CAN FATAL DRUG MIX BE BLAMED ON DOCTOR?

PORT ST. LUCIE -- Tina Smith had been taking painkillers prescribed by Dr.
Asuncion Luyao of Port St. Lucie for a back injury for about five months
when her mother, Connie Velie of Vero Beach, started to worry.

The once vivacious, bouncy 27-year-old had become sluggish and dull,
slurring her words and sleeping too much.

Then, in May, she missed Mother's Day. Smith, a mother of two who worked
delivering pizzas, had always made Mother's Day a big production. She once
gave Velie four dresses.

When Velie phoned her a few months later, Smith's 2-year-old daughter, Zoe,
answered.

"Mommy is sleeping and won't wake up," she said.

Velie rushed to her daughter's home in Sebastian and found her lying in a
fetal position on the living room floor, the toddler at her side. Velie
started CPR, "trying to give her my life." But when paramedics arrived,
they told Velie her daughter had been dead for some time.

Smith's autopsy showed that she died July 13 of accidental multiple drug
intoxication.

In the Florida Department of Health emergency order suspending Luyao's
medical license on March 22, experts reported that Luyao did not do a
complete check of Smith's medical history, conduct a thorough examination
or justify Smith's need for the drugs before prescribing her the powerful
and addictive painkiller OxyContin -- along with Zanaflex, Soma and Xanax.

Luyao, who was charged last week with several counts of drug trafficking
and Medicaid fraud, is scheduled to appear in court today seeking to have
her $1.89 million bond reduced.

Investigators are now deciding whether to charge Luyao in connection with
Smith's death, as well as 11 other deaths that the Treasure Coast medical
examiner believes were caused at least in part by a combination of drugs
prescribed by Luyao.

Luyao is the latest in a string of physicians targeted by prosecutors who
see them as the main suppliers in a booming network of legal but
potentially lethal narcotics.

'Very frightening' trend Richard Lubin, one of Luyao's attorneys, said his
client has become the latest victim of a "very frightening" trend, where
law enforcement agents second-guess the subjective judgments of experienced
physicians. Lubin also represents Denis Deonarine, the Jupiter doctor
awaiting trial in Palm Beach County on charges of murdering one of his
patients, drug trafficking and committing fraud.

Relatives of some of Luyao's former patients say that Luyao's careless
prescriptions of pills on a cash-only basis gradually turned legitimate
pain patients into addicts -- and fueled the addictions of veteran drug
abusers across the Treasure Coast and South Florida.

Luyao set up her practice in St. Lucie County 25 years ago, after being
graduated from the University of Santo Tomas in the Philippines in 1965 and
completing her residency in New York City. The 60-year-old physician
practices internal medicine and does not have an official specialty in
chronic pain, Lubin said. She developed her knowledge of pain management
over the years with classes, conferences and reading, he said.

Chief Deputy Sheriff Garry Wilson said that authorities first became aware
of Luyao a couple of years ago when they arrested several of her patients
on drunken driving and prescription fraud charges.

In June, detectives got a call from a man who said his wife, identified
only as "A.H.," was getting strong narcotics through Luyao without any
medical need. When he told the doctor his wife was addicted, she told him
"to quit complaining and come in and get his own drugs," according to the
arrest affidavit.

A St. Lucie County sheriff's detective posing as a patient got multiple
prescriptions from Luyao with a perfunctory exam and no medical history of
pain, according to the affidavit. When the detective asked to come back
later than his regularly scheduled appointment, Luyao responded: "If you
come back that late you will run out of dope," the affidavit said.

During their investigation, authorities found $63,000 in cash in the
doctor's file cabinets, patients from as far away as Coral Springs -- a
160-mile round trip -- and in one case, patients standing outside her
office in the rain.

Lubin said she attracted patients from a wide area because "her patients
love her."

But that popularity doesn't mean guilt, Lubin said -- in fact, just the
opposite. Lubin said the recent arrests of doctors on drug-related charges
make other doctors afraid to prescribe the painkillers that can help
legitimate patients with chronic pain.

Luyao "was not a doctor who was afraid to be a patient advocate. Yes,
patients would come to see her when others were afraid to treat them for
their pain, because she was not afraid."

In many cases, Lubin said, Luyao dumped patients for lying about their
addictions and she gradually weaned others off painkillers.

But it is difficult for doctors to identify every drug abuser, Lubin said,
because they learn to hide their addictions, even from close relatives.

In the case of J.B., a mother of three from Vero Beach who died of an
overdose in November, Luyao expressed doubts in her patient file about
prescribing drugs to the woman, according to the emergency order suspending
her medical license.

J.B. told Luyao in a December appointment that she needed more painkillers
because hers had been stolen, according to the order. Luyao noted that this
was the second time J.B. had reported her medications stolen, that her
story was not adding up and that she seemed intoxicated.

Despite her reservations, Luyao wrote J.B. prescriptions for OxyContin and
Demerol, according to the order.

Several office visits later, in April, Luyao made notes in her file about
police investigating a sale of OxyContin at J.B.'s home. Again, she
prescribed OxyContin and Valium to J.B., according to the order.

A review of the patient files for office visits over 15 months shows that
"J.B.'s medical records do not indicate that Dr. Luyao attempted to
independently confirm J.B.'s pain in any way," according to the order.

If other doctors would have given her the potent medication, her father
asked, why would she drive more than 20 miles to Port St. Lucie to see Luyao?

"We've got plenty of doctors and drug stores right here in Vero Beach," he
said.

Pain patient 'wanted to stop' Lynne Peterson, a former news producer for
NBC, took extensive notes detailing her son's desperate three-year battle
with prescription drugs. In the year before 23-year-old Stephen "Joey"
Snyder of Jensen Beach went to see Luyao, he had been treated for a
prescription drug addiction in several rehabilitation centers and was
arrested at least three times for forging prescriptions.

Joey surely lied to Luyao to get the drugs, Peterson said. But the smart
kid who had played four or five sports at Martin County High School and
loved to surf would not have been able to prove any physical problems worse
than a slightly misaligned jaw and sprained ankle, Peterson said.

In June, Luyao prescribed him the powerful painkiller OxyContin and the
strongest available dose of Xanax, Peterson said.

Snyder overdosed the next month and was rushed to the hospital by
paramedics who found him unconscious in his car. Terrified that he would go
back to Luyao for more, he told his mother and a local prosecutor that the
Port St. Lucie physician had become his main supplier.

"Joey wanted to stop and was asking for help," Peterson said. "One of the
ways he was doing that was turning in the sources where he was getting the
stuff."

Snyder committed suicide in December, leaving behind a 2-year-old son,
Ethan. He shot himself the day after he heard about the overdose death of a
close friend. His mother said she found two pill bottles marked with recent
prescriptions from Luyao hidden in his room.

The week before he killed himself, Luyao had prescribed him 80 tablets of
the painkiller Dilaudid and 50 tablets of Xanax, Peterson said.

Barry Heisler, who is representing Luyao in civil court against a medical
malpractice suit filed by the husband of a patient who overdosed, said he
is confident families of former patients will not be able to prove that
Luyao was liable. Medical experts have already reviewed the state's
findings, he said, and decided that Luyao met the standard of care in
treating her patients. The Florida Department of Health disagrees.

Luyao's "egregious and repeated" prescription of inappropriate and
dangerous narcotics makes her unfit to practice medicine, according to the
order suspending her medical license.

The doctor "presents an immediate and serious danger to the health, safety
and welfare of the public," the order concluded.