Clinic endures grow­ing pains

Camino Nuevo, Albany at odds over how many, who to treat for drug ad­dic­tion

Albany Times Union - Sunday - - FRONT PAGE - By Bethany Bump

Albany

There were two dis­tinct oc­ca­sions that brought Micky Jimenez and her staff at Camino Nuevo to tears.

The first was on April 22, 2015, when the brand new methadone clinic opened its doors on Cen­tral Av­enue in Albany and its very first pa­tient walked up for a dose of medicine.

The methadone even­tu­ally helped the man re­claim con­trol of his life af­ter a long bat­tle with opi­oid ad­dic­tion. But on that day, all Jimenez and her staff knew was that he was the first in a long line of pa­tients who needed help and would fi­nally get it.

For four decades Albany had only one methadone main­te­nance pro­gram for peo­ple bat­tling opi­oid ad­dic­tion, run by Whit­ney Young Health on Dewitt Street. The next near­est pro­gram was in Am­s­ter­dam. But as com­mu­ni­ties na­tion­wide be­gan to see a ris­ing toll of deaths from pre­scrip­tion painkiller and heroin over­doses, the

city’s sin­gle clinic reached ca­pac­ity. By 2015, it had a wait­ing list of nearly 250 peo­ple.

Camino Nuevo’s ar­rival to the scene brought im­me­di­ate and pal­pa­ble re­lief. But ask city, law en­force­ment and busi­ness of­fi­cials, and they’ll tell you it also brought traf­fic, loi­ter­ing and crime to one of the city’s busiest com­mer­cial cor­ri­dors. They want it to re­lo­cate to an iso­lated area of the city, or out of the city al­to­gether.

That’s why three years later, on a re­cent April day, Jimenez was moved to tears again. The state Of­fice of Al­co­holism and Sub­stance Abuse Ser­vices told the clinic it could no longer ac­cept an un­lim­ited num­ber of pa­tients. It must stop ac­cept­ing pa­tients when it hits 581, it was told, in or­der to pla­cate com­mu­nity concerns. Cur­rently the clinic is a few dozen shy of that to­tal, and the vast ma­jor­ity of its pa­tients must visit the clinic daily to re­ceive their med­i­ca­tion.

“When you have a mom come into your of­fice and drop on her knees, beg­ging you to take her son who’s in ICU for the third time with an over­dose — you don’t care about traf­fic, you’re gonna take them,” said Jimenez, di­rec­tor of the clinic and re­gional di­rec­tor of its par­ent or­ga­ni­za­tion, Acacia Net­work, which runs sim­i­lar pro­grams in Buf­falo and New York City.

Here’s the prob­lem, as city of­fi­cials see it: Camino Nuevo of­fers a ser­vice their com­mu­nity and oth­ers nearby des­per­ately need. But it’s in the worst pos­si­ble lo­ca­tion.

Oc­cu­py­ing the first and fourth floors of a five-story build­ing at 175 Cen­tral Ave., the clinic op­er­ates in close prox­im­ity to a school, bar­ber­shop, gro­cer, tax prepa­ra­tion com­pany, phone re­tailer and auto re­pair shop. It also hap­pens to sit di­rectly op­po­site the Cen­tral Av­enue Busi­ness Im­prove­ment District head­quar­ters, giv­ing An­thony Capece, its ex­ec­u­tive di­rec­tor, a first­hand view of the op­er­a­tion.

“If you can imag­ine three or four peo­ple be­ing dropped off ev­ery few min­utes, you can imag­ine the num­ber of ve­hi­cles we get through here,” he said. “You’ll see cabs do­ing U-turns, let­ting peo­ple out in the mid­dle of the street, dou­ble park­ing.

You al­most have to see it to be­lieve it.”

That wasn’t the case when the Times Union vis­ited the clinic dur­ing its busiest time on its busiest day — Tues­day be­tween 8 and 11 a.m. Traf­fic was sparse. Two se­cu­rity guards pa­trolled a mostly empty side­walk in front of the clinic, at one point in­struct­ing two peo­ple who had lin­gered at the cor­ner to move along. A white van the clinic had re­cently pur­chased idled at the curb.

But that visit also came af­ter the clinic had taken var­i­ous steps to ap­pease com­mu­nity concerns. It hired more se­cu­rity guards, who cracked down on loi­ter­ing, dou­ble park­ing and idling cabs ig­nor­ing park­ing me­ters. It bought two vans to trans­port pa­tients af­ter their ap­point­ments — a move it pre­dicts will cut down on loi­ter­ing among pa­tients wait­ing for cabs, as well as traf­fic con­ges­tion.

“What­ever the city wants, we’re try­ing to just make it hap­pen,” said Pro­gram Di­rec­tor Jas­mine Guer­rero-wiggs. “What­ever sug­ges­tions they have, we’re try­ing to make it hap­pen. Even with my bud­get, which isn’t a lot, we got more guards and po­lice en­force­ment. We’re not say­ing we’re per­fect and have no is­sues. But we’re try­ing, that’s all I can say.”

Ad­dress­ing crime

Mayor Kathy Sheehan went to the clinic her­self one day to see the prob­lems she had been hear­ing about first hand. Stand­ing across the street, she says she watched “large amounts of cash” ex­chang­ing hands among peo­ple ex­it­ing the build­ing.

Po­lice Chief Robert Sears con­firmed that crime has risen in the area since the clinic’s ar­rival. The city’s other clinic on Dewitt Street has had fewer is­sues, he said, be­cause it’s in a less vis­i­ble, rel­a­tively iso­lated area of the city near the In­ter­state 787 over­pass.

Be­tween 2014 and 2017, Sheehan said the city saw a 76 per­cent in­crease in EMS and po­lice calls to the area, a 53 per­cent in­crease in calls for fights, a 130 per­cent in­crease in calls for “an­noy­ing peo­ple” and a 55 per­cent in­crease in calls for “an­noy­ing groups.”

“The is­sues that have oc­curred have been sig­nif­i­cant, with acts of vi­o­lence erupt­ing,” she said. “So I don’t see how this methadone clinic is re­ally meet­ing the needs of those who are seek­ing re­cov­ery and it cer­tainly is neg­a­tively im­pact­ing the busi­nesses and res­i­dences in and around this lo­ca­tion.”

Don­ald De Pass, the clinic’s head of se­cu­rity and a re­tired State Po­lice ma­jor, dis­agrees.

He joined Camino Nuevo in Oc­to­ber 2015, six months af­ter it opened, and was brought on specif­i­cally to han­dle is­sues of crime that had arisen around the clinic. Po­lice have been called oc­ca­sion­ally in the years since, he said, but on a lim­ited ba­sis.

The sta­tis­tics the mayor cites, he said, are culled from a four-block area and all hours of the day and night.

“We’re only open from 7 to 2,” he said. “Is there gonna be an in­crease in ac­tiv­ity? Yes. I will ad­mit that read­ily. But when you blame us for all the crime, that just doesn’t make sense.”

Guer­rero-wiggs said she’s talked to fam­i­lies in the area who said they feel safer since the clinic moved in, be­cause of the in­creased po­lice and se­cu­rity pres­ence.

“I talked to one woman who says she now lets her daugh­ter play in the front yard be­cause she sees po­lice pa­trolling, our guards out there,” she said. “So she feels safer now than be­fore the clinic came in.”

An out-of-town refuge

For Sheehan, a key con­cern is that once again, the city of Albany, as the re­gion’s largest pop­u­la­tion cen­ter and state cap­i­tal, seems to be tak­ing on more than its fair share.

Roughly 72 per­cent of Camino Nuevo pa­tients hail from out­side the city, while 48 per­cent are from out­side Albany County, ac­cord­ing to sta­tis­tics pro­vided by the clinic. Some pa­tients come from as far away as Ful­ton County and Ver­mont, for lack of ser­vices or ca­pac­ity in their own com­mu­ni­ties.

To city of­fi­cials, the growth seemed to hap­pen

overnight.

“This is a site that orig­i­nally had roughly 50 pa­tients and has since bal­looned to 600,” Sheehan said. “They’re com­ing on a daily ba­sis to a small clinic on Cen­tral Av­enue in a com­mer­cial district that is not de­signed to han­dle that vol­ume of in­di­vid­u­als.”

Camino Nuevo was orig­i­nally cer­ti­fied to serve 400 pa­tients — more than any other clinic in the area. In the mid­dle of an epi­demic, it didn’t take long to reach ca­pac­ity. In De­cem­ber 2016, the state lifted its cap. But as the pa­tient load neared 600, out­cry from city and com­mu­nity of­fi­cials grew.

In re­sponse, the state again im­posed a cap — set­ting it at 581 pa­tients this past April. Only about 300 of those pa­tients come on a daily ba­sis, Guer­rerowiggs said. The oth­ers are pa­tients who have been in the pro­gram a long time and fol­lowed the rules. They’re given a month­long sup­ply of methadone as a re­sult.

“The un­der­ly­ing is­sue is that peo­ple need treat­ment and they need treat­ment op­tions in their com­mu­ni­ties,” Sheehan said. “So the frus­tra­tion for me is that for a pop­u­la­tion that over­whelm­ingly lives out­side of the city of Albany, we are yet again the epi­cen­ter for hav­ing to solve that prob­lem.”

But for staff at Camino Nuevo, what mu­nic­i­pal­ity a per­son comes from is ir­rel­e­vant. If they’re in need, and the clinic has space, they’re go­ing to take them.

“It’s only right,” Jimenez said.

Meet­ing the need at home

As the opi­oid epi­demic has grown, so too have lo­cal treat­ment op­tions — but not nearly enough,

ad­vo­cates say. Deaths from opi­oid over­dose are far out­pac­ing avail­able treat­ment op­tions, and state fund­ing to en­hance th­ese ef­forts has fallen short, many say.

In the years since Camino Nuevo opened, the state cer­ti­fied two more methadone clin­ics to op­er­ate in the re­gion — Conifer Park opened fa­cil­i­ties in Troy and Sch­enec­tady, but it is cer­ti­fied to treat just 75 pa­tients and 25 pa­tients at each, re­spec­tively.

Whit­ney Young

Health’s clinic has a cap of 350 pa­tients. And St. Mary’s Health­care in Am­s­ter­dam has a cap of 100 pa­tients.

Caps are set based on need, as well as a provider’s past per­for­mance, said Rob Kent, gen­eral coun­sel at the state Of­fice of Al­co­holism and Sub­stance Abuse Ser­vices. They also can­not ex­ceed a build­ing’s cer­tifi­cate of oc­cu­pancy, which is de­ter­mined by lo­cal code.

The state is try­ing to en­cour­age clin­ics to open in more com­mu­ni­ties as a way of off­set­ting the den­sity that places like Albany have seen. But gain­ing lo­cal sup­port is a ma­jor bar­rier, Kent said.

“Lo­cal com­mu­ni­ties have to sign off,” he said. “(Acacia) worked with the city of Albany to site (Camino Nuevo), so I don’t know what their process was but this was not snuck in. It was done in full view.”

“Sit­ing a treat­ment pro­gram is dif­fi­cult to be­gin with, and for some rea­son when you make it one that of­fers methadone — even in the midst of an opi­oid epi­demic — it’s re­ally dif­fi­cult,” he added.

To open a clinic, a provider needs state ap­proval from OASAS and fed­eral ap­proval from the Drug En­force­ment Ad­min­is­tra­tion. It also has to meet strin­gent se­cu­rity guide­lines en­forced by the DEA, and they don’t come cheap.

“This is not an easy process,” Jimenez said. “(The DEA) kept com­ing in with some­thing new we had to ad­dress, whether it was the thick­ness of the wall, the types of screws that went into the wall. We ac­tu­ally had ... to put this spe­cial coat­ing on a win­dow be­cause when the sun was peaked at 1 o’clock we re­ally couldn’t see the face of the nurse in the dis­pens­ing win­dow on our se­cu­rity cam­eras. And then they said, ‘Wait a sec­ond, what if some­body goes up onto your roof and comes down on a rope and

breaks into your win­dow?’ So we had to put sen­sors in ev­ery win­dow. It was $5,000 just to pour the ce­ment for the vault that stores the methadone.”

All told, she said it cost $3 mil­lion to meet DEA re­quire­ments for such se­cu­rity en­hance­ments.

“So what we’re try­ing to con­vey to the city is, ‘Lis­ten, we hear you, but it is not like we can just pick up right now and go some­where else.’ ”

Paul Buck­owski / Times Union

Micky Jimenez, re­gional di­rec­tor of Cap­i­tal District Camino Nuevo, dis­cusses work at the methadone clinic in Albany last month.

Paul Buck­owski / times union

Win­dows where methadone is dis­pensed at Camino nuevo in Albany. the clinic has to meet strin­gent dea guide­lines, such as en­sur­ing nurses’ faces are vis­i­ble on cam­era footage.

Guer­rero-wiggs

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