Part One: The Nazi
It seemed I was in and out of there, bringing Tommy to appointments, over the course of two weeks. A lot of details were forgotten quickly, buried by anger.
The waiting area was pleasant enough. The health and recovery clinic was new and the building was understated. It was located among a cluster of other social service agencies. To get there we drove down a road surrounded by large fields. It was late autumn, and the fields were brown with frozen dirt and littered with the pale remains of dead corn stalks.
I assumed the land was state owned. One morning we saw a swarm of state police conducting some sort of field exercise. The sight unnerved Tommy, who had yet to clear the warrants from his past. An addict does not want to find himself suddenly behind bars.
Driving by the fields we could see looming up on the hill the tall, creepy Victorian last remains of the former state insane asylum. And yes, one of its actual names included “insane asylum.” It was also formerly known at one time as “lunatic asylum.” The rest of the complex had been demolished and replaced with a rental and condominium development, which caught fire during the early stages of development.
Nearby is a county jail, one of the lower security facilities often used for holding before transport or release. All in all, it was an interesting area.
Outside the clinic, nothing about it shouted detoxification facility. Nothing shouted methadone treatment. There was no indication that the place was filled with substance abusers. The exterior sign just had three letters, an acronym, and the words, “Health and Recovery.”
Tommy was trying to get into their methadone program. He had been battling heroin addiction on and off, more off than on, for fifteen years. He had significant periods of sobriety during those years. He also had had significant success in a methadone program, which allowed him to work steadily, building his own business.
But he had developed a habit over the course of the past year. To help escape it, he’d left the area he had always lived in, left the dealers he had lived with who got him back on the junk by giving it to him, left the people he knew who lived chaotic lives in a city best known for drugs and prostitutes. He was in a suboxone program, but that wasn’t working out that great for him. He said he thought he may be having an allergic reaction to the narcan in it. I don’t know. That happens. Maybe it just prevented him from getting high, and he liked that high. He was far more productive and creative on the heroin than off it.
Anyway, what program he chose was not my call, and he wasn’t happy with the suboxone at this point. And, of course, there was always someone who pressured him to sell his suboxone, which gave him money for dope. “Suboxone leeches,” I called them. Once I even verbally tore into one of them. I told the guy to get his own prescription and leave Tommy alone. Whether the leeches had already been kicked off their program or couldn’t be bothered to get into one was not my concern. Tommy asked me to help him get into a methadone program, and I did my best.
He did his best. He recognized that he needed change. He made the decision. He made the call. He waited and answered the return call. He put up with the admissions administrator’s seemingly pointless questions. “Are you in withdrawal now?” “Why are you sniffling?” I think she was just showing off. He was angry with her, but he made the appointment. He asked me to take him. And he kept returning.
Inside, the waiting area was pleasantly designed, lots of light wood, open spaces, interesting angles, furniture covered in a soft, soothing light gray color. But it was strategically flawed. I sat waiting, watching addicts check in for admission, watching addicts come in for their methadone, watching addicts being shuttled from one location to another. They moved in a line like school children with a monitor at each end. Many of them made eye contact with me. Maybe they thought I was checking in. But I was just waiting for Tommy. The receptionist, the counselor, the administrator all knew I was there for him. No one asked me to leave.
We hit the first glitch the first day. During his interview with the counselor she told him that the dosing hours were 6:30 am to 8:30 am. She explained how to get there via public transportation. It was going to be an arduous challenge. I’ve taken public transportation. Breakdowns and delays are inevitable, and when you are switching from train to bus the arrangements do not always work. On the methadone program you can not be late, and you can not miss doses. If you are or if you do, they will terminate your program. You’ll be back on the streets chasing down a dealer.
The early morning hours, however, do work well for people who work during the day, our ultimate goal. They get their dose and are stable. I told him I would get him there. I would shift my work hours a little, and I had two back-up people on whom I could rely. One of them operated a little transportation business.
That first day his appointment was long, and I was there long enough to have a disturbing drama unravel before me. A young, ethnically attractive man thrashed out of a door into the waiting room. His features combined to give him that appealing dangerous look. He reminded me of someone I once knew. His mood was as black as his hair and eyes. He ranted loudly. His rant included a veiled warning. Someone they threw out the previous week had overdosed. He peppered his comments with foul language. He’d been thrown out of his program apparently in the midst of a group session. He allegedly had a cell phone on him, which he vehemently denied. It was clear he did not want to leave. He was not only angry. He was scared.
Cell phones are not permitted in de-tox facilities, not because one is not allowed to make calls. There are pay phones for that. The patients are required to relinquish their cell phones upon admission for confidentiality reasons. Cell phones have cameras. The administration can’t have people taking pictures of the patients. It violates confidentiality.
During his ranting he made frequent eye contact with me. Did he expect me to say something? I was sympathetic. I was certain he was a heroin addict and would be mainlining within an hour, possibly overdosing after being clean for a few days.
Two years before one of this facility’s patients had left after one day and was found dead in a field, one of those fields that had once been part of the psychiatric hospital’s property. I wonder if he was thrown out, too.
I said nothing to the young man. I did not tell him how ludicrous the situation was. I had already seen a significant portion of the patient population while waiting there. The confidentiality was already blown.
Tommy and I slogged through more appointments. He was determined. But then, I knew he was like that. Once he set a goal, he achieved it. He may have his sensitivities and weaknesses but this guy is tough, strong-willed, smart.
Then we hit another glitch. He needed a government issued picture identification, preferably a driver’s license. I had wondered about this, seeing the people coming in the morning for their methadone dose. How did they get there? The place was virtually in the middle of nowhere, barely accessible by public transportation. Did they all have drivers? People who knew where they were going every morning? I doubted that many of them had driver’s licenses. The life of a heroin addict is generally chaotic: legal violations lead to revocation of drivers’ licenses, the ability to hold down a job is challenged by the lifestyle and hours they keep. Sure, there are exceptions. I’ve known of exceptions, people who can schedule their addiction around a job. But not many of them actually drive. And they lose things. Most people don’t want to live with a junkie, so they tend to bounce around from place to place. And then they misplace their personal papers. It’s just the nature of the hobby. Chaos breeds more chaos.
I saw Tommy arguing with the administrator about the identification. She was a big woman, as big as him, and he is one tall, broad-shouldered, country boy. He does not look like a junkie. He looks healthy. I make sure his living environment is safe, calm, well-stocked with nutritious food, and he keeps his place clean. In other words, much chaos has been reduced.
I could see it was not going well with this Nazi at the gate. Tommy is not a young guy. He is not a guy that you can talk down to. He stands right up for himself, has a quick mind and is one hell of a talker. I could see she did not like him. He was too strong and bold to be a junkie. Things did not look promising. I knew he hadn’t found his i.d. yet, nor his insurance card, and his social security card was probably long gone.
It was Friday. She told him that if he could find his identification he could bring it in Monday morning and he could be dosed Tuesday and begin his methadone treatment. I could see the flaw in this immediately. He was worn out. They didn’t trust him. He’d get high over the weekend, because he is, after all, a heroin addict and then likely he’d be dope sick Monday morning. I knew his patterns. This was a disaster. I had seen problems with this place and was already looking for another facility.
Over the weekend during his rambling around from place to place, he had miraculously uncovered his expired temporary license. It was better than nothing. But as anticipated, on Monday morning he was sick, too sick to make it through another anticipated confrontation with the Nazi. Likely fearing for her safety more than his embarrassment or discomfort as he expected her to bombard him with more questions and insinuations, he asked me to bring the i.d. to her. We figured this was all she needed, the document. She quite obviously was not a people person. She was a paper person.
Expecting a problem, expecting some sort of judgement, I dressed in a conservative silk suit. I have a very good job, and I looked like I did. I am a responsible person, and I looked like one. I am also the person they had seen accompanying him for the past two weeks.
I swung open the front doors and marched in businesslike and asked to see the administrator by name. I answered the receptionist’s question about my business there saying, “We were told to hand this to her personally.” The receptionist picked up the phone and called the administrator, whose little office was about 10 steps away from me. I was denied admittance to the Nazi’s office. “I need to give this to her,” I said. The receptionist explained that the administrator would not receive the i.d. from me. “Why not?” I said, getting suspicious.
“HIPPA,” she answered.
“HIPPA?” I repeated, and I’m sure my eyebrow arched reflecting my cynicism. All I knew at the time about HIPPA was that it was a regulation that had something to do with medical records and confidentiality, hence my amazement that I had been allowed to be a daily spectator in the waiting room.
She explained their confidentiality policy. “We’re not even allowed to let family members know if a relative is here when they call,” she continued. Then she said, “I’m sorry. My son is a heroin addict. I know.”
There it was again. She just blew it. She gave me confidential information. Nevertheless, she wasn’t the one making decisions. I said, “Then you know. It’s hard.” I thought she was going to cry. I felt badly for her. Her son is an addict, she’s probably working here as a volunteer to try to take action, try to help someone if she can’t help him, and she works for a Nazi who has no compassion.
But I had to persist. That was my role. “Listen,” I said. “I’ve been here every day with him. Everyone knows that. He knows I’m here. He told me to bring this to her.”
“He has to bring it himself. Why can’t he come in himself?”
I looked at her pathetically. “He’s dope sick,” I said. “He is a junkie, you know,” I added harshly.
“There’s nothing I can do,” she said.
“You can take a copy of this and give it to her,” I said, spitting out the administrator’s name. I handed over the temp i.d. She held it like it was toxic, walked away, returned, placed the copy in an envelope and handed over the original.
I knew it was not the receptionist’s fault, but after I whirled around to storm out of that place I turned back and said, “There should be an advocacy program for these people!”
The next day Tommy called the Nazi.
“That’s not you on the i.d.,” she said. “That’s not your picture.”
When he told me this, I actually laughed. “What a moron that woman is,” I said when I recovered. “Is she blind?”
“She said, ‘You sent that woman in with it,” he told me. “She sounded angry.”
“Big deal. It’s not about her. She’s supposed to be a facilitator not a Nazi.”
“She said she’d bring it up before the Board, whether I can get in.”
“Yeah, right,” I responded.
Then it was his turn to rant. “It’s all about insurance. If it’s not me, insurance won’t pay. It all comes down to who gets the money.”
“It’s a dose of methadone,” I said. “How much can that cost? And they know you have insurance. They checked it off your social security number. That’s pretty much it. They stick the copy of your i.d. in a file. The name on the i.d. matches your social. Your social proves you have insurance. End of story. What’s the problem?”
“She doesn’t think it’s me.”
“Blind Nazi bitch,” I spit out.
Months later, doing a little poking around in the regulations regarding substance abuse treatment centers I realized just how much of a bitch this woman was, how she abused her power, and how she took advantage of applicants to do so. Either that or she was just ignorant and incompetent.
Federal Regulation, Title 42, Chapter 1, Subchapter A, Sec. 2. imposes restrictions on the disclosure of the records of substance abuse patients in treatment in any federally assisted substance abuse program. This treatment organization is funded with donations, grants, and refers to the federal regulation on their website. The violations for unauthorized disclosure of patient information are not more than $500 for the first offense and not more than $5,000 for each subsequent offense. Nevertheless, a patient may consent to the disclosure of the patient’s records and the facility may disclose the patient records to any individual named in the consent.
HIPPA, which stands for Health Insurance Portability and Accountability Act, 1996, covers much ground, including the portability of benefits from one health plan to another and the exclusion of rejection for pre-existing conditions when transferring from one plan to another, national standards for electronic data maintenance and coding, and privacy of medical information. Again, however, a patient may provide written consent that an individual is privy to the patient’s medical information.
That’s all the Nazi had to do: suggest that Tommy provide written consent that I could be informed of certain aspects of his medical condition and care. Then I could hand her the i.d. card. I could know he was in their program. I could know about his medical condition. Like I didn’t know already. In effect, I could be his advocate. Maybe the bitch was afraid of this. It’s one thing to deal with addicts who are at your mercy for their care. The Nazi could make arbitrary and capricious decisions. It’s another thing to be exposed to deal with a savvy advocate.
And about that young guy that was thrown out for alleged possession of a cell phone within the walls of the Nazi’s power center. The State of Massachusetts has regulations that govern the activities of substance abuse treatment facilities in addition to Federal regulations. Massachusetts regulations provide for patient protection of treatment termination. The patient must be notified in writing of the reason for termination, and the patient must be notified that there is an opportunity to appeal the decision to terminate treatment. That young guy was tossed out onto the parking lot so fast, I very much doubt he was notified of his rights. If he had been, I am certain he would have ranted about exercising them on his way out the door.
I don’t know why this woman is employed in this position of power. I would expect the goal of a substance abuse treatment center would be to work with the addict to remove obstacles so they can achieve the goal they sought help with in the first place. And there are so many obstacles. In this treatment center with Tommy, this woman was the obstacle.
I’ve been referring to this woman as a Nazi, but I don’t know what rigid code she was following. Everything about Tommy matched up except her stated suspicion about the picture, which was just too ridiculous. Anyway, an auditor couldn’t possibly pick up on a picture match. They trace paper and numbers, and the paper and numbers matched.
Nevertheless, she had her check list. She had her agenda. The fact that Tommy was a heroin addict was not enough. She had her own definition of who fit the profile for admittance into her little domain. Tommy didn’t conform. His existence as a unique individual was irrelevant.
In hindsight, I wish that when we entered that facility the first day that I had been better informed. And I was already better informed than many in that position. This was not my first experience with an addict. I had previously made phone calls around the country, receiving information on how to facilitate treatment for another addict, a crack addict. Armed with that information, I worked the rules of the system to get the individual admitted into a public de-tox facility. Public de-tox facilities do not admit crack addicts, because there is no physical detoxification. It didn’t work anyway. It was just a week out of the fire and an introduction to group and individual therapy.
People attending to the possible admittance of a loved one into a treatment facility should become aware of the regulations. Unfortunate, but true. Addicts not accompanied by an informed friend or family member, good luck. Surely not all treatment facility admissions are policed by a Nazi, but let’s face it, some individuals are prone to abuse power and some individuals treat addicts like scum.
In hindsight, after traveling down a long road navigating programs, it is best that Tommy did not enter the liquid hand-cuff fiefdom of that bitch. One might think that after his experience at the treatment facility down the hill from the menacing, lunatic asylum building that he would use her rejection to just give up, that he would use that negative experience as another reason to be a dope addict. Someone in her position of power should consider such ramifications and be more responsible to the actual reason for her job. However, after much perseverance by both of us, and because he was not alone, we didn’t need her anyway. She became obsolete.