By Ella Nilsen
Colonial Management Group methadone clinics across the country have been cited for multiple violations, including not giving clients adequate counseling, not screening for other illicit drugs and raising doses without a doctor’s orders.
State legislatures in West Virginia, Minnesota, Pennsylvania and Maine have put measures in place to combat these issues, including increasing oversight and requiring methadone clinics in some states to hire more counselors.
But New Hampshire’s government has taken little action on these for-profit clinics; the state regulatory structure on the clinics has no money and little power, according to health officials.
Colonial Management Group officials did not return multiple phone calls and emails asking for comment on this story.
In Minnesota, the company is in the midst of a court battle with that state’s Department of Human Services. If Colonial loses the case, the department will revoke its license and the company will have to close all of its Minnesota clinics.
“We believe we have a pretty strong case,” Minnesota Inspector General Jerry Kerber said in a recent interview.
That court case stems from allegations of misconduct and negligence at the Lake Superior Treatment Center, a Colonial clinic located in Duluth, Minn.
In 2012, the Duluth News Tribune ran a series of articles alleging that Lake Superior clients sold take-home doses on the street after clinic staff gave excessive doses. The newspaper linked this to a high number of fatal overdoses in that community.
Articles from the Duluth News Tribune
When Department of Human Services investigators inspected the Lake Superior Treatment Center in 2012, they compiled a list of more than 50 violations, many of them repeat violations from inspections since 2007.
Investigators found clinic staff had given them false information, loaded counselors with high caseloads and failed to monitor take-home doses.
Inspectors also found instances where Lake Superior clients were given increased doses, but there were no reasons or physician’s orders given for these increases.
“In virtually every area, their performance was substandard and of concern,” Kerber said.
He said that while other methadone programs in Minnesota have also had violations, none has had such an extensive number “across the board and in so many areas.”
The company has had problems in other states too.
From 2009 to 2013, multiple violations were documented at Colonial Management Group clinics in Texas. Investigators at the Texas Department of State Health Services said clinic staff did not perform routine urine drug screens on clients. They also saw counselors with high caseloads and documented instances where clients had not received counseling.
In addition, there were instances where doses went missing, staff did not keep dosing records, doses were increased without a physician’s orders and counseling interns treated patients unsupervised, records showed.
In 2011, the Texas health department reported staff from the Metro Treatment of Texas, LP clinic in San Antonio had given inspectors “misleading information” about the number of clients they could treat, saying they could handle increasing their number of patients to 825.
“When we inspected in October 2011 we determined that you neither had adequate space or staff to accommodate a capacity of 825,” Texas health department documents said. “Providing the state with inaccurate or misleading information is a very serious breach of trust.”
Despite this, no disciplinary action was taken against any Colonial clinics in Texas, according to a department spokeswoman.
Still more violations are listed in Indiana, where a Colonial clinic didn’t comply with state counseling requirements. In Florida, caseloads at one clinic were two to three times higher than state standards allowed. Again, the company was not fined.
The same can’t be said in other states. In Alabama, the U.S. Attorney’s Office fined a Colonial clinic in Huntsville $95,000 because it failed to keep records and couldn’t account for more than 3,000 missing doses of methadone.
And in multiple states, including Alabama, Florida, South Carolina and New Hampshire, the company has been sued by former employees or clients for claims ranging from workplace discrimination to medical malpractice.
Colonial Management Group isn’t the only treatment company in New Hampshire sued in relation to car crashes. Community Substance Abuse Centers, a treatment company that owns and operates methadone clinics in Massachusetts, Maine and New Hampshire, was sued after a 2008 crash involving a client leaving its Somersworth clinic.
Colonial was sued in New Hampshire under similar circumstances, after two clients fell asleep at the wheel and caused serious crashes.
One occurred in Keene when then-19-year-old Keene Metro Treatment Center patient Addison Southwick of Swanzey hit 24-year-old Jenna A. Lydon, who was jogging on the side of the road. Lydon survived the accident, but suffered serious, permanent injuries.
The other crash involved a Concord Metro Treatment Center patient and Goshen resident named Shawna Palmer, who crashed her car, severing her spine.
In both cases, lawyers suing the clinics and their parent company alleged clinic staff failed to monitor Southwick and Palmer for illicit drug use and continued to increase their doses despite knowing about use of other drugs, including marijuana and benzodiazepines, such as Xanax, respectively.
Kerber he said he doesn’t know why Colonial Management Group operates the way it does.
“We always speculate whether it’s ability or motivation,” he said. “In the end, we don’t know.”
A lack of state regulation
The oversight in Minnesota and Texas doesn’t exist in New Hampshire, because the state rarely inspects for-profit methadone clinics.
The N.H. Bureau of Drug and Alcohol Services does not receive any funding to regulate methadone clinics, according to its director, Joseph P. Harding.
Harding said he was not aware of the crashes involving Southwick and Palmer, even though the state requires clinics to report incidents involving clinic patients or staff members.
Rather than inspecting clinics itself, New Hampshire relies on the nonprofit Commission on Accreditation of Rehabilitation Facilities, or CARF, which is responsible for making sure methadone clinics are following standards put in place by the federal Substance Abuse and Mental Health Services Administration.
Many other states across the nation also rely on CARF to accredit methadone clinics and other rehab facilities.
CARF accredits and licenses these clinics, either for a period of one or three years. Three years is the highest level of accreditation a clinic can achieve.
More than 95 percent of service providers seeking CARF accreditation receive it, and just over 80 percent receive the full three-year accreditation, a CARF spokesman told the Duluth News Tribune in 2012.
CARF spokesman Brad Contento declined to comment on whether that is still the case.
Contento said CARF looks only at federal standards; it doesn’t take state regulations into account.
“Individual states may have regulations that providers have to comply with in addition to accreditation, but those would not be directly applied through the CARF accreditation process,” he wrote in an email.
Clinics need to be CARF-accredited to get reimbursed by Medicaid, and some states use CARF’s federal accreditation in place of state licensing or inspection, Contento added.
In New Hampshire, the state’s Bureau of Drug and Alcohol Services is more involved with clinics when they are first being set up than later in their operation, Harding said. The bureau accepts CARF accreditation in lieu of a site visit from state inspectors, he added.
“With any of the providers that are accredited, we would do that even if we had lots of resources,” Harding said. “It would be redundant and really a waste of everyone’s time.”
If any problem with a clinic comes to the state’s attention, the bureau would perform a review of the complaint, and could request information from CARF to check if it encountered similar complaints, Harding said.
Electronic records checks “occasionally” happen, Harding said.
In Minnesota, Kerber said he is aware that different states have different abilities to regulate methadone clinics.
“It’s that kind of thing that we struggle with as regulators,” he said. “It should be investigated. It shouldn’t be up to the media; it really is our job.”
Discrepancies in accrediting
Despite New Hampshire’s reliance on CARF, the commission’s accreditation of methadone clinics has differed widely from what state health inspectors found in other states.
In 2012 in Minnesota, CARF gave high marks in accreditation to Lake Superior Treatment Center, the Colonial Management Group clinic in Duluth, Minn., with more than 50 violations from state health inspectors.
In its remarks, CARF praised that clinic, saying it had “made a dedicated effort to maintain international accreditation and is providing much needed services to persons in need of treatment for opiate dependence.”
Three months later, Minnesota’s state investigators recommended the clinic be shut down.
In 2012, Kerber called CARF’s findings “completely inconsistent” with his department’s report.
At that time, a CARF spokesman declined to comment to the Duluth News Tribune on the discrepancy.
A spokesman told a Sentinel reporter CARF does not comment on individual cases.