STATE ALLOWS SOME DOCTORS TO PRESCRIBE DRUGS EVEN AFTER THEY'RE CHARGED
WITH CRIMES

State health officials declared Dr. Mark Kantzler unfit to practice
medicine because of drug abuse and, fearing for his patients' safety,
suspended his license by emergency order in July 1991.

Today, the family practitioner runs a St. Petersburg area pain clinic . He
is among Florida's top prescribers of narcotics to low-income people --
$419,751 worth in the past three years. During that time, eight of his
patients have died of drug overdoses.

A South Florida Sun-Sentinel investigation found dozens of doctors allowed
to continue freely prescribing dangerous drugs at state expense, even after
multiple patients have died of an overdose, and even in extreme cases where
they have been charged with drug crimes or serious misconduct. The state
has no system that monitors, sounds an alarm or stops doctors who abuse the
system.

The Investigation Found:

As a group, the doctors who prescribe the most narcotics to Medicaid
patients are 10 times more likely to have troubled professional histories
than doctors overall in the state.

State officials have disciplined or charged 10 of the top 200
Medicaid-prescribing doctors for abusing drugs, trading pills for sex with
patients, or recklessly handing out prescriptions. At least another 15 have
faced criminal charges ranging from insurance billing fraud to drug
trafficking, or have been accused by state regulators of incompetence or
misconduct.

Doctors who prescribed the costliest volumes of drugs have some of the
shakiest practice records. And doctors who prescribe the largest amounts of
OxyContin, an often-abused painkiller, have the highest rate of
disciplinary problems.

Seven of 16 doctors who each wrote more than $1 million worth of narcotics
prescriptions had professional misconduct charges or criminal arrests in
their pasts, including two doctors arrested for narcotics trafficking. Nine
of 29 doctors who ordered OxyContin for 100 or more Medicaid patients last
year had serious disciplinary action or arrests in their pasts.

No state agency has set up a system to monitor the practices of troubled
doctors whose patients wind up dying of pill overdoses. Even when
investigations have been opened, they took years to complete and the
doctors continued to see patients and to hand out prescriptions.

No Alerts In Place

The Sun-Sentinel traced hundreds of overdose deaths through autopsy records
collected from Florida's two dozen medical examiners and through pharmacy
billing data to many of the top Medicaid-prescribing doctors.

In some cases, doctors who dramatically increased the number of those
prescriptions experienced a rash of deaths among their patients. State
officials concede that they have no system that alerts them to spikes in a
doctor's Medicaid billings for narcotics or to numerous deaths among a
doctor's patients.

Medicaid's costs for Kantzler's prescriptions nearly doubled in 2001 and
into 2002, when he wrote more controlled-drug orders than all but 79 of
almost 57,000 Florida medical professionals.

During that time, six of his patients died of overdoses.

Two men in their late 40s died in March 2001, one from codeine and the
other from the painkiller hydrocodone and a muscle relaxant, records show.
In August of that year, a man died of "acute hydrocodone toxicity" a day
after he filled a prescription for the drug from Kantzler. Then, in
December, a 42-year-old female patient mixed pills with cocaine and died,
autopsy records show.

Kantzler's personal problems with drugs go back a decade.

Starting in late 1989, he spent six months hospitalized in a rehabilitation
program for drug abuse. About a year later, a urine screen found Nubain, a
morphine-like drug, in his system, and the state suspended his license.

Florida's Board of Osteopathic Medicine gave it back two months later after
a psychologist said Kantzler could safely return to practice as long as he
kept up counseling and submitted to random urine screens.

Kantzler, without admitting he did anything wrong, agreed to pay a $2,500
fine and complete a course of drug rehabilitation. He could not be reached
for comment for this story after repeated phone calls and a letter sent to
his office. Kantzler is one of a small number of doctors who stand out for
writing high volumes of prescriptions, according to the newspaper's
analysis of Medicaid billing records.

Of all the medical professionals in Florida, only 200 prescribed more than
$215,000 worth of painkillers and other controlled drugs through Medicaid
in the past three years.

While about 3 percent of the state's doctors have been disciplined for
misconduct, such sanctions were 10 times more common among the top
narcotics-prescribing doctors.

State officials don't routinely monitor Medicaid pharmacy billings or
autopsy reports to guard against doctors or pharmacists who may be
endangering patients, or ripping off taxpayers, by oversupplying drugs.

Instead, doctors are disciplined through a cumbersome process that
typically takes two years or more. It begins after a patient or other
aggrieved party files a written complaint with the state. The state then
assigns experts to decide whether the care provided fell below standards.
The doctor can contest these findings and keep on practicing while problems
remain shielded from the public.

The Department of Health can suspend a doctor's license by emergency order
to protect the public while it investigates a doctor, but it has done so in
only 12 cases since September of 2001. Four of those actions came in
response to Sun-Sentinel articles tying the doctors to multiple overdose
deaths.

Pill-pushing allegations can take even longer to sort out because Florida
law requires doctors to treat pain aggressively, and many experts disagree
about the proper limits for dosages of narcotics.

Doctors are expected to keep persuasive evidence of the need for these
drugs, such as diagnostic tests that confirm injuries, and to document
their patients' improved ability to function as a result of taking the
drugs over time.

Those who deviate from these standards without "good cause" can be
disciplined, according to the Florida Board of Medicine, which also warns
in guidelines that doctors will be judged "to a great extent by the
treatment outcome."

Death from overdose as an outcome of treatment has mostly escaped the
attention of state regulators.

The 16 doctors who each generated $1million or more in narcotics billings
to Medicaid illustrate the situation.

Deaths Documented

The newspaper documented 61 deaths from overdoses for people under the care
of these doctors, most in the past two years.

Three of the million-dollar prescribers have been arrested in recent years,
two on drug trafficking charges. One, Dr. Asuncion Luyao of Port St. Lucie,
was suspended from practicing medicine in Florida as a result. She also
faces trial early next year on manslaughter charges.

One doctor the newspaper investigated, Jayam Krishna-Iyer, stayed on track
in her career despite an arrest for illegal distribution of prescription
drugs in 2000.

Federal agents set their sights on the Clearwater pain specialist because
they thought she gave out drugs "without a legitimate medical purpose."

Their undercover investigation ended in June 2000 when a federal grand jury
in Tampa indicted the anesthesiologist on drug trafficking charges. In
court filings, prosecutors alleged she accepted $175 in cash for
prescribing narcotics to undercover drug agents whom she did not examine or
run any medical tests on.

Prosecutors dismissed the charges after Krishna-Iyer agreed to take a week
of courses in medical ethics and pain management and pay another doctor to
supervise her pain-care practice for one year.

Medicaid has paid more than $1.6 million for narcotics Krishna-Iyer ordered
during the past three years, when at least 10 of her patients died of
overdoses, the newspaper found.

Medicaid paid another doctor $3.9 million for her to see patients and for
other services for patients over four years, from 1998 through 2001, the
Sun-Sentinel found. Dr. Shelley Wolland, an osteopathic physician who lived
in Davie, got into trouble in November 2001 when a surprise state
inspection found she was stocking outdated, possibly adulterated,
injectible AIDS drugs at Sunshine Medical, a clinic she owned in Miami. The
state osteopathic board in March 2002 prohibited her from dispensing or
injecting any medication.

About two months later, investigators arrested her on charges of cheating
Medicaid out of more than $400,000 by filing phony claims for services.
Neither her arrest nor the board's disciplinary action restricted her from
writing prescriptions for narcotics -- which she had done in huge volume.

Medicaid paid $1.5 million for narcotics and other controlled drugs billed
in Wolland's name, the 10th highest among doctors in the state, during the
past three years, billing records show.

The newspaper could not reach the doctor for comment. Her lawyer did not
return repeated phone calls and her clinic is apparently closed.

The newspaper found that out of the top dozen narcotics prescribers, only
Dr. Barry Rodwick had not at some time been charged with or disciplined for
professional misconduct or faced criminal charges or had claims for payment
flagged by state officials.

Many other doctors under state investigation for errant prescription
writing, or personal drug abuse, had patients die of drug overdoses either
while the disciplinary process lumbered along, or after a sanction was imposed.

Five Had Difficulties

In the Sarasota area, five of the 29 doctors the newspaper linked to
overdose deaths have been in trouble with the state.

Dr. West Magnon, a 79-year-old Bradenton psychiatrist with a history of
alcohol and drug abuse, was one.

In March 2002, a pharmacist reported to the state that Magnon had written
"suspicious prescriptions." Officials ordered the doctor to undergo a urine
test, which disclosed a sedative in his system.

Also that month, one of Magnon's patients, a 34-year-old Bradenton woman
with a history of drug abuse and back pain from arthritis, died on her
living room floor of an overdose of pills. Her last appointment with Magnon
was two days before, records show.

Magnon also had treated a 44-year-old woman who lived in Palmetto for
migraines. The woman died in November 2001, after mixing three drugs Magnon
prescribed, including the painkiller oxycodone, with cocaine, autopsy
records show.

Despite evidence that the doctor was drug impaired, state officials took
until April 24 of this year to suspend his license to practice medicine.
The Florida Board of Medicine granted his request to be reinstated in
October. He remains on probation.

The doctor could not be reached for comment in repeated calls to his office.

In several other cases, the newspaper found that happenstance, not an
aggressive surveillance system, led to doctors being weeded out of the
profession.

Such was the case with Dr. Steven Everett, a former Port St. Lucie pain
doctor whose career ended as a result of a disastrous affair with a 36-
year-old patient turned employee. In October 1999 Everett hired the woman,
whom he had treated for a year for muscle spasms and lower back pain, as a
respiratory therapist. Within four months they were involved sexually, and
a few months after that she was pregnant and saying the baby was his. She
miscarried, but during their affair Everett wrote her a prescription for
injectable Demerol, a potent narcotic, that he billed to another patient
with insurance.

The scheme came to light in May 2000 when his lover landed in jail on
charges of unauthorized use of a controlled substance. More than a year
later, in July of 2001, the state medical board filed a civil complaint
accusing Everett of engaging a patient in sexual activity and committing
fraud in the practice of medicine.

Everett didn't show up to contest the charges before the medical board in
October 2001. The board revoked his license.

But in the months before the state filed its case, two of Everett's
patients, both disabled, died of drug overdoses, according to autopsy reports.

The first was a 30-year-old Jensen Beach woman whom he began treating in
February 1999 for what medical records describe as "a constant, aching,
burning, shooting sensation that is associated with muscle spasms in the
right hip and buttocks." The woman said the pain came on a day after she
had done some heavy lifting.

Everett put the woman on OxyContin and kept her on it until May 2001 when
she died in her bathroom of an overdose of oxycodone, the drug in
OxyContin, three days after filling her prescription.

A month later, the second patient, William Wright, died. He was 43 and had
been under the doctor's care just under two years. Everett prescribed 100
injectable Demerol doses, 360 Dilaudid, and 200 pills of methadone, all
potent narcotics, in the month before the man's death, medical records
show. Everett also had ordered the sedative Valium for the man, who he said
in his medical chart would "never be able to work again," and require
"potent pain meds and management for a lifetime." The man died of an
overdose of methadone and the sedative, an autopsy found.

Some of the doctors who had patients die significantly stepped up their
drug prescriptions -- in a few cases by 10 times or more in a single year
- -- but state officials don't routinely monitor billings so they never noticed.

No case illustrates the pattern of patient deaths after a spike in
prescriptions more starkly than that of Jerome Waters. The 74-year-old
family doctor practices from a stucco house he owns near downtown Miami,
where, he told a reporter, he had built a "reputation" for catering to pill
users.

In 2000, Waters prescribed $65,000 worth of OxyContin. By 2002 he was
prescribing almost $1 million worth, earning him a spot as the fourth-
highest Medicaid prescriber of the drug in the state.

Need For Review

"When you see a growth of geometric proportions in drug billings, that
should be an indicator that the medical practice needs to be reviewed, said
Florida drug czar James McDonough. "The data should not be ignored."

They Were Ignored.

By reviewing autopsy case filings at morgues in Miami and Fort Lauderdale,
the Sun-Sentinel uncovered six deaths among Waters' patients from 2000
through the end of 2002, four involving either methadone or OxyContin. That
prompted state health officials to begin an investigation last fall.

But it took until early May this year for them to file an emergency order
prohibiting Waters from prescribing narcotics. Nine days after state
officials restricted the doctor's practice, another patient died of an
overdose, autopsy reports show.

Mitchell Ocana, a 31-year-old Miami Beach actor with a drug abuse problem,
didn't call his mother on Mother's Day. She began to worry about her son
and called police. They knocked down his door and discovered his body on
the bed alongside a crack pipe. Police also found a bottle of morphine
pills that Waters had ordered.

Ocana had the prescription filled on May 2, three days before the state
order against his doctor.