This transcript of chapter 3 of “The Mayor of Maple Avenue” is provided for those who need assistance following along with the episode. We encourage you to listen to the episode. It can be found on Apple Podcasts, Spotify or your favorite podcast app. Please refer to the corresponding audio before quoting it in a story.

Sara Ganim: For a man in his 20s, Shawn Sinisi really didn’t have much of an internet footprint. He didn’t post much about himself, or even use email. But he was a pretty prolific writer.

He wrote letters to his parents to friends and to girlfriends and in rehab facilities, he wasn’t shy about writing notes about his stays reflecting on his life and what he wanted for his future. He often wrote about his family, how he felt supported by them, how they were always there for him.

These are excerpts from his first letter home after checking into a private rehab facility called The Ranch.

Shawn Sinisi entered the Ranch on December 10, 2017. Having just gotten out of of jail with a new year and birthday just around the corner, Shawn was eager for a new start. On his intake form, he said he was feeling helpless, hopeless and he repeatedly wrote about how he has buried the fact that he was abused, and he wanted to ‘finally talk.’

For a moment – the first in quite a while – Marianne and Mike breathed a sigh of relief. It appeared as if Shawn was as he said in his first letter home—finding the old, loving Shawn that everyone knows and loves once again. It was an affirmation of Marianne’s dogged determination. She had been anxious to transition Shawn out of that state-funded rehabilitation system and into a more specialized tier of treatment.

Months earlier, She had done that by enlisting the help of Attorney Andy Shubin, who brought Shawn’s case to the attention of Penn State university.

One of the most complex and disturbing things about Sandusky’s crimes is that they couldn’t have happened without Penn State. The university gave him access to the locker rooms where many of the assaults happened. It gave him the power he needed to pull off his decades-long abuses. It gave him legitimacy, and it gave him cover.

And so, when Sandusky went to jail and the Second Mile Charity went under, Penn State became the obvious place for Sandusky victims to sue. Within the first few years, they’d spent nearly 100 million to settle dozens of claims. And Attorney Andy Shubin handled a bunch of those cases. And after he met with Shawn at Blair County Jail, Shubin told Marianne that he could immediately tell that Shawn was a victim. and he was willing to take on his case.

But Marianne told him she felt differently about Shawn’s case. She wasn’t looking for a drawn-out legal fight and a monetary settlement. What she wanted, what she needed, was something more urgent.

And so Shubin went to Penn State with that request. It turns out, it wasn’t foreign to them. They’d had other victims who were struggling in the same way. So, they sent the Sinisis to the Praesidium—a consulting firm out of Texas. Penn State had hired the founder, a man named Dr. Richard Dangel, to be the intermediary between the victims and the university. Think of him as quality assurance. Dangel provided expertise in victim evaluation and made recommendations as to where victims should be placed for treatment. He used his relationships to make sure that placement went smoothly and he did ongoing evaluation of the quality of treatment received. When Penn State paid for treatment facilities. It was based on Dangel’s feedback… on his expertise… on his evaluations.

The first step was an evaluation. A psychologist named Cynthia MacNab went to the Blair County Jail to talk to Shawn In this case, A psychologist named Cynthia MacNab. She went to the Blair County Jail to evaluate Shawn. She wrote in her assessment that Shawn is consistent with Sandusky’s victims, and that Shawn ‘had not told anyone about the abuse until recently, although he reports that he knew something was wrong.’

Together, Dangel and MacNab told Marianne they recommended Shawn go to a top-tier rehab facility in Arizona that specializes in trauma-based addiction. A facility called the Meadows.

This is precisely the type of counseling Marianne had been waiting for. The type of counseling that the state services could not and did not provide. It was glamorous. The Meadows boasted patients like Whitney Houston and Kevin Spacey. As you can imagine, it was the type of treatment that is out of reach for so many because it’s so prohibitively expensive. In 2017, a 45 day stay at the Meadows cost $58,000.

Emails between Dangel and MacNab show that the Tuesday before Thanksgiving 2017, Dangel confirmed that Shawn would go to the Meadows for 45 days, paid for by Penn State. But the next day, he wrote, ‘Greetings Dr. MacNab, I wanted to give you an update. At this point the patient is not approved for payment for this service. If we get any other relevant information, I will keep you in the loop. Meanwhile I hope you have a pleasant holiday break.’

Cynthia MacNab typed a reply, ‘What happened? I understood from your email yesterday that there was authorization for a maximum of 45 days treatment. What has changed?’

On Thanksgiving day, Dangel responded, ‘I’m sorry for the change of plans. I am not involved in this case. Attorneys are involved.’

And Cynthia MacNab replied with a single phrase, ‘I don’t understand.’

Later on, the Sinisis were told Shawn would instead be approved to attend a facility just outside of Harrisburg, Pennsylvania – The Ranch.

Several people who I’ve spoken to during the course of my reporting, people who had direct contact with Dangel and the Praesidium, told me that there was a sudden and obvious shift around this time in what kind of treatment Penn State was approving for Sandusky victims.

Treatment at The Meadows had been approved several times before, but there was vocal leadership at the university suddenly pushing back because of how expensive it was. Just a few months prior, one Penn State trustee named Al Lord told a reporter he was ‘running out of sympathy for 35-year-old so-called victims.’ The sudden change in policy had trickled down to Shawn and As Dangel’s email indicated, it was out of his hands.

So, instead of packing for Arizona and The Meadows, the Sinisis switched out Shawn’s clothes from summer attire to winter, and he was on his way to The Ranch. And because they had been so desperate and then so hopeful as it related to the Meadows, they tried to treat this new plan as a minor change up. After all, Shawn was still going to get treatment.

In short, Shawn looked like he was getting better.

For the first time, his rehab experience was what you might expect. He was getting one-on-one counseling four times a week — in addition to group therapy. He was opening up. Notes from his first session give an insight into what he was dealing with. ‘Sleep,’ he told the therapist, ‘is hard.’

On its surface, The Ranch was a far cry from the state-funded facilities Shawn had spent the last 5 years bouncing between – mostly because this place promised to address Shawn’s trauma - his sexual abuse - alongside his addiction.

Records show he was placed in a dual-diagnosis program—addressing his addiction along with depression, anxiety, flashbacks, guilt, shame, anger and lack of trust. Shawn was also under the care of a medical doctor and a psychiatrist, and he was making friends.

Jack Green was a police officer at the time who checked into The Ranch shortly after Shawn because he had turned to alcohol in his struggle with job-related PTSD.

True to its name, the Ranch is a sprawling campus perched on a hill overlooking the Susquehanna river. The grounds include an archery field, obstacle course, and a meditation space with large standing rocks.

Shawn also befriended a staff member, a man who was also sexually abused as a child. They struck up a relationship and would talk sometimes in the mornings. Shawn was even getting more comfortable talking about it in group therapy—something that he’d never done before.

Jack said the program kept participants busy, leaving very little time for goofing off or getting off track.

About three weeks after Shawn arrived, Mike and Marianne went for a visit.

The family had a session scheduled with Shawn’s therapist to bring everyone up to speed and give his parents time to ask some questions.

Shawn’s medical records from the ranch note that ‘substance abuse has to stop completely before meds or therapy will be effective for PTSD and depression.’ But then, just a few lines later it says that he was prescribed two kinds of pain pills. One was Requip, a drug often used for restless leg syndrome. When I Googled ‘Requip and addiction,’ immediately I saw a bunch of warnings about how it can cause intense urges including gambling, eating and sexual compulsion. One warning says ‘you may not be able to control these urges.’ I asked Dr. Neeraj Gandotra Chief Medical Officer of the US Department of Health & Human Services and he confirmed it.

Dr. Neeraj Gandotra: That’s been, that’s a known side effect. It is a dopamine agonist, which means that it acts on the dopamine system.

The manufacturer, GlaxoSmithKline, decided in 2019 to discontinue Requip, but this was late 2017.

The other pain pill they prescribed is—you guessed it—gabapentin, noting once again that it’s for Shawn’s back pain. Marianne became doubtful of the Ranch’s ability to place Shawn on a stable path to recovery. As long as he had consistent access to opiates and their substitutes she could never be sure that Shawn could return to his old self.

And then, Shawn got a toothache.

For years, he had struggled with the health of his teeth. Not surprising given the combination of street drugs and prison, where dental care is—let’s say—less than ideal.

Suboxone is a drug that’s used to treat opioid addiction like methadone. It has a somewhat controversial reputation in the world of drug rehabilitation. Suboxone works by tightly binding to the same brain receptors as opioids, therefore preventing cravings and allowing many people to transition back to a life free from addiction.

But Suboxone treatment is still controversial. Not everyone agrees that it’s the best path to recovery. And at the time, Marianne was one of those people who was skeptical … partly because she knew Shawn had been abusing Suboxone.

At his last state-funded rehab, it turned up in his system during a drug test. And that time, he’d admitted that he bought it illegally on the street and was abusing it.

Here, at The Ranch, is was prescribed legally, by a doctor. Marianne recalls a contentious conversation she had with staff about it.

The drug Shawn was prescribed was actually Subutex. It contains one of the main ingredients in Suboxone, called Buprenorphine.

All these drugs, brand and generic names, and then different variations—it can get kind of complex and confusing, but if you stick with me for a minute, I’m going to tell you what you need to understand this particular circumstance. Suboxone is a drug made up of two other drugs: Buprenorphine—which is a partial opioid, it’s a drug that acts like an opioid, even though it’s not fully one—and Naloxone, which is an opioid antagonist—meaning it blocks the effects of opioids. Subutex only contains Buprenorphine. Not the opioid blocker.

So, if officials recognized it as an attempt at drug-seeking, why did they give him the drug? We can’t know for sure because The Ranch declined to comment on this subject, noting that they are no longer owned by the same company that was in charge back when Shawn was a patient, and so they do not have a comment on prior care.

What we do know is that the doctor who prescribed it, he also had a private medical addiction practice outside of The Ranch facility.

According to his LinkedIn profile, Dr. Christopher Davis was simultaneously working several jobs: as medical director at The Ranch, at a methadone clinic and running his own private practice where he advertised suboxone maintenance therapy. Records show that Dr. Davis began talking to Shawn about using Suboxone as a way to slowly taper and stay sober. The conversation happened Just a little more than two weeks after Shawn arrived at The Ranch. In his notes, Davis wrote that he told Shawn that he would run into problems taking suboxone because a lot of sober living facilities won’t allow residents to be on it, but he suggested one sober house that does and says,

The Ranch was drug testing its residents and toxicology reports show that Shawn was negative for all drugs until that same week when the main ingredient in suboxone, Buprenorphine, showed up. The paperwork helps piece together the story. According to The Ranch records, the very same day that Dr. Davis and Shawn talked about suboxone is the same day Shawn reported that he bit into a pretzel and broke a tooth filling. Dr. Davis examined him two days later and found that he did have a partial break of the filling on one of his left molars. Dr. Davis prescribed Subutex, noting in the records there was ‘risk of having a mild withdrawal.’

Marianne noted that Dr. Davis’ website mentioned that he didn’t take insurance, and patients were required to self-pay.

The example that I might give is if I’m running a residential facility and then I’m going to transfer the patient upon discharge to an outpatient level of care. I may have my own outpatient clinic that I could refer them to, but I need to at least give the patient the information that there are other facilities available that provide the same service. And perhaps, one of them may be more convenient, either by cost, location, hours of operation. There’s lots of factors that the patient may be considering outside of keeping things the same in terms of the same place.

Jennifer Storm, the former Pennsylvania state victim-witness advocate turned author and advocate for trauma-informed rehab services for victims of sexual abuse—she was a little more blunt.

Dr. Davis no longer works for The Ranch, but his LinkedIn profile says he’s still in private practice, and that he is the medical director at a different clinic owned by Pyramid Healthcare. Officials there declined to let me speak to him, and when I reached out several times privately—he didn’t call me back.

Shawn was nearing the end of his 30-day stay at the ranch, and from what Marianne could tell, he hadn’t truly been sober for very much of it. She felt the promise of this fancy rehab facility atop a hill slipping through her fingertips.

Dr. Richard Dangel was the founder of the Praesidium — and in his position as middleman between Penn State and victims like Shawn, played a pivotal role in the treatment he received. In no uncertain terms, Dangel held the pursestrings. It was Dr. Dangel who approved the $30,000 payment for Shawn’s stay, and so it was Dangel who had to approve any extension.

We don’t know exactly how Richard Dangel felt about Suboxone treatment for heroin addicts. The Praesidium declined to answer specific questions or talk to me for this podcast, and Dr. Dangel himself died in March, of Lewy Body dementia. What we do know for sure is that … after learning about the Subutex prescription … Dangel approved payment for Shawn to spend seven extra days at The Ranch.

The thing is Dr. Davis’s original idea to put Shawn on Suboxone was not necessarily an evil plan to make more money. It was probably rooted in good intentions and in science, too.

Shawn, at this point, has been addicted to heroin since he was 18 years old — almost eight years — and quitting cold turkey, quitting even without a short taper, that’s not really realistic for someone who has been addicted as long as Shawn.

Dr. Gandotra gave me a little background on how the industry view of Suboxone treatment is evolving.

That’s Dr. William Miller again, the researcher from the University of New Mexico.

The reason Marianne wasn’t sold on this path for Shawn at the time is because he admitted to her that he was relying on it because it was so easy to get.

Marianne Sinisi: In different facilities, he’d come right out and say, ‘What did you expect? It’s right there. It’s everywhere, mom. It’s in the place. I’ve only detoxed for five days. What did you think of going to do?’

Plus, the Subutex that Shawn ended up receiving at The Ranch wasn’t used for a longer-term taper. It was a short-term fix. And it didn’t have the opioid blocker that Suboxone contains.

Essentially, it’s just a pain pill. And when the facility abruptly took it away, and switched him to another drug, Tramadol, Shawn became really unsettled. Shawn got really agitated.

From there, his whole entire momentum at The Ranch changed. His daily progress notes rapidly switched from compliments about his attitude to concern over how much he’s focused on getting that Subutex again. It’s like a light-switch is turned. His behavior change, according to the notes, is drastic.

On January 2, the notes say

By Jan. 9, Shawn was sleeping through group therapy instead of participating. On the 10th, he was slurring his words. On the 11th, he’s caught committing a pretty serious indiscretion. One that could have gotten him kicked out. Shawn was caught having sex with a woman who was also seeking treatment at The Ranch. But they let him stay. And they kept prescribing Tramadol. On the 15th when he was discharged, the notes say exactly what I’ve just laid out for you. I’m going to read it.

‘Shawn went from being invested and doing well to disrespecting the rules and regulations. It became apparent that he was trying to manipulate the doctor, therapist and other staff in an effort to control his future plans post-discharge.’

Shawn did eventually get his tooth pulled, and it happened on what ended up being his very last day at The Ranch. It was meant to be his second-to-last day, but for an unknown reason, the facility decided to discharge him right to the dentist’s office.

This moment really stands out to me. When I look at the timeline of Shawn’s life, two things become clear.

The first is that Shawn had so many failed attempts at finishing rehab programs, that leaving The Ranch one day early probably had a lot more meaning for him than we might imagine.

The second thing is that after his stay at the Ranch — Shawn never has a period of sobriety that lasts more than a few weeks. It’s not all because of what happened there. There are plenty of other things that contribute.

As Marianne put it, The Ranch took him in, opened up a very painful wound and then spit him out abruptly.

While he was there, they gave him a drug that he was trying to shake, and then abruptly cut him off from it.

And on top of all of that, they wouldn’t even give him the satisfaction of completion. That’s, of course, the opposite of the mission of the facility, the opposite of the reason the Sinisis were told to send him there. Maybe things would have been better had they gone directly to The Meadows as originally planned.

As Shawn packed his bags. Marianne called to make sure his experience was accurately recorded.

The manager of compliance and quality for Elements Behavioral Health, which at the time was the parent company of the Ranch, responded to assure her that “appropriate follow-up actions, including training reinforcement, had been taken.

In the email dated three weeks after Shawn checked out, she wrote,

“It may interest you to know that Dr. Davis is no longer an employee of The Ranch Pennsylvania or associated with Elements Behavioral Health at this time. The leadership team at The Ranch Pennsylvania were active participants in our internal investigation of the concerns you brought up and will use this information to further train and develop their staff and improve.”

But in any case, that morning Shawn packs his bags. Except there’s one more thing he has to do before going to the dentist to have his tooth pulled—

But before Shawn really checked out of The Ranch .. he has to do one more thing..

…meet with his new attorney, Andy Shubin, and provide a taped conversation, … to put on the record for the first time what he endured at the hands of Sandusky. Shawn is going to meet with his attorney, Andy Shubin, to provide a taped conversation, and put on the record for the first time what he endured at the hands of Sandusky.

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