DOCTOR FIGHTS VERDICT IN DEATH

Woman Died During Addiction Treatment

Amy McCauley of Imperial Beach hoped a four-day program to kick her heroin
addiction would bring her a new life. Instead, a powerful mix of medications
given to McCauley by a La Jolla physician killed her.

McCauley chose the program because it allowed her to undergo withdrawal at
home with her boyfriend instead of in a hospital treatment program that
costs thousands of dollars. The physician, Dr. John Sack, claimed to have
helped hundreds of heroin addicts break their addiction with a program that
cost less than $300.

However, a lawsuit brought against Sack by McCauley's family alleged the
treatment, in which drug addicts were given dozens of pills by people
without any medical training, is unsafe. A San Diego jury awarded McCauley's
two children about $1 million in May.

The verdict is being appealed. Sack defends his treatment as medically
sound. He said in an interview that he was only trying to aid McCauley -- as
he had many others -- overcome a powerful addiction.

"I'm convinced it's safe if you follow the simple directions I give," Sack
said. "It's the only treatment for a vast percentage of the addicted
population" who can't afford hospitalization. After the jury's verdict, the
state Medical Board filed a complaint alleging that Sack's methods were
improper. The board restricted Sack's medical license, requiring him to
treat addicts at a hospital, not at their homes. A board hearing is set for
January.

The state's action is little consolation to Lincoln Wilson, McCauley's
boyfriend for three years before her death March 5, 1997. He is now raising
their 3-year-old son and her 13-year-old daughter at his home in Pittsburgh.

Wilson said he was always skeptical that Sack's withdrawal treatment would work.

"I just thought it was too good to be true," Wilson said. "I certainly
didn't think it would kill her."

A powerful addiction

Wilson, a 61-year-old flight mechanic for U.S. Air, remembers McCauley as an
intelligent woman who loved reading, cooking and taking care of her children.

But McCauley, 35 years old when she died, had also been a heroin addict for
more than 10 years. For three years, she had been receiving methadone from a
federally sponsored program to help keep her off street drugs.

Wilson said McCauley wanted to end her addiction to methadone, itself a
powerful narcotic, and heard about Sack's program through word of mouth at
the methadone clinic.

"She just wanted to get rid of (the drug habit)," Wilson said. "It sounded
like the light at the end of the tunnel."

Sack, 51, specializes in internal medicine, but about a third of his
practice involved helping addicts kick drugs.

Sack said he is one of only a handful of private physicians in San Diego
County doing so. After treating addicts in a hospital, Sack said, he began
his home treatment program in about 1990 for those unable to afford any
other help.

"I find it rewarding," he said. "When you've found a way to help people,
it's hard to say no."

Sack said about 1,700 patients have successfully completed his home
treatment. He is proud of those who wrote him letters of gratitude, like the
recovering addict who said, "I can't thank you enough for saving my life."

For addicts such as McCauley, with little money and no medical insurance,
home treatment programs are their only hope for ending a crippling
addiction, said Jeffrey Bogart, one of Sack's attorneys.

"If you have a lot of money, you can afford hospitalization," Bogart said.
"What's available to you if you don't have insurance or a substantial
pocketbook? I think the answer is nothing."

About 300 of Sack's patients -- including McCauley -- were treated with the
drug Naltrexone, which shortens the withdrawal process. The doctor promised
the drug would shorten the agony of withdrawal from methadone's three to
four weeks to just four days.

Sack also gave his patients seven other medications to combat withdrawal
symptoms -- anxiety, restlessness, sweats and chills, nausea and vomiting,
diarrhea, and aches and pains.

Wilson said he and McCauley met with Sack for about 20 minutes, during which
Sack reviewed a two-page sheet listing the instructions for his program.
Sack's fee was $150 for the program, plus $117 for the medications he gave
McCauley.

McCauley's lawyer, Edward Babbitt, said Sack conducted an inadequate
physical examination of McCauley to determine whether her system could
tolerate the drugs.

An attorney for Sack, Bruce Bailey, disagreed. He said Sack met with
McCauley and Wilson for up to an hour and gave her a thorough medical
examination.

Bailey said Sack gave Wilson another paper, in addition to the instruction
sheet, telling Wilson not give medications to McCauley unless she could sit
up and take the drugs on her own. Wilson said he never got that piece of paper.

Sack gave McCauley the medications and sent her home to her Imperial Beach
apartment, giving Wilson the responsibility of doling out the pills about
every four hours and monitoring his girlfriend's condition.

That was a dangerous plan, according to the trial testimony of Michael
Lardon, chief of staff at Charter Hospital, a psychiatric center that treats
drug addicts. Lardon told the jury he would not even use the mix of drugs
prescribed by Sack in a hospital where a patient could be regularly
monitored by nurses.

"To send someone home with this type of protocol without being medically
supervised puts someone at very substantial risk," Lardon said. "And my
understanding is that Ms. McCauley was not really aware of what type of risk
she was getting involved with."

Wilson said he followed Sack's instructions and gave McCauley 33 pills on
her first day of treatment. By the second day, Wilson said, she slept so
deeply that he couldn't awaken her.

"She looked like a dead person, except she was breathing. She was just
laying there," Wilson said.

He said that when he called Sack's office the doctor did not seem urgently
concerned. Wilson said Sack just told him to let McCauley sleep a few more
hours before giving her next round of medications.

Sack's notes from his conversation indicate that he told Wilson not to give
McCauley any more medication until she was alert, awake and able to take the
pills on her own.

Sack said he told Wilson to call him back if McCauley continued her deep
sleep. He said he assumed she had gotten better when he did not hear back
from Wilson.

McCauley's condition never improved. The day after Wilson talked with Sack,
McCauley went into respiratory arrest and was taken by ambulance to Scripps
Hospital in Chula Vista.

She died six days later. The county Medical Examiner's Office concluded that
McCauley's death was caused by respiratory arrest associated with her
withdrawal therapy.

Sack did not visit McCauley in the hospital, although he said he called her
doctor and Wilson several times to discuss her condition. Asked about it by
McCauley's attorney, Sack replied that he felt bad about McCauley's comatose
condition.

"I think I would have just felt ashamed or guilty about being there," Sack
said, later adding, "I found it very hard to take that this had happened on
my watch, so to speak, while she was under my care."

Sack's expert witness in treating addictions, Dr. Robert MacFarlane, said
Sack's program met accepted medical standards. He said McCauley fell ill
because Wilson had not followed Sack's instructions.

Bailey, Sack's attorney, said that Sack only accepted patients who had
acceptable caregivers to help them through withdrawal. Wilson appeared to be
an excellent person to take care of McCauley, he said.

"For some reason, the person we thought would be the best caregiver in the
world turned out to be not so good," Bailey said.

Other patients

About a month before McCauley went to see Sack, two of the doctor's other
patients were hospitalized while undergoing withdrawal treatment.

Eleanor Bowyer of Imperial Beach said her husband, John, went into
convulsions soon after he began taking the medications Sack gave him. She
said Bowyer was in a hospital for 10 days.

She said Bowyer hoped the treatment would end his addiction to heroin and
methadone.

"He wanted to have a normal life," Bowyer said. "What it did was ruin his life."

Defense lawyer Bailey said Bowyer and the other patient were undergoing a
different type of treatment than McCauley's. He said Bowyer had cocaine in
his system when he was admitted to the hospital, which could have caused his
medical problems.

Jurors in the suit brought by McCauley's family found by a 9-3 vote that
Sack was at fault for her death, and awarded her two children more than $1
million in damages. The amount was reduced to about $960,000 because of
legal limits on medical damages and a finding that Wilson was 20 percent at
fault for McCauley's death.

Bailey sought a new trial for Sack because one of the jurors, a nurse, was
quoted as telling other jurors that Sack's treatment program was dangerous
and that he kept sloppy medical records. San Diego Superior Court Judge
Thomas LaVoy denied the request for a new trial.

The state Medical Board stepped in after the verdict, accusing Sack of
negligence in his treatment of McCauley, improperly using the home treatment
and prescribing excessive amounts of drugs.