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LA Times: Reckless Rx in the desert?

Discussion in 'Pharmacy' started by BMBiology, Jul 29, 2007.

  1. BMBiology

    BMBiology temporarily banned~! 10+ Year Member

    Feb 26, 2003,1,2602090.story?page=1&track=rss

    Pharmacist's suit reveals allegations of doctors overprescribing drugs at the hospital tied to the Betty Ford Center.

    When the Highway Patrol found Dr. Wade Grindle, he had just crashed a rented SUV, rolling it over in Indian Wells.

    It was 8 o'clock on a Monday morning and Grindle, a pain management specialist, had been drinking and taking painkillers, according to an officer's report. He was cited for driving under the influence and using controlled substances without the proper prescription. Last summer, he pleaded guilty to reckless driving, drawing a fine.

    Less than two months after the first incident, Grindle, clad in his doctor's smock, was arrested by Riverside County sheriff's deputies and booked on suspicion of DUI and possession of narcotics, according to a sheriff's spokesman. In that case, which is still under investigation, officers reported finding a hypodermic needle and fentanyl, a painkiller, in the car.

    All of this might have gone down as the story of one troubled physician. But Grindle's woes turned out to be a postscript to a larger tale: It involved allegedly reckless prescribing and dispensing of drugs at Eisenhower Medical Center in Rancho Mirage, home to one of the best-known addiction treatment clinics in the country, the Betty Ford Center.

    The story came to light in a little-known lawsuit resolved in January. In it, a former Eisenhower pharmacist contended that Grindle and two other doctors had been prescribing dangerous amounts of addictive drugs to chronic-pain patients through the Eisenhower outpatient pharmacy, located minutes from the renowned clinic devoted to battling addiction.

    According to court filings and trial testimony, the doctors, who at various times ran busy practices next to Eisenhower, prescribed so many drugs that patients became hooked. One of them, an operating-room nurse at Eisenhower, later sought treatment at Betty Ford, according to testimony by the pharmacist, Terry Blasingame.

    In December, she told the jury: "There became a point where the quantities, the frequencies [of painkiller prescriptions] were so extraordinary that I feared that if there was an automobile accident, if there was an intentional or accidental overdose … that the government agencies would come into our pharmacy and say, 'What in the world were you … pharmacists thinking about?' "

    Grindle did not return messages seeking comment.

    Hospital officials generally denied Blasingame's allegations. They said the pharmacy has a good record handling complaints.

    "I cannot speak to what happened before…. But I am proud of what we're doing now," said Lyle Matthews, the director of pharmacy services.

    Eisenhower Chief Executive Aubrey Serfling said he had not been aware of Blasingame's allegations until the trial began in November.

    When told about letters she and her attorney had written to him as early as 2001 detailing her concerns, Serfling said he did not recall seeing them. He did say that all hospitals have to guard against over-dispensing narcotics, and the issue needs to be addressed at a statewide or national level.

    "It's a major problem, and a lot of this is due to patients working the system," Serfling said.

    The Betty Ford Center, though a separate corporation from Eisenhower, is described on the hospital's website as one of the hospital's specialty centers, "the premier … in the field."

    There is no suggestion in the lawsuit that patients being treated at Betty Ford received excessive prescriptions. But Blasingame alleged that after she brought her concerns to top officials at both Eisenhower and Betty Ford, they failed to act.

    Indeed, Blasingame, a 14-year employee who was fired in 2003, testified that the hospital retaliated against her. The jury agreed, awarding her $1.3 million in December. She later settled for an undisclosed sum and has declined to be interviewed.

    In court documents, Blasingame alleged that she approached Betty Ford Chief Executive John Schwarzlose in 2002, figuring that he would be uniquely disposed to help her. Schwarzlose, who sits on Eisenhower's board, told her the doctors' actions were "illegal if not criminal," she alleged, but when he learned she had contacted a lawyer, he urged her to resign.

    In court testimony, Schwarzlose disputed that he encouraged Blasingame to resign. He said he himself shared some of her concerns about how pain was managed at Eisenhower, and for that reason often sent patients to other hospitals for such treatment.

    But he said he reported Blasingame's concerns to the hospital's attorney, and though he did not follow up, he believed he had satisfied his obligation.

    "If I went to the CEO of Eisenhower and said there are too many doctors pushing pills still over there, I wouldn't expect they would wave a wand and get rid of those doctors," Schwarzlose said in an interview. "But I could help them bring in doctors who offer alternatives to pain pills.

    "I don't try to impose my philosophy on Eisenhower Medical Center any more than I would Loma Linda or Cedars-Sinai."

    A congressman with a long-standing interest in stemming prescription drug abuse said that the Betty Ford clinic, and the medical center that houses it, have a unique responsibility to address such concerns.

    "They need to be held to a higher standard," said Rep. Stephen F. Lynch (D-Mass.). "They have positioned themselves as an authority in the area of recovery and dealing with substance abuse. I think that responsibility requires high diligence on their part in dealing with this type of situation."

    Blasingame, who said she first raised her concerns in 2001, alleged that patients would pick up a 30-day supply of drugs from the Eisenhower pharmacy — then return the next day for a similar amount. Some would fill suitcases with drugs, she alleged, calling contacts from cellphones to report how much they had managed to get. Others, she said, arrived barely able to walk.

    "Eisenhower stands for something better than the kind of things that are going on in that pharmacy," Blasingame wrote in a Dec. 16, 2001, letter to hospital officials that is in the court file.

    Prompted by Blasingame's complaints, an internal review by the hospital in 2002 confirmed that the pharmacy had gained a reputation "regarding its willingness to fill narcotic prescriptions without question, and for its cozy relationship with certain physicians who have a reputation for writing them without appropriate safeguards," according to a letter written at the time by hospital attorney Joe Truhe, which was filed in court.

    But six years after Blasingame first complained, few of those implicated in the case have been substantially penalized — except for Blasingame, who was fired for alleged prescription errors and tardiness.

    Two of the doctors she singled out as problems — Grindle and Roland Reinhart — have no public record of discipline by the California Medical Board, which, until contacted by The Times, was not aware of Blasingame's complaint. Reinhart still practices in the office building next to the hospital, although Grindle has moved.

    Reinhart denied overprescribing, saying Blasingame was not qualified to judge a doctor's prescription practices. "She doesn't know her hat from a hole in the ground," Reinhart said.

    The third physician, Mary Ann Phillips, now practices at another desert hospital. Though unaware of Blasingame's case, the state medical board formally accused Phillips in August of overprescribing painkillers to two patients. She is contesting the allegations and said in an interview that she suspected the patients had forged prescriptions in her name.

    As to the allegations by Blasingame, she said she wasn't even aware of them until The Times called.

    Phillips estimated that, in her practice with Reinhart, about 10% of the patients were addicts. But the practice was so busy — with about 90 patients a day — that she couldn't do anything about it, she said.

    Based on Blasingame's allegations, Eisenhower's pharmacy suspended the three doctors' prescription privileges in 2002. After a brief inquiry, it restored them 2 1/2 weeks later.

    Joseph Kotansky, the outpatient pharmacy director who, according to the hospital's own 2002 review, had retaliated against Blasingame, still is working in the pharmacy, although no longer as a supervisor.

    Kotansky declined to talk to The Times. He said in court testimony that he had passed along Blasingame's concerns, which he said were shared by other pharmacists, to his boss. He denied retaliating against Blasingame.

    Blasingame alleged that the hospital pharmacy filled the obviously excessive prescriptions because the money was too good to pass up. "The income to the pharmacy was probably well over $100,000 per month off Actiq lollipops alone," she wrote in a complaint to the pharmacy board in 2002.

    Actiq lollipops, which contain fentanyl, are federally approved to treat pain in cancer patients, although doctors can prescribe them for other purposes. Increasingly, such painkillers have been diverted to the underground market, where they are much sought-after.

    The lollipops were just one part of the problem, according to Blasingame. In 2002, she alleged, one of Grindle's patients sought to fill prescriptions for 400 Percocet tablets and 180 methadone pills. She was already equipped with a morphine pump.

    "She was having trouble keeping her eyes open, and she was leaning on the dividers … out front to keep herself upright," Blasingame said in a sworn deposition. "I told her that it would be the last time I would fill a prescription for her unless she brought someone else in to drive."

    For saying that, Blasingame testified, she was suspended for a day without pay.

    Other signs of trouble emerged apart from Blasingame's case. A former patient of both Phillips and Reinhart, who for a time shared a practice, sued the pair for alleged medical malpractice and negligence in 2005. Kevin Lamb, under treatment for a back injury, claimed that he became so hooked on Actiq lollipops prescribed by the doctors between 2001 and 2003 that all but nine of his teeth rotted.

    "It was basically a factory. 'Get 'em in. Get 'em out,' " said Lamb, 52, of the doctors' practice. "I was in such a fog that I really didn't know how bad things had gotten."

    Friends became alarmed when he started dropping lighted cigarettes in his house, he said. "Everyone was worried I was going to end up burning the place down."

    Lamb's attorney said he was in negotiations to settle the lawsuit. Both Phillips and Reinhart denied that their care had anything to do with Lamb losing his teeth.

    Grindle came to Eisenhower with a history of drug abuse. When he joined the staff as an anesthesiologist in 1996, he was still serving a two-year probation imposed by the North Dakota Board of Medical Examiners after it determined that he had been prescribing himself painkillers, records show. He was forced to complete an "impaired physicians program," according to the records.

    It is unclear whether Eisenhower officials knew about Grindle's past. Reinhart, who was a staff anesthesiologist (and former anesthesiology chief) at the time, says that he did not know.

    "He was a good doctor, that's all I know," Reinhart said.

    Reinhart and Grindle left the Eisenhower medical staff in the late 1990s but continued to practice in an adjacent building and refer patients to the Eisenhower pharmacy, records show.

    Grindle wasn't afraid to prescribe heavy doses of painkillers and didn't always give thorough exams before issuing refills, according to Judith Knudsen, a nurse who worked for him from about 2002 to 2004. "These patients needed to be seen more often," Knudsen said. "They needed to have their conditions reassessed. And that wasn't happening."

    A Palm Springs woman sued both Eisenhower and Grindle in 2001 after her husband died of a painkiller overdose. She alleged that he had become hooked on painkillers Grindle had prescribed and Eisenhower's pharmacy had sold. The case was later settled under undisclosed terms.

    The California Medical Board's chief executive, Dave Thornton, expressed concern over the way the hospital had handled the problems at the pharmacy in general, echoing some of Blasingame's concerns. Failing to address them "endangers not only the patients who are being prescribed those drugs but also every other citizen who is on the road when these patients are … driving," he said.

    In at least one respect, however, Eisenhower has taken decisive action: Truhe, the attorney who concluded in 2002 that Blasingame was the victim of retaliation, was terminated without cause a month after the trial ended.
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  3. PharmDstudent

    PharmDstudent 7+ Year Member

    Jan 8, 2007
  4. BMBiology

    BMBiology temporarily banned~! 10+ Year Member

    Feb 26, 2003
    The double spacing is from the original article which makes it easier to read. Why make it hard on the eyes?
  5. tussionex

    tussionex Pharmacist 2+ Year Member

    Jan 23, 2007
    po-town, NY
    or, just post the link....adds to the mystery!
  6. ZpackSux

    ZpackSux Retired Banned

    Feb 25, 2005
    Dallas, TX
    Who's suing who here? Blasingame sounds like to me is a pissed off terminated employee who wants to take down the hospital for whatever the reason backed by a scumbag attorney.

    "Large" amount of controlled substance is very subjective.

    So when a pharmacy refuses to fill narc for an addict who goes into a withdrawal seizure and dies, who's reponsible now? Dang if you do and dang if you don't.

    Blame everyone else but yourself. And sue. How pity.
  7. sdn1977

    sdn1977 Senior Member 10+ Year Member

    Jul 28, 2005
    I don't know this story personally. I have worked with a tech who did work at Eisenhower during this time period. His comment - money can & will buy ANYTHING!
  8. ZpackSux

    ZpackSux Retired Banned

    Feb 25, 2005
    Dallas, TX
    Rich retirees of Palm Springs. Heck yeah.

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