State investigative report reveals numerous violations at HOPE pain clinic

May 24--There were no nurses among the 31 clinic employees at the HOPE Clinic in Beaver, which the West Virginia Department of Health and Human Resources ordered in April to shut down.

Salaries for medical professionals would "cut into doctor's profits," a clinic worker explained, so none were hired.

Instead, a janitor was the official lab technician. A receptionist doubled as the "infections control specialist."

Untrained, unlicensed, non-medical clinic staff -- called "narcotics auditors" -- took patients' blood pressure, made clinical evaluations, took patient histories, ordered drug tests and entered narcotic prescription information into the clinic RX machines.

Those violations of strict laws for West Virginia pain clinics are detailed in a report by the DHHR Office of Health Facility Licensure and Certification that was obtained by The Register-Herald. OHFLAC investigators examined the clinic in December and January.

State officials decided not to approve an initial license for HOPE. Instead, they ordered it closed by May 15, writing that the clinic had failed to follow state law requiring a designated physician owner (DPO) to oversee patient care and that patients were being placed in danger by practices at HOPE.

According to the report, which The Register-Herald obtained via a Freedom of Information Act request, six HOPE employees were also among the HOPE pain patients, including a physician who had been charged with undisclosed crimes by the West Virginia State Police. None of the employees appeared on the master list of the clinic's 1,283 patients.

None of the employee's medical records at HOPE were complete.

HOPE staff also couldn't prove that they'd had one year of training in pain management, as required by state law.

One physician's personnel file was missing, and the HOPE human resources manager told investigators that doctor "is all the way in South Carolina and difficult to reach."

OHFLAC discovered a box of 216 narcotics prescriptions inside a brown cardboard box in the HOPE designated physician-owner's office. They'd been prepared and printed by the unlicensed medical staff -- "narcotics auditors" -- for a physician to sign.

Narcotics auditors, according to the report, were contracted, non-medical personnel who worked for Patients Physicians Pharmacists Fighting Diversion (PPPFD).

According to the PPPFD and HOPE websites, the clinic shares a physical address with PPPFD.

Since July, OHFLAC has been investigating clinics around the state for licensing purposes. The licensing process is part of a law signed by Gov. Earl Ray Tomblin in 2012. The law aims to reduce substance abuse in the state and to increase patient safety at pain management clinics such as HOPE.

The FBI and other law enforcement agencies raided the HOPE clinic in Beaver in March. No criminal charges have been filed.

OHFLAC officials had ordered a sister HOPE clinic in Charleston to close in February. HOPE also operates clinics in Mechanicsville and Wytheville in Virginia, all under the name HOPE Family of Pain Centers.

HOPE officials weren't available for comment Friday but had previously responded through a Charleston public relations firm on May 6 to the OHFLAC decision to deny licensure.

"HOPE Clinic has been thrust to the forefront of the news recently because of a series of actions by state and federal agencies," read the statement. "Unfortunately, these actions have the potential to create a perception about HOPE Clinic that does not accurately reflect its core values or operations.

"HOPE Clinic is a pain management clinic that provides important, compassionate and necessary care to a segment of society that has essentially been abandoned by modern medicine: law-abiding chronic pain patients.

"Primarily, HOPE Clinic treats patients, through licensed medical providers, for chronic pain," the statement read. "Our patients suffer from constant pain and discomfort, which impact their ability to function in life.

----OHFLAC investigators reported that patient health and safety was put at risk by HOPE practices and that patient care was sub-par.

Patient records at the Beaver HOPE clinic didn't contain enough information to identify patients. The records didn't support patient diagnosis or justify treatment, OHFLAC investigators reported. HOPE staff didn't document patients' health histories, current medications, or whether or not they were dependent on controlled substances or being treated at another pain clinic. Results of follow-up physical exams were absent from records.

There was no proof that HOPE staff had sent inquiries about patients to the West Virginia Controlled Substance Monitoring Program. There were no records that CSMP had sent results of patient checks back to the clinic.

By law, all licensees who dispense Schedule II, III and IV controlled substances must provide the dispensing information to the West Virginia Board of Pharmacy within 24 hours.

The CSMP program is compliant with the federal Health Insurance and Portability Accountability Act (HIPAA), which protects patient privacy and is designed to cut down on prescription pill abuse in the state by identifying patients who are being prescribed painkillers by multiple doctors.

Doctors were unable to produce documents that showed patients were given initial exams or offered counseling and 90-day check-ups as required by law. Auditors used their own personal judgments on whether a patient was abusing drugs.

There wasn't an effective infection control program to prevent communicable diseases, and OHFLAC investigators saw one patient leave the clinic without being checked by a physician.

Investigators watched an auditor take a patient's blood pressure. He admitted that he'd only read the directions and watched the doctor do it and that he didn't now how to calibrate the pressure cuff.

One worker told OHFLAC investigators that she had been hired as a janitor in July but had been promoted to lab technician the following September.

"They came to tell me they were putting letters in my file for medical assistant and lab tech and that these would be added to my job titles," the janitor reportedly told OHFLAC officials.

She added that she had been trained to take vital signs but was not practicing in the full scope of her medical assistant certification and that she did not write in patient charts.

Additionally, OHFLAC officials discovered that 73 patients had been transferred from another HOPE clinic to the HOPE location in Beaver. Of those, 22 were patients who had been transferred to Beaver after becoming unhappy with changes that untrained, unlicensed staff at the "sister clinic" had ordered to their narcotics medications.

The sister clinic location was not identified in the report. Names of doctors and staff members weren't listed in the OHFLAC documents.

On the HOPE website, Dr. Sanjay R. Mehta, D.O., is identified as the designated physician-owner of the Beaver clinic.

-- E-mail: [email protected]

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