Oversight of clinics still lax

Cure elusive for methadone industry ills

Ever the neglected stepchild of drug treatment centers, methadone clinics are growing even more estranged from the state agency that's supposed to oversee them. And nobody — from inspectors to patients — seems to have a firm grasp on how to clean them up.

In April, a CL investigation showed that methadone providers in metro Atlanta routinely violate state regulations, and that state inspections of clinics are sporadic, at best.

Now, four months later, there are few signs of improvement in the way methadone is dispensed to recovering drug addicts. While the number of inspections is up, the clinics themselves are showing the same chronic violations. And penalties for infractions remain essentially toothless.

What's more, Dr. Thomas Hester, who headed the state Department of Human Resources division that oversees methadone clinics, has moved to Hawaii. His replacement, Dr. Tom Mueller, has no experience in regulating methadone clinics, according to division spokeswoman Xenia Wiggins.

Responsibility for monitoring the state's 19 methadone clinics has fallen to Mary Lou Rahn, a DHR director of unification and certification whose job already requires her to review 300 other health clinics in Georgia.

"I'm trying to get this into gear," she says.

So far this year, state inspectors have visited three of 10 metro Atlanta clinics. While that may not seem like many, the state is on pace to double the number of inspections conducted in 1997, 1999 and 2000. The problem is, the same violations keep cropping up over and over again. Inspections are illuminating, but not remedying, the woes.

Qualified staffers are quitting many clinics, and new hires tend not to be well trained in treating heroin and pain pill addicts, according to state inspection reports. Some patients have been admitted into clinics and dosed with methadone, a long-lasting opiate, without first proving a drug addiction. Meanwhile, four clinics have gone three or more years without a visit from inspectors, while one clinic was visited five times in two years.

Rahn says she's trying to improve inspections by requiring that the state's two methadone inspectors use a new form that illuminates which rule is broken and how often.

In addition, state regulations could pack more punch by year's end, according to Wiggins, the DHR spokeswoman. That's because a new set of federal standards will require an accreditation process for methadone clinics akin to that of hospitals.

"That gives us a definite opportunity to strengthen our regulations and put some of the teeth into them that you've noted are missing," Wiggins says.

Currently, Rahn and her staff have some leverage — including the power to revoke a clinic's license after repeated serious violations. But no Georgia clinic has ever lost its license as a methadone provider — even though similar infractions have shut down clinics in other states.

The DHR may be falling short of the law, which requires that the agency provide "continuing evaluation of the effectiveness of programs" and states that clinics must be manned by "trained or experienced staff who are competent in the duties they are to perform."

Despite erratic inspections, repeated reports of inexperienced staff, and five methadone-related deaths in Fulton County last year, no clinic has been convicted of breaking the law.

In April, inspectors visited Atlanta Metro Treatment in Norcross, and found that neither the program director at the time, Jerry Walters, nor his staff, were versed in the rules and regulations for operating a clinic. Inspectors also determined there was no supervision for the nurses, a violation cited numerous times before. All but one of the five counselors had a caseload above the 40-patient limit set by the state, and all but one of the counselors had been hired within the past year. Training records could not be found for any of the new counselors.

The April infractions at Atlanta Metro mirror ones found there in February 1999, when an inspector wrote: "There is much work to be done to bring this program into compliance." Similar infractions were noted in December 1999 and June 2000.

Walters, who at the time of the April inspection had been director for less than six months, has since left Atlanta Metro. One of the counselors, Dana Wallace, has taken over for him. She did not return phone calls.

Some patients complain that shoddy regulating and inadequate training has hurt the people clinic staffers are supposed to serve.

"When new counselors come, you can tell they care about you and they really try to make a difference," says one patient. "But then after a couple of months, they get defeated and they quit. They're so overworked, there's no way they can keep up."

Another Atlanta Metro patient, who has filed a complaint with the state, says that patients who openly question what's going on face repercussions.

A patient's biggest fear, she says, is for a clinic to withhold methadone, which is highly addictive. Without it, a patient enters a painful withdrawal.

"There's nothing we can do," the patient says. "If they make the mistakes, we pay for them."??