Pubdate: Sun, 07 Dec 2003
Source: Roanoke Times (VA)
Copyright: 2003 Roanoke Times
Contact:  http://www.roanoke.com/roatimes/
Details: http://www.mapinc.org/media/368
Author: Laurence Hammack

METHADONE COMPANIES' RECORDS DIFFER

One Company Had 64 Minor Violations At West Virginia Sites. A Virginia 
Company Hasn't Been Cited.

The company that plans to open a methadone clinic in Northwest Roanoke has 
been cited 64 times for violating state regulations at the six clinics it 
operates in West Virginia.

State inspections of the clinics run by National Specialty Clinics found 
the following violations: too many patients assigned to counselors, 
inadequate treatment plans, incomplete record keeping, insufficient 
training for some employees and failure to investigate complaints about 
possible misuse of methadone by patients.

National Specialty Clinics is planning a clinic at 3208 Hershberger Road 
that will be its first Virginia operation.

A second drug treatment company that is proposing a methadone clinic in 
Southwest Roanoke County has a clean record at the two facilities it 
operates in Virginia.

Inspections of clinics in Galax and Tazewell County run by the Life Center 
of Galax uncovered no violations since January 2001 - the same time period 
covered by the West Virginia inspections.

Inspection reports from the Virginia and West Virginia agencies that 
regulate methadone clinics were obtained by The Roanoke Times under the 
states' Freedom of Information Acts.

All of the problems found at the facilities run by National Specialty 
Clinics have been corrected, and none was serious enough to merit shutting 
a clinic down, according to Sheila Kelly, program director of West 
Virginia's Office of Health Facility Licensure and Certification.

"Frankly, most of the problems we ran into were pretty minor," Kelly said.

Kelly said one of the more serious violations involved the clinic in 
Charleston, W.Va., where state inspectors found that the ratio of patients 
to counselors regularly exceeded the limit of 50-to-1. Sixteen of the 21 
counselors had excessive caseloads that ranged from 63 to 67 patients, 
according to the report.

David Gnass, chief executive officer of National Specialty Clinics, said 
the Charleston clinic had an unusually large number of patients because it 
was the first methadone clinic in West Virginia when it opened in early 2001.

"We were swarmed under by patients," Gnass said. "Before we even opened the 
doors, we had a long, long waiting list of people begging to get in and get 
treatment."

Since then, National Specialty Clinics has opened five other methadone 
clinics in the Mountain State, with locations in Beckley, Clarksburg, 
Huntington, Parkersburg and Williamson. National Specialty Clinics now 
operates six of the state's seven methadone clinics and treats about 2,800 
recovering drug addicts.

The Nashville, Tenn.-based company transferred some Charleston patients to 
the other clinics and hired more counselors to relieve problems with 
excessive caseloads, according to the state inspection reports.

Kelly said it's important that counselors have enough time to monitor the 
needs of each patient.

In addition to receiving a daily dose of methadone - a synthetic narcotic 
that curbs cravings and blocks withdrawal symptoms for addicts of 
opium-based drugs such as heroin and OxyContin - patients at methadone 
clinics meet regularly with counselors as part of a broader treatment plan.

As for the other violations found in the inspections, Gnass said it's not 
unusual for that to happen when clinics are opened in a state that has no 
prior experience in dealing with methadone treatment.

"It's not always clear exactly what the state's expectations are," he said. 
"It's a learning experience for both sides."

But, he added, "I'm not making excuses. Any time you get deficiencies like 
that, it shows that we weren't as prepared as we should have been."

Gnass said the company has moved quickly to correct the problems.

According to Kelly, the state found the same level of violations at the one 
clinic not run by National Specialty Clinics.

"Nobody's ever 100 percent," she said.

Because there are two methadone clinics already operating in Southwest 
Virginia, Gnass said he does not expect a rush on the Roanoke facility like 
the one his company saw in Charleston. Still, the proposal has generated 
controversy.

Opponents say that for-profit companies such as National Specialty Clinics 
are more interested in making money than getting addicts off drugs. In a 
license application filed with the state of Virginia, National Specialty 
Clinics said it expected to clear about $127,000 a year at the Hershberger 
Road site.

Concerns about crime and drug dealing have also fueled opposition to the 
Northwest Roanoke site and the one in Roanoke County.

Although police in Virginia jurisdictions that have methadone clinics say 
they have not experienced major problems with clinic-related crime, 
inspections conducted by West Virginia officials raise the possibility of 
problems there.

At the Charleston clinic, inspectors found an inadequate system for 
tracking and analyzing so-called unusual events.

There were at least 20 such events from Jan. 1 through March 17 that 
warranted further investigation, the report stated.

In one case, a highway patrol officer in Ohio stopped a clinic patient for 
a traffic violation and found that his take-home doses of methadone had 
been placed into other plastic containers and resealed. "The officer 
reported that he believed [the patient] had intended to sell his doses of 
methadone," the report stated.

When drug addicts first enroll in methadone programs, they must report to 
the clinic every day to receive the medication. But as patients progress 
through treatment, most programs allow them to take home doses of methadone 
to last for a day or longer without a clinic visit.

In the case reported by the Ohio state trooper, some of the patient's 
privileges were revoked and he was required to visit the clinic every day, 
with just one take-home dose for Sundays.

Other unusual events cited in the inspection report included allegations of 
patients abusing drugs away from the clinic and selling their methadone.

Kelly said the job of state regulators was not to investigate the validity 
of such reports, but simply to determine whether the clinics had an 
adequate system to do so themselves. But if the state had credible evidence 
of criminal activity associated with a clinic, she said, it would be 
reported to police.

So far, that has not happened in the Charleston area. "We've not had any 
abnormal activity in the area that could be directly attributed to the 
methadone clinic," said Lt. Jess Bailes of the Kanawha County Sheriff's 
Department.

At five of the six facilities operated by National Specialty Clinics, 
inspectors found that treatment plans for each patient were not detailed 
enough.

"Generic treatment plans are developed and do not take individual needs and 
preferences into account," a report on the Beckley clinic stated. In one 
case, a treatment plan that had been typed in advance for one patient was 
identical to the plans found in the files of five other patients.

Officials at the Beckley clinic resolved those problems to the satisfaction 
of state regulators by revising the treatment plans and implementing new 
forms and training, according to the report.

Meanwhile, Virginia officials reported no regulatory violations at the 
Galax and Tazewell County clinics run by the Life Center of Galax, which 
has proposed a third location at Colonial Avenue and Ogden Road in 
Southwest Roanoke County.

"Their compliance has been very good with state regulations, and they have 
had very few complaints made about them," said Leslie Anderson, director of 
the Office of Licensing with the Department of Mental Health, Mental 
Retardation and Substance Abuse Services. Anderson said Virginia regulators 
look for many of the same things that were cited in the West Virginia 
inspections.

In addition to conducting routine inspections of methadone clinics, 
Virginia regulators also investigate reports of abuse.

One such investigation involved an allegation in August that a nurse at the 
Life Center's Tazewell County clinic was "partying" with patients after 
hours, using Xanax, marijuana and alcohol, according to the state's records.

A drug test administered after the allegation, and another one the nurse 
took when she was hired in June, were both negative, the report stated. 
When the person who made the complaint declined to provide names of 
witnesses, the allegation was found to be unsubstantiated.

While National Specialty Clinics has received a business license from the 
city and hopes to have the Hershberger Road clinic open by early next year, 
the Life Center's plans were delayed when the county denied its business 
license application.

The Life Center is appealing that decision. The Roanoke County Board of 
Supervisors is scheduled to hear the appeal at 7 p.m. Dec. 16, and the 
Board of Zoning Appeals will meet at 7 p.m. the next day to take up the issue.
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MAP posted-by: Beth Wehrman