A proposed downtown methadone clinic continues to face heavy opposition, with most of the criticism coming from employees of regional behavioral health care provider Seven Counties Services, which already houses an opioid addiction treatment program in the same building. But despite concerns about the appropriateness of the clinic’s location and model of treatment, the Texas-based company behind the proposal intends to push forward with their plans.
Representatives from BayMark Health Services held a neighborhood meeting at the Louisville Western Branch Library on Monday to discuss their plans to open a medication-assisted treatment (MAT) clinic for patients with an opioid addiction. They recently filed a pre-application with the city for a conditional use permit to locate in office space at 708 Magazine St. — just north of Broadway in the Central Business District — which would require approval by the Board of Zoning Adjustment.
While BayMark pitched their MAT clinic as a needed tool in the city’s efforts to combat the growing heroin epidemic, Seven Counties employees made up nearly half of the audience for the sparsely attended meeting, voicing the same concerns the nonprofit raised last week: that a private cash-based clinic in their building would duplicate services that the nonprofit already provides and might undermine the treatment of their patients — in addition to BayMark making no attempt to contact Seven Counties about their plan.
BayMark attorney Nick Pregliasco opened the meeting by saying they chose the location due to nearby TARC routes that make it accessible and the commercial zoning of the block, adding that they expected to file their official application “in the next week or so.” In addition to dispensing methadone — which patients receive once daily, early in the morning — Pregliasco sad the BayMark clinic also will prescribe Suboxone, a medication the federal government has made recent efforts to expand access to and is taken daily by patients on their own.
After being peppered with questions and criticism from Crescent Hill resident Evan Clark, who has been in recovery from a heroin addiction for six months, BayMark’s vice president of development, Dominic Spano, filled in additional details on how the clinic would operate. Instead of accepting insurance and Medicaid, the clinic would accept cash payment, with methadone costing $10 to $12 per day. Each patient on methadone would be assigned a counselor, who they would have to see at least once per week for the first 90 days. Asked if BayMark also would offer injections of the addiction medication Vivitrol, or distribute the overdose antidote Narcan to patients for free, Spano said these were options they could consider.
After Clark expressed strong opposition to methadone and Suboxone as a form of treatment — especially from a company with a profit motive — Spano claimed their methadone programs have an 80 percent success rate and “you have to offer people different roads to recovery. It doesn’t meet everybody’s need. Some people do well in an abstinence program, but opioid addicts normally don’t.”
The only nearby resident to show up at the meeting was Minnie Lee Wilson, who has lived in the Russell neighborhood for 30 years and said that BayMark should have made a better effort to inform neighbors about the meeting. Wilson said the area already has enough problems with drugs and crime and they don’t need more addicts coming into it, as “this neighborhood is being dumped on.” An employee of the adjacent federal building claimed that workers there already are harassed by Seven Counties patients in the building and that another clinic would put women in danger, “adding another group that may have a desire to do criminal activity.”
Spano responded to those concerns by saying drug-related crime usually goes down in the area where most of BayMark’s new clinics open around the country. If their Louisville application is successful, the clinic would be BayMark’s 46th location spanning 10 states.
While acknowledging BayMark is a for-profit business, Spano noted that they serve a vital role by providing addiction treatment to communities in the grips of a heroin and opioid epidemic, such as Louisville. He said BayMark decides what markets to go into by analyzing drug statistics from federal agencies and opioid-related emergency room visits, adding that “in Louisville, you’re looking at possibly two to three people per 1,000 that could benefit from treatment.”
Louisville already has two methadone clinics: the city-run MORE Center in Park Hill and the for-profit Center for Behavioral Health in St. Matthews. Asked why the city needed another methadone clinic a mile and a half away from the MORE Center, Pregliasco said it’s a matter of supply and demand, as “the government isn’t providing enough services and the demand outweighs what is there.” Spano added that BayMark’s clinic would see just under 300 patients a day, which is similar to the number at the MORE Center but far below the 1,300 patients at the private clinic in St. Matthews.
Five employees of Seven Counties then spoke up to question BayMark officials, including director of addiction services Scott Hesseltine.
Hesseltine brought forth concerns about duplicating MAT services that Seven Counties already provides to patients, many of whom have persistent mental illness and are a highly vulnerable population. He added that while the MORE Center already provided quality methadone treatment for patients in the area, he questioned whether BayMark as a private company would emphasize discontinuation of the medicine as a goal.
“I think a lot of the concern that people have — and I’m not just talking about BayMark — is when you have a profit motive and a revenue stream tied to having someone on a medication,” said Hesseltine. “That’s a disincentive to look at discontinuation as part of the recovery process.”
Hesseltine added that he also is concerned that BayMark put forth “no effort to collaborate with the community here whatsoever at all,” as they first learned about the company’s plan to move into their building by reading an Insider Louisville article last week.
“We’re all about collaboration at Seven Counties,” said Hesseltine. “But it makes you wonder, is that the way you do business? And is that the way you’re going to continue to do business? If that’s the way you’re doing business now, what’s it going to be like later? That’s a concern.”
When Seven Counties CEO Tony Zipple mentioned the same concerns, Pregliasco said BayMark is “not in direct competition with Seven Counties,” as they offer different kinds of treatment, and while the company is based on private pay, Seven Counties accepts Medicaid. Zipple responded that he was “not going to talk about this as a competition kind of thing. That may be a BayMark kind of thing as to how much of the market they can corner.” Zipple said their primary concern is the quality of their clinical service to patients, and BayMark’s description of services sounded like it overlapped with that of Seven Counties.
Kim Brothers, who manages the Seven Counties clinic at Magazine Street, then asked Spano if BayMark will offer patients evidence-based practices and intensive outpatient treatment. When Spano said they would not, Brothers noted that her program already does so at that location.
Seven Counties’ director of government affairs Lauren McGrath noted that Spano appeared to suggest in his comments to IL last week that they would accept patients’ Medicaid at their clinic, but that he indicated earlier in the meeting they would be private pay. Spano explained that methadone and Suboxone are not covered by Medicaid in Kentucky, only to be corrected by those in the room that Suboxone is in fact covered — though such providers have faced difficulty with delayed, denied and meager reimbursements from Kentucky’s managed care organizations.
Asked by Seven Counties spokeswoman Gwen Cooper if BayMark still plans to file their formal application with the city for this location after hearing the feedback in the meeting, Pregliasco said the criticism they heard was common wherever they propose a clinic, but “the plan is to proceed with that.”
After the meeting, Spano told IL this is just the beginning of the process, and BayMark “wants to work with the community, we always do. We want to work with not only Seven Counties but other providers. That’s just how we do things. So we’ll see. We’re going to be taking all of this information back to our company and fill them in on how the meeting went.”
“We want to be in the right area,” Spano added. “If the zoning goes through, this is a good location for us.”
Asked if BayMark would seek another location to open a clinic in Louisville if their application with the city is denied, Spano answered “Absolutely. The need is great here.”
Metro Planning and Design services currently is drafting proposed regulations to determine where methadone clinics would be allowed in Louisville, spurred by an ordinance passed by Metro Council last year. Councilman Brent Ackerson, D-26, sponsored that ordinance after leading an effort to block a for-profit methadone clinic in his district, and he recently cited BayMark’s application as a reason why the council should consider passing a moratorium on new methadone clinics until they are delivered and pass the proposed regulations.
Hesseltine told IL it is “concerning” that BayMark indicated they would push forward with their plan to open a clinic on Magazine Street despite the criticism they heard in the meeting. Asked if Seven Counties would oppose BayMark opening a clinic in another part of Louisville if their current plan is blocked by the city, Hesseltine said “We’d have to know all the facts and make a well-informed decision about where it would make the most sense.”
As of Wednesday afternoon, Seven Counties CEO Tony Zipple told IL that BayMark still has not officially contacted the nonprofit to discuss plans to move into the building.