PAPER: PRESCRIPTION DRUG DEATHS RISE

FORT LAUDERDALE, Fla. A small group of Florida doctors are drugging
the poor at taxpayer expense and exploiting the Medicaid system by
prescribing hundreds of millions of dollars worth of dangerous drugs,
a newspaper reported Sunday.

Regulators have largely failed to curb excesses in billing as
pain-relief patches, sleeping pills, tranquilizers and other highly
abused drugs have poured out of pharmacies over the past three years,
feeding a booming black market and adding to a torrent of fatal overdoses.

"This is a crime in plain sight," said David Moye, director of
economic crimes and health care fraud for the Florida Attorney
General's Office.

An eight-month investigation by the South Florida Sun-Sentinel
included a hand review of more than 2,000 reports of prescription drug
deaths and a computer analysis of pharmacy billing records, through
which the newspaper learned that abuse of the system seems to go
unpunished if not unnoticed.

The Sun-Sentinel identified Florida's top Medicaid drug prescribers by
analyzing 8.8 million pharmacy billings from the state.

Drug companies keep careful records of controlled drugs that doctors
order for Medicaid and for the privately insured, but they don't share
that information with state regulators, law enforcement or the public.

Medicaid, which serves about 2 million disabled and low-income
Floridians, more than half of them children, paid pharmacies $346.6
million for narcotics and other potent drugs over the past three
years. Frequently, the Medicaid prescriptions were for the maximum
doses.

Between 2000 and the end of last year, Medicaid in Florida, a program
larger than all other states except New York, California, Texas and
Pennsylvania, purchased about 800 types of controlled drugs. Some were
brands such as OxyContin 80 mg, which costs more than $7 a pill, and
some were generics that cost less than one-hundredth that amount.

As doctors have switched patients from OxyContin, which has been
linked to deaths and is highly addictive, three other painkillers have
grown in popularity.

Medicaid purchases of methadone, morphine and fentanyl have more than
doubled since 2000, and deaths that can be linked to those narcotics
have skyrocketed.

Less than 3 percent of the state's medical professionals issued the
vast majority of these prescriptions.

Sixteen doctors each ordered more than $1 million worth of dangerous
drugs. By comparison, only 574 of the state's 56,926 medical
professionals topped even $100,000 in pharmacy billings. Most
prescribed less than a tenth that amount. Thousands of others wrote
far less.

Seven doctors in Florida each prescribed more than $1 million worth of
OxyContin in three years. Only two have formal training in pain management.

Many doctors who handed out the most prescriptions also are linked to
multiple drug-related deaths. At least 40 doctors each had four or
more patients die of overdoses in the past two years. Sixteen of the
physicians had eight or more such deaths. Whether those victims were
also Medicaid participants could not be determined from available records.

Medicaid paid out far more for OxyContin than for any other
narcotic.

The state spent $82 million in the past three years on that painkiller
alone. The pills can cost $600 to $800 a month per patient, and the
newspaper has linked them to scores of overdose deaths.

Morphine deaths also stand out in the Tallahassee area, where the
Sun-Sentinel found nine of 48 people who died of prescription
overdoses since the start of 2001 had been taking morphine pills,
including two nurses.

The top Medicaid prescriber of dangerous drugs in the state from 2000
through 2002 was Miami-Dade ophthalmologist Ronald Lubetsky, who wrote
orders worth $2,527,453. Medicaid paid more than $2.3 million of that
for OxyContin, for which Lubetsky was also Florida's top Medicaid
prescriber, the billing analysis showed.

Not far behind Lubetsky was Dr. Armando Angulo, a Hialeah general
practitioner with $2,282,268 in controlled drugs, almost all paid to
pharmacies for OxyContin.

Two of Angulo's patients died, including Richard Thompson, 56, a
longtime drug abuser disabled from a railroad job injury. The doctor
gave him OxyContin and the sedative alprazolam, records show. Thompson
died in Miami on Sept. 9, 2001, of an accidental overdose of both, an
autopsy found.

The newspaper was unable to locate Angulo, his attorney or many former
employees. His office phone lines have been disconnected.

In each area of the state, the newspaper tracked overdoses to a small
number of doctors -- many the same ones who are prescribing narcotics
liberally for Medicaid clients.

Around Jacksonville, where more than 3,500 physicians practice, 67
could be identified as prescribers of drugs that contributed to an
overdose death in the past two years.

In Pasco County, near St. Petersburg, eight of 11 doctors who had each
prescribed more than $100,000 of narcotics lost patients to overdoses.
Three of those doctors experienced five or more patient deaths.

"We've got to get our hands around this and do everything we can,"
State Attorney General Charlie Crist said. "Unfortunately, too many
lives have been lost."