Sam Mandel is the CEO of Ketamine Clinics Los Angeles, which he co-founded with his father in 2014. A lifelong advocate for mental health, he oversees the day-to-day operations of the clinic, including patient satisfaction, legal and compliance, marketing and publicity, construction and interior design, and business development.
Mandel recently described the early days of KCLA, the widespread stigma ketamine treatment had a decade ago, and the strategies his clinic adopted to maintain quality control and grow its client base.
How did you personally come to this line of work?
I have a personal interest in mental health. I’ve had a lot of friends and family who have struggled with addiction and suicide, as well as depression and bipolar disorder. So it’s something that’s near and dear to me. When I was 12 years old, I volunteered for a teen-to-teen suicide prevention hotline. So from a very young age I had exposure to assisting my peers in crisis, and it’s an area I’m passionate about. The opportunity to start Ketamine Clinic Los Angeles — which I co-founded in 2014 with my father, Dr. Steven Mandel — was really amazing. We had followed the early research of ketamine for mental health, and to see something new and different that actually worked was inspiring. It was faster, better and safer than the alternative treatments. I got excited about that. So we started offering infusions to people, and the results spoke for themselves.
So 2014 was pretty early in the so-called psychedelic renaissance. It was three years before Michael Pollen’s book or any other mainstream media. What was the environment like when you launched?
It was very, very different then. Today, you see a lot of enthusiasm, a lot of big money coming into the space, there are many more operators — probably about 20 to 25 ketamine clinics in LA alone, and well over 1,000 throughout the country. When we started, we were really the only one in town. There was so much stigma then around ketamine, so much misinformation about the treatment, even within the medical community. Many people just didn’t really get what ketamine is, or how it works.
Early patients who called us were very, very suspicious that this some kind of snake oil or something. I took every single call. I created a very basic website, got a cheap flip phone and just started taking calls. We really bootstrapped it from the ground up. We didn’t have investors, we put everything on credit cards. So I talked with every single person who called, sometimes for well over an hour. They had tons of questions. They’d make multiple calls before feeling comfortable enough to take a chance and try it. So, I would check everyone in and do all the prescreening work. Then my father would do the direct clinical care. It was just he and I back then. Today we have 15 employees and 5,000 square feet in purpose-built facility. So it’s been an amazing evolution looking back to those days.
What treatments did you start with and has your offering expanded over the years?
We offer IV infusions of racemic generic ketamine, and that’s what we’ve remained focused on. We never offered Spravato, frankly because it’s not very effective. It works maybe 40% of the time at best, whereas IV ketamine at our clinic works 83% of the time. So it’s literally more than twice as effective. It’s faster-acting, safer and has better quality relief. That’s what we started with and what we continue to specialize in today.
Set and setting get talked about a lot when it comes to psychedelic treatments. How important was getting the setting right as you built out your business? And what impact do you think it has had on patient outcomes?
Yes, definitely we wanted to create a really calm, peaceful environment for patients. Their mindset is super important. So we didn’t want anything to feel too medical. Our space is very nature inspired. It feels more like an elegant hotel than a doctor’s office. Every little detail is taken into account from music that’s playing throughout the suite to just the energy everywhere. We keep it very calm and quiet and peaceful.
It’s also really important that patients interact with a team that’s compassionate and reassuring. We go to great lengths to really prepare them for the experience in advance. A lot of people in this field kind of skimp on this safety and comfort part. We’re very big on safety. Even though ketamine is a really safe medicine when used responsibly, we’re actually accredited as an ASC (ambulatory surgery center) one the only ones with that accreditation. We have a ton of safety equipment: resuscitation equipment, oxygen, a crash cart. Our whole team has advanced training in CLS (cardiac life support) and BLS (basic life support), and they all have done moderate sedation training with the American Society of anesthesiologists. If there is ever an issue, we can handle it here — that being said, we’re really fortunate never to have needed to.
How long did it take for your clinic to become financially sustainable? How did your growth trajectory go?
That’s a good question. I would say it was a couple of years before we had some meaningful revenue. I mean we actually had pretty good numbers in our very first year, but as far as profits go, we’ve always just reinvested into the company. We haven’t really taken a lot of profit out. When we started out, we were literally just in a closet — an 8- by 7-foot room — in another doctor’s office. Then we moved to our own suite in Brentwood that was 1,700 square feet. Then we moved again to where we are now. It used to be 3,600 square feet, but we expanded it to 5,000, because the space next door was available. As far as our staff’s growth, we have a really great collaborative team. We have two in-house psychiatrists, a psychiatric nurse practitioner, a physician’s assistant, a team of RNs, and then an admin team for support. And we believe in a one-to-one ratio of clinician to patient at all times.
What’s the average length of time door-to-door that an IV infusion treatments takes?
Usually around two hours. On the fast side, maybe 90 minutes.
Can you talk about the average price per infusion? I imagine rates in Los Angeles are higher than a national average.
We provide a series of six infusions over two to three weeks for $3,900. The first two are $750 each, and then every infusion thereafter is $600 each. We’re also in-network with nine of California’s largest health insurance plans because we’ve also added the services of psychiatric medication management, conventional management of people’s prescriptions, and also transcranial magnetic stimulation or TMS, which is a new service we’ve added this year. So we’re able to bill insurance for those.
As for ketamine access, we’re working with a couple of different organizations on trying to increase access to care. We’re currently contracted with Kaiser Permanente SoCal specifically for ketamine infusions. They’re actually sending us referrals and paying for patients to have treatment here. It’s really at the providers’ discretion on who gets, but that’s been a huge step forward in increasing access to care for people.
If and when MDMA gets approved, are you making plans to offer MDMA-assisted therapy? Or do you see that as a whole different field?
Yes, we’re really enthusiastic about the early research on MDMA. It seems very promising, and we’d like to incorporate it into the practice when it’s legal. Same with psilocybin and other psychedelics. We feel psychedelic medicines are really head and shoulders above everything else that we have today and can provide the most dramatic relief for people for mental health issues. A lot of people think ketamine clinics are in a good position to incorporate them — and I think in some ways we are — but there’s some really substantial differences in the care model with those treatments. It won’t be as easy to pivot from ketamine to MDMA as many people might think.