LEGAL DRUGS, LETHAL ACCESS

Improperly prescribed pain medicines result in deaths, little
discipline for doctors

Daryl Collie lived with pain most of his life.

The Milwaukee man, who worked as a cook and waiter, fractured a
vertebra in a car accident when he was a teenager and never fully recovered.

In April 2005, Daryl's father, Alfred Collie, found his 35-year-old
son dead. Near Daryl Collie's body were bottles for seven kinds of
pills prescribed by several doctors, according to the medical
examiner's report.

Daryl Collie overdosed on a combination of painkillers oxycodone and
diazepam, the report says. Daryl Collie's other prescriptions included
more painkillers, anti-depressants and anti-anxiety drugs. He also was
drinking vodka shortly before he died.

Alfred Collie said he knew his son took prescription pain medications
but had no idea Daryl Collie was abusing them.

"I figured he's got a doctor that he trusts and relies on," he said.

What he had, though, was a host of doctors with troubled pasts.

Daryl Collie's primary doctor had struggled with addiction herself and
would later go to prison for selling prescriptions in a department
store. Another doctor was flagged by investigators for prescribing
huge amounts of addictive painkillers. A third had been targeted by
law enforcement for his prescription-writing more than a decade before.

Authorities agree there is a fine line between the legitimate
treatment of pain and improperly prescribing drugs. When doctors cross
it, they almost always avoid criminal charges and often keep their
medical licenses. Yet for their patients, the consequences can be
grave: prison, addiction and even death.

"What defines a physician is that they're acting solely for the
benefit of the patient," said Scott Fishman, president of the American
Academy of Pain Medicine. "When that is no longer the case, they're no
longer a doctor. They're a drug dealer or a criminal."

Unlike other street drugs, addictive narcotics such as OxyContin can
hit the streets two ways: either someone steals them or gets a
prescription, said Milwaukee police Capt. Timothy Burkee of the vice
control division.

"These are not things that Bubba can make in the garage or basement,"
he said.

OxyContin is a painkiller that addicts snort for a heroin-like high.
It is meant to be absorbed by the body over 12 hours. Crushing and
snorting it delivers all of the medication at once. Its generic
equivalent, oxycodone, is also addictive but has a lower street value.

In Milwaukee, authorities say they saw abuse of the drugs spike about
five years ago. Prescription painkillers have been in the news again
lately, with the revelation that actor Heath Ledger died in January of
an accidental overdose of prescription drugs, including oxycodone and
diazepam.

Three of the doctors who wrote prescriptions for Daryl Collie - Robin
Ferron, Marc L. Smith and Robert J. Wetzler - have been repeatedly
sanctioned by the state's Medical Examining Board in connection with
other cases. Only Ferron has lost her license.

Michael Berndt, attorney supervisor in the enforcement division at the
state Department of Regulation and Licensing, said that when a doctor
practices badly, the board's goal is rehabilitation, not punishment.

"Poor medical practice doesn't mean a criminal violation," he said.
Rarely prosecuted

Area physicians are almost never criminally convicted for incorrectly
prescribing OxyContin and other potentially dangerous drugs.

In fact, they're almost never prosecuted. Over the past seven years,
the Milwaukee County district attorney's office has not charged a
single doctor with the crime, according to Assistant District Attorney
Mark Sanders.

The U.S. attorney's office for the Eastern District of Wisconsin,
which covers 28 counties including Milwaukee, has investigated three
cases since 2000. Only one resulted in a conviction. Another doctor
paid civil penalties but avoided criminal charges. A third was charged
but found incompetent to stand trial.

"Trying to balance the appropriate treatment of pain versus the damage
that can be done by addiction is hard," Sanders said. "These cases
require tremendous amounts of time and resources."

Ferron, 51, was convicted on a federal drug dealing charge in December
2006 and is serving a three-year prison term. Court records indicate
that she continued to see "numerous" patients after being sanctioned
by the medical board. Just two are named in the records. Daryl Collie
is not one of them, but records indicate that she wrote him more than
20 prescriptions for painkillers, anti-depressants and anti-anxiety
drugs over an eight-month period shortly before his death.

"He was my life," said Alfred Collie, who raised his son alone from
the time Daryl Collie was 12. Back then, the two played baseball and
went to high school football games. As Daryl Collie got older, he
often put his culinary skills to work for his father, whipping up
stuffed hamburgers, barbecued chicken and homemade pizza.

"I'm fighting to stay alive now that he's gone," Alfred Collie said.

Ferron declined to be interviewed. Her attorney, Randal Arnold, called
his client "a very capable and caring doctor who should be allowed to
return to practice when she can safely do so."

In 2003, Ferron, who had a long history of substance abuse, was
convicted of bank fraud. She was sentenced to six months in prison but
was allowed to keep her license, according to medical board and court
records. When Ferron was released, the board allowed her to keep
treating patients as long as she continued with substance-abuse
treatment and screenings and regularly reported her progress. Within
three months, she had failed to live up to the conditions, and her
license was suspended in December 2004.

After that, Ferron began working with another doctor, Jerry Yee of
Wauwatosa, according to court records. At first, Ferron consulted with
Yee, and he wrote her patients prescriptions for medications such as
OxyContin, Percocet and Vicodin. Yee told authorities he grew
concerned about the large numbers of patients and prescriptions and
told Ferron he could no longer work with her.

Even so, Yee gave her a pad of signed, blank prescriptions, he told
police. He said he did it because Ferron complained that her patients
would suffer withdrawal.

Assistant U.S. Attorney Matt Jacobs, who prosecuted Ferron, said he
was able to make the case largely because of what happened next: On
Dec. 16, 2005, Ferron was captured on surveillance video placing some
of those prescriptions, which she wrote for OxyContin, on a stack of
shirts at a Kohl's department store in Brookfield. A man took the
prescriptions and handed her a wad of cash.

Yee is under board investigation in connection with Ferron's case, his
attorney confirmed. It's not the first time. He was sanctioned by the
medical board for improper prescribing in 1990.

Yee declined to comment. The attorney, Pat Knight, said many patients
can't afford pain specialists, which leaves family practitioners such
as Yee struggling to navigate a complex, new field.

"You get a lot of regular neighborhood practitioners that are being
held to standards that didn't exist not long ago," he said. 12th victim

Nationwide, prescription painkillers such as oxycodone are more likely
to cause overdose deaths than heroin or cocaine, according to a study
released last year by the federal Centers for Disease Control and Prevention.

But the traditional methods used to investigate drug crimes are
ineffective when it comes to prescription drugs - even when doctors
can be linked to fatal overdoses.

Street drug dealers often get busted because they can't explain where
their money came from. In prescription cases, however, doctors are
able to charge for office visits, which enables them to account for
large amounts of cash. Doctors can claim they trusted patients'
reports of pain and didn't know they were addicted or faking, claims
that would be ludicrous if uttered by a crack dealer.

There also are no hard-and-fast rules for how much of a certain drug
is too much for a given patient, because each person's body has its
own way of metabolizing the chemicals, said the American Academy of
Pain Medicine's Fishman, a physician.

Most people will not become addicted to painkillers, but they might
need more of the drugs over time to allow them to function, he said.

"If people are abusing these drugs, they don't function," he said. "If
they use too much, they get side effects. If someone comes into my
office and they're sleepy and unable to walk and they say, 'This is
the best I've ever felt,' this is not treatment success."

Many doctors simply have not been well-educated on how to manage pain,
so they make mistakes, he said.

To differentiate between a mistake and a crime, prosecutors have to
demonstrate that a doctor's actions fall outside legitimate medical
practice, which is a difficult standard to meet, Jacobs said.

Federal authorities were unable to meet that standard during an
investigation of Richard I.H. Wang, a clinical pharmacology specialist
linked to 11 overdose deaths in Milwaukee and Waukesha counties
between June 2000 and April 2004, according to a search warrant. Six
were Wang's patients. Authorities said some of those patients were
selling or sharing pills, resulting in five more deaths.

Before the federal investigation started in April 2004, the state's
Medical Examining Board had dismissed five complaints against Wang
without discipline, according to Berndt, of the Department of
Regulation and Licensing. A pharmacist also said he had called the
state about 10 times over the years with concerns about Wang's
ever-increasing numbers of prescriptions.

At the beginning of the three-year investigation, Wang agreed to stop
prescribing certain drugs, according to court records. He kept his
license.

Onetime Milwaukee mayoral candidate Sandy Folaron and her husband,
John, consider their son to be Wang's 12th victim.

John R. "JR" Folaron committed suicide in June 2004. JR Folaron was a
motivated kid and an Eagle Scout, according to his parents. As a
teenager, though, he rebelled, dropping out of high school and getting
a job in construction. A knee injury at work led to surgery. After
that, he sought pain treatment from Wang.

At one point, Wang was prescribing between 300 and 400 pills to JR
Folaron each month, his mother said. Her son had lost a lot of weight
and looked sick. He reassured his parents, saying he was under a
doctor's care.

"You grow up to believe you need to respect people in these
professions," Sandy Folaron said. "Then you realize they're just as
crazy as the next person. They're not without fault by a long shot."

By the time Wang lost prescribing privileges, JR Folaron was addicted.
His mother said the doctor did nothing to help him. With the
painkillers cut off, JR Folaron started using heroin. Within a month,
he had killed himself by drinking antifreeze. He was 24. In writings,
he blamed his addiction for his inability to go on.

JR Folaron's parents complained to federal and state authorities after
his death, while Wang already was under investigation in the 11 other
cases.

In the end, Wang wasn't criminally charged with improperly prescribing
drugs to anyone. The federal investigation against him ended in March
when he agreed to repay the federal government $509,000 in overbilled
charges to Medicare and Medicaid and to give up his license.

Wang, 83, did not return telephone calls for this report. At the time
of the settlement, the doctor said he had planned to retire anyway and
blamed patients for selling and abusing their medications without his
knowledge.

Wang's case is typical in that it took years to investigate, yet
didn't result in criminal charges.

That's a source of frustration for the Milwaukee police's Burkee.
Charging more doctors, he said, would stop others from writing
prescriptions for painkillers likely to end up on the black market.

"But those are decisions that prosecutors make," he said. "Not police
officers." Keeping their licenses

The Medical Examining Board has allowed several doctors to keep their
licenses despite repeated investigations of inappropriately prescribed
drugs - even when patients were harmed.

Marc L. Smith, a Milwaukee osteopath who wrote Daryl Collie at least
two prescriptions in 2005, first caught the attention of the board and
of law enforcement in 1993.

An undercover police officer posing as an exotic dancer went to his
office and asked for the anti-anxiety drug Xanax. She told the doctor
she was healthy but needed the pills because of her late nights on the
job, according to medical board records. Smith gave her a prescription
for 60 pills.

The woman returned to his office 2 1/2 weeks later, saying the pills
were gone because she had used some of them to come down from a
cocaine high and had shared some with a friend.

Smith wrote a prescription for 90 more pills, records say.

"There has to be a legitimate medical reason to prescribe something,"
said James F. Bohn, assistant special agent in charge of the Drug
Enforcement Administration's Milwaukee office. "If there's not a
medical reason, that's cause for a criminal investigation."

But the case against Smith stalled when the undercover police officer
returned a third time, and he said he could no longer treat her,
according to records. He was not charged.

A 1997 incident involving Smith's then-girlfriend, whom he met at the
clinic where they both worked, triggered another board investigation.
Smith and other doctors gave the woman numerous prescriptions for
painkillers, which she filled at different pharmacies, records say.

In October 1997, Smith took the woman to a hospital emergency room. At
the time, the 5-foot-3-inch woman, unidentified in board records,
weighed 91 pounds. Smith did not tell doctors about the woman's
"history of chronic drug abuse" or a previous emergency room visit,
medical board records show. She died of complications from pneumonia
eight days later.

In February 1999, the medical board suspended Smith's license for 30
days and imposed several other sanctions based in part on those two
cases. The board also determined that Smith had improperly prescribed
pain medication to other patients and had trouble diagnosing certain
conditions.

By 2002, Smith was back to the same sort of prescribing that got him
in earlier trouble, according to board records. He repeatedly
prescribed Norco (a painkiller similar to Vicodin) and other drugs to
a female patient who complained of a different problem almost every
time she came to his office. First it was an old car accident, then
another car accident. Anxiety and a fall also made the list. In some
cases, Smith prescribed higher doses than he recorded on the patient's
chart. He also did not adequately record details of her pain,
treatments or medical history, the board found.

In 2004, Smith prescribed OxyContin to a man, the man's twin brother
and the brother's wife all within the same month, according to board
records. Smith doubled the man's dose after a week and increased the
brother's dose after two days. Over a period of months, Smith
prescribed ever-increasing dosages to the three, according to medical
board records.

This time, the medical board reprimanded Smith and substantially
limited his ability to prescribe opiates. The restrictions, which were
handed down along with several others in December 2006, remain in
effect, according to board records. Smith was among the doctors who
wrote prescriptions for Daryl Collie the previous year, but no claims
of wrongdoing have been made against him in that case.

Smith did not return telephone calls.

Last year, Robert J. Wetzler, who works with Smith and who also wrote
prescriptions for Daryl Collie, gave Smith signed blank prescriptions,
which Smith used to prescribe opiates and other drugs, according to
medical board records. Some discipline

It wasn't the first time Wetzler drew the board's attention. He was
disciplined in 1991 for inappropriately prescribing the depressant
Quaalude to a female patient, according to records. The board also
limited his license to practice and to prescribe controlled
substances. The limitations were removed in 1998.

A medical board review of Wetzler's prescriptions revealed that during
April, he was the second-largest prescriber of oxycodone products in a
five-state area that includes Wisconsin. In May, Wetzler was
Wisconsin's top prescriber of oxycodone products and of methadone, a
painkiller used to wean addicts off other drugs. The findings were
based on data from 80% of the nation's pharmacies.

Oxycodone is often used to treat terminal cancer patients, who need
strong pain relief and for whom addiction is not a concern.

Wetzler's prescriptions raised red flags with the Medical Examining
Board because he does not treat a lot of cancer patients or work in a
hospice program. He also does not have any specialized training in
pain medicine, according to board records.

The fact that more than 80% of his May prescriptions of oxycodone and
methadone were paid for with cash also raised questions with the
board, because prescriptions for those drugs are almost always paid
for through insurance, according to board records.

Fearing for patients' safety, the board suspended Wetzler's license
immediately for 30 days in July and opened an investigation.

In an interview, Wetzler, a former state medical society Physician of
the Year, said he came out of retirement to open Milwaukee's Riverwest
Clinic a few years ago because there were many uninsured people in the
area who needed care.

Wetzler said he has learned a lot about how to monitor patients. The
clinic counts patients' pills, communicates with pharmacies and
conducts drug tests, he said. He employs a full-time staffer to keep
tabs on patients and has dismissed hundreds of patients for not
following the rules, he said.

His problems with the board arose primarily due to two patients who
were getting prescriptions from several other doctors without his
knowledge, he said.

"When somebody overuses medicine or uses it inappropriately, that is a
medical problem. Maybe they're still in pain. Maybe they don't know
what they're doing," he said. "When somebody puts in a false
prescription, doctor shops, or sells prescriptions, that's a legal
problem, and we are quick to turn these people over to the cops."

Wetzler said he initially referred Daryl Collie to Ferron for pain
management. At the time, he was unaware of her problems. When Ferron
lost her license, Daryl Collie returned to the Riverwest Clinic for a
short time, Wetzler said. Records confirm that Daryl Collie received
most of his prescriptions from Ferron.

Wetzler contended that Daryl Collie's abuse of alcohol was a big part
of the reason he died.

In January 2007, the medical board disciplined Wetzler in connection
with Daryl Collie, but not for improper prescribing. Instead, the
board found that Wetzler did not document Daryl Collie's care
adequately and ordered the doctor to take a course in patient-records
maintenance.

By December, Wetzler had been disciplined again, this time for
prescribing medications to his wife and sons without keeping
sufficient records. In one case, his wife ended up in intensive care
because an injection administered by her husband interacted with pain
medications other doctors had prescribed for her and with alcohol,
according to board records.

As a result, Wetzler's license was limited again. He was barred from
treating family members, except in an emergency. Like Smith, he was
ordered to submit to a skills evaluation and, if necessary, get
continuing medical education. The board also ordered Wetzler to pass
certain exams and to work under the supervision of a professional mentor.

Under another part of the agreement, Wetzler has stopped prescribing
OxyContin and other drugs like it.

That's not enough for Alfred Collie, who has written to everyone from
the police to the governor, trying to get Wetzler criminally
prosecuted for giving his son a prescription for painkillers two weeks
before Daryl Collie died in 2005.

"It's not just Daryl, it's a lot of other people's loved ones," Alfred
Collie said. "We can't bring Daryl back. We've lost him. But we can
save other children."