APPALACHIA MIGHT BENEFIT FROM LOSING DRUG-SCAM DOCTORS

PIKEVILLE, Ky. - A growing list of doctors who once were welcomed into
medically underserved Appalachia have been taken away in handcuffs.

In E astern Kentucky alone, seven small-town doctors are in prison or on
their way there for illegally p rescribing powerful narcotics such as Oxy
Contin. At least six others have been arrested in the hills of West
Virginia, Virginia and southern Ohio.

Advocates for the mountain region say the loss of so many doctors ordinarily
would have left a void. In these cases, they say, the departures can only
improve medical care.

"As badly as we need more physicians, we certainly don't need the type that
will violate their oaths and do much more harm than good," said Ewell
Balltrip, executive director of the Kentucky Appalachian Commission.

Federal and state law - enforcement agencies began cracking down on wayward
physicians in Appalachia in 2000 after OxyContin, a powerful painkiller
intended for cancer patients and others suffering from severe pain, began
showing up in large quantities on the black market.

The first E astern Kentucky physician arrested in the crackdown - Dr. Ali
Sawaf, 61, of Harlan - turned to illegally prescribing OxyContin and other
painkillers after he lost his $250,000-a-year job at a regional clinic.

Assistant U.S. Attorney Roger West said at the time that Sawaf was desperate
for money and had opened an office in a Harlan mall where he handed out
prescriptions almost as quickly as he could write them.

The latest physician to plead guilty, Dr. David Procter, 52, of South Shore,
traded painkillers for sex. He admitted to a federal judge that he had
sexual relations with two female patients after he got them hooked.

Assistant U.S. Attorney Pat Molloy said most of the doctors caught in the
past two years had been recruited to help care for rural residents.

"They may not have stepped over the line before they got here, but clearly
they were corruptible," Molloy said. "I don't think they were of high moral
character when they got here."

The problem is not confined to Appalachia.

Dr. Dudley Hall, a physician from Bridgeport, Conn. , was nicknamed "Dr.
Feelgood" by police for writing so many prescriptions for Oxy Contin and
other painkillers. Hall was convicted last year on 22 counts of illegally
prescribing a narcotic substance and 14 counts of illegally prescribing a
controlled substance.

In Milton, Fla., Dr. James Graves was convicted of manslaughter in the Oxy
Contin overdose deaths of four patients. Graves was the first doctor in the
nation to be convicted of manslaughter or murder for OxyContin deaths. He
testified that he was unaware that patients were abusing the prescriptions.

Authorities blame the abuse of Oxy Contin for scores of overdose deaths in
the Appalachian region and beyond.

If taken properly, the drug's ingredients are released slowly into the body.
But abusers circumvent the time release by crushing the pills and inhaling
or injecting the powder to get the same kind of euphoric high that heroin
brings.

Larry Bailey of Grayson, Ky., said he believes his son, who became hooked on
painkillers and died from an overdose, would still be alive if unscrupulous
doctors had not been so willing to feed his addiction.

At first, his son, Paul Bailey, 35, had a legitimate need for medication to
ease severe back pain. The last time he visited Dr. Rodolfo Santos of South
Shore, he left with prescriptions for painkillers, tranquilizers and muscle
relaxants. It was a combination of those pills that killed him .

So when Santos went on trial for overprescribing drugs, Larry Bailey sat
quietly in the courtroom day after day, hoping the doctor would be convicted
on the charges. Santos was convicted last month, making him the seventh
doctor in E astern Kentucky to be sent to prison .

"Being angry doesn't solve anything," Larry Bailey said. "But I was thrilled
to see him being put out of business. My son tried to break the addiction.
He had moved himself into a treatment center at Ashland, and did well for a
few months. The desire came back, and he could get drugs freely from
Santos."

A jury recommended that Santos, who was recruited to work in E astern
Kentucky, serve 16 years in prison. He could be eligible for parole in a
little more than three years.

Procter, the physician who owned the clinic where Santos worked, pleaded
guilty in April to one count of conspiracy and two counts of illegally
prescribing controlled substances. Procter faces 10 to 12 years in prison.

To attract more doctors to rural Appalachia, leaders pushed for and received
a medical school. The Pikeville College School of Osteopathic Medicine will
have graduated 168 doctors as of this month.

The idea is to ease the shortage of primary-care doctors with homegrown
physicians.

Dr. John Strosnider, dean of the Pikeville college, said the new doctors
will immediately begin to narrow the physician-to-patient ratio, easily
replacing those who have been sent to prison.

"Those numbers I don't even worry about," he said. "If we have physicians
who are unethically writing prescriptions and selling narcotics, they're not
practicing medicine anyway."

The first 53 graduates are scheduled to complete residency training in July
of next year, at which time they wi ll be opening offices throughout E
astern Kentucky.

"Five years from now, we should see hundreds of new primary-care doctors in
these communities," Strosnider said.