There's not much seedier than the sight of the sun rising on a methadone clinic's early-morning trade. Everything about the scene screams shame, from the darkened predawn opening hours to the shaded, lifeless windows to the absence of identifying signage on the dingy, partly vacant brick building that anchors Houston Maintenance Clinic to an aggressively unrevitalized stretch of Main Street. Solitary clients trickle through the plate-glass entrance door and then re-emerge, a few minutes later, with suspicious glances up and down the street before ducking into waiting cars or shuffling off down the sidewalk.
Methadone patients generally don't like to advertise their status, because methadone's inevitable implication is heroin. People on methadone are usually trying, with or without success, to stay off heroin, to maintain jobs and families and lives, and to eventually get clean. And while there are good arguments to be made for heroin addiction's status as a disease, the daylight world perceives it as a lifestyle choice. A poor one. As far as Main Street's passing traffic is concerned, a methadone patient is just a junkie, and nobody much wants to be seen strolling into the junkie shop in broad daylight.
The double whammy of addiction and shame, experienced as need and fear, tends to make methadone patients doubly powerless. They are easily manipulated by the fear of having treatment withheld, and they are rarely in any position to complain.
Methadone, being itself addictive, is a tightly regulated medication subject to state and federal oversight, with scattered local providers such as Houston Maintenance Clinic contracted to serve as faucets through which the medicine flows, with little fanfare, to those who need it. But on a gray, anonymous morning in February, with clients and clinic employees arriving before daylight to conduct their quiet business, three agents of the Texas Commission on Alcohol and Drug Abuse (the state agency that distributes and regulates funding for the nonprofit clinics serving the poorest methadone clients), along with a representative of the Texas Department of Health (which licenses methadone providers), converged on Houston Maintenance Clinic to turn off the faucet.
For many former HMC patients and employees -- most now moved on to other clinics and other jobs, and thus no longer bound to silence by fear -- the only real question raised by TCADA's termination of HMC's contract is this: Why did it take so long?
In 1997, the inaugural year of TCADA's contract with HMC, the clinic received $386,540 in federal block grant money through the agency. HCM then received $509,900 in 1998 and $496,400 in 1999. TCADA's 2000 allotment to HMC, before the contract was terminated, was set at $546,040. All told, close to one and a half million dollars of state funds have been routed to Houston Maintenance Clinic, and the reason those funds have dried up, according to TCADA spokeswoman Stephanie Goodman, is that TCADA doesn't have any idea how any of that money was spent.
"The problem in this particular case is we don't have the information in hand to tell you what they were doing financially. We can't tell if it was a good use of state dollars or not, because they never provided the financial statements we need to make that determination," Goodman says.
According to TCADA regulations, clinics receiving more than $300,000 per year are required to provide independent financial audits annually. HMC has "occasionally submitted some financial statements, but they are not complete. They don't meet generally accepted auditing standards," Goodman says. "They just had a number of problems, and we can't tell basically if they are doing what they should be doing with the money." One of HMC's audits, says Goodman, was "so poor that we've filed a complaint against the auditor with the board."
Goodman stresses that TCADA has received no allegations of "mis-spending" at HMC, and that the termination of the clinic's contract was based entirely on the clinic's failure to provide required accountings of proper spending. But for TCADA to be unaware of such allegations, the agency must have spent the past three years stumbling under a heavy dose of opiates itself.
"I tried to tell TCADA what was going on," says Tabitha Okeke, who served as the clinic's bookkeeper from September 1997 until January 1998. "A lot of people have called TCADA, but they never did anything about it."
Okeke's stories of HMC operations, combined with dovetailing accounts by a dozen former and present HMC employees interviewed by the Press, constitute a dirty laundry list of irregularities and possible illegalities that should have waved red flags in regulatory faces long before that February morning when TCADA agents arrived at HMC to direct patients to alternate treatment centers.
Responsibility for the dirty laundry, these sources say, lands squarely on the desks of HMC's husband-and-wife team of CEO Dr. Amos Ozumba and program director Cecilia Ozumba.
Amos Ozumba was reportedly out of the country during Press interviews, and unavailable for comment. Cecilia Ozumba, in a brief interview, attributed allegations to unnamed "instigators" with designs to close her clinic.
"We're contracted to render services to clients. We exceeded the amount of service we were expected to give, and even when we exceeded the number, the due process was not rendered. They know what they did. If they think trying to put all the lies together is going to help them, so be it."
Amos and Cecilia Ozumba incorporated Houston Maintenance Clinic as a 501(c)(3) nonprofit corporation operating at 4900 Fannin Street in July 1996, with Cecilia Ozumba as the corporation's registered agent and an initial board of three directors, including both husband and wife. By August 1998 a doctor originally on the clinic board had been replaced by HMC's current financial manager. The Press was unable to document the membership of the clinic's current board of directors.
From the start, Houston Maintenance Clinic comprised two distinct entities housed in the same quarters: the nonprofit methadone clinic funded with TCADA dollars, and a private, for-profit methadone clinic funded by paying client/patients. To qualify for the TCADA program -- which might require a small co-pay from patients, or might be free, depending on the level of need -- patients are required to meet financial eligibility standards. Patients who don't meet standards for enrollment have the option of enrolling in the private clinic and covering the cost of treatment themselves.
The arrangement is not an uncommon one, but it does require strict accounting and separation of income streams and expenses between the two entities. That accounting and separation, current and former employees agree, did not exist at HMC.
Gail Lee, a former administrative secretary at HMC, answers her phone, listens to a reporter's introduction and laughs. "Oh, I know what this is about."
Hired on the TCADA payroll, Lee says she spent a good portion of her three months at HMC answering phones for both the private clinic and the Partial Hospitalization Program, which accepts Medicare and Medicaid patients for various therapies, operated by the Ozumbas in the Fannin building's downstairs office.
Additionally, she says, the Ozumbas directed her to conduct personal business for the couple on state time. Lee provides copies, which she says she took with her when she left HMC, of letters she typed on the Ozumbas' personal stationery. One is addressed to the consulate general of Nigeria, requesting passport renewals. Another thanks state Representative Garnet Coleman for a "Declaration" delivered upon the occasion of son Donald Ozumba's college graduation. A letter to the Home Depot customer satisfaction department requests the replacement of kitchen cabinets installed in the Ozumba home.
Lee hands over another three-pager she says she typed up for the Ozumbas on state time. Titled "Anyibuofu Group Agreement," the document lays out conditions under which money is to be collected for what appears to be a lottery pool. Six names are listed on the apparent draft, including that of Amos Ozumba, the only HMC employee on the list.
Lee says she left HMC over a disagreement about how her work time was being spent.
"I would have to count the receipts for the week, and this is both TCADA and private clients. So I was in there in the middle of counting money, and the phone's ringing, and CeCe [Cecilia Ozumba] comes in, and she's like, 'You're not answering the phone.' And I told her, 'No, I'm counting money.' And she said something about TCADA, if they call up and nobody answers the phone, then I'm going to be in trouble. And I said, 'Really, well, would I be in trouble if they found out that while they pay me, I'm doing work for the clinic downstairs?' And she said, 'Oh, no, that's okay, they wouldn't mind about that at all.' "
Two days later, Lee says, she was fired.
Lee says she had called TCADA to complain, left a message on the state agency's voice mail and never got a call back.
Former HMC nurse Joyce Thomlinson, speaking of her three months at the clinic, is succinct and extravagant at the same time.
"That is the worst job I ever had in my life. I had to do weeks and weeks of prayer to get over that experience. I was on my knees day and night begging the Lord to forgive me for the thoughts I had about those evil people."
Thomlinson has been in nursing 25 years, and took the HMC job "because it's easy," she says. "You don't have to deal with doctors and IVs and sick people. You just sit behind a computer and dose."
It did not, however, turn out to be easy. She, a TCADA-payrolled employee like Gail Lee, also was asked to perform work at the PHP clinic downstairs. "Just things that you could do for him for free."
Thomlinson is one of a large majority of HMC employees who report a chronic problem with payroll checks bouncing, and salaries sometimes covered with personal checks from Amos Ozumba, some of which have bounced as well. "How can you get government funds and then give bad paychecks?"
Like others, she says she observed Ozumba harassing patients for money and intimidating both clients and staff.
Like others, she says she was asked to manipulate documents.
"I didn't start there until September 7, and they wanted me to go back in July and sign my name to work I didn't do. Hell, no! My license is on the line! I'm a registered nurse!"
Thomlinson worked the day in late 1999 that the DEA arrived unannounced.
"We were just sitting there dosing, and all of a sudden they said, 'The DEA is in the building.' We weren't expecting them, but from the gossip, people were complaining about the clinic.
"[HMC] failed the inspection big-time, and then [Amos Ozumba] tried to blame it on [nurse] Audrey [Shippey] and I that things weren't right. They're looking through the books, the balances were wrong, the medicine was wrong, all of it was wrong. Dr. Ozumba tried to say it was us."
Nurse Audrey Shippey backs Thomlinson's story and then some.
"They are abusive to everyone. The employees, the clients, they are very rude to them. For example, there is this client that comes in every morning to be dosed, and since TCADA closed the place down, he's requesting to go back to the VA hospital where he came from, because now he has to pay $45 or $40 a week, and he doesn't have this money. And every time he comes and he requests to go back there, they get mad. I've heard Dr. Ozumba saying to the patient, 'Look at what I've done for you. When you came in here you looked so bad, you looked like nothing, and look at you now, you want to turn your back on me.' That's manipulation. These people are on drugs, and they're easily manipulated."
Nurses are not always as easily manipulated, and when the Ozumbas told Shippey to deliver a dose of methadone to a prison-bound client, Shippey had to refuse.
"They know that the client is no longer in their jurisdiction. I had to call the board of nurses."
The Board of Vocational Nurse Examiners confirms that it did receive an advice call from a nurse at HMC regarding prison delivery of methadone. The board advised the nurse that she could lose her license for following the Ozumbas' instructions.
Shippey also confirms a story related by several individuals about the late-February TCADA shutdown.
"Drugs were missing that day. There were two nurses there, myself and someone else, and I and the other nurse did the final count on the medication. She told me her balance was wrong, and I knew the balance was wrong, because I knew what I had out, and then when I go to find it, it was really missing. The medication was stolen from where we had it. We had three keys. I have one key, [Cecilia Ozumba] has one key, and her husband has another key. And I was with the people from TCADA. When I went back, the medication was missing. TCADA was made aware. I told TCADA everything that I knew. The lady from TCADA told me and the other nurse that we had inherited a problem, the books have not been kept properly for years. It's nothing new."
Emma Haywood, the "someone else" working with Shippey that day, says that a bottle of orange 40 milligram methadone wafers totaling 5,080 milligrams disappeared.
Shippey, who still worked at HMC at the time of her interview, said she was looking for a different job. Asked why she remained, she says, "Because of my clients. These clients are attached to me, and I look forward to taking care of these clients. That's the only reason I'm there, and I've told them that. And I've told my clients also that I'm looking for work, and they beg me every day not to go. I'm the only stable person they have there, if I have to say so myself."
Former nurse Lucille Villareal worked at HMC for two years, from 1996 to 1998, and, she says, almost had a nervous breakdown over the abuses.
"CeCe and Dr. Ozumba would tell me to ask the [methadone] patients if they had Medicare or Medicaid, and if they did to furnish their number. And that that would pay for their medication. And they would have counseling. They would have therapy. Well, they never did. They were charging their account 800 and some-odd dollars a month, and they never did get any kind of counseling or therapy. They would just come in every day to dose, get their medication and leave. They never did get counseling or therapy, but CeCe was still charging, billing Medicare/Medicaid, for something they weren't receiving. In fact, she used to get mad when they'd come in and talk to me about a problem."
Carl Sprague, a blind former HMC client whose name has been changed to protect his identity, was one such patient. Sprague says he agreed to sign papers that had not been read to him, and when he and his companion were called into the clinic for what was described as a routine physical examination, he went. Sprague says he stayed at the clinic an entire Friday and part of the morning on a Monday before deciding that the Narcotics Anonymous-style lectures he was hearing were something he had already heard plenty of times before, and he chose to leave. He did not return. Several weeks later Sprague's lawyer and trustee noticed a Medicare summary indicating a $3,950 HMC billing to Sprague's Medicare account for therapeutic and psychiatric services over a seven-day period.
With help from Steve Tapscott, owner of the Texas Treatment Center methadone clinic, to which many HMC patients were transferred after TCADA's HMC shutdown, Sprague alerted Medicare to the apparent fraud. As of February 22, 2000, Medicare provider TrailBlazer Health Enterprises of Dallas had investigated and informed Sprague that "Medical records were secured from the provider and reviewed by our medical staff. It was determined that the services were not properly documented. We have, therefore, taken the necessary steps to recover the overpayment made to this provider."
Nothing above surprises Patrick Nolan, an HMC counselor who worked at the clinic less than five months before TCADA shut it down. Nolan has since gone to work for Tapscott's Texas Treatment Center.
Nolan never could understand the system by which HMC billed its methadone clients. TCADA provided reimbursement of up to $56 per week for HMC's treatment of methadone patients, some of whom qualified for free treatment or co-payments on a sliding scale, generally $1 to $3 per treatment.
"The clinic was still charging $21 a week extra. We determine eligibility as counselors, to see whether these clients can afford nothing, 50 cents a week, $5 a week. No matter what we determined, the computer would always say $21 a week, and it would keep racking up that bill for them, and racking it up and racking it up."
Nolan says clients were never forced to pay the bill before being treated, a practice known with an ugly lack of euphemism as "administrative detox," but that the bills caused a lot of arguments and confusion at the clinic. "Every morning, every day, every week, it was, 'Why do I owe so much when you told me I only owed a dollar a day?'
"I don't know if they somehow could get reimbursed for that. I really don't know that angle of keeping that in the computer. I'd say, 'It's not right,' and they'd say, 'You don't understand how we bill.' You could tell it was money-oriented because that's all we ever talked about. It was always, 'Where's the money, let's talk about the money, we need more money.' And I can tell you for a fact: I happened to get a glance of the payroll one time, for the Ozumbas, and it was shocking. They're literally [taking home] around $300,000 a year for both of them."
A current employee claiming knowledge of the payroll, who doesn't want his name used, confirms, after a long pause, the $300,000 figure as "close enough."
Regulatory agencies were not unaware of Houston Maintenance Clinic's idiosyncrasies. The Texas Department of Health, in response to a Freedom of Information Act request filed by the Press , provided copies of its own inspection reports for 1997, 1998 and 1999. TDH found that in HMC's first year of operation, a random review of 23 patient files found 21 that were incomplete or inaccurate. In 1998, 18 files were reviewed at random, and 15 were deficient. In 1999, 16 out of 19 patient files contained various irregularities.
TCADA also long had reason to be suspicious. The agency had, by its own account, weathered the entire course of HMC's contract without an acceptable accounting of the clinic's finances. A November 1998 TCADA audit reads like an encyclopedia of mismanagement. "Significant programmatic and financial weaknesses previously identified by the Commission in September 1997 remain uncorrected," the auditors wrote. "The clinic does not have policies and procedures for the following areas: Recording and reporting of program income." The commission found, contrary to Patrick Nolan's belief that no administrative detox was practiced at HMC, that 10 percent of examined client records "indicated that inability to pay would result in 'no dose' or administrative detoxification." Of the examined client records, 52 percent "contained no financial assessment, an incomplete assessment, or an assessment showing inability to pay," wrote the auditors. "However, progress notes discuss repeatedly 'client fees' and 'need to make payment' as an ongoing issue."
"A review of client records at Houston Maintenance Clinic indicates that treatment services are not adequately planned and delivered."
"Based on a review of general ledger accounts, it is evident that the Clinic charges the commission for costs that are unallowable such as bank charges, donations made, employee meals, property taxes, and penalties & fines."
TCADA identified "questioned costs" totaling $23,299.
HMC management provided replies and corrections to the commission's findings, but a post-audit letter from TCADA to HMC board chairman Dr. Youmay U. Ogboso stated that while "Management's responses do indicate corrective action planned they did not adequately address all of the recommendations in the report." One year later, in November 1999, the commission wrote to Amos Ozumba, rejecting HMC's request for "more time" to submit "an acceptable single audit covering the fiscal year 1997 and fiscal year 1998 periods." Later the same month TCADA wrote Ozumba that HMC's failure to submit the audits had resulted in suspension of the TCADA contract. Ten days later TCADA wrote Ozumba again, "abating" the suspension because Ozumba had "indicated that cash flow problems may impact [HMC's] ability to continue contractual obligations to TCADA clients."
Finally, on February 16 of this year, TCADA terminated HMC's contract. Final audits, and possibly a final payout of state money to cover recent documented and acceptable expenses, are still to come. TCADA's Goodman also confirms that the commission is investigating "a complaint" against the clinic, but she is not authorized to say more than that.
This is hardly the first time that TCADA has been caught short by apparent mismanagement of state funds on the agency's watch.
In 1995 a state investigation of the commission showed that TCADA had failed to take action against an Austin rehabilitation clinic, even though it had been aware of financial irregularities for three years. TCADA, the investigation concluded, "failed to probe allegations of misuse of funds."
That same year, after the preliminary investigation revealed TCADA's "gross fiscal mismanagement," Governor George Bush placed the agency into conservatorship, widely reported as the first time such action had been taken against a Texas agency in modern history. TCADA was still in conservatorship in 1997 when it awarded the contract to HMC. Also in 1997, a follow-up state audit indicated that while improvements had been made in the two years since the conservatorship board took over, "a number of issues related to rate setting, performance measures, management information systems, and complaint resolution were left for the new commission and management to address."
Current director Jay Kimbrough took TCADA's reins in February of this year, as the agency emerged from conservatorship, and announced a scaling back of 200 contracts statewide because of an estimated $28 million budget shortfall.
The newly-moved-into rental house is sufficiently close to Houston Maintenance Clinic to walk, in a pinch (after TCADA shut down the subsidized clinic, HMC relocated from its original Fannin Street location to a nearby Main Street location). And the $750 monthly rent is considered a good deal by the current and former patients who share it, mostly youngish people who are trying to get back on their feet after years of heroin use, with the methadone treatment, with new jobs.
Debra and Greg -- their names have been changed -- have gathered two more former HMC clients to describe for a reporter their experiences at the clinic, which have little to do with the alphabet soup of regulatory agencies like TCADA and TDH and DEA. These are the people who trickle in and out of the clinic's plate-glass door in the early-morning hours, three or four or five times a week, to get dosed on their way to work, so that they can go to work, so that they won't, hopefully, fall back into the pattern of spending their days hustling for heroin.
Greg, without a conveniently close alternative, has continued treatment at HMC's private clinic, at a cost of $40 a week, but says that CeCe Ozumba told him he could get a discount if he'd get his wife on the program as well.
All say that they have watched Amos Ozumba make change, for both private and TCADA clients, out of his own pocket, and stash incoming cash in a shoebox.
All have taken advantage of lax medication controls to take their methadone wafers out of the clinic, unsupervised. The wafers have a street value that Greg estimates as $40 to $50 for 100 milligrams, and some clients, they say, sell their methadone to get money to buy heroin. Others will sell a day's dose to make the money to pay the Ozumbas for a week's treatment.
Greg says he has seen doses sold, client to client, inside the clinic and on the street in front, which he describes as "an open-air drug market."
Debra says, "It's very hard to detox at that clinic." The single prescribing doctor on staff, she says, is only on site two Wednesdays a month, and thus any change in dosage can take up to two weeks to authorize. At other clinics, she says, such requests are processed in a matter of days.
"I went in asking for a three-month detox," she claims. "But I started on 40 [milligrams] and left three months later on 80."
Debra entered the program, she says, as an indigent client qualified for dollar-a-day payments, which she paid in advance, and within three weeks found herself staring at a bill for $80. One day, when several clients got upset over the billing, they confronted Amos Ozumba. Ozumba, Debra says, got angry and yelled, "You're all upped to $3 a day." CeCe Ozumba, she says, once told her that if she could afford a heroin habit, then she should be able to pay for her methadone.
Three different patients report being dosed on "20 or more" occasions by CeCe Ozumba, who is not a registered nurse, and thus is not authorized to dispense medicine, a charge documented by TDH investigators.
At the Fannin Street location, former clients say, there were three "dosing windows," where clients received medication. Two were designated for TCADA program clients, one for private clients. "In the three months I was there," Debra says and Greg supports, "I never saw anyone dosed at the private window."
"They cater to the long-haulers," Debra says. "That's where the money is."
Male clients, Greg adds, aren't even supervised during required urinalysis tests, making it more than easy to test clean with fake samples and qualify for take-home doses. "It's just straight-up legal dope-running."
Cecilia Ozumba, contacted by phone, wanted to know which clients had given a reporter her name before saying, "I don't have the authority to talk to anyone, anytime, without authorization, from the board of directors, or corporate attorney, or somebody."
She went on to say that TCADA's stated reason for the termination of HMC's contract was "more bureaucratic than what they're stating. It's just that they found a loophole, but there's no such thing. That's not the truth. That's not the truth at all." She won't elaborate on what she means by "loophole."
Presented with a partial list of client, employee and regulatory allegations, Ozumba offers a blanket denial.
"I think all these are made-up stories. I'm not available to speak to you at this point, and what I want you to know is that all of that is made-up stories. You got this off what the instigators are making up for the clients to say. People have been after closing this program, and there's been instigating on the clients to claim everything."
Asked if she knows who the instigators might be, Ozumba says, "Yes, I know who. A competitor has been wanting to close this program."
Asked if that competitor is Steve Tapscott, who operates Texas Treatment Center and inherited the state contract after TCADA shut off HMC's money, she says, "It could be him, yes. He's been claiming that he wants to close this program and he will do it by all means. He's been trying to sabotage it by all means."
Tapscott thinks that's absurd.
"I helped them start. I gave them everything to get started. All my forms, policy and procedure manuals. So I can't see how I've done anything but been up-front. And I have no idea why TCADA took her funds. I just know that TCADA did. We were on the board of the Texas Methadone Treatment Association up until November of last year together, so I don't know where that's coming from. All I've ever done is report what I believed, at the request of a patient, was Medicare fraud."
Before terminating the phone call, Cecilia Ozumba promised to provide contacts for several former and current HMC clients who, she implied, would counter the allegations with a balanced version of events. She then asked that a written questionnaire be faxed to her so that she might respond in particular to specific questions. The promised contacts were not provided, and the questionnaire was not returned, but perhaps Ozumba felt that her reply was not, in the long run, necessary.
"God will know what is right," she had said. "The right information, the Lord knows. Whatever they tell has happened, let God judge them."
E-mail Brad Tyer at firstname.lastname@example.org.
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