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Updated: Wednesday, 20 Mar 2013, 10:12 AM EDT
Published : Tuesday, 19 Mar 2013, 6:22 PM EDT
BURLINGTON, Ind. (WLFI) - Four doctors from one family practice are being linked to nearly a dozen patient deaths, some of which date back to 2008.
The investigation began in February when the Drug Enforcement Agency raided the Burlington location on a search warrant.
The doors to the clinic remain open as of Tuesday, but the attorney general now wants four of the physicians' licenses suspended.
A sign that reads “Now Accepting New Patients” sits outside the Wagoner Medical Center on East Seventh Street in Burlington, despite four physicians being accused of using “dangerous prescribing practices” and “unsafe drug mixes.”
"I don't know everything that is going on here but I can say that I am happy here and I hope I can still come here because they are my medical family," said one Wagoner Medical Center patient.
On Monday, the Indiana Attorney General's office filed an emergency license suspension against four of the center's physicians. Named in the 10-page petition is Dr. Don Wagoner, his wife, Dr. Marilyn Wagoner, Dr. Robert Brewer and Dr. William Terpstra.
WLFI-News 18 stopped at both offices Tuesday morning – one in Burlington, the other in Kokomo. We were declined a comment and asked to leave the property.
However, Delores Gifford, who has been a patient at Wagoner Medical Clinic for more than a decade, was leaving the Burlington office at the time of our visit, and says the news came as a complete surprise.
"I've been coming here for 16 years and I have been more than happy with the services here," Gifford said.
The attorney general's office alleges the four doctors were over-prescribing medication to their patients.
Fourteen patients are named in the petition. Twelve of them are now deceased.
The documents show seven of them died from drug overdoses. In one instance the document states suboxone, a drug used to treat opiate addiction, was prescribed to a patient during their first visit despite no medical records and a positive urine drug screen for methadone.
The document went on to say multiple phone calls were ignored from the patient's psychiatric center to stop all prescriptions because of signs of drug abuse.
Gifford said, though, that she and other patients have never had a problem with the medical center.
"A lot of people are going to be devastated if they don't have this place to come to," Gifford said.
The state's Medical Licensing Board will vote on the suspensions March 27.
PATIENT A: DECEASED
Patient A was treated at Wagoner Medical Center from roughly Oct. 23, 2009, to Oct. 15, 2010 and was prescribed opiates during that time, despite the presence of several risk factors that would render that prescription inappropriate. Doses of these medications remained high until the patient’s death on or about Oct. 19, 2010. The coroner confirmed buprenorphine and Xanax were present at the time of death.
PATIENT B: ALIVE
Patient B was treated from roughly April 20, 2007, to July 26, 2010, being prescribed opiates despite numerous risk factors. The amount of prescribed opiates continued to climb despite no pain management plan set in place along with multiple failed urine tests that showed an absence of prescribed medications, and a presence of non-prescribed ones.
PATIENT C: DECEASED
Patient C was treated from roughly July 25, 2006, to Jan. 6, 2010, and was prescribed opiates despite several risk factors. The patient showed extremely obvious examples of opiate non-compliance, including a hospitalization for methadone overdose and numerous urine drug screen inconsistencies – yet opiate prescriptions continued. On the patient’s last visit, a prescription was written for 360 30-milligram oxycodone tablets. Eight days later on Jan. 14, 2010, Patient C died of respiratory failure after an overdose.
PATIENT D: ALIVE
Patient D was treated from roughly Nov. 28, 2006, to Feb. 2, 2010, and was prescribed opiates despite risk factors. The patient had a history of hospitalization for overdose on four separate occasions for abused substances, which includes benzodiazepines, cocaine, amphetamines, opiates and alcohol (all high-risk substances often associated with continued abuse and risk of death). This history was not acknowledged or even incorporated into Patient D’s treatment plan.
PATIENT E: DECEASED
Patient E was treated from roughly Jan. 12, 2012 until June 12, 2012 and was prescribed opiates despite multiple risk factors. Although no medical records were used and the patient
tested positive for methadone and benzodiazepines in urine test, the patient was prescribed Suboxone on first visit. A Klonopin treatment began halfway through the patient’s treatment regimen, despite a past history of abuse and multiple phone calls from Patient E’s psychiatric center to stop all benzodiazepine prescriptions. The patient died of an overdose on July 1, 2012. The coroner’s report showed the presence of Xanax, methadone, Klonopin, fentanyl, oxycodone and buprenorphine.
PATIENT F: DECEASED
Patient F was treated from roughly April 20, 2009, to Aug. 15, 2012, and was prescribed opiates during that period despite several risk factors. Narcotics were prescribed on the patient’s first visit without a urine drug screen and despite the presence of another prescriber. These prescriptions escalated over a 3-year period without any indication that they were clinically effective or being used for appropriate pain management. The patient’s use of these powerful substances was mostly unmonitored and signs of diversion were largely ignored. This ultimately facilitated the patient’s poly-pharmacy death (accidental death from prescription medication) in August 2012.
PATIENT G: DECEASED
Patient G was treated from roughly Dec. 11, 2006, to Oct. 31, 2008, and was prescribed opiates despite the presence of several risk factors. In the four weeks prior to Patient G’s death, the patient was prescribed 10-milligram hydrocodone tablets. The last prescription written for the patient was for 240 10-milligram hydrocodone tablets, which is equal to about 600 milligrams of morphine per day, which is an excessive and lethal amount of medication. The patient died of respiratory depression after poly-pharmacy overdose on Nov. 3, 2008. Toxicology reports showed the presence of methadone and benzodiazepines.
PATIENT H: DECEASED
Patient H was treated from roughly Oct. 28, 2002, to Oct. 31, 2011, and was prescribed opiates despite risk factors. Throughout the patient’s time with the medical center, the patient continually demonstrated the obvious presence of drug abuse and addiction, as evidenced by failed and inconsistent drug screens on at least 36 separate occasions in which the patient tested positive for marijuana and oxycodone – medications that were not prescribed. Wagoner Medical Center practitioners took no action and consistently noted “no abnormal behavior” on Patient H’s charts; practitioners also ignored the patient’s lack of compliance and continued prescribing controlled substances that were likely for non-medical purposes. The clinic failed to stick to the acceptable standards of medical practice in 2011 when a dangerous combination of two potent opiates, a muscle relaxer, and a benzodiazepine was prescribed to the patient. This led to Patient H’s death on Nov. 1, 2011.
PATIENT I: DECEASED
Patient I was treated from roughly March 2, 2005, to Dec. 28, 2007, and was prescribed opiates despite numerous risk factors. Although Patient I’s last medical record is dated Dec. 28, 2007, the patient continued to receive prescriptions from practitioners at Wagoner Medical Center for the following 11 months. During those months there is no record of the patient receiving care – only prescriptions for medications representing a significant risk for over-sedation that could lead to death. Six days before the patient’s death, Patient I was prescribed methadone (with a morphine equivalent dose of 210 milligrams) and two benzodiazepines (Valium and Ambien), posing a high risk of death secondary to over-sedation. The coroner’s report shows the presence of these drugs when the patient died in 2008.
PATIENT J: DECEASED
Patient J was treated from roughly May 13, 2008, to Oct. 4, 2011 and was prescribed opiates despite risk factors. The patient had severe end-stage COPD (chronic obstructive pulmonary disease), yet was prescribed opiates and benzodiazepines consistently for the nearly 3 years leading to the patient’s death. Additionally, the patient had a history of psychiatric diagnoses including anxiety and panic disorder, which also rendered the patient inappropriate for opiates without strict monitoring. Evidence of diversion or abuse of medications and other substances was ignored. The patient’s medications were continually escalated, with the sharpest escalation occurring in the 6 weeks prior to the patient’s poly-pharmacy drug intoxication death on Oct. 9, 2011.
PATIENT K: DECEASED
Patient K was treated from roughly May 11, 2009, to Feb. 1, 2012 and was prescribed opiates despite numerous risk factors. The patient was immediately started on methadone and Remeron (an anti-depressant) without any patient history, despite the patient testing positive for marijuana on his initial urine drug screen. Several subsequent drug screens tested positive for THC, methamphetamine and un-prescribed opiates. It also tested negative for prescribed benzodiazepines. With the documented habits of THC use, Xanax dependency
and history of drug abuse, the dosage of methadone predisposed the patient to serious risk of death. These risks should have been so obvious to practitioners that he should not have been started on the methadone at all. Patient K received the last prescription on Feb. 1, 2012, and died two weeks later. Toxicology reports show the presence of methadone, Xanax, THC, clonazepam and Opana.
PATIENT L: DECEASED
Patient L was treated from roughly Feb. 11, 2009, to Sept. 20, 2012, and was prescribed opiates despite numerous risk factors. The patient received the treatment even though an unspecified “back pain” that was never confirmed through any appropriate diagnostic means. In addition to this vague complaint, Patient L exhibited several signs of diversionary behavior, including 25 failed urine drug tests, requests for early refills and failed pill counts. All indications of abuse or diversion were ignored by the providers at Wagoner Medical Center. The patient’s history of alcohol abuse was also largely ignored. The patient displayed concerning depressed function and lucidity after changes in medication and died in the fall of 2012 due to complications from cardiopulmonary disease, liver cirrhosis and COPD, all of which were most likely exacerbated by her opiate regimen.
PATIENT M: DECEASED
Patient M was treated from roughly July 24, 2007, to July 15, 2011, and was prescribed opiates during that time despite several risk factors. Patient M was started on a steady supply of slowly escalating opiates and benzodiazepines without any documentation of testing or objective findings of pain. The patient tested positive for methadone – a drug her husband was being treated with – yet her supply of medication continued to grow. The risk of respiratory depression should have been clear to practitioners considering she had asthma, COPD, sleep apnea, morbid obesity and a dependency on supplemental oxygen. Patient M’s prescriptive combination of multiple opiates and sedatives/hypnotics heavily contributed to her poly-pharmacy death, which occurred on July 16, 2011, eight days after her last prescription.
PATIENT N: DECEASED
Patient N was treated from roughly July 22, 2008, to June 23, 2011, and was prescribed opiates during that time despite risk factors. The patient was being treated for a complaint of lower back pain that was unsubstantiated and never objectively confirmed. Patient N had a significant psychiatric history of depression and anxiety and a history of the use of marijuana, alcohol and other drugs. The patient also had multiple inconsistent urine drug screens that involved opiates and benzodiazepines. Patient N refused orthopedic consultation and expressed no benefit from acupuncture, TENS (Transcutaneous Electrical Nerve Stimulation) or a back brace – information that clearly denoted her desire for controlled substances only. The patient was consistently prescribed Xanax and oxycodone throughout the patient's tenure until the patient died of a drug overdose on June 26, 2011, in which a toxicology report shows the presence of both drugs.
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