Pubdate: Fri, 13 Jun 2003 Source: Dallas Morning News (TX) Copyright: 2003 The Dallas Morning News Contact: http://www.dallasnews.com/ Details: http://www.mapinc.org/media/117 Author: HOLLY BECKA, and TANYA EISERER, The Dallas Morning News FAMILIES' COMPLAINTS LED TO RAID ON CLINIC State Agencies Track Prescription Data But Can't Detect Problems If not for the complaints of grieving family members, investigators might have never known about the prescriptions written from a South Dallas medical office, as detailed this week in an affidavit. Officials with several state agencies said Thursday that they track facets of doctors' practices and drug-prescribing habits but some don't analyze the information, and others say problems aren't readily identified. Acting on family members' complaints, investigators on Tuesday raided the South Dallas clinic of Dr. Daniel Maynard after Dallas police linked his prescription practices with the deaths of 11 patients. The state has since stopped his Medicaid reimbursements. Dr. Maynard has not been charged with a crime, and his lawyer insists that he has done nothing wrong. District Attorney Bill Hill said Thursday that publicity from the raid has generated several calls to his office from people complaining that their family members became dependent on painkillers prescribed by Dr. Maynard. Officials with Texas Department of Public Safety said that they track physicians who prescribe certain narcotic, stimulant and depressant drugs, but they generally don't analyze the information. The DPS started its tracking program called the Triplicate Prescription Program in 1982 to help stop medically useful controlled substances from traveling from legal to illegal channels. The program tracks what are known as Schedule II drugs, which can cause severe dependence, including morphine and oxycodone. DPS spokeswoman Tela Mange said doctors' licensing agencies use the drug information that her agency gathers. She said the prescription tracking program was intended as a tool to help the licensing agencies determine whether there is a problem. "We share that [information] with the licensing boards," Ms. Mange said. "We don't make that judgment about whether they are prescribing too much of something. That's something the licensing board should do. We're not doctors." Dr. Donald Patrick, executive director of the Texas State Board of Medical Examiners, said he could not comment on any action that board investigators might or might not have taken regarding Dr. Maynard. But he said that, in general, a physician who was prescribing large numbers of Schedule III drugs including certain anti-anxiety drugs, tranquilizers, sedatives and stimulants, such as hydrocodone and Tylenol with codeine would not necessarily come to the attention of the board. Even information on Schedule II prescriptions that the DPS collects might not prompt an investigation, Dr. Patrick said. "There's no mandate to analyze that data," he said. Dr. Patrick said he hopes to put into place a board operation for such analysis in conjunction with DPS. According to a search warrant affidavit, Dr. Maynard was the leading prescriber of diazepam in Texas in 2002 and the second highest prescriber of Tylenol with codeine that same year. Diazepam, also known as Valium, is a Schedule IV drug. Ms. Mange said DPS officials were trying to determine where authorities would have gotten that information about Dr. Maynard since DPS does not track those drugs. "If he was writing all of these through Medicare and Medicaid, I would assume that they would keep track of that," she said. Robert Evans, Dallas DEA spokesman, said there is no federal prescription monitoring program. There is a tracking system at the wholesale-distribution level of Schedule I and II drugs, and controlled substances in Schedule III. Some pharmacists buy from the wholesale-distributor level, he said. "If a doctor or someone was prescribing something that was below what DEA looks at, at a federal level, there would be no way we would know it unless someone brought it to our attention," he said. "Then, of course, we would look at it." Meanwhile, the Medicaid vendor drug program at the Texas Health and Human Services Commission monitors physicians who prescribe drugs for reimbursement. But problems aren't always caught. "We should catch it," said Aurora LeBrun, associate commissioner for investigations and enforcement. "Sometimes you do, sometimes you don't. ... Sometimes they know enough to stay below a pattern of utilizing that will bring them to the attention of investigators." The Texas Health and Human Services Commission monitors Medicaid use, doctors' prescribing patterns and the recipients of Medicaid benefits. For about the last two years, the vendor drug program has used a new system in which a computer analyzes patients' diagnoses and prescriptions against normal standards and hunts for irregularities. Even then, problems might not be flagged because the socioeconomic status of a doctor's practice and the number of his patients are taken into account. "The system is built to pay the claim and pay it on time," Ms. LeBrun said. "So, in the system, yes, there's a large volume, but when you analyze it there are things that come into play. What type of population is he serving? Is his clientele sicker than the average? A lot of work has to be done before you come to conclusion that because he is prescribing in a high pattern it is fraud or abuse." Another hurdle is the fact that Texas has no way to compare records of patients who, for example, pay for their doctor visit with federal Medicare but then pay for their prescription with state Medicaid, she said. "Texas is one of two states working with the federal government to start a data match project" to compare Medicare and Medicaid information, she said. Drug Risks Controlled drugs are rated in the order of their abuse risk and placed in schedules by the federal Drug Enforcement Administration. The drugs with the highest abuse potential are in Schedule I, and those with the lowest abuse potential are in Schedule V. Here is a look at the drugs in each schedule: Schedule I Drugs with a high abuse risk. These drugs have no safe, accepted medical use and include heroin, marijuana, LSD, PCP and crack cocaine. Schedule II Drugs with a high abuse risk, but they also have safe and accepted medical uses in the United States. These drugs can cause severe psychological or physical dependence. They include certain narcotic, stimulant and depressant drugs such as morphine, cocaine and oxycodone. Schedule III, IV and V Drugs with an abuse risk less than Schedule II. These drugs also have safe and accepted medical uses in the United States. Schedule III, IV or V drugs include those containing smaller amounts of certain narcotic and non-narcotic drugs, anti-anxiety drugs, tranquilizers, sedatives, stimulants and non-narcotic analgesics. Some examples are acetaminophen with codeine, paregoric, hydrocodone with acetaminophen, diazepam and alprazolam. - --- MAP posted-by: Keith Brilhart