Pubdate: Sun, 12 September 1999 Source: San Diego Union Tribune (CA) Copyright: 1999 Union-Tribune Publishing Co. Contact: http://www.uniontrib.com/ Forum: http://www.uniontrib.com/cgi-bin/WebX Author: Anne Krueger, Union-Tribune Staff Writer DOCTOR FIGHTS VERDICT IN DEATH Woman Died During Addiction Treatment Amy McCauley of Imperial Beach hoped a four-day program to kick her heroin addiction would bring her a new life. Instead, a powerful mix of medications given to McCauley by a La Jolla physician killed her. McCauley chose the program because it allowed her to undergo withdrawal at home with her boyfriend instead of in a hospital treatment program that costs thousands of dollars. The physician, Dr. John Sack, claimed to have helped hundreds of heroin addicts break their addiction with a program that cost less than $300. However, a lawsuit brought against Sack by McCauley's family alleged the treatment, in which drug addicts were given dozens of pills by people without any medical training, is unsafe. A San Diego jury awarded McCauley's two children about $1 million in May. The verdict is being appealed. Sack defends his treatment as medically sound. He said in an interview that he was only trying to aid McCauley -- as he had many others -- overcome a powerful addiction. "I'm convinced it's safe if you follow the simple directions I give," Sack said. "It's the only treatment for a vast percentage of the addicted population" who can't afford hospitalization. After the jury's verdict, the state Medical Board filed a complaint alleging that Sack's methods were improper. The board restricted Sack's medical license, requiring him to treat addicts at a hospital, not at their homes. A board hearing is set for January. The state's action is little consolation to Lincoln Wilson, McCauley's boyfriend for three years before her death March 5, 1997. He is now raising their 3-year-old son and her 13-year-old daughter at his home in Pittsburgh. Wilson said he was always skeptical that Sack's withdrawal treatment would work. "I just thought it was too good to be true," Wilson said. "I certainly didn't think it would kill her." A powerful addiction Wilson, a 61-year-old flight mechanic for U.S. Air, remembers McCauley as an intelligent woman who loved reading, cooking and taking care of her children. But McCauley, 35 years old when she died, had also been a heroin addict for more than 10 years. For three years, she had been receiving methadone from a federally sponsored program to help keep her off street drugs. Wilson said McCauley wanted to end her addiction to methadone, itself a powerful narcotic, and heard about Sack's program through word of mouth at the methadone clinic. "She just wanted to get rid of (the drug habit)," Wilson said. "It sounded like the light at the end of the tunnel." Sack, 51, specializes in internal medicine, but about a third of his practice involved helping addicts kick drugs. Sack said he is one of only a handful of private physicians in San Diego County doing so. After treating addicts in a hospital, Sack said, he began his home treatment program in about 1990 for those unable to afford any other help. "I find it rewarding," he said. "When you've found a way to help people, it's hard to say no." Sack said about 1,700 patients have successfully completed his home treatment. He is proud of those who wrote him letters of gratitude, like the recovering addict who said, "I can't thank you enough for saving my life." For addicts such as McCauley, with little money and no medical insurance, home treatment programs are their only hope for ending a crippling addiction, said Jeffrey Bogart, one of Sack's attorneys. "If you have a lot of money, you can afford hospitalization," Bogart said. "What's available to you if you don't have insurance or a substantial pocketbook? I think the answer is nothing." About 300 of Sack's patients -- including McCauley -- were treated with the drug Naltrexone, which shortens the withdrawal process. The doctor promised the drug would shorten the agony of withdrawal from methadone's three to four weeks to just four days. Sack also gave his patients seven other medications to combat withdrawal symptoms -- anxiety, restlessness, sweats and chills, nausea and vomiting, diarrhea, and aches and pains. Wilson said he and McCauley met with Sack for about 20 minutes, during which Sack reviewed a two-page sheet listing the instructions for his program. Sack's fee was $150 for the program, plus $117 for the medications he gave McCauley. McCauley's lawyer, Edward Babbitt, said Sack conducted an inadequate physical examination of McCauley to determine whether her system could tolerate the drugs. An attorney for Sack, Bruce Bailey, disagreed. He said Sack met with McCauley and Wilson for up to an hour and gave her a thorough medical examination. Bailey said Sack gave Wilson another paper, in addition to the instruction sheet, telling Wilson not give medications to McCauley unless she could sit up and take the drugs on her own. Wilson said he never got that piece of paper. Sack gave McCauley the medications and sent her home to her Imperial Beach apartment, giving Wilson the responsibility of doling out the pills about every four hours and monitoring his girlfriend's condition. That was a dangerous plan, according to the trial testimony of Michael Lardon, chief of staff at Charter Hospital, a psychiatric center that treats drug addicts. Lardon told the jury he would not even use the mix of drugs prescribed by Sack in a hospital where a patient could be regularly monitored by nurses. "To send someone home with this type of protocol without being medically supervised puts someone at very substantial risk," Lardon said. "And my understanding is that Ms. McCauley was not really aware of what type of risk she was getting involved with." Wilson said he followed Sack's instructions and gave McCauley 33 pills on her first day of treatment. By the second day, Wilson said, she slept so deeply that he couldn't awaken her. "She looked like a dead person, except she was breathing. She was just laying there," Wilson said. He said that when he called Sack's office the doctor did not seem urgently concerned. Wilson said Sack just told him to let McCauley sleep a few more hours before giving her next round of medications. Sack's notes from his conversation indicate that he told Wilson not to give McCauley any more medication until she was alert, awake and able to take the pills on her own. Sack said he told Wilson to call him back if McCauley continued her deep sleep. He said he assumed she had gotten better when he did not hear back from Wilson. McCauley's condition never improved. The day after Wilson talked with Sack, McCauley went into respiratory arrest and was taken by ambulance to Scripps Hospital in Chula Vista. She died six days later. The county Medical Examiner's Office concluded that McCauley's death was caused by respiratory arrest associated with her withdrawal therapy. Sack did not visit McCauley in the hospital, although he said he called her doctor and Wilson several times to discuss her condition. Asked about it by McCauley's attorney, Sack replied that he felt bad about McCauley's comatose condition. "I think I would have just felt ashamed or guilty about being there," Sack said, later adding, "I found it very hard to take that this had happened on my watch, so to speak, while she was under my care." Sack's expert witness in treating addictions, Dr. Robert MacFarlane, said Sack's program met accepted medical standards. He said McCauley fell ill because Wilson had not followed Sack's instructions. Bailey, Sack's attorney, said that Sack only accepted patients who had acceptable caregivers to help them through withdrawal. Wilson appeared to be an excellent person to take care of McCauley, he said. "For some reason, the person we thought would be the best caregiver in the world turned out to be not so good," Bailey said. Other patients About a month before McCauley went to see Sack, two of the doctor's other patients were hospitalized while undergoing withdrawal treatment. Eleanor Bowyer of Imperial Beach said her husband, John, went into convulsions soon after he began taking the medications Sack gave him. She said Bowyer was in a hospital for 10 days. She said Bowyer hoped the treatment would end his addiction to heroin and methadone. "He wanted to have a normal life," Bowyer said. "What it did was ruin his life." Defense lawyer Bailey said Bowyer and the other patient were undergoing a different type of treatment than McCauley's. He said Bowyer had cocaine in his system when he was admitted to the hospital, which could have caused his medical problems. Jurors in the suit brought by McCauley's family found by a 9-3 vote that Sack was at fault for her death, and awarded her two children more than $1 million in damages. The amount was reduced to about $960,000 because of legal limits on medical damages and a finding that Wilson was 20 percent at fault for McCauley's death. Bailey sought a new trial for Sack because one of the jurors, a nurse, was quoted as telling other jurors that Sack's treatment program was dangerous and that he kept sloppy medical records. San Diego Superior Court Judge Thomas LaVoy denied the request for a new trial. The state Medical Board stepped in after the verdict, accusing Sack of negligence in his treatment of McCauley, improperly using the home treatment and prescribing excessive amounts of drugs. - --- MAP posted-by: Jo-D