Suboxone Treatment Permitted in Linthicum – Part II
By Kevin Plessner
LSIA has continued its investigation into Phaeton Health Group’s opioid treatment across the street from Linthicum Elementary since the publication of last month’s article. Unfortunately, we do not have much good news to report. The County Executive’s office will not take any action against Phaeton Health Group and has closed its investigation. This article provides the County Executive Office’s explanation as to why it will not take any action, along with the reasons why LSIA believes that the County’s decision is wrong. To be clear, LSIA does not oppose opioid treatment facilities. LSIA agrees that such treatment is necessary for our community and most communities nationwide. However, we do oppose the placement of such walk-in outpatient treatment facilities across the street from our schools, especially where the location is in violation of the law.
Public Information Act Documents
LSIA received documents from the Office of Planning and Zoning pursuant to our Public Information Act (PIA) request for pertinent documents related to the County’s investigation into Phaeton Health Group. The County confirmed that it provided “all records and communication between Phaeton Health Group and the Anne Arundel County Office of Planning and Zoning.” According to the Public Information Act Officer, the only documents that were not provided were two email communications between the Office of Planning and Zoning and the Office of Law. The emails were not shared, according to the PIA Officer, because of attorney-client privilege.
The PIA documents related to Phaeton Health Group consist of some documents that contain data about the building and the building owner, a building section complaint with two letters (dated January 12, 2018 and February 23, 2018) to the building owner because he did not have a permit for new tenant Phaeton Health Group, two letters from the County to Phaeton Health Group (dated October 13, 2017, January 11) reporting Phaeton Health’s violations, a handful of Google search results and Maryland.gov results regarding Phaeton Health, a photo of the front door of Phaeton Health’s office, a permit for Phaeton Health to operate in the space for “Professional Office for Occupational Medicine Consulting,” an advertisement that Phaeton Health Group distributed in Linthicum describing nothing other than opioid treatment services, and a letter from Phaeton Health Group to the County investigator (October 24, 2017) stating that they are not a state licensed medical clinic since “[t]he majority of our clients entering our facility for [sic] will not be opioid dependence…” Phaeton Health Group also sent the County investigators an advertisement for their business that was modified from the one that they actually distributed in the space. The advertisement states that it “is a healthcare consulting company offering a broad array of solutions from Occupational Medicine to Primary Care…and ancillary services, addiction medicine and primary care.”
Based on the documentation in the file, the County’s investigation appears to have consisted of police surveillance outside of the building, internet searches, and asking Phaeton Health Group what its business consists of. Since Phaeton Health Group denied conducting the business that was stated in its advertisement, the County has taken the position that their word is good enough since it provided the County with an updated advertisement that purported to modify its business from only opioid treatment to just some opioid treatment.
Notably, Phaeton Health Group appears to be no longer listed on www.suboxone-directory.com as providing Suboxone treatment, which is a positive step. However, Phaeton Health is still listed on other websites as a Suboxone provider. For example, its doctors are registered as Suboxone doctors on medicallyassisted.com, with address and phone number for the provision of Suboxone treatment.
Reengagement from County Executive’s Office
County Executive Schuh’s office reengaged with LSIA following the publication of LSIA’s Phaeton Health Group article on May 2. The reengagement occurred because a number of our community members contacted Schuh’s office and demanded that they provide answers as to why Phaeton Health Group was still operating across the street from Linthicum Elementary. On April 19, County Executive Schuh’s office had previously instructed LSIA, via email, that it would not answer our questions about their investigation into Phaeton Health and that LSIA should contact the Office of Zoning Enforcement and Phaeton Health itself for further questions.[1] I mention these facts to highlight the importance of community engagement: every phone call and every letter makes a difference. Without the support from our community and our membership, we would not have the information that we have today.
The County Executive’s office emailed me on May 4 to ask additional questions relating to LSIA’s article. LSIA was told at this time that they had received complaints from our community and that they are “not finished with this issue” and “will revisit with agencies.”
On May 7, County Executive Schuh’s office informed me for the first time that Phaeton Health Group had in fact prescribed Suboxone from its Linthicum office a number of times. The office reported:
“We know from a flyer circulating in the community the office space was being advertised as a site for treating patients with Suboxone. However, the doctors within the medical practice never distributed Suboxone from the office space. They did "prescribe" wrote a prescription [sic] for Suboxone for 3-5 patients during 2017. Zoning Enforcement and the Police Department found no evidence that Suboxone was being dispensed from this location.”
The County went on to explain that all of the doctors at Phaeton Health Group had waivers from the state to prescribe Suboxone but they were not licensed to dispense suboxone:
“Phaeton Health Group received a Certificate of Use for a Professional Office which allows them to operate their Occupational Medicine [sic] practice. The doctors [sic] do hold a waiver from the State of Maryland to prescribe Suboxone. They do not have a license from the State of Maryland to dispense suboxone. Today, the doctors communicated [sic] to me they are not a Suboxone clinic; they are not treating patients with suboxone. They are providing Occupational Medicine services.”
The County further explained that it could not find any violations by Phaeton Health Group and that “[t]he investigation was conducted and is now closed.” LSIA asked the County to explain why it believes that advertising opioid treatment and prescribing Suboxone did not qualify Phaeton Health as a State Licensed Medical Clinic. LSIA also asked the County to describe the definition it used to determine whether a business is a State Licensed Medical Clinic since our reading of the law indicates that prescribing Suboxone and advertising opioid treatment clearly qualifies Phaeton Health as a State Licensed Medical Clinic under the County and related state law. The County law prohibiting State Licensed Medical Clinics paints a broad prohibition[2] and, as the County itself reports (see quote directly above), the state had issued waivers for the business to prescribe Suboxone and the state licensed physicians were in fact prescribing the opioid treatment drug.
Meeting with County Executive Schuh
On May 10, LSIA leadership and other community leaders attended a small event held by County Executive Schuh called “County Executive Steve Schuh for Coffee and Conversation” at Italia’s Corner Café. LSIA discussed Phaeton Health Group with Mr. Schuh, including LSIA’s frustration that all of Phaeton Health Group’s advertising in the community was directly related to opioid treatment and that it is apparent to us that Phaeton Health is violating County Law by operating across the street from Linthicum Elementary. Additionally, we reminded Mr. Schuh that he had previously told LSIA and about 200 other people that Phaeton Health was in an inappropriate location and that it would be removed because of their violations of the law. In spite of his statements, the County did the opposite and issued a permit to Phaeton Health to operate.
Mr. Schuh’s staff stated that the County is allowing Phaeton Health to operate in its location because they are only prescribing Suboxone but are not distributing it out of their office. LSIA explained that the law clearly prohibits the advertising and prescribing of opioid treatment—whether the business is prescribing or dispensing is not dispositive of the issue. Councilman Smith was also present at the meeting. He agreed with LSIA that the business is violating the law and asked Mr. Schuh for “a stop order on running the business” while a law suit is straightened out. Mr. Schuh was not sure about what the law directs and promised that his office would look at the law to see if the business can operate. He promised that his office would also look to see if the doctors are licensed and would contact the health department.
Following the meeting, LSIA sent County Executive Schuh’s office the relevant portions of the County Law that pertain to the prohibition of Phaeton Health in its present location. LSIA sees no possible interpretation of the law that would not prohibit Phaeton Health's activities in its location—whether Suboxone is being prescribed, distributed or both does not resolve the analysis. LSIA requested that the County pursue legal action, if necessary, to ensure that the business does not continue to operate in violation of County law.
County Executive Schuh’s Office Follow-Up from May 10 Meeting
County Executive Schuh’s office responded on May 14 with an email stating that the Office of Law considered the evidence from various agencies and decided that they were not able to pursue a zoning case. The County’s explanation begins by saying that “writing prescriptions for Suboxone is technically not the equivalent of operating a state-licensed drug treatment clinic, the type of entity barred in County code from operating within 1000 feet of schools, etc.” I need to note here that this is an incorrect statement of the law. The County law does not bar a “state-licensed drug treatment clinic,” it bars a “state-licensed medical clinic.” This wording is important because the County seems to be attempting to narrow the scope of the County law in its explanation and does not cite any the important legal terms from the law.
The County went on to explain that “Methadone clinics ARE state licensed entities as therefore must comply with the County set-backs. Methadone clinics hold a specific State clinic license and they bill as clinic entities, not as individual providers. Phaeton is not a licensed clinic or medical facility. It is a group practice of physicians— comparable to several hundred other medical practices located all over the County.” Again, the County is narrowing the scope of the law and obfuscating the actual wording here in order for its conclusion to make sense. The County law bars “state-licensed medical clinic[s]” according to a very specific definition contained within the County law. The prohibition includes “any individual or organization that provides treatment, care, or rehabilitation for individuals who show the effects of drug abuse or alcohol abuse, and represents or advertises itself as an alcohol abuse or drug abuse treatment program…[including]...A health professional licensed under the Health Occupations Article who is treating patients within the scope of the professional’s practice and who does not advertise the practice as an alcohol abuse or drug abuse program.” Nowhere in the County’s explanation does it mention the actual legal definition of a State Licensed Medical Clinic – it is simply making conclusory statements without explanation. Clearly, Phaeton Health Group is providing treatment for individuals who show the effects of drug abuse, and advertises itself as a drug abuse treatment facility. These are simply the objective and demonstrated facts.
The County then contradicts its own explanation by stating that “The physicians hold valid individual physician licenses and are also licensed by the State and DEA to prescribe scheduled drugs inc [sic] Suboxone.” This portion of the County’s explanation actually states that the physicians are licensed by the state to prescribe suboxone, which appears to be the portion of the law that the County denies is applicable Phaeton Health.
The County then wrote that “Moreover, despite a reference to Suboxone services on their website and in past promotional materials, there did not seem to be patient foot traffic into the offices when monitored on various shifts by police. Other than one flyer there is no evidence to suggest that the physicians are writing suboxone prescriptions or any prescription for that matter.” First, there is not a mere reference to Suboxone services—their past promotional materials that were distributed in Linthicum did not mention any services whatsoever except for treatment for opioid addiction. The advertisement that LSIA was able to discover was included in the May Monitor. Phaeton Health continues to advertise its Suboxone services on multiple websites as of the time we submitted this article for print. More importantly, the County’s claim that “there is no evidence to suggest that the physicians are writing Suboxone prescriptions or any prescription for that matter” is patently false. The County previously reported on May 7 that Phaeton Health had in fact “did ‘prescribe’ wrote a prescription [sic] for suboxone for 3-5 patients during 2017.”
Next Steps
Since the County has made it clear that it does not intend to challenge Phaeton Health Group’s activities in Linthicum and will not continue to investigate the business, the community is charged with continuing to monitor the business to ensure that it engages in safe business practices. The County has refused to enforce County law as LSIA and other elected representatives have requested. LSIA will continue to attempt to contact Phaeton Health Group’s owners with the hope that they will discuss their business with us. LSIA will also continue to search for other solutions to this issue. In the meantime, if you care about this issue, please contact our County representatives (contact information below). You can also file reports of zoning violations with the Office of Planning and Zoning. If you see something or have any comments about this issue, please also let LSIA know about it.
Anne Arundel County Executive
Steven R. Schuh Arundel Center
44 Calvert Street
Annapolis, MD 21404-1831
email: sschuh@aacounty.org
(410) 222-1821
County Council (District 1)
Councilman Peter Smith
44 Calvert Street, 1st Floor
Annapolis, Maryland 21401
email: peter.smith@aacounty.org
(410) 222-1401
County Law Prohibiting Phaeton Health Group in its Present Location
Anne Arundel County Code 18-1-101(123) and 18-10-149 provides, in pertinent part, that
State-licensed medical clinic means an outpatient medical clinic licensed by the state of Maryland as a detoxification facility or a substance abuse treatment program under Title 8, Subtitle 4 of the Health General Article including programs exempt from licensing requirements under section 8-403(C)(1) of the Health General Article of the state code….A state-licensed medical clinic shall comply with all of the following requirements:
(1) The facility may not be located within 1000 feet of a dwelling or school… [emphasis added]
Title 8, Subtitle 4 of the Health General Article provides that, inter alia:
(a) In this section, “alcohol abuse and drug abuse treatment program”:
(1) Means any individual or organization that provides treatment, care, or rehabilitation for individuals who show the effects of drug abuse or alcohol abuse, and represents or advertises itself as an alcohol abuse or drug abuse treatment program…
[including]...(c)(1) A health professional licensed under the Health Occupations Article who is treating patients within the scope of the professional’s practice and who does not advertise the practice as an alcohol abuse or drug abuse program;
(MD Health-Gen Code §8-401 (2015)) [emphasis added].
[1] Phaeton Health still has not returned LSIA’s phone calls or messages to discuss its business.
[2] The relevant text from the County law and state law are included at the end of this article for reference.
