DANGEROUS DOCTORS ONLINE

Doctors Medicate Strangers On Web Some Physicians Face Own Troubles

Third Of Five Articles

SAN ANTONIO -- At his worst, Ernesto A. Cantu was injecting himself 10
times a day with Demerol, swallowing tablet after tablet of hydrocodone,
taking Ambien to sleep and using Valium for anxiety.

"I became addicted," the stocky 60-year-old doctor said. "It's an illness."

Even as Cantu wrestled with his own addiction, he was writing thousands of
prescriptions for painkillers for customers of the Internet pharmacy
thepillbox.com. Those orders were based on brief telephone conversations
with patients Cantu never examined or even met. All together, he approved
more than 1 million doses of hydrocodone and other dangerous drugs, court
records show.

At least five of Cantu's customers were addicts or later became addicted,
according to state and federal records. An Alabama patient suffering from
chronic alcohol abuse and depression overdosed on hydrocodone and was
hospitalized for nine months. A San Francisco patient addicted to narcotics
developed liver damage after receiving multiple orders of the painkiller
Darvocet. A New Jersey mother previously treated for substance abuse
received more than 800 doses of hydrocodone from Cantu and other
thepillbox.com doctors.

Cantu earned as much as $1,500 a day for writing Internet prescriptions. In
nearly eight months, he said, he made $147,000. Other online doctors have
made as much as $500,000 a year.

"This is not Albert Schweitzer on the other end of the computer box," said
Lee S. Anderson, a physician and president of the Texas State Board of
Medical Examiners. "The people who are doing this know exactly what they
are doing -- and they are doing it for the money."

Across America, doctors beset by troubled histories work for rogue Internet
pharmacies, grinding out tens of thousands of prescriptions each year for
narcotics and other controlled substances. What passes for medicine in
these online transactions is mostly a fiction. There are no medical
records, examinations, lab tests or follow-ups.

The doctors are recruited by middlemen who link them to Internet customers
seeking access to the coveted drugs. The result is a virtual
pain-management industry that feeds millions of doses of highly addictive
drugs into the shadow market for pharmaceuticals, bypassing the normal
checks and balances in the physician-patient relationship.

"It's an easy way to make big bucks," said Jerry Ellis of the Drug
Enforcement Administration's Houston office. "It's not like any of the
doctors are truly practicing medicine or caring for the patients."

Internet pharmacies have attracted doctors with substance abuse problems,
legal setbacks and financial woes.

Among them:

David L. Bryson: After losing his job as a staff physician for a state
facility in Texas, the 65-year-old joined thepillbox.com in 1999 after
reading a newspaper article about its owner. Bryson had undergone alcohol
dependency treatment in 1995 and filed for bankruptcy protection in 1999,
according to Texas medical board records. In fewer than three years for
thepillbox.com, he wrote 20,000 prescriptions for more than 4.7 million
doses and collected nearly $1 million in fees, records show. About
three-quarters of the prescriptions were for hydrocodone and Xanax. In
2002, the Texas board revoked his license for prescribing dangerous drugs
to people he had not examined. A consultant to the board called Bryson's
actions "a travesty." Bryson pleaded guilty last month in a related federal
case and is awaiting sentencing. He declined to comment through his attorney.

Allen L. Browne: In 1999, the 46-year-old obstetrician pleaded guilty to
sexual exploitation of a minor and was sentenced to 10 months in prison.
Browne was caught secretly videotaping his girlfriend's 13-year-old
daughter showering and using the bathroom in his home in Mesa, Ariz. He
kept his license but closed his practice in March 2001. Soon after, he
began writing prescriptions for hydrocodone, codeine and Alprazolam for a
Web site based in a Mesa auto parts store. In seven months, Browne wrote
2,568 prescriptions, earning $36,520. He surrendered his medical license
earlier this year. He admitted to the board that customers might have
misled him to get pills. Browne could not be reached to comment for this story.

Marvin Gibbs: The 55-year-old gynecologist had recently lost privileges at
an Arizona hospital, where he saw 90 percent of his patients, when he was
approached in 2000 to write prescriptions for an online pharmacy. In 10
months, he wrote more than 9,000 prescriptions for more than 700,000 doses
of controlled substances, according to records of the Arizona Board of
Medical Examiners. "What in God's name were you thinking," a board member
asked during a 2002 hearing, "prescribing to folks you have no idea who
they are, where they're coming from, what they're doing with the
medications?" In February, the board placed Gibbs on 10 years' probation.
He did not respond to an interview request.

Ricky Joe Nelson: Unemployed and reeling financially after the collapse of
a business venture, the 47-year-old physician signed on in 2001 to write
prescriptions for an Internet pharmacy in Oklahoma. In a few months, he
wrote more than 5,000 prescriptions for controlled substances. In 2002, a
federal jury convicted him of conspiring to distribute controlled drugs and
launder $175,000 through an offshore bank account. He was sentenced to 51
months. He declined to be interviewed.

Many other cases bear out that there are few checks on doctors who hand out
drugs over the Internet:

A Colorado doctor had a history of alcohol abuse. An Arkansas doctor was
being treated for bipolar disorder and drug dependency. A Florida doctor
had twice been cited for providing inadequate care to elderly patients, one
of whom died. A Texas doctor was under investigation by the FBI for
suspected Medicare fraud and later committed suicide. A California doctor
was disciplined for operating under a fictitious name. A North Carolina
doctor had held 22 jobs in five years.

Prescriptions Without Exams

Doctors who write prescriptions for Internet pharmacies maintain that the
practice is safe and serves people who might otherwise not have access to
painkillers and other medicines.

Cantu, for example, told The Washington Post in an interview that his
earlier experience working in a hospital emergency room helped him identify
online patients who might abuse drugs. "Yes, it would certainly be better
if I saw them, but this is a new form of communication," he said.

Others stressed that many of their patients were between jobs, uninsured or
had no regular doctor. The Internet sites allow them to refill
prescriptions quickly without having to find another physician.

State and federal regulators say all of these arguments lead to a larger
question: What should physicians reasonably be expected to do before they
write a prescription for a dangerous drug?

In the past, the answer was relatively simple. Patients went to the

A: No. The conversation was less than 10 minutes. Very simple, very quick.
I was very surprised when I hung up. I couldn't believe it was that easy.

Cuccaro admitted taking more of the Vicodin than needed. "I am a
prescription-drug addict," she told investigators.

In November 2000, Cuccaro was scheduled for another consultation with Cantu
but missed the call when she left on a three-day anniversary trip with her
husband, Joe. A few days after returning, Cuccaro contacted the doctor
referral service to reschedule. The manager said it was not necessary,
records show. Her medical chart showed she had already had the
consultation. A few days later, Cuccaro received her next shipment of
Vicodin, with the number of pills increased from 90 to 100.

At that point, Joe Cuccaro was begging thepillbox.com to stop the
shipments, he told The Post.

"They basically laughed at me," he said.

Cantu said he would never have sent Cuccaro more pills without a
consultation. "It's not something I would do."

It is easy for patients with drug problems to fool doctors, he said. "They
were the ones trying to get these meds. They were the ones who asked for
certain meds, who gave symptoms that led you to prescribing certain meds."

Road To Addiction

Cantu's own road to addiction started with the pills he said he took 20
years ago for back pain. "I initially started with Darvocet in the '80s and
around 1995 I started using hydrocodone." In October 2000, Cantu added
Demerol to the mix. "I briefly became addicted to it."

At the time, Cantu was living with Anne Malley and her teenage daughter in
a gated community known as the Enclave.

Although Cantu's signature appeared on the prescriptions he wrote for
thepillbox.com, he allowed Malley "to represent herself as Dr. Anne Cantu
and provide the telephone consultations with patients," according to the
Texas medical board.

Cantu said Malley "did answer the phone at times and speak with patients.
But she would not prescribe any medications."

Malley's name appeared on a summary sheet of physicians prescribing drugs
for thepillbox.com, according to a 2001 affidavit prepared by a Food and
Drug Administration investigator. The affidavit states that she was paid
$42,340 by the Internet pharmacy, and used several of the checks as a down
payment for a 2001 Mercedes-Benz E350 costing $54,575.

Cantu frequently wrote prescriptions for Demerol in the names of patients
and employees who had not sought the drugs, state investigators said.

"The fictitious prescriptions were for the purpose of obtaining Demerol for
Respondent's girl friend, Anne Malley, and/or the Respondent himself," the
Texas medical board later stated. "There is probable cause to believe that
Respondent abused Demerol and/or that he has knowingly aided his girl
friend, Anne Malley, in abusing Demerol."

When federal agents searched Cantu and Malley's home in October 2001, they
found 96 empty vials of Demerol and syringes in the trash. "At that time,"
Cantu said, "I did not feel either of us was abusing. But at that time both
of us were addicted."

Malley did not respond to repeated interview requests.

Cantu said he was taking as many as 10 tablets of hydrocodone during the
day and injecting himself with as many as 10 ampules of Demerol at night.
"I didn't use the Demerol during office hours," he said.

He insisted that his addiction did not interfere with his practice of
medicine. "Just because a person takes hydrocodone and is addicted to it
doesn't mean he can't function in a normal way," he said.

Anderson, head of the Texas medical board, wondered why the board did not
catch Cantu sooner. "What he did is shocking," Anderson said. "It is
absolutely shocking behavior, and it's totally out of control."

The board did have Cantu on its radar. In October 2000, it alleged that he
prescribed "frequent high doses of narcotics" to a patient, including
numerous painkillers. Cantu was ordered to complete at least 50 hours of
continuing medical education.

Porter, the board's former head of compliance, described the settlement as
"garbage." He said Cantu "was handing out drugs left and sideways." Porter
said he was worried that Cantu was going to repeat his mistake "and
probably hurt somebody."

License Suspended

Cantu said that on Thanksgiving 2001 he prepared a turkey and watched as
Malley's daughter and two neighborhood girlfriends roasted marshmallows in
the fireplace. He had taken Demerol, Soma (a muscle relaxant), Valium and
Ambien. He said he went to bed and blacked out.

According to court records, Cantu returned to the living room, where the
girls were sleeping, and fondled a 13-year-old neighbor. The girl raced
from the house.

Cantu said he cannot recall the incident. "As to what happened, I have no
idea," he said. "I don't remember anything else."

He was charged with indecent sexual contact with a child.

The next month, on Dec. 7, 2001, Cantu's Texas medical license was
suspended. But a week later he appeared at a local pharmacy with a
prescription he had written for himself for Demerol. An alert pharmacist
contacted the DEA and Cantu was arrested. When police searched his car,
they found a .22-caliber rifle that Cantu said he purchased at a gun show.
Police said it was stolen from the Nashville Police Department.

"It was broken," Cantu said. "Here in Texas everybody has a rifle."

Cantu hopes that he will be released soon and that he will get his license
back.

Anderson said, "That is very unlikely."