Written by Ben Allen, General Assignment Reporter | Dec 16, 2014 5:50 PM

(Harrisburg) — A midstate doctor is facing a new set of charges over allegedly prescribing highly addictive painkillers in exchange for cash.

55 year old Doctor David Wait of New Cumberland is accused of writing prescriptions for 102-thousand oxycodone pills for those who weren’t under his care.

He had already been indicted on similar charges in August, and his license is suspended by the state Board of Medicine.

A voicemail left with Wait’s attorney was not immediately returned.

Doctors who are the most prolific prescribers of powerful narcotic painkillers and stimulants often have worrisome records, a ProPublica analysis of Medicare data shows.

In 2012, 12 of Medicare’s top 20 prescribers of drugs such as oxycodone, fentanyl, morphine and Ritalin have faced disciplinary actions by their state medical boards or criminal charges related to their medical practices, and another had documents seized from his office by federal agents. These drugs have a high potential for abuse and are classified as Schedule 2 controlled substances by the Drug Enforcement Administration.

The No. 1 prescriber Shelinder Aggarwal of Huntsville, Ala., with more than 14,000 Schedule 2 prescriptions in 2012 — had his controlled-substances certificate suspended by the state medical board in March 2013. He surrendered his medical license four months later. (Aggarwal could not be reached for comment.) Prescribing high volumes of Schedule 2 drugs can indicate a doctor is running a pill mill, said Andrew Kolodny, chief medical officer of Phoenix House, a New York-based drug treatment provider. “We wait ’till these doctors kill people … It doesn’t make any sense,” said Kolodny, founder of Physicians for Responsible Opioid Prescribing, which advocates for tighter regulation of painkillers.

Medicare’s drug program, known as Part D, now covers about 38 million seniors and disabled people and pays for more than one of every four prescriptions dispensed in this country. Concerns about oversight of controlled substances date back to at least 2011, when the Government Accountability Office highlighted abuse of opioids in Part D and called on Medicare to take action. Within the past year, Medicare has started to use prescribing data to identify potentially problematic doctors, as have some state medical boards. Beginning in mid-2015, Medicare will have the authority to kick doctors out of the program if they prescribe in abusive ways.

“It’s a real area of concern for us,” said Shantanu Agrawal, a physician who is director of the Center for Program Integrity within the federal Centers for Medicare and Medicaid Services. The 2012 data shows the upward trend line for prescriptions of controlled substances before these initiatives took hold as USA TODAY reported in Peter Eisler’s June 2014 story, Aggarwal’s Medicare prescribing history had plenty of red flags. The pain-medicine specialist has consistently shown up in Medicare’s data as a top prescriber of narcotics. By 2012, the year before he stopped practicing, more than 80% of his Medicare patients received at least one prescription for a Schedule 2 drug, in many cases oxycodone.

It took a complaint from pharmacies near Aggarwal’s office to alert the Alabama Board of Medical Examiners to his unusual prescribing habits, said Larry Dixon, the board’s executive director. Board investigators subsequently made undercover visits to the doctor’s office and videotaped him prescribing drugs without an exam. “If you paid $1,200 in cash, they would put a VIP stamp on your medical records and you didn’t ever have to have an appointment,” Dixon said.

Medicare’s Part D data draws a roadmap to the doctors who prescribe controlled substances most frequently. In 2012, 269 providers wrote at least 3,000 prescriptions for Schedule 2 drugs, ProPublica’s analysis shows. They were concentrated in a handful of states. Florida led the country with 52 providers, followed by Tennessee with 25. (Look up your doctor using our Prescriber Checkup tool.) About one in five doctors who wrote at least 3,000 prescriptions for Schedule 2 drugs have faced some kind of sanction or investigation, ProPublica found. Because of their risk of abuse and dependence, these drugs require written prescriptions and cannot be refilled.

In September, Medicare sent 760 letters to doctors who prescribed far more Schedule 2 drugs than others in their medical specialty and state. Officials hope the initiative will cause doctors to examine their prescribing and make changes.

“Simply being an outlier doesn’t establish that you’re doing something wrong,” said CMS’ Agrawal. “What we are trying to do is give physicians the ability to assess themselves, given their comparative data.” Medicare also has sent information on 71 prescribers for possible investigation to the inspector general of the U.S. Department of Health and Human Services, and on one doctor to a state medical board. Some medical licensing boards are also expanding their efforts to use data to spot problematic prescribing. North Carolina’s medical board has proposed new regulations allowing the agency that runs the state’s prescription drug monitoring program to share data with the board. The board currently can only access the data when it is pursuing an active investigation into a particular physician. Similarly, Alabama’s Legislature recently authorized its medical board to regulate pain medicine clinics and proactively access data from its prescription monitoring database.

Herald-Leader staff report December 10, 2014

A Michigan doctor has been sentenced to five years in prison after admitting he conspired to distribute large amounts of pain pills in Eastern Kentucky. Anthony Jungho Choe agreed as part of his plea deal to give up his medical license and never practice again. U.S. District Judge Amul R. Thapar made lifetime parole supervision a part of Choe’s sentence.

Choe worked in Chelsea, Mich. People who got prescriptions from him brokered thousands of pills to drug dealers in Eastern Kentucky from around the end of 2009 through October 2012, according to court records.

Choe admitted he prescribed pills without a legitimate medical reason; that he didn’t really examine the drug runners; and that it was “reasonably foreseeable” the pills were being abused or sold, according to his plea agreement.

Jon Ross Twadelle, 29, pleaded guilty to stealing drugs and falsifying records at a Randolph pharmacy.
By Betty Adams Staff Writer
[email protected] | 207-621-5631

AUGUSTA — A former pharmacy technician who skimmed hydrocodone tablets from a Randolph pharmacy’s stock for at least two years was sentenced Monday in Kennebec County Superior Court.

Jon Ross Twadelle, 29, of Pittston, pleaded guilty to stealing drugs and falsifying records in a scheme that the prosecutor says was discovered when an audit was done, which led to Twadelle being caught on camera pocketing handfuls of pills.

Twadelle was sentenced to two years in jail with all but 30 days suspended and two years’ probation. He was fined $400. He was ordered to pay $500 restitution for the missing medication, and conditions of probation ban him from being at any Community Pharmacy location.

In exchange for the pleas, a charge of aggravated trafficking in scheduled drugs was dismissed. As part of a disciplinary action by the state Board of Pharmacy, Twadelle agreed to the permanent revocation of his pharmacy technician license and agreed to pay a civil penalty of $1,000 in a consent agreement he signed in October 2013.

Separately, the Board of Pharmacy reprimanded his father, John D. Twadelle, the pharmacist in charge at Randolph Community Pharmacies in Randolph when the drug diversion occurred, for violating a rule by “failing to establish and maintain effective controls against diversion of prescription drugs.”

That consent agreement, signed at the end of May 2014, included a civil penalty of $1,500 and a minimum one-year probationary period in which John Twadelle, also of Pittston, must provide quarterly reports of all purchases and dispensing of scheduled drugs for businesses where he is the pharmacist in charge. He now is the pharmacist in charge at Gardiner Apothecary.

The younger Twadelle is in treatment with a mental health counselor and taking medication for depression, anxiety and other problems, according to a sentencing memorandum filed with the court by his attorney, Ronald Schneider. Part of the problem, Schneider says in his memo, stems from a head injury suffered when Twadelle crashed while riding a mountain bike down a trail at Sunday River. Schneider quotes Jon Twadelle, who prefers to be known as Ross, as saying, “I am no longer trapped in a cycle of addiction” and that he plans to seek a career in the outdoors. “In short, Ross’s behavior has its origins in mental illness and physical and mental trauma. … Ross did not take drugs to profit from them or to simply get high. Rather he took the drugs to self-medicate himself with a desire to feel normal and confident and to avoid feeling bad,” Schneider writes.

More than 40,000 hydrocodone/acetominophen tablets, an opioid pain medication, were unaccounted for between 2010 and October 2013, when the scheme was discovered, according to a memo from the prosecutor, Assistant Attorney General William Savage.

Jon Ross Twadelle told an investigator that he took 8 to 15 pills a day over a period of up to two years while working as a pharmacy technician. Savage’s memo describes an instance caught on surveillance on Sept. 9, 2013: “Pharmacy Technician John Ross Twadelle removed a stock bottle of 1,000 10/235 hydrodocone pills, walked to a corner and poured 10 handfuls of pills out of the bottle and placed them in his pants pocket.” Later that day, he used his home computer to alter the pill count in the inventory system by 800 “in order to ensure that the inventory count would trigger replenishment of the pills to keep enough on hand,”

Savage continues. “Twadelle adamantly denied that he had stolen the whole 40,039 pills.” Jon Ross Twadelle is to report to jail in January to begin serving the 30-day unsuspended portion of the sentence.