Physicians Monitor Painkillers

By Jim Killackey, The Daily Oklahoman

Dec. 11–Oklahoma doctors who have been penalized for over-prescribing prescription painkillers practiced sloppy medicine, a state medical official said.

Disciplined doctors Some Oklahoma physicians have found themselves in trouble for overprescribing prescription painkillers. Among the cases documented by the Oklahoma State Board of Medical Licensure and Supervision are:

Oklahoma City anesthesiologist Dr. Troy Anthony Tortorici, 39, for years routinely wrote prescriptions for Percocet, Valium, Lortab, OxyContin and Ultram without examining his patients, board records show.

A staff member regularly used a stamped signature to approve his prescriptions, a practice prohibited by pharmaceutical regulations.

After a lengthy investigation, Tortorici now has a restricted medical license. He isn’t allowed to prescribe any pain medication.

Dr. Orville Lynn Webb, 72, of Lawton recently turned in his state medical license after he was caught writing prescriptions for controlled dangerous drugs to patients who had “alleged carpal tunnel syndrome” and “alleged spinal pain.”

Webb typically gave prescriptions for Lortab, Loma and Xanax to patients “regardless of their complaints,” board records show.

In 2000, Webb wrote prescriptions for nearly 1.7 million doses of Hydrocodone, Xanax, Soma, Oxycodone and other controlled dangerous drugs.

From 1998 to 2003, Oklahoma City physician Roger Lee Picket, 72, wrote 458 prescriptions for 60,798 doses of pain drugs.

In one case, Picket ordered a large supply of Hydrocodone for a patient simply after “placing his hands on the patient’s lower back,” records show.

Dr. Carl P. Griffin, 49, of Oklahoma City is on probation for frequently writing pain medicine prescriptions without substantiating “any clinical symptoms” and “not establishing a legitimate medical need” for the drugs, according to licensure board records.

One of Griffin’s patients was prescribed enough pain pills to take 21 per day.

He also gave patients access to syringes and needles “for unclear and unsubstantiated diagnoses,” and allowed his patients to “double up on pain medications on their requests alone,” records show.

“These doctors become lax in their medical record keeping,” said Lyle Kelsey, executive director of the Oklahoma State Board of Medical Licensure and Supervision. “And patients themselves can be real schmoozers.”

Some doctors who specialize in pain management say they are sympathetic to their patients’ pain within strict limitations.

Dr. Jack Marshall of Oklahoma City uses opioids drugs which attach to receptors in the brain and spinal cord to alter the body’s perception of pain and reduce or alleviate it.

These prescription drugs treat severe chronic pain, and Marshall advises other physicians to use them. Marshall is an anesthesiologist specializing in pain management.

However, Marshall also uses random drug tests to pinpoint abusers and is willing to stop treating his own patients to prevent them from abusing painkillers.

Many doctors fear government intrusion and even the loss of their medical licenses if opioids they prescribe are abused or illegally sold, he said.

Finding a balance Marshall said opioids should be considered when physical and psychological therapy options don’t work.

Patients using them should be carefully monitored, he said.

Marshall also recommends more training for medical students on the use of opioids and the evaluation of chronic pain.

Dr. Sidney Williams, 60, a pain specialist in Stillwater, is so concerned about prescription drug abuse that he requires all prospective patients to complete an 11-page questionnaire and agree to random drug testing during treatment.

“Legitimate patients are willing to fill out our questionnaire, but we have to screen out the fakers,” Williams said.

Some patients found themselves abusing painkillers when drugs such as Vioxx and Celebrex drew health warnings or were forced off the market, he said.

Proper monitoring and new pain drugs that don’t have the addictive qualities of opioids could give greater comfort to patients and doctors, said Williams, who is president of the Oklahoma Pain Education Society.

Doctors need to be more conservative in overseeing the pain medications they prescribe to their hurting patients, said Bryan Potter, executive director of the Oklahoma State Board of Pharmacy.

Specifically, physicians shouldn’t always authorize pain drug refills without seeing the patient a second time, Potter said.

There are large numbers of people in Oklahoma who have legitimate pain for a particular medical problem “and those drugs help,” Potter said.

But many patients start feeling so well they don’t want to stop the prescription pain medication once the medical problem has been fixed, he said. And that leads to problems.

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