Sunday, January 6, 2013

Do doctors have too much political clout? Kamala Harris protects bad doctors from public scrutiny

Doctors seem to have too much clout in government, protecting them from scrutiny. We need more oversight of doctors and less secrecy in the medical profession.

Kamala Harris has a powerful tool for identifying reckless doctors, but she doesn't use it.
By Lisa Girion and Scott Glover
LA Times
December 30, 2012

As California's attorney general, Harris controls a database that tracks prescriptions for painkillers and other commonly abused drugs from doctors' offices to pharmacy counters and into patients' hands.

The system, known as CURES, was created so physicians and pharmacists could check to see whether patients were obtaining drugs from multiple providers.

Law enforcement officials and medical regulators could mine the data for a different purpose: To draw a bead on rogue doctors.

But they don't, and that has allowed corrupt or negligent physicians to prescribe narcotics recklessly for years before authorities learned about their conduct through other means, a Times investigation found.

Prescription drug overdoses have increased sharply over the last decade, fueling a doubling of drug fatalities in the U.S. To help stem the loss of life, the federal Centers for Disease Control and Prevention recommends that states use prescription data to spot signs of irresponsible prescribing, and at least six states do.

California is not one of them.

By monitoring the flow of prescriptions, authorities can get an early jump on illegal or dangerous conduct by a doctor. Among the telltale signs: writing an inordinate number of prescriptions for addictive medications or for combinations of drugs popular among addicts.

Harris' office keeps CURES off-limits to the public and the news media. But information from a commercial database containing the same kind of data illustrates how valuable CURES could be as an investigative tool.

Private firms purchase prescription data from pharmacies and sell it to drug companies for use in marketing their products. The Times obtained a list from such a database ranking the most prolific prescribers of narcotic painkillers in the Los Angeles area for June 2008.

Of the top 10 doctors on the list, six were eventually convicted of drug dealing or similar crimes or were sanctioned by medical regulators. One of them was a cocaine addict. Some had been prescribing narcotics in high volume for years before authorities caught up with them.

At least 20 of their patients died of overdoses or related causes after taking drugs they prescribed, according to coroners' records.

Had officials been tracking the doctors' prescriptions in CURES, some of those deaths might have been prevented.

Harris, a career prosecutor who was elected attorney general in 2010, declined repeated requests to be interviewed for this article.

Nathan Barankin, her chief of staff, said Harris wants to improve CURES so more doctors can use it to identify drug-seeking patients, and to help prosecutors pursue dealers and other drug offenders.

She has not proposed using CURES to detect signs of excessive prescribing.

Barankin said financial constraints limit the attorney general's options. CURES is "on life support" because of state budget cuts and is barely able to fulfill its primary mission of helping doctors and pharmacists track patients' use of medications, he said.

Even so, the database, as is, could be used to look for signs of improper prescribing. "It certainly has that capacity, as I understand it," Barankin said.

He added, however, that if Harris did begin using CURES to monitor doctors, the state Department of Justice lacks the resources to follow up on leads.

"We don't have the horses or the ability to do that kind of work," he said.

The Medical Board of California, which licenses and oversees physicians, has appealed to the public to report instances of excessive prescribing, a step it took in response to recent Times articles on overdose deaths.

But the board does not use CURES to identify doctors whose prescribing poses a danger to patients.

"We don't have the resources," said executive director Linda K. Whitney.

Dr. Tyron Reece was one physician who would have tripped an alarm early on, if officials had been watching his prescriptions in CURES.

The Inglewood family practitioner ranked fourth among prescribers of oxycodone and hydrocodone in the Los Angeles area in June 2008, according to the commercial database. Reece's customers paid for nearly all those prescriptions in cash, the data show.

The pharmacies that filled Reece's prescriptions were required by law to report them to CURES.

But Reece was not stopped until 2011, and then only because federal authorities investigating a drug smuggling ring stumbled upon evidence that implicated him. Dozens of prescription vials bearing the doctor's name had been found in the trash at a suspect's home.

Confronted by investigators, Reece admitted that he regularly sold prescriptions for cash to patients he had never examined. He pleaded guilty to drug dealing and is awaiting sentencing.

Nathan Kuemmerle, a West Hollywood psychiatrist, was busted in 2010 after narcotics detectives arrested a suspect for selling prescription pills on Craigslist. The suspect identified Kuemmerle as the source of the drugs, court records show.

During their investigation, detectives requested a CURES report on Kuemmerle in 2009 and found that he was the No. 2 prescriber of narcotic painkillers in California and the No. 1 prescriber of the highest-dose form of the stimulant Adderall, according to court records.

Kuemmerle prescribed nearly four times as many of the Adderall pills as the next doctor on the list, the CURES report showed. A medical expert said Kuemmerle wrote an average of 15 prescriptions per day for controlled substances over a four-year period, a "remarkably high" figure, court records show.

Kuemmerle pleaded guilty in 2011 to drug dealing and was sentenced to three years' probation.

Investigators expressed amazement that Kuemmerle was able to get away with such high-volume prescribing while his prescriptions were being reported to CURES. The failure to use the database to look for signs of improper prescribing closes off a valuable source of leads, they say.

"If a doctor is prescribing in a way that could be considered unreasonable, there is nothing from CURES to say, 'This might be a problem,'" said Redondo Beach Police Det. Robert Carlborg, who worked on the case. "If there had been, Kuemmerle would have been caught way sooner."...

Debra, 54, and Jesse Barajas, 20

Amos Barajas holds his wife's driver's license and a photograph of his son Jesse as a young boy. As Jesse got older, he began abusing drugs and alcohol and stole his mother's medications, Amos said. Jesse was 20 when he died of an overdose on fentanyl, which was believed to have been his mother's. Debra died of an overdose about 16 months later at the age of 54. Amos Barajas' son, Jesse, and his wife, Debra, overdosed in their home in Goleta, where Amos still lives with the family dog. Amos Barajas lost his 20-year-old son, Jesse, then his wife, Debra, to prescription medication overdoses.

Joey Rovero, 21

Joey Rovero drove more than 350 miles from Arizona State University in Tempe to get his prescriptions from a doctor in Rowland Heights and then 33 more miles to Pacifica Pharmacy in Huntington Beach. “I thought to myself, ‘Why in the world would these kids go that much farther out of their way?’ ” said Joey’s mother, April Rovero, above, with husband Joe. The fading sun reflects off the windows of the apartment complex in Tempe, Ariz., where Joey Rovero overdosed. (Aaron Lavinsky / For the Los Angeles Times) April and Joe Rovero hold a picture of their son Joey with his birthday cupcakes. He had flown home from Arizona State University to celebrate his 20th birthday with his family and girlfriend. He was 21 when he died from a drug overdose.

Byron McKinney, 33

Byron McKinney in a family photo with his brother Clint, left. Clint McKinney's brother Byron died of prescription drug-related causes in 2008. Byron McKinney was found dead of a prescription medication overdose in this Van Nuys house.

Andrew Corless, 46

Leslie Greenberg found her boyfriend, Andrew Corless, dead in front of their Northridge home. “He was a kind and gentle soul and did not deserve this,” Leslie Greenberg said of her late boyfriend Andrew Corless. He called Dr. Carlos Estiandan’s office on Aug. 11, 2006, saying he was about to undergo drug detoxification and asking the doctor to “please not see him anymore.” Corless recanted, and Estiandan continued prescribing drugs for him. He died of an overdose months later. Greenberg said the phone call was a “cry for help.” Leslie Greenberg keeps a photo and mementos from her late boyfriend, Andrew Corless, who died at the age of 46 of acute combined medicinal drug and alcohol intoxication in December 2006.

Naythan Kenney was living in an apartment in this building in Huntington Beach when he fatally overdosed in 2008, at the age of 34. Photographs of Verlene Crawford's late son, Naythan Kenney, fill much of the space on her refrigerator. “It's sad, but I need to see his face,” Crawford said. “I don't want to forget him … or put him in a storage closet. It hurts to look at him, but I can't imagine putting everything away and not looking at him.” “A lot of people say it stems from home, drugs. No, not all of it stems from home. It takes just a prescription. Just a prescription can tear a whole family apart. And that's the God's truth,” Darlene Cronin, right, with daughter Verlene Crawford, says of her grandson Naythan Kenney.

Naythan Kenney, 34 speaking, grandmother Darlene Cronin

Kelle Stavron found her son Matthew on her bathroom floor, dead at the age of 24. OxyContin, Soma and Xanax were strewn around. Matthew Stavron was 13 when he shattered his leg in a motorcycle accident in the 1990s. He had numerous surgeries — with complications — and began abusing prescription drugs. “I mean, oh my God, how could this be? How could this be? On the street, when the kids are using...they're using, they're using. But this is a doctor. My son saw a doctor,” Kelle Stavron, with her husband, Bruce, said of their son Matthew's death.

Matthew Stavron, 24 speaking, mother Kelle Stavron

Chaz La Bry, a 26-year-old aspiring rapper from San Clemente, died of an overdose of prescription medication and methamphetamine at his parents' apartment in San Clemente. Chaz La Bry, 26, was last seen alive by his father, Randy La Bry, sleeping on the living room couch. He had recently been released from jail and had been living with his parents. Darenee La Bry comforts her mother, Robin, center, as Robin recounts the day her son died of an overdose.

Chaz La Bry, 26 speaking, mother Robin La Bry

William “Skip” Halpin was found dead in a planter outside a private business complex in the 6011 block of Ball Road in Cypress from a prescription drug overdose. “There's just something different about it. It's not heroin. It's not marijuana. It's not cocaine. It's not alcohol. They're just little pills,” Jerry Halpin, principal of Brea Olinda High School in Brea, said about his brother's abuse of prescription drugs. Jerry Halpin's older brother, William “Skip” Halpin, second from left, died of a prescription drug overdose in 2008. He was a heroin abuser who had been sober for nine days before his death and was using methadone for detoxification, according to coroner's records.

William "Skip" Halpin, 51 speaking, brother Jerry Halpin

Margaret Polizo, an occupational therapist, saw her husband Doneno “Rick” Polizo on the couch before he died in 2009. He appeared to be “sleeping and snoring.” He died of multiple drug overdose. Margaret Polizo's husband, Doneno “Rick” Polizo died of an overdose in 2009. Not only did he miss watching his son and daughter grow up, she said, but his children missed out on having him in their adult lives. Margaret Polizo holds a photograph of her and her husband, Doneno “Rick” Polizo, who had a long-term problem with heroin and other illicit drugs.

Doneno "Rick" Polizo, 58 speaking, wife Margaret Polizo

“When I look at the Medicare statements that I was given for the last three months of his life, and I look at the incredible, unbelievable number of prescriptions that were prescribed to him by five different doctors — it makes me wonder what is going on out there,” Sally Finnila-Sloane says of her brother Karl Finnila, who died of an overdose in 2007. Karl Finnila sat down on the curb and died of a prescription medication overdose on the cul-de-sac at the end of this street near a sober-living home he checked into that day. Sally Finnila-Sloane's brother Karl Finnila in a photograph taken at the sober-living home shortly before he died of an overdose.

Karl Finnila, 43 speaking, sister Sally Finnila-Sloane

Danielle Thurber keeps a photograph of her late sister, Jennifer Beth Thurber, in a wallet that once belonged to her sister, who died of a prescription medication overdose in 2007 at the age of 22. Jennifer Thurber overdosed at home in May 2007. Her father, Charles, found her in her bed, pale and motionless. Charles Thurber, an Orange County sheriff's deputy, sits with his daughter, Danielle, at a park near their home in Fountain Valley.

Jennifer Thurber, 22 speaking, father Charles Thurber

As a teenager, Alex Clyburn was an athlete and Eagle Scout. In 2006, after he suffered painful injuries in an auto accident, he became addicted to OxyContin. Alex Clyburn, 23, died of a drug overdose after being admitted to a rehab facility in 2008. "If it can happen to us, it can happen to anybody," Arline Clyburn said of her son Alex's addiction to prescription drugs.

Alex Clyburn, 23 speaking, father Ron Clyburn

Larry Carmichael filled a doctor's prescription for half a dozen pain and anxiety medications days before he fatally overdosed on March 12, 2007. He was 51. Dan Carmichael found his father, Larry, dead from an accidental overdose of morphine in this apartment complex. Larry had moved in days before his death and Dan told a coroner's investigator that he thought his father’s back might have been bothering him during the move. Larry Carmichael didn’t live to see the children of his son Dan, and daughter-in-law, Rachel.

Larry Carmichael, 51 speaking, son Dan Carmichael

“Was he a junkie? No. Was he in pain? Yes. Could he get it fixed with prescriptions? Evidently not; you have to take too many,” Ron Oshier said about his brother, Clifford Dwight Oshier, who died of a prescription medication overdose in July 2009. Clifford Dwight Oshier, who had worked as a financial planner, had lost his business and home in the months before he died, said his brother, Ron Oshier. Clifford had been involved in multiple motorcycle accidents and had developed chronic pain. Clifford Oshier died in his San Diego apartment located in this residential community atop a secluded hill overlooking Mission Valley.

Clifford Dwight Oshier, 60 speaking, brother Ron Oshier

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