Drug War Shifting to Medical World

              Drug war shifting to medical world
A Times Enterprise Report
by KEENAN GINGLES
and MARILYN COX
After years of fighting street drugs such as mari-juana
and heroin, federal dollars and manpower are
homing in on another form of drug abuse — in the
offices of doctors, pharmacists and other members of
the medical community.
Although not perceived by the public as nearly the
problem that traditional street drugs are, illegally
diverted prescription medicines — including am-phetamines,
depressants and other habit-forming drugs
— do constitute a "very real problem" and one that is
being increasingly addressed, according to federal
drug enforcement agent Jack Redford of Baton Rouge.
Redford coordinates activities of a select team of
narcotics agents known as DILI — Diverted In-vestigative
Unit. Its job is to help stop the diversion of
legally manufactured drugs for illegal purposes. In less
than a year of operation, the unit has made drug
distribution cases against three doctors — two con-victed
in federal court in South Louisiana — and two
pharmacists. The third physician was taken into
custody recently at his office in Blanchard and charged
with 32 counts of distribution of controlled drugs.
"We have a bad problem in Louisiana," Redford said,
adding that before DIU, criminal convictions of doctors
or pharmacists were practically unheard of in Louisi-ana.
Physicians command great respect in society, he
said, and prosecutors often "are very reluctant to
prosecute a socially prominent individual... It's hard to
get a conviction unless you have an airtight case."
Spurred by numerous complaints, the DEA and state
police asked for a grant from the Drug Enforcement
Administration to form DIU. Other units around the
nation have met with a great deal of success in ebbing
the flow of prescription medicines into the wrong
hands, he said.
Shreveport narcotics agent Sgt. Thomas F. Dupree
echoed Redford's sentiments about the need for stricter
enforcement in the medical community. Each agent
said, though, that the majority of medical community
members support efforts to clean out the bad.
Dupree, who has been monitoring local hospitals and
pharmacies for several years, said Shreveport police
have long known of the problem. He pointed to two
large file cabinet drawers and said they contain
intelligence information gathered over the years. He
said the DIU is the best tool to come along in years to
fight illegal diversion of drugs.
Dupree is critical of the way the cases were handled
until the unit was formed. He said most were disposed
of through administrative actions rather than criminal
prosecutions. However, the following indicate there has
been some criminal prosecution:
• A late 70s case in which a physician was reported-ly
addicted to codeine and was still treating patients.
He was charged by police with illegal possession of a
controlled dangerous substance and later pleaded guil-ty
to the charge. His license was also suspended.
• The arrest of a Centenary area physician in 1977 on
drug charges following a lengthy Shreveport police
investigation. He was not prosecuted, but voluntarily
surrendered his license to prescribe controlled drugs.
• A 1978 case in which a physician was operating a
narcotics treatment program and dispensing am-phetamines
and depressants. He was not prosecuted,
but had his license to dispense the drugs suspended. The
program folded.
• A recent case involving an anesthesiologist, in
which he was given immunity from prosecution after
diverting 250 milligrams of Demerol prescribed for a
4-year-old child admitted to a local hospital. The child
died and an autopsy turned up no narcotics adminis-tered.
The physician admitted diverting the drugs for
personal use after being granted immunity from prose-cution.
Why aren't most prosecuted? It's one thing to sus-pect,
another to prove, said local hospital officials
interviewed.
For the most part the hospitals are left alone to
police themselves and unless they have concrete
evidence, it's hard to make a case. So many times,
doctors and nurses suspected of abuse are either fired
or quit when confronted. In a few instances when a
person suspected of abuse admits his or her guilt, the
hospital will help with rehabilitation.
Such has been the case at two hospitals: in the first
case a nurse was rehabilitated, and in the other, a staff
doctor. The nurse later quit but the doctor remains on
staff, although he no longer has access to the drugs.
Opinions differ over just how big the problem is
locally. Considering that there are more than 400
doctors in Shreveport, said Dr. D.A. Hiller Jr., spokes-man
for the Shreveport Medical Society, isolated cases
don't seem much of a probl em. On the other hand there
are those who consider just one case of suspected abuse
a "big problem."
"If I think one is under surveillance, it is a big
problem," said Mrs. I.M. Rogers, director of nursing at
Willis-Knighton, who said in the seven years she has
been at the hospital there have been six cases involving
nurses that were possible problems.
Dr. Marshall Metzgar, former chairman of the
anesthesiology department at LSU Medical Center in
Shreveport, said drug and alcohol abuse were the
biggest problems he faced while serving in that capaci-ty.
He said that during the seven years he worked there
he was aware of eight or nine instances of alcohol or
drug abuse.
Dr. John Bush, acting chairman of that department,
said he knew of the past problems but wasn't aware of
any problems there now.
Other hospitals have had drug problems too. Zelda
Hogue, director of pharmacy at Highland, said there
have been three cases there in the past five years, and
Earl Kephart, chief of nursing at Veterans Adminis-tration
Hospital, recalled one.
In recent years hospitals have tightened security on
narcotic drugs. Willis-Knighton, touted as a "model" by
local law enforcement officials, has worked on its
system for about four years.
"We will never stop all of it. People are people ...
their problems are there. But it is our responsibility to
control as much of it as we can for the protection of the
patient," Mrs. Rogers said. (She and Mary A. Irwin,
director of pharmacy, work very closely with Dupree
on drug control.)
Miss Irwin said the key to control is record keeping.
Willis-Knighton has a rather complex system that
traces the drugs from the pharmacy to the nursing
stations, then to the patient. There is a four-key lock on
the narcotics cabinet and a warning system that goes
off when that cabinet is opened.
Law officials agree that existing regulations and
safeguards are beneficial and that a handful of physi-cians
are responsible for most drugs diverted for illegal
use. It is those physicians, they say, who could be
getting an office call from the anti-drug diversion unit
in the not-too-distant future.