Pubdate: Sun, 27 Mar 2005 Source: Richmond Times-Dispatch (VA) Copyright: 2005 Richmond Newspapers Inc. Contact: http://www.timesdispatch.com/ Details: http://www.mapinc.org/media/365 Author: Bill McKelway Bookmark: http://www.mapinc.org/oxycontin.htm (Oxycontin/Oxycodone) Bookmark: http://www.mapinc.org/find?232 (Chronic Pain) PROBES OF DOCTORS NOT ALWAYS ON FAST TRACK Delay In Proceedings At State, Federal Levels Can Allow Suspect Physicians To Stay In Business Despite a statewide uproar over prescription abuse by doctors, patient deaths and pain-medication overdoses, the state's medical board continues to allow suspect doctors to stay in business. In three ongoing cases, state and federal records show that the state medical board delayed action or declined to pull licenses against Virginia pain specialists whose care had been linked to patient deaths and sweeping allegations of negligence and fraudulent prescription writing. Each of the cases involves years of alleged abuse. In a case involving longtime Newport News internist Dr. James H. Shegog, the state medical board this month suspended the man's license, citing patient deaths and drug overdoses. But the suspension followed months of procedural delays during which an additional patient died, a death the board cited in suspending Shegog's license. At the federal level, two doctors face lifelong prison sentences; but both Dr. William E. Hurwitz, who had offices in Northern Virginia, and Dr. Sidney S. Loxley, an orthopedist in Chesapeake, retained their licenses after reviews by the state medical board. Robert A. Nebiker, director of the state Department of Health Professions, said last week that actions by the medical board have been sufficient to deter improper conduct. But he acknowledged that because state investigators are overworked, a thorough review of a physician's practice can be difficult, and that state regulations require the full medical board to act on license suspensions or revocations. Directors of the various medical boards are powerless to do that unilaterally. In some cases, state actions are forestalled by secret federal court orders that protect federal investigations but allow suspect doctors to stay in business, Nebiker said. "It's one of our concerns that people can be harmed in the interim," said Nebiker, noting that some of the federal cases take years to mature. But delays in state proceedings take their toll as well. Two weeks ago, the medical board suspended Shegog's license; his prescriptions for powerful pain medications are allegedly tied to nine deaths and dozens of instances of negligent care, according to the medical board. But medical-board records show that the board delayed action against him for nearly eight months, granting a continuance to Shegog's lawyers and, in December, failing to reach a decision in the case during an informal conference. In the interim, a 30-year-old Newport News man suffering from attacks of anxiety and muscle spasms sought help from the doctor and died from "acute combined toxicity" from two narcotic medications, OxyContin and Alprazolam, prescribed by Shegog. Even with that ninth death in November, it took the medical board until March 16, meeting in an emergency telephone conference of 13 board members, to vote to summarily suspend Shegog's license. In suspending Shegog's license, the board cited the unidentified Newport News man's death, allegations of Shegog's failure to create a proper treatment plan for him, excessive prescribing, and allegations of Shegog's failure to confirm prior diagnoses or medications. The board also cited the allegations of the other eight patient deaths and overprescribing it had first alleged in August. The March 16 decision was delayed five days because "a good faith effort to assemble a quorum of the Board in person was made, but failed." Shegog could still regain his license. Shegog's lawyer, William Devine, said last week that he will contest the allegations and the suspension. "I'm confident that once the full board hears the details of this case, Dr. Shegog will be back practicing medicine for his patients," Devine said. That hearing will not occur until May, nine months after the bulk of the allegations were first issued. The board still has not moved to take the license of Loxley, the Chesapeake orthopedist who was the subject of a 91-count federal indictment in January. The charges involve four patient deaths and dozens of cases of prescription fraud. He faces a potential life sentence in prison if convicted. The 62-year-old doctor, who did not carry insurance and had no hospital privileges, is still listed as having a valid Virginia medical license on the state board's Web site. In October 2003, the state medical board found that Loxley improperly prescribed various quantities of controlled substances to his wife, who was described as chemically dependent and who had been treated for drug addiction. The board concluded he "demonstrated gross carelessness" by failing to keep complete and accurate records of controlled substances. In fact, he had no record of distribution of drugs, the board found. The board placed Loxley on probation, ordered him to take a course in prescribing controlled substances, ordered him not to prescribe controlled substances, subjected him to unannounced inspections and ordered him to return to the board in three years. In 1993, Loxley's license was suspended after findings that he had had sex with a minor patient and his conviction of contributing to the delinquency of a minor; the license was restored a year later without restriction. Loxley was hardly compliant with terms of the 2003 probation, according to the federal indictment. In the weeks prior to and after the state's probation order, Loxley was dispensing hundreds of tablets of narcotics to a patient whom he knew had previously overdosed, the federal indictment alleges. On Oct. 29, 2003, 12 days after the state order, he allegedly dispensed 120 tablets containing oxycodone to an undercover Drug Enforcement Agent. "I'm one of the few doctors around here who will write this much," he allegedly told the agent, referring to the quantities of narcotics he prescribed. "Most doctors give you 12, not 120." While state investigators uncovered only a handful of violations, federal agents found scores of improprieties and acts of allegedly criminal drug distribution. In addition to four deaths, the federal indictment cites repeated incidents of failing to examine patients before prescribing medications and of continuing to ship narcotics to patients hundreds of miles from his office. Nebiker, the director of the state Department of Health Professions, said that further state action against Loxley in light of the federal case would be impractical. Loxley is being held in jail on the federal charges and hasn't made bail. "He doesn't represent a threat to the public," Nebiker said. But Loxley's lawyer, Andrew Sachs, said Loxley is being judged by a double standard. "The state is telling him one thing, and the federal government is saying something else." That same argument was used by lawyers for Hurwitz, whose Northern Virginia pain practice generated years of debate before the medical board and saw hundreds of advocates come forward in his support. Briefly revoked in 1996, Hurwitz's license was restored but came under subsequent review; he was allowed to continue his practice under close supervision. Then in May 2003, the state found that three patients had died from drugs prescribed by Hurwitz and there were repeated allegations of substandard and grossly negligent care, prescriptions for massive doses of narcotics, poor record-keeping, and a failure to suggest less-severe forms of treatment. Hurwitz closed his office, and the medical board allowed him to keep his license. Now Hurwitz faces a possible life sentence after being convicted late last year of 50 federal charges similar to those considered by the state board of medicine -- prescription fraud, patient deaths, and patient endangerment. This month, a federal judge in Alexandria refused to release the doctor on bail pending sentencing in April. Described by his lawyer as "the top guy in his field," a federal prosecutor said Hurwitz "dispenses misery and death." The misery still lingers for LeeAnna Sasse, whose 25-year-old daughter Lenae visited Loxley's office Jan. 24, 2003, and died the next day. "I went to get her in her room for a phone call. She was unconscious," Ms. Sasse said last week. Loxley's care of Lenae is spelled out in the criminal indictment. But Ms. Sasse can't forget her daughter's desperation to ease the severe pain she felt, repercussions from three automobile accidents. She remained an avid hiker and outdoors enthusiast. She had come back home to Chesapeake and her medications had run out, and Loxley was the only one who could see her right away. The only other available physician was booked up until March. A month after her daughter's death, Ms. Sasse went to Loxley's office to recover her medical records; they showed that Loxley hadn't been aware of medications she had been taking and hadn't done tests to determine her blood content. The combination of what was in Lenae's system and the methadone prescribed by Loxley proved fatal, Ms. Sasse said. "I can't help thinking that if more doctors were available and not so afraid to handle patients with pain, Lenae would still be alive today," she said. - --- MAP posted-by: Larry Seguin