Family Seeks Reform of State Law Governing Methadone Clincs Following Fatal 2011 Fountain Green Crash

Rob DiCocco’s cell phone rang just after 10 a.m. on the morning of July 21, 2011. His father’s number displayed on the screen.

DiCocco knew his mother, Carolyn, often used her husband’s phone. So, stopped at the red light at Route 543 and Wheel Road, he answered the way he often did.

“Hi, mom.”

The voice on the other end was female, but it wasn’t his mother’s. It was a woman he’d never met before, a woman who had just witnessed a traumatic event. It was a moment which would turn an issue Rob had never much considered into a mission.

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Two hours earlier, and less than three miles away, Alycia Hoffman was staying with her grandmother and recovering from recent gall bladder surgery when her own phone rang. On the other end was Nicole Albers, a one-time close friend who Hoffman, then 23, had grown apart from in recent months. Albers wanted to know if she could pick Hoffman up for a ride and lunch. Hoffman agreed, but didn’t have to wait long—Albers had called from outside the home.

The pair traveled to Medication Assisted Treatment Technologies, Inc., a methadone clinic located just off Route 7 in Belcamp. Albers, then 27, had sought treatment for drug addiction at the clinic since March. When they arrived, Hoffman went into the clinic with Albers, but was asked to wait outside by its staff , she would tell Maryland State Police investigators.

Albers emerged just before 10 a.m. and drove the pair to a nearby McDonald’s. Low on gas, they then crossed the street to a gas station. As Albers pulled up to the gas pump, Hoffman said Albers collided with a protective barrier, damaging the left corner of her car. Hoffman asked Albers to take her home.

As they drove back up Route 543, Hoffman told state police that Albers was going “a little fast,” and said she told her to slow down several times. Eventually, having slept poorly following her surgery, Hoffman began to doze off.

She awoke to Albers screaming as their car crossed the center line, and looked up to see a white Lexus sedan a moment from impact.

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Al and Carolyn DiCocco left their home on Redfield Road in Fountain Green a few minutes earlier, heading to BJ’s Wholesale Club and Kohl’s to do some shopping.

Carolyn, 64, retired earlier that year from CitiBank Financial, where Al had also worked. The couple met decades earlier at a shore house in Bowley’s Quarters. Al was in the Army and stationed at the Pentagon at the time, while Carolyn had been in a convent, but decided to leave before taking her final vows and found work at a credit card company.

After that, Al said, the two were “inseparable,” eventually marrying and raising two sons, working full careers before moving into their first years of retirement.

The couple had traveled less than a quarter-mile on Route 543 when Al, then 65, saw Albers’ silver Chrysler sedan approaching. Just as the two cars neared a sweeping curve in the road by the Fountain Green Swim Club, the Chrysler crossed the double yellow line into the southbound lanes.

DiCocco swerved his own car across the center line and into the northbound lanes, desperately trying to avoid a crash. But at that moment, Albers corrected her path and steered back into her own lane—and directly into the DiCoccos.

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As the shock of the crash began to fade, Al turned to his wife.

“I reached over to my wife and asked her, ‘wake up, wake up,’” he recalled. “I thought maybe she had just passed out. I put my arms around her and I had blood all over my hands. I knew then…I heard her gasp a little bit and that was it.”

In the other vehicle, both Albers and Hoffman were seriously injured. Passersby began to stop and aid those in the crash, and call emergency crews to the scene.

That morning Rob DiCocco, then 41, and his daughter Serena, then 11, ran several errands and were on their way home after paying employees at C & D Services, the plumbing and excavation business he owns in Riverside. As they approached the intersection of Route 543 and Wheel Road, passing through the same area Albers had driven just minutes before, traffic was stacking up behind the accident. That’s when DiCocco’s phone rang.

DiCocco raced up the opposite side of the road, past the stopped traffic. He found the crash, and his father, who had gotten out of the car and was on the ground as police started to arrive.

“That’s when he came up to me and he asked, ‘what happened, what happened, what happened?’” Al DiCocco said. “I told him, we lost mom. And he went crazy.”

A short distance away, Albers remained in the wreckage of her car with a broken arm and other injuries.

“I ran up to the girl and I was like, ‘what the eff are you doing,’” DiCocco said. “She’s laying in the car screaming, saying my car stalled out, I lost control of the steering.”

“State Police are there with me and they’re holding me back, because I was getting ready to go crazy,” he said. “And she was like, yeah, my car stalled, I lost complete control.”

DiCocco said neither he nor his family have talked to Albers since that exchange.

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In the following weeks and months, Maryland State Police began an investigation which centered on the combination of Xanax and methadone in Albers’ system at the time of the crash.

Both Albers and Hoffman were taken to the R Cowley Adams Shock Trauma Center at the University of Maryland Medical Center, the latter with a severely broken leg, a broken back, and “numerous other injuries,” according to a state police report. In an interview with troopers, Albers changed her story several times, ultimately blaming the crash on her car’s steering locking up, preventing her from avoiding the crash.

Crash reconstruction experts calculated Albers’ speed at the time of the crash at between 63 and 66 mph, well above the posted speed limit. Heavy damage to both vehicles prevented a close inspection for any mechanical problems.

Albers eventually admitted to having taken Xanax at about 9 a.m. that morning. When combined with methadone in a practice called “boosting,” the cocktail results in a powerful high.

Harford County State’s Attorney Joseph Cassilly provided state police investigators with MATT, Inc. records which showed Albers failed a drug test on June 14, testing positive for benzodiazepine—a central nervous system depressant of which Xanax is one type. The report, signed by Albers, warned of the dangers of mixing that substance with methadone.

According to state police records, troopers also met with Linda Smith, the MATT clinic’s director, in September 2011. Smith told investigators that Albers’ treatment counselor, Christian Gruhler, quit the clinic that August, several weeks after the crash. Contacted by the state police, Gruhler declined to discuss Albers’ treatment, citing confidentiality clauses.

Meanwhile, Rob DiCocco began his own investigation.

Rob and Carolyn DiCocco in Italy, June 2011. (Photo courtesy DiCocco Family)

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Two weeks after Carolyn’s funeral, Rob and Al DiCocco sat in a truck outside the MATT clinic.

While Al waited outside, Rob entered the clinic—not to start a confrontation, he said, but intending to learn more about how the facility operated. He made up a story, telling clinic staff that he had an employee whom he suspected of using drugs, and wanted to get information about starting the worker on methadone treatments.

According to the clinic’s web site, MATT, Inc. was founded by J. Charles Smith Jr. and his daughter Rebecca, a former heroin addict herself. His son, J. Charles Smith III, has served as the State’s Attorney for Frederick County since 2007, and has been a member of that county’s Substance Abuse Council, for the same period.

DiCocco said he met with an older man he believes was the elder Smith, and talked with him for a half-hour about the program. DiCocco said Smith told him that as long as the (fictional) employee tested positive for drugs, they could start treatment immediately.

“And then he just started bragging on how much money he makes,” DiCocco said. “He says, ‘I’ve got customers that have been coming in from your competitors,’ other plumbing companies.’ I’ve got guys, 15, 18 years they’ve been coming to me.’ All this stuff is going through my head, and I’m thinking, you’re a legalized drug dealer, that’s all you are.”

“When he was doing that, it took every ounce of energy not to whack that guy in the face,” DiCocco said. “I can still see him smiling.”

Before opening his own local business, Rob spent 15 years in the pharmaceutical industry. He said that the packaging for methadone medication calls for patients to be weaned off the treatment in about one year.

But drug addiction is considered a medical illness, and decisions such as when to stop treatment are left up to the clinics and their patients, not state or federal regulation. Furthermore, there is no state or federal law which prevents the administering of methadone to a patient who has recently tested positive for other drugs.

Even the quickest on-scene drug tests take several days to obtain results, and though clinic personnel can detain patients who are visibly intoxicated or high, there’s little they can do to test someone who may have quietly dosed themselves with a “boosting” substance ahead of a methadone treatment.

As, it would turn out, Albers had.

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Though methadone is a legal medical treatment, DUI charges are still possible for those who drive while under its influence. According to Harford County State’s Attorney Joseph Cassilly, while exact testable limits exist to determine whether a driver was legally drunk, in cases of drugged driving, it is up to his office in consultation with investigators to decide whether a driver was “under the influence.”

A total of 17 states nationwide have “per se” laws, under which any detectable amount of prohibited drugs is enough to qualify as driving under the influence. Maryland is not one of those states.

“That would be nice, if we had that in Maryland,” Cassilly said.

In Albers’ case, it wouldn’t matter. In November 2011, the results of the blood test showed she was positive not just for methadone but for alprazolam, the generic name for Xanax, as well as amphetamines.

Six months later, on May 22, Albers was indicted on nine charges in connection with the crash that killed Carolyn DiCocco, including negligent homicide by motor vehicle while impaired by drugs and vehicular manslaughter. She would plead guilty to the latter charge, receiving the maximum 10-year sentence with five years suspended, as well as five years of supervised probation, including conditions of drug treatment and testing.

As the criminal case closed, the DiCocco family in late September launched their personal campaign in the form of a $20 million lawsuit against MATT, Inc. for negligence, alleging that the clinic administers methadone despite knowing that many of its patients engage in “boosting.”

MATT, Inc. was purchased in April by Texas-based MedMark, one of several clinics the company bought in an expansion into Maryland.

“We are excited to have Medication Assisted Treatment Technologies, Inc. become part of MedMark Services,” MedMark CEO and President David White said in a statement at the time. “The MATT Program will complement our recent acquisition of the Glass Health Programs in the Baltimore, Maryland area. The program is known for compassionate and patient focused care.”

Repeated calls to MedMark executives for this story were not returned.

Alongside the lawsuit against MATT specifically, the DiCoccos hope to change state regulations surrounding methadone clinics, recruiting state Senators Barry Glassman and Nancy Jacobs to help bring the issue to Annapolis.

The family said they seek changes which would strengthen requirements for clinics to test methadone patients for other drugs and prevent them from immediately treating those who test positive. Current federal regulations require methadone clinics to screen patients for illicit drugs eight times per year; Maryland regulations are stricter, requiring monthly testing.

Other possible measures sought by the DiCoccos include the use of state-provided transportation for patients to and from methadone treatments, and better oversight of existing requirements on the clinics. Rob DiCocco said he has spent hours collecting reams of information on methadone clinic regulation nationwide.

The DiCocco family. From left: daughters Erika and Serena; Rob DiCocco; Meghan DiCocco (Photo courtesy DiCocco Family)

In an interview at their Street home last month, Rob, his wife Meghan, and Al DiCocco all insist that their goal is not to shut down methadone clinics, saying the facilities provide a valuable treatment service.

“Methadone does help people,” Rob said. “We’re not saying, ‘You’ve got to shut all methadone clinics down.’ There are hundreds if not thousands of successful [treatment] stories all over the Internet. But there’s hundreds or thousands of incidents just like this [accident].”

But the family’s good intentions may collide with difficult realities surrounding methadone programs, state officials cautioned.

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Harford County is home to three methadone clinics: MATT Inc. in Belcamp; Joppa Health Services Inc. in Joppa; and Serenity Health LLC in Aberdeen.

Compliance with state and federal law among those three facilities and the 64 other methadone programs in Maryland is monitored by the Department of Health and Mental Hygiene’s Alcohol and Drug Abuse Administration, based in Catonsville.

Donald Hall, director of quality assurance for ADAA, said he is sympathetic to the DiCocco family’s desire to see the law changed. But the decision whether to dose a patient who has tested positive for other drugs in the past is a medical decision, he said, and not one that should be left to regulation.

“We’re talking about a disease, and people getting treatment for an illness,” he said. “What other illness would you deny a patient treatment for the illness?”

Clinic staff members are required to examine patients for signs of intoxication before dosing them with methadone; if a patient appears to be under the influence of other drugs, they can be detained and treated with other techniques. But “boosting” is not a new practice, and many substances can have an additive effect without making the patient appear visibly high—previously, something as innocuous as a motion sickness pill was a popular choice for boosting, Hall said.

Ultimately, requiring a patient to be clean of illicit drugs for a certain period of time ahead of a methadone treatment would render the methadone treatment itself unnecessary, Hall said.

“The reality is, the whole reason they’re in the program is that they have a drug problem,” he said.

State Senator Barry Glassman said his staff is researching the issue, and has run into the same problems surrounding the nature of methadone as a medical treatment.

Also unclear is the exact effects of methadone on an individual’s driving ability. Patients just starting on the treatments can experience more severe side effects. But in a 2008 essay, Dr. Nora Volkow, director of the National Institute of Drug Abuse, maintained that those who had stabilized on methadone could drive safely.

“Unlike heroin, it has a slow onset and long duration of action when taken orally as directed,” Volkow wrote. “Properly prescribed, methadone is not intoxicating or sedating and does not interfere with ordinary activities like driving a car.”

International experts disagree. The Australian Drug Federation is unequivocal, saying that “it is dangerous to drive after using methadone. The effects of methadone, such as sedation, can affect driving ability.”

A 2009 study conducted by the Norwegian Institute of Public Health found that, of 635 cases of drivers suspected of driving under the influence of drugs and who had methadone in their system, all but 10 had some other psychoactive drug in their system. The study also found that men on methadone treatment for drug addiction were more than twice as likely to be involved in an accident as the average driver; critics pointed out that the study lacked detailed information on the crashes cited, including whether alcohol or other drugs were involved.

In Maine, a 2011 law banned methadone drivers from operating commercial vehicles. The issue came up again in that state earlier this year, after an eight-year-old boy was killed when a vehicle driven by his mother, a methadone patient who said she fell asleep at the wheel, left the roadway.

Though the DiCoccos suggested a state program to provide methadone patients with transportation to their appointments, Glassman said doing so could run afoul of the Americans with Disabilities Act by forcing them to give up their right to drive due to their medical condition.

“We’re going to keep trying to research it, and see if something if there’s something practical that can be done that doesn’t violate doctor/patient confidentiality,” Glassman said.

“It’s a complex issue, there doesn’t seem to be any easy solution,” he added. “There don’t seem to be any quick answers, it’s going to take some time.”

State Senator Nancy Jacobs said her office is conducting similar research, including how other states have handled methadone clinic regulation, and has sought input from the State’s Attorney’s Office. She said she expected to have additional information later this month or in early December.

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Though improving public policy governing methadone clinics may be difficult, public funds help keep many of them in business, and public regulators often find areas of non-compliance at various facilities, including the MATT clinic.

The Harford County Health Department contracts with MATT, Inc. to provide treatment for certain clients via funds provided through the state Department of Health and Mental Hygiene. The exact amount of public funds spent with MATT varies annually depending on the number of clients served, according to county Health Department spokesman Bill Wiseman.

Albers was not a client of the department while receiving treatment at MATT, Wiseman said, and he declined to speculate on whether the county would discontinue its relationship with the clinic in light of the criminal case and civil suit, saying “any consideration of that is premature until we know all the facts.”

Wiseman said the basis for such an action would depend on whether MATT violated any terms of its contract with the county, or if it were to receive the severe punishment of being de-licensed by state authorities.

“We are confident that…the oversight we [the county] provide administratively and medically is sufficient for our needs and the needs of our patients,” he said.

The ADAA monitors publicly-funded programs annually, while private treatment programs such as MATT are certified and monitored through site visits in alternating years, according to Hall.

According to ADAA records, MATT Inc. was first reviewed in June 2007, and was cited for two areas of non-compliance: a lack of procedures for assisting a client’s family with counseling and including them in the treatment process; and for patient records which were missing updates to their treatment plan, required every 90 days for active patients. A “Plan of Correction” was sent to the clinic to address the violations.

State regulators opened an investigation into the clinic in September 2009 following an unspecified complaint. Regulators found non-compliance in five areas, including the two cited in the 2007 review, but also found that all of the files reviewed by investigators were missing records of random drug testing for alcohol.

Another review in December 2010 found five more violations, among them that MATT maintained patient to counselor ratios higher than the maximum 50-to-1 ratio allowed by state law.

The clinic responded to the latter review in June 2011, according to ADAA records, and “a review of the plan of correction indicated that the program would address each of the specified areas of non-compliance.”

Hall, who oversees ADAA’s regulation of methadone clinics, said it is not uncommon for patients to contact state regulators about various issues at the clinics, but that even serious issues are often addressed and rectified.

“I do understand where the family is coming from,” he said. “I do understand, ‘how could you dose them after failing a drug test,’ but it’s not that cut and dry.”

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In the 16 months since his wife died, Al DiCocco has sought counseling, while quietly backing his son and daughter-in-law’s lawsuit and their efforts to change state law.

“We have to change the law, so no one else will get hurt or killed,” he said. “These meth clinics are just out there for a profit. They’re a legal drug dealer. And no one’s doing anything about it.”

“Mom was such a positive person, negativity was just not an option to her,” Meghan said. “It didn’t matter, across the board. If there’s a way we can take this and make it a positive somehow, you know, get through our sorrow, our grief and make it so it will have a positive effect on others in the community, that’s the best thing we can do to honor her memory.”

Though both Al and Meghan speak passionately about their family’s effort, it has become something of a crusade for Rob. Since his phone rang that morning more than a year ago, he said he has taken days off work and stayed up long into the night researching methadone clinics and relevant laws in other states.

“There’s a reason why God wanted this to happen, and I’m hoping it’s because we can get this law changed so it’s not going to happen to someone else,” he said. “There’s a flaw in the system. And that flaw needs to be taken care of.”