The head of the agency that runs the city's drug abuse clinics -- beset by controversy over the last six months -- has been removed from office by Albert Russo, director of the D.C. Department of Human Resources.
Dr. Fred R. West Jr. was asked to resign last week amid continuing charges of inefficiency and mismanagement in the Substance Abuse Administration, which serves about 2,000 addicts in the city.
After West resigned, Russo assigned him to work as a psychiatric consultant at the mental health clinic at D.C. General Hospital.
West's attorney has informed the city government that he intends to appeal the involuntary resignation.
Russo said the "difficult decision" was made in "Dr. West's own best interest, the interest of the Substance Abuse Administration, and the clients it serves."
The decision came after a city administrator's report to the mayor recommended changes at the drug agency, where problems have centered around a special clinic for women addicts at 1905 E St. SE.
In February, the chief doctor at the Women Services Clinic reported that a patient had lost her baby because the clinic had never received the necessary equipment to treat her.
In April, Dr. Frederick Green, chairman of the mayor's committees on infant mortality and child abuse, visited the Women Services Clinic and called it an "abomination."
In June, the manager of the Women Services Clinic, and six others of the city's 11 drug clinic managers, met privately with Mayor Marion Barry and criticized the leadership of West, who has headed the Substance Abuse Administration for five years.
Barry asked City Administrator Elijah Rogers to investigate, and his report was sent to Barry and Russo last week.
The Substance Abuse Administration has approximately 250 employes and a $5 million budget. Some of its clinics provide a continuous "methadone maintenance" program; others offer specialized services, such as the women's clinic, which has a gynecologist for pregnant addicts.
Robert Keyes, deputy director of the Substance Abuse Administration, was named to replace West as acting director; Dr. Kurt Brandt was named acting medical officer. Formerly, West served in both capacities.
The battle between West and his clinic managers -- which West apparently lost -- began last February when a woman, 24 weeks pregnant and heavily addicted to heroin and amphetamines, came to the Women Services Clinic repeatedly over a two-week period complaining of abdominal pains.
The clinic, which was supposed to offer full gynecological services for female drug addicts, had no equipment for even a routine medical examination.
Dr. Richard Peters, the clinic's doctor, recommended several times that the women seek treatment at a hospital emergency room, but like many drug addicts, she ignored the advice.
The next the doctor learned, the woman had been rushed to the hospital aborting a dead fetus.
Peters sent a memo to his superiors on Feb. 28, five days after the accident.
It said the "tragic occurrence" may have been caused by "lack of equipment and supplies. I could not even perform a basic pelvic exam or any diagnostic tests."
According to Peters, the Women Services Clinic had been overwhelmed by problems for more than a year, and was never able to fulfill its announced mission to treat and protect the addicted mother -- and even more important -- her unborn child.
Peters recalled that at the time he was without a fetalscope to assess the "fetal status, sterile lubricating jelly, an examination lamp, physicians' glove, or a table with stirrups."
"I don't think you can blame us" for the death of the unborn child, the doctor said, "but can anyone swear that it wasn't our fault?"
One month before the fetal death, the former chief nurse at the clinic, Earnestine McCants, had written her superiors that pregnancy services at the clinic were "grossly insufficient."
The clinic, which has existed in one form or another since 1973, concentrates on getting pregnant addicts -- many of them prostitutes -- off the various street drugs they are addicted to and on to a controlled intake, namely methadone, which the clinic administers.
Because of the adverse effects on the fetus, doctors say, pregnancy is not the time to take an addict off drugs entirely. Therefore, the clinic puts patents on the lowest dosage of methadone that will block their craving for heroin.
Over the last year, it has attempted as well to offer such "specialized services" as complete physical examinations, Pap smear, gonorrhea culture, prenatal care, urine analysis, and veneral disease referral and treatment.
According to Peters, however, almost none of these services was actually provided by the clinic until just last month.
Peters said there was no equipment to provide the services, though it had been ordered for more than a year.
Lab test arrangements he said, were also inadequate.
On March 19, Green, associate director of Children's Hospital, brought his committee on child abuse to the clinic and found it "not adequately equipped at all."
He wrote to the mayor immediately, saying "This situation . . . represents the ultimate in unresponsive bureaucracy."
Shortly after Green sent his letter to the mayor, equipment began arriving at the clinic.
West, who practices psychiatry, said he donated supplies from his own medical practice when he learned the clinic was short. He blamed the equipment problems on budget constraints and ordering delays.
"All out clinics are in perfect order," he said.
But the city administrator's report disagreed. It called for a tighter administrative structure to improve the atmosphere between clinic managers and high-level management, which one source described as "poisonous." Forest Haven Official Replaced in DHR Shakeup
Clifford Hubbard has replaced Chester Jones as the acting superintendent of Forest Haven, the District's institution for the mentally retarded, following a minor shakeup in the Department of Human Resources.
DHR Director Albert P. Russo said Jones was replaced eight months after he was hired to clean up the trouble-ridden institution because of Russo's "dissatisfaction with the way he was handling his job."
Russo said he notified Jones on July 23 that he would be reassigned as a program specialist in the office of the mental health administrator in DHR. Jones was immediately replaced by Hubbard, who at the time was chief of the Medicaid services division at Forest Haven, Russo said. Hubbard's position has been filled by another Forest Haven employe, Silas Butler.
Russo said the changes were made with Mayor Marion Barry's approval.
Hubbard will continue as acting superintendent of Forest Haven while DHR conducts a nationwide search for a permanent director, Russo said.