Kokomo Tribune; Kokomo, Indiana

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April 26, 2013

Licensing board insists on conditions

Wagoner-affiliated doctor facing formal license complaint.

Dr. Robert Brewer might have written thousands of narcotics prescriptions over the past two years, but lawyers for the Indiana Attorney General’s office claim Brewer was just acting as a fill-in for Dr. Don Wagoner.

Brewer, 86, is one of nine people charged in connection with alleged “pill mill” activity at the Wagoner Medical Center offices in Kokomo and Burlington.

Brewer is still able to practice medicine, for now, after the attorney general’s office dropped efforts Thursday to impose an emergency license suspension.

But the Medical Licensing Board of Indiana insisted on putting conditions on Brewer’s license, in part due to two felony charges Howard County prosecutors filed against Brewer last week.

At the same hearing, the AG’s office also dropped an emergency suspension petition against another Wagoner physician, Dr. William Terpstra, who remained incarcerated at the Howard County jail Thursday morning on $1 million bond. Terpstra has already agreed to voluntarily give up his Drug Enforcement Administration registration number, meaning he no longer has legal authority to prescribe medication.

But it was Brewer’s case which created the most controversy Thursday, as state officials wrangled over how to deal with the elderly doctor.

At the start of Thursday’s hearing, Jessica Krug, the deputy attorney general assigned to the case, indicated the state was satisfied with Brewer’s promise not to practice pain management, and said it no longer appeared Brewer was a threat to the community.

Brewer, she said, treated only two of the 14 patients — all of whom died of drug overdoses or complications from over-medication — listed in the AG’s formal complaint against him.

Krug said Brewer filled in for Wagoner, the head of the two clinics, on days when Wagoner wasn’t seeing patients. She said Brewer resigned from the clinic Feb. 27, and hasn’t practiced medicine since.

In the charges filed against Brewer in Howard County, investigators said Brewer wrote more than 5,300 prescriptions for controlled substances last year. At the hearing, Brewer said he worked partial days Mondays and Wednesdays, and all day Thursdays.

“All I can say is right now, I’m in such a state of shock and total unpreparedness, I haven’t thought about anything for the future,” Brewer said when asked if he intended to continue practicing. “I was more or less semi-retired when I met Dr. [Don] Wagoner two years ago and came to the clinic.”

The proposal to drop the emergency suspension without conditions didn’t sit well with board chair Steven Huddleston, who grilled Krug as to why two months ago, the state thought Brewer was enough of a threat to ask for an emergency suspension.

“Isn’t Dr. Brewer facing criminal charges in Howard County?” Huddleston demanded. “One one hand you have the attorney general saying there’s no problem, and on the other hand you have a prosecutor saying there’s enough of a problem for criminal charges.”

After Huddleston indicated he wasn’t satisfied with no formal conditions being placed on the doctor’s license, Brewer’s attorney, Richard Kiefer, revealed the AG’s office had signed a “private agreement” with his client, which did, in fact, lay out a set of conditions.

After the AG’s office filed formal complaints against four Wagoner clinic doctors in March, two of the doctors, Don Wagoner and his wife, Dr. Marilyn Wagoner, agreed to quit prescribing all controlled substances other than Suboxone, and to keep a log of every prescription they wrote.

According to what Kiefer revealed Thursday, Brewer’s private agreement contained similar conditions.

But Huddleston said allowing the AG’s office to enter into a private agreement with a doctor for license restrictions was a “bad precedent,” and said no agency other that the licensing board has legal authority to enforce license restrictions.

When none of the licensing board members would back the state’s motion to dismiss the emergency suspension petition, Huddleston suggested Krug and Kiefer come back later with a better plan.

Both sides eventually agreed on conditions, which Huddleston insisted be put in writing and signed, stating Brewer can no longer write prescriptions for controlled substances for pain and would have to refer any patients in need of pain medication to an independent specialist. Brewer must also keep a log of all prescriptions he writes.

“Of 14 deaths we looked at, [Brewer] was only involved in one or two, and his involvement in those deaths was minimal,” said Senior Deputy Attorney General Michael Minglin.

All four of the Wagoner doctors are now barred from prescribing narcotics and state officials are proceeding with the formal complaints which could result in all four doctors’ state licenses being revoked. The medical licensing board will have a formal hearing for both Wagoners June 27, Terpstra will appear July 25 and Brewer’s case will be heard Oct. 25.

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

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