UPMC Chautauqua tried opening clinic, then state stepped in

The need or want of a methadone clinic in Chautauqua County has been a pressure point of contention, on both sides, throughout the region. Almost all agree that with the growing opioid epidemic and the prevalence of street drugs, laced with more dangerous chemicals than the drugs themselves, that one is desperately needed. The problem that has literally split people in two arises with where that clinic would go.

Andrew O’Brien, former director of behavioral health for UPMC Chautauqua — formerly WCA Hospital in Jamestown, spoke at length with the OBSERVER this week about a clinic his former organization was supposed to take on.

According to O’Brien, on May 15, 2017, Arlene Gonzales-Sanchez, state Office of Alcoholism and Substance Abuse Services commissioner, visited the city of Dunkirk at the invitation of Mayor Wilfred Rosas. Gonzales-Sanchez participated in a community forum where worried citizens and the mayor, described the significant concern regarding the opioid crisis. This included the lack of a methadone clinic in Chautauqua County. Gonzales-Sanchez left Dunkirk, promising that she would address the concerns raised by the community and city officials.

“She left that meeting in Dunkirk, not very happy at all to hear how badly the community felt they were being served,” O’Brien said. “When she got back to Albany she advised her staff to ‘fix it.’ The state then contacted me and asked if I would help them. One senior official traveled to Chautauqua County to meet with me to get a better sense of Chautauqua. Another official then contacted me and asked if UPMC Chautauqua would be willing to open up a methadone clinic in Dunkirk. They were clear in stating that if UPMC was willing the state OASAS would ‘fast-track’ the application as a priority.”

O’Brien was a likely choice of contact since UPMC already had an established substance abuse program providing opioid related services in Dunkirk.

Not long after the request was made, the UPMC Chautauqua leadership and the Strategic Affairs Committee of the UPMC board of directors began work on the application to establish a methadone clinic. In the application, the state Department of Health along with OASAS required “prior consultation” with the Chautauqua County Director of Community Services, the Chautauqua County Community Services Board and staff of the Western NY Regional Office of OASAS based in Buffalo. A consultation was conducted which included a review of a need for such service, and impact of the proposed location on the community. These officials toured the neighborhood adjacent to the proposed site, which was to be located at 306 Central Ave.

“I provided a summary of the businesses and residences close to our location,” O’Brien added. “OASAS staff specifically asked about distance from schools. It’s part of the application. I had already charted all schools in the area since OASAS routinely inquires about this prior to approval of an application. I also provided OASAS a detailed plan that outlined UPMC’s plan to engage the community, on an on-going basis, not just during the application phase.”

The consultation was a success and they were granted approval by the Chautauqua County Community Services Board and OASAS Regional Office.

While all the paperwork was pending O’Brien and his staff were made aware of a grant that OASAS was applying to receive from the Substance Abuse and Mental Health Services Administration. They invited him to offer ideas of how that grant could help the Chautauqua County area.

Following a lengthy proposal by O’Brien, OASAS accepted and the end result was a three-year grant totaling $1.5 million to expand opioid related services in Chautauqua County.

Happy to see all their efforts come to fruition, a public event was held and attended by Rosas and then County Executive Vince Horrigan.

“I informed them of the probability that we would receive the grant, and that our plan included a methadone clinic in Dunkirk,” O’Brien explained. “While we at UPMC thought a methadone clinic was also needed in Jamestown, I informed the mayor that we had decided to prioritize Dunkirk because of his advocacy and the effective community voice raised by many.”

Amongst all this red tape however, O’Brien had to keep one other thing in mind — the financial viability of a clinic. “We are a not-for-profit hospital but we wanted to ensure that the program could break even,” he said. “My assessment of the need for such a service in Dunkirk, was while clearly needed, the number of clients required to break even might be difficult to achieve.”

OASAS turned out to be quite helpful in his opinion and provided consultation about the number of clients seen at methadone clinics in similar sized counties. The consultation indicated that a combined target population from towns within the north county and a few from southern Erie County, would be just enough to reliably “break even.”

Shortly afterward, O’Brien met with Rosas at City Hall to inform him the grant application was successful.

“At that meeting, I informed Mayor Rosas that this was quite an achievement and that he deserved some credit for his leadership on the matter,” O’Brien stated. “I was impressed by the mayor’s statement that he was committed to bringing methadone services to Dunkirk. We left the meeting, assuring the mayor that we would work collaboratively with the mayor and the community and provide services in both Spanish and English.”

Then the hammer dropped. OASAS approved two methadone clinics in Dunkirk; UPMC’s and Hispanics United. “At no stage during our discussion with OASAS did they indicate that two programs might be approved, two programs within three blocks of each other,” O’Brien said. “This development would immediately render obsolete my financial calculations and estimated volume of business. I notified the Director of Community Services and the County Executive (Horrigan) of our concern and sought an immediate consultation with senior leadership at OASAS in Albany.”

At this May 2017 meeting, O’Brien’s group explained the costs, hoping that OASAS would withdraw their approval of Hispanics United.

“We hoped that they would be in favor of our application, by a hospital with over 100 years of service to Chautauqua County, and in recognition of the fact our facility already existed and would take minimal renovations to establish the methadone service,” O’Brien said. “Our application would require no funding by local or state government for the annual operation of the program, whereas Hispanic United, had reportedly requested hundreds of thousands in state aid.”

Their request fell on deaf ears as OASAS denied it. The meeting concluded with the two agreeing to a plan to open a clinic in Jamestown, which would likely take a year or more, according to O’Brien, to achieve since a Jamestown site required construction.

Hispanics United turned to a location near Northern Chautauqua Catholic School and were met with public outcry.

Many urged that an alternative site be found. Community forums were held and Rosas was asked to help find a site further away from the school.

“Myself and others at UPMC were astonished that at no time were the public informed that UPMC had a site that was approved that was better placed than Hispanics United,” O’Brien added. “At no time did the mayor of Dunkirk reach out to us and ask us to renew our Dunkirk plans since the Hispanic United’s plan was stuck in limbo.”

In January 2018, Fourth Ward Councilman Mike Civiletto, made an impassioned call for opioid help. He later joined O’Brien and heard the story of what UPMC had tried to do.

“I was concerned that Civiletto seemed unaware that UPMC had previously had a better site, I contacted Civiletto and we had a two hour meeting in my Dunkirk office,” O’Brien shared. “He appeared surprised when I provided him the full details and implied that he and other council members, were never aware that Mayor Rosas had been informed about UPMC’s successful application.”

O’Brien went on to say that at the time (since he is now retired), he would have been willing to lead a partnership of city officials, community members and local agencies in establishing a clinic in Dunkirk as an emergency project.

“I even stated that I would support Hispanic United as much as I could, if they wanted to be involved,” O’Brien added. “Civiletto left my office stating he would advise city officials of this conversation and get back to me. I advised New York state OASAS and the Chautauqua County Director of Community Services of this conversation and Civiletto’s insightful view that the city urgently needed these services. I outlined steps that I thought could be immediately taken, this included reaching out to a methadone clinic newly established in Orchard Park and seeking a temporary partnership where their methadone license could be ‘shared’ with an existing provider in Dunkirk until a permanent Dunkirk program could be established. This would end the need for people to travel out of county for methadone. OASAS officials responded that while unusual, they urged this ‘sharing’ idea be pursued. Alas , I never heard back from Civiletto or any other city official.”


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