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Problem doctors went unchecked for years as the opioid crisis exploded. Here's how we found out.

Behind our investigation: Prescription for Failure
Posted: 12:00 PM, Nov 11, 2018
Updated: 2018-11-11 22:58:08Z

In the last two decades, prescription opioids have taken an unrelenting hold on Ohio. The opioid crisis has claimed the lives of thousands.

Our exclusive investigation, “Prescription for Failure,” traced the opioid crisis back for decades, right as it found its place in Ohio. We also spent six months examining the role of the state medical board, whose mission is to protect the public by regulating doctors.

We uncovered many instances where problem doctors with serious discipline histories were able to keep their medical licenses and continue to prescribe patients painkillers. Issues ranged from felony drug convictions, having sex with patients, pre-signing blank prescriptions and other misconduct. Many went on to operate some of the largest pill mills in Ohio.

Former Attorney General Jeff Sessions even responded to our findings.

Our 30-minute special goes even deeper. It details how the crisis was fueled by a medical board that was slow to act and gives you a glimpse into the lives of families changed forever by the same doctors their loved ones trusted.

Here’s how we did it.

Why we started investigating

It started with a routine news release. It was June 28. The U.S. Justice Department had just sent out an email to local media announcing four doctors were indicted for running “pill mills” in Hamilton.

It’s not unusual we get these types of announcements from law enforcement officials – whether it be federal or local – about indictments, arrests and convictions of people involved in different types of crimes. The On Your Side investigative unit typically wouldn’t do a story based on a single news release. But this one struck us as unique. We kept reading.

As we continued to scan the announcement, the scope and number of painkillers these doctors had distributed was staggering. Federal prosecutors even connected these doctors to multiple patients’ deaths.

We thought, how could these doctors have gotten this far?

Based on our experience reporting on medical issues in the past, our team knew a critical tool existed on the Ohio State Medical Board’s website, where you can look up the status of a doctor’s license. It would also show you if the medical board has disciplined the doctor at any point and if so, why.

We ran a quick check of the doctors in the news release. We found one of them had a lengthy discipline history, but the medical board never revoked his license. And ultimately, he was able to go on to run one of the biggest pill mills in Ohio, helping to fuel the crisis.

But that was just the start. He wasn’t the only one.

The origin of the opioid epidemic

Our research led us to question whether this was an isolated incident or if there were even more doctors who were able to continue working with patients despite serious discipline in the past.

We also wondered, if there was a pattern of problems, could this have contributed to the opioid crisis as a whole?

We went back into our archives to see how many other doctors federal and state prosecutors had announced indictments in past years for pill mills. So we reviewed three dozen of the most significant cases since 2010, which we found was around the same time pill mills started coming under increased scrutiny by law enforcement.

Our team analyzed those cases, their outcomes and the doctors’ disciplinary histories with the medical board. We found nearly one-third of those doctors continued to practice for years before being convicted for operating pill mills.

During the process, we learned of a Portsmouth-based doctor, Paul Volkman. Along with two other individuals, Volkman prescribed 1.5 million painkillers in a five-year period that led to the deaths of at least 14 people, according to federal prosecutors.

This led us to find that much of the opioid crisis really began in that small town of Portsmouth, where we ended up interviewing a police chief who witnessed the start of the crisis in 2000 and a recovering user of prescription opioids. It also led us to a recovery center that serves as a haven for those recovering.

We peeled back the layers, one by one, and found there was so much more to uncover.

Digging deeper

We wanted to go even deeper and figure out how often doctors with issues actually got their licenses revoked – both in the early years of the crisis and as the prescription opioid death toll continued to rise in the years after.

Our team reviewed thousands of records, including state medical board documents and findings dating back to 2000 when opioid usage began to increase dramatically across the U.S.

We also scoured years’ worth of minutes for medical board hearings. We knew it would be tedious since it hadn’t been done before. But we tracked all of our findings by building a database of doctors who were able to keep their licenses despite serious histories.

Our findings were concerning. In the first decade of the opioid crisis, only 47 doctors lost their licenses for improper prescribing.

In the last seven years, it has more than doubled to 112 doctors who have lost their licenses, showing that at the beginning of the crisis, regulators were slow to act when it came to revoking licenses of problem doctors.

While these statistics showed a pattern of failures in the early years of the crisis, the people we ended up speaking to as part of this investigation brought these numbers to life by taking us inside the system.

We know these stats were more than just numbers – they involved real people – real lives impacted – on the other end of the prescribing.

While digging into one doctor’s history, we obtained an indictment related to a doctor who federal prosecutors linked to a patient death.

We knew we had to find this family and talk to them to let their voice be heard. But how? This patient was only identified as “J.M.” in the court record. There may have been a cause of death, but the only other tidbit of information to go off of was a rough date of death.

But we knew the doctor was indicted in the Southern District of Ohio. So, the death had to have occurred in a county south of Columbus.

Chief Investigator Ron Regan contacted medical examiner offices in multiple counties, asking them to query their systems based on the initials and rough date we had.

In response, he received two autopsy reports. Only one contained the exact cause of death next to the initials, “J.M.” On the same document was the next of kin.

That’s how we found Wayne Rogers, who was courageous enough to share his story. His mother, “J.M.” or Johnna Morgan, ultimately died of a drug overdose. We got to learn more about who Johnna was and how Wayne felt the system failed her.

We also tracked down key people who’ve either worked for or with the medical board to help us understand how the regulatory arm makes decisions about whether or not to revoke a doctor’s license.

Frank Younker, a former agent with the Drug Enforcement Administration, and Mike Staples, a former medical board investigator, both walked us through the process. Ultimately, their interviews were eye-opening – their experiences found the medical board to be “reactive” rather than proactive with license revocation, and they also found there to be a lack of consistency with doctor discipline.

A response from the White House

We never thought when we first start digging on this story that it would take us to Washington, D.C.

We quickly realized during our research process that this topic was much bigger than Ohio. We knew that President Donald Trump had instructed his justice department to crack down on the illegal distribution of painkillers.

We saw this as an opportunity to achieve real reform in Ohio. In July, we began reaching out to who was the nation’s top law enforcement officer, former Attorney General Jeff Sessions. We contacted his aides to see if they would grant us an exclusive sit-down interview with him to share our findings. We continued those discussions with his aides into the summer and fall, waiting months for a response.

When we learned Sessions was coming to Cleveland in early September, we thought this was the prime opportunity. But according to his aides, his schedule was too busy. We began to lose hope for our chance at an interview.

Weeks later, on Sept. 27, we got an email from a Sessions aide – the sit-down interview was a go. Could we make it down to his private conference room in D.C. on Oct. 16 for an interview with Sessions, the email asked. Sessions was ready to talk.

And we were ready to ask questions.

In the interview, Sessions was raw and upfront about the role that medical boards across the country have played in the opioid crisis. He was alarmed by our findings. In response, he called for state medical boards “to be more aggressive.” He also said medical boards failed to act quickly at the beginning of the crisis. You can watch the interview here .

Finding a solution

We knew it wasn’t enough to just report our findings. We also wanted to uncover and present solutions.

During our research process, we came across another state whose program for identifying problem doctors was more robust than Ohio’s.

We traveled to North Carolina to speak with their state medical board about how they’re taking a different approach to combat their own opioid crisis. The board sets specific limits on doctors that would prompt an automatic investigation. This includes the doctor exceeding a fixed threshold of opioid prescriptions and having two or more patient deaths.

The state also maintains a prescription drug database that contains this data, as well as records of every patient’s prescription history.

We found while Ohio has the same database, it’s operated by the state pharmacy board – not the medical board.

While we knew we couldn’t hold the current Ohio medical board accountable for decisions made prior to their appointment, we wanted to learn more about what the current board was doing to ensure action was being taken against problem doctors.

So we sat down for an interview with Board President Robert Giacalone to ask him why his board doesn’t have a threshold that automatically triggers an investigation. He said he believes “hard and fast rules tend to become arbitrary in terms of results.”

He also said when we got on the board five years ago, the members were “more attuned” to overprescribing and other issues, and that many of the doctors we uncovered would not have been able to keep their licenses if they were treating patients today.

Our analysis does show the current medical board has gotten tougher in recent years.

Uncovering a potential conflict of interest

Public officials and medical board members are required to file ethics reports with the Ohio Ethics Commission under state law that would indicate if they’ve received any gifts, contributes or have any stock ownership that would indicate a conflict of interest.

We were curious to see whether board members who were tasked with making decisions about doctors’ licenses would have any possible conflicts.

We ultimately found board members can own as much stock as they want in drug companies – even those that make or distribute painkillers.

In our research, we learned Giacalone served as Cardinal Health’s’ senior vice president of regulatory affairs before joining the medical board. So, we asked him about the potential conflict of interest that could arise when someone, who owns stock in drug companies, must also sit in judgment of doctors accused of improper prescribing.

He said he did not view it as a conflict.

Although there is nothing in Ohio’s ethics law that prevents board members from owning stock, and there’s no evidence that owning stock has influenced decisions, we thought it was imperative to share with the public our findings.

Dr. Sidney Wolfe, co-founder of the public watchdog organization Public Citizen Health Research Group, spoke to us for our report and said he believes the potential conflict raises red flags.

Piecing it all together

After conducting dozens of interviews, gathering hours of footage and sifting through thousands of records, News 5 Investigators pieced together the untold story of how the opioid crisis began and how the medical board was slow to act at the start, enabling it to explode.

From big pharma’s refusal to acknowledge its pills could be addictive, to the medical community searching for a solution to help patients deal with pain, we knew from our research there were multiple factors that led up to the crisis.

But we decided to focus on another critical factor that we realized no one had gone in depth on – relentless overprescribing by doctors, how that puzzle fits into the bigger picture of how the crisis got to this point and how it’s impacted thousands of Ohioans.