Kokomo Tribune; Kokomo, Indiana

March 18, 2013

Officials connect deaths to Wagoner clinics

— Monday, Indiana Attorney General Greg Zoeller filed a 10-page petition with the Medical Licensing Board of Indiana, asking the board to impose a 90-day suspension of four doctors connected with the Wagoner Medical Center locations in Burlington and Kokomo.

In the petition, the attorney general’s office alleges Drs. Don and Marilyn Wagoner, William Terpstra and Robert Brewer overprescribed medications to numerous patients, 14 of whom are listed below. Twelve of those patients are dead, and seven of the deceased died of drug overdoses.

The petition alleges the doctors’ prescribing practices “present a clear and immediate danger to the public health and safety” and that the doctors have created the potential for the illegal resale of drugs, drug abuse and drug addiction.

Here are summaries of the attorney general’s allegations regarding the care each of the 14 patients received at the Wagoner clinics. Quotations are directly from the attorney general’s petition:

Patient A, died Oct. 19, 2010

Treated from Oct. 23, 2009 to Oct. 15, 2010. Given Suboxone therapy for dependency on opiates, along with the habit-forming drugs Xanax and Ambien “despite an extremely high risk of sedation and respiratory depression.” Dosages remained “high” until the patient’s death on Oct. 19, 2010. The drugs Suboxone and Xanax were present in the patient’s body at the time of death.

Patient B, living

Treated from April 20, 2007 to July 26, 2010. Prescribed opiates despite being at high risk for addiction and other problems. Prescribed doses continued to escalate despite no documentation of a pain management plan, along with multiple failed urine screens showing the presence of non-prescribed substances. Drug screens also indicated patient wasn’t taking the medications prescribed by the clinic.

Patient C, died Jan. 14, 2010

Treated from July 25, 2006 to Jan. 6, 2010. Prescribed opiates despite risk factors that included an overdose on the synthetic opiate methadone, and numerous “drug screen inconsistencies.” Patient given a prescription for 360 30-mg oxycodone tablets on his last visit, and died eight days later of respiratory failure secondary to opiate overdose.

Patient D, living

Treated from Nov. 28, 2006 to Feb. 2, 2010. Had a medical history that included four overdoses for abused substances, including benzodiazepines (Xanax, Valium and Klonopin are all drugs of this group), cocaine, opiates and alcohol. The information about the overdoses wasn’t included in the patient’s treatment plan, and the patient continued to receive prescriptions for opiates.

Patient E, died July 1, 2012

Treated from Jan. 12, 2012 to June 12, 2012. Suboxone was prescribed on first visit, despite the presence of benzodiazepines and methadone in the patient’s urine. Patient was prescribed Klonopin, despite a history of abusing benzodiazepines, and phone calls from the patient’s psychiatric center requesting the Wagoner clinic stop all benzodiazepine prescriptions. Died of overdose on July 1, 2012. Coroner found Xanax, Klonopin, fentanyl (a synthetic opiate), oxycodone and buprenorphine (Suboxone).

Patient F, died Aug. 27, 2012

Treated from April 20, 2009 to Aug. 15, 2012. Narcotics were prescribed on first visit and dosages were escalated over a three-year period, “with no indication they were clinically effective or being used for appropriate pain management.” There was no documentation any drug screens were performed on the patient, and the patient’s use of the prescribed drugs was “largely unmonitored.” Died of a multiple drug overdose.

Patient G, died Nov. 3, 2008

Treated from Dec. 11, 2006 to Oct. 31, 2008. Prescribed opiates despite numerous risk factors for addiction. A week prior to death was prescribed 240 10-mg tablets of methadone, the equivalent of taking 600 mg of morphine per day. Investigators called it “an excessive and lethal amount of medication.” Died of respiratory depression, caused by a multiple drug overdose. The coroner’s toxicology report showed methadone and benzodiazepines.

Patient H, died Nov. 1, 2011

Treated from Oct. 28, 2002 to Oct. 31, 2011. Showed “obvious presence of drug abuse and addiction,” as evidenced by failed and/or inconsistent drug screens on 36 separate occasions. Consistently tested positive for marijuana and oxycodone, substances he was not prescribed. “The practitioners at the Wagoner Medical Center deliberately ignored Patient H’s lack of compliance and continued prescribing controlled substances for non-medical purposes.” Was prescribed a combination of opiates, a muscle relaxer and a benzodiazepine — referred to by medical professionals as the “Fatal Triad.” Died of an overdose.

Patient I, deceased

Treated from March 2, 2005 to Dec. 28, 2007. Prescribed opiates despite numerous risk factors for addiction. Her last documented visit was in December 2007, but she continued to receive prescriptions from practitioners at the Wagoner Medical Center for the next 11 months. Six days prior to her death she received prescriptions for a high dose of methadone, Valium and Ambien, posing a high risk of over sedation. Those drugs were present in the toxicology report received by the coroner.

Patient J, died Oct. 9, 2011

Treated from May 13, 2008 to Oct. 4, 2011. Prescribed opiates despite numerous risk factors for addiction. Had severe respiratory problems, but was prescribed opiates (which can cause respiratory depression) for years prior to his death. His history of psychiatric problems also made the patient a bad candidate for long-term opiate use without strict monitoring. The dosages of his medications were continually escalated, with the sharpest escalation occurring six weeks prior to his death. Died of events related to multiple drug intoxication.

Patient K, deceased

Treated from May 11, 2009 to Feb. 1, 2012. Prescribed opiates despite numerous risk factors for addiction. Was immediately started on methadone and Remeron, an antidepressant, without any verification of medical history/medication history, and despite testing positive for marijuana on his first drug screen. Numerous subsequent drug screens showed the presence of marijuana and unprescribed opiates, and an absence of the benzodiazepines he’d been prescribed at Wagoner. Had documented problems with drug addiction and a history of abuse. Died two weeks after receiving his last prescription. Toxicology report showed methadone, marijuana, Xanax and other controlled substances.

Patient L, died Aug. 28, 2012

Treated from Feb. 11, 2009 to Sept. 20, 2012. Came in with an unspecified complaint of “back pain” that was never confirmed or refined through any available means of diagnosis. Prescribed opiates despite numerous risk factors for addiction. She had 25 failed drug screens, had a history of failing pill count tests and of requesting early refills, and had a history of alcohol abuse that was ignored. Died Aug. 28, 2012, of complications related to cardiopulmonary disease, liver cirrhosis and respiratory problems, “all of which were likely exacerbated by her opiate regimen.”

Patient M, died July 16, 2011

Treated from July 24, 2007 to July 15, 2011. Prescribed opiates despite numerous risk factors for addiction. Prescribed escalating doses despite a lack of “testing or objective findings of pain.” Tested positive for methadone — a drug her husband was being treated with — yet afterward had her own prescribed dosages increased. Had a history of severe respiratory depression including asthma, obesity and sleep apnea, and was dependent on supplemental oxygen. A prescribed combination of drugs was blamed for her overdose death.

Patient N, died June 26, 2011

Treated from July 22, 2008 to June 23, 2011. Prescribed opiates despite numerous risk factors for addiction. Her complaint of lower back pain was never substantiated. She had a psychiatric history of depression and anxiety, and a history of using marijuana and other drugs. Had multiple inconsistent drug screens and rejected other available therapies in favor of controlled substances. Died of a drug overdose.