"If I didn't use before I went to class, I used when my class ended at 10," said Evans, a heroin addict.

Although BBH's house rules begin with a warning about drugs, former patient Kevin Brown said patient-managers sometimes used them in the rental housing. The state does not require BBH to test patients, and Hathaway did not respond to questions about testing.

"Absolutely, there was drug use going on" among BBH patients, said Bouldin, the former employee laid off in 2008 amid cost-cutting. "A lot of people were using in the houses. There were frequent relapses."

Former staff members said patients would vanish around the first of the month when they received public assistance checks. Anyone who missed two days of treatment was automatically discharged, but Bouldin said they would soon return, creating what she described as a constantly revolving door.

"I didn't understand how people could continue to leave the program and come back a couple days later," said Bouldin, 24. "They were going out to use [drugs]. They would come back, get detoxed and do the same thing. … I questioned it and was told treatment is cumulative and no patient is going to get it right on the first try, and we have to keep accepting them back."

Mixed reviews

Dr. Orlando Davis is a psychiatrist who worked at BBH in 2008 and last year before going to work for another area provider. He defended the center overall, including the patient relapse rate. In an e-mail he wrote: "The drug use that occurs in BBH houses around the campus and at HRC" — the Poppleton Street shelter — "is not out of line with a provider of this size."

Davis, who called BBH's diagnoses "good to very good," said "detoxes and inappropriate abstinence programs" at other facilities create their own revolving doors. He noted that hospital-based programs cost the public far more per patient than do outpatient clinics such as BBH.

Taryn Toman, 33, a licensed graduate social worker there from May 2008 until last year, called BBH "a source of hope for many individuals who had no home, no family, no income and absolutely nowhere else to turn," even if it took multiple tries.

"After a lifetime of conditioning and instability, it unfortunately takes many attempts at treatment before one becomes comfortable enough with structure — a completely foreign concept to many — before finding the strength to make a commitment to change," she said.

Sometimes temptation floated through the window. Stephen Brown, 53, a former patient, recalls being at BBH one day when someone on Pratt Street shouted, "Testers, testers!" Soon, eight or nine people ran out of therapy to get the free drug samples. The program kicked them out, he said.

"They didn't care," Brown said. "They wanted to get high."

For Chris Lubold, the heroin addict who enrolled at BBH last year, it was his first attempt at drug treatment. He'd been caught with marijuana in 2006 and a year later was charged with attempted murder. (He says he was wrongly accused, and records show that the case was dropped.) Two weeks into his intensive therapy at BBH, he says, he resumed sniffing heroin.

"I was trying," he said, "but I know for me it was hard just seeing people high, like, all around BBH." New to the area, he sought tips on where to purchase "good dope." Using $185 a month in temporary state disability assistance, he began buying drugs nearby. After getting high, Lubold would go to his BBH-provided housing on Hollins Street or head to group therapy. In two months there, he was never tested for drugs, he said.

Fire Department records show 13 calls about possible overdoses at BBH from last fall to mid-June. On Nov. 3, paramedics found a 27-year-old woman in a bathroom. A fire report said "she's been seeing demons and shadows" and had taken heroin and cocaine with prescription drugs. A month later, a 51-year-old man who had passed out in a bathroom at the Poppleton housing center reported having used heroin and cocaine 30 minutes earlier.

Hepburn said he had not heard about drug use at BBH. While relapses are to be expected, he said, "the fact it would happen on the premises of a provider, that's of great concern."

State health officials began to scrutinize BBH in May. Investigators with the Office of Health Care Quality visited BBH in August and reviewed 12 patient files chosen at random. Among other deficiencies, the records indicated that three of those patients had attended separate drug treatment sessions and mental health sessions at the same times.

Lissa Abrams, Hepburn's deputy, said Mental Hygiene Administration officials are reviewing the findings and will meet soon with Office of Health Care Quality staff. BBH has until early next month to file a plan of correction.

A separate review last year by the state's Medicaid administrator, Value Options, based on interviews with BBH staff and an examination of 20 randomly chosen patient files, yielded a favorable assessment.

Hepburn acknowledged that a better way to gauge the appropriateness of the diagnoses and treatment would be for outside psychiatrists to assess patients. But such a step is not under consideration.