DOCTORS WHO DEAL, NOT HEAL, TARGETED

Local Conviction Bolsters Crackdown On OxyContin

At first, Special Agent Dennis Norred did not even know the doctor's name.

Informants were telling the veteran Florida Department of Law Enforcement
agent that a physician in Santa Rosa County was freely writing
prescriptions for narcotics.

It was early 1999. Months earlier, Dr. James Graves had opened his practice
on U.S. 90 in Milton, advertising as a pain-management specialist, Norred
learned.

Three years later, Graves, 55, would become the first doctor in the nation
to be convicted of manslaughter for recklessly prescribing OxyContin - and
other potent narcotics - with which four of his patients fatally overdosed.
Graves faces up to 165 years in state prison when he is sentenced March 19.
His attorney has promised to appeal.

The Pace doctor also would become one of Florida's top prescribers of
OxyContin, a time-released synthetic opiate. Addicts get a heroin-like high
when they crush the pills, mix them with water, heat the mixture, then
inject it intravenously.

Graves' conviction last Tuesday is likely to be examined closely by
prosecutors in other communities trying to combat a surge of OxyContin abuse.

At least three other physicians face charges of causing the deaths or
injuries of patients who took OxyContin, including one doctor in Florida:

Dr. Denis Deonarine of West Palm Beach could face a death sentence if
convicted of first-degree murder in an overdose death. No trial date has
been set.

Dr. Frank Fisher of Redding, Calif., is set for trial this week on three
manslaughter counts.

Dr. Cecil Knox of Roanoke, Va., is facing federal charges including that he
illegally prescribed narcotics that led to the deaths or serious injury of
10 patients.

"I hope this will set a precedent for doctors with too much greed and
power," said Nancy Elliot of Jacksonville, whose brother, Howard Rice, was
a patient of Graves. Rice, 41, overdosed and died on April 12, 2000.

Elliot said Graves should not have prescribed narcotics to her brother, who
was an addict and did not have the the ability to make wise decisions.

But back in 1999, Norred had just begun a complex homicide investigation
focusing on Graves, whose practice was booming as patients were dying.

"On the one hand, you're saying '(Graves) can't be doing this,' " Norred
said. "On the other hand, you're seeing all these people dying."

'Drug doctor'

Law enforcement officers say a doctor such as Graves rarely comes along.

"There are thousands of doctors who prescribe narcotics legitimately," said
Gregg Wood, a health-care fraud investigator with the U.S. Attorney's
Office in Roanoke. "Ninety-eight percent are good, and there are 2 percent
who aren't."

But when a "script doc" - a physician with a reputation for overprescribing
narcotics - sets up shop, Wood said, the signs are obvious: crowded waiting
rooms, carloads of patients who know each other and fights breaking out in
the parking lots.

"You'd spend a couple hours waiting, there was so many people," testified
James Bennett, a former patient.

Once he got to see Graves, they spent a few minutes talking about phone
service he was selling or talking about other people's personal lives.

Paul Mylock, a patient who later became an informant for the FDLE,
testified that Graves' waiting room "was like a Grateful Dead concert."

The parking lot was so full that physical-therapy patients at NovaCare
Physical Rehabilitation next door had nowhere to park. Some patients gave
the "thumbs up" sign to friends after seeing Graves.

One former patient called Graves her "drug doctor." She had another family
physician she saw for other illnesses.

Another patient testified Graves' office was "like Christmas" for addicts.

When Graves saw needle marks on one patient, he advised, "You don't have to
shoot it to feel it."

Both Martha Blackmon, and her husband, Danny Blackmon, were patients. She
also cooperated with investigators and secretly recorded two visits with
Graves.

After telling Martha Blackmon that injecting OxyContin was "a bad thing"
and she needed to get treatment, Graves said: "If you stop it right now,
I'll give you enough medication to keep you comfortable.

The doctor ended the visit by saying: "I'll take care of you and your kids,
OK?"

Graves, who testified during the trial, maintained his innocence.

He said he was merely treating his patients' symptoms and they lied to him
to get their fix.

The doctor wrote so many of the same prescriptions, they were dubbed the
"Graves cocktail" by pharmacists: OxyContin in two strengths, Lortab, Xanax
and Soma. Lortab is another painkiller, Xanax is a tranquilizer, and Soma
is a muscle relaxant.

"He's not a healer; he's a dealer," Assistant State Attorney Russ Edgar
told jurors.

Yet, at first, law enforcement agencies received few reports.

Edgar, who prosecuted Graves, speculated the hesitancy to complain came
from the respect doctors usually command.

"This is a physician, and people show great deference to physicians," Edgar
said.

The deaths

As 1999 progressed, the information came quicker.

Norred talked to a few pharmacists, law enforcement officers and a friend
who worked at a funeral home. They said they were suspicious of Graves'
prescriptions and the associated deaths.

One pharmacist told Norred he told people they would die if they continued
taking the mixture of medication. For many, Graves prescribed up to 12
pills a day.

On March 14, 1999, five months after Graves opened his practice, Anne
Carroll overdosed and died.

Two days earlier, Carroll, 34, had been to see Graves and received
prescriptions for OxyContin and MS Contin, a synthetic morphine.

Carroll's death rattled other patients and prompted some pharmacists to
stop filling Graves' prescriptions.

Even though Carroll was not named as a victim in the manslaughter cases,
jurors heard from her son, father and friends.

They all testified Carroll sometimes had needle marks on her arms. Her son,
Shane Carroll, said most times when his mother went to Graves, she was
"staggering, obviously intoxicated."

By the summer, Norred had asked the state Agency for Healthcare
Administration, which oversees pharmacies, to examine records for certain
patients. In August 1999, Norred had enough information to open a case. He
had reason to think crimes had occurred, and he had a target: Graves.

Norred put the word out to local police agencies that he wanted to know
about any drug-overdose deaths. Authorities usually don't investigate fatal
overdoses as crimes. By the time Norred heard of some of the first deaths,
they were "cold cases."

"Most of them had already been autopsied,"Norred said. "Some of them
already had been buried."

By September, Mylock began to cooperate with the investigation. Before the
end of the year, authorities sent him in twice with a wire. Each visit
lasted about five minutes, and Graves prescribed Lortab, OxyContin and
Xanax to Mylock. During the second visit, Graves talked to Mylock about the
price of OxyContin on the street.

Toward the end of 1999, patients continued to die and Graves knew it.

After Gwen Carpenter overdosed on Dec. 21, 1999, Graves faxed her records
to the medical examiner's office, then sent faxes to several local
pharmacies with a list of patients he was discharging.

Edgar suggested during trial that Graves did so to cover his tracks.

Throughout, Norred asked himself the same question:

"How have I been treated by years of going to the doctor's office? You look
at it, and you compare it to your own personal experience," Norred said.

Another issue bothered Norred, especially after talking to patients who
were not dependent on narcotics before they went to see Graves, then became
hooked on the medication Graves prescribed.

"How much trust do I put in my doctor?" Norred said. "I put a lot of trust
in my doctor."

Building the case

When Edgar became involved in January 2000, he had two goals: to apply for
a search warrant, then present the case to a grand jury.

"It was a race," Edgar said. "On the one hand, we wanted to complete the
investigation as soon as possible so there wouldn't be further criminal
activity or additional overdose deaths.

"The other concern was to be able to completely determine whether there was
a prosecutable criminal case."

Edgar directed three more undercover visits by Mylock while police
periodically watched the office.

They saw cars with license plates from Texas, Louisiana, Panama City and
Tallahassee. Graves testified he had about 1,000 patients, but authorities
later seized about 800 patient cards at his offie.

At first, patients and their families were hesitant to come forward. They
didn't want to become involved with the law.

"People just wanted to get their loved ones away from this person," Edgar said.

On April 13, 2000, the day after Rice died, authorities took the unusual
step of searching Graves' office while allowing him to see patients.

"We wanted to let him continue to practice, just in case there was a
patient out there with legitimate reasons," Norred said. "We didn't think
so, but we wanted to do that just in case."

Among the most interesting finds: a notebook of telephone calls with
messages from family members who called to beg Graves to stop prescribing
narcotics.

"His own records, his own actions, led us to the patients," Edgar said.

Once the media reported the search, more patients came forward.

Two months later, Graves was indicted by the grand jury.

The case should remind people that, ultimately, we are all responsible for
our own health, Edgar said.

"If our families or friends or ourselves are given drugs, we should ask: Is
this necessary? Is this appropriate? Is this benefiting me?"

He cautioned that if communities are not vigilant in reporting suspicious
doctors, another operation could spring up.

"A lot of people left it up to others and hoped others would act on it,"
Edgar said of the Graves case.

He does not worry the verdict will have a chilling effect on area physicians.

"A good doctor is going to make a decision on his professional judgment,
not on the prosecution of a bad doctor," Edgar said.

Timeline

Significant dates in the case against Dr. James Graves:

a.. September 1998: Graves opens office on U.S. 90 in Milton.

b.. March 14, 1999: Patient Anne Carroll, 34, dies of drug overdose.

c.. Aug. 25, 1999: The Florida Department of Law Enforcement opens
investigation.

d.. September 1999: Patient Paul Mylock agrees to cooperate with the FDLE.

e.. Nov. 10, 1999: Jeffrey Daniels, 30, dies of drug overdose.

f.. Dec. 21, 1999: Gwen Carpenter, 37, dies of drug overdose.

g.. April 12, 2000: Howard Rice, 41, dies of drug overdose.

h.. April 13, 2000: Authorities search Graves' office, as doctor continues
to see patients.

i.. June 28, 2000: William Morris, 48, dies of drug overdose.

j.. June 29, 2000: Graves indicted by Santa Rosa County grand jury.

k.. July 9, 2001: Alabama Medical Licensure Commission revokes Graves'
Alabama medical license.

l.. Jan. 15, 2002: Graves trial begins.

m.. Jan. 29, 2002: The Florida Department of Health issues emergency
suspension of Graves' Florida medical license.

n.. Feb. 19, 2002: Jury convicts Graves on four counts of manslaughter,
five counts of unlawful delivery of a controlled substance and one count of
racketeering.

o.. March 19, 2002: Scheduled sentencing date for Graves. He faces up to
165 years in prison.