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Date Posted: 22:43:52 10/20/03 Mon
Author: Don
Subject: Doctors Medicate Strangers on Web

Doctors Medicate Strangers on Web
Some Physicians Face Own Troubles
By Gilbert M. Gaul and Mary Pat Flaherty
Washington Post Staff Writers
Tuesday, October 21, 2003; Page A01

Third of five articles

SAN ANTONIO -- At his worst, Ernesto A. Cantu was injecting himself 10 times a day with Demerol, swallowing tablet after tablet of hydrocodone, taking Ambien to sleep and using Valium for anxiety.

"I became addicted," the stocky 60-year-old doctor said. "It's an illness."

Even as Cantu wrestled with his own addiction, he was writing thousands of prescriptions for painkillers for customers of the Internet pharmacy thepillbox.com. Those orders were based on brief telephone conversations with patients Cantu never examined or even met. All together, he approved more than 1 million doses of hydrocodone and other dangerous drugs, court records show.

At least five of Cantu's customers were addicts or later became addicted, according to state and federal records. An Alabama patient suffering from chronic alcohol abuse and depression overdosed on hydrocodone and was hospitalized for nine months. A San Francisco patient addicted to narcotics developed liver damage after receiving multiple orders of the painkiller Darvocet. A New Jersey mother previously treated for substance abuse received more than 800 doses of hydrocodone from Cantu and other thepillbox.com doctors.

Cantu earned as much as $1,500 a day for writing Internet prescriptions. In nearly eight months, he said, he made $147,000. Other online doctors have made as much as $500,000 a year.

"This is not Albert Schweitzer on the other end of the computer box," said Lee S. Anderson, a physician and president of the Texas State Board of Medical Examiners. "The people who are doing this know exactly what they are doing -- and they are doing it for the money."

Across America, doctors beset by troubled histories work for rogue Internet pharmacies, grinding out tens of thousands of prescriptions each year for narcotics and other controlled substances. What passes for medicine in these online transactions is mostly a fiction. There are no medical records, examinations, lab tests or follow-ups.

The doctors are recruited by middlemen who link them to Internet customers seeking access to the coveted drugs. The result is a virtual pain-management industry that feeds millions of doses of highly addictive drugs into the shadow market for pharmaceuticals, bypassing the normal checks and balances in the physician-patient relationship.

"It's an easy way to make big bucks," said Jerry Ellis of the Drug Enforcement Administration's Houston office. "It's not like any of the doctors are truly practicing medicine or caring for the patients."

Internet pharmacies have attracted doctors with substance abuse problems, legal setbacks and financial woes.

Among them:

David L. Bryson: After losing his job as a staff physician for a state facility in Texas, the 65-year-old joined thepillbox.com in 1999 after reading a newspaper article about its owner. Bryson had undergone alcohol dependency treatment in 1995 and filed for bankruptcy protection in 1999, according to Texas medical board records. In fewer than three years for thepillbox.com, he wrote 20,000 prescriptions for more than 4.7 million doses and collected nearly $1 million in fees, records show. About three-quarters of the prescriptions were for hydrocodone and Xanax. In 2002, the Texas board revoked his license for prescribing dangerous drugs to people he had not examined. A consultant to the board called Bryson's actions "a travesty." Bryson pleaded guilty last month in a related federal case and is awaiting sentencing. He declined to comment through his attorney.

Allen L. Browne: In 1999, the 46-year-old obstetrician pleaded guilty to sexual exploitation of a minor and was sentenced to 10 months in prison. Browne was caught secretly videotaping his girlfriend's 13-year-old daughter showering and using the bathroom in his home in Mesa, Ariz. He kept his license but closed his practice in March 2001. Soon after, he began writing prescriptions for hydrocodone, codeine and Alprazolam for a Web site based in a Mesa auto parts store. In seven months, Browne wrote 2,568 prescriptions, earning $36,520. He surrendered his medical license earlier this year. He admitted to the board that customers might have misled him to get pills. Browne could not be reached to comment for this story.

Marvin Gibbs: The 55-year-old gynecologist had recently lost privileges at an Arizona hospital, where he saw 90 percent of his patients, when he was approached in 2000 to write prescriptions for an online pharmacy. In 10 months, he wrote more than 9,000 prescriptions for more than 700,000 doses of controlled substances, according to records of the Arizona Board of Medical Examiners. "What in God's name were you thinking," a board member asked during a 2002 hearing, "prescribing to folks you have no idea who they are, where they're coming from, what they're doing with the medications?" In February, the board placed Gibbs on 10 years' probation. He did not respond to an interview request.

Ricky Joe Nelson: Unemployed and reeling financially after the collapse of a business venture, the 47-year-old physician signed on in 2001 to write prescriptions for an Internet pharmacy in Oklahoma. In a few months, he wrote more than 5,000 prescriptions for controlled substances. In 2002, a federal jury convicted him of conspiring to distribute controlled drugs and launder $175,000 through an offshore bank account. He was sentenced to 51 months. He declined to be interviewed.

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