Kokomo Tribune; Kokomo, Indiana

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April 25, 2013

Too many pills

Doctors say prescriptions in Wagoner case were excessive.

— Medical experts agree the doctors implicated in the Wagoner Medical Center investigation were prescribing too many narcotic pills.

An expert witness for the prosecution found numerous cases where four doctors — all now facing felony drug dealing charges — overprescribed.

And the chairman of the Indiana Pain Society, who recently spoke in defense of a Fort Wayne pain clinic doctor at a state suspension hearing, said there’s no way family practice doctors should have been writing so many prescriptions.

Police say overprescription of painkillers, sedatives and other controlled substances by doctors Don Wagoner, Marilyn Wagoner, William Terpstra and Robert Brewer was responsible for a rash of overdose deaths, addicted patients and a flood of pills into the community.

Howard County Prosecutor Mark McCann filed a total of 95 charges against nine employees associated with the Wagoner centers in Burlington and Kokomo, including more than 20 charges against the man police paint as the center of the operation, Don Wagoner.

Police outlined the case against Don Wagoner in a 29-page affidavit filed in Howard Superior Court 1 using testimony from former Wagoner employees and medical experts.

Unidentified patients and former Wagoner Medical Center employees described the clinics as operating almost on a cash-and-carry basis, where addicted patients paid their bills in full before receiving prescriptions for narcotics.

A former employee told police the Burlington clinic had a reputation as “the place” to go if someone wanted narcotics.

But the Wagoner doctors’ alleged failure to properly monitor patients could be the biggest legal issue.

Several individuals told police the clinics routinely ignored the conditions set out whenever a patient agreed to start what doctors call “chronic opioid therapy” or COT.

In order to keep patients from abusing highly addictive, opiate-based drugs such as hydrocodone (Vicodin, Lortab) and oxycodone (Percocet, OxyContin), doctors require patients to be drug tested.

Testing positive for substances not prescribed is usually grounds for a patient being dropped by a doctor, as is testing negative for the prescribed substances.

For instance, if a patient is prescribed Vicodin, but tests negative for the drug, doctors become concerned the patient either doesn’t need the medication, or might be giving away, stockpiling or selling the drug.

According to police, doctors at the Wagoner clinics gave prescriptions to patients for narcotics, even after multiple failed drug screens.

One patient told police the Wagoner clinic started requiring her to come in every week to be seen after she tested negative for the drug she’d been prescribed.

The patient said for seven straight weeks she would come in, test negative for the opiates she’d been prescribed, pay $332 in fees, and walk out with a seven-day supply of Lortab and Adderall, an often-abused drug used to treat attention deficit hyperactivity disorder.

Police also relied on the testimony of Dr. Timothy King, M.D., president and chief medical officer of Advanced Pain and Anesthesia Consultants Group, who has served as an expert witness for both the Indiana Attorney General’s office and the U.S. Drug Enforcement Administration.

After Kokomo Police and the DEA served search warrants on both Wagoner clinics Feb. 7, law enforcement seized medical files.

Police then asked King to review the medical files of 18 deceased patients and numerous living patients to determine if the prescriptions written for those patients were consistent with the usual course of professional medical practice, and whether there was any medical purpose for the prescriptions.

In case after case, King found either the patient shouldn’t have been prescribed controlled substances in the first place or the amounts prescribed put the patient in danger of an overdose death.

Dr. Michael Whitworth, a Columbus pain specialist who disagrees with King’s analysis of some of the cases, said there’s no doubt that some of the Wagoner doctors’ prescription practices were excessive.

“That would be high. That’s a high, high dose,” Whitworth said of the amounts prescribed to someone identified only as Victim 10 in the police affidavit.

Victim 10, who police said was an 81-year-old male, received a prescription for 420 OxyContin pills Nov. 16, 2012, with dosages ranging from 30 mg to 80 mg per pill.

“There is a limit to how much you should prescribe, even for pain doctors,” Whitworth said.

A local emergency room doctor said the man came into the ER unable to walk and incoherent, and told police that overmedication of Wagoner patients was a “chronic problem.”

In all, police are now investigating 27 deaths they believe are linked to the Wagoner clinics.

Over a four-year period, police have documented 127,495 prescriptions for controlled substances written by the four Wagoner doctors. Many, if not most, of the prescriptions were for more than one month of medication, sometimes as much as 300 to 400 pills per prescription.

Police say the doctors routinely signed blank prescription forms, which physician assistants at the clinic — who cannot legally prescribe narcotics — would fill in. One former employee said Don Wagoner and physician’s assistant Gary Hartman would sometimes write prescriptions for 60 patients a day.

Whitworth said it’s against federal law for a doctor to sign a blank prescription form and allow an employee to fill in the medications and amounts. The DEA is cracking down on such practices, he added.

As for the sheer number of controlled substance prescriptions, Whitworth said, a legitimate pain management clinic might write that many, but stressed that legitimate clinics have tighter controls and take significant measures if a patient fails a drug screen.

“I think the issue here is that they were supposed to be a family practice clinic. They didn’t have experience in pain management, they just hung out their shingle and said they were practicing pain management,” he said.

Scott Smith can be reached at 765-454-8569 or at scott.smith@kokomotribune.com.

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