Charge in Limbaugh drug case rarely used, court records show

WEST PALM BEACH -- Radio commentator Rush Limbaugh says prosecutors are unfairly targeting him with a prescription fraud charge known as "doctor shopping" because he is a famous political conservative.

In fact, a records search by the Clerk of Courts Office revealed only one case in the past five years in which Palm Beach County prosecutors charged a defendant with illegally acquiring overlapping prescriptions.

That case never went to trial because the defendant, Michael Schlosman of West Palm Beach, died. Schlosman received painkillers from one of the same doctors who treated Limbaugh.

A case of doctor shopping was transferred from St. Lucie County this year, while another was transferred from Martin County, according to records.

Doctor shopping, a third-degree felony punishable by up to five years in prison, is duping at least two doctors into prescribing the same controlled substance in a 30-day period. Records from a pharmacy near Limbaugh's $24 million Palm Beach mansion showed the radio show host obtained more than 2,000 pain and anti-anxiety pills in a five-month period in 2003 from four doctors.

If the law against doctor shopping is rarely used in Palm Beach County, it could lend weight to Limbaugh's argument that the investigation is politically motivated.

"The Post's research confirms what we have been saying all along. Rush Limbaugh has been singled out for special prosecution because of who he is," said Limbaugh's attorney, Roy Black, in a written statement. "We believe the state attorney's office is applying a double standard."

At a court hearing Dec. 22, Black said Limbaugh, 52, received pills from doctors in the same office and was being treated for a spinal condition as well as for ear surgery.

"This was legitimate treatment by legitimate physicians for major medical reasons," Black said.

State Attorney Barry Krischer has said his office has scrupulously protected Limbaugh's rights. "Whether Mr. Limbaugh is subject to prosecution for any crimes is still under investigation. Mr. Limbaugh is presumed innocent at this time," Krischer said after it became public that investigators seized the syndicated radio star's medical records Nov. 25.

Trying to find out how many doctor-shopping cases have been filed in the county is not easy.

Early last month, when it became public that Limbaugh was being investigated on the charge, Krischer's office said it could not provide a list of previous cases because its database can't be searched for that specific crime.

Doctor shopping has been against the law since at least 1984 and a felony since 2002.

Prosecutors also can file -- they did in the Schlosman case -- a doctor-shopping charge under the broader drug abuse and prevention laws and can call it by any number of names. The clerk's office searched under the broad statute containing the doctor-shopping charge as well as the specific subsections.

The state attorney's office is expected to conduct a case-by-case search for doctor-shopping charges.

The lawyer in the Schlosman case and the judge who presides over the county's drug court say doctor-shopping charges are rare.

Schlosman, whose case was dropped in February after he died of a congenital heart defect, was accused of obtaining 3,200 pills from seven doctors for his own use.

"I think that was the only time the statute had been used -- that is what I was told -- and I haven't heard of any cases since then," said defense attorney John Tierney.

Schlosman was the ex-husband of Jamie Massey, who died of an overdose after being prescribed more than 20,000 prescription pills in a three-month period from West Palm Beach psychiatrist Dr. George Kubski.

Kubski was sentenced to a year in jail for manslaughter by culpable negligence. Schlosman was charged after he failed to give any helpful information for the prosecution of Kubski, Tierney said.

One of the doctors who prescribed the powerful and addictive painkiller OxyContin to Schlosman was Dr. Lawrence Deziel, according to court records.

Deziel also prescribed Limbaugh hundreds of painkillers, including OxyContin and Norco, a combination of acetaminophen (Tylenol) and hydrocodone, according to a Nov. 25 search warrant.

Deziel has not been charged with any crime. He could not be reached for comment.

In October, former Fort Pierce resident Kerri J. Miller's case of doctor shopping was transferred into Palm Beach County and she received 18 months' probation. If Miller, 33, completes probation successfully, a conviction will be withheld from her record.

County Judge Nelson Bailey said the behavior of doctor shopping is prevalent among the case histories of addicts who show up in front of him in drug court. But those defendants usually are charged with other drug crimes, such as possession.

"I don't see that as a charge. I see the end product of the doctor shopping," Nelson said. "I don't see anybody out there trying to prosecute those types of cases. We can't even get the state legislature to pass a statute to monitor multiple pharmacies in order to catch people who doctor shop."

The case transferred from Martin County involves Victor Carbone, who faces eight drug counts. The case remains open after Carbone missed a court date in April.

Limbaugh's drug problem became public when his maid, Wilma Cline, told supermarket tabloid The National Enquirer that she and her husband provided Limbaugh with thousands of illegal pills over a four-year period.

After the Enquirer story, Limbaugh said he was addicted to prescription drugs and completed a five-week drug treatment program. He returned to his show Nov. 17 and has repeatedly criticized the criminal investigation, especially the seizing of his medical records.

Circuit Judge Jeffrey Winikoff ruled that prosecutors could view the medical records, but he stayed his order when Limbaugh said he would appeal it. Limbaugh has asked Winikoff to clarify his stay order at a hearing scheduled for Monday.

Tierney, Schlosman's attorney, said doctor shopping can be a difficult crime to prove and should be filed only in cases of gross abuse or where the pills are being obtained to be sold to others.

Rank	Location	Receipts	Donors/Avg	Freepers/Avg	Monthlies
28	Idaho	60.00	2	30.00	92	0.65	45.00	2

Dear fml,

The reason you are puzzzled it that this is the Sheeples Republic of FloriDUH. Here is arguably the highest development of the intrusive Nanny State ever dreamed of by the socialism inpaired.

The "Doctor Shopping" law is an admission of incompetence in drug control. It is also a gross intrusion into the doctor/patient relationship. That a few patients kill themselves by lying to a series of physicians to obtain drugs is the business of the suicidal patient. It is not a valid excuse to allow wholesale violation of the rest of the citizenry's rights.

That the Sheeple allow such egeregious "Nanny-ing" is why they earned the "Sheeple" title. Welcome to the Sheeples Republic of FloriDUH - where the Legal Boys and the inmates of the socialist asylum have taken over.

By the way, the nasty little legal boy playing Torquemada in the State's attorney's office, is likely to be eaten alive by Roy Black. Legal Boy forgot to do the numbers, to determine the realities of chronic back pain, etc.

So, as they say on National Palistinian Radio (opps, sorry - I was just told that is actually National Public Radio), "Let's do the numbers." 2,000 pills over five months divides out to only 400 PILLS PER MONTH.

Don't go away, "Legal Boy", I am not finished: 400 pills per month divided by 30 days equals 13.3 pills per day. This means 4.3 pill taken three times a day. Rather normal isn't it? BUT YOU ARE "INVESTIGATING" NORMAL USAGE LEVELS??

Having both a spinal problem causing back pain, and an ear problem, Mr. Limbaugh had two physicians in these very different medical areas of specialization.

"Let's do the numbers": 400 divided by 2 equals 200 pills
per month from each doctor.

Got that, Legal Boy? Good, I knew you could understand that. Now try this.

200 pills per month divided by 30 days per month equals 6.6 pills per day.

HELLOOOOOO! Legal Boy! Lots of people take that many pills for one medical problem. But Mr. Limbaugh has two medical problems, remember?

No? Try really, really hard to remember - and have your secretary do something legal and moral for a change, like helping your memory. She can do it. Together both of you can do it. 'Cause Roy is going to do teh numbers in front of that jury. Count on it.

Now let's continue with doing the numbers. Ever heard of a second opinion? If Mr. Limbaugh has two medical problems which have defied resolution, it is both reasonable and prudent to seek a second opinion. Ask any physician, any lawyer, any citizen.

Back to "Let's do the numbers", Legal Boy. So far we have two medical problems and a second opinion from a second physician. Two problems times two phycisians equals four physicians.

Standard medical practice for anyone with two diseases which have not been cured by the first two physicians is two more physicians = 4 physicians!

Ohhh, Legal Boy! You said he was "Doctor Shopping"!!! Bad move, Legal Boy! Verryyy Baaad Move!

What this Palm Beach "Legal Boy" has done is criminalize a reasoned and prudent medical decision for egregious political reasons.

With this Liberal "Legal Boy" did is set a precident which puts any citizen at the risk of arbitrary and capricious prosecution. The 'Doctor Shopping' law is inherently arbitrary and capricious and is thereby unconstitutional.

As it is not possible to medically determine beyond a reasonable doubt, clearly and unambiguously, that a patient using the number of pills which Mr. Limbaugh used for known disease syndromes, this case is both arbitrary and capricious.

Having had, and occasionally still having back pain even after an operation, I clearly remember being prescribed several hydrocodone pills per day. I even more clearly remember that they eventually were of little use.

Before I was taken to the hospital in the state of a thrashing, out of control, hunk of meat, I had doubled the maximum dosage and that had done no good. Fortunately, the operatio was a success. Mr. Limbaugh sems to have been somewhat less fortunate.

Summary: A Liberal, Democratic 'Legal Boy" is trying to trash a conservative to curry favor with the seething mad Socialists in the Sheeples Republic of FloriDUH.

Lawyers like this 'Legal Boy" are why America has come to despise a once honored profession. "Legal Boy" is below contempt. So are FloriDUH Democrats.

Contrary to what many believe, oxycocone has become a serious problem -- especially in Florida. Below is an article from the Orlando paper.

ORLANDO, Fla. ( KRT ) -- Sylvia Cover remembers her husband telling the physician, "Just fix me up, Doc, so I can get back to work and take care of my family."

Six months later, Gerry Cover was dead.

Hooked on a powerful painkiller called OxyContin, the 39-year-old handyman and father of three died from an accidental overdose. The drug had been prescribed by his doctor for pain from a mild herniated disc.

The Kissimmee, Fla., man's death in September 2000 was an individual family's tragedy. But a nine-month investigation by the Orlando Sentinel found a broader, more disturbing pattern: During 2001 and 2002, more than 200 deaths statewide have been linked to the highly potent painkiller that has been criticized as being aggressively marketed and eagerly prescribed with only routine oversight from government regulators.

OxyContin, made by Purdue Pharma of Stamford, Conn., is a 12-hour time-release drug with the same potential for abuse and addiction as morphine.

The active ingredient in OxyContin and dozens of other strong painkillers is oxycodone, which comes from the opium poppy. The drug is so powerful it is sometimes called "heroin in a pill" and most recently has been linked to a prescription-drug investigation involving conservative commentator Rush Limbaugh.

The Sentinel's investigation tracked how three key forces - Purdue's strong marketing campaign, the government's lax controls and a medical community unschooled in OxyContin's true power - have contributed to a wave of addiction and death.

In turn, illegal use of the medicine has grown as more patients have become dependent on the drug and a new black market has emerged.

Jim McDonough, head of the governor's Office of Drug Policy, said he found the results troubling in light of unreleased reports that show oxycodone overdoses in Florida for the first half of this year continue to rise. He plans to respond with a number of legislative and educational proposals to counter what he called "overwhelming salesmanship to expound on the benefits of these drugs without enough cautions."

"There always was that suspicion when you did have data surrounding the death scene that the predominant drug that seemed to be there was OxyContin," McDonough said.

"If this was a rash of crimes resulting in death we wouldn't stand for it."

The U.S. Food and Drug Administration, which approved OxyContin in 1995 and which has come under fire for failing to respond adequately to safety concerns about the drug, turned down repeated requests to comment on the Sentinel's findings.

Purdue denies its marketing ever put the public's safety at risk.

"Allegations that Purdue's marketing contributed to diversion and abuse are simply not true," said company spokesman Jim Heins, referring to the rerouting of drugs from medical to illegal use. "No evidence has been found to support these allegations."

Purdue executives, battling hundreds of lawsuits and several investigations throughout the country, blame bad publicity on a few criminal doctors and drug abusers who used their pain medication illegally.

In fact, the company says, there are about 2 million patients nationwide being helped by the painkiller. Purdue says no one has ever become addicted to OxyContin when taking it as prescribed.

The Sentinel's investigation, however, found evidence that dozens of oxycodone overdoses in Florida involved patients such as Gerry Cover.

The newspaper launched its inquiry after the Florida Attorney General's Office ended a tobacco-industry-style investigation last year of Purdue's marketing practices.

The yearlong investigation ended Nov. 1, 2002, when Florida Attorney General Bob Butterworth signed an agreement promising never to sue Purdue for any actions up to that point. Purdue pledged $2 million toward a prescription-tracking program that has failed to gain legislative approval.

Butterworth and one of his assistants who helped in the probe, Dave Aronberg, acknowledged that their enthusiasm was dampened by calls from pain patients who feared the drug might be pulled from the market and by an online poll that showed little support for a lawsuit.

In its research, the newspaper examined 500 autopsy reports from across Florida, reviewed more than 5,000 pages from the state's inquiry and interviewed scores of health-care professionals, law-enforcement officers, OxyContin patients, addicts and drug-rehabilitation experts.

The Florida Department of Law Enforcement tracks drug-related deaths based on toxicology tests performed during autopsies. Everyone from doctors to law-enforcement officers follows deadly drug trends outlined in semiannual reports.

Illegal substances such as heroin once topped the charts. Today, prescription drugs turn up more often than street drugs. Drugs with oxycodone were not tracked as a separate class until 2001, after state officials said they became alarmed about anecdotal reports of OxyContin overdoses.

From Jan. 1, 2001, to Dec. 31, 2002, Florida's 24 medical-examiner districts reported that oxycodone overdoses caused 573 deaths. But because oxycodone is available in almost 60 medications, no one knew which specific painkillers were involved in the overdose deaths.

To find out, the Sentinel obtained copies of the 500 autopsy reports in the 573 overdose cases. Some deaths are still under active law-enforcement investigation and autopsy results were not public record. The newspaper also reviewed hundreds of police records and talked to relatives or witnesses to identify the pain medication involved.

The key findings:

Oxycodone was more deadly than heroin during 2001 and 2002 in Florida. The 573 deaths reported as caused by oxycodone overdoses compare with 521 deaths caused by heroin overdoses during the same period.

The most recent statistics publicly available, from 2000, show OxyContin accounted for 25 percent of the market for oxycodone prescriptions. But the Sentinel's research showed OxyContin was the drug identified in about 83 percent of the 247 cases linked to a specific medication. In the remaining 253 oxycodone deaths, the Sentinel was unable to determine a brand-name drug.

The Sentinel review of the 500 oxycodone deaths found 87 people who had a history of back pain, 19 who were recuperating from surgery and 157 others with health conditions that included arthritis, AIDS, cancer and car-crash injuries. By contrast, 38 cases could be identified in which users had no health issues beyond recreational drug abuse.

Purdue has directed drug-education efforts mostly toward teenagers. But the average oxycodone overdose victim is 40 years old, the autopsy reports show. And white, middle-aged men between the ages of 30 and 60 - many with back pain or other medical problems - accounted for 254 oxycodone deaths.

Purdue officials would not comment on the details of the Sentinel's autopsy review, referring instead to the company's own study of more than 1,000 "drug-abuse deaths" nationwide involving oxycodone from 1999 to 2002. That study, published in March, found only 30 of the deaths involved oxycodone alone, and only 12 of those were specifically tied to OxyContin.

The newspaper's approach differed from the Purdue study in many ways. One key difference: The Sentinel pinpointed cases in which medical examiners had determined oxycodone to be the cause of death, not simply "involved." And Purdue's study relied on a scattershot sampling of cases from 23 states, not a comprehensive review of a single category of overdoses in one state.

Meanwhile, Purdue is set to launch another painkiller that is 10 times more powerful than morphine. Purdue's Palladone, which the FDA reviewed in September, is a time-released version of hydromorphone, sold under the brand name Dilaudid. A drug-enforcement official called Dilaudid "the drug of choice for addicts."

The FDA is weighing the drug's potential for abuse before making a final decision. OxyContin was approved before consideration of abuse forgetting conversations and dates. He was obsessed with counting pills. He made sure his OxyContin was always close at hand, fearing the horrendous withdrawal symptoms that might kick in otherwise.

On Sept. 19, 2000, it looked as though the Covers' lives were turning around.

Gerry Cover had been seeing a pain-management specialist who was helping him reduce his medication to 20-milligram doses. Just what happened that night might never be fully known. Sylvia Cover and her son Gerry Jr., 18, were watching television while Gerry Sr. was napping. Sylvia checked on her husband and heard him snoring.

When she returned a little later, she found him blue and cold. An autopsy determined that he had a lethal dose of oxycodone.

Cover's death left his wife and children emotionally and financially devastated, and they are suing Purdue Pharma. Foreclosure of their modest home hangs over their heads.

Last Christmas, Cover made a homemade card for her son. Inside was an IOU until the day comes she can afford to buy a present.

"Our house used to always be full of family and friends," Sylvia Cover said. "We even had a party for Groundhog Day.

"But I no longer have a life."

If you have read this, you deserve an additional reward. First, it is uncommon for people habituated to substances to be habituated to just one. Second, deaths occur from oxycodone for two reasons: (1) There is a differential between tolerance to euphoriant and sedative effects and lethal effects with the lethal effects developing less tolerance than the others; (2) And, a common is the loss of tolerance after treatment or cessation and then the abuser tries to take his old dose with fatal effects --the tolerance to the old dose was lost with sobriety.

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