Wednesday, February 11, 2009

Doctor Arrested For Dispensing Narcotics Without Examining His "Patients"

A physician with a practice in Duarte in Los Angeles County was arrested on February 10, 2009, on federal narcotics charges for allegedly dispensing powerful and addictive painkillers, such as oxycodone and hydrocodone, directly out of his office without examining “patients” who simply paid him cash for pills. The criminal complaint charges Daniel J. Healy with distribution of controlled substances and conspiracy to distribute controlled substances, charges that carry a maximum statutory penalty of 20 years in federal prison.

As attorneys who protect peoples' rights under the Constitution, please remember that an indictment or felony complaint contains allegations that a defendant has committed a crime. Every defendant is presumed innocent unless proven guilty in court.

The doctor was arrested at his office by special agents with the Drug Enforcement Administration (DEA). According to a criminal complaint filed last week in the U.S. District Court for the Central District of California, Healy allegedly ordered, dispensed and prescribed huge amounts of prescription painkillers over the past three years to patients he often did not examine. In fact, the complaint alleges that no single doctor in the nation purchased more hydrocodone tablets than Healy did last year.

According to the complaint, Healy drew the attention of federal authorities when an informant reported that Healy was dispensing controlled substances in exchange for cash payments. The informant reported that “patients” could obtain any amount of nearly any kind of painkillers they wanted from Healy, and then use the pills themselves or sell them for profit. On some occasions, Healy allegedly accepted on-the-spot cash payments for manufacturer bottles of narcotics containing as many as 500 pills. According to DEA informants, Healy either did not examine or made only cursory examinations of “patients” who directly received drugs or obtained prescriptions. The complaint alleges that Healy was known to inquire whether his “patients” wanted a “party size” or a “family size” bottle of narcotics.

The complaint alleges that in 2008, Healy ordered an “exceedingly high” amount of hydrocodone and wrote “large quantities of prescriptions for oxycodone and hydrocodone and other controlled substances.” After reviewing pharmacy records, the DEA determined that Healy ordered over 1 million hydrocodone tablets last year – more than any other individual practitioner in the nation. Based on Healy’s ordering history and the prices he charged, the DEA agent who authored the complaint affidavit estimates that Healy made $688,840 in 2008 on his sales of hydrocodone tablets alone.

The investigation of Healy was conducted by the DEA, which received assistance from the Monrovia Police Department and the Medical Board of California.

Commentary Regarding Pain Management And Keeping Your Practice Compliant With The Standard of Care: Even doctors who are not selling prescription medications for cash can learn something from this case. If they are prescribing or dispensing controlled substances for pain, they need to follow the California Medical Board directives for pain management and maintain well-documented patient records so they cannot be accused of being a "Dr. Feelgood."

Physicians and surgeons who prescribe opioids either for acute or persistent pain should not fear disciplinary or other action from California law enforcement or regulatory agencies for the mere fact of having prescribed opioids. The appropriate use of opioids in the treatment of intractable pain has long been recognized in California's Intractable Pain Treatment Act, which provides that "No physician and surgeon shall be subject to disciplinary action by the Medical Board for prescribing or administering controlled substances in the course of treatment of a person for intractable pain." (California Business and Professions Code Section 2241.5(c))

In 1994, the California Medical Board formally adopted a policy statement titled, "Prescribing Controlled Substances for Pain." The statement outlined the Board's proactive approach to improving appropriate prescribing for effective pain management in California, while preventing drug diversion and abuse. The Medical Board expects physicians and surgeons to follow the standard of care in managing pain patients which includes (1) history and physical examination; (2) treatment plan/objectives; (3) informed consent; (4) periodic review; and (5) consultation, referrals to other providers and identifying those at risk for prescription abuse.

If a medical practice involves some treatment for pain including that associated with trauma, surgery, medical procedures, or cancer, we recommend developing a compliance plan. A number of medical organizations have developed guidelines for acute and chronic pain management. Two of the countries biggest pain societies, the American Pain Society and the American Academy of Pain Medicine, published guidelines for doctors about how best to manage patients chronically taking strong, potentially addictive opioids. See:

Doctors need to know how to assess risk, manage risk and assess patients for the likelihood of misuse before prescribing. We have seen good practices face problems when events occur that are out of the doctor's control and bring scrutiny to the practice. For example, if a patient overdoses on prescription pain medications (especially with a prior history of addiction or mental illness), the Medical Board or family may scrutinize the practice's pain management records and his or her practices. Or if the patient is doctor shopping without the knowledge of the prescribing physician and pharmacies report the case to DEA. Having a compliance plan will help your practice avoid any adverse administrative or legal actions.

Any questions or comments should be directed to: at 213-233-2260. Tracy Green is a principal at Green and Associates. The firm focuses its practice on the representation of professionals, with an emphasis on health care professionals.


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