QUESTIONABLE PRACTICES

Prospect of Docs Dealing Drugs Pressures Medical-Licensing Board

SOUTH SHORE - Illegal machine guns. Drug arrests and drug addiction.
Tales of bad debts, exploitative sex and gunpoint confrontations.

Credentials for a street gang, perhaps. Not a medical
career.

But these five men weren't gangsters. They were doctors -- doctors who
authorities say supplied millions of dollars' worth of prescription
narcotics to drug abusers in Eastern Kentucky.

Each of the physicians, who have been indicted on specific counts of
illegally prescribing drugs, worked at one time or another at a small
clinic in the tiny Ohio River town of South Shore.

Each got started or managed to stay in business in Kentucky thanks to
the way the state polices doctors.

At a time when a raging drug crisis has killed or damaged thousands of
Kentuckians, the state Board of Medical Licensure has been confronted
by a problem unforeseen when it was created 30 years ago:

The narcotics of choice choking rural Kentucky don't come from Turkish
poppy fields or Colombian coca plants. Most come from the prescription
pads of licensed doctors.

And a board created to monitor professional standards and assure
high-quality health care has been overmatched by the growth of a
lucrative, illicit market for pills.

The panel, which screens more than 1,000 new applicants for licenses
annually, often makes trusting assumptions. It doesn't get as much
information about applicants as it could. And it's confined by
statutes that limit its powers in controlling -- or even monitoring --
the 8,800 doctors already practicing in Kentucky.

In the South Shore cases:

. Three of the physicians were granted Ken-tucky licenses despite
histories of criminal, civil or professional trouble elsewhere.

. A fourth escaped scrutiny by Kentucky regulators until an Ohio
coroner raised questions about him. By the time Kentucky acted, he had
been linked to seven patient deaths.

. The fifth doctor, who at various times employed all the rest, first
came into regulators' sights 20 years ago, but kept his clinic open
until last fall despite two attempts to sanction him.

One has pleaded guilty; the others face trials this year.

Board members say they know it's their job to prevent all
this.

The board "is not in business to protect physicians, we're in business
to protect the public," said president Danny M. Clark, a Somerset
doctor with 16 years on the panel.

Still, the state's soaring prescription-drug problem has some members
of the board reeling. They aren't accustomed to looking for criminal
potential in a fellow doctor.

"Until a few years ago, you just didn't think about physicians having
felony convictions," Clark said.

A very small number of Kentucky doctors are unscrupulous, but just one
can do serious damage, said Michael Duncan, director of special
investigations for the state attorney general's office.

"Bad docs are just overwhelmingly horrible for a community," Duncan
said. "Get people addicted, take their money."

Regulator Can't Look for Trouble

In a 66-month stretch that ended last month, Kentucky licensed 4,715
new medical and osteopathic doctors, and rejected just 27. Eight
rejections came in the last six months.

The medical board couldn't check any applicants' backgrounds through
the FBI's criminal record database -- despite a law passed by the
General Assembly last year authorizing such checks. The FBI rejected
the bill's wording as too vague.

This session, lawmakers will be asked to try again, specifying that
the board would submit applicants' fingerprints to the FBI for checking.

Kentucky doesn't look for or ask applicants about bankruptcies,
income-tax liens or big disputed debts -- many of which are easily
discoverable through Internet searches or credit reporting agencies.

Few if any states do those things, though some states' medical boards
ask about delinquent child support; and other states, including
Kentucky, ask about delinquent student-loan payments.

Such financial information might signal that a doctor is "desperate
for money," said Dr. L. Douglas Kennedy, a Lexington pain specialist
who often evaluates suspect physicians for the board. But the board's
general counsel, C. Lloyd Vest II, said members couldn't deny an
applicant a license on financial grounds alone without citing some
violation of state law.

Kentucky runs applicants' names through two national databases for
probation. Three years later, he quit medicine to sell real estate. He
won his license back in 1992.

Citing New Mexico's lead, Kentucky accepted him in 1993, imposing a
shorter probation.

Cohn declined comment, but in a 2001 interview, he said he was tricked
by some patients. "I'm a very believing kind of guy," he said.

Coroner Sends a Warning

By the time Dr. Rodolfo Santos hit South Shore in late 2001, Procter
had given up his license. Snyder had been indicted; Cohn was under
arrest. Williams was under investigation.

But there were more problems coming. According to board records, an
Ohio coroner sent a Nov. 29 alert about a new drug problem in South
Shore.

One of Santos' patients had been found dead, clutching a bottle that
had contained drugs he prescribed. "This is a familiar pattern to us
and warrants your attention," Thomas O. Morris III, the coroner of
nearby Scioto County, Ohio, advised.

The Kentucky board quickly interviewed the coroner, local lawmen and a
federal drug agent. A federal Drug Enforcement Administration agent
told board officials that in the preceding year, six other patients of
Santos had died of drug overdoses. A doctor who reviewed 18 patient
files for the board called Santos' prescriptions "alarming."

In July, the board took Santos' license, and a Greenup County grand
jury indicted him. But it had taken six months from the Ohio coroner's
first alert.

Santos did not respond to several interview requests that were made to
his lawyer.

The medical board last month crafted a new policy requiring that "high
priority" cases be handled in 90 days or less.

Why didn't regulators monitor the new doctor at Procter's clinic from
the beginning?

"That's something we probably should have been doing," said Clark, the
board president.

But Vest, the counsel, doesn't think the board could have done that
legally. As a complaint-driven agency, the board must "have a reason"
for investigating, and "we never had anyone coming in saying (Santos)
was doing anything." Vest said he doubted that allegations about
earlier South Shore doctors would be enough.