-Terry Smith collapsed face-down in a pool of his own vomit.
-Lynn Blunt snored loudly as her lungs slowly filled with fluid.
-Summer Ann Burdette was midway through a pear when she stopped breathing.
-Larry Carmichael knocked over a lamp as he fell to the floor.
-Jennifer Thurber was curled up in bed, pale and still, when her father found her.
-Karl Finnila sat down on a curb to rest and never got up.
These six people died of drug overdoses within a span of 18 months. But according to coroners’ records, that was not all they had in common. Bottles of prescription medications found at the scene of each death bore the name of the same doctor: Van H. Vu.
After Finnila died, coroner’s investigators called Vu to learn about his patient’s medical history and why he had given him prescriptions for powerful medications, including the painkiller hydrocodone.
Investigators left half a dozen messages. Vu never called back, coroner’s records state.
Over the next four years, 10 more of his patients died of overdoses, the records show. In nine of those cases, painkillers Vu had prescribed for them were found at the scene.
Vu, a pain specialist in Huntington Beach, described himself as a conscientious, caring physician. He declined to comment on individual cases, citing confidentiality laws, but he said he treats many “very, very difficult patients” whose chronic pain is sometimes complicated by substance abuse and depression, anxiety or other mental illness.
“Every single day, I try to do the best I can for every single patient,” he said in an interview. “I can’t control what they do once they leave my office.”
Prescription drug overdoses now claim more lives than heroin and cocaine combined, fueling a doubling of drug-related deaths in the United States over the last decade.
Health and law enforcement officials seeking to curb the epidemic have focused on how OxyContin, Vicodin, Xanax and other potent pain and anxiety medications are obtained illegally, such as through pharmacy robberies or when teenagers raid their parents’ medicine cabinets. Authorities have failed to recognize how often people overdose on medications prescribed for them by their doctors.
A Los Angeles Times investigation has found that in nearly half of the accidental deaths from prescription drugs in four Southern California counties, the deceased had a doctor’s prescription for at least one drug that caused or contributed to the death.
Reporters identified a total of 3,733 deaths from prescription drugs from 2006 through 2011 in Los Angeles, Orange, Ventura and San Diego counties.
An examination of coroners’ records found that:
- In 1,762 of those cases — 47% — drugs for which the deceased had a prescription were the sole cause or a contributing cause of death.
- A small cadre of doctors was associated with a disproportionate number of those fatal overdoses. Seventy-one — 0.1% of all practicing doctors in the four counties — wrote prescriptions for drugs that caused or contributed to 298 deaths. That is 17% of the total linked to doctors’ prescriptions.
- Each of those 71 physicians prescribed drugs to three or more patients who died.
- Four of the doctors — including Vu — had 10 or more patients who fatally overdosed.
- Vu had the highest total: 16.
Experts said the findings challenge the prevailing view of what is driving the surge in overdose deaths and should prompt closer scrutiny of doctors and their prescribing practices.
“The data you have is something that’s going to shock everybody,” said Dr. Jorge F. Carreon, a former member of the Medical Board of California.
Carreon, a South Gate physician whose term on the board ended in July, said he had long suspected that doctors’ prescriptions were contributing to the increase in overdoses. The Times’ analysis, he said, showed that it was “worse than what I thought.”
President Obama’s drug czar, R. Gil Kerlikowske, said of the findings: “Do I think this has the potential to change the game in the way it’s being looked at and being addressed, both at the state and federal level? Yes, I do.”
In its review of prescription drug fatalities, The Times examined cause-of-death findings, toxicology reports and other information in county coroners’ files, including lists of prescription medications found at death scenes. Those lists typically identify the prescribing doctor.
The deaths often stemmed from multiple drugs, sometimes prescribed by more than one physician. In some cases, the deceased mixed alcohol or illicit drugs with prescription medications.
Medical experts say that even one overdose death should prompt a doctor to conduct a thorough review of his or her prescribing.
“Personally, it would be a big, big deal,” said Dr. Peter Przekop, a pain and addiction specialist at the Betty Ford Center in Rancho Mirage and an assistant professor at Loma Linda University School of Medicine. “I would certainly want to stop using those medications until I knew what was going on.”
The 71 doctors with three or more fatal overdoses among their patients are primarily pain specialists, general practitioners and psychiatrists. Almost all work alone, without the peer scrutiny that is standard in hospitals, group practices and HMOs.
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