MAD DOG'S Sandwich Drug Treatment Clinic Closes

A clinic that offered addiction treatment closed abruptly last month, creating a hole in a service that is rare enough already.

SANDWICH — A clinic that offered addiction treatment closed abruptly last month, creating a hole in a service that is rare enough already.

Primary Care Associates of Sandwich was shut down Aug. 16 and three employees were laid off without any warning during their lunch hour by the clinic's owner, Dr. Punyamurtula Kishore, according to the clinic's former medical director, Dr. Robert Friedman.

Kishore, who owns more than 30 medical clinics statewide, including three remaining on the Cape, said the Sandwich practice that he's owned since 1990 has helped a lot of people suffering from opiate addiction but was not profitable.

Treating addiction is not a lucrative sector of the medical industry, Kishore said. The clinic owner said he hopes to reopen the Sandwich facility when he finds a way to round out the practice to make it more financially viable. While most of his clinics focus on treating people with addiction, they also offer more general medical treatments that help pay the bills.

The closing of an office that has been on the front lines of opiate addiction comes at a bad time for the Cape, where addiction to the prescription painkiller oxycodone has reached epidemic levels. Police say it is the motive behind increased property crime and violence.

The 100 patients Friedman treated have been sent by an office assistant in Sandwich to Kishore's offices in West Yarmouth, Falmouth and Wareham, said Dr. Wendel Price, the doctor at Cape Cod Primary Care Associates in West Yarmouth.

But Friedman, the physician for the past two years at the Sandwich clinic, and other Kishore employees say the sudden closing in Sandwich is a bad omen for the rest of Kishore's clinics, which have been in financial peril for some time.

Working for Kishore means occasionally having your paychecks bounce, receiving eviction notices at the office because the rent has not been paid, and suffering interruptions in phone service because of unpaid office bills, Friedman and others say.

"You cannot not pay people for a whole month and expect them to keep working for you," said Caroline Riley, the former nurse manager of the Barnstable Education and Guidance Center, a Kishore clinic located on Main Street in Barnstable.

A spokesman for Kishore sent an email in response to the allegations about unpaid bills.

"Like any business, Preventative Medicines Associates is subject to ups and downs of the economic cycle," spokesman Scott Farmelant wrote. "Regardless, all agreements with vendors will be honored."

Riley recently resigned from the Barnstable counseling center, where she says 85 percent of the offenders in Barnstable County's drug court go for referrals and treatment.

She said she resigned about two weeks ago after not being paid for a month.

"Dr. Kishore has a way of breaking you," she said. "He expects a lot from you, but then he doesn't pay you. He makes you feel bad. He says, 'What about the kids? You were helping them.' He tries to tell you you're not a loyal person."

Riley worked for Kishore for four years, she said. "I believed in what I was doing, but I'm not doing this anymore," she said.

"We've all had to hound him to get paid," said Friedman, who worked for two years for Kishore. "But we all did it because we believed in what we were doing."

For patients who have been helped by Friedman, the news of the closing was devastating.

"My son had a really good rapport with Dr. Friedman," said Marjorie Hall, whose 24-year-old son is being treated for opiate addiction. "My son went through hell before he was ready to get help. He was really sick for a while."

Hall, who asked to keep her son's name unpublished, said her son's life turned around when he began to receive Vivitrol shots from Dr. Friedman four months ago.

One day he said to her, "'I'm tired of waking up each day wanting to die,'" she said.

The shots, which cost about $800 each and last a month, are covered by most insurance companies, Friedman said.

At Kishore's clinics, doctors practice a unique form of addiction treatment. They give non-narcotic medicines to stop the severe flulike symptoms that torture opiate addicts in withdrawal.

To manage long-term cravings, staff dispense Vivitrol, a form of Naltrexone that blocks opiate receptors in the brain, preventing the user from getting high from opiates such as heroin or oxycodone. Unlike long-term sobriety management drugs such as methadone, Vivitrol is not addictive.

Daniel Clausen, a West Barnstable resident who has been struggling with opiate addiction since 2007, said getting into a detox clinic can take days because there are so few facilities on the Cape.

Clausen, 26, failed to find a bed when he tried to get clean two months ago. So he began taking Vivitrol instead. That, combined with the counseling he's received from Friedman, has helped him stay drug-free.

"That's why it's so important for people like Dr. Friedman to get recognition," Clausen said.

Dr. Kishore — who received his medical degree in 1974 from Andhra University in Waltair, India, and has a 1979 master's degree in public health from the Harvard School of Public Health — said his treatments have been successful.

Friedman and Riley agree.

"The model really works," Friedman said. "My biggest fear is that all of Dr. Kishore's clinics go belly up. That will leave a huge hole and put a lot of people in crisis."

"The model is very sound," he added. "It's the business part of his practice that's in shambles."

It's true that treating addicts is labor intensive, Friedman said. Few doctors take on such patients, said Lisa Murphy, who founded Parents Helping Parents, a support group for parents of opiate addicts. The group meets Mondays at 6:30 p.m. at the Mashpee Senior Center.

"The patients are very fragile," Friedman said. "They don't take lightly to going to a different doctor and a different place. It's a very personal practice. Patients tell us their deepest, darkest secrets. ... And there's a lot of input from the family members. You have to talk to them because you very rarely get the whole story from the addict."

About 80 percent of Friedman's patients are between the ages of 17 and 25, he said.

"I am hearing great things about Dr. Friedman," Murphy said. "I know he was very dedicated to his patients and their families, including giving the parents his cellphone number and stressing to call him at any hour, any time, especially if they are in crisis."

Finding a dedicated caregiver is a key factor in successful addiction treatment. If an addict takes anything, Vivitrol, methadone or Suboxone, the chances of it working go way up if treatment comes with intense counseling, Clausen said.

Friedman, who is job hunting now, will still offer counseling to his patients free of charge on Fridays