Pubdate: Wed, 10 Aug 2005 Source: Lexington Herald-Leader (KY) Copyright: 2005 Lexington Herald-Leader Contact: http://www.kentucky.com/mld/heraldleader/ Details: http://www.mapinc.org/media/240 Author: Lee Mueller Bookmark: http://www.mapinc.org/heroin.htm (Heroin) Bookmark: http://www.mapinc.org/find?136 (Methadone) Bookmark: http://www.mapinc.org/oxycontin.htm (Oxycontin/Oxycodone) METHADONE DEATHS TO BE STUDIED Lawsuit Brings Attention To Drug Treatment Facilities HAZARD - In the wake of a $2.8 million jury award last week to the family of a Leslie County man who died while being treated for drug addiction at a methadone clinic, state regulators are taking the first steps toward monitoring the deaths of clinic patients. "There is no investigation process for the state with the death of a client," said Mac Bell, administrator for the State Narcotic Authority, which oversees 11 methadone maintenance programs in Kentucky. Bell said his office has no legal jurisdiction to investigate deaths reported to his agency. "When there's a death, that goes back to the clinic director -- the doctor in the program," he said. After a five-day trial in a wrongful-death lawsuit, a Perry County jury decided Friday that the Hazard Professional Associates clinic -- not a doctor and nurse named in the suit -- was negligent in the 2002 death of Jason Caldwell, 21, of Leslie County. Caldwell was a former coal miner who was injured in a car wreck and became addicted to the powerful painkiller, OxyContin, said Gary C. Johnson, a Pikeville attorney who represented Caldwell's estate. Caldwell went to the methadone clinic in Hazard to "get off" OxyContin, but died five days later after receiving allegedly toxic doses of methadone, Johnson said. Bell said his agency receives reports of about five deaths a year at methadone clinics in Kentucky. The number of methadone patients is rising across the state -- as many as 1,800 patients are being treated in methadone clinics, Bell said. While state law doesn't allow his agency to conduct a criminal investigation, he said the agency plans to begin compiling data on clinic deaths. "Now, since we've gotten so large, we are in the process -- and have been for the last year -- of implementing a data collection system that will look at mortality and morbidity rates in our state," Bell said. Invented in Germany during World War II as a substitute for morphine and used now as a painkiller and to treat heroin addiction, methadone has been available in Kentucky since 1971, Bell said. Too much methadone In the Caldwell case, Johnson and his co-counsel, Kenneth Buckle of Hyden, argued the clinic had administered too much methadone too fast. Defense attorneys claimed Caldwell supplemented the liquid methadone he received at the clinic with methadone pills he bought from street dealers. While Dr. Ashok Jain of Pittsburgh and nurse Tammy Cornett were absolved of blame, the jury ordered the clinic to pay $1.8 million to Caldwell's mother and $1 million to his four-year-old son. Attorneys, however, said they settled the case for lesser, undisclosed amounts before the jury announced its decision at midnight. "We were certainly shocked by the jury's verdict, particularly since they found neither the doctor or the nurse to have been at fault," said H. Brent Brennenstuhl, a Bowling Green attorney who represented all of the defendants. "Had we not agreed to a settlement that was substantially less than the verdict, we would absolutely appeal it," Brennenstuhl said. A patient every 21/2 minutes The Hazard clinic is one of several in Kentucky operated by Bowling Green Professional Associates PLC, which is owned by two licensed practical nurses. Bell said the clinics are among the nine privately owned methadone clinics that have opened since 1995 when Kentucky first began regulating them. There are also state-operated clinics in Lexington and Louisville. Buckle said clinics owned by the Bowling Green firm charge methadone patients $85 a week, which includes the cost of the methadone. He said a nurse testified the Hazard clinic was treating a patient every 21/2 minutes. "The problem is, the state of Kentucky doesn't enforce the regulations," said Johnson. "When somebody dies from taking methadone at a clinic, there's not a single state agency that investigates it." Brennenstuhl said Bell's agency in the state Department for Mental Health and Substance Abuse Services has no law-enforcement jurisdiction and fulfills its responsibilities under existing state law. "There can be a bad outcome in a treatment program, even with the best of care," he said. Two clinics a decade ago Bell said that when state regulations were adopted in 1995, the state-operated clinics in Lex--ington and Louisville were the only methadone clinics in Kentucky. "We've not had enough client population to do any kind of investigation, even on a single basis," he said. "In other words -- and this is going to sound terrible -- for it to be cost effective, it has to be worth your while to do it. ... We've not had a lot of statistics in the past because we've not had a lot of deaths." That has changed with the addition of clinics across the state, and that is why Bell's agency has decided to compile data on deaths at the clinics. But compiling the information does not go far enough for Buckle. The state agency has an obligation to "ferret out" the reasons for any deaths in clinics, he said. - --- MAP posted-by: Beth