Prescription For Abuse, Part 2c

DOCTORS GOT KENTUCKY LICENSES EVEN WITH HISTORY OF LEGAL TROUBLES

Two Eastern Kentucky doctors charged in the last two years with illegally
prescribing prescription drugs had legal troubles before coming to the state.

Yet the state doctor licensing agency -- which has broad discretion in
granting licenses and deciding penalties for those who violate their
profession's rules -- allowed both Steven Snyder and Fortune Williams to
practice in Kentucky.

Critics say what happened in South Shore shows that the Kentucky Board of
Medical Licensure can be too trusting. And it's evidence, they say, of the
need to do criminal background checks -- something the Kentucky board only
recently won authority to do.

"I'm beyond frustrated," said Greenup County Sheriff Keith Cooper, who
believes the agency has been slow to investigate complaints and has done
too little to keep questionable practitioners out of Kentucky.

In all, five doctors who practiced at a single South Shore clinic have been
indicted in the last two years on state or federal charges that they
illegally prescribed painkillers for thousands of addicts since 1996.

"When one doctor is locked up, there's always one willing to take his
place," Cooper said.

Earlier this year, the Kentucky General Assembly granted the licensing
board the authority to do criminal background checks. Such a check would
have enabled the board in 1996 to discover that Williams had lied on his
license application in asserting he had never been arrested. The board did
not learn of a 1987 drug arrest in California until after Williams was
licensed and was accused of further wrongdoing.

Lloyd Vest, the Kentucky medical board's general counsel, said it's a
"recurring problem" that applicants who have been charged with a crime --
but not convicted -- answer "no" on their applications when asked if they
have "been charged or been convicted."

The new law went into effect July 15, but Vest wasn't certain when the
Kentucky board will begin verifying applicants' criminal histories using
the National Crime Information Center database. Board officials are
awaiting final FBI approval and working out budget and other operational
details.

When the checks start, Vest said, "We will have the most current, most
accurate information we can get as far as a person's criminal history, and
we won't be relying solely on the good faith of our applicants."

Makingjudgment calls

But members of the medical board acknowledge that they still will be called
upon to make judgment calls about physicians' ability to put past behavior
behind them.

That's what happened in the case of Snyder, who was licensed in 1997, said
Dr. Danny Clark, president of the medical board. Though Snyder did not
fully disclose his past problems on his application, the board knew he had
been arrested in 1986 on prescription drug and weapons charges and twice
had his Indiana medical license suspended in the 1980s.

"Unfortunately, I guess that we don't always make the right decision,"
Clark said.

Snyder surrendered his license last year after pleading guilty to federal
charges that he illegally prescribed pain pills for patients, himself and
his wife.

Dr. Rice Leach, the state public health commissioner and the licensing
board member who made the motion to license Snyder, said he couldn't
remember why he did so.

"Some of these things are judgment calls," he said, and most of the time
they work out. "Every now and then, these guys don't know how to take
advantage of a second chance."

Told of the Snyder case, Dr. Sidney Wolfe, director of Public Citizen's
Health Research Group, said the board should have acted more forcefully
when it discovered he had made misstatements about his past. Wolfe, whose
consumer advocacy group monitors the performance of state medical boards,
said anyone caught lying to conceal a criminal record or other past
problems should not be licensed.

"It's one strike and you're out," he said. "These boards would do much
better if they got tough on those kinds of lies."

Problemsin Indiana

In January 1997, Snyder applied for a license to practice medicine in
Kentucky. Asked on the application whether he had ever been charged or
convicted of a crime, he answered "No," although in an attached affidavit,
he acknowledged that he had been arrested and jailed for three days in
Indiana on drug charges.

He'd been arrested on March 31, 1986, after a nine-month Indiana State
Police undercover investigation. At the time, he was practicing in
Milltown, Ind. He was charged in Crawford County Circuit Court with eight
felony counts of dealing a controlled substance and 10 felony counts of
issuing an invalid prescription for drugs such as Percocet, Percodan and
Valium.

Later that year, he also was charged in Crawford County with three felony
counts of owning and possessing a machine gun.

Under a pretrial diversion agreement, all the charges were amended to one
misdemeanor charge of carrying a handgun without a license, and prosecutors
agreed to dismiss that charge after one year if Snyder committed no
criminal offenses and refrained from prescribing controlled substances
during the probationary period. The charge was dismissed in September 1988.

Snyder's Indiana medical license was temporarily suspended after his arrest
but reinstated in June 1986 with restrictions, including that he not
prescribe or possess controlled substances, that he enroll in a course on
prescribing controlled substances, and that he perform community service.

Angela Smith-Jones, director of the Medical Licensing Board of Indiana,
said Snyder's reinstatement was "probationary" and a form of discipline.

Three years later, on June 13, 1989, the Indiana medical board again
suspended Snyder's license, saying that he "exhibits global ineptness."

According to the suspension order, the board's review showed that Snyder's
diagnoses were not documented by physical exams or tests and that
treatments were begun on "the thinnest shreds of evidence."

His medical practice, along with his statements in a deposition, "places in
serious question his mental and/or physical capacity to practice safely,"
the order concluded.

Snyder surrendered his license rather than contest the allegations, and
then moved to Florida, where he enrolled in a three-year postgraduate
training program in West Palm Beach.

Florida issued Snyder a license in December 1991 but placed him on
probation, citing his problems in Indiana. The probation was lifted in
October 1993.

In his application to practice in Kentucky, Snyder mischaracterized the
diversion agreement in the Indiana case, writing: "The Court subsequently
dismissed all criminal charges for lack of prosecution."

In answer to another question, about whether his medical license had ever
been suspended, restricted, placed on probation or otherwise disciplined
elsewhere, Snyder wrote that after a two-month suspension in Indiana, his
license had been "re-instated without discipline."

Clark, the Kentucky licensing board president, said he couldn't recall the
board's discussion about Snyder. But after reviewing documents in the
board's files, he noted that Snyder's trouble in Indiana "was something
that was several years old.

"He had been practicing in Florida, apparently without difficulty. Because
of that, I would assume that was why we had decided to give him a license,"
Clark said.

Asked about Snyder's statement that he had never been charged with a crime,
Clark said, "He should have answered the question differently and we should
have picked up on the fact he didn't."

Three board members voted to deny Snyder a license, including Dr. Preston
Nunnelley of Lexington. In an interview, Nunnelley said he didn't recall
his reasons, but added, "When you see people get in trouble in a couple
different states, that's always a red flag."

Armed with his Kentucky license, Snyder in 1999 began practicing in a South
Shore clinic owned by Dr. David Procter, who has been indicted on charges
that he conspired to distribute prescription drugs.

In entering his guilty plea in federal court last year, Snyder admitted
unlawfully prescribing more than 30,000 tablets of pain pills between
February 1999 and August 2000, when he was practicing in Procter's clinic
and at another he opened in South Shore after a dispute with Procter.

Earlierdrug charge

When the Kentucky licensing board considered Dr. Fortune Williams' May 1996
application to practice in the state, it didn't know he had been charged in
May 1987 with possession of a narcotic controlled substance in California,
where he'd been practicing.

The charge was dismissed, but Williams, like Snyder, falsely answered "No"
when asked on his Kentucky license application whether he had been charged
or convicted of a crime.

He was granted a license.

The charge was not discovered until last year, when the state attorney
general's office was investigating Williams for allegations of excessive
prescribing of controlled substances at a clinic he had opened in Lewis County.

Based on the false statement on his application and the allegations, the
board last year suspended Williams' license and issued a complaint, the
start of disciplinary proceedings.

Williams has been indicted by a Lewis County grand jury on four felony
counts of unlawful prescribing of a controlled substance. He has pleaded
innocent and is awaiting trial.

The Federation of State Medical Boards has recommended that every state's
doctor licensing agency perform criminal background checks on applicants to
catch those who attempt to hide their pasts. But as of April, boards in
just 13 states, in addition to Kentucky, were authorized or required to do
background checks, according to the federation. Three of them were checking
only for in-state crimes.

Indiana is among the states without the authority to do checks.

In Florida, which began criminal background checks in 1997, 3 percent of
doctors licensed between 1997 and 2000 had criminal histories, and almost
half of them had failed to disclose that fact on their application,
according to the federation.

"Lying to a medical board is not an uncommon kind of occurrence," said
Wolfe, the consumer advocate.