It's just after 4 am on a cold Tuesday morning and people are gathering outside a gray two-story building on NE 82nd, lining near the front door as hundreds before them have done for nearly two decades. They’re addicts waiting for a dose from the RAM Clinic (short for “Recovery and Methadone”), one of only 14 methadone clinics in the state.
Oregon, like many places around the country, has been hard hit by rising addictions to heroin and other opioids. Fatal heroin overdoses in Multnomah, Clackamas, and Washington counties shot up over the past 15 years—from an average of 1.154 overdose deaths per 100,000 people between 2000 and 2002 to 4.132 between 2012 and 2014, the Oregon Health Authority (OHA) reports.
But the patients gathered sullenly on this chilly morning might soon have to head elsewhere to get their methadone fix, which is intended to dampen the effects of opioid withdrawal.
In the spring, state health officials notified RAM they want to revoke its license. They then tipped off the US Drug Enforcement Agency (DEA) to a list of worrisome potential federal crimes—including dosing vulnerable patients without proper supervision. The federal agency has been investigating the clinic since May and executed a search warrant last month, seizing its records.
In an affidavit (see below, or click here) for that search warrant obtained by the Mercury, the DEA says RAM Clinic went without a doctor on staff for a month last winter after its medical director’s license was suspended while he went to rehab for his own addiction. The agency claims that non-physician staff changed methadone dosages for its patients during that time, that there were “fraudulent” methadone order forms and “suspicious” distribution of the meds, and that the owner’s daughter—who was convicted of felony drug tampering and identity theft while working at the clinic nearly a decade ago—is still the clinic’s IT technician and has access to the drugs.
Viccie Boeckel, the clinic’s owner, is fighting back. Boeckel accuses OHA investigators of carrying out “a personal vendetta,” and says the female DEA agent leading the feds’ investigation “has a real hard-on” for busting her business.
Boeckel says the clinic lost about 150 of its 400 patients after FamilyCare Health, one of Oregon’s largest coordinated care organizations, didn’t renew its contract with the clinic after learning of the investigation.
“This is a witch hunt,” she tells the Mercury. “It’s simply that—it’s just not possible that anything is that off.”
The problems began last winter.
RAM Clinic’s physician at the time, Sounak Misra, had been flagged for an addiction assessment by the state’s Health Professionals’ Services Program, which knew he’d been an addict in the past. The state wound up suspending his license on January 15.
The DEA says Misra told Boeckel on January 12 he was resigning that day because his license would soon be suspended and he’d be headed to rehab. The clinic didn’t hire another doctor, which it was required to, until a month later. During that month, the DEA says, “RAM employees dispensed controlled substances to patients and changed patient controlled-substance dosages.”
Boeckel denies it. “That allegation is a crock,” she says. “I don’t know exactly when his license was suspended.”
She adds that just because Misra’s license was suspended, it doesn’t mean the dosage orders he gave patients prior to the suspension were invalid. Though Misra hadn’t been in the office since he resigned, Boeckel says she learned of the suspension far later than the state and DEA claim. She tells the Mercury that she was under the impression he’d be returning to the clinic shortly, and that non-physician staff dictated dosages for just one day—“the day we found out” about Misra—not for a month.
“It was a matter of five hours,” she says. “We made the best choice that we could make. Do we medicate these people or do we send them out knowing we gave them a highly addictive narcotic every day and [then] give them absolutely nothing?”
The DEA, which was notified by the state of the clinic’s issues in April, began its investigation in May and conducted an audit of RAM’s records over the previous eight months. It says during that time the clinic had nine methadone order forms with “conflicting information” (dates, packages received) compared to a distributor’s form, including one that was “completely fraudulent.” The DEA alleges RAM’s records of dispensing to patients didn’t contain information on the dosage given out and consumed, nor even records of which employee dispensed them. The audit also shows “an excessive overage” of 113 liquid methadone bottles and “a significant shortage” of 48 methadone wafers compared to what was ordered.
Boeckel says, again, that the DEA is wrong.
“It very well may be that the DEA is not looking at the right report,” she says. “They have a backup of our computer system. I do not believe this DEA agent knows what she’s looking at, and she has not asked for any explanation. Every single dose is accounted for.”
The DEA also points out in the affidavit that Boeckel’s daughter, a convicted felon, works there illegally. While working at the clinic in 2008, she was indicted on 33 counts of identity theft and 35 counts of tampering with drug records. She was convicted on 10 counts.
Methadone clinics can’t employ felons convicted of charges related to controlled substances.
“It was so long ago that I completely forgot she was a felon,” Boeckel says of her daughter, the clinic’s IT technician, who the DEA says has access to the clinic’s records and the methadone itself. But, she says, her daughter is “qualified to do what she does” and “doesn’t have anything in her record that says she can’t work there.”
The state’s hearing to revoke the clinic’s license is scheduled for January, records show. The DEA is still developing its case with the records it recently seized.
Boeckel, for her part, hired a lawyer and is fighting back.
“The last time [the DEA agent] was in, she offered me the opportunity to surrender my license and I laughed at her,” she said. “If you really believed there was something wrong, you would have locked the door.”