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.
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