that line, even if I he hadn’t given me any context.
“Would it be accurate to say that treatment at a facility such as this is one of the more expensive options?”
“Individualized treatment is never cheap. Although I only consult here, this is a facility that believes strongly in a period of in-patient care, followed by out-patient therapy, and then ongoing support for as long as necessary. A lifetime perhaps for some. Each leg of the treatment is interconnected with the others. It’s quite labor intensive.”
“Excuse me, I wasn’t intending to sound critical of the cost. I just wanted to establish the fact that if a patient came to you, whether through this facility or through direct contact and did not have insurance coverage, there would be some kind of expectation of an out-of-pocket payment plan.”
“Yes, of course. Although these days, my work directly with patients is limited. I’m primarily a consultant serving the therapist community and the legal community. This process is a costly endeavor, and the money spent is an investment in life. So many lives are ruined by addiction, it’s difficult to think about it as a simple ROI equation.”
He snuck a peek at his watch, reminding me that my time with him was not unlimited.
“Have you ever run across a center, a private center, that treats patients for free?” I asked.
“Completely free? I’m certainly familiar with a few charity organizations that provide treatment to individuals, but those facilities would either have been funded by some type of endowment or they are a need-based sliding scale with supplemental funds coming from the community or a government source.”
“But not a for-profit facility?”
“I don’t see how that would work. Staff does expect to be paid, utilities are not cheap, and then there is the pesky problem of taxes.” He gave me a weak but condescending smile.
“How about more of a barter system?” I said, throwing out an unformed thought, brainstorming just to see where it got me.
“It’s a preposterous idea. Why in the world would you ask?”
“Just curious,” I said, quickly changing the subject. I’d irritated the man. Time for a little stroking. “Given your prominence in this field, I assume you are up on the cutting edge of treatment protocols, protocols that might be considered experimental or are in early stages of evaluation. Would that be accurate?”
“I do my best to keep up. As I’m sure you know, we have a significant problem in our country right now, particularly in the area of opioids, and we in the field are all anxious to make an impact. Not only for individual lives but for the greater good of society. That is the heart of why we do the work we do.”
“And what would some of the newer, more experimental drug treatments be? And by that I mean medication-assisted treatments.”
He sat up straighter in his chair. I’d finally found something that interested him.
“One of the things becoming more common now is NAD therapy, nicotinamide adenine dinucleotide. It’s a coenzyme of niacin that helps our bodies produce energy. Drug and alcohol abuse depletes the body’s production, and this can contribute to a co-occurring disorder. But I view the treatment more as an adjunct support versus a stand-alone treatment.”
“And how is NAD administered?”
“Typically through an IV. As I said, it is a co-treatment, not a stand-alone. It assists with flushing drugs out of the user’s system and helps curb cravings. It also reduces the pain of withdrawals, which puts the patient into a place where they are more able to work with the other therapies.”
Although the IV part seemed to fit the bill, I wasn’t sure a naturally occurring enzyme did, unless the usage was brand or dosage dependent or used in combination with other drugs.
“Are there any potential risks or toxicities to NAD?”
“It’s a fairly recent addition to the arsenal, and although I can’t imagine any obvious problems—after all, it is a naturally occurring enzyme—in reality, we don’t yet have long studies to clarify.”
“What about medications or combinations of medications that perhaps have not yet reached acceptance?”
“Are you talking about off-label use?”
“Is that an issue?”
“Of course, but not at any facility that wants to keep its license. There are treatment centers outside of the US utilizing hallucinogenic’s, LSD, psilocybin, and ibogaine. But none of that is currently legal in the US. I’m not up-to-date on the current clinical trials, but there are people who leave the country. Have you heard the term ‘medical tourist’?”
“Yes, I have, but only in the context of cost savings for things like cosmetic or dental surgeries. You’re talking about going overseas for addiction treatment not approved in the States.” My mind was running ahead with this thought. “If a US-based facility wanted to utilize some of these products, these medications you just mentioned, even though they’re not legal currently, how would they go about doing that?”
“By smuggling it in and not telling anyone what they were doing.”