ONCE-HERALDED MEDICAL RECRUITS FALL FROM GRACE

Doctors Face Drug Charges In Appalachia

PIKEVILLE -- A growing list of doctors who were once welcomed with open
arms into medically underserved Appalachia have been taken away in handcuffs.

In eastern Kentucky alone, seven small-town doctors are in prison or on
their way there for illegally supplying drug addicts with prescriptions for
powerful narcotics such as OxyContin. At least six others have been rounded
up in the hills of West Virginia, Virginia and southern Ohio.

Advocates for the mountain region say the loss of so many doctors
ordinarily would have left a void. In these cases, they say, the departures
can only improve medical care.

"As badly as we need more physicians, we certainly don't need the type that
will violate their oaths and do much more harm than good," said Ewell
Balltrip, executive director of the Kentucky Appalachian Commission.

Federal and state law enforcement agencies began cracking down on wayward
physicians in Appalachia in 2000, after OxyContin, a powerful painkiller
intended for cancer patients and others suffering from severe pain, began
showing up in large quantities on the black market.

The first eastern Kentucky physician snared in the crackdown -- Dr. Ali
Sawaf, 61, of Harlan -- turned to illegally prescribing OxyContin and other
painkillers after he lost his $250,000-a-year job at a regional clinic.

Assistant U.S. Attorney Roger West said at the time that Sawaf was
desperate for money and opened an office in a Harlan mall where he handed
out prescriptions almost as quickly as he could write them.

The latest physician to plead guilty, Dr. David Procter, 52, of South
Shore, traded painkillers for sex. He admitted to a federal judge that he
had sexual relations with two female patients after he got them hooked.

Assistant U.S. Attorney Pat Molloy said most of the doctors caught in the
past two years had been recruited to come to the region to help care for
rural residents.

"They may not have stepped over the line before they got here but clearly
they were corruptible," Molloy said. "I don't think they were of high moral
character when they got here."

The problem is not confined to Appalachia.

Dr. Dudley Hall, a Bridgeport, Conn., physician, was nicknamed "Dr.
Feelgood" by police for writing so many prescriptions for OxyContin and
other painkillers . Hall was convicted last year on 22 counts of illegally
prescribing a narcotic substance and 14 counts of illegally prescribing a
controlled substance.

In Milton, Fla., Dr. James Graves was convicted of manslaughter in the
OxyContin overdose deaths of four patients. Graves was the first doctor in
the nation to be convicted of manslaughter or murder for OxyContin deaths.
He testified that he was unaware patients were abusing the prescriptions.

Authorities blame the abuse of OxyContin for scores of overdose deaths in
the Appalachian region and beyond.

If taken properly, the drug's ingredients are released slowly into the
body. But abusers circumvent the time-release by crushing the pills and
inhaling or injecting the powder to get the same kind of euphoric high that
heroin brings.

Larry Bailey of Grayson said he believes his son, who became hooked on
painkillers and died from an overdose, would still be alive if unscrupulous
doctors had not been so willing to feed his addiction.

At first, his son, Paul Bailey, 35, had a legitimate need for medication to
ease severe back pain. The last time he visited Dr. Rodolfo Santos of South
Shore, he left with prescriptions for painkillers, tranquilizers and muscle
relaxants. It was a combination of those pills that claimed his life.

So when Santos went on trial last month for overprescribing drugs, Larry
Bailey sat quietly in the courtroom day after day, hoping the doctor would
be convicted on the charges. The conviction came last month, making Santos
the seventh doctor in eastern Kentucky to fall.

"Being angry doesn't solve anything," Larry Bailey said. "But I was
thrilled to see him being put out of business. My son tried to break the
addiction. He had moved himself into a treatment center at Ashland and did
well for a few months. The desire came back, and he could get drugs freely
from Santos."

A jury recommended in April that Santos, who was recruited to work in
eastern Kentucky, serve 16 years in prison. He could be eligible for parole
in a little more than three years.

Procter, the physician who owned the clinic where Santos worked, pleaded
guilty in April to one count of conspiracy and two counts of illegally
prescribing controlled substances. Procter faces 10 to 12 years in prison.

Others in eastern Kentucky who have either pleaded guilty or been convicted
of overprescribing drugs include two physicians in Paintsville, one in
Garrison and another in South Shore. Some of those individuals saw as many
as 150 patients a day, ushering them into and out of examination rooms in
as little as three minutes.

Lewis County Sheriff Bill Lewis said no one in Garrison was sorry to see
the arrest of Dr. Fortune Williams, the only physician in the community of
800 people, because of the large number of addicts he created and attracted.

In southern Ohio, two doctors have been convicted over the past two years
for writing unnecessary prescriptions for painkillers, as have two from
West Virginia and two from southwest Virginia.

In an effort to get more doctors in rural Appalachia, area leaders pushed
for and got a medical school. The Pikeville College School of Osteopathic
Medicine will have graduated 168 doctors as of this month.

The idea is to ease the shortage of primary care doctors with homegrown
physicians.

Dr. John Strosnider, dean of the Pikeville college, said the new doctors
will immediately begin to narrow the physician-to-patient ratio, easily
replacing the physicians who have been sent to prison.

"Those numbers I don't even worry about," he said. "If we have physicians
who are unethically writing prescriptions and selling narcotics, they're
not practicing medicine anyway."

The first 53 graduates are scheduled to complete residency training in July
of next year, at which time they'll be opening offices throughout eastern
Kentucky.

"Five years from now, we should see hundreds of new primary care doctors in
these communities," Strosnider said.