RECKLESS RX IN THE DESERT?

Pharmacist's Suit Reveals Allegations Of Doctors Overprescribing
Drugs At The Hospital Tied To The Betty Ford Center

When the Highway Patrol found Dr. Wade Grindle, he had just crashed a
rented SUV, rolling it over in Indian Wells.

It was 8 o'clock on a Monday morning and Grindle, a pain management
specialist, had been drinking and taking painkillers, according to an
officer's report. He was cited for driving under the influence and
using controlled substances without the proper prescription. Last
summer, he pleaded guilty to reckless driving, drawing a fine.

Less than two months after the first incident, Grindle, clad in his
doctor's smock, was arrested by Riverside County sheriff's deputies
and booked on suspicion of DUI and possession of narcotics, according
to a sheriff's spokesman. In that case, which is still under
investigation, officers reported finding a hypodermic needle and
fentanyl, a painkiller, in the car.

All of this might have gone down as the story of one troubled
physician. But Grindle's woes turned out to be a postscript to a
larger tale: It involved allegedly reckless prescribing and
dispensing of drugs at Eisenhower Medical Center in Rancho Mirage,
home to one of the best-known addiction treatment clinics in the
country, the Betty Ford Center.

The story came to light in a little-known lawsuit resolved in
January. In it, a former Eisenhower pharmacist contended that Grindle
and two other doctors had been prescribing dangerous amounts of
addictive drugs to chronic-pain patients through the Eisenhower
outpatient pharmacy, located minutes from the renowned clinic devoted
to battling addiction.

According to court filings and trial testimony, the doctors, who at
various times ran busy practices next to Eisenhower, prescribed so
many drugs that patients became hooked. One of them, an
operating-room nurse at Eisenhower, later sought treatment at Betty
Ford, according to testimony by the pharmacist, Terry Blasingame.

In December, she told the jury: "There became a point where the
quantities, the frequencies [of painkiller prescriptions] were so
extraordinary that I feared that if there was an automobile accident,
if there was an intentional or accidental overdose ... that the
government agencies would come into our pharmacy and say, 'What in
the world were you ... pharmacists thinking about?' "

Grindle did not return messages seeking comment.

Hospital officials generally denied Blasingame's allegations. They
said the pharmacy has a good record handling complaints.

"I cannot speak to what happened before.... But I am proud of what
we're doing now," said Lyle Matthews, the director of pharmacy services.

Eisenhower Chief Executive Aubrey Serfling said he had not been aware
of Blasingame's allegations until the trial began in November.

When told about letters she and her attorney had written to him as
early as 2001 detailing her concerns, Serfling said he did not recall
seeing them. He did say that all hospitals have to guard against
over-dispensing narcotics, and the issue needs to be addressed at a
statewide or national level.

"It's a major problem, and a lot of this is due to patients working
the system," Serfling said.

The Betty Ford Center, though a separate corporation from Eisenhower,
is described on the hospital's website as one of the hospital's
specialty centers, "the premier ... in the field."

There is no suggestion in the lawsuit that patients being treated at
Betty Ford received excessive prescriptions. But Blasingame alleged
that after she brought her concerns to top officials at both
Eisenhower and Betty Ford, they failed to act.

Indeed, Blasingame, a 14-year employee who was fired in 2003,
testified that the hospital retaliated against her. The jury agreed,
awarding her $1.3 million in December. She later settled for an
undisclosed sum and has declined to be interviewed.

In court documents, Blasingame alleged that she approached Betty Ford
Chief Executive John Schwarzlose in 2002, figuring that he would be
uniquely disposed to help her. Schwarzlose, who sits on Eisenhower's
board, told her the doctors' actions were "illegal if not criminal,"
she alleged, but when he learned she had contacted a lawyer, he urged
her to resign.

In court testimony, Schwarzlose disputed that he encouraged
Blasingame to resign. He said he himself shared some of her concerns
about how pain was managed at Eisenhower, and for that reason often
sent patients to other hospitals for such treatment.

But he said he reported Blasingame's concerns to the hospital's
attorney, and though he did not follow up, he believed he had
satisfied his obligation.

"If I went to the CEO of Eisenhower and said there are too many
doctors pushing pills still over there, I wouldn't expect they would
wave a wand and get rid of those doctors," Schwarzlose said in an
interview. "But I could help them bring in doctors who offer
alternatives to pain pills.

"I don't try to impose my philosophy on Eisenhower Medical Center any
more than I would Loma Linda or Cedars-Sinai."

A congressman with a long-standing interest in stemming prescription
drug abuse said that the Betty Ford clinic, and the medical center
that houses it, have a unique responsibility to address such concerns.

"They need to be held to a higher standard," said Rep. Stephen F.
Lynch (D-Mass.). "They have positioned themselves as an authority in
the area of recovery and dealing with substance abuse. I think that
responsibility requires high diligence on their part in dealing with
this type of situation."

Blasingame, who said she first raised her concerns in 2001, alleged
that patients would pick up a 30-day supply of drugs from the
Eisenhower pharmacy -- then return the next day for a similar amount.
Some would fill suitcases with drugs, she alleged, calling contacts
from cellphones to report how much they had managed to get. Others,
she said, arrived barely able to walk.

"Eisenhower stands for something better than the kind of things that
are going on in that pharmacy," Blasingame wrote in a Dec. 16, 2001,
letter to hospital officials that is in the court file.

Prompted by Blasingame's complaints, an internal review by the
hospital in 2002 confirmed that the pharmacy had gained a reputation
"regarding its willingness to fill narcotic prescriptions without
question, and for its cozy relationship with certain physicians who
have a reputation for writing them without appropriate safeguards,"
according to a letter written at the time by hospital attorney Joe
Truhe, which was filed in court.

But six years after Blasingame first complained, few of those
implicated in the case have been substantially penalized -- except
for Blasingame, who was fired for alleged prescription errors and tardiness.

Two of the doctors she singled out as problems -- Grindle and Roland
Reinhart -- have no public record of discipline by the California
Medical Board, which, until contacted by The Times, was not aware of
Blasingame's complaint. Reinhart still practices in the office
building next to the hospital, although Grindle has moved.

Reinhart denied overprescribing, saying Blasingame was not qualified
to judge a doctor's prescription practices. "She doesn't know her hat
from a hole in the ground," Reinhart said.

The third physician, Mary Ann Phillips, now practices at another
desert hospital. Though unaware of Blasingame's case, the state
medical board formally accused Phillips in August of overprescribing
painkillers to two patients. She is contesting the allegations and
said in an interview that she suspected the patients had forged
prescriptions in her name.

As to the allegations by Blasingame, she said she wasn't even aware
of them until The Times called.

Phillips estimated that, in her practice with Reinhart, about 10% of
the patients were addicts. But the practice was so busy -- with about
90 patients a day -- that she couldn't do anything about it, she said.

Based on Blasingame's allegations, Eisenhower's pharmacy suspended
the three doctors' prescription privileges in 2002. After a brief
inquiry, it restored them 2 1/2 weeks later.

Joseph Kotansky, the outpatient pharmacy director who, according to
the hospital's own 2002 review, had retaliated against Blasingame,
still is working in the pharmacy, although no longer as a supervisor.

Kotansky declined to talk to The Times. He said in court testimony
that he had passed along Blasingame's concerns, which he said were
shared by other pharmacists, to his boss. He denied retaliating
against Blasingame.

Blasingame alleged that the hospital pharmacy filled the obviously
excessive prescriptions because the money was too good to pass up.
"The income to the pharmacy was probably well over $100,000 per month
off Actiq lollipops alone," she wrote in a complaint to the pharmacy
board in 2002.

Actiq lollipops, which contain fentanyl, are federally approved to
treat pain in cancer patients, although doctors can prescribe them
for other purposes. Increasingly, such painkillers have been diverted
to the underground market, where they are much sought-after.

The lollipops were just one part of the problem, according to
Blasingame. In 2002, she alleged, one of Grindle's patients sought to
fill prescriptions for 400 Percocet tablets and 180 methadone pills.
She was already equipped with a morphine pump.

"She was having trouble keeping her eyes open, and she was leaning on
the dividers ... out front to keep herself upright," Blasingame said
in a sworn deposition. "I told her that it would be the last time I
would fill a prescription for her unless she brought someone else in to drive."

For saying that, Blasingame testified, she was suspended for a day without pay.

Other signs of trouble emerged apart from Blasingame's case. A former
patient of both Phillips and Reinhart, who for a time shared a
practice, sued the pair for alleged medical malpractice and
negligence in 2005. Kevin Lamb, under treatment for a back injury,
claimed that he became so hooked on Actiq lollipops prescribed by the
doctors between 2001 and 2003 that all but nine of his teeth rotted.

"It was basically a factory. 'Get 'em in. Get 'em out,' " said Lamb,
52, of the doctors' practice. "I was in such a fog that I really
didn't know how bad things had gotten."

Friends became alarmed when he started dropping lighted cigarettes in
his house, he said. "Everyone was worried I was going to end up
burning the place down."

Lamb's attorney said he was in negotiations to settle the lawsuit.
Both Phillips and Reinhart denied that their care had anything to do
with Lamb losing his teeth.

Grindle came to Eisenhower with a history of drug abuse. When he
joined the staff as an anesthesiologist in 1996, he was still serving
a two-year probation imposed by the North Dakota Board of Medical
Examiners after it determined that he had been prescribing himself
painkillers, records show. He was forced to complete an "impaired
physicians program," according to the records.

It is unclear whether Eisenhower officials knew about Grindle's past.
Reinhart, who was a staff anesthesiologist (and former anesthesiology
chief) at the time, says that he did not know.

"He was a good doctor, that's all I know," Reinhart said.

Reinhart and Grindle left the Eisenhower medical staff in the late
1990s but continued to practice in an adjacent building and refer
patients to the Eisenhower pharmacy, records show.

Grindle wasn't afraid to prescribe heavy doses of painkillers and
didn't always give thorough exams before issuing refills, according
to Judith Knudsen, a nurse who worked for him from about 2002 to
2004. "These patients needed to be seen more often," Knudsen said.
"They needed to have their conditions reassessed. And that wasn't happening."

A Palm Springs woman sued both Eisenhower and Grindle in 2001 after
her husband died of a painkiller overdose. She alleged that he had
become hooked on painkillers Grindle had prescribed and Eisenhower's
pharmacy had sold. The case was later settled under undisclosed terms.

The California Medical Board's chief executive, Dave Thornton,
expressed concern over the way the hospital had handled the problems
at the pharmacy in general, echoing some of Blasingame's concerns.
Failing to address them "endangers not only the patients who are
being prescribed those drugs but also every other citizen who is on
the road when these patients are ... driving," he said.

In at least one respect, however, Eisenhower has taken decisive
action: Truhe, the attorney who concluded in 2002 that Blasingame was
the victim of retaliation, was terminated without cause a month after
the trial ended.

Times news assistant Nardine Saad contributed to this report.