Commentary By:

John McCarthy, M.D. Executive/Medical Director
Bi-Valley Medical Clinic, Inc.

An important aspect of Prop 36 is the totally new relationships that have formed around implementation. A county probation officer (PO) now visits the Capitol clinic once a week during the time I do the Prop 36 group. Patients are able to satisfy requirements for meeting with their PO and to participate in an educational group at the same time. After this group, we have a multidisciplinary team meeting (MDT) with a county prop 36 psychologist and the probation officer to discuss individual cases and formulate recommendations for the courts. Our patients have the best record for consistent meetings with probation and, in focus groups, have given high marks to probation. A pretty remarkable statement.

At the level of the courts, we initially had problems with a rigid approach to minor infractions that resulted in a number of deletions of patients who had barely started treatment. However, with time we have seen a more flexible and fair system evolve, although there is still too much emphasis on drug test results as opposed to positive program participation. Recovery takes time and that has not been an easy sell. Dennis Ding, Jim Britten, and Terry Campbell all share the task of meeting with probation, DAs, and the public defenders where cases are reviewed prior to court appearances. We have had patients on methadone, but who needed residential care, be allowed to enter Promise House and remain on methadone. We now have a second enlightened residential program, joining Options for Recovery, in accepting patients on methadone. Prop 36 will pay for methadone and residential care simultaneously. On other occasions, such as when stimulant abuse surfaces as the major problem, we have arranged for a withdrawal from methadone and transfer to the Effort detox program and then transfer to residential.

Bi-Valley has been referred a total of 54 patients which is about 15% of all prop 36 enrollees. Ten of our patients have been deleted for getting 3 violations of probation (VOP). They get a VOP if they test positive for any drug, including alcohol or marijuana. Three VOPs and they are deleted, although we are now getting more flexibility. We have arranged for 4 patients to be discharged and transferred to residential care. Overall 80% of patients referred to us for care are still in treatment and complying with prop 36. Thanks to our excellent staff and a high level of patient engagement in treatment this is really working!