CHARLESTON, W.Va. — At a Raleigh County pain clinic earlier this year, state inspectors interviewed a medical director who said he tried to change pain-pill prescribing practices at the facility, but the clinic’s practice manager nixed the idea and issued a directive: “Give patients what they want.”
The state Office of Health Facility Licensure and Certification later cited Hope Clinic in Beaver with dozens of deficiencies that put patients’ health and safety at risk.
The state’s 136-page report shows that the pain clinic operated mostly without medical professionals, except for a doctor who had no say over how the facility was run. Inspectors discovered at least six people who worked at the clinic who also received pain medications as patients there. And they flagged higher-ups for allegedly putting profits over patient care.
“Our biggest issue with this clinic was the designated physician owner not having care and control and complete oversight of the clinic, as well as various personnel without appropriate experience providing medical treatment,” said Jolynn Marra, director of the state Office of Health Facility Licensure and Certification.
Instead of nurses, retired police officers worked at the facility, according to the report. The officers had no medical training, yet they were printing out hundreds of prescriptions without a doctor’s order, diagnosing patients and taking their pulse and blood pressure, documents show.
“When I take blood pressure and it is high, sometimes I tell the patient it is high and sometimes not,” one officer told inspectors. “If I tell them, and the patients get upset, I will sometimes ask if they have had a sausage biscuit, or had lots of coffee that morning and tell them that may be the reason their blood pressure is up.”
After the inspection, the state ordered the Raleigh County pain clinic to close by May 15. Hope appealed and requested an administrative hearing. The clinic remains open, but now faces a May 30 deadline to shut down unless it wins the appeal.
“We have begun a cooperative and productive dialogue with OHFLAC, exploring the possibilities for continuing to serve chronic pain patients in Southern West Virginia,” said George Manahan, a public-relations specialist hired by Hope. “Although Hope Clinic remains confident in its past practices, we look forward to working with regulatory authorities to meet their expectations and to continue providing the best possible care to our patients.”
U.S. Attorney Booth Goodwin also is investigating Hope Clinic. Federal agents raided the Beaver facility in March.
For years, Hope also operated an affiliated pain clinic in Charleston. That clinic, at 4407 MacCorkle Ave. SE., in Kanawha City, failed a state inspection and shut its doors in late February.
Both the Beaver and Charleston clinics employed former law enforcement officers who worked under a contract through a company called PPPFD Inc., which shares the same address as Hope’s Beaver office.
A doctor at the Beaver location told inspectors that “PPPFD hires and fires all employees.”
“I realize they are not medical people,” he said, according to the report. “We rely on them to take the patient’s legal history and vital signs.”
The clinic allowed patients to “opt out” of seeing a doctor and pick up prescriptions “pre-printed” by the ex-officers. PPPFD auditors also routinely looked up and verified patients’ medications on a website called Drugs.com, and decided whether patients should undergo a drug test.
“Narcotic auditors are untrained, unlicensed, non-medical personnel, and preparing narcotics prescriptions is outside their scope of practice,” inspectors concluded in their report.
At the Beaver clinic, inspectors found a box stuffed with 216 prescription slips. Ninety were unsigned. The rest had a physician’s signature but no record the doctor had ordered the prescription.
Inspectors interviewed PPPFD CEO Mark Radcliff and asked him why he didn’t hire any nurses or physician assistants or other medical professionals at the pain clinic.
“We try to maximize the doctor’s profit,” Radcliff said, according to the report. “We have not hired any other medical personnel because it will cut into the doctor’s profit.”
Radcliff “did not place any emphasis on the safety, care and well-being of patients being treated at the clinic,” inspectors wrote in the report.
Other findings in the 136-page report:
n The clinic’s operations director had two felony arrests, but supervisors never checked on the outcome of the charges.
n More than 70 patients transferred from Hope’s Charleston clinic to the Beaver facility after a doctor changed the Charleston clinic’s prescribing practices.
n Hope employees treated for pain at the clinic got prescriptions at no charge. The clinic kept no medical records on the workers who also were patients.
n A woman hired as a janitor to clean the facility was “giving appointments and prescriptions.”
n The clinic’s manager scolded a doctor for writing prescriptions for brand-name painkillers, such as OxyContin, instead of generic drugs. The manager warned that insurance companies would “punish” the clinic, driving up costs and forcing Hope to hire more staff.
Since January, the state has ordered five pain clinics to close in West Virginia. It’s the first time the state has inspected the clinics — part of a new law that aims to curb prescription drug abuse.
At the Hope Clinic in Beaver, inspectors discovered a document posted on the side of a file cabinet in the medical records room. It was a list of patients who had died.
The report cited the clinic for failing to investigate, track or report patient deaths to the state Department of Health and Human Resources.
A clinic manager disclosed that charts for deceased patients were kept in the bottom drawer of the file cabinet.
The list of dead patients had 30 names.
Reach Eric Eyre at firstname.lastname@example.org, 304-348-4869 or follow @ericeyre on Twitter.