Prescription for Pain : How Do Dangerous Painkillers End Up On Upstate Streets
By Gordon Dill
The evidence locker at the Travelers Rest Police Department looks like a spare closet and is jammed just as tight. Captain David Gardner points to big cardboard boxes, they look like shoe boxes, filled with baggies of drugs. He pulls one down from atop a pile, locks the door, and walks it to a table in the next room.
A former narcotics officer in Greenville County, Gardner has a sharp eye for prescription pills. As he unloads evidence bags onto a courtroom table, he can identify each by their color and shape.
"We become familiar with names based on the cases that we work," Gardner said.
Each baggie is from another case. Much of it gives new meaning to the term "traffic stop."
"We often get calls about someone sleeping at a gas pump, at a stop light, people are just sitting there and the guy looks like he's dead and we get there and he's under the influence of prescription medication," Gardner said.
Those prescription drugs are big business on the street. One of the most popular, and most dangerous in the wrong hands, is a painkiller called Oxycontin.
That drug can be prescribed by a doctor 180 pills at a time. At the pharmacy they sell for about a dollar apiece. On the street a 30mg pill sells for closer to $30.
Police and federal investigators say dealers have several ways of getting those pills. They use fake prescriptions, lure patients into getting real doctors orders and then selling their legal pills, and police say there are some doctors looking for a quick buck.
"Often times, in many different areas in this region, there are doctors who are known as pill mills. People can come in and ask for a prescription, pay a fee, and get a prescription for their pain medication," Gardner said. "It becomes a cash business that makes doctors a lot of money."
Emergency room doctors told 7 On Your side drug seeking patients have long been a concern. Doctors weigh the needs of a patient against the threat of addiction.
In South Carolina, all doctors are licensed by a group called the South Carolina Board of Medical Examiners. Doctor Louis Costa, a plastic surgeon in Charleston, is the board's president.
"We have had instances where we believe the doctor was utilizing his prescription privilege to generate his welfare and his income," Costa said.
Costa said "pill mills" aren't new to the state and they "preceded my tenure on the board, which has been since 1995."
But how does Costa know?
State and federal investigations start in several ways. The Department of Health and Environmental Control handles them on the state level while the Drug Enforcement Agency handles federal cases.
Many leads are generated by local police, who call in with suspicions about overprescribing doctors. Sometimes local pharmacies do the same thing. Even a suspicious patient can trigger an investigation with a call to D-HEC.
Once the state investigates, the Board of Medical Examiners can suspend a doctor's license and, if the charges are later admitted or proven, that license can be permanently revoked.
Costa said the board would see about a half dozen cases of suspected pill mills each year.
"Number one, protection of the public is paramount. So, to the extent that the public may be at risk not only gives priority to the investigative aspect of it but the nature of the sanction," Costa said.
YOUR RIGHT TO KNOW
Once a doctor is suspended, it's hard to know why. The state maintains a searchable website, accessible to the public, but in most cases the reasons for the suspension will be left unclear.
7 On Your Side found several examples.
Doctor Titus D. Caddell, of Travelers Rest, was suspended in November of 2011. There website listed no reason for the temporary order.
Likewise there was no explanation for several conditions placed on Dr. Caddell when he was reinstated early the following year.
There is no reason in the order why Caddell, who was not a pain management specialist, was told he "should discontinue his treatment of chronic pain or fibromyalgia."
The board also told Caddell he "shall not prescribe Schedule II or III controlled substances."
Those controlled substances would include narcotic painkillers like Oxycodone.
To date, there has been no public accusation or criminal charge alleging any prescription drug crimes involving Dr. Caddell. Yet, for reasons the board did not release, he was banned from writing many prescriptions.
Because it would not be possible to track any of the cash for prescription practices that might have been associated with a "pill mill", 7 On Your Side used a Freedom of Information request to get a list of the top 10 prescribers of several medications in the state's medicaid program.
In 2011, Titus Caddell was reimbursed for more Roxycodone, a fast-acting form of Oxycontin, than any other doctor in the state. In fact, despite his license being suspended for the last part of the year, Medicaid paid Caddell more for that drug than the next two top prescribers combined.
Calls to Caddell's attorney for comment were not returned.
7 On Your Side also asked the state about another Upstate doctor. Doctor Daniel Jebens was not listed on the state website as having a suspended license. In fact, there were no listings of any actions against him at all.
But in December of 2012, police shut down his Internal Medicine practice on Wade Hampton Boulevard in Greer. The office is still closed. A Special Agent with the DEA said the US Attorney's office was handling the ongoing investigation. That office had no comment.
When 7 On Your Side asked Costa about Jebens, Costa said he hadn't heard of the case.
The following day, after 7 On Your Side asked Costa about the case, an order of suspension appeared online dated December of 2012. A spokesperson for the Medical Board said there was a typo in the first version that had since been corrected which delayed posting it online.
There was no reason given, the notice only said that Dr. Jebens was "temporarily suspended".
Costa said the public would only know the reasons for those suspensions if they progressed to a "final order", meaning if the license was revoked.
To be clear, Jebens does not face any criminal charges.
7 On Your Side tried to contact Jebens but he did not respond to those requests.
Doctor Caddell is currently suspended. It is again listed as a "temporary suspension" without any reason given.