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2016-08-08 16-290 Council Documents (7)
CAR Survey Report for Colonial Management Group dibia Penobscot County Metro Treatment Center with Accreditation Expiration Date of 11/30/2018 " Iz 0 1 "z< LU CARF 0" Survey Report for Colonial Management Group, LP dba Penobscot County Metro Treatment Center J z Organization. 0 Colonial Management Group,LP dba �► Penobscot County Metro Treatment Center 659Hagan Road car * < Bangor,ME 04401 ACCREDITED Ce Organizational Leadership . F-- Mike Ford " ` Director of Accreditation/ Three-Year Accreditation ...� Corporate Compliance irmaiox Survey Date Lou September 17-18,2015 0 Survey Team CO) Lesley J.Levin,LCSW,Administrative Surveyor Karen S.Garrett,M.A.,CPLP,CAP,CMFIP,CPP,Program Surveyor Programs/Services Surveyed Outpatient Treatment Opioid Treatment Program(Adults) Previous Survey October 18-19,2012 Tree-Shear Accreditation Survey Outcome Tee»Year Aeditation Expiration:November 30,2018 www,cartorg SURVEY SUMMARY Colonial Management Group,LP dba Penobscot County Metro Treatment Center has strengths in many areas. ■ Administrative,medical,and clinical staff members are committed to treating persons served with empathy,dignity,and respect.Staff members recognize the importance of collaboration, coordination,and communication on an internal as well as external basis to best meet the needs of persons served. ■ Persons served report satisfaction with the organization and feel all staff members are readily accessible,willing to listen,and responsive to their needs. ■ The program facility is currently being expanded and renovated.This is in response to the increased need for services in the community. ■ Funders praise the organization for how well it collaborates with other organizations in the community.It has strong ties to area hospitals and psychiatric treatment progrbams, ▪ The organization recognizes the importance of families to the continued recovery of persons send.It provides programming for family members,including both adults and children. ■ The program director knows every person served and greets them by name. She inquires about their health and the health of their family members. ! Recovery services offered enable persons served to preserve their basic human rights,dignity, health,and safety while enhancing their independence,self-sufficiency,self-esteem,and quaiitp of life.Persons served praised the organization for the difference it has made in their lives. it Services are provided in a warm and welcoming environment located in the central part of the city for easy access. ■ The staff is very cohesive and strives to provide the best services possible to the person served. Penobscot County Metro Treatment Center should seek improvement in the areas identified by the recommendations in the report. Consultation given does not indicate nonconformance to standards but is offered as a suggestion for further quality improvement. On balance,Penobscot County Metro Treatment Center provides compassionate and professional opioid treatment services in the Penobscot County area of Maine.Services are provided in clean and welcoming offices that are conveniently located.Staff members work well together and collaboratively with other organizations in the community.The commitment to provide quality services can be seen throughout the organization.The organization has a few areas for improvement,including ensuring that data collected are related to objectives established inthe strategic plan and collecting additional information for the assessment that includes efficacy of current or previously used medication,gender expression,and history of witnessed trauma. Leadership has expressed a commitment to address the recommendations noted in this report. Colonial Management Group,LP dba Penobscot County Metro Treatment Center has earned a Three-Year Accreditation.Leadership and staff members are commended for this achievement and encouraged to continue applying CSF standards. .�# r INTERNATIONAL 2 SECTION 1 . ASPIRE TO EXCELLENCE® A. Leadership Description CARP-accredited organizations identify leadership that embraces the values of accountabilityand; responsibility to the individual organization's stated mission.The leadership demonstrates corporate social responsibility. Key Areas Addressed N Leadership structure ■ Leadership guidance • Commitment to diversity ■ Corporate responsibility ▪ Corporate compliance Recommendations There are no recommendations in this area. Consultation ▪ The organization has a comprehensive policy and procedure that include a code of ethics that addresses all the appropriate areas in the standards.The code that is provided to employees and posted in the office does not include all the elements in the policy and procedure.It is suggested that the code of ethics given to employees be the same as the one in the policy and procedure. G. Strategic Planning Description CARF-acctedited organizations establish a foundation for success through strategic planning focused on taking advantage of strengths and opportunities and addressing weaknesses and threats. Key Areas Addressed ▪ Strategic planning considers stakeholder expectations and environmental impacts ■ Written strata c plan sets goals N Plan is implemented,shared,and kept relevant car 1 INTERNATIONAL 3 Recommendations There are ria recommendations in this area. D. Input from Persons Served and Other Stakeholders Description CARF-accredited organizations continually focus on the expectations of the persons served and other stakeholders.The standards in this subsection direct the organization's focus to soliciting, collecting,analyzing,and using input from all stakeholders to create services that meet or exceed the expectations of the persons served,the community,and other stakeholders. Key Areas Addressed ▪ Ongoing collection of information from a variety of sources • Analysis and integration into business practices Pt Leadership response to information collected Recommendations There are no recommendations in this area. E. Legal Requirements Description CARP-accredited organizations comply with all legal and regulatory requirements. Key Areas Addressed IN Compliance with all legal/regulatory requirements Recommendations There are no recommendations in this area. car I INTERNATIONAL 4 F. Financial Planning and Management Description CARF-accredited organizations strive to be financially responsible and solvent,conducting fiscal management in a manner that supports their mission,values,and annual performance objectives. Fiscal practices adhere to established accounting principles and business practices.Fiscal management covers daily operational cost management and incorporates plans for long-term solvency. Key Areas Addressed ▪ Budget(s)prepared,shared,and reflective of strategic planning ■ Financial results reported/compared to budgeted performance ■ Organization review M Fiscal policies and procedures ■ Review of service billing records and fee structure ■ Financial review/audit ■ Safeguarding funds of persons served Recommendations There are no recommendations in this area. G. Risk Management Description CARF-aecredited organizations engage in a coordinated set of activities designed to control threats to their people,property,income,goodwill,and ability to accomplish goals. Key Areas Addressed ▪ Identification of loss exposlo ■ Development of risk management plan ■ Adequate insurance coverage car I INTERNATIONAL Recommendations G.1.a.(1)through G.1.b.(2) The organization has a written policy and procedure for risk reduction.It is recommended that this result in a risk management plan that includes identification and analysis of loss exposures, identification of how to rectify identified exposures,implementation and monitoring of actions to reduce risk,reporting results of actions taken to reduce risks,and inclusion of tisk reduction in performance improvement activities.The plan should be reviewed at least annually for relevance and updated as needed. H. Health and Safety Description CARF-accredited organizations maintain healthy,safe,and clean environments that support quality services and minimize risk of harm to persons served,personnel,and other stakeholders. Key Areas Addressed ▪ Inspections • Emergency procedures st Access to emergency first aid • Competency of personnel in safety procedures • Reporting/reviewing critical incidents • Infection control Recommendations H.9.e. The organization's policy and procedures for critical incidents should provide for timely debriefing of personnel involved following these incidents. H.13.b.(1)through 1-1.13.b.(3) The organization was inspected by the local fire department,but a written report was not completed. It is recommended that the annual inspection by a qualified external authority result in a written report that details areas inspected,recommendations for areas needing improvement,and actions taken to respond to the recommendations. car I INTERNATIONAL 8 Consultation • The building's front door is difficult to open if a person uses A walker,crutches,Of wheelchair.It is suggested that staff members receive training on helping persons with disabilities open the door.It is also suggested that the organization install a buzzer at the front door that is identified as a way for persons with disabilities to receive assistance in opening the door. ▪ It is suggested that the posted evacuation routes include an indication of"you are here"to aid in reading and using the escape routes. I. Human Resources Description CARF-accredited organizations demonstrate that they value their human resources.It should be evident that personnel are involved and engaged in the success of the organization and the persons they serve. Key Areas Addressed • Adequate staffing • Verification of background/credentials • Recruitment/retention efforts • Personnel skills/characteristics Annual review of job descriptions/performance si Policies regarding students/volunteers,if applicable Recommendations There are no recommendations in this area. J. Technology Description CARP-accredited organizations plan for the use of technology to support and advance effective and efficient service and business practices. car I INTERNATIONAL 7 Key Areas Addressed a Written technology and system plan a Written procedures for the use of information and communication teclmologies(ICI)in service delivery,if applicable ▪ Training for personnel,persons served,and others on ICT equipment,if applicable a Provision of information relevant to the ICT session,if applicable a Maintenance of ICT equipment in accordance with manufacturer recommendations,if applicable a Emergency procedures that address unique aspects of service delivery via ICT,if applicable Recommendations There are no recommendations in this area. K. Rights of Persons Served Description CARE-accredited organizations protect and promote the rights of all persons served.This commitment guides the delivery 1;4 stokes and ongoing interactions with the persons served. Key Areas Addressed • Communication of dghts III Policies that promote rights ▪ Complaint,grievance,and appeals policy la Annual review of complaints Recommendations There are no recommendations in this area. I. . ACCeSSibillty Description CARF-accredited organizations promote accessibility and the removal of barriers for the persons served and other stakeholders. car I INTERNATIONAL 8 Key Areas Addressed • Written accessibility plan(s) II Requests for reasonable accornrnodations Recommendattons There axe no recommendations in this area, M. Performance Measurement and Management Description CARP-accredited organizations are committed to continually improving their organizations and service delivery to the persons served.Data ate collected and analyzed,and information is used to manage and improve service delivery. Key Areas Addressed • Information collection,use,and management • Setting and measuring performance indicators Recommendations There are no recommendations in this area. N. Performance Improvement Description The dynamic nature of continuous improvement in a CARP-accredited organization sets it spur from other organizations providing similar services.CARP-accredited organizations share and provide the persons served and other interested stakeholders with ongoing information about their actual performance as a business entity and their ability to achieve optimal outcomes for the persons served through their programs and services. Key Areas Addressed • Proactive performance improvement I Performance information shared with all stakeholders car I14 I TERNATIONAL 9 Recommendations N.1.b.(1)through NI.c.(3) The organization currently collects data primarily from satisfaction surveys of persons served. However, these data are not consistently related to objectives stated in the strategic plan.It is recommended that the organization analyze performance indicators in relation to performance targets,including business functions;service delivery,including effectiveness and efficiency of services,service access,and satisfaction and other feedback from persons served and other stakeholders;and extenuating or influencing factors.This written analysis should identify areas needing performance improvement,result in an action plan to address improvements needed to reach established or revised performance targets,and outline actions taken or changes made to improve performance. SECTION 2. GENERAL PROGRAM STANDARDS Description For an organization to achieve quality services,the persons served are active participants in the planning,prioritization,implementation,and ongoing evaluation of the services offered.A commitment to quality and the involvement of the persons served span the entire time that the persons served are involved with the organization.The service planning process is individualized, establishing goals and objectives that incorporate the unique strengths,needs,abilities,and preferences of the persons served.The persons served have the opportunity to transition easily through a system of care. A. Program/Service Structure Description A fundamental responsibility of the organi7ation is to provide a comprehensive program structure. The staffing is designed to maximize opportunities for the persons served to obtain and participate in the services provided. Key Areas Addressed • Written program plan • Crisis intervention provided • Medical consultation • Services relevant to diversity • Assistance with advocacy and support groups II Team composition/duties car I INTERNATIONAL 10 • Relevant education I Clinical supervision III Family participation encouraged Recommendations There are no recommendations in this area. B. Screening and Access to Services Description The process of screening and assessment is designed to determine a person's eligibility for services and the organization's ability to provide those services.A person-centered assessment process helps to maximize opportunities for the persons served to gain access to the organization's programs and services.Each personserved is actively involved in,and has a significant role in,the assessment process.Assessments are conducted in a manner that identifies the historical and current information of the person served as well as his or her strengths,needs,abilities,and preferences. Assessment data may be gathered through various means including face-to-face contact,telehealtii, or written material;and from various sources including the person served,his or her family or significant others,or from external resources. Key Areas Addressed • Screening process described in policies and procedures is Ineligibility for services • Admission criteria IN Orientation information provided regarding rights,grievances,services,fees,etc. MI Waiting list • Primary and ongoing assessments • Reassessments car I INTERNATIONAL Recommendations B.241(2) B.24.m.(2) B.24.n.(1)(b)through B.24.n.(2)01) It is recommended that the assessment process gather and record information regarding efficacy of current or previously used medication;gender expression;and history of witnessed tranma,including abuse,neglect,violence,and sexual assault. C. Person-Centered Plan Description Each person served is actively involved in and has a significant role in the person-centered planning process and determining the direction of his or her plan.The person-centered plan contains goals and objectives that incorporate the unique strengths,needs,abilities,and preferences of the person served,as wellas identified challenges andpotential solutions.The planning process,is person- directed and person-centered.The person-centered plan may also be referred to as an individual service plan,treatment plan,or plan of care.In a family-centered program,the plan may be for the family and identified as a family-centered plan. Key Areas Addressed ■ Development of person-centered plan. ■ Co-occurring disabilities/disorders 11 Person-centered plan goals and objectives ■ Designated person coordinates services Recommendations There are no recommendations in this area. D. TransitionlDischerge Description Transition,continuing care,or discharge planning assists the persons served to move from one level of care to anotherwithin the organization or to obtain services that are needed but are not available within the organization.The transition process is planned with the,active participation of each person served.Transition may include planned discharge,placement on inactive status,movement to a different level of service or intensity of contact,or a re-entry program in a criminal justice system. cal 1 I TERNATIOC AI 12 The transition plan is a document developed with and for the person served and other interested participants to guide the person served in activities following transition/discharge to support the gains made during program participation.It is prepared with the active participation of person served when he or she moves to another level of care,after-care program,or community-based services.The transition plan is meant to be a plan that the person served uses to identify the support that is needed to prevent a recurrence of symptoms or reduction in functioning.It is expected that the person served receives a copy of the transition plan. A discharge summary is a clinical document written by the program personnel who are involved in the services provided to the person served and is completed when the person leaves the program (planned or unplanned).It is a document that is intended for the record of the person served and released,with appropriate authorization,to describe the course of services that the program provided and the response by the person served. Just as the assessment is critical to the success of treatment,the transition services are critical for the support of the individual's ongoing recovery or well-being.The organization proactively attempts to connect the persons served with the receiving service provider and contact the persons served after formal transition or discharge to gather needed information related to their post-discharge status. Discharge information is reviewed to determine the effectiveness of its services and whether additional services were needed. Transition planning may be included as part of the person-centered plan.The transition plan and/or discharge summary may be a combined document as long as it is clear whether the information relates to transition or pre-discharge planning' or identifies the person's discharge or departure from the program. Key Areas Addressed SI Referral or transition to other services ii Active participation of persons served it Transition planning at ea riiest point ▪ Unplanned discharge referrals • Plan addresses strengths,needs,abilities,preferences ra Follow-up for persons discharged for aggressiveness Recommendations There are no recommendations in this area. car r INTtRNATIONAL i3 E. Medication Management Description These standards address the practice of evaluating,prescribing,and dispensing opioid agonist treatment medications approved by the Food and Drug Administration for use in the treatment of opioid addiction. Key Areas Addressed I Individual records of medication IIII Physician review la Policies and procedures for prescribing,dispensing,and administering medications U Training regarding medications IN Policies and procedures for safe handling of medication Recommendations There are no recommendations in this area. F. Medication Use DescriptiOn Medication use is the practice of handling,prescribing,dispensing,and/or administering medications to persons served in response to specific symptoms,behaviors,and conditions for which the use of medications is indicated and deemed efficacious.Medication use may include self administration,or be provided by personnel of the organization or under contract with a licensed individuals Medication use is directed toward maximizing the functioning of the persons served while reducing their specific symptoms and minimizing the impact of side effects. Medication use includes prescribed or sample medications,and may,when required as part of the treatment regimen,include over-the-counter or alternative medications provided to the person served.Alternative medications can include herbal or mineral supplements,vitamins,homeopathic remedies,hormone therapy,or culturally specific treatments. Medication control is identified as the process of physically controlling,transporting,storing,and disposing of medications,including those self administered by the person served. Self administration for adults is the application of a medication(whether by injection,inhalation, oral ingestion,or any other means)by the person served,to his/her body;and may include the organization storing the medication for the person served,or may include staff handing the bottle or blister-piak to the person served,instructing or verbally prompting the person served to take the medication,coaching the person served through the steps to ensure proper adherence,and closely observing the person served self-administering the medication. car I INTERNATIONAL 14 Self administration by children or adolescents in a residential setting must be directly supervised by personnel,.and standards related to medication use applied. Dispensing is considered the practice of pharmacy;the process of preparing and delivering a prescribed medication(including samples)that has been packaged or re-packaged and labeled by a physician or pharmacist or other qualified professional licensed to dispense(for later oral ingestion, injection,inhalation,or other means of administration). Prescribing is evaluating,determining what agent is to be used by and giving direction to a person served(or family/legal guardian),in the preparation and administration of a remedy to be used in the treatment of disease.It includes a verbal or written order,by a qualified professional licensed to prescribe,that details what medication should be given to whom,in what formulation and dose,by what rout;when,how frequently,and for what length of time. Key Areas Addressed ▪ Individnal records of medication I Physician review • Policies and procedures for prescribing,dispensing,and administering medications a Training regarding medications a Policies and procedures for safe handling of medication Recommendations There are no recommendations in this area. G. Nonviolent Practices Description Programs strive to be learning environments and to support persons served in the development of recovery,resiliency,and wellness.Relationships are central to supporting individuals in recovery and warless.Programs ate challenged to establish quality relationships as a foundation to supporting recovety and wellness.Providers need to be mindful of developing cultures that create healing, healthy and safe environments,and include the following: • Engagement III Partnership—power with,not over a Holistic approaches ai Respect U Hope a Self direction car f INTERNATIONAL 15 Programs need to recognize that individeats may require supports to fully benefit from their services. Staff are expected to access or provide those supports wanted and needed by the individual. Supports may include environmental supports,verbal prompts,written expectations,clarity of rules and expectations,or praise and encouragement. Even with supports,there are times when individuals may show signs of fear,anger,or pain,which may lead to aggression or agitation.Staff members are trainedto recognize and respond to these signs through de-escalation,changes to physical environment,implementation of meaningful and engaging activities,redirection,active listening,etc.On the rare occasions when these interventions are not successful and there is imminent danger of serious harm,seclusion or restraint may be used. to ensure safety. Seclusion and restraint are never considered treatment interventions;they are always considered actions of last resort.The use of seclusion and restraint must always be followed by a full review,as part of the process to eliminate the use of these in the future. The goal is to eliminate the use of seclusion and restraint in opioid treatment,as the use of seclusion or restraint creates potential physical and psychological dangers to the persons subject to the interventions,to the staff members who administer them,or those who witness the practice.Each organization still utilizing seclusion or restraint should have the elimination thereof as an eventual goal. Restraint is the use of physical force or mechanical means to temporarily limit a person's freedom of movement;chemical restraint is the involuntary emergency administration of medication,in irnrned ate response to a dangerous behavior. Restraints used as an assistive device for persons with physical or medical needs arenot considered restraints for purposes of this section.Briefly holding a person served,without undue force,for the purpose of comforting him or her or to prevent self- injurious elfinjurious behavior or injury to self,or holding a person's hand or arm to safely guide him or her from one area to another,is not a.restraint Separating individuals threatening to harm one another, without implementing restraints,is not considered restraint. Seclusion refers to restriction of the person served to a segregated roomwith the person's freedom to leave physically restricted.Voluntary time out is not considered seclusion,even though the voluntary time out may occur in response to verbal direction;the person served is considered in seclusion if freedom to leave the segregated room is denied. Seclusion or restraint by trained and competent personnel is used only when other less restrictive measures have been found to be ineffective to protect the person served or others from injury or serious harm.Peer restraint is not considered an acceptable alternative to restraint by personnel Seclusion or restraint is not used as a means of coercion,discipline,convenience,or retaliation. In a correctional setting,the use of,seclusion or restraint for purposes of security is not considered seclusion or restraint under these standards.Security doors designed to prevent elopement or wandering are not considered seclusion or restraint Security measures for forensic purposes,such as the use of handcuffsinstituted by law enforcement personnel,are not subject to these standards. When permissible,consideration is made to removal of physical restraints while the person is receiving services in the behavioral health care setting. car f INTERNATIONAL A16 Key Areas Addressed • Training and procedures supporting non-violent practices • Policies and procedures for use of seclusion and restraint • Patterns of use reviewed • Persons trained in use IN Plans for reduction/elimination of use Recommendations There are no recommendations in this area. H. Records of the Persons Served Description A complete and accurate record is developed to ensure that all appropriate individuals have access to relevant clinical and other information regarding each person served. Key Areas Addressed • Confidentiality • Time frames for entries to records • Individual record requirements • Duplicate records Recommendations There are no recommendations in this area. Quality Records Management Description The organization has systems and procedures that provide for the ongoing monitoring of the quality,appropriateness,and utilization of the services provided.This is largely accomplished through a systematic review of the records of the persons served.The review assists the organization in improving the quality of services provided to each person served. car I INTERNATIONAL 17 Key Areas Addressed is Quarterly professional review I Review current and dosed records • Items addressed in quarterly review ■ Use of information to improve quality of services Recommendations There are no recommendations in this area. SECTION 3. OPIOID TREATMENT CORE PROGRAM. STAN DARDS Description The standards and intent statements in this,section address the unique characteristics of each type of core program area.Opioid treatment programs provide rehabilitation and medical support for persons addicted to opioid drugs.The duration of treatment should be based on the needs of the persons served and should take into consideration the benefits of medication.Medications used to achieve treatmentgoals include methadone or other opioid agonist treatment medications approved by the Food and Drug Administration for use in the treatment of opioid addiction.Some other nonopioid agonist drugs have been determined to be efficacious and generally acceptable in current practice. Services are directed at reducing or eliminating the use of illicit drugs,criminal activity,,and/or the spread of infectious disease while improving the quality of life and functioning of the persons served.Opioid treatment programs follow rehabilitation stages of sufficient duration to meet the needs of the persons served. c 1 INTERNATIONAL 18 G. Outpatient Treatment Description Outpatient treatment programs provide culturally and linguistically appropriate services that include,but are not limited to,indiviclnol,group,and family counseling and education on wellness, recovery,and resiliency.These programs offer comprehensive,coordinated,and defined services that may vary in level of intensity. Outpatient programs may address a variety of needs,including, but not limited to,situational stressors,family relations,interpersonal relationships,mental health issues,life span issues,psychiatric illnesses,and substance use disorders and other addictive behaviors. Recommendations There are no recommendations in this area. car INTERNATIONAL19 CARF Survey Report for Colonial Management Group d/b/a Penobscot County Metro Treatment Center with Accreditation Expiration Date of 11/30/2015 1 car INTERNATIONAL , ! ,.. III • • !car . iii ACCREDMID ha it' 4111. . a Three-Year Accreditation, N 111 • • cARF Survey Report • for I u Colonial Management • Group, P dba I Penobscot Metro im. a Treatment Center a CARF*TERNAMMcm CANADA CARF-CCAC . , 09S1 Last$4410041 Road MO R4044141444446444,MA.04110410 1400-100*40141Nalue NW .11414414.A2 MA OA 1**004.DC 200241 BSA EdniontOn;AO tsi* CANADA . To11.11411101201 NFU 1101048FAINgt 1122 To041.4877#13A5444 . .. W11Y*0 4115 0144 1W 2*4105001 *no 410 2538 ca iso. 42 s i in Fax-520348 WI F4401158T5009 I Icar INTERNATIONAL iii \ow Brce, Organization if 111 Colonial Marmgetnent Group,LP dba Penobscot Metro Treatment Center ii car * • 659 Hogan Road I Bangor,ME 04401 IL Organizational Leadership -v 11 Mike Ford,LCDC Three-Year Accreditation Director of Accreditation&Corporate Compliance IITern L Senkow Licensing Coordinator 111 Survey Dates October 18-19,2012 11 Survey Team Michael J. O'Malley,Ph.D.,Administrative Surveyor 1111 Christine E.Miller,Ph.D.,Program Surveyor aPrograms/Services Surveyed Outpatient.Treatment Opioid Treatment Program(Adults) IIPrevious Survey October 5-6,2009 MIThree-Year Accreditation U Survey Outcome IIIThree-Year Accreditation Expiration:November 2015 II U U - - CARF INTININATICINAL CM1F-COAC CAW CANADA 0951 Ea01Southpoltitito94 1730 abaft Idandkantuk NW,344410 1400.10020 MA Awe*ION Monk AZ 037410 USA W8701470.AC 20036 USA E6000144,311 75/303 0414A0A 0014/4018/1101 833/ rott.000840 OA 1122 T40400877 434 5444 WITY11211325 1044 36202647500* 361E44292634 Fax$20318/129 Fag 20:1 meths roxvie4261214 • 1 SURVEY SUMMARY Colonial Management Group,LP dba Penobscot Metro Treatment Center has strengths in many areas, I Penobscot Metro Treatment Center is committed to delivering quality outpatient methadone treatment services.Persons served are key members of its treatment team. ■ The regional director and program director lead by example as they routinely demonstrate Colonial Management Group's commitment to quality,person-centered care.They are passionate,caring individuals working hard to ensure that persons served and staff members are successful. ■ Administrative and clinical staff members are committed to treating persons served with empathy,dignity,and respect. ■ Penobscot Metro Treatment Center is a valuable community asset to Bangor,Maine,and the surrounding area.It has an extensive networking database and access to community resources. Staff members know their community and resources and work diligently to maintain strong relationships with family service organizations,housing and employment resources,and the offices of children's services and juvenile justice. ■ Family members and persons served report they are very pleased with the organization. One person served stated,"I feel like everybody there wants to help me." ■ Penobscot Metro Treatment Center has a pool of counselors who are well trained and committed to developing quality clinical outcomes based on the goals of persons served. IN Penobscot Metro Treatment Center has a focus on improving the retention of those served. Staff members implemented a 30-day program in which persons served contact their counselor every day for 30 days to pick up their identification cards and meet with their counselor to discuss treatment progress.The absenteeism rate dropped from 9 percent to 4.8 percent as of September 2012. ■ Treatment staff members write thorough interpretive summaries that are part of the assessment. The summaries include key components from the assessment;a review of the person's strengths, needs,abilities,and preferences;and recommendations for the treatment plan. In the following area Penobscot Metro Treatment Center demonstrates exemplary conformance to the standards, ■ Penobscot Metro Treatment Center is commended for providing outstanding advocacy on behalf of persons served.The program director speaks regularly with a wide variety of public andprivate organizations,service groups,and individuals for the purpose of educating them about methadone and other opiate treatment methodologies,clarifying the recovery process and the language of recovery,and performing outreach to break down the stigma that accompanies. methadone treatment. INTERNATIONAL Page 2enhancing 1't<oPi.rs was Penobscot Metro Treatment Center should seek improvement in the areas identified by the recommendations in the report.Consultation given does not indicate nonconformance to standards but is offered as a suggestion for further quality improvement. On balance,Penobscot Metro Treatment Center has made a dedicated effort to maintain international accreditation and demonstrated substantial conformance to CARP standards.The organization provides excellent outpatient opiate treatment services and has support and cooperation from its referral sources.Persons served and referral sources have all expressed satisfaction with services provided. Staff members are committed to the provision of quality care and continuous improvement.Penobscot Metro Treatment Center has the human resources and support needed to address the recommendations,detailed in this report.It also has the,ability to grow and change to meet the various challenges that affect the individuals it serves. Colonial Management Group,LP dba Penobscot Metro Treatment Center has earned a Three-Year Accreditation.Colonial Management Croup's regional director and Penobscot Metro Treatment Center's program.director and staff members are congratulated for this accomplishment and encouraged to continue using CARP standards as guidelines for continuous quality improvement SECTION 1 . ASPIRE TO EXCELLENCE® A. Leadership Principle Statement CARP-accredited organizations identify leadership that embraces the values of accountability and responsibility to the individual organization's stated InissiOttl.The leadership demonstrates corporate social responsibility. Key Areas Addressed ▪ Leadership structure III Leadership guidance • Commiunent to diversity III Corporate responsibility • Corporate compliance Recommendations There are no recommendations in this area. carf INTERNATIONAL - Page 3 eilbarteing PEOPLE'S LIVES Exemplary Conformance Penobscot Metro Treatment Center is commended for providing outstanding advocacy on behalf of persons served.The program director speaks regularly with a wide variety of public and private organizations,service groups,and individuals for the purpose of educating them about methadone and other opiate treatment methodologies,clarifying the recovery process and the language of recovery,and performing outreach to break down the stigma that accompanies methadone treatment. C. Strategic Planning Principle Statement CARF-accredited organizations establish a foundation for success through strategic planning focused on taking advantage of strengths and opportunities and addressing weaknesses and threats. Key Areas Addressed • Strategic planning considers stakeholder expectations and environmental impacts II Written strategic plansets goals III Plan is implemented,shared,and kept relevant Recommendations There are no recommendations in this area. D. Input from Persons Served and Other Stakeholders Principle Statement CARP-accredited organizations continually focus on the expectations of the persons served and other stakeholders.The standards in this subsection direct the organization's focus to soliciting, collecting,analyzing,and using input from all stakeholders to create services that meet or exceed the expectations of the persons served,the community,and other stakeholders. car r INTERNATIONAL Pane 4 enhancing KOMI'S LIVES Key Areas Addressed II Ongoing collection of information from a variety of sources U Analysis and integration into business practices II Leadership response to information collected Recommendations There are no recommendations in this area. E. Legal Requirements Principle Statement CARF-accredited organizations comply with all legal and regulatory requirements. Key Areas Addressed 1111 Compliance with all legal/regulatory requirements Recommendations There are no recommendations in this area, F. Financial Planning and Management Principle Statement CARP-accredited organizations strive to be financially responsible and solvent,conducting fiscal management in a manner that supports their mission,values,and annual performance objectives. Fiscal practices adhere to established accounting principles and business practices.Fiscal management covers daily operational cost management and incorporates plans for long-term solvency. Key Areas Addressed • Budget(s)prepared,shared,and reflective of strategic planning II Financial results reported/compared to budgeted performance • Organization review II Fiscal policies and procedures CO IgratHATIONAL Page 5 .1 /1, ?0, pEoPuvs LIVES • Review of service billing records and fee structure R Financial review/audit II Safeguarding funds of persons served Recommendations F.7.a.through F.7.b.(3) It is recommended that the organization conduct a quarterly review of a representative sample of billing records of persons served to document that dates of services provided coincide with billed episodes of care,determine if bills accurately reflect services rendered,and identify necessary corrective action. G. Risk Management Principle Statement CARP-accredited organizations engage in a coordinated set of activities designed to control threats to their people,property,income,goodwill,and ability to accomplish goals. Key Area*Addressed N Identification of loss exposures 111 Development of Risk Management plan E Adequate insurance coverage Recommendations There are no recommendations in this area. Consultation IN It is suggested that Colonial Management Group develop a process that allows for review and analysis of potential loss exposures specific to the Penobscot Metro Treatment Center location. H. Health and Safety Principle Statement CARF-accredited organizations maintain healthy,safe,and clean environments that support quality set-vices and minimize risk of harm to persons served,personnel,and other stakeholders. car f INTERNATIONAL Page 6 enhancing PEOPLE'S LIVES Key Areas Addressed In Inspections II Emergency procedures II Access to emergency first aid IS Competency of personnel in safety procedures R Reporting/reviewing critical incidents II Infection control Recommendations There are no recommendations in this area. 1, Human Resources Principle Statement CARP-accredited organizations demonstrate that they value their lunnan,resources It should be evident that personnel are involved and engaged in the success of the organization and the persona they serve, Key Areas Addressed • Adequate staffuig • Verification of background/credentials MI Recruitment/retention efforts ▪ Personnel skills/characteristics • Annual review of lob descriptions/performance • Policies regarding students/volunteers,if applicable Recommendations There are no reconunendations in,this area. car I INTERNATIONAL Page 7 enhancing PEOPLE'S LIVES J. Technology Principle Statement CARP-accredited organizations plan for the use of technology to support and advance effective and efficient service and business practices. Key Areas Addressed ■ Written technology and system plan Recommendations There are no recommendations in this area. K. Rights of Persons Served Principle Statement CART-accredited organizations protect and promote the rights of all persons served.This commitment guides the delivery of services and ongoing interactions with the persons served. Key Areas Addressed ■ Communication of rights MI Policies that promote rights ■ Complaint,grievance,and appeals policy • Annual review of complaints Recommendations There are no recommendations in this area. L. Accessibility Principle Statement CARP-accredited organizations promote accessibility and the removal of barriers for the persons served and other stakeholders. ear INTERNATIONAL Pages enhaiteingPEOP„LE'S WES Key Areas Addressed ▪ Written accessibility plan® III Status report regarding removal of identified barriers III Requests for reasonable accommodations Recommendations There are no recommendations in this area. M. Performance Measurement and Management Principle Statement CARP-accredited organizations are committed to continually improving their organizations and service delivery to the persons served.Data are collected and information is used to manage and improveservice delivery. Key Areas Addressed I Information collection,use,and management MI Setting and measuring performance indicators Recommendations There are no recommendations in this area. N. Performance Improvement Principle Statement The dynamic nature of continuous improvement in a CARP-accredited organization sets it apart from other organizations providing similar services CARP-accredited organizations share and provide the persons served and other interested stakeholders with ongoing information about their actual performance as a business entity and their ability to achieve optimal outcomes for the persons served through their programs and services. Key Areas Addressed III Proactive performance improvement • Performance information shared with all stakeholders Car tr4f—:-"--intto.'"."--"A"="----TtoN Page 9 (4n ?copal LIVES Recommendations There are no recommendations in this area. SECTION 2. GENERAL PROGRAM STANDARDS Principle Statement For an organization to achieve quality services,the persons served are active participants in the planning,prioritization,implementation,and ongoing evaluation of the services offered.A commitment to quality and the involvement of the persons served span the entire time that the persons served are involved with the organization.The service planning process is individualized, establishing goals and objectives that incorporate the unique strengths,needs,abilities,and preferences of the persons served.The persons served have the opportunity to transition easily through a system of care. A. Program/Service Structure Principle Statement A fundamental responsibility of the organization is to provide a comprehensive program.structure. The staffing is designed to maximize opportunities for the persons served to obtain and participate in the services provided. Key Areas Addressed I Written program plan M Crisis intervention provided 111 Medical consultation • Services relevant to diversity II Assistance with advocacy and support groups 11 Team composition/duties II Relevant education • Clinical supervision II Family participation encouraged car ffiTERMTIONAL Page 1 0 eniandkagnoptrs Recommendations A.2t.g. Although ongoing supervision of clinical service personnel addresses various clinical and treatment issues,the organization is urged to include cultural competency issues in supervision sessions. Consultation ■ Although documented team meetings occur regularly,it is suggested that the organization. structure these meetings to include regular input from the medical director. B. Screening and Access to Services Principle Statement The process of screening and assessment is designed to determine a person's eligibility for services and the organization's ability to provide those services.A person-centered assessment process helps to maximize opportunities for the persons served to gain access to the organization's programs and services.Each person served is actively involved in,and has a significant role in,the assessment process.Assessments are conducted in a manner that identifies the historical and current information of the person served as well as his or her strengths,needs,abilities,and preferences. Assessment data may gathered through various means inducting face-to-face contact,telehealth, or written material;and from various sources including the person served,his or her family or significant others,or from external resources. Key Areas Addressed • Screening process described in policies and procedures ■ Ineligibility for services ■ Admission criteria. ■ Orientation information provided regarding rights,grievances,services,fees,etc. 1• Waiting list ▪ Primary and ongoing assessments a Reassessments Recommendations B.24.m.(3) The assessment Should include information about the culture of the person.served.This section of the assessment Was often left blank or had minimalinformation. card INTERI4AnottAt, page-11 enhancing Mann LIVES C. Person-Centered Plan Principle Statement Each person served is actively involved in and has a significant role in the person-centered planning process and determining the direction of his or her plan.The person-centered plan contains goals and objectives that incorporate the unique strengths,needs,a.ilities,and preferences of the person served,as well as identified challenges and potential solutions.The planning process is person- directed and person-centered.The person-centered plan may also be referred to as an individual service plan,treatment plan,or plan of care.In a family-centered program,the plan may be for the family and identified as a family-centered plan. Key Areas Addressed ■ Development of person-centered plan ■ Co-occurring disabilities/disorders ■ Person-centered plan goals and objectives ■ Designated person coordinates services Recommendations C.2.b.(7) It is recommended that treatment objectives in the person-centered plan be time specific.Start dates were written without corresponding completion dates. E.8,a.(1)(a) C.8.a.(1)(b) Although progress notes were consistently written following a treatment service,the organization is urged to document progress toward achievement of identified objectives and goals. D. Transition/Discharge Principle Statement Transition,continuing care,or discharge planning assists the persons served to move from one level of care to another within the organization or to obtain services that are needed but are not available within the organization.The transition process is planned with the active participation of each person.,served.Transition may include planned discharge,placement on inactive status,movement to a different level of service or intensity of contact,or a re-entry program in a criminal justice system. The transition plan is a document developed with and for the person served and other interested participants to guide the person served in activities following transition/discharge to support the gains made during program participation.It is prepared with the active participation of person served when he or she moves to another level of care,after-care program,or community-based car INTERNATIONAL Page 12 = =,'""r g PEOPLE'S LIVES services.The transition plan is meant to be a plan that the person served uses to identify the support that is needed to prevent a recurrence of symptoms or reduction in functioning.It is expected that the person served receives a copy of the transition plan. A discharge summary is a clinical document written by the program personnel who are involved in the services provided to the person served and is completed when the person leaves the program (planned or unplanned).It is a document that is intended for the record of the person served and released,with appropriate authorization,to describe the course of services that the program provided and the response by the person served. fust as the assessment iscritical to the success of treatment,the transition services are critical for the support of the,individual's ongoing recovery or well-being.The organization proactively attempts to connect the persons served with the receiving service provider and contact the persons served after formal transition ox discharge to gather needed information related to their post-discharge status. Discharge information is reviewed to determine the effectiveness of its services and whether additional services were needed. Transition planning may be included as part of the person-centered plan.The transition plan and/or discharge summary may be a combined document as long as it is clear whether the information relates to transition or pre-discharge planning or identifies the person's discharge or departure from the program. Key Areas Addressed ▪ Referral or transition to other services U Active participation of persons served • Transition planning at earliest point U Unplanned discharge referrals ■ Plan addresses strengths,needs,abilities,preferences, ■ Follow-up for persons discharged for aggressiveness Recommendations There are no recommendations in this area. E. Medication Management Principle Statement These standards address the practice of evaluating,prescribing,and dispensing opioid agonist treatment medications approved by the Food and Drug Administration for use in the treatment of opioid addiction. r INTERNATIONAL Pass 13 enhancingpeoptirs two Key Areas Addressed ▪ Individualrecords of medication ■ Physician review ▪ Policies and procedures for prescribing,dispensing,and administering medications • Training regarding medications IIII Policies and procedures for safe handling of medication Recommendations There are no recommendations in this area. F. Medication Use Principle Statement Medication use is the practice of handling,prescribing,dispensing,and/or administering medications to persons served in response to specific symptoms,behaviors,and conditions for which the use of medications is indicated and deemed efficacious.Medication use may include self administration,or be provided by personnel of the organization or under contract with a licensed, individual.Medication use is diretAxd toward maximizing the functioning of the persons served while reducing their specific symptoms and minimizing the impact of side effects. Medication use includes prescribed or sample medications,and may,when required as part of the treatment regimen,include over-the-counter or alternative medications provided to the person served.Alternative medications can include herbal or mineral supplements,vitamins,homeopathic remedies,hormone therapy,or culturally specific treatments. Medication control is identified as the process of physically controlling,transporting,storing,and disposing of medications,including those self administered by the person served. Self administration for adults is the application of a medication(whether by injection,inhalation, oral ingestion,or any other means)by the person served,to his/her body;and may include the organization storing the medication for the person served,or may include staff handing the bottle or blister-pak to the person served,instructing or verbally prompting the person served to take the medication,coaching the person served through the steps to ensure proper adherence,and closely observing the person served self-administering the medication. Self administration by children or adolescents in a residential setting must be directly supervised by personnel,and standards related to medication use applied. Dispensing is considered the practice of pharmacy;the process of preparing and delivering a prescribed medication(including samples)that has been packaged or re-packaged and labeled by a physician or pharmacist or other qualified professional licensed to dispense(for later oral ingestion, injection,inhalation,or other means of administration). car f KTERNATIONAL Page,4 enhancing PEOPLE'S S inns Prescribing is evaluating,determining what agent is to be used by and giving direction to a person served(or family/legal guardian),in the preparation and administration of a remedy to be used in the treatment of disease.It includes a verbal or written order,by a qualified professional licensed to prescribe,that details what medication should be given to whom,in what formulation and dose,by what route,when,how frequently,and for what length of time. Key Areas Addressed I Individual,records of medication II Physician review I Policies and procedures for prescribing,dispensing,and administering medications ▪ Training regarding medications II Policies and procedures for safe handling of medication Recommendations There are no recommendations in this area. G. Nonviolent Practices Principle Statement Programs strive to be learning environments and to support persons served in the development of recovery,resiliency,and wellness.Relationships are central to supporting individuals in recovery and wellness.Programs are challenged to establish quality relationships as a foundation to supporting recovery and wellness.Providers need to be mindful of developing cultures that create healing, healthy and safe environments,and include the following: II Engagement I Partnership—power with,not over U Holistic approaches II Respect • Hope • Self direction Programs need to recognize that individuals may require supports to fully benefit from their services.Staff are expected to access or provide those supports wanted and needed by the individual. Supports may include environmental supports,verbal prompts,written expectations,clarity of rules and expectations,or praise and encouragement. carf INTERNATIONAL Page 15 enhancing PEOPLE'S LIVES Even with supports,there ate times when individuals may show signs of fear,anger,or pain,which may lead to aggression or agitation.Staff members are trained to recognize and tespond to these signs through de-escalation,changes to physical environment,implementation of meaningful and engaging activities,redirection,active listening,etc.On the rare occasions when these interventions are not successful arid there is imminent danger of serious harm,seclusion or restraint may be used to ensure safety,Seclusion and restraint are never considered treatment interventions;they are always considered actions of last resort.The use of seclusion and restraint must always be followed by a full review,as part of the process to eliminate the use of these in the future, The goat is to eliminate the use of seclusion and restraint in opioid treatment,as the use of seclusion or restraint creates potential physical and psychological dangers to the persons subject to the interventions,to the staff members who administer them,or those who witness the practice.Each organization still utilizing seclusion or restraint should have the elimination thereof as an eventual goal. Restraint is the use of physical force or mechanical means to temporarily limit a person's freedom of movement;chemical restraintis the involuntary emergency administration.of medication,in immediate response to a dangerous behavior.Restraints used as an assistive device for persons with physical or medical needs are not considered restraints for purposes of this section.Briefly holding a person served,without undue force,for the purpose of comforting him or her or to prevent self- injurious behavior or injury to self,or holding a person's hand or arm to safely guide him or her from one area to another,is not a restraint.Separating individuals threatening to ham one another, without implementing restraints,is not considered restraint. Seclusion refers to restriction of the person served to a segregated room with the person's freedom to leave physically restricted.Voluntary time out is not considered seclusion,even though the voluntary time out may occur in response to verbal direction;the person served is considered in seclusion if freedom to leave the segregated room is denied. Seclusion or restraint by trained and competent personnel is used.only when other less restrictive treasures have been found to be ineffective to protect the person served or others from injury or serious harm.Peer restraint is not considered an acceptable alternative to restraint by persomiel. Seclusion or restraint is not used as a means of coercion,discipline,convenience,or retaliation. In a correctional setting,the use of seclusion or restraint for purposes of security is not considered , seclusion or restraint under these standards.Security doors designed to prevent elopetnent or wandering are not considered seclusion or restraint Security measures for forensic purposes,such as the use of handcuffs instituted by law enforcement personnel,are not subject to these standards. When permissible,consideration is made to removal of physical restraints while the person is receiving services in the behavioral health care setting. Key Areas Addressed Training• and procedures supporting non-violent practices • Policies and procedures for use of seclusion and restraint it Patterns of use reviewed X Persons trained in use ▪ Plans for reduction/elimination of use CCII I TligNTPage 16 eidatichig PEoPtics E1YES 1 Recommendations There are no tecormnesaciations in this area. H. Records of the Persons Served Principle Statement A complete and accurate record is developed to ensure that all appropriate individuals have access to relevant clinical and other information regarding each person served. Key Areas Addressed • Confidentiality II Time frames for entries to records le Individual record requirements Is Duplicate records Recommendations There are no recommendations in this area. I. Quality Records Management Principle Statement The organization has systems and procedures that provide for the ongoing monitoring of the criality,appropriateness,and utilization of the services provided.This is largely accomplished through a systematic review of the records of the persons served.The reviewassists the organization in improving the quality of services provided to each person served. Key Areas Addressed • Quarterly professional review • Review current and dosed records III Items addressed in quarterly review MI Use of information to improve anality of services Car r INTERNATIONAL Page 17 enbandng*Aortal's- Ely...Es Recommendations 1.1.a.through 1.1.b.(3) The organization is urged to conduct a quarterly records review of services that documents quality of service delivery,appropriateness of services,and patterns of service utilization. I.2.a.through I.2.c. The organization should verify that the quarterly records review is conducted by trained and qualified personnel.The review should be conducted on a representative sample of current and dosed records and in accordance with an established review process. 1.4.8.(1)through 1.4 j. The quality records review should address whether persons served were provided with an appropriate orientation and actively involved in making informed choices regarding,services they received;confidential information was released according to applicable laws/regulations; assessments of persons served Were thorough,complete,and timely;actual services reflect appropriate level of care and,reasonable duration;the person-centered plan was reviewed and updated in accordance with the organization's policy;when applicable,the transition plan and discharge summary have been completed;services were documented in accordance with the organization's policy;and when billing for services occurs,clinical documentation is consistent with billing records. 1.5.a.through I.5.c.. The organization should demonstrate that information collected from its review process is used to improve the quality of its services,used to identify personnel training needs,and reportedto applicable personnel._ SECTION 3. OPIOID TREATMENT CORE PROGRAM STANDARDS Principle Statement The standards and intent statements in this section address the unique characteristics of each type of core program area.Opioid treatment programs provide rehabilitation and medical support for persons addicted to opioid drugs.The duration of treatment should be based on the needs of the persons served and should take into consideration the benefits of medication,Medications used to achieve treatment goals include methadone or other opioid agonist treatment medications approved by the Food and Drug Administration for use in the treatment of opioid addiction. Some other nonopioid agonist drugs have been determined to be efficacious and generally acceptable in current practice. Services aredirected at reducing or eliminating the use of illicit drugs,criminal activity,and/or the spread of infectious disease while improving the quality of life and functioning of the persons served,. Opioidtreatment programs follow rehabilitation stages of sufficient duration to meet the needs of the persons served. car f INTERNATIONAL Page 18 enbanchlg PEOPLE'S LIVES F.Outpatient Treatment. Principle Statement Outpatient treatment programs provide services that include,but are not limited to,individual, group,and family counseling and education on recovery and wellness.These programs offer comprehensive,coordinated,and defined services that may vary in level of intensity. Outpatient programs may address a variety of needs,including,but not limited to,situational stressors,family relations,interpersonal relationships,mental health issues,life span issues,psychiatric illnesses, addictions(such as alcohol or other drugs,gambling,and internet),eating or sexual disorders,and. the needs of victims of abuse,domestic violence,or other trauma. Recommendations There are no recommendations in this area. C 0 INTERNATIONAL Page 19 s a l. Rag PEOPLE`S LIVES New Directions Treatment Services V. City of Redding 490 F.3d 293 (2007) New Directions Treatment Services v.City of Reading,490 F 233(2001) 19 A.Q.Cases .;7,30 NOLR P [A summary judgment in favor of city was precluded on +is Yellow Hag-S ` lthavarellt clinic'sclairtneagainst against city for dmagsfttdeniaIofzoning by Gest Bath Up the v.Ckv afiClefroth 6th c k. permitpursuant to Pennsylvania statute;and Ohl. Marco 1s,205 490 P.3d 293 [ l sumniarY judgment in favor of city ways pmcluded can United States Court of Al eals, clinic's equal protection challenge to statute. Third Ludt NEW DIRECTIONS TREATMENT SERVICES, Reversed and remanded. on its own behalf andon behalf of its patients; Angel Doe;Dan Coe;Joseph Joe;tonis Carlos'PoPeter Voe on their West I4ea tes(6) behalf and on behalf of timeless,Appellants CM' CITY OF READING;Vaughn Spencer,CityAloohol or drug use Council President,in,his ol al capacitY,and Zoning and Phisting city Members;Angel Figueroa;Gone Kerns;Michael I).Scluorn; Sterner; ew Handicappedand, led individuals Dom*Its Jeffrey Waltman;C Genes, Pennsylvania zoning imposing a ban on the establishment of methadone clinics In their individual and offdal capacities.. wig500 feet of many structures,iwiluding No.O5-4$ . schools, churches, and residential housing developments, was facially diseritehattory in Argued;Ute it,20°6. violation of Americans with I Act (ADA) and the habilitation Act fact that nett Jtitrt0 15,-2007. statute gave municipalities power to waive the statutory ban in no way altered the fact SPOP* that statute facially singled out methadone Background:Methadone clinic and individual methadone clinics,and thereby methadone patients, for pat nts brought suit on constitutional: and federal differ at treatment. Rehabilitation Act of statutory grounds, raising both facial awl as applied 1913,4 $64, 29 I.t;SG'.A, § 794; Amesicans challenges to Pennsylvania stotute that gave the city the with Disabilities Mt of 199(),.§§202; 510(a), opportunity to vote to deny zoning permit to methadone sX1),42 U,S.C.A.§12132,12210(a),(bXI); clinics.The Unrated Slates ';4' Ccant for the Pest= 53 P.&§10621, District of yl Paul S. Diamond, .t., 415 p.,5 2r1 0l,granted summary judgment in favor of 17 Cases that cite this headnote city,and clinic appealed. 121 Civil Rights Discrimination in General Itold#ngs: The Court of Appeals, Circuit Judge, Ceertilational Law held,than: aw Disability and Disease,Physical or Mental (11 Ponnthylvania statute imposing a baa on the Principal difference between equal protection establishment of methadone clinics within Stiff bet and Americans with Disabilities Act(ADA) of many structures, including schools, churches, inquiries is that, in an as applied €r facial and residettial housing developments was facially equal protection challenge,the plaintiff bears discriminatory in violation of mer' with Disabilities the burden ofnegating all conceivablerational Act(ADA)and the Rehab tion Act; W '2016 Thomson teens.No claim to original U.S.Government Wks, New Ditections Treatment Services v.City of Reeding,490 F.3d 209( 7) t9 At b.Oases 687,361401.R P 1 justifications for the allegedly discriminatory for denying permit for methadone clinic, action or statute,whereas to make out a claim Pueutuding summary suluntaryludgmerttin favor of city under the ADA,the plaintiff need only show in suit challenging validity of Pennsylvania thatinte ntionai discrimination was the but for statute imposing a ban on the establishment. cause,of the allegedly tliscrimi al y action. of methadone clinic within 500 feet of many ConstAmend. 14; Americans with structures, including schools, h and ' Disabilities Act of1 ,4 ,42 U.SCA. residentialhousing developments equal, 12132. protection clause. 11.1CA. Const.Antend. 14;53PPS.§10621. 24 Cases that cite this headnote Cases that dm this tate (31 Fe&md Preembre Civilerr rights ChB Frontline miine issue of material fact existed as to a"" Reprerantation of ty; whether methadone clinic's patients posed s' to general a significant risk so a to be deensui A class representative need only possess qualified under Americans with Disabilibes a minimal degree of knowledge accessary Act (ADA) and the Rehabilitation Act, to meet the adequacy standard. Fed.Ruks precluding, judgment in favor of city Civ.Pmeitule 23( 4),2915 .C, on cies claims against city for damages for of zoning permit under fel 41 that r invalid Pennsylvania statute impa ban on the establishment et methadone clinics within 5(X feet of many structures,including schogls, churches, and nsidential housing West Codeuetes development Rehabilitation Mt of 1913, § 7(20)(001 (20)(0(0X11 29 U.S.C'.A. §' Heb d 70500Xexi). Mexnxix Americans with 53 P.S.§10621 Disabilities Act of 19)0, § 510(4 (b)()) 42 Attorneys and Lary Fhms l.S .A. 12214N4 ChM 53 P.S.410621, *293 Michael Churchill. nra E .Rangy(argued), 17 Cases that cite this„ :,. ore Public Interest Law Center of Philadelphia,Philadelphia,.. PA,for Appellants. 141 Federal Civil Procedure 400. Rightscif ttrird or l c,, Steven (argued),K. Ludwig Pax Rothschild, A -may may only assert claims based Philadelphia.RA,for Appellees. on the injuries of others to the t that Before: SMITH and BOTH, Circuit Judges, and those who suffered', the direct harm would * IASDistrict Judge. t e+-: s have diog to sue. Const.Arta 3,*2,cl L * The Honorahle Joseph R Senior District that It ate' ledgefar the United States District of New Jew, Casessitting by designation. 151 Menai Procedure Ow Civil rights in oral OPINION Genuine issue of material fact existed as to whether city rat its burden of dem n.®k tin SMITHo+ ircuit"judge. a legitimate,. n liscriminatery purpose 2D16 Thomson Reuters.No claim to original.U.S.Government Works. 2 New Directions Treatment Services it.City of Reacting,490 F.3t# 7) 19 aha.Cases s:7,35140LR1 This ease remota the familiar conflict between the legal and have emotional reactions Most important, principle o1 nom-di�tt tion and the pow Pf c ple methadone relieves the craving associated with of not-in-my-backyard. New Dations Treatment heroiri addiction;craving is a major reason for Services, a reputable and longstanding provider of relapse.Among methadone it has been Methadonetreatment, sought to locate a new facility infolium that normal street doses of heroin are ineffective at producing euphoria,thus making the city of Reading.A Penntylvania statute that facially. the use of heroin more easily extinguishable. singles out methadone clinics gave the City of Reading Methadones effects last four to six times the opportunity to vote to deny the permit The City of as long as those of heroin, so in Reading availed itself of that opporttleity- treatment seed to take it only once a day Also, methadove is medically safts even when used New motions and individual methadone patients continuously for 10 years or more, Combined brought suit on constitutional and federal statutory with behavioral therapies or eounstilin and grounds,raising both facial and applied challengee to other mpportive servims, methadone enables the statute. The City of Reading etweensfoily moved for patients to stop using heroin(and other opiates) summary judgment against all of plaintiffs'*inn,New and teturn to more stable and productive Directions and the individual Alai 'appeal is before lives. hair/ :rude nimgov rchreportsf us. h ro ero ti .htn treatment. The Offof National Dry Control Poley fol t Executive Office of the . )prof further information on methadonetreatment L SuMmary offeets mut procedural wry Background information Methadone is a rigorously well-tested New Directions Treatment Services("NDTS") operates medication that is sale end efficacious for several me =s.n.,, clinics throughout Pennsylvania, the treatment of narcotic withdrawal and dependence. For more than 30 years t including one in West Reding.. NDTS provides �"! rmaintenance for who synthetic narcotic hat been used to treat-00°1d methadaddiction addicted to heroin for at least a year.NDTS's Executive Director, Glen Cooper, contacted the City of ReadingMethadone reduces the cravings ("the City")to discuss opening an additional treatment with heroin. use and Moeda the high from center, as their West Reading facility had developed a heroin, but it does not provide the euphoric waiting list for treatment.NDTS met with City oirtelels rush Contequattly,methadone patients do not on January 24, 2001, to discuss potential sites within experience the and lows diet math t.„ City. Is TS met with the City Council two months from the waxing.and waning of heroin in blood later to continue the di ° n,Although NDTS had not levels.Ultimately,thepatietit remains physically yet obtained an oforating permit from the City-,NDTS dependent on the 'opioid but is freed from signed a ten-year lease on a property at 700 the uncontrolled, compulsive, and: disruptive Lancaster Avenue.PINS t d.a ung pea behavior seen ilii heroin addicts. application. Withdrawal from methadone ss h than that from heroin. As a rust, it is l The Natiorsai,In�ritute on Drug Abuse'(part or ate. possible to maintain an addict on methadone Without harsh side effects. Many MMT Netional Institutes of Health)describes ,,, [methadone e mail ase treatment' patients treatment require timous treatinellt,Sonefunes over:a Methadone treatment has beet used fox more period of years. than 3Oy es 'very and say trtopsoid Methadone maintenance treatment provides addiction, Properly prescribed methadone is the heroin addict with individualized health not intoxicating or sedating and its effeeM do care and medically prescribed methadone to not interfere with ordinary activities such tie ranee aswithdrawal symptoms,reducesthe opiate dr wing a car. The medication is taken orally =vine,and t a biochemical balance and it supprmses nares withdrawal for 24 in the body. Important elements in heroin. to 36 hours. Patients are able to sive pain +201$Thomson Realer .No claim to otigliviE.E.S.Government Works. 3 New Directions Treatment Services v.City of Reading,490 F.3d 293(2007) 19 AD.Cates 6ar,as NoLR treatment include comprehensive social and share needles and participate in at-risk sexual rehabilitation services, activity and prostitution, which are significant Availability of Treatmerit factors in the spread of many diseases.Research About 20% of the estimated 810,000 heroin suggests that MMT significantly decreases addicts in the United States receive MMT the rate of IfIV infection for those patients (American Methadone Treatment Association, participating in MMT programs (Firshein, 1999). At present, the operating practices of 1998). clinics and hospitals are bound by Federal MMT allows patients to be free of heroin regulations that icbtiict the use and availability addiction. The National Institute on Drug of methadone.These regulations are explicitly Abuse found that,among outpatients receiving stated in detailed protocols established by the MMT, weekly heroin use decreased by 69%, U.S. Food and Drug Administration (FDA). This decrease in use allows for the individual's Additionally,most States have laws that control health and productivity to improve(Office of and closely monitor the distribution of this National Drug Control Policy, 1998a).Patients medication. were no longer required to live a life of crime In July 1999 the U.S. Department of Health to support their habit, and criminal activity and Human Services released a Notice of decreased by 52/Q among these patients. Full- Proposed Rulernaking (NPRM) for the use time employment increased by 24%. In a of methadone. Por the first time in more 1994 study of drug treatment in California, than 30 years, the NPRM proposes that researchers found that rates of'illegal drug use, this medication take its rightful place as a criminal activity,and hospitalization were lower clinical tool in the treatment of the heroin for MMT patients than for addicts in any other addict. Instead of its use being mandated type of drug treatment program. by regniations, programs will establish quality The Drug Abuse Treatment Outcome Study assurance guidelines and have to be accredited. (1)ATOS)conducted an outpatient methadone The proposed new system will allow greater treatment (OMT) evaluation examining the tlexthility by the treating physician and ensure long-term effects of KMT (Hubbard et al,, appropriate clinical management of the patient's 1997).The pretreatment problems consisted of needs. This proposed change in policy would weekly heroin use,no full-time employment,and eliminate most of the current regulations and illegal activity. Results of the 1—year fallow- allow greater clinical discretion for treatment up showed a decrease in the number of weekly by the physician. Accreditation establishes a heroin users and a reduction in illegal activity clinical standard of care for the treatment of after OMT.There was no significant change in medical conditions. In the foreseeable future, unemployment rates. clinic and hospital programswould be accredited A Review by a national and/or State acerediting body. MMT is one of the most monitored and Responsllility for preventing the diversion of regulated medical treatments in the United methadone to illicit use will remain with the Drug States. Despite the longstanding efficacy of Enforcement Administration. MMT, only 20°A of heroin addicts in the *** United States are currently in treatment Benefits The National Institutes of Health Consensus Evidence shows that continuous MMT is Development Conference on Effective Medical associated with several other benefits. Treatment of Heroin Addiction concluded that MMT costs about$13 per day and is considered heroin addiction is a medical disorder that a cost-effective alternative to incarceration can he effectively treated in MMT programs. (Office of National Drug Control Policy,1998a). The Consensus panel recommended expanding MUT has a benefit-cost ratio of 4:1,meaning$4 access to MMT by increasing funding and in economic beaefit luxnuesfor every$1 spent on minimizing Federal and State regulations MMT(COMPA,1997). Further research must be conducted on factors MMT has a significant effect on the spread leading to heroin use and the differences of HW/AIDS infection, hepatitis B and C, among various users and their ability to end tuberculosis, and sexually transmitted diseases opiate addiction before the demand for heroin (COMPA, 1997), Heroin users are known to WESTLAW 2016 Thotneort Reuters.No claim to original,U.S, Government Works. 4 New[lire Treatment Services v.City of Reading,490 F.3d 29.3(2001) ib A.G3.Caws 687 6 NOIR:Ft addiction treatment can be dr +ety met by both transitional(women andchildren)and increased WO availability, pint housing for persons with disabilities httpt'.lwww wbpautrug ' f for the past twelve years. publicatiOns/factsbt1m ethadoneimdeahtmt bttp;!/www.volunteerseluttionssorgfawberksl The Lancaster Avenue prrmerty is located on a.. cergf220334.htm1. Olen Cotner, the Executive. commercial highway that is interspersed with - Director ofNOT'S,referred to the tens tCnSn Y 75private residences. The Counseling Center oftheSaks ling Carter at thesamoloaation in his comments before the City Council: previously occupied the providing treatment to The Borks Counseling Center was in the vary patientswith mental health problems and drUgaddictiOns. building that we arepaoposingto pin this fitality It did not provide methadone treatment:.2 POTS in.They did esactly the same sort of work that intended to *298 'a elle hundred or so" cm do;drug addiction treses mental health ewthadorte patients at the new facility, NITS proposed *s*services, a 4,000 square foot addition to the property to accommodate this ea d usage. MOTS planned to We found what I think is a good site where .+maoPerare the y heW& it from 3;30 .m. to 6:00..,�yy ,'a , on the place formerly�#.,heroin 1, wereadrficts treated,former—very I mean TF 9^#es well .more e R.RI 9:X# hours on wmE Y+nd3.. tF[iit 1$proposing is a l ei s meanly a,farmer site Per treating heroin addicts andmattallyilipeople.We'resimPlyrePlechrI Sot 2 The website for the Berks Counseling Center,which proposing to them which hal theta has sitiM relocated,denctibei its activities: not too long ago,replace theta with our own Out n is to provide counseling and facility.And,yen know,doers were no problems supportive serVises to enable individuals and when Baks Counseling Ce ter va sthcre that i m families to achieve a healthy and more aware of They treated the same kind of people productive lifestyle we treatThey were there for a long time. bescriptions In 1999, Pennsylvania adopted 53 PA. CONS.SeTAT, Our purpose is-to eller addiction and mental ANN. 10621, a zoning sten* regnlaring locations of health out patient treetnietat,Mae management, stIPPortive ,fid housing,Servicestatend methadone treatment facilities. The statute provides indMduals, eat4IW, fatuities, adolescents that *a methadorm treatment ciiltty shall not be and children Our target population includes establishedor operated within $feet of an existing #� County residents : upon by spool public playground, ftub Park- iia cat l ® ,,+R.91 ,, an#d/ot 05014 akieW1 w,y!/Marea,cluld"cate facility,church,meetinghouse or Oaks Counseling Center OICC) places a Other actual place of regularly stated religious worship emphasis on sertMg those persons, eatablished mor to the proposed methadone a treateaent who cannot iteeese neatment ehewhere due tO faculty,'" unless, "by majority vote, the governing body financial difAcultiea We bet evetbat'eCIOnunity fel the tatadoipality in which the proposed methadone enlightemnent and Aunty strength are keytreatment facility be located votes in favor of the a mn to prevention and reduction issuance of ars occupancy permit.' 14 at¢ II*21(aX1) of drug atm, 8Vit have a Mahe We at t e gewlicelerks:Emergency Shelter int order tad f a The Lancaster Avenue property falls within the to better the population residing at tom, ambit ofthe tote.WhenNDT ulred aboutstt uouot abetter. covered by the statute,a City zoning official referred t m to three including a cemetery and a.heavy ial Berks Counseling Cater- BCCI is a private. area,all of which NDTS considered upasui`table. noreproilt corporation founded in OctOber 1971 as BerksYouth Counseling Center.» Thestatuteprovides,in full,that; by the of lTeafth. 4a ll Notwithstandhig any other provision of Division of ter and the Dept. law to the contrary and eft as pluvidedhi of Public WelfareOffiee of htlental Soaltb.- subsection(b),a metitedone treatment facility BCC has been providing ent services to shall not be established or operated within 500 the residents of neuter city leading for the past Additionally,BCC has provided feetof elating saYltoat, public playgrC+und, Public park, residential housing area, LAW 6 2016 Thomson Reuters.NO claim't ortfirlat U.S.Government Works, r New Directions ent Sendv,City of Reading,400 F.3d 2.93(2007) 19 AD.Naas 07,35 Edi P 1 ram church, meetinghouse or other methadone in the treatment, maintenance Or actual plaCt remilaily stated religious worship detoxification of peons established per to the proposed methadone 53 PA,C( STAT.ANN.§1o6n. treatment facility, The City notified NUTS that it would hold a hearing (2) The provisions of this subsection shall on January 14, 2002. Olen Cooper, the Executive apply whetherteor not an o nety Director of TS,appeared at the hea g aaad described or ceatiate of use has been issued to the or of a d t nt N])T 's history and its proposed treatment center. lie oWiterfacility for a location that is within MO feet est questi from the ( Conrail. NDTS of an existing school,public playground,public achnowledged that it had experienced some loitering and park,residential housing area child-care ity, Uttering at its West itrAiding facility.At a second bearing c harsh meetinghouse or other actual place of on February 2/3,20112,the Council heard additional public regularly stated religious worship established comments. At a March 2S, 2002 Cotmcil meeting, the Prior to the pro methadone treatment City heaid more comments and then unanimously voted against NT 's application. (b)N atw batandingsuort a inethadone treatment facility may be established and Nurs filed eompiaints with the Pennsylvania Human operated closer than 500 feet to au e:w Relations iss (" "`CIRC") and, the U.S. school, public Playground, public lam residential area, child-care R Department of Honing and Urban Delo s Office church„ aterssagho a or other actual per:of of Fair lousing and Equal Opportunity("HUD*).The PEI C r ulerly stated rebgipus wars* established dismissed 1�1DTS's is a staling prior to the pr aced adore that,"the factsof the case[did]not establish that probable facility it by ma**trate,the g na body causeeared] to credit the allegations of unlawful for the maniematity in which the proposed discritnination." NDTS and several individual plaintiffs methadone treatment facility is, to be l :teedproceeding in pseudonym filed snit in the United States votes in favor of the issuance of an occupancy District Court,for the Eastern District of Pennsylvania on permit or certificate of use for said facility at d rah 25,2004. sack a location. At least 14 delta poor to the governing body of a municipality voting On The complaint states four counts. First, NDTS alleged wbetber to apptese the issuance of an Occupancy violations of the Fourteenth Amendment guarantees of permit or certificate of use for a methadobeDue Proms and Equal Protection, stating that the treatment Citi'at a Iacatinaa that is user than Pennsylvania statute was unconstitutional on its face 500 feet to a school,public phsyground,public and as applied to the,proposed Reading facility. park,residential housing area,ch' facility, church, rtglaou or ether actual of NDTS allegedthat the statute,. both facially and as regularly stated religious worship established, applied,. violates § 504 of the Rehabilitation Act. 29 prior to the proposed methadone trearaent U.S.0 § 794, Third, NDTS alleged that the state, facility,one or more public hearings reortikg both lhcially and as applied, violates Title 1T of the the ptoposed medUuhme treatment racility Americans with Disabilities Act ("ADA"). 42 U.S.C. fir shall be held whhin the municipality # 12132. Fourth, NDTS allegod that the statute, both following public 'notice. All owners of real facially and as applied,contravenes the federal scheme PloPeat loomed within 500 feet aft proposed for regulation of methadone treatment and is therefore 'oration shall be provided written notice amid. preempted. NcEmssoughtdeclaratory and injunctive public beatings at least30 days prior to said: relief for harm resulting from the Cii ParPmtedlY public hearings occurring. army aha. Individual Plaintiff methadone This section shall not apply to a methadone treatment that is icensal by the urs, sought damages. Department of Health prior to May 15,1 .. (d)As uold in this section.the t "methadone The City moved on September 3, 2004 to dismiss treatment c ility"shall man a facility licerand individual City officials on the grounds of common by the Department of Roan to use the drug law quasi-judicial i man and qualified immunity, See E'ED,ICCI"V.P. 12(e). The District Court granted the 2016 Thomas RraderS.NO clisim lo original d .S;GovernMeni Woraa. $ "Directions Treatment Services v.City of Reacting,490 F:3d 293(20071 19, l t Cases ete,35 IUbi_R. 1, motion on°era r'17, .NDTS does not appeal this Amendment, the ADA,and the Rehabilitation Act, (2) decisien that the individual. hoe stag to make out ADA,and Rehabaitation Act:challeages,(3)that the qty The City moved for partial summary judgment with violated the Equal Protection Clause of the Fourteenth respect to the fourth count of the complaint, in which Amendment the ADA, and the Rehabilitation Act by NDTS argued on Supremacy Clause groeds that the denying NDTS a ,and(4)that the It Court statute was tempted by federal law.The District Court abused its discretion by denying the motion for class granted the motion and dismissed the fourth count on certification October 15,,2004.NDTS does not appeal this decision. *300 NDTS and the individual plaintiffs .filed the 1,Whether 53 PA.CON 1 AT.ANN.#10621 complaint as a action and Moved to cortifY the fen ny slettitetrthe ADA and the-Rehabilitation Act class on September 27, 2004, as "all in the City or Readingand its surrounding community (1) NDTS and the individual plaintiffs argue that 5 who have been,are currently,or will be at risk of being PA. CONS$TAT. ANN. 10621 facially violates the on the waiting list to receive methadone treatment and,, Equal Protection Clause of the Fourteenth Antenebnent, all olviate.delmndaht rodents of the City of Reading the ADA,and the Rehabilitation Acd.The Court and its surrounding community whir have needed,now didnotengap Ina deviled analysis ofthestatutesvaralitY need or hi the future may need methadone treatment?' under eitber Title II of the ADA or the R bllitaticnt FED.R C1V.P: 24X2)..The District Court denied Act,Rather.:the Court focused on the Equal Protection the motion without prejudice, reasoning that the COnrtinquiry.4 Howeve rr, a301 these inquiries are analytically lacked adequatniuformationtodetermine ifthe-individual plaintiffs could adequately represent the and must be aper ac cordingly: The City moved for summary judgment. NDTS fid 4 The 'Xenia Court dna analyzed the as applied a cr, tion for partial mummery judgment on their and Bial challenges t o the statute under the Equal claims against the validity of the statute. The District Promotion Clause.The Dicuict Co held that these Court granted the City's motion in its entirety and denied claims must Whute the City had asserted rational NDTS's cross-motion on A $.NDTS timely for the permit denial and in support of the appealed statute, including "substantial loitering and noise problem landl increased vehicular and poles—trian les parking, and repeated instances of patient jking.'' II, DiseusArin The District Coert then held that the Plaintiffs' claims under the ADA and Rehabilitation Act The District Court had jurisdiction under 28 D.S . could not survive summary t because 1331. We have Judaic-ion over an appeal from the "Piaintiffe must show that their khan:4 as heroin District Court's final ortiet under 28 U.S.0.§ 1291.We addicts or methadone tsars was the sole ressonfor review the grant of summary judgment de anew, Unfree the anis decision'The City concedes that this which Poe,tut v. tt�+ee . . T'r ' Co,293 F.3d 12{?' our interpretation of the ADA, need (M.Cir. ).This Court conclusively settled that the requia,os mat;. ``int a pl tilf proprietors of a 6•• methadone treatment facilityprove only that the illicit factor`Pfaff a role in have standing to relief both Own behalf the deci�ei akin that it on behalf of theirclients under both the ADA had a # s €is -eRt on the a that and '"N 6thOste thio,. Rehabilitation Att.See Atetefitet Specialists.inn Tap. P.34133,Ls$(34 19StWeithsg Miller v.aGNA hththPtah,411 F.3d 199,405-08(3d.+mac Corp47 Fad 586, (3d Cir.1995*see also Ilairdv Nose, 192 P.34462,46940(4thCir.1999) NDTS raises a myriad((issues on appeal. They argue (specifically rejecting the sole cause ten for ADA (1) that 53 PA. CONS.STAT. ANN. § 10621 facially claims). violates the Equal Protection Clause of the Fourteenth W 2018 Thomson Reuters,No cid to original U.S.GOve rare Worts. T New Directions Treatment Services v.City of Reading,490 F3d 293(200 ti A;;D Cases SST,35 NDLR P t The District Court appears to have overlooked A statute that facially discriminates against disabled that,despite the fact-that Congress has directed the intlividuals, however, fay a far different and more courts to construe the ADA and the Rehabilitation skeptical inquiry wider the ADA and Rehabilitation Act Act such that conflicting; standards do not arise, see fir or,i.., Y, ditten, 524 US. 624, fWe noted in Newman that "courts the la .Ct 2'1%, 141 L.55.2d 540 , 'the' ADA and the Rehabilitation Act are not meetly allocations of hardens of proof and persuasion urs the The language of these ttvo atatcrtory the ADA uniformly have looked for guidanceto Title provisions"regardingthe causative lid dPtice VII, 15 i p 3d at 157.TheCourt held in discrimination and adverse action is significantly tearer 1 U.S.22$,109 g Ct 192 lye at 468.Seed=504 of M5, L.Edad:268(19891,that,forridevlicases,feel Rehabilitation + ♦� " of does not mean"solely because e'f x"teL the Reh '. aitati`orn �a0.w�that �� qualified with a disability-;shall„sofety at241,Kola_1725, by reaSMS of:tear or his aisabtlay,be exeluded from Section 12132 of Title II of the ADA. provides that the participation in,hedenied the henerft'of,or be "Nub to the provisions ofthis subchapter,no qualified subjected to trisoriMinatiore by sPecifted entities- Individual with a disability 1, by reason of sum 2eC+1 7 (al hass.adder. however}: disability,be excluded from partici..:tion in or be domed. the ADA prohibits di tiiruir tion. against an the benefits of the services, programs, or activities of individual"by ofsu dila ility."42 US:C, a public entity or be sutdected to dtacrb tion hlr * 12132 a�deiedl. We *`held:in any. Web onl .” 42 U.S.C. * 12132 Ilk Statement Newnan: that this language in the ADA clearly estasiehee tuatthe“soiereason7standard tutored constitutes a general prohibition discrimination by by the Olivia Court is Inapplicable-to the ADA, publicentities,regardless of activity.7 Bay Area.441ietton whiebrainisesonty but for mutation See 60 F.3d Research and Deanne*, ate. it City or Antioch, l at 15t. 1,',3d 725,730-31 h Cir.l999 (striling down a ban on ire mess t fed i startarttzry es first; methadone ern within 50 feet ofa residential *302 both because they involve a tem stringent s Section 504 of the itatioms similarly and becausevie have an ion not to decide �t "[n]o o. g red individual with constitutional unless neonsary. See,4 } a disability ;,- shall, solely by reason of him or his Speetor Motor Sets v, McLaughlin 323 DS. 101, disabay, bas exchuled from the participation in, he 105,e5 8.0-t52,g9 Li 101(1denied the benefits of,or be subjected to discrimination 121 The .tud dif*renee equal protection under any Program or activity r e Federal frnancial'. " d t ADA un, it that,in an as a c #'ac 1 29 t3.g:C. � 794(a�; We havenoted that equal prochallenge,the Alai i the bur. �e `c a 5 theADA simply expands the ] eb0 tat hos # for prohibhticrnsagainatdi + tion into' the Ovate of of negating all conceivable rationaljustifications the allegedly discriminatory action or statute, Roord CenigesS has directed that the two ants` and Mateo of the Univ. a" et531 U.5.356, fey standards be harmonized"and we will' accm. - 367, 121 S,Ct 955, 148 I.E424. 566 whereas to analyze the twe provisions Neliffnal4 60 F.34 me out a, ADA,the p�tif?nd only at 1„57-58;s +�Innovativefl + . v. City of sh o that intentional discrimination was the butler cause moire 117 F.34 37,44(x1 Chi.1997 of The allegedlydiscriminatory action. NewmanvGIIS F fes, 60 Fid 1 , 15 (3d Cir l 6 7 The City of dies is a qui i liuendty.See A.facially discriminatory statute b;vim, on a nein-suspect42 C. 12131(1 A). elate(such as 53 PA. COI .STAT. ANN.. 10621)'i The Sixth and Ninth Circuits have considered the survive an equal protection chat,.,A Be unless it is based issue of whir a municipal ordinance prohibiting on a hate desire to harm a politically unpopular group methadone clinics within 500 feet of a resithmtu.si area or"a classification whom relationship to an asserted goal violated the general proscription contained in the ADA a so attenuated as to render the distinction z arbitrary ot and Rehabilitation Act. See MX Inc. v City irrational." City o, aebutmtaCleburne Living cenrer,, of Covington. 291 F.3d 326, 342 (6th Cir Bay 473 US.432,446,105 S.Ct.3249,57 L.E4.24 313(1985). 179 F.3d at 737, Both Courts concluded that " , 2016 Trantion Reuters,No of im to original U. sGovernment Works. £1 New Directions Treatment Reivices v.City of Reading,490 F 3d 293(200 t9 A.D.Cases 587. 5 NDLR P 1 the ordinances were "facially discriminatory laws" and; law. See id at 734-35. U.B. Department of Jug therefore "pre ntfed)per se violations of§12132."Ray regulations require that would--be plainflffs request Area, 179 F.34 at 737;see MX GS0up,2931x`.34 at 342.s reasonable niodifiaatiri s to avoid discrimination unless the modification *303 would fundamentally alter the One8 District Conn struckanordinance 'rte, activity, ordinance, or statute. C.F.R. fMet[ ®: 53 down Sr�k .Ate. 35.1 b 1). H ver,where the"statute disates f10 1. {t r- Marc s against qualified individuals on its f rather than in its All, !115 523 {15.1 c1 } Tit application"the applicable regulationinterpreting Title Cone rational that a aatate that facially singled II,, which only requires 'reasonable accommodation, out methadone c imposed a disparate impact makes little tense. lay Area, 179 F3d at 734. The on methadone users Although we agree with the only way to alter a facially discriminatory ordinance Sixth and t fundi Circuits that such statutes are is to remove the discriminating language. The Antioch monody analyzed as finial violations of the ADA ordinance could only have been"rendered facially neutral and Rehabilitadon Act,we IleVettheiCOS concur with by expanding the class of entities that may not operate the Smith Beech.Court's ultimate conclusion. The within 500 feet of a residential neighborhood to include District court re*. the argument that a Publicall clinics at which metrical services are provided, or hearing requitement Wa.a sal to the local by striking the reference to methadone clinics entirely," zoning Id at 3. . The*nth Bart Court awl, ioNdics, modification would f mda entaiy alter gypthat there was no nort-discriminauiry tire zoning ordinance, the former by expearmg reason to differentiate methadonetreatment centers from other `Madan nt c etatera Id covereda , said the latter by TheCircuit confronted many of the issw rendering the ordinance a nullity.? Therefore, the reasonable modifictionstest:could.notapplytz a facially presented in this case When the Bay Area Addidion disaiminalory ordinance. See .44at 735 (holding that Research and Treatment,Ian.("MART")and Califerate, "facially discriminatory laws prrecnt per se violations of Detoxification Programs, Ina ("CDP")tried to relocate §121321„ their methadone club to the City of Antioch,California. Bay'tree' 179 Pid'Ar 771.BAART had hem ePerathlg The Ninth quit noted that this determination does a methadone clinic near the courthouse in Pittsburg, not god the ... ,however,.as both statutes withhold for 13 years.MART and CPP received notice protection from any"nd"ividual whoposes a sivmcant from Antioch that the props =..location could he used for risk to the health or safety of others that cannot be a methadone clinic under Antioch's zoningplan.However, ameliorated by means of a reasonable modification." the Antioch City Cr mcil enacted anurgency ordinance let The Supra Court developed the significant risk banning methadone s within feet of residential test itn setwalBoard of Maw County v. Arm a case thereby barring use of the Preliasedsite. RAART involving a teacher who alleged a violation of§ 504 of and other m" alleged that Antioch hal violated the Rehabilitation Act atter she was discharged because both Title It of the ADA and§5144 of the Rehabilitation she had an active case of tuberculosis. 480 us, 273, Act. The District Court denied Bay Area's motion for a 276,107 B,Ct, 1123,04.LI?d.2d 307(1987)..The supreme Preihnimary injunction enjoining the ordinance' "ART Court hell that°fa)person who poses a significant risk appealed.See id of communicating an infectious disease to others in the workplace will not be otherwise qualified for bis or her After disposing of issues not contested in the instant case, job if reasonable accommodation will not eliminatethat. the Ninth C reeit analyzed whether the District C curt risk."IA at 287n.16,1078.Ct.I 1 3.TheCoutt essentially load alaiise l i on hi atdi: ' bon by denying„ histestRehabilitation not have a Acts definition of a disabled person qualified to receive§ hIgelihood of success on the mita. d :at 733. The 504 s protection.The Court noted that this test effectuates Ninth Circuit held that the District Court had abused s1 504`s ogoal of protecting handicapped individuals titeeretthh by app13ett an eittirierinalePlstandard front deprivations hued on pospidim. stereotypes, or and remanded the case. letThe Ninth Circuit first unfounded fear,wridegiving appropriateweight to such held that the Distriet Court erred by dying the lettimme concerns ., as avoiding exposing others to "reasonable modification*test to afacially discriminatory nAw o2.016-Thomson netters,to Claim to original l U.S.,Gomnie nt: s. 9 New farections Treatment gerveses v.City of Reading,490 F.3d 293( 7) 10 AD.Cases 687,85 NDLR P 1 . ,®Meant health and safety risks."kL at 287, 107 S.Ct. or housing accommodations,The ordinancel noted the 1123: number of all such facilities to one facility for every 20,000 persons in the city.This amendment prevented M Although the Ninth Circ*. disclaimed any elusion Group from locating a facility in the city. id. at 330-31. about the outcome of this it icy of the ultimate merits flovasver,the zoning administrator testified at ttial that it of the claim, it repeatedly'. that Arline was was his ir a ion from thecity solicitor that amendments designed to 'ensure C 1 that decisions are not made on permitting individual clinics would be considered on a I the was of'the prejudiced attitudes or the ignorance cased-case basis. 14 at. 331. MX Group brought suit of others,' " and that aftlitis is particularly important pursuant to time AICA and Rehabilitation fit..TheDistriet because, as with individuals with contagious diseases, Court held that Covington's denial of the permit and the Viva aspects of a haedicap give rise to the same level subsequently enacted amendment violated both feral of public fear and misapprehension,' as the challenges statutes..4 at 328. facing recovering drug addicts." Bay Arm 17,F.34 at 736(internal citatims omitted)(eningArline, 480 US Covington alleged that the District Court had committed at 284, 107 &Ct. 1123),), The Ninth Circuit held that, varies errors of lair,of which only one is relevant here in order Pot` aMet•±.6one clinic to fail the sir„int —whether the District Court correctly concluded that risk test,it must present Severe and likely harms to the MX Group was not required to request a reasonable community that are dlree tly associated with the operation modification.Id at 334.The Sixth amok.cited.may Are a of the methadone clinic.” Id at 736-37. Such alleged approvingly and rejected the"reasonable auhumutedation harms must be supported by evil and"May,include argument because it is inapplizabk inasmuch as the a reasonable likelihood ofa signifiea nt increase in crime." ordinance at issue is facially discriminatory." IS The hi The Ndrtth Circuit noted that isourtsaltould bemindful Sixth Circuit nom that"the district court,found that of the ADA and ltehabilitmion Act's goals of et the blanket prohibition of all methadone clinics clink:81mm the discrinsinstion against Individuals with disabilities and: entire city is discrhnhxatory on its face,"agreed with th protecting those individuals "from deprivations besed conclusion,and also agreed with the Ninthmit"that on prejudice,stereotypes,or unfbwtded fear.* *304 hi it would make little sense under these circ stances to at 737 ( , .*s'e 1.1.S. at 287, 107 s,a 1123). rtquitentititiff reqrhe Plaintiff to seekan,ac oda ,when the only Therefore, "it is not enough that individuals pose a accommodation,a fundamental change to the ordinance, hypothetical orpres edri "--tile evidence must reflect could not be sid d reasonable."14 at 335. a risk that is significant and harm that is mus.t Although Day Area and MI Group dealt with outright Three years later, the Sixth Circuit invoked Bay Area bans, we believe that the reasoning of those cases and *ached a similar result in t Grow r, City ef' is equally applicable here. The Pennsylvania statute Covington 293 F 3d 326, (6th C ). MX imposes a ban on the establishment of methadone clinics Group is a for-profit operator of methadone amiss.Id within 500 feet of many structures, inn ding schools, at 328-29. In 1997, the process of locating churches,and residential housing developments.ts. See 53 a suitable site for a methadone in Covington, PA.colissTAT.ANN.§10621(1X1).The Pesmsylvenla. Kentucky.MX Cirrnmw,leeted a location.,, CovingtonN law differs from those hi Bay Area and.1 XGag)in that zoning administrator issued them a pe it.Public outcry the"the governing body for the municipality in which the spurred the Covington Board of Adjustment to overrule proposed methadone treatment facility is to be located" the issuance of the permit. MX Group located another can WItiVa the bait if,and only if,it approves the sunt suitable sde,PromPting the citY solicitor to inform the of aby majority vote.53 PA.CONS.STAT.ANN. zoning administrator that methadone clinics were not a t 1(b). Hower, this ability of ttlOoktPabtiO8 to permitted use anywhere in the city. Shortly thereafter, waive the statutory ban in no way alters the fact that Covington adopted anamendment to the zoning code 53 PA. CGNS.STAT.ANN. § 10621 facially singles out expanding the definition of"addiction treatment facility" methadone cfmics,and thereby methadone patients, for in the zoning code to include any place whore primary different treatment,thereby rendering the statute facially function is to care for cher**dependent.This term diseriminatory. had applied only to programs that provided overnight WESTI.A. et 2016 Thomson Retituts.No claim to od s c.t 11.$ GOVVialittant Wim. W New Directions Treatment Services v.City ng,490 Fitt 293( 7 i9 AD.Cases:i:'r.3 NOLA Pi *305 We agree with the Sixth and Ninth Circuits that 161 F.3d 292, 295-96 (5th Cir.19910, depression, see a law that singles out methal clinics for different EEOC v ,,Inc,110 F.3d 135,143-45(1st Ck.1997),. zoning proceduresis facially discriminatory under the diabetes, see wear v. Hawke Celaneve Com, 101 F.3d ADA and the Rehabilitation Act We also agree that it 1090,1091(5thCir.1 ),violeatempl P v is inappropriate to apply the 'reasonable wit,,,' r Co:0.of Cook County. 117 F341351,353(7th C ir.1997}, test to facially disc atony laws. See MX Cow, 293or epileptics whyjobs involve operating potentially. 1.3r1 at 344-45; SO Area 179 F,34 at 734-35. The dangerous machinery.See Donahue.224 Fld at 231. only way to'modify a fecially discriminatory stature is to remove.the discriminaterylanguage.However,amending The Supreme Court emphasized in Oragdan v. Abbott 53 PA. CONS:STAT. ANN. § 10621 to remove the that the ,nasi€a w.;st risk test requires rigorous objective facial d tion against methadone clinics would inquiry. 524 1.3.S.624,626, 118 S Ct 2196, 141 Lpd.24 “ftuidatnentally aitet'''the statute,Say Area 179 Fid at 540(1998),Inliregrion.a dentist refused to fill a cavity for 734 an asymptontasdc AIDS petient. See-id The Court held that: awing coneluded that$3 PAF CO RSTAT.ANN., § 10621 is family diectitninetory and that the reasonable The c e, or ramexistenee, hroMication test does not apply, We proceed to inquire, of a significant risk must be whether I TS's clients pose a significant risk. This, determined from the standpoint the inquiry is alsoreferred to as the "directthreat" defense who rte' m cases arising under Title I of the ADA. fengekvi v. treatment Or atoOMMotiation, and 524 U.S. 624,x,118&Ct. 2196,141 LP-did the risk of assessment must be 540(1''. (Stevens,.J.,concurring).The Court's analysis, based on medical or other objective of the Rehabs itation Act in Alike reinalaa the galling evidence.., As a health care Precedent.See Ariine.480 U.S.at 2-/S-79,1 'S.Ct.112-3. I . `anal,petitioner had the duty The Court concluded that contagious diseimes soh as to assess the risk of infection tuberculosis fit within the Rehabilitation Aces dei'i citsion based on the objective, scientific of " r l wed," and then addressed the question of information available to him and whether the plaintiff was otherwise qualified for her job as cwt in Ida prof sSiOn Nis belief an elementary school teacher.Id at 279,107 S.Ct. 1123. that a signifimtnt risk Witted,even. The Court held thatla]person who poses a significant if maintained *306 in good t'aitit risk of con nunicating an infectious diseases to others in would not relieve him of liability. i tororltpl will net be d for or her g at 649, 1.18 S.Ct, 2196. Accordingly, we cannot jam �if atioe will not etim that base owu decisionon the subjective judgments of the risk.'I et 28711# lt 107 C . 112 .The Court adopted poor& purportedly at risk, the iteading resident; City the language prePeeedbentielle curiae the,Alnerieell eau or,even Pennsylvania citizens, w ns,but must loto Media A tion,stating the significant risk inquiryobjer i. in the�of any dangersposed should include cideration waf four factors:the nature of methadone clinics and patients.The purported risk must the risk,the duration of the rick,the of the risk* be su.: tiait notspeculative or remote. See ki at 649,. and the probability that the pionnitial harems will w UT.: is ct 119 .ctBeatuite few ,if any.activitiesin life are pcinslialeiv' Carps., 224x.31 , 231 (3d risk free,Arline and theAIDA do not ask whether a risk Cir: www (citingU.S.at! _}_ 107S,Ct. 1123 but whther Iris sifnuficant.n.The Plaintiffss.are not, The Ari6te Court limited its decision to oases where a required to show that they pose tea risk at all.9 See irk sig iMcaut risk is alleged on the basis of an infectious disease. See 480 U.S.at 289,107 SCS 1123,Tire ADA 9 Although the concept of significant risk has been and subsequent eases expanded the significant tisk test much MOM 1uib' considered in the Title I+gout to cases where a disability created a significant risk to courts have not come to an agreement in either Tide the health or safay of others, such as attention deficit 1 cr Title II cases as to wherethe burden lies. e hyperactivedisorder, r Neuro :tit 'r.':Co, courts have heed ithat w heat is a segrw:�t tisk is a factor in.whether aplaintsttis ed"within W201S Thomsbn Rauters,1*claim to original i .S,Govarnrnent Worcs. _ New Directions TreatmentServicesCity of Reading,490 F.9d (nal la A.D.C; 6d7,36Not.RP1 .. the meaning of the statute. These courts conclude methadone patients pose a significant risk.Representative that the plaintiff bears the burden of demonstrating Plats; the bills principal sponsor, stated that the that they do not pose a significant risk,,See Mots v. legislaticm would protect "chic re a front the high mime Ch es World Ott,.1t..213 F.3d 209, rates associated with heroin addicts,"tbet,"Io)n oerage 213 f. Cir: )EEOC v. d o /se, 110 F.3dheroin addicts before treatment commit a etinwon 13 ,t4 f est Cr.1 .Other courts view"direct threat"as a ative defense;These courts average 200 days oft year,*and than jealven after that the burden is on the-d ant to that the; months of methadone treatment,they still average once a plaudit at signifieaut rim, note utouth committing 4307 a crimp.,Representative Plates that theprovision appears in a offered no source for this.statistic; find it difficult of Title t entitled"Defense,"Sta Nunes is Wal-Mart to Plage txtueh wit on.this unsupported statistic given r„res, Inc., 164 E34 1243,1247-48 Cu 1 °s unm`ebutted testimony tut oto NUTS facilities ESOC v.4W See.Investigations,La.55 F.341 1274 had experienced no criminal incidents and the extremely 12g3-85(7th CI 199,3)„ positive mets of the National Institute on Drug Abuse Webave prevy reservedjudgmentortttcisi ue and the Offiee of National Drug Control Poli, In wnen it was"unnecessary to decide this question," addition,the statement of Representative Santini betraYs and do sea spin in this case as it would not affect the generalized prejudbm and fear warned against.by the our holding ►:,,:,, x a Centelideted ^°°' Corp., Arline Court 224;F.3d 226,2*( The record contains ample evidence that i "I'S`s clots, It is unfortunate that we have to, and methadone patients as a class, do not pose a have methadone treatment facilities caret risk. Neither the City nor its amicus, the at all, but to locate them ht areas Commonwealth, have offered any evidence to they that are residential or close to where contrary. The City refers to the &position of Glen Young People might congregate or Cooper, the Rtecutive motor of )T , hi which he the cotrea txutsity might meet and tedthat err 30 percent of the clinic's patients gather is a dem mistake, and would test positive for illegal drugs.However,NUTS also these facilities, in my opinion, do submitted the results of drug screens at its West Reading not benefit anyone but the heroin and Bethclinics showing that milypatientsenrolle addict, and they should be located for less than six months test positive at the 30 percent rate, either in.a community that welcomes whereas .;than six percent of patio nts enrolled for mote thus kind of facility or out in an than six months test Positive for illegal drugs. area aurae from people who have lit themselves clean and free of More importantly, the record demonstrates no link drugs and should not be confronted between methadone clinics and increased crime, Cooper by this kind of a pollution in their- testified that there had been no criminal incidents at etaautity, NDTS's West Reading facility. The Commonwealth offered no evidence to support its contrary assertion On hand,we have before us utroverted testimony that there is a"frequent rn"between methadone that NDTS's methadone treatment facilities have not clinics and criminal activity. In depositions,; City experienced any criminal incidents or other potentially Council members oSpWantons about heavy traffic, dangerous behavior.We have the objective viewpoints of loitering, noise pollution, i g,double perkily, and the National Institute on Drug Abut and the Office of jaywalking. flower, the City offered no evidence to National Drug Control Policy,brought to our attention support an association between these concernsand by miens Curiae.the Pennsylvania Coity Providers methadone clinics. Even if such Oraineetirals existed,we Association. On. the other hand, neither tete City nor are skeptical that they wrxuld qualify as the substantial amicus,the Commonwealth of Pennsylvania,offered any harms contemplated by the*ant and&splint Courts evidence in the proteedings below or in the statute's legislative history demonstrating that methadone patients The brief legislative history of 53 PA. C©NS.°TAT. pose a significant risk. The Armee Court speed/ea-11Y ANTI. f 10621 provides no further mddence that recognized that the Rehabilitation Act was int to 0)2016 Thornton Reuters.No claim to original U.S..Government Works. 12 New Directions Treatment rvic City of Reading,490 F.3d 203(2007) 19 At.Cas '':7,3S NCO P i Protect disabled individuals"gym deprivations based on Plaintiffs do not argue this issue on appeal, it is prejudice, stereotypes, or unfounded " 480 ti , ai waived. 287, 107 S.Ctr 1123;see also bznovutive Health, 117 F.3d at 49. The speculative, hypothetical, and unsupported statements in 53 PA. CONS$TAT. AN § 10621's 2.mer the Individual plaintiffs have standh4.to legislative history and record ord of the Reams City >p e+gtst ADA and Actachalltmges Council meeting do not suffice to create a triable issue of al The Pennsylvania statute is facially invalid under fact as to whether TS's tents%Or methadone Patienats the ADA and the Rehabilitation Act Because of that generally,pose a alp-Meant tib the indivichtal plaintiffs'standing has no impar on the issue efinjunctive relied,However,the individual plaintiffs We have no doubt that some methadone patients are also assert claims to damages under the ADA and the inclined to criminal or otherwise (Ian-germsbehavior' Rehabilitation.Act, The District Court roust reaeh the However,in the words of the Arline Court issue of the individual Plaintiffs' standing in order to The fact that r s who resolve their claims for damage&l 1 have contagious dse s may pose a serious threat to others under I t We recognized in k Speefaiint, fats lk certain circumstances does not rownihip of Hampton that methadone clinic justify excluding from the coverage providers may assert both direct sang based. of the Act ail persons with actual an td Own curie and associational standing or perceived contagious ceases. based on al tines to the disabled individuals they Such exclusion would mean that, serve.See 411 F.34 399,407(3d C1r.20G3),A third- those b*those accused of being contagious P may only Wert claim traced on the*ales would therrity' of others to the extent that those who maned the direct balmwould themselves have standing to to have lir of evidenceand a sue. See lot v Washington ate Adaen fot comet, 432 US. 333, 343, 97 S,CL 2434, 53; determination made to whether LEd.2d 333 0977).Third-party standing is y they were "otherwise qualified." relied to facial challenges, in which a sin part/ Rather, they would be vulnerable asserts that a law is invalid not only as applied to toi ' ation on the basis of theme,but as applied to all parties that might conw myt olo --p ig' the tyrt of before the dourt. See Broaditek v. Oidtkoata. 413 inn ss t to prevant. U.S. 691, 61O41 91 s.Ct. 4 , 37 1..11421 830 (1973)("Embedded in the traditional rules ing 480 . at 285,107;S.Ct.1123. constitutional adjudication is the principle that a perlOn to whom a statute may constitutionally be e will reverse the order of the District Court and remand applied will not be heard to challenge that statute with ihetthetioas that it grant ND-TVs motion for partial on the that it may conceivably be applied summary ju t because 53 PA.CONS.SfAT.ANN. unconstitutionally to others,in ether Sitliati011S not Mal faehilly faciallyviolates the ADA and the Rehabilitation before the Court.A closely related prbisiple is that .Act..We need not reach h the question of whether 53 PA. constitutiOnal rights are personal and may not be COist&STA .ANN,§ 10621 fachilly violates the Equal asserted vi y," (Internal eitadous omitted* Protection Clause of the Fourteenth Amendment,as Om int a tJ g 17,31,-1 'g t 514, 4 L.BeL2d 524(064 Asa see Richard H. Fallon,:. statute fails the less stringent tests required by the;ADS:. Av-Apptied Facia ty and the Rehabilitation *308 Act. 4 Suroatg,113HARN.1...1tBV,..13 t,13 4( ) (Minting the diffewswm between facial challenges t#fand tbsd-party standing). Plaintiffs berme the Irict Court tb §504 of the Rehabilitation Act and Title II of the ADA "Theme esr ry isullvidlual n 1 harmed by 53 PA. CONS.STAT. ANN,§ 10621. As the `applicationof the Pennsylvania is preempt notnecessanly entitled to damages by virtue of wilri!TS's successful demonstration that the statute W 0 2016 Thomson Reuters. leo claim to orlva, .a U.S.GovernMent Works. New Directions Treatment Sonde v.City of Reading,490 F.3d 29344073 19 Aad.oases 687,3h NDLR facially violates die ADA and Rehaliditation Act. action drug free. See td, (quoting II.R.REP, NO. 101- Individual 01-Ind idual plaintiffs'may have suffered a harm 596, at 62 (1 9901 U,.. Code Cong. A Admin Ne vs because the ease or timeliness of their methadone 1990, pp 565, 570-371 (Conl.Rep.)). This provision treatment was compromised by operation of the makes its first appearance at 42 U.S.C. § 12114(a), invalid statute.However,if they are current users where it appliet to Subchapter I of the ADA,concerning orf two drags,their statutory rights under the employment.However,this Previsien reannears verbattiatt ADA and Rehabilitation Act have not been in "Subchapter IV: Miscellaneous Provisi ons," which invaded—indeed, outwt use of illegal drugs makes 1t applicable to the entire ADA. This perplexing j are entirety exempted from. the audita the Mute the allegedlydi i tory action draftsmanship, which to make of was taken on the basis of that illegal drug use the provision;in.the employment section,mandates that See 42 r.S: .§IU:IO(a); r D.S.C. C we apply this provision to Subchapter f, 42U, . . § (h.Neither NI:rib associational standing nor,its 12210W—even tough it is uttet how the provision facial challenge can mane damages for individual should apply outside the employment context. plaintiffs when they themselves have not mirrored a violation of ter rights and lack stan First, H'I'S contends that the appropriate time frame Therefore,the District Court sh€mld consider the for this inquiry is 2004,when it filed the complaint in the individual plaintiff standing under the ADA District Court,shriller to a traditional standing analysis. and RehabilitationAct and, the District Court The City responds that the statutory text speoi les that the fleas that some of the individual plaintiffs lack relevant time frame is when the covered entity ten*its standing,itshould proceed to their as-applied equal " allegedly .. atonyn. Weagree with the City llintentierichAtiente, inasmuch as both the ADA and Rehabilitation Act both The fact that some plaintiffs were n rt harmed. uredo the ADA and Rehabilitation Act does state that an indilantrat 000.3 not enjoy these statutory not neceelarily support the facial validity of protections if"currently engaging in the illegal use of the Pennsylvaniastatute. If the Pennsylvania drugs,whew the coed entity act on the basis of such General Assembly luirl passed a statute regulating ."42 U.S. .§ 12210(4 see 29U.S.0§ 2t})(C(i) only curet illegal drag amts. then the ADA ( and RehabWWlitatigu Mt could not he effended if a covered entity took action based on that Less clear is the question of whether the City"acted on drug use. However, the record makes dear that the basis of"the individual plaintiffs'addictions. Ste 42 methadone dies serve a combination of current U.R.C. § 12 10(a); 29 U.S.C. ¢70$(2OXCXi). The City and rehab ted drug users, asserts,that it acted an the basis of non-discriminatory The parties do not dispute that recovering heroin addicts reasons,such as traffic and loitering.NDTS contends that arc presumptively"gualrf" peraoits under titeALIA and the City acted on the basis of general fear and proludiets Rehabilitation Act. See 42 U.S.C.§ 12131; 29 U.S.C.§ ainociated with recovering heroin addicts, NDTS wants . However, both the ADA and the Rehabilitation to have its cue andoat it too.It claims that the City's Act contain *309 carve-outs stating that individuals are allegisdlydiscriminatorymotive does not ct ute action not deemed"qualifier if they are"currently engaging in on the basis of a drug addiction, but action against the WWI use uf druSewheu the"ooh entity[the MY) recovering addicts.fawn e,much of-the evidence is the acts on the basis of"the plaintiffs ttrog addictiOA.See 42 record to whyNDTS refers illustratesthe Coq's concern SSC.§12210(a 29 t t s,t Q( Flaintiffe are about the possibility of NflTS's clients relapsingintodrug not considered"qu "under the statutes if they have use. used illegal drugs "recently ertroth so that continuing use is a real ongoing i problem." Brown v. Lucky Slum The ADA and Rehabilitation.Ara specifically provide t ,t Lne F.3d 1182, 1199(9th Cir.; I) statutory a person.wile-haus completed a.supervised rehabilitation li exception is an add fit for the Whitt ease.It Was intended program or is currently participating in such a program to ensure that employers could discharge employees who and"is no lor}ger gates in drug use shell be deemed were actually under the influence while at work and a qualified individual.42 U.S.C.if 12210(a)and(01);29 that employers could not discharge employees who were USX.C. ' 5 f : and ; . The Ninth Circuit recovering addicts but were,at the time of any personnel has observed that"(mime partictiipation in a rehabilitation 2046 Thomson Reuters.lel claim to original U.S.Government Werke.. 14. New Directions'freeform*Services.v,City of Reading,490 p.3d 293 ) 19AD.Cai;7,351'bIAP1 program is not enough," and that covered entities mare aehicile "is distinguishable because unlike IS)*the entitled to seek reasonable assurances that no illegal use Appellants[in Cleburne]hadpresented evidence,that the of drugs is occut'1 ." 246 F:3d at 11°":, Thi decision to deny the special use permit for homes for the state toxy gualifiesttlans:weigb ageing thelegit of deeming mentally retarded was based on mere negative attitudes the City to have acted solely on the basis of the plaintiff's' and fear that was Unsubstantiated by factors which am status as recovering mcts-even if we apt k TW`s' properly cognizable."NDTSadduced evidence of a 1 version of the City's motivation. similar character,The records of the City Council ergs contain numerous statements by both publliiopartit ipants *310 The Second Circuit has recognized that the and council members expressing opposition based on question of whether drug use is effectively ongoing or what can only be characterized as generalized prejudice, a serious problem is a fact bound inquiry best left to st stypes,andftar of NI?T5's clientele.12 the districtcourts. Tostasa v Metro-North Commuter 1 Lit Ox, 951 F.24 511. 518- Z"4 C '.19 1) This 12 The records of the three i j Council hustings are determination requires detailed knowledge of-methadonereplete with statements by participants illustrating the treatment protevols to assess whether a MU/Catty enrolled atmosphere of prejudice and fear that permeated the methadone patient who relapsed, for le. three proceedings.Participants stated that the new NnTS months ago,is likely to relapse again The parties do not facility would "compromise the quality of life for ditionte that oneplaineft,Coe,has been drug,fine far some children and families residing in this area,* would time.liowcver,three other plaintiffs,Joe,I oe,and lam, "this stable,tesidential.ar "would"tom had been drug free for only three months prior to the dem the quality of life opportunities for families permit denial td We will remand with instructions that residing in the arca,"would"break Ethel community the District Court closely co.nsaler whether the individual spirit," wed "have a detrimental effect on the plaintit use pond a "rel ongoing problem.* family mint ofthe neighbotheedcommunety,"would Brown,246 RV 11 fig, “have a detrimental effect on the neighborhood and community i es,” and might "require additional police patrol:" One pardcipant opined dui"the community would not be able to face the 3.Whether the,City the Fourteenth additional stress brought by the treatment facility." Amendment's gwarantee at Equal Protectiou Another participant t obs vend that [TR*overaticonmiunity opposes Ilielocation of ]5) The District Court shotdd also consider NDTS's as the clinic on Lancaster Avenue,The eamum applied ehnllenge elit5at the s,ual Protection Clause of believes that the locatiOn oldie cil in this area the Fourteenth Amendment if it finds that any of the will destroy neighborhood and family standards. individual plaintiffs lack standing under the ADA and Erlic cc mitunity wants the]Connote to recognise. the Rehabilitation Act.NDTSalleges the City improperly the eect this clinicw'►11 have on their community administered 53 PA.. COS« TA`.. ANN. * 10621 as d pml Y vanes_[1]f-i ' hospitals-will applied to their alt icatitni for the Re�€g net the cynic as a tenant, themedical irpe The City replies that NDTS to show that pj profession may not believethis type of was a motivating facer and,hithe alternative,that the Anattairney reeresenting" of tbe Millmont City met its burden of demmistrathig a.Iegitimate,non- aim,"engaged in an exemded colloquy with Olen thrierintinatory purpose. Cooper,11 tine lir of1413TS,etthe initial CtyCO'o Council hearing on January 14,2002: The pa/1 agree that classifications based on disabled Attorney questions (Q): What do yen tell individuals, such, as recovering heroin addicts, are the neighborhood that you're ming in a reviewed under the rational basis test which requites a community that you didn't investigate, the rational means to-serve a leghilmete and, City of ClaUnte neighbors you didn't are, the resit its whose v Cleburne 4,ivbmOr., 473 US. 4* 450, 105 S.Ct« property values may or maynot be 3249, 87 L.F.4.24 313 (1985)(holding that the decision What do you give them to suggest in some to i a " to a home for the"mentally retarded" way their kids aren't going to be their fwd the rationalbasis test). Yet the Cityasserts that that tot going affected,How do you Maier tthem? `.Y 6 2016. Thomson Rer .No claim toengine"1.),S.Government Works. 1:5 New Directions Treatment Services v.City of Reading,490 F 3d 293(2007) LL , w ,CS -` ,35 IIDLRP Cooper answers( :EXPlain what?' Qt Whether or not they will or will not he Appellees showed that the City's ate,their property values,if their kids will alleged cnntern about a.. droP be involved with heroin addicts or -addicts or in Property values was irrational methadone addicts. since ARC [the operator of the A;I don't offer eh explanation I don't otte that treatment centers] bad operated in times been animus.Its never been an i w,:Do the neighborhood for wtme years you have any evidence that that's atti-issue? and adduced evidence indicating Q: I suspect ihat common arrise wouldtell that property values would not anybody that they're not going to Purchase a bee adversely affecied, by the: house next to a methadone,clinic with heroin Cent presence. Appelleo also addicts. established that the 4 y's alleged A: rin Whin about children being involved. concern with orderly You raised the question about childrenbeing. involved.Do you have any evi Do you was irrational ARC was have an example already Wonted in the North Q That chAttten will he—cluldren will bewithin Side Section..Additionatly,aPPalees 509 feet demonstrated that ARC facilities k That wasn't my question, My 'on was, met lot size and other zoning Do you have evidence that that is a typical requirements and that the City's P1'0101 in relationship to methadone treatment alleged cords about density were faeilithi? addressed. by defray ordinances Q:I have a.daughter,414 I don't went ler near with which ARC had a metlademe elinit, And nattily, here as in ClebtOK A:So,you don't have any evider►ce: k appellees demonstrated that the City Q:I de have personal evidence:I dont want my l9-yea ld daughterat a methadone clinic or took its ally=justified action within gittfeetoramethadone ' `_-glean help in an atmosphere charged with it,And ifl lived next to there,I wwtild move, hosts towards a minority lir A Well,you have any reap=to believe,; These proof$, and their lack of any statistieal reason to believe,that that would contradiction by the City,head us to be a prolikm. You just have a gut footles that conclude that, in fight of Cleburne, you.wouldn't like it~ class min *ups-appellees are I'cl use common 14011C likely to prevail on the merits oftheir CitY Council member Waltman staixii'that this Equal Protection claim:; method of trec don addicti ,"andthat "the aty should he considering a Pace' substation /d (likening the reorwering&kaoline claim to that made forthisarryarather than amothadonecliniethatwill its a w )., compromise the irtability of the c n" ' sty."'City Council member Kerne claimed ase;t"the potential *312, The City claims that it met its burden of showing damage a clinic amiddo that would break the, legitimate purposes motivating its decision.The District communiW '" COurt observed that the City Council expressed concerns *311 We have suggested,albeit in a different context, about heavy trate loitering,noise pollution, littering,. that a factually similar would have a;likelihood of double parking„ and jaywalking, Yet we consider it success. See&Owns v. CO of ftesbiggit 811 11.2d 171, inexplicable that the City failed to offer any evidence 185 (3d Cir 1913' . We considered in ,Sultan a request to supportconcern& Indeed, the Dim Court by =cycling alt s fear a Preliritinarf injunction fiats to lave relied can tens of the Cowwil. requiring isauctlee of a permit for the operation of a members which are not supported by the records of treatment center fat RICOhOliCS. hi The Suli'iwm Court the three Council meetings meeting& Records of these obremed.thar meetings contain no reference by the Council members to jaywalking, loitering,, litterinS, double parking, at increased traffic..The only recce appears in.CooPerta W 206 Thomson Reuters.No cis=to orkjinal ti .Goverment Works, 416 Now Directions Treatment Servkne v..City of Reading,490 F:3d 29 (moil) response to Gouncll Member Figuer+oa.'s general question eertification.The District Courts only stated reason was about "problemrt(sj with citizens of West Reading," to that NUTS had failed to "providtej cedant with which herespended;that boli.tering and littering problems the information titon ry for Defendant to determine at its West Reading facility were minimal.The concern, w the namedrepresentatives can represent the raised by Council member Reed in her deposition about class adequately."lis not clear what further information double parking does not account for NDTS%statement is required,as tilDTS responded to all the Ci' 'a reclaims that the new flicility would have 20 off-street parking for information onthe named plaintiffs,including their space& identities.IS The able District Judge also failed to a.telY l3 meT istzict hurt grartte t the individual plaintif ' consider Whetl x any of these legitimate concernsminion to proceed in pseudonym on the same day differentiated the proposed lS faeility from permitted it denied awn motion for elass certification The uses of Lancaster Avenue site. See Cleburne, » Court mired only that the is 473 U.S. at 448, 105 M. 324 (holding that the City ccelleel receive iite.iedividual ' 'IWI names, of Cleburne could not treat the facility for the mentally which was dulydone. retarded differently"unless Lit]would threaten legitimate *313 The named plaintiffs bear the harden ofshowing interests of the city in a way that other Permitted uses such as bo g how d h � dam eligibility and tailed to file a£ft `i spc€ • t' reed,. the District Court should consider support of their mo for elass certification. l�oe�e�rer whether arced tet par spply egaally to theDistriet pnrt'� denial a# rtiffcttiir dies when deciding the forted not provide sufficient information for us to engage permitted uses legitiniate purposes pts-te cn nal. t The I caster in ""mean1" ap hate r+ a have had tl t Avenue site,�zoned commercial highway and therefore [ate reprntation depends on two Baton: (a) t and its permitted uses Wit% the pl�ff's attorney-must he qualified.experienced* includes among distributors, rrvetaio^ stores; h carp tallse y able tr►conduct the propod litigation,and(b) the pl " must not have interests antagonistic to thaw facilities,mom,nighteinba andminiatme golf courses. tithe "Wetzelv.Liberty Co„,508 1.2d 239, The prior occupant,the s Co Center,treated 247(3d tr.197$). recovering drug and alcohol addictsas well es mentally ill' InnientS.Thecontainsno evidenceofcomplaints The City does not dispute that.Plaintiffs' counsel are from nearby residents.The District Court should focus able to handle the lid. tion, supporting the conchae). n; early on whether there is any nal realest that, the clan would be adequately res sited. See differentiate methadone treatment cent,such as those Gralry a Amalgamated memo+rg Textile Worken Una; operated by NUTS.from non-methadone drug treatment 828 F2 123, 129 (3d Cir.1� (notingthat"the • s as the .Berks Co li R Center. ett., assurance of vigorous prosecution** by class counsel is A reasonable a fact could conclude,on the present a 'significant factor" in the Rule 23 X4) analysis); record,that too" ably coxtvable std of f ,.; �"` �T taw itlex meanies, etc.:4483 r.24 8 32 could Provide a hint al Vis" for deny- 1+t TS% Gtr ,1973)(444;p6eri teaches that it is c ouxt l for the Blassrepremntative,and not the named parties,who requested t, itelc i c "the Vi .'. ef fir. r. direct and manage these actions."). 531 [i:S. 3 367,121 R,Ct. 955, 148 L.R41,2d 866 1). haat is presented,then, is a triable issue of 1i1 The record issericiently developed to support the material fart. conclusion that the named plaintiffs could adequately represent the class. Bide 23 a - raentnt that a class representative "fairly and adequately protect the 4.Whetherthe District Court it diacretlea interests of the mainly seeks "to uncover conflicts by denying the for elites certification. of interest between named parties and the they s to represent" In re Winfoxitt When Antitrust Litt, NtYrfl arguesthat the District Coin abused its discretion 391 f.ad $16, 532 (3d Cir.: see FED, R. CIV. by denying out prejudice their motion for clam P. 23(0(4). A class representative need only possess .." .1 C 2016 Thomsen Reutars,No dnim to original U.S.Government Wei. 17 New.Directions Treatment Services v,City of Reeding,490 P3d 283(2007) 19A C3: 7`, Nom p "a minimal of knowledge necessary to meet individual plaintiffs' and the other members of the s ndard" v; C ndant 3� €tge putative cos.However, the District Court did not ruleadequacy Corg, 215 P.11.1). 107, 114(13.N. 3), Conflicts of on thhe otherRule23(a)factors,numerosity'c Dist€iet interest are rare in Ririe actionsweld and t pity. Aro , we will vacat t declaratory and injunctive relief.14 See f~'ED.R..CW,P Court's order denying the motf©r class e n 2 bX2).Further dis eov+ary is unlikely to reveal any actual or potential conflict.The parties do not dispute that all of the class representatives'Twat&were produced, III,COMiturk01 Neither the record nor the legislative history of 53 PA. 1.4 TheatYlogues that there is doubt abotawhetherthe COWS.. A.T: ANN, § 1021 contain any evidence tbatt. named plates can adevately represent the would preserve thestatuteagainstinst the guaranteesprovided bemuse their claims Pax"p io by the ADA and the Rehabilitation Act.We reverse theme tempest for 440netive re See Aikrar a arp. the judgment of the District Court denying summary Perroirtor corg, Fad 402,r,the individual ,ei+a°a 413 d t' s 19941). Judgment for TD'S with respect to the claim that 53 Ho for themselves,and thereforedo not implicateCONS.STAT.ANON.§ 1 1.facially violates these possible lure claims for damages by other members federaistatutes atkdremandfm-further *314 p of the"class..Moonlit*,tlae City's argumentthis consist with this°pillion, point lin We are unable to perceive from the record or the All outflow brief's What additional information might he required to establish that there is no conflict of interest between the 490 F.3d293,.19 A.D.Cases 687,35 7+NDLR,P 1 End of Document 2016 Thomson Reuters.No claim to original tl.S GovemmoatU.S. Wim. ce2016" omson Ranters. NO claim to 04001 Li,S,Government Work, t8 New Directions.Treatment Services v.City of Reading Negative Treatment Negative Citing References(3) The leteyCited do stent has been neg reibrencect by the fa/owing events or deo sfons in otherNigation or Pro ` p'YItestment Data TVP40 000 •a Distinguished f. Paidty Top.LLC of ti, Case tar E2,3 ,.. 2012by WL 3930371,N.J. per,A.n. Plakciff Rocky Top,LLC appeals from sumer ludgmerti agsaassai of Its siaven-cotint complaint against Ste I i r of South Amboy(theWs the CO 's Mayor John T.,Me" rDistinguishert 2. TWO Snap,LLC xZsmilv ad.of Atbustment Mar 06;20141Case 1110111r by 14,1 80A.3ci.330,Pa.Cmwith. REAL PROPERTY-r and n Gs.Methadone f= clinic was a:permitted use in conniertasi district even though clinicwas not a specifically mentioned inzoning Distinguished 3, Get y up,Trtc.v,„ of EyouvaniageSS Mar.i3 9 5 Case 1110 »:.Fed.Appx.192.6th Cls( .) CML Rim`S-Disabilities.ardi requiting residential nibstance abuse treatment: to attain condittinal use perivdt did not discrimMate against disabled persons, Ot6 Thomson mess.No claim to origin U.S.Govarritrieni W Analysis of Penobscot County Metro Treatment Center Expansion Alternatives James Scully, Director of Facffity Operations Colonial Management Group, LP Improved Securitysystem $20K s, a ,, vc c Vin*Out $630K Annual Di>;=, , Increase $25K 4 ',ccAdd I Coun •-r 5O Patients $40K-SSW i•iS:� Treatment Berm Coordinator very 30047 *a $SO'-SOW «,y N $28K'... t•}...'s r5i'ice+` v t :- - .. Total inve rent©Current Census. $675K Total Investmentr>,350 Patients Adel Counselor TOW Invent 400 Patiente Addl Nue,TSC i4 Counselor Total Investment©450 Patients Addi Counselor Total Investment.:-,Max' ...• €50 Counselor NOWCri ' Maine <,x' Census •,,,• N_.e 77 4` $5K 4fl'rcv,xr. AT, .rp $20K a x °`:,'l'Legal SOK z ry "gs fi� aYstem $20K lout MO-- S raped:on 3,000-3, SF •Vie.$200-$250K -.,? -#,{t -+F-' w Low V e,r $12K ... Furniture USK � 'T'.�xv a 1 ;Technology SOK tes $2,500 , � � �� � .._ � , .. �..�� . Ex,- -,Annual $ " "•�'� c-.C.ek�1c ' F ClinicStart-U. ff Annual ++.-:e,la $89OK •r:.Investment vee Census :,, p4 PC Maine Primary Care Association Testimony Before the Joint Committee on Health and Human Services in Opposition to . . . L.D. 1213: An Act to Reduce Costs and Increase Access to Methadone Treatment Vanessa Santarelli, CEOMa 13, 2013) CEO (May rEC 6 Maine Vanessa Santarelli, CEO Primary Care James Davis,Board Chair and President Association Testimony before the Joint Standing Committee on Health and Human Services In Opposition to LD 802,"An Act to Encourage Alternative Forms of Treatment for Opiate or Opioid Addiction by Prohibiting MaineCare Coverage for Medication-Assisted Treatment for Addiction" And LD 1213: "An Act to Reduce Costs and Increase Access to Methadone Treatment" Vanessa Santarelli, CEO,Maine Primary Care Association May 13,2013 Senator Craven,Representative Farnsworth and distinguished members of the Health and Human Services committee my name is Vanessa Santarelli, and I serve as CEO of the Maine Primary Care Association(MPCA). I am testifying today in opposition to LD 802:An Act to Encourage Alternative Forms of Treatment for Opiate or Opioid Addiction by Prohibiting MaineCare Coverage for Medication-Assisted Treatment for Addiction; and LD 1213: An Act to Reduce Costs and Increase Access to Methadone Treatment on behalf of MPCA and our members, which include all 20 of Maine's Federally Qualified Health Centers(FQHCs),and other Community Health Center members. Maine's Health Centers provide comprehensive primary and preventive care for approximately 200,000 individuals and employ over 1,900 workers,including clinicians,administrators and support staff. As part of our"health home"model of care,the majority of our 60 primary care delivery sites also integrate behavioral health, oral health, chronic disease management and other services. The intent of LD 802 is to eliminate all MaineCare coverage and reimbursement for Suboxone and methadone treatment for individuals struggling with the disease of opiate/opioid addiction; however,the purpose of LD 1213 is to increase access to methadone treatment at Federally Qualified Health Centers(none of which currently offer this form of treatment in Maine). The stated goals of these two pieces of legislation, sponsored by Rep. Lockman,appear to conflict with one another. If LD 802 were to become law,it would undermine the goal of increasing access to care. Further,it would exacerbate the problems associated with those trying to seek help for their addictions. We have seen more frequently in the news what can happen when those facing addiction cannot get the counseling,treatment and support they need to manage their diseases-whether it is by overdosing,robbing pharmacies or their friends and family,or in the worst cases-death. Eliminating reimbursement and coverage for these treatment options will have a devastating effect on those in need, as well as on their families and in the communities that they call home, With respect to LD1213,we appreciate the focus shifting to increase the access to services. We also understand the sponsor's interest in wanting to provide more community-based care that would also save the state resources in lowered mileage reimbursement for those whose only options are to drive to the few communities where methadone is available, such as Bangor. 73 Winthrop Street,Augusta, ME 04330*207-621-0677* www.mepca.org Maine's Community Health Centers have a holistic approach in addressing each of their patient's primary care needs(this includes oral health and mental health services). They are also sensitive to the complex and challenging needs of those suffering from addiction. For example, some of our health centers prescribe Suboxone and offer counseling and other behavioral health services.It is our philosophy that in order to provide best patient care-especially to those confronted with addiction,you can't simply prescribe drugs;you need to also offer comprehensive and supportive counseling services. The current bill asks health centers to take on these additional at-risk patients,with the possibility,if the former bill is enacted,that coverage and reimbursement will cease for those on MaineCare. And we would be asked to do all of this without any additional funding in order to support that new patient population. In addition to the concerns outlined above,not only would Maine's FQHCs have to apply to the Centers for Medicare and Medicaid Services(CMS)for a Change in Scope-because prescribing methadone would result in adding a new service that they currently do not offer;there is also a great deal of upfront investment in upgrades to facilities that they would need to absorb (and they are already operate on the narrowest of margins). I talked with health centers in other states that currently prescribe methadone(there are only a few that I could ident{fy in all of New England),and they said that there are certain facility and security changes that need to be made before CMS will allow you to move forward. For example, storing methadone requires security enhancements that our health centers currently don't have in place,because of the risk for theft and other issues, Despite our various concerns,we understand and appreciate the views of those supporting LD 1213. In fact,we have met with them and Representative Lockman to see if there is a way to find common ground on this issue. However,there is very little time left in this legislative session to have those in-depth discussions. At the time of our last meeting,Rep.Lockman said he would contemplate whether or not to request that the bill be carried over to give the interested parties more time to meet. If he makes such a request,MPCA is willing to participate in those stakeholder meetings,and we would appreciate your consideration in allowing us to do so. As it relates to LD 802,however,we continue to urge the committee to vote"ought not to pass." Thank you. • 73 Winthrop Street,Augusta,ME 04330*207-621-0677* www.mepca.org