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Reckless prescribing of narcotics endangers patients, eludes regulators

The Medical Board of California is often slow to act when investigating doctors suspected of abusing their prescription pads—even when patients are dying.

December 09, 2012|Lisa Girion and Scott Glover, Los Angeles Times
  • Dr. Carlos Estiandan served about half of a five-year sentence for illegally prescribing controlled substances. He refers to his time in state prison as “my vacation.”
Dr. Carlos Estiandan served about half of a five-year sentence for illegally… (Liz O. Baylen, Los Angeles…)

Dr. Carlos Estiandan was up to no good, and the Medical Board of California was on to him.

He prescribed powerful painkillers to addicts who had no medical need for them, conducted sham examinations and appeared to be a key supplier for drug dealers, according to court records.

He wrote more prescriptions than the entire staffs of some hospitals and took in more than $1 million a year.

Worse, one of Estiandan's patients had fatally overdosed on drugs he prescribed, a board investigator learned. The investigator said in her report that she confronted the doctor and told him the death was "the inevitable result" of giving narcotics to an addict.

Unknown to the investigator, two other Estiandan patients had suffered fatal overdoses. More deaths would follow.

By the time the medical board stopped Estiandan from prescribing, more than four years after it began investigating, eight of his patients had died of overdoses or related causes, according to coroners' records.

It was not an isolated case of futility by California's medical regulators. The board has repeatedly failed to protect patients from reckless prescribing by doctors, a Los Angeles Times investigation found.

It is board policy to give such cases a high priority. But The Times' examination of board records and county coroners' files from 2005 through 2011 found that:

At least 30 patients in Southern California have died of drug overdoses or related causes while their doctors were under investigation for reckless prescribing. The board ultimately sanctioned all but one of those 12 doctors, and some were criminally charged — too late to prevent the deaths.

The board seldom tries to suspend the prescribing privileges of doctors under investigation. The agency can petition a judge for an interim suspension order. It has obtained orders only rarely: 12 times in the last five years in cases of excessive prescribing, in a state with more than 100,000 practicing physicians.

Even when the board sanctions doctors for abusing their prescribing powers, in most cases it allows them to continue practicing and prescribing. In 80% of the 190 cases of improper prescribing filed by the board since 2005, the offending physician was given a reprimand or placed on probation. In most of those cases, the doctor was allowed to continue writing prescriptions with few or no restrictions.

Eight doctors disciplined for excessive prescribing later had patients die of overdoses or related causes. Prescriptions those doctors wrote caused or contributed to 19 deaths.

At the heart of these shortcomings is the board's approach to oversight. It investigates when it receives a complaint of abuse or poor treatment of a specific patient or patients. It generally does not look for evidence of wider problems in a physician's practice.

For example, in looking into cases of improper prescribing, investigators usually do not search county coroners' files to determine whether — as in Estiandan's case — a doctor's patients are dying of drug overdoses.

Dr. Rick Chavez, a pain management physician in Redondo Beach, serves as an expert for the board in cases of reckless prescribing. He said overprescribing is a pervasive problem, and oversight is inadequate.

"We have doctors out there doing things that no one is monitoring," he said. "It's scary."

The medical board's president, Sharon Levine, a pediatrician who is an executive at Kaiser Permanente, declined to be interviewed, saying it would be "inappropriate" because disciplinary cases are ultimately decided by the board. Executive Director Linda Whitney declined to comment, and staff members said they are barred by policy from speaking with reporters.

Responding by email to written questions, board officials asserted that their "highest priority and primary mission is consumer protection."

In response to The Times' findings, they have asked the Legislature to require county coroners to report all prescription drug deaths to the board.

"If only one physician was found to be overprescribing," the board said in its request to legislators, "this could save numerous lives."

Estiandan, a diminutive man with a cheerful demeanor, had a thriving general practice. He sang tenor in his church choir, played golf once a week with his sons and took his wife ballroom dancing. He was a lieutenant colonel in the U.S. Air Force Reserve and led medical relief missions to the Philippines, where he grew up and attended medical school.

In October 2004, one of his employees reached out anonymously to authorities.

The man told Robin Hollis, a medical board investigator, that Estiandan, then 62, was taking in $3,000 in cash a day selling prescriptions. Drug-addicted patients, the employee said, crowded the lobby of the doctor's clinic west of downtown Los Angeles, one of three he owned.

"Estiandan will give the patients anything they want," he told Hollis, according to her report.

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