CRACKING DOWN, SLOWLY

ONE obvious question is: Why did it take a note from an Ohio coroner to
prompt effective scrutiny of Dr. Rodolfo Santos' practice at the Plaza
Health Care clinic in Greenup County?

Another question is: Practicing what? A physician hired by the Kentucky
Board of Medical Licensure to review the records of 18 Santos patients
found that some included no diagnostic or therapeutic plans, and others
included histories, physicals and case notes that the consultant wouldn't
accept from a first-year med student. Dr. Santos says he was weaning
patients away from drugs, but the consultant says, "It is clear that it was
primarily a cash transaction."

What patients did with their nerve, pain and diet drugs when they got back
home to places like Hazard, Paintsville and Prestonsburg is not publicly
known. What is obvious is that many mountain communities are centers for
the unlawful sale and illicit use of prescription medicine.

The good news is that Dr. Santos has been arrested, and his medical license
suspended. But two of his clinic colleagues had been indicted last summer
on charges of misprescribing drugs.

It wasn't until November, however, after an Ohio coroner reported that one
of Dr. Santos' patients had died from an overdose of Ativan, that the board
began a thorough check of his practice. As it turned out, six other
patients had died from drug overdoses over a one-year period.

And it was only this week that a six-month probe of his activities by
federal, state and local officers resulted in charges.

The culture of prescription drug abuse is especially apparent in Central
Appalachia, and long has been. That, combined with earlier indictment of
two Plaza Health Care doctors, should have rung alarm bells. But for too
many months the public heard only the sounds of silence. What it needed was
full information on which to act.