Drug dealing doctor or compassionate caretaker?

By chillinwill · Feb 17, 2009 · ·
  1. chillinwill
    With guns drawn, a dozen federal agents stormed a nondescript South Florida office on Feb. 11, 2008, to arrest a drug suspect.

    The alleged culprit was not a cocaine importer or marijuana grower. He was a state-licensed physician, charged with prescribing medication that caused the death of a man from Palm Beach County.

    When the case goes to trial today in Miami federal court, it will fall to jurors to decide whether Dr. Ali Shaygan was a compassionate doctor looking out for his patients or a drug dealer peddling prescriptions to addicts for easy cash.

    His case is part of a national debate over who should set the standards for medical practice and how much responsibility doctors bear when they prescribe potentially deadly drugs.

    Since 2003, nearly 400 physicians nationwide have been charged with prescription-related offenses, many under tough federal statutes intended to fight drug trafficking, according to the Drug Enforcement Administration.

    Of those cases, 51 involved Florida doctors. It is unclear how many were in South Florida, but the region leads the state in deaths from prescription drug overdoses.

    Authorities lay some blame for the abuse of prescription drugs on what they say are unscrupulous doctors and have been cracking down on those they claim are willing to supply drugs to addicts and dealers.

    But some lawmakers, medical professionals and patient advocates say such prosecutions make physicians afraid to prescribe the proper medication, even to those who desperately need it.

    "As a result, we have an epidemic of untreated and under-treated pain," said David Brushwood, a professor of pharmaceutical regulation at the University of Florida.

    Garrison Courtney, chief of public affairs for the DEA, said there is no evidence the agency's investigations hamper legitimate prescribing.

    "Doctors know if they're practicing within the confines of the law, there's not an issue," he said.

    A key question in Shaygan's trial will be whether the Miami Beach doctor, who agreed to meet patients late at night and at his home, performed adequate examinations before writing prescriptions for powerful narcotics.

    At the center of the government's case is 29-year-old James "Brendan" Downey, of West Palm Beach, who died of a drug overdose in June 2007. If the jury finds Shaygan responsible, he would face a minimum of 20 years behind bars.

    Shaygan, 37, completed his residency at the prestigious Mayo Clinic and specialized in family medicine. He treated Downey on three occasions and wrote him prescriptions for methadone and Valium, court records state.

    Downey filled his last prescription on June 9, 2007. He popped several pills before going to sleep that night, his girlfriend told investigators, and never woke up. According to the government toxicology report, fatal levels of methadone were found in Downey's blood.

    Prosecutors contend that makes Shaygan responsible, but the evidence is hardly clear-cut, according to the doctor's lead attorney, David O. Markus.

    Markus said Shaygan had good cause to prescribe medication for Downey, who broke his ankle in a 2005 car accident. Moreover, an autopsy showed Downey was a heavy cocaine user and had cocaine and other drugs in his system when he died, Markus said.

    Prescription bottles with Shaygan's name were found in Downey's bedroom, but so were multiple prescriptions from other doctors, Markus said.

    After Downey's death, two undercover police officers posing as patients visited Shaygan's office. Prosecutors will tell jurors that each received numerous prescriptions after minimal examination, proving Shaygan was more interested in recruiting customers and earning a profit than providing medical treatment.

    Markus has a different take: "These agents went in and acted like real patients."

    Stories like Shaygan's convince many general practitioners that it's simply too risky to prescribe certain drugs regardless of medical need, said Dr. Sanford Silverman, a Broward County pain and addiction specialist.

    Like many in his field, Silverman said he requires patients on narcotic pain medications, such as Oxycontin and hydrocodone, to sign contracts and submit to random drug screening. Such tests can be used to confirm patients are taking medications as prescribed or detect signs of illicit drug use. Silverman never prescribes such drugs on the first visit, he said.

    "The run-of-the-mill physician out there may feel that it is too much to be bothered with," he said. "Inevitably, that affects the patient."

    February 17, 2009
    South Florida Sun-Sentinel

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  1. pinksox
    This is true. As a medical professional, I've had discussions with many, many prescriber's about their concerns about heavy-handed DEA tactics and the fact that the DEA seems to like making a few examples of doctors that could be considered even minimally borderline in their prescribing habits.

    I also know many pain specialists that will absolutely refuse to provide narcotics to a new patient during their first visits even if they believe that patient legitimately needs such meds. Often times, this is an attempt on the part of the doc to root out "seekers." How a patient reacts when they're given non-narcotic meds to try on a first visit can be very telling for a doc. If the patient is obviously distressed and angry about not receiving a narcotic for a first visit, their behavior sends up all sorts of red flags to the provider.

    A top pain specialist I know has relayed stories of patients actually threatening him and his family with harm or reporting to sue him for not prescribing narcs on a primary visit. It's gotten so bad for him that he absolutely refuses to provide ANY medicare/medicaid patient with any t ype of narcotics...even people who've been his patients for years who, for whatever reason become more disabled and need to give up private insurance for m'caid/care.

    Because of DEA crackdowns on even moderately prescribing docs most pracitioners will never write for any narcs without having the patient sign a contract that they will ONLY recieve narcotics from them and they will only get those scripts filled at ONE pre-selected pharmacy of the patients choice. More and more are demanding drug screening and random patient pill counts to show compliance and help prevent diversion.

    I also caught this:
    Given those two contradictions, it's hard to believe the DEA's statement that patients aren't suffering when providers on the ground are saying just the opposite. From my experience, it obvious that many patients with legit needs are being denied because docs aren't willing to risk their livlihoods or the well-being of their other patients by putting their licenses on the line.
  2. twoofus2
    and this is what is f~n swim he is new in fl and the new Dr. is playing with him...:mad:
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