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.