DEATHS PUT ILLEGAL TRADE OF MEDICINE IN SPOTLIGHT

Prescription Smugglers Overlooked In Drug War

LOS ANGELES - Maria Cardenas-DeMoreno was a regular at the San
Ysidro border crossing.

Customs agents stopped the Los Angeles-area woman at the border at
least six times trying to cart into the United States packages of
medicine she purchased legally without a prescription in Mexico,
authorities said. After she was charged and then ignored a court
summons, "Wanted" posters were put up along the border.

"She was like a professional smuggler," said an agent familiar with
the case.

The posters paid off. Cardenas-DeMoreno was arrested in 1996 and
accused of trying to smuggle injectable penicillin and two other
medicines, court records state. She pleaded guilty to a smuggling
count, did a six-month stint in prison and then received three years
of supervised release. In December, authorities allege, she was
dabbling in the Mexican medicine trade again. She was arrested in a
store she co-owned in El Monte -- east of downtown Los Angeles --
after allegedly selling penicillin and other medicine to an undercover
California Department of Health Services agent. Last week,
Cardenas-DeMoreno admitted in court that she violated the terms of her
release, and federal Judge Gordon Thompson in San Diego sent her back
to prison for 14 months.

Cardenas-DeMoreno and other purported smugglers are considered a
crucial and often elusive link in an illegal medicine trade that is
receiving increased scrutiny in the wake of the recent deaths of two
Orange County toddlers who died after receiving illegal injections of
what is believed to be Mexican-produced medicine.

The trade, which authorities say has existed in Southern California's
Latino enclaves for years, relies on a shadowy group of smugglers and
middlemen who often are overlooked amid the higher-profile war on narcotics.

The dealers of these medicines are often self-appointed apothecaries
who are hardly your white-coat-wearing, pill-counting neighborhood
pharmacists. They sometimes sell the drugs at swap meets, in general
stores, video outlets and party supply shops, and they don't have
pharmaceutical licenses. Often the drugs are kept in a secret stash or
a back room.

Their customers are mostly recent immigrants. Some want to purchase
the remedies they used back home and are accustomed to getting without
a prescription. Other customers fear seeking legitimate medical care
may expose their questionable residency status.

Sometimes shop owners themselves diagnose their customers' ailments
and sell them the medicine -- often at five times the typical cost.

As for Cardenas-DeMoreno, her lawyer George Siddell said she wasn't
malicious in selling the drugs. The case shows that for some in the
Latino community buying such medicine without seeing a physician is
just what they are used to doing in their homeland.

"My client was not intending to harm anyone," he said. "In her mind,
she thought she was helping people . . . This is a cultural clash, a
cultural conflict."

The prosecutor in the case, Assistant U.S. Attorney Bruce Smith, said,
"People must keep in mind that there's a reason these drugs are
prescription drugs. They're prescription drugs because it takes
someone with medical training to assess what a person's needs are."

The drugs aren't cheap

Those familiar with the illegal sale of pharmaceuticals said when the
medicines first started showing up in Southern California shops
roughly nine years ago little more than birth-control pills and
antibiotics were sold.

"It now seems to have evolved into a whole practice of medicine where
there is a person who is diagnosing illnesses and giving injections,"
said Howard Ratzky, a supervising investigator with the California
Department of Health Services.

The death of 18-month-old Selene Segura Rios -- who received an
injection in February in a makeshift office in the back of a Tustin
toy shop -- has sparked a grand jury probe in San Diego involving the
Food and Drug Administration and the U.S. Customs Service, a source
familiar with the case said.

Since last May, a task force in Los Angeles County has arrested more
than 50 people and conducted more than 150 investigations of shops in
Latino neighborhoods selling codeine syrups, Valium and other
medications -- sometimes at prices five times higher than most
legitimate pharmacies. Last month, authorities also made a few arrests
in predominantly Asian neighborhoods.

"I do believe we've only scratched the surface," said Todd Sample, an
administrator with the Los Angeles County Department of Health
Services. "There could be hundreds more stores."

Extensive problem

Proving just as difficult to find, however, are cases like
Cardenas-DeMoreno and what officials say is a vast network of people
who are buying the medicines in Tijuana, getting them over the border
and then trafficking them to shops.

"We kept hearing about Juan in a white van," said Gregory Thompson, a
pharmacist and head of Los Angeles County's Regional Drug Information
Center who has joined police on many busts of retailers. "In East
L.A. and Inglewood the name came up. We laughed: `How many Juans with
white vans are there in the county?' I guess we have to find them
all." In Los Angeles, police and health officials have found
inventory lists of Mexican medicines in stores. Retailers check off
the medicine they want on these lists, then pass them to the
suppliers who fill the orders. Last year, authorities identified a
"warehouse" of illegal medicines in southeast Los Angeles County. But
when police came to the site, there wasn't a large amount of drugs in
storage, said Sachi Hamai, an administrator with the county
Department of Health Services.

"There's apparently a vast network that involves the importers, who
bring these medications in very large numbers across the border," said
state Assemblyman Martin Gallegos, D-Baldwin Park, who has closely
followed this issue and pushed legislation stiffening the penalties
against the sellers. "They then go to a network of distributors, who
are the ones who go to these local establishments, these retailers.
"It is very difficult to trace back. But (investigators) know the
system is working that way. They haven't been able to pin down the
individuals involved," Gallegos said.

Local authorities privately grumble that customs agents at the border
are focused on finding cocaine, heroin and marijuana and rarely take
note of pharmaceuticals.

Between October and January, statistics show, agents made 107 seizures
of pharmaceuticals at ports along the California-Mexico border. Six
people have been arrested on smuggling charges while in possession of
restricted prescription drugs. Between October 1997 and September
1998, there were more than 400 seizures.

"Yes, we will focus hardest on cases that we know will result in a
conviction," said a customs agent, who asked to remain anonymous.
"Clearly we're not getting all of these. If we were, there wouldn't
be the problem that you're having up there."

Atypical smugglers

The way the drugs come over varies widely and isn't always easy to
detect. One of the most sophisticated cases recently prosecuted had
nothing to do with Latino markets.

On March 15, Utah pharmacist Terrence Frank, 59, pleaded guilty to
smuggling prescription medicines over the border.

In December 1996, Frank tried to bring more than 22,000 pills he
purchased in Tijuana through San Ysidro. He planned to sell the
medicine at one of eight pharmacies he owns, prosecutors said. As part
of his plea agreement, he said his pharmacies sold Mexican
pharmaceuticals valued somewhere between $120,000 and $200,000 from
1996 through January 1998. Two of Frank's colleagues were caught at
the San Ysidro border trying to smuggle $60,000 worth of Premarin,
Prozac and other drugs into the United States. One of them, Clifford
Holt, a manager of one of Frank's pharmacies, also pleaded guilty in
October and was sentenced to 13 months in prison. He admitted that
since 1989 he had smuggled 25 loads of drugs, including Prozac, from
Tijuana.

Two other cases are pending in San Diego's federal court, according to
Assistant U.S. Attorney Melanie Pierson.

One involved a woman caught smuggling $15,000 worth of pharmaceuticals
on Feb. 25. She told officials she planned to hand over the drugs to a
contact she was meeting at the Wal-Mart store in Chula Vista. The
other came one week later, when a husband and wife were caught
crossing the border with $50,000 in pharmaceuticals in their car. The
customs agent acknowledged that such prescription drug smugglers often
can't be detected by the methods used to detect "drug war" narcotics.
"It's sometimes just looking in the right backpack or catching a
glance of a box that looks out of place," the agent said.

"They'll bring small amounts across and then go back and bring another
small amount across. That's what they call `rat packing.' They'll put
it all in a storage locker in Chula Vista. When they get a lot of
them, they'll get a van and head north."

And agents also encounter the uninsured, senior citizens, the
desperately ill, teen-age pill thrill seekers and others just looking
to buy medicine on the cheap and without a prescription.

In the case of Selene's death, police are investigating the King
family, the purported owners of the Tustin shop.

Members of the King family were also investigated over allegations
they provided illegal drugs to a Santa Ana clinic where 13-month-old
Christopher Martinez received five injections from an unlicensed
physician. The boy died last April. The Kings, who police say have a
history of selling illegal pharmaceuticals, were not charged.

Now, both the FDA and the U.S. Customs Service are looking into the
King family. At least two employees of the Tustin shop reportedly
testified before a federal court in San Diego considering the case.

Safer options

While the investigations mount, public health officials are trying to
heighten awareness about the availability of health care for
immigrants, as well as the dangers of self-medication and using
foreign-made pharmaceuticals that do not have to meet the same
standards as FDA-approved drugs.

"In Mexico, people are accustomed to going to the store and buying
medicine for themselves," said Mary Watson, who founded the Santa Ana
Safe Medicine Coalition after Christopher Martinez's death. "That's
what they're comfortable with and they'll keep going to a place where
they're comfortable. This is an emerging market and it shows there is
a hole in our (health care) delivery system. We've got to close that
hole." Los Angeles County's Thompson said people who self-diagnose and
medicate their ailments frequently exacerbate their illness and end up
seeking more treatment at hospital emergency rooms and school clinics.
"People don't know about possible side effects or allergic reactions
or whether it's dangerous to take that medicine when they're
pregnant," he said.

"The message we want to get out is: There are places to go for no-cost
or low-cost medical care," Sample said.

As he said this, he was standing outside Arco Iris Party Supplies, a
small shop in a beat-up strip mall in the north San Fernando Valley
community of Arleta. At the shop, officials say, amid pinatas, candies
and other legitimate goods they found $25,000 worth of Mexican-and
Central American-made antibiotics, steroids, influenza vaccines, blood
products and treatments for venereal disease.

Oddly enough, the same message Sample was pushing was advertised on a
homemade sign that was taped to Arco Iris's door.