DOUBTS RAISED ABOUT HEAD OF DRUG PROGRAM

Letcher Dentist Was Fined For Not Documenting Drugs

EASTERN KENTUCKY BUREAU

WHITESBURG - When a local chapter of Eastern Kentucky's newest
drug-fighting program chose its chairman this year, it picked a dentist who
had been fined by state regulators for failing to document narcotics he had
prescribed to patients.

Dr. David Narramore paid the $500 fine in January as part of an agreement
to settle a 17-count complaint that claimed he had overprescribed
painkillers. Investigators said the dentist prescribed narcotics 20 times
for a patient who was already in a drug-abuse treatment program.

Narramore, the Republican Party chairman in Letcher County, said in a
recent interview that the Kentucky Board of Dentistry's decision to drop
the more serious charges against him amounted to vindication.

Critics have called for his resignation from the local anti-drug board, but
Narramore says he has no intention of quitting: "I won fair and square."

Still, Narramore's election as chairman of the Letcher County chapter of
UNITE shocked some local officials, who noted that improper prescriptions
are a key source of the illegal pill trade in rural Kentucky.

"I've got a problem with a doctor that has been investigated and charged
with improperly dispensing prescription drugs being chairman of a coalition
whose goals include looking at doctors who are prescribing drugs," said
Letcher Judge-Executive Carroll Smith.

UNITE, which stands for Unlawful Narcotics Investigation, Treatment and
Education, is a $16 million federally financed program initiated by U.S.
Rep. Hal Rogers, R-Somerset, that is supposed to bring police, drug
rehabilitation groups and grass-roots coalitions of citizens together in a
concerted street-level war on illegal narcotics.

A key part of the effort involves community-level groups in the 29 counties
in Rogers' congressional district -- groups that will monitor what courts
and doctors are doing to halt prescription-drug abuse, among other things.

In Letcher County, the dustup over the selection of leaders has some
residents saying the grass-roots effort has already gone awry.

'Hostile takeover'

Letcher County's community-level group began meeting informally -- without
electing any leaders -- earlier this year. Many of the initial attendees
were residents who lived beside drug dealers, or parents whose children
were abusing drugs, said Smith, who attended the meetings.

Two Blackey residents, Dean and Nina Cornett -- who spend their winters in
Letcher County and their summers near Anchorage, Alaska -- said they called
the first organizational meeting in Whitesburg at the request of Sheriff
Danny Webb and because, they said, it seemed like a good cause.

During the meeting, some residents criticized local doctors and judges --
criticism that got coverage in Whitesburg's weekly newspaper, The Mountain
Eagle.

At the next meeting, in March, when leaders were to be elected, a large
crowd of people who hadn't attended before showed up and voted Narramore
into the chairman's post.

"They consisted in large part of the medical community, the legal
community, old-line political leaders and the school system," said the
Cornetts in a letter to The Mountain Eagle.

Smith, the county judge-executive, called it a "hostile takeover."

Others said it was merely an attempt to participate.

Narramore said he attended the March meeting because he heard "fallout"
from earlier sessions and thought the local UNITE chapter "should be a
coalition of everybody."

Lois Baker, executive director of Mountain Comprehensive Health Corp., said
she was discouraged by the tone of the group's initial meeting and did not
return.

"I didn't want to be part of a witch hunt and it looked to me like that's
what it turned into," said Baker, whose company operates a non-profit
medical clinic based in Whitesburg, with five branch offices in three
Eastern Kentucky counties.

Baker said she had nothing to do with the March election, although 15
Mountain Comprehensive employees, including about eight doctors, showed up
for it.

Dr. Van Breeding, a Mountain Comprehensive clinic physician, wrote a memo
that urged employees to attend, but he said the memo was in response to a
quote in a local newspaper story that questioned the absence of doctors at
the first meetings.

Since the election, most of the group's original grass-roots members have
stopped coming to the meetings, said Madeline Flannery-Kincer, a Hazard
Community College faculty member who lost to Narramore by a 65-53 vote.

Flannery-Kincer, who was chosen to co-chair the group, said only 54 people
showed up for a May 17 meeting.

"It's very clear they're a different set of people," she said. "They're the
people whose job it is to be involved in these programs."

UNITE officials downplayed the fracas in Letcher County. Dan Smoot, the
agency's law-enforcement director, said, "The Cornetts have complained
every day, non-stop."

"Me, personally, I'm tired of all the doom and gloom," said Smoot, a former
Kentucky State Police detective. "We have a chance to turn this around."

Smoot and Narramore both emphasized that Narramore's role as a county
chairman will not involve steering any law-enforcement activities.

UNITE's primary targets are street-level drug dealers, Smoot said. Any
doctor or pharmacist under suspicion would be investigated by federal or
state agencies, he said.

Smoot added that his branch of UNITE will not share information from its
investigations with the local grass-roots groups.

"If law enforcement is looking at someone here, we'll never know it,"
Narramore said.

Karen Engle, UNITE's executive director, said she was aware of the
controversy surrounding Narramore, but thought most members were
comfortable with his leadership. Engle said she had not contacted Rogers
about the dispute.

Rogers did not return telephone calls to his Washington office.

Narramore has contributed at least $7,500 since 1997 to Rogers' campaigns,
according to federal campaign-finance records.

In addition to his post as the local Republican chairman, Narramore is also
Eastern Kentucky's representative to the state dentistry board, which
disciplined him in January.

'No proof'

Narramore's attorney, Gene Smallwood Jr. of Whitesburg, dismissed the
significance of the original complaint filed by the dentistry board's
executive director, Gary Munsie, in 2002.

"Charges are charges," Smallwood said, shrugging. "When they investigated,
there was no proof of those."

The complaint's 17 counts included eight allegations of overprescribing
painkillers. The complaint also alleged that Narramore failed to keep
written dental records and medical history records to justify prescribing
drugs to several patients.

It referred to prescriptions written "when no dental treatment was noted in
the dental records ... or the script that was written was not appropriate
for the dental treatment that was documented as performed."

Other records obtained from the state Board of Dentistry show that a 2000
investigation of Narramore preceded the board's 2002 complaint.

Board investigators and U.S. Drug Enforcement Administration agents
inspected 21 patient files and noted that Narramore had filled
"questionable prescriptions" for a woman employee and had given the
narcotic Percocet to a woman participating in a methadone program in Lexington.

Most of the prescriptions were written in cases that involved tooth
extractions, the records say.

After an interview with Narramore, DEA agents told the dentistry board's
investigators "they really did not have enough provable activity from their
perspective to charge Dr. Narramore," according to a memo filed Nov. 11,
2000 by board investigator Marquetta Poynter.

After the dentistry board made its 2002 complaint, it reached a settlement
with Narramore last January. In it, Narramore agreed to accept a public
reprimand, admitted he failed to keep written documentation for some
prescriptions, and paid the $500 fine.

Dentistry board chairman Dan Clagett of Elizabethtown said Narramore
received no special consideration, despite his seat on the state dental board.

"If anything, he came under more scrutiny than any other dentist would,"
Clagett said.

Narramore had "even asked that his reprimand not be put in our newsletter,
but the board said, 'no, we can't do that,' so he didn't get any special
consideration from us, even on a request as minor as that," Clagett said.

A public reprimand is "pretty strong because for most of us, the best thing
we have is our reputation," he said.

Clagett praised Narramore's work on the dental board and said he personally
had no problem with prescribing pain medication for tooth extractions.

"I'd say if you prescribe very much at all, sometimes you don't get all the
documentation," he said.

A new tone

Meanwhile, the tenor of the meetings of UNITE's Letcher County chapter has
changed somewhat.

At last month's meeting, attended by an even smaller crowd, Smith's motion
for a new election was voted down.

Chairman Narramore read a prepared statement that asked the group to "move
in a positive direction."

He said, "there have been some allegations about the court system, about
members of the medical community and some concerning myself ... all of
which were later shown to be untrue."

Facing the Cornetts, he said: "When you make an unfounded allegation, all
it serves to do is undermine your credibility, and if you are speaking on
behalf of the program, it severely compromises its ability to succeed."

The Cornetts stood to ask Narramore if he was talking about them, but he
declined to answer. When Nina Cornett demanded an apology, Narramore said
the couple was out of order and, at one point, threatened to have them
removed from the meeting.

"We apparently were the only people out of order," Nina Cornett said
afterward. "Everybody else talked without being recognized."

Later, a copy of the group's proposed bylaws was released. It limited
membership in Letcher County UNITE to "permanent" residents of the county
- -- which ruled out the Cornetts, who are returning to Alaska for the summer.

"We can't say it's deliberate, but it's certainly effective," Nina Cornett said.