Prescription For Abuse, Part 1A

FIVE DOCTORS AT CLINIC ALLEGEDLY FED ADDICTIONS

SOUTH SHORE, Ky. -- On Sept. 26, 2001, a South Shore doctor prescribed a
painkiller, a tranquilizer and a muscle relaxant for Navy veteran Paul Bailey.

There were so many painkillers -- 180 -- that a pharmacist had to divide
the tablets between two bottles.

The next morning, Bailey's wife found him dead of a drug overdose in their
trailer in Grayson. He was 35.

Federal and state law enforcement officers allege that Bailey was one of
thousands of drug abusers whose addictions were fed by five doctors who
practiced at various times since 1996 in a clinic in tiny South Shore that
is owned by Dr. David Procter.

Bailey's doctor, Rodolfo Santos; Procter; and the three other doctors have
been indicted on state or federal charges that they illegally prescribed
prescription drugs at Procter's clinic and at offices that three of the
doctors opened in the area.

South Shore is an Ohio River town in Eastern Kentucky that has just 1,200
residents and two sets of stoplights, but three drugstores. Law enforcement
officials allege that because of an easy supply of drugs and the town's
proximity to other states, patients came to Procter's clinic from more than
100 miles away -- from Ohio, West Virginia, Indiana and as far as Michigan.

And at least nine of them died of overdoses in the last several years,
according to the federal Drug Enforcement Administration and the Greenup
County coroner.

"Those pills, it's like they just took over his life," Bailey's wife,
Fiona, said recently as tears welled in her blue eyes. "And these doctors,
as long as he had the money . . . they'd give him whatever he'd want."

Prescription drug abuse is a nationwide problem, but in Eastern Kentucky,
the excessive use of painkillers and tranquilizers -- widely called "nerve
pills" -- is fostered by the region's poverty, joblessness and despair.

Some abusers start using drugs for legitimate pain, while others favor
prescription drugs over illicit drugs because they don't need to buy them
in street deals or burglarize drugstores, said Tony King, resident agent in
charge of the DEA office in Louisville.

Instead, they become "doctor-shoppers" -- addicts who visit several doctors
and pharmacists, often on the same day, to get multiple prescriptions.

Procter's South Shore practice, and other clinics it spun off like
fast-food franchises in South Shore, Garrison and Paintsville, were
allegedly the major suppliers in northeastern Kentucky, according to Cliff
Duvall, commonwealth's attorney for Greenup and Lewis counties.

"Why steal it? Just go in and get it from the doctor," Duvall said.

One of the doctors who worked for Procter, Steven Snyder, has pleaded
guilty and surrendered his medical license. He is cooperating with federal
prosecutors and told the DEA after his arrest that at Procter's direction,
he wrote prescriptions for controlled substances 10 to 12 hours a day,
according to records of the Kentucky Board of Medical Licensure.

Procter, 51, and the other three doctors indicted during the past two years
- -- Drs. Santos, Frederick Cohn and Fortune Williams -- have pleaded
innocent and are awaiting trial. A federal grand jury also indicted two of
the clinic's former office managers -- Nancy Sadler and Mary Katherine
Dials -- this summer on charges that they conspired with Procter to
distribute controlled substances. Both pleaded innocent and are scheduled
to go on trial April 23.

Procter arranged for other doctors to work in his clinic after a car
accident in November 1998 that impaired his memory, according to court
records. He testified last year in a lawsuit he filed over the accident
that he had contracts with multiple companies to supply temporary doctors.

Procter's lawyer, Tracy Hoover, said his client was "incapacitated and
mostly at home" after the accident, although he acknowledged that Procter
still went to the clinic.

He said Procter did not act as office manager, did not hire and had no
control over the temporary doctors.

"He did not tell them to do it this way," Hoover said. "He did not allow
them to do it this way."

South Shore's location, across the river from Ohio and just downriver from
West Virginia, made it an ideal place for addicts seeking to visit doctors
and pharmacies in different states to avoid detection.

Belinda Rose was a billing clerk for Procter from 1995 to 1997, when the
clinic was on U.S. 23, about a mile east of its current location.

"You'd pull in the office, and the lot would be full, and down the alley
you would turn in, there would be cars all down the road," she said. "He'd
see so many people in a day's time . . . you'd get back from lunch, there'd
be 10 people waiting on you."

After the clinic moved in November 2000 to the South Shore Plaza shopping
center, the center's parking lot became an open-air drug market, according
to Greenup County Sheriff Keith Cooper and merchants.

"They brought coolers," said Peggy Webb, manager of a discount store in the
shopping center. "You'd see them eating sandwiches on top of their car. It
was unbelievable."

Some who would come into her store said they were from as far away as North
Carolina; Tennessee; Columbus, Ohio; and Louisville, she said. "They would
tell us they had been on the road for two hours to come up here and see the
doctor."

Webb said some patients would shoplift. Others would buy a single plate.
She recalled once seeing a carload of girls parked outside her door,
snorting crushed pills off dishes.

"I lost my local customers," said Webb. "They were afraid."

The DEA led an investigation of the clinic and was assisted by the
federally funded FIVCO Area Drug Enforcement Task Force, an agency based in
Ashland that investigates drug cases in five counties.

"Law enforcement agents and officers determined that thousands of
pharmaceutical drug addicts in Northern Kentucky and Southern Ohio were
being provided controlled substances through the activities of Procter" and
two of his office managers, Robert Jessie, the FIVCO task force project
director, said in a statement July 15, the day Procter and the office
managers were indicted.

Law enforcement officials say hydrocodone, sold under brand names such as
Lorcet, Lortab or Vicodin, is the most commonly abused prescription drug in
Kentucky. The state has ranked third nationally in per capita use of the
painkiller for the last 10 years, according to Mark Caverly, diversion
group supervisor in the DEA's Louisville office. Consumption of the drug
per person in Kentucky is almost twice the national average.

In 2000, nine of the state's top 10 counties for per capita hydrocodone use
were in Eastern Kentucky.

Greenup County, where South Shore is located, ranked second.

According to court records, Santos told a DEA agent after his arrest in
June that the community was "the most worst area in the nation" for drug
addicts.

"The patients cannot go without the narcotics; not for pain but for
withdrawals," Santos said. "I tell them they don't need the medicine, the
patients are told to go to rehab."

Procter faced past troubles

A native of Vancouver, Canada, Procter was one year out of medical school
when he came to South Shore in 1977 to work for another doctor. Two years
later, he opened his own clinic on Main Street. It has moved several times
since then and operated under various names, most recently Plaza
Healthcare. It's now closed.

Rose said that when she left in 1997, the clinic was charging $45 for an
office visit; that had almost doubled by this year, when patients were
required to pay in cash.

A sign still hanging inside the front door of Plaza Healthcare says in red
letters: "Initial office visit $120.00. Follow-up visit $80.00."

The clinic generated an annual income for Procter of $450,000 in 1997,
according to a credit application he filled out that year.

But two years later, in 1999, the medical licensure board suspended
Procter's license and issued a formal complaint, alleging that in 1996 and
1997, he had engaged in oral sex with two women patients after sedating
them, and repeatedly had sexual intercourse in his office with a third
female patient for whom he regularly prescribed controlled substances.

After reviewing the medical records of more than 60 of Procter's patients
in 1996-98, a board consultant wrote that Procter prescribed excessive
amounts of controlled substances. Patients were prescribed as many as 200
pain pills a month for several years, an average of seven a day, according
to board records.

"I do not believe that Dr. Procter's activity with his patients constitutes
the practice of medicine," the consultant wrote. "I believe it constitutes
the prescription of controlled substances for symptomatic relief over
extended periods of time."

Procter denied engaging in sexual acts with the three women and disputed
the consultant's conclusions, but he surrendered his license in August 2000.

He had already stopped practicing after his accident and was using
temporary doctors to staff his clinic. In a deposition taken as part of the
lawsuit he filed over the accident, Procter said 10 to 12 physicians had
worked in the office since the accident.

Some stayed only a day or a week before leaving because they were
uncomfortable with what they were asked to do, said the DEA's King. Others
stayed long enough to draw the attention of law enforcement and the
licensure board.

Board consultants who examined portions of the indicted doctors' clinic
records from 1996 through earlier this year found that most included no
diagnosis or other explanation for why patients were prescribed large
quantities of narcotics, according to the board's records.

In most cases, there was no indication that the indicted doctors had
conducted more than a cursory physical exam or sought to discover and treat
the underlying source of patients' supposed pain, the records showed.

One clinic encounter is detailed in a FIVCO task force report filed in
Greenup Circuit Court. It says Mary Reed of South Shore posed as a patient
and wore a hidden recording device during two visits to Santos last spring
that were monitored by the FIVCO task force and DEA investigators. In the
first visit, on April 23, Reed showed Santos "normal" X-rays she had been
given by investigators, according to the report; Santos said they looked
fine and asked Reed whether she had any pain.

"He never checked me at all," Reed wrote in a statement accompanying the
report. "Santos ask me a lot but he gave me the (answers) as well. Santos
had me to lift my legs and told me 'there was pain' but there was not."

Santos told Reed that she should take only ibuprofen for her pain, because
five people had died from taking stronger prescription pain pills, she
wrote in her statement. But he nonetheless gave Reed prescriptions for the
painkiller Lorcet -- "he told me that he knowed that I needed them so he
would give them to me" -- and for Xanax, a tranquilizer; and Soma, a muscle
relaxant.

Reed returned on May 23 and Santos wrote her prescriptions for the same
medications, according to the FIVCO report. Reed could not be located for
comment.

Patients typically left Procter's clinic with prescriptions for Lorcet or
Lortab, both forms of the painkiller hydrocodone; Xanax; and Soma,
according to licensure board and court records. This drug cocktail is
favored by addicts because of the euphoria and carefree feeling it produces.

"All three of them would definitely go to make you feel dizzy, make you
feel good and make you feel less pain," said Robert Rapp, a University of
Kentucky professor and associate director of the UK Hospital's pharmacy
department.

For abusers, the drugs have an additive effect, he said. "If one's good,
two's better, three's greater."

Only in rare cases would the drug combination be appropriate for a patient,
Rapp said, and even then, it would be needed for less than a week. Only
cancer patients should take potent pain pills over a long period, he said.

Yet Procter and the four other doctors who were indicted routinely refilled
prescriptions for this combination of drugs, according to licensure board
and court records.

Procter apparently was still involved in the clinic after his accident and
after surrendering his license. Terry Fyffe, an Ashland accountant who had
to go to a nearby clinic for tests during two weeks in 2000, said that
through the lobby window, he would see patients park behind Plaza
Healthcare, where Procter would let them in a back door.

Santos told a DEA agent in June that Procter was the clinic's office
manager and signed his paychecks.

Crime blamed on abusers

In South Shore, officials blame prescription-drug abusers for an increase
in shoplifting, break-ins, robberies, bad checks, medical-record forgery
and drug cases in the last two years.

Two of the town's three pharmacies -- South Shore Drug Store and Wright
Pharmacy -- are being investigated by the DEA, according to the FIVCO drug
task force's statement in July and federal court orders allowing the DEA to
inspect and seize the pharmacies' records.

South Shore Drug Store is in the same shopping center as Plaza Healthcare.
Iron bars cover the front door of the pharmacy, and an armed guard sits inside.

Cooper, the sheriff, said people openly sold and traded drugs in the
parking lot, with Lorcet going for $7 or $8 a tablet and Xanax for $5. The
openness of the alleged drug abuse "dumbfounds everyone," he said.

"A lot of them will get a prescription, sell enough of them to pay for the
(prescription) and the doctor's call, then eat the rest of them," he said.

Elizabeth Madden, a nursing assistant for another South Shore doctor, said
that as she walked out of South Shore Drug Store one day, "this van door
slides open and this man says, 'I'll take every Lorcet you've got. I
couldn't get in to see the doctor today.' "

In some instances, "hustlers" drove acquaintances to the clinic, according
to law enforcement officials. The hustler would pay for the visit and to
fill the prescriptions at a drugstore, and in return, would get most of the
pills. Some worked on their own and kept the drugs for personal use, but
others were part of organized rings, with four or five recruiters working
for a higher-level dealer, said Cooper, adding, "It's like a cottage industry."

Last year, the sheriff's department videotaped a plainclothes detective
making drug buys in the parking lot, leading to 10 arrests, Cooper said.
And during one eight-week period earlier this year, his deputies arrested
73 people on various drug charges as they were leaving the parking lot.
Most were from out of state.

"We'd lock them up by the scores, and practically every one of them had a
big bottle of Lorcet and a big bottle of Xanax," he said. But with just 12
deputies to patrol the entire county, Cooper said his department couldn't
stop the trafficking. "They just keep coming back," he said.

Duvall, the commonwealth's attorney, said the circuit court's docket
increased almost 25 percent last year because of cases stemming from
prescription-drug abuse. "I can foresee a situation where we are going to
need another judge just to handle all the criminal cases that we have," he
said.

Deaths linked to doctors

Last November, Thomas O. Morris, then the coroner in Scioto County, Ohio,
across the river from South Shore, wrote a brief letter to the Kentucky
medical board. "Today, November 29, I had the unfortunate duty of
pronouncing dead a Jeff Riley," he wrote, informing the board that Riley, a
42-year-old resident of Portsmouth, Ohio, had died of an overdose of
tranquilizers prescribed by Santos.

"This is a familiar pattern to us and warrants your attention," he concluded.

In an interview from his home in California, Morris recalled that when he
was coroner in Ohio, he would ask rescue workers and police who had written
the prescription for pills found in the homes of overdose victims.

"I kept hearing this name (Santos), a few times, which is too many for
people living in Scioto County," Morris said. "It seemed odd to me," he
added, that so many people were leaving that county, with more than 100
doctors, to see a doctor in South Shore.

Morris said he couldn't recall how many overdose victims had been Santos'
patients, but earlier this year, the DEA informed the Kentucky medical
board that seven patients seen by Santos and other doctors at Plaza
Healthcare had died of drug overdoses during the previous year. The death
certificates of two of the seven list the cause of death as natural causes
- -- not an overdose -- but King, of the DEA, said the agency has reason to
believe both involved overdoses.

In addition, Greenup County Coroner Robert Greene said two county residents
died of drug overdoses about two years ago after getting prescriptions from
Procter's clinic, though he wasn't sure which doctor was involved.

One of the overdose victims named by the DEA was Paul Bailey.

Fiona Bailey said her husband began abusing prescription drugs in 1992,
when she went back to her native Perth, Australia, to be with her dying
father. The couple had met in Australia while Paul Bailey was serving in
the Navy on the USS New Jersey.

"He was a strong man," she recalled. "He had so much confidence. My husband
could have been anything."

But on her return to Grayson in January 1993, she noticed a change: Her
husband would slur his speech at times and stare blankly. "His eyes, it's
like there's nothing," she said.

Paul Bailey's father, Larry, said his son told him that he began using
drugs instead of alcohol to keep from being arrested for drunken driving.
His son said he had back pain, "but I think he used that as a crutch, as a
reason to take the pills," Larry Bailey said.

Paul Bailey attended Ashland Community College, Morehead State University
and Marshall University, eventually earning an associate degree and
becoming a medical lab technician. He got a job in Portsmouth, Ohio, but
quit because of his drug addiction, his father said.

"He'd fight the disease, but the old Satan would come by and he'd give in,"
Larry Bailey said.

Paul Bailey's addiction worsened about three years ago, when he discovered
OxyContin, a potent painkiller that federal prosecutors have blamed for
dozens of overdose deaths in Eastern Kentucky. Twice, Fiona Bailey had to
call paramedics to pump his stomach after he lapsed into unconsciousness at
home.

He went through a drug rehabilitation program, but relapsed, and in January
2000, Fiona Bailey took their son Zachary, then 8, and returned to
Australia. She said they came back later that year, on Christmas Eve, after
her husband said he had stopped taking drugs. But he had not, she said.

On Sept. 26, 2001, a friend drove Bailey to South Shore to see Santos. He
got prescriptions for 180 tablets of hydrocodone; 90 tablets of alprazolam
(generic Xanax); and Soma. He filled them at South Shore Drug Store and
returned to his trailer, behind his parents' house.

At 3:30 the next morning, Fiona Bailey got up to get a glass of water. Her
husband was asleep on the living room couch, snoring louder than normal.
She went back to sleep and awoke at 7. "I stood in the hallway. I knew he
was gone. I don't know how I knew. But I knew," she said.

With tears rolling down her face, she added, "My husband, he wasn't a bad
man. I mean, the pills just consumed him."

Problem is persistent

Law enforcement officials claim that the arrests of Procter and the other
doctors he hired have cut into the trafficking in prescription drugs in
northeastern Kentucky. Two prescription-drug users said in interviews that
hydrocodone and Xanax are harder to get now, and that their street prices
have about doubled in recent months.

But abusers still are getting painkillers, including from doctors in Ohio,
said Sheriff Cooper and the DEA's King.

"There's just too much money in it," said Cooper. "It's going to persist
until the people who are making most of the money off of it get hammered."

At Tri-State Health Care, which opened last January on Main Street in South
Shore, patients seeking pain pills show up regularly. The clinic's
employees say they have caught about a dozen patients with faked MRI
reports; about a half dozen have been arrested.

Tri-State said it now screens new patients by checking with Kentucky's
prescription drug monitoring system and calling pharmacies in Ohio. The
clinic has refused to treat 200 to 300 patients on suspicions they were
abusing drugs, said office manager Alice Jewett.

Plaza Healthcare, meanwhile, is shut down and its phone disconnected,
though it succeeded in briefly hiring two doctors since Santos' arrest.

One arrived June 24 and didn't return the next day, according to a lawsuit
the clinic filed against a doctorrecruitment agency. Another came in
mid-September but was gone by early this month.

"There were efforts made to get another doctor there, after Santos' arrest,
but everybody is scared to death to have anything to do with that place,"
said Hoover, Procter's lawyer.

[Sidebar]

Drugs Prescribed

Drugs prescribed Law enforcement officials allege that patients at Dr.
David Procter's Plaza Healthcare typically left the clinic with
prescriptions for Lorcet or Lortab; Xanax; and Soma.

The Physicians' Desk Reference lists this information about those drugs:

LORCET OR LORTAB

Purpose: Relief of moderate to moderately severe pain

Ingredients: Hydrocodone and acetaminophen

Usual dose: 1 or 2 5-mg. tablets every four to six hours, not to exceed 8
tablets per day; or 1 10-mg. tablet every four to six hours, not to exceed
6 per day. Warning: May be habit forming; a schedule III controlled
substance, it may lead to low to moderate physical dependence or high
psychological dependence.

XANAX

Purpose: Short-term treatment of anxiety or panic attacks

Ingredients: Alprazolam

Usual dose: Generally no more than 4 mg. per day, though can be higher for
panic disorder patients

Warning - A schedule IV controlled substance, it may lead to limited
physical or psychological dependence.

SOMA

Purpose: Muscle relaxant; relief of pain due to acute musculoskeletal injuries

Ingredients: Carisoprodol

Usual dose: 4 350-mg. tablets per day

Warning - Psychological dependence and abuse are rare, but drug should be
used with caution in addiction-prone individuals.