Should Prescribing Doctors Be Held Responsible When Their Patients OD and Die?
In Florida, a state where more than seven people a day die from prescription drug overdoses, pill mills disguised as pain clinics - where addicts and dealers can procure stockpiles of meds like OxyContin, morphine and Xanax legally from registered physicians - are popping up as fast as police can knock them down. The reason that this relatively new societal cancer has spawned is as simple as pinpointing the middle man of supply and demand: cash.
Christopher George was handed more than 17 years in prison for his crimes after admitting to running some of South Florida’s most lucrative pill mills, pocketing a reported $40 million in the process. Though he had over three years shaved off his sentence for cooperating with prosecutors to bring doctors from his clinics to justice, US District Judge Kenneth Marra, who presided over the case, painted an unapologetic picture of George. “He was proud of what he did,” Marra told the court. “He was just upset that he got caught.”
Two of the doctors that worked at George’s clinics, Cynthia Cadet and Joseph Castronuovo, were recently cleared of prescribing drugs that contributed to the overdose deaths of eight patients and charged only with money laundering. Cadet received six and a half years and Castronuovo 18 months. Both are appealing their respective sentences but are expected to report to prison before the year is out.
The story and subsequent criminal trials played out like Pain & Gain, with as many sick twists and more bodies, drugs and drama. George starred as the Daniel Lugo of the South Florida pill mill game and his brother Jeffrey, who is serving time in federal prison for his role in the conspiracy and second-degree murder after a customer of one of brothers’ clinics died of an overdose, played the Adrian Doorbal.
The millions were stacked in garbage bags and video showed security guards yelling at patients not to shoot up in one of the clinic's waiting rooms. The investigation was headed by the FBI, DEA, IRS and a number of local law enforcement agencies. Of the 33 people, mostly doctors, caught up in the web, most took plea deals and got off free of charge. Sadly, the story was not an isolated incident. Clandestine pill mill ventures continue unabated in Florida and throughout the country.
Two years ago, a Los Angeles Times investigation found that drugs prescribed by doctors contributed or caused almost half the prescription overdose deaths in Southern California in the period leading up to the study. The investigation examined 71 doctors who had prescribed drugs to three or more patients who died from drug overdoses over a five-year window and found that four of the physicians had written scripts for 10 or more patients who died of ODs. Frighteningly, one of the doctors the Times identified was Van H. Vu, who had written prescriptions for 16 patients who died from drug overdoses.
Dr. Vu’s story is a case in point - a sad example of the dire relationship between criminal behavior and doctors, doctors and patients, patients and drugs and, ultimately, drugs and death. Last month, California medical authorities announced they were seeking the suspension of the doctor’s license. In a 15-page complaint, Vu is accused of corruption, incompetence and negligence, among other infractions.
The complaint against the notorious pain management specialist implicated him in the death of three patients, including that of 21-year-old Jennifer Thurber who passed in 2007 from an opiate overdose. According to the allegations, Vu stated that Thurber was not sedated as a result of the medication and he continued to prescribe her pain pills for a back injury, despite contradictory reports that the young woman was lethargic and incoherent.
An investigation similar to the one conducted by the LA Times was recently completed by the Centers for Disease Control and Prevention and published last month by The Journal of the American Medical Association. In addition to finding that the lead source of prescription drugs for addicts was doctors, the study also pushed for a renewed focus on dealing with doctors deemed problem prescribers.
Asked what could be done to remedy the issue, Dr. Len Paulozzi, medical officer at the CDC’s Center for Injury Prevention and Control, offers a concise solution by way of an existing program. He believes prescription drug monitoring programs are the most efficient and effective way to examine and, thus, control the prescribing behavior of doctors by the collection and filing by state pharmacies of every script that gets written.
“By looking at that information you can identify prescribers who have a lot of patients seeing multiple prescribers in their practice; you can identify the doctors who are prescribing at very high daily dosages,” he says. “That is a good way to do surveillance on the state level.”
The CDC study found that doctors were the most common source for people who had taken pills at least 200 days out of the last year, accounting for 27.3% of the cases. The streets and medicine cabinets were, of course, still a lead source, as family members and friends made up 26.4% and drug dealers 15.2%. What the results show, Paulozzi points out, is that the high-risk users most likely to overdose from prescription medication are most reliant on doctors for the drugs they use to live and, in some cases, abuse to die.
Other findings of the study were that rehab admissions increased, emergency room visits were up and overdose deaths from prescription medication multiplied dramatically. All of the revelations point to a disturbing trend: the issue seems to be getting worse, not better. As for the important question of whether doctors should be tried when their patients die of overdoses from prescribed meds, Paulozzi believes that answer needs to be determined on a case by case basis.
“Some doctors, for example, may only be seeing patients with chronic pain and addiction. In that population of people, who may be using a prescription as well as illicit drugs, the mortality rate may be quite high,” he says, concluding: “If there is a clear violation of law or fraudulent behavior, then I think prosecutions are appropriate.”