Doctor With 12 Dead Patients Gets Four Consecutive Life Terms

November 27, 2013

No -- today's BrokeAndBroker Blog offering isn't about securities fraud. Sometimes a story just grabs me, and today's blog is just such a situation.  For starters, consider the opening lines of the Opinion in this recent federal 6th Circuit Court of Appeals: 

When a doctor first enters the practice of medicine, he or she swears to abide by a prime directive of the profession: "First, do no harm." Paul Volkman breached this sacrosanct tenet when he prescribed narcotics to addicts and individuals with physical, mental, and psychological frailties. A federal jury looked at Volkman's actions and found him guilty of breaking several laws, chief among them the law prohibiting the unlawful distribution of controlled substances. After receiving the jury's verdict, the district court sentenced Volkman to four consecutive terms of life imprisonment, to be served concurrently with a number of less-lengthy terms. 

United States of America v. Paul H. Volkman (6th Circuit, November 21, 2013) 

Spiraling Down

Paul Volkman, who held both an M.D. and a Ph.D. in pharmacology from the University of Chicago, was board-certified in emergency medicine and an American Academy of Pain Management "diplomat." Starting in 2003 he was sued and wound up either settling or loses many cases, resulting in the exhaustion of his malpractice insurance and the loss of his job. Having fallen on tough times, he wound up taking a position at the cash-only Tri-State Health Care clinic, for about $5,000 a week.

Not Just Illegible

After some six months at Tri-State, Volkman found that local pharmacies were refusing to fill the clinic's prescriptions because of improper dosing issues. At that point, Volkman came up with what he viewed as a workaround solution to the prescription problem: He would open his own dispensary on the clinic's premises. As more fully explained in the Opinion:

Volkman submitted to the Ohio Board of Pharmacy an application for a license to distribute controlled substances. Board representatives conducted an inspection of the clinic grounds, during the course of which they found a Glock in the safe where the drugs were stored. Despite this discovery, the Board issued a license after its initial inspection.

Agents from the Board conducted a follow-up inspection in December 2003. This time, they saw several problems with the new dispensary's practices. For instance, the dispensary logs were sloppily maintained; Volkman provided little oversight over recordkeeping processes. No licensed physician or pharmacist oversaw the actual dispensing process. Patients returned unmarked and intermixed medication.

By February 2004, the clinic took adequate measures to ameliorate the Board's administrative concerns. But the clinic still had its problems. Volkman was in charge of the dispensary, but did a poor job of regulating access-the drug safe's security was porous, with unauthorized personnel regularly accessing the pharmaceutical stockpile contained inside. Despite these issues, the dispensary saw much activity-it purchased 135,900 dosage units of oxycodone between July and December 2003, 457,100 dosage units for the entirety of 2004, and 414,200 dosage units between January and September 2005.

It eventually became clear that Volkman's medical practice followed a questionable pattern. Drug addicts, drug peddlers, or individuals otherwise not complaining of pain would come to see him as his "patients." Very little was done in terms of taking medical histories or conducting physical examinations. Volkman would regularly prescribe a drug cocktail consisting of opiates (such as oxycodone and hydrocone) as well as sedatives (diazepam, alprazolam, and carisoprodol; more commonly referred to as Valium, Xanax, and Soma). He had a tendency of first resorting to narcotics, disregarding first lines of treatment for pain management such as non-steroidal anti-inflammatory drugs (NSAIDs).

A federal investigation of Tri-State led to a search of the clinic facility on June 7, 2005. Medical personnel accompanying the investigative team saw that the clinic was in utter disarray. Urine specimen cups, filled with urine, were scattered all over the floor. The clinic had no equipment to view X-rays and MRI results. Miscellaneous pills were strewn all throughout the clinic premises.

Although you wouldn't think that things could have gotten more bizarre or worse, in fact, they did. Twelve of Volkman's patients died during his tenure at Tri-State and during the early months of a new practice that he had opened after leaving the clinic.

So many troubling questions. How did this troubled physician get permission to continue to practice medicine? Why was the clinic allowed to continue to operate despite so many warning signs? Why the pharmacy board issue the license? Sadly, you're only likely to come away shaking your head in disbelief after you read the full-text of the Opinion at United States of America v. Paul H. Volkman (6th Circuit, November 21, 2013).