Despite providing critical medical intervention and its long residency in downtown El Centro, the Imperial Valley Medical Treatment Center does not enjoy particularly cordial relations with all its merchant neighbors.
The treatment center, also known as the Methadone clinic, has been at 200 S. Fifth St. (at State Street) for four years and the 700 block of Main Street for eight years prior.
Imperial Valley Medical Treatment Center that stirs support and opposition because of its location in downtown El Centro. Photo Credit: William Roller
Methadone is a synthetic drug given to counter addiction to opioids—often the pervasive street drug heroin. Patients must take it every day so they can be productive and have a better quality of life, stressed Lupe Acuna, clinic assistant administrator.
Defending the treatment, she argued, “Why not? It makes the patient functional. They don't get a high on Methadone. It helps them participate in regular things-- work, family and social events."
But as downtown El Centro struggles to maintain its position as a Mecca for commerce—and the city devotes considerable resources to that end—the clinic has become a flashpoint. Without debate, the area from Fourth to Eighth streets between Broadway and State Street is a gathering point for the homeless and indigent. Merchants complain of mini encampments, crime, trash on the streets and defecation and urination in their doorways.
The controversy is whether the clinic causes and exacerbates the blight.
El Centro city officials said treatment center managers have made it clear their focus is on medical service for substance abuse. Shoppers and merchants who pass by then clinic can see a “No Loitering” sign on the center's property, noted Mayor Cheryl Viegas-Walker.
"But across the street there's a big group of people hanging out on the corner," she said. "Then by the Greyhound Bus station (on State between Fourth and Fifth streets) there's another big group of people. So the perception is a number of clients with substance abuse come into El Centro and loiter in downtown because of the proximity to downtown."
Vacant lot across from the Greyhound Station near the Imperial Valley
Medical Treatment Center whose location creates controversy in El Centro, August 28.
Photo Credit: William Roller
Amid a campaign for a sixth term on the city council, Viegas-Walker added, "They’re congregating in groups is not only intimidating but it doesn't present a welcoming environment to downtown. I get more complaints from business owners saying, ‘Clinic clients hanging around downtown negatively impacts my business.’"
Clinic officials defended their efforts to maintain security.
"Not all of those outside are our patients," said counselor Norma Quinones. "Our security guard makes rounds several times a day. And if it is necessary we will call the police and they're really cooperative, really helpful. We take care of patients here, but once they leave we have no control of that."
But Jacob Zavala, co-owner of El Dorado Printing & Embroidery at Sixth and Main streets, scoffed at that notion, maintaining many pretend to not see what goes on downtown.
Jacob Zavala, Co-Owner of El Dorado Printing & Embroidery in the heart of downtown near the Imperial Valley Medical Treatment Center, a cause of concern for some merchants.
Photo Credit: William Roller
“After they get their medication they get their real meds (heroin)," he said. "Once they get hooked up they walk as far as they can and fall asleep on Main (or) Broadway.”
He added, “If they got the clinic out of here there wouldn't be that many transients loitering around here. The police need to patrol the entire area and not just the corners. That would probably clean it up. But I try to stay focused on running the business."
Equally wary of those frequenting the neighborhood is Lucy Walker who co-owns Shaolin Kung Fu Five Animals Cardio/Kick-boxing studio at 452 W. Main St. She conceded it is not just clients of the clinic but numerous homeless who loiter on Main Street and the alley in back of her business between Fifth and Fourth streets.
"I don't allow any of my students to wait on the sidewalk for their parents," she said. "We keep them inside and then the adults (instructors) walk our students out to their parent's car."
Even arriving for work at 7:30 a.m. Lucy Walker said she sees plentiful gatherings at Fifth and State streets.
The city, she said, was helpful in providing trash cans they can lock to discourage dumpster diving. Yet with the skate park just blocks away on Adams Avenue and
the new swimming pool adjacent to the park that will draw even more children, she added it is not a good idea to have a substance-abuse clinic in the neighborhood.
"They moved all the homeless out of Adams Park," said Lucy Walker. "But for me the only way to solve the problem is remove the clinic...the only way to clean up the area.”
Other business owners who have complained to this newspaper declined to be interviewed for this story.
But Quinones, who has worked for the clinic for 21 years, said it seeks to maintain a good relationship with neighboring businesses.
"We go across the street to the taco place (Rigoberto's) and they're really friendly," said Quinones. "We order by phone and they have the food all ready."
Humanitarianism is at the root of Methadone use in Imperial County, an area where heroin addiction has been a problem for generations even as other drugs—cocaine and methamphetamine—seized the national attention in the 1980s and 1990s.
The late Calexico physician, Amelia Katsigenis, initially helped detoxify in-patients at the now-defunct Calexico Hospital. But as increasing numbers relapsed into addiction, with the help of the Calexico City Council she established the original treatment center 44 years ago at Third Street and Paulin Avenue that soon moved to a long-standing location at 535 Cesar Chavez Blvd.
The El Centro facility is operated by the same group that runs the Calexico facility.
"Dr. Katsigenis started doing out-patient treatment at her office in 1974 but her office was too small to accommodate their needs,” Acuna said. “So now the El Centro clinic treats 250 patients. And since it is more centrally located, patients are arriving from Calipatria, Brawley and other places."
In the 2000s opioid addiction has made an unfortunate comeback, furthered by the now-pervasive abuse of prescription painkillers, to which clinic officials said some of their patients have fallen prey.
Clinic officials stressed it is not just an off-the-street drug supplier. Before any patient is admitted they must submit to an intake procedure with a social worker. Then the patient gets a medical exam from a physician to make certain they have an addiction. Only then is someone registered in the treatment program. Once registered, patients receive one-to-one counseling.
"Our counselors have a lot of empathy for the patients because it's a difficult life," said Acuna. "We monitor them to make sure they're not abusing any drugs. They get random urinalysis twice a month. And the clinic is closely monitored by the state and the federal Drug Enforcement Administration. We had a federal review last year and received a three-year accreditation."
Most clinic patients are supported by Medi-Cal but some do have private insurance. A few patients can wean off Methadone within five years yet some must rely upon it for the remainder of their lives.
The clinic does outreach by scheduling health fairs in the spring and provides information tables for exhibitors such as Imperial County Behavioral Health Services, Clinicas de Salud del Pueblo, Imperial County Health Department and other health professionals who share best practices with the community.
Yet when patients arrive at the clinic they do not loiter, Acuna insisted. Medication is available only from 6-11 a.m. A few patients remain for counseling sessions. But once treatment is completed patients leave the clinic. They have a regimen they must follow and if they do not they are issued a warning by their counselor.
"At the end of the day, we make sure we service patient needs the best way we can address them," said Acuna. "Nobody has had to be asked to leave the program because of disciplinary issues."
The amount of time for each patient to adjust to Methadone and progress with the program optimally varies with each individual. But patients also cope with other challenges--home life, work and school--and the clinic strives to ensure patients can engage responsibly with the rest of society because they share many similarities with the community at large.
"All along they've been looked down upon by the rest of society," said Acuna. "Yet, they're human beings just like you and me but with an illness. That's what an addiction is ... like overeating. It starts out as recreation but becomes habitual."
Further discussing the concerns of downtown businesses, Viegas-Walker noted zoning for the area allows for medical treatment services to operate at that location without the need to seek a more stringent conditional use permit, she explained.
"The city has no authority to close down the clinic and ask them to move." she said. "For land use and zoning you try to group like-services together. You don't want heavy industrial next to housing."
Viegas-Walker added the city can update its general plan for zoning but it is rarely done since the general plan follows a logical pattern.
"Essentially that's your blue print for growth," she said. "But as a city expands, you might update your general plan to include annexed areas, such as was done for Imperial Avenue, north of Adams Avenue, which was an unincorporated area."
Norma Villicãna, city director of community development, an umbrella organization of planning and zoning, remarked the mayor's explanation of zoning is correct. Yet since the clinic is regarded as a medical office, if the city allows one medical facility it must allow others.
"We can do enforcement for loitering by calling the police," said Villacana. "Obviously it's becoming more of a problem. And it's not just the clinic but the transit station (at Seventh and State streets). But we contracted out to a security company. And we now have an armed guard during hours of operation (of the transit center)."