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Crow Wing County Board: New ownership possible for methadone clinic, letter of support denied

A company in the process of acquiring a controversial methadone clinic in Brainerd was denied a letter of need Tuesday from the Crow Wing County Board.

Pinnacle Recovery Services, which provides medication-assisted treatment for those addicted to opioids, is located at 2215 S. Sixth St., Brainerd. The county board Tuesday denied a letter of support requested by Meridian Behavioral Health, which is seeking to acquire the clinic. Steve Kohls/Brainerd Dispatch
Pinnacle Recovery Services, which provides medication-assisted treatment for those addicted to opioids, is located at 2215 S. Sixth St., Brainerd. The county board Tuesday denied a letter of support requested by Meridian Behavioral Health, which is seeking to acquire the clinic. Steve Kohls/Brainerd Dispatch
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A company in the process of acquiring a controversial methadone clinic in Brainerd was denied a letter of need Tuesday from the Crow Wing County Board.

Charles Hilger, vice president of Meridian Behavioral Health, requested the letter per state requirements concerning the transfer of ownership of the clinic, currently operated by Pinnacle Recovery Services. Located at 2214 S. Sixth St., the clinic is licensed by the Minnesota Department of Human Services to provide medication-assisted treatment for those with opioid addiction.

In his July 13 request to Community Services Director Kara Terry, Hilger said Meridian operates three other programs in the Twin Cities and "has strong reputation for integrated, patient centered care, among those we serve and with referents and community partners."

"The need for this program is evident by its continued growth, the increasing number of persons seeking treatment for opioid addiction and the current opioid epidemic," Hilger wrote. "Opioid overdose is currently the number one cause of accidental death in the United States."

In a request for board action, Terry recommended the board deny Hilger's request. Since opening in April 2012, the clinic has been the subject of criticism by public officials and law enforcement. Critics have pointed to the transportation of people from outside of the community to the clinic and an increase in law enforcement activity.

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In January, the clinic and its former CEO admitted negligence in an $8.5 million wrongful death lawsuit. The lawsuit was filed by the families of two men killed in a multi-vehicle crash on Highway 210 after another driver crossed the centerline. That driver admitted to injecting a take-home dose of methadone, which she acquired from the Pinnacle clinic, before driving back to Cloquet.

Commissioner Paul Thiede asked Hilger how many patients at the clinic live in Crow Wing County. Hilger said of the 440 patients treated by the clinic, 48 claim addresses in the county, while 62 live in St. Louis County and 96 in Carlton County. Patients are transported from these areas and other communities in the state, with costs associated with that transportation picked up by the state.

Thiede asked whether a measure of success of the program existed. Hilger said of those patients who remain in the program for one year, 90 percent of patients remain free of illicit opiate use and 70 percent remain free of any illicit drug use. Of patients accepted at the clinic, 60 percent remain in the program for one year, and the average time to sobriety is 2.5 years.

Commissioner Rachel Reabe Nystrom asked why the clinic would be located in Crow Wing County, if many of the patients were from the Duluth area.

"We don't want to be the methadone capital of Minnesota, I don't think," Nystrom said. "This is our opportunity to say this was a, I think a lapse of judgment five years ago."

Hilger said he agreed with Nystrom, and ideally there would be several smaller sites opened throughout the state instead of larger programs like the one in Brainerd.

Nystrom said she had no problem assisting drug users in the area, but "it's the thought of busing them from other places."

Hilger said he understood the board's concerns, but noted whether the board approved the letter of need or not, the clinic was not going anywhere.

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"If we don't do this acquisition, they're going to continue to function as they have been," Hilger said. "To me, this is an opportunity to bring in a provider that's more involved in the community."

Hilger said Meridian would offer mental health services, more hours of medical care and a medical clinic embedded in the treatment center, which could meet the needs of patients in other ways, including flu shots. The company also offers Narcan, he said, which is a prescription medicine that blocks the effects of opioids and reverses overdoses.

"We have an arrangement at this point to acquire them and one of the only things that's holding us up at this point is the letter of need," Hilger said.

Commissioner Rosemary Franzen voiced her opposition to the clinic.

"Five years ago, we weren't asked," Franzen said. "This was never brought to the county board, or I'm almost positive there never would have been a letter of support."

Franzen mentioned the wrongful death lawsuit as a reason she was opposed, noting she believed there were "many cases of negligent use of methadone" associated with the clinic.

"I am just opposed to this," Franzen said. "There will be no change in my mind."

Hilger said with 6,000 patients in the state treated with methadone daily at 100 milligrams per dose, Hilger said 600,000 milligrams are consumed each day with very few incidents.

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Commissioner Paul Koering said he would refrain from getting into his feelings too in depth on the matter, and he made a motion to deny the letter. Franzen seconded the motion.

"I think one incidence is too much myself," Koering said.

Chairman Doug Houge asked County Attorney Don Ryan how the county board could prevent the existence of a clinic. Ryan said even if the county board chose to deny the letter of support and send a letter explaining its opposition, the state could go forward with approving the ownership transfer.

"The state can take our position into consideration, and the state would have the authority if it chose to to deny this acquisition, and the state has the authority, should it choose to do so, to close Pinnacle," Ryan said. "There can be a lot of legal debate about that, but what the state giveth, the state can taketh. That's not the issue before you today."

Ryan said if the board did not submit a letter stating its opposition, the state would only hear one side of the issue. He noted he and others had a "good meeting" with Hilger, but it didn't change his feelings.

"I'm not in favor of having the methadone clinic here now," Ryan said. "I wasn't in favor of having it then, and I'd love to see it disappear."

Hilger said some counties have attempted to put zoning restrictions in place to prevent treatment facilities, but ultimately, those decisions have led to lawsuits related to the Americans with Disabilities Act.

During the discussion, several law enforcement leaders were seated in the county board room. Houge asked whether any of them would comment on the clinic. Brainerd Police Chief Corky McQuiston approached the microphone.

McQuiston explained his department experienced an increase in "secondary police activity" related to the clinic-meaning activity not necessarily occurring at the clinic, but as a result of some of the patients being in the community. McQuiston said Aitkin County Sheriff Scott Turner asked to meet with him awhile after the clinic was opened, wanting "to know what we were doing about this problem."

McQuiston said according to Turner, people were leaving the clinic and then stopping at convenience stores to use methadone in the restrooms, "creating messes in the restrooms of the gas stations." Other impacts, McQuiston said, included fights or other disturbances and shoplifting.

"It's not just the patients, it's some of the people that come with the patients," McQuiston said. "Just as I was afraid of, it's the secondary of the patients and the users of the clinic."

Mark Ostgarden, Brainerd city planner, told the board from a community development perspective, the methadone clinic was located in "one of the worst spots we could have it in our city."

Ostgarden said he felt it was negatively impacting attempts to redevelop the vacant hotel property just to the north of the clinic.

"It kind of casts a cloud on that location," Ostgarden said. "They (patients) are outside in packs, smoking, huddled in the wintertime, and it gives kind of a negative image to that part of the community."

Ostgarden said through personal anecdotes from convenience store managers, he'd learned of situations when syringes were left in bathrooms and blood found in sinks.

Ostgarden said although the clinic was not something they could ban from the city, it was necessary the city look at zoning regulations that could prevent one from being located in such a visible area.

Thiede said he believed the board needed to relay its concerns and those expressed by others Tuesday through a letter to the state.

"I think the letter has to be carefully worded to the state to address the issues that have been addressed here," Thiede said.

The board unanimously approved Koering's motion to deny a letter of support.

Chelsey Perkins is the community editor of the Brainerd Dispatch. A lakes area native, Perkins joined the Dispatch staff in 2014. She is the Crow Wing County government beat reporter and the producer and primary host of the "Brainerd Dispatch Minute" podcast.
Reach her at chelsey.perkins@brainerddispatch.com or at 218-855-5874 and find @DispatchChelsey on Facebook, Twitter and Instagram.
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