‘Do no harm’

OxyContin tablets are seen at Brooks Drugs in Montpelier, Vt., in this 2001 file photo. The prescription painkiller is one of several that doctors and other healthcare professionals have been accused of being responsible for diverting recently. Some of the professionals are facing disciplinary action and even jail time.

Prescription drug abuse has dominated news headlines across the state over the last several weeks and new cases are leading officials to believe that more and more cases will be filed against physicians in and around Eastern Kentucky.

Officials on both the state and federal level have been busy over the last year in taking action against a number of medical professionals, both in and around Pike County.

Several cases, involving a number of local physicians and pharmacists, have only recently come to light, causing some to be “concerned” that problem is worsening and “saddened” that more and more lives are being impacted in a negative way by prescription drug diversion and abuse.

UNITE Pike Director Jarrod Hunt said Friday that the problem may be worsening and more physicians will likely be brought the forefront with accusations of misconduct.

“It appears that more and more physicians are not abiding by the laws that they have to follow,” Hunt said. “I’m saddened by it because these physicians are members of our community. And this is one more person, one more family that is having to face this monster that all of us are facing.

“If we’re going to make a difference in our community; if we’re going to make a dent in this, then physicians are going to have to be held accountable; all prescribers are going to have to be held accountable,” he said.

Hunt’s comments come on the heels of several actions by law enforcement and medical board regulators in attempting to fight prescription drug diversion and abuse.

Over the past year, officials have had their hands full in that fight.

According to the Kentucky Board of Medical Licensure website, a total of five physicians in Pike County have received disciplinary action this year from the board.

According to KBML documents, Pikeville physician Dr. Nicholas Raschella surrendered his medical license in March after he pleaded guilty to obtaining oxycodone, Valium and Xanax  by misrepresentation or fraud. He was sentenced to three years probation in the case, the documents said.

According to an investigation into Raschella’s activities by the KBML, it was revealed that Raschella has prescribed narcotics to himself to feed an addiction to hydrocodone which developed following a car accident in 2002.

A pair of Pikeville physicians, Dr. Chadward Thacker and Dr. William T. Gaunt, were the subject of disciplinary action by the KBML this year when their licenses were suspended indefinitely after an investigation revealed the two physicians were writing prescriptions for one another.

According to an investigation by the KBML, it was revealed that both of the physicians suffered from previous medical conditions and developed a dependence on hydrocodone. The physicians’ indefinite suspensions are still active, according to the KBML website.

Those cases accompany those of other Pike physicians, including Dr. Kermit D. Gibson, who recently was restricted from “prescribing, dispensing or professionally utilizing controlled substances,” effective Aug. 15. The decision follows an investigation detailed in a KBML filing which found that Gibson prescribed large amounts of prescription pain medication and maintained inadequate medical records for patients.

Also disciplined recently was Dr. James A. Dennis, was accused of prescribing large amounts of hydrocodone to a patient without ever performing a physical exam. The prescriptions were allegedly written using several different names.

According to the investigation of Dennis, the physician prescribed more than 9,600 doses of hydrocodone over a 13 month period to the patient. The investigation was the result of a grievance filed against Dennis by a relative of the patient who found approximately 35 empty prescription bottles in the patient’s possession, KBML documents said.

Another physician, Augusto Abad, lost his license in December 2010 after he pleaded guilty to misuse of his DEA registration.

Action has not only been taken by the KBML, but also by federal authorities in the form of several indictments which, among others, targeted Pike and Floyd County physicians and pharmacists.

Those indictments included that of physician Dr. Thad Manning, pharmacist Ron Huffman and Beverly Lockhart of the Marrowbone Hometown Family Practice and Pharmacy.

According to court documents, Manning, Huffman and Lockhart — Huffman’s sister and an office manager at Huffman’s pharmacy — are accused of conspiring to sell prescription drug samples supplied to Manning by pharmaceutical representatives.

Huffman and Lockhart are also charged in the indictment with attempting to defraud Medicare and conspiracy to conduct illegal financial transactions with proceeds from health care.

Manning is also charged with lying to federal investigators, the indictment said.

Huffman died before he could answer to the indictment. Manning pleaded not guilty to the charges, while Lockhart is scheduled to appear in court on Aug. 28 for an arraignment hearing.

In a separate federal indictment, a pair of Floyd County physicians, Dr. Stephen C. Arny and Dr. Emmanuel Acosta, are accused of conspiring to distribute oxycodone, hydrocodone and Xanax along with Ray and Tina Stapleton.

According to the indictment, the Stapletons opened Paintsville Auto Accident and Recovery in Auxier for the purpose of distributing and unlawfully dispensing controlled substances. Arny, who worked for the Stapletons, prescribed “disturbing combinations of medications to almost all of his patients over long periods of time” at the clinic, a KBML investigation said.

According to the investigation, Arny prescribed controlled substances on many occasions when the use of narcotics was noted in patient charts as not being necessary in their treatment. He also prescribed the drugs without adequate examinations or documentation of examinations, the investigation said.

Arny’s actions at the clinic “demonstrated gross negligence and wanton indifference to the patients’ health” to such an extent that Arny “was no different than an ‘internet prescriber,’” the investigation said.

Arny, as a result of the investigation, was forced to surrender his medical license.

Acosta was accused of similar activities, including prescribing controlled substances in a manner in which he knew or should have known they would be used contrary to their intended purpose, the investigation said. Acosta’s actions, like those of Arny, also “suggested reckless indifference for patient health.” His medical license was suspended as a result of the investigation.

Arny and Acosta were each charged with conspiracy to distribute oxycodone, conspiracy to distribute hydrocodone and conspiracy to distribute xanax.

Tina Stapleton was charged with conspiracy to distribute oxycodone, conspiracy to distribute hydrocodone, conspiracy to distribute xanax and operating a place of for the distribution of controlled substances. Ray Stapleton was charged with conspiracy to distribute oxycodone, conspiracy to distribute hydrocodone, conspiracy to distribute xanax, operating a place of for the distribution of controlled substances and possession of a controlled substance with the intent to distribute.

The incidents aren’t only linked to local physicians, however.

The Bowling Green Daily News reported earlier this week the office of Dr. James Bridges, a Tennessee-licensed physician, was ordered to shut down by the Kentucky Board of Medical Licensure.

The Daily News further reported that the doctor’s clinic, Advanced Therapeutics, raised eyebrows with law enforcement when it began receiving customers from as far away as Pikeville.

Kerry Harvey, U.S. Attorney for the Eastern District of Kentucky, said his office is taking the problems with prescription drug diversion and abuse in Eastern Kentucky very seriously.

“Entire communities are drowning in a sea of pills,” he said.

Dr. Shawn Jones, director of the Kentucky Medical Association, said that the doctors in Kentucky who are practicing appropriately are supportive of the actions of law enforcement in dealing with those involved in the diversion of prescription drugs.

“We recognize there’s a drug problem,” Jones said. “The physicians that are practicing medicine according to the standards appropriately are 100 percent behind the efforts of law enforcement to crack down on prescription drug abuse, whether that’s the person who is doctor shopping or whether that’s a physician who is inappropriately prescribing.”

Jones said the KMA, though in support of fighting prescription diversion, does not want any new regulations which could impact the proper prescribing of medication or which could prevent doctors from properly taking care of patients.

“I don’t think that balance has been struck,” he said.

Jones said the problem with the regulations enacted as a result of HB 1 are that they are written using guidelines for physicians dealing with chronic pain sufferers and it has been applied to patients across the board.

That, he said, has put doctors in a position where they may break the law by giving their patients the proper care.

“Multiple lawyers across the state, we’ve heard, have advised clients, ‘We don’t know how to tell you to practice and stay within the confines of this law,’” Jones said. “In fact, some have said it’s practically impossible to do the right thing medically and not run afoul of the law.”

In order to truly deal with the problem, Jones said, the state must deal with the root causes of addiction.

“The cure for that is difficult: It is solving the problem of joblessness in Eastern Kentucky; it is having domestic violence being eradicated in our society, strengthening the nuclear family,” Jones said. “Those are the breeding grounds for the adult addict.”

Also, he said, in addition to punishing those who commit crimes, the state must also treat the cause of the crime, the person’s addictive behavior.

“I fear that if we ... just made it so no one can obtain a Lortab or an OxyContin in Kentucky, period, there’s heroin, there’s meth, there’s all these other illicit drugs,” he said. “If we don’t solve the underlying problem, I fear we’re just going to go from one substance to another.”

Jones said  Kentucky Attorney General Jack Conway has been quoted as saying that changes to the HB 1 regulations are needed. That, Jones said, leaves him hopeful that action will be taken soon.

Others, however, have a bit of a different assessment of the problem.

State Sen. Ray S. Jones II laid the some of the blame for the problem at the feet of medical professional regulators. Those agencies, the senator said, “have done a bad job of policing their own profession” and have forced the hand of lawmakers to address the problem.

“It’s forced us to have to strengthen the requirements (of the profession) and it’s now putting a lot of burdens on good doctors who try to do the right thing,” he said. “The old saying is, ‘A bad apple can spoil the bunch.’ Well, that’s pretty true of the medical profession.”

Ray Jones said laws such as HB 1 and monitoring systems such as KASPER are not intended to harass responsible doctors. Those that are irresponsible, he said, are the target of those initiatives.

“The vast majority of doctors are hard-working, dedicated professionals who focus on the health of their patients, but you have a few who have found a way to make easy money at the expense of a lot of heartache and suffering for those with family members addicted to drugs,” he said. “The doctors who are doing this thinking they are going to get away with it, this should be an indication there are consequences for that.”

Ray Jones also said prescription drugs are an important treatment tool to responsible physicians.

“Pain medications are important. There’s a lot of people that need that medicine,” he said. “We need to walk a fine line between cracking down on people who are abusing the ability to prescribe controlled substances and we can’t preclude people who need these medicines from getting these medicines.”

More pressure, however, may be on the way, Hunt said, but not just on doctors.

The recent actions against pill diversion cannot be attributed to one source, he said, but to several different sources. One of which, in the case of Dr. James Dennis, “individuals are getting tired of seeing prescribers abuse their office ... the trust of their license.”

“We’re tired of seeing lives destroyed,” he said, adding that communities are showing a willingness to put pressure on local and state officials to address the problem.

Hunt also said the people of Kentucky may, someday, be willing to take away the power of boards such as the KMA in regulating the industry.

“We, the people of this Commonwealth, allow the physicians, the pharmacists, the dentists, to be governed by a board of fellow providers. That’s not a right given to them, that’s something that we, the people of this state, allow to happen,” Hunt said. “If they can’t govern their membership well, then I think the people of this Commonwealth should take that right from them.”

Hunt said he agrees that the drug abuse problem in Eastern Kentucky is “an economic development and an education problem.” He also agreed that patients’ problems should be treated and not just their symptoms.

Ray Jones said the main motivator of the problem, however, is the greed of the physician.

Hunt said doctors who misuse prescription-writing privileges are “no different than any other drug dealer.”

Harvey said the U.S. Attorney’s office will continue in its partnership with agencies such as federal law enforcement and the Kentucky State Police in order to combat prescription drug problems in Eastern Kentucky.

Those who continue to participate in prescription drug diversion and trade in Eastern Kentucky, Harvey said, can be assured that his office is committed to prosecuting them.

“They are taking a great risk to their own freedom,” he said.

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