Psychiatrist Priscilla Ilem guilty in pain pill prescriptions for cash scam

An 85-year-old psychiatrist from Wayne (New Jersey), caught in an undercover sting a year ago, pleaded guilty Friday to selling prescriptions of the powerful pain medication oxycodone and agreed to forfeit $500,000 to the government.

Dr. Priscilla G. Ilem admitted her guilt to U.S. District Judge Joseph E. Irenas during a hearing in Camden at which she paid the $500,000 representing the value of her now-shuttered home office, her lawyer said.

Ilem pleaded guilty to four counts of unlawful distribution of a controlled substance, admitting that she prescribed an inordinately large quantity of oxycodone to people that she reasonably knew were falsely claiming to have physical ailments in order to get the highly-addictive drug.

A native of the Philippines, Ilem came to the United States in 1955 and became a citizen in 1964. She had practiced medicine for more than 50 years when she was arrested in August 2011 following an investigation by the U.S. Drug Enforcement Administration and Wayne police.

The probe began after police received information that Ilem was selling oxycodone prescriptions out of the office she kept at her Alps Road home.

During June and July of 2011, at Walgreens Pharmacy alone, 238 patients filled 291 prescriptions for oxycodone that had been written by Ilem, authorities said.

Using confidential sources and undercover officers posing as patients, authorities obtained oxycodone prescriptions from Ilem “during office visits which lasted an average of 10 minutes each and involved no physical examination or testing whatsoever, and for which Ilem charged a cash fee of $200,” her arrest complaint said.

In confessing her guilt, Ilem acknowledged failing to give patients proper physical exams before issuing prescriptions. She also admitted that she wrote prescriptions that were medically unnecessary for four people whom she later learned were undercover officers.

A week before her arrest, the psychiatrist took steps to cover-up her crimes, the complaint said. She went to police headquarters in Wayne and reported a possible prescription fraud, claiming that someone was using her name to write prescriptions, authorities said.

Following her arrest, Ilem admitted that beginning in May 2011 she began writing Roxicodone prescriptions — the brand name of the drug — for patients in their early 20s and 30s who claimed to have physical pain and that she did not perform physical exams, authorities said. She also admitted that the number of young patients visiting her office for Roxicodone increased dramatically in the ensuing months.

After the hearing, Paul Brickfield, a River Edge attorney who represents Ilem, was at a loss to explain his client’s conduct.

“It’s classic aberration behavior that is hard to explain,” he said.

“I can only say it’s a mystery because she had a very distinguished career. It was puzzling to everyone who knew her.”

A former Army Reserve colonel who served as chief executive officer of the 187th Medical Battalion during the Persian Gulf War, Ilem’s license to practice medicine was suspended by the New Jersey Board of Medical Examiners after her arrest.

Once she’s sentenced she will consent to the permanent loss of her license, Brickfield said.

Under federal sentencing guidelines, Ilem faces between 24 and 30 months in prison, Brickfield said. But under her plea agreement, she reserved the right to seek a downward departure based on her age, health and otherwise exemplary life, he said.

The judge set sentencing for Dec. 18 and continued her $1 million bail.

Source: Peter J. Sampson, “Wayne psychiatrist pleads guilty to unlawful distribution of oxycodone,” The Record (New Jersey), September 14, 2012.

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California psychiatrist Joel S. Dreyer going to prison for 10 years for federal drug/prescribing conviction

Nearly five years after one of his patients was found dead of an overdose, a 73-year-old former Murrieta psychiatrist has been sentenced to 10 years in federal prison for his role in a prescription drug scheme.

Joel Stanley Dreyer had pleaded guilty in federal court to conspiracy and distributing a controlled substance. U.S. District Judge Virginia A. Phillips on Monday ordered Dreyer to surrender Feb. 1 at a federal bureau of prisons medical facility in Rochester, Minn.

Dreyer prescribed “some of the most addictive and dangerous opiates without even a pretense of a physical exam,” Phillips said during sentencing. “I think he shows an astounding lack of self-awareness of the seriousness of his conduct.”

Investigators said Dreyer from 2004 until his July 2007 arrest had been prescribing large amounts of addictive drugs, such as the painkillers oxycodone and hydrocodone, for $100 to $200 per prescription. He met patients at his office as well as in parking lots and restaurants. Dreyer’s patients often were young and seemingly healthy people and he did not perform physical exams before writing prescriptions, authorities said.

On at least one occasion he prescribed addictive drugs to a minor for no medical reason, and his practices contributed to the death of Jessica Silva, 35, of Orange County, prosecutors said.

Defense attorney William Ginsburg said at Monday’s sentencing in a Riverside courtroom that Dreyer has been suffering for years from a degenerative brain disorder that robbed him of his moral compass but not his intellect. He said justice would not be served by sentencing a mentally ill man with about 3½ years to live to federal prison or a medical detention facility.

He met patients at his office as well as in parking lots and restaurants. Dreyer’s patients often were young and seemingly healthy people and he did not perform physical exams before writing prescriptions, authorities said.

“He has gone mad,” Ginsburg told the judge. “I beg and beseech you to show some mercy here.”

Assistant U.S. Attorney Antoine Raphael countered that at the time of his arrest, Dreyer did not appear to be suffering any brain damage.

“This is a defendant who was lucid, who tried to outsmart the detectives,” he said. “Let’s be clear, your honor. This was a drug dealer.”

Until shortly before his arrest, Dreyer had been employed as a staff psychiatrist at Oak Grove Institute in Murrieta, a nonprofit residential treatment facility for special-needs children. Silva, who had a history of addiction to prescription drugs, was found dead Dec. 25, 2005, in her Newport Beach home, a police report said. An oxycodone bottle with Dreyer’s name as the prescribing doctor was found near her body.

Her brother, Brett Siciliano, held a portraint of Silva while speaking in court about finding her body.  He blamed her death on the doctor’s greed, arguing that Dreyer should have recognized that his sister needed help, not drugs.

Source: Sarah Burge, “Murrieta: Former doctor sentenced in drug scheme,” The Press-Enterprise, December 13, 2010.

North Dakota-Puerto Rico psychiatrist Enrique Rivera-Mass guilty of prescribing over Internet

On October 27, 2010, psychiatrist Enrique Rivera Mass signed an agreement with federal prosecutors to plead guilty to a charged of conspiracy to distribute a controlled substance.

[Note: Rivera Mass is identified as a child and adolescent psychiatrist on the websites Psych Yellow Pages, San Juan Doctors andVitals.]

Mass became involved with Internet prescribing while in his native Puerto Rico and continued to do so while employed at the Center for Psychiatric Care in Grand Forks, North Dakota between January 2007 and April 2009.

Authorities report that Mass signed off on prescriptions for nearly 1.8 million pills—weight loss drug phentermine, tranquilizers, painkiller and the smoking cessation drug Chantix—issuing prescriptions to customers in almost every state though he did not meet or talk to any “patients” or have access to their medical records prior to approving the prescriptions.  (Examinations, medical/social/treatment histories and the like are part of the standard of care for physicians.)

Mass now faces a maximum of 10 years in prison and the surrender of $100,000 in profits when he is sentenced April 15, 2011.  He also had his North Dakota medical license revoked.

Source: Dave Kolpack, “Former North Dakota doctor signs plea agreement in Internet prescription fraud case,” Canadian Business, October 27, 2010.

Psychiatrist Joel S. Dreyer blames holes in his brain for his unlawful prescribing

Brett Siciliano drove home to San Clemente from the Riverside Federal Courthouse on Tuesday morning, disappointed once again. A small urn with his twin sister’s ashes hung from his neck.

The man he blames for the death of his sister, Jessica Silva, at her Newport Coast home was scheduled to be sentenced to prison for giving out Xanax and OxyContin prescriptions for $100, among other things.

As he has done several times in the year since he pleaded guilty, Joel Stanley Dreyer got a delay in his sentencing again, this time until Dec. 13, by firing his lawyer and arguing that he had brain damage. Three holes in his frontal lobe affect his sense of smell and judgment, he’s told the court.

The federal prosecutor handling the case, Antoine Raphael, said Dreyer may try to back out of a plea agreement at another hearing Nov. 29.

Siciliano, 41, came ready to give a victim impact statement, to have his say at last. But the letdown, he said, “sucked the life out of me.”

Siciliano isn’t just a grieving brother waiting for justice from others. He launched an investigation that helped lead to Dreyer’s arrest.

Prosecutors cited Siciliano’s independent investigation in court filings.

Court records link Dreyer not just to Silva, but to Brandon Keating, a 25-year-old who died in a Costa Mesa detox facility in 2007. Dreyer, who lost his psychiatry license this year, was charged with distributing around 150,000 pills of Oxycontin, Xanax, Vicodin, and other often-abused drugs.

He was also accused of taking part in a conspiracy to illegally supply prescription drugs to a Tijuana pharmacy.

For Siciliano, it started Christmas Day, 2005.

He was outside Jessica Silva’s condo, pounding on the door.

Silva hadn’t shown up for Christmas with the family, even though it was likely to be the last one they’d have with their ailing grandmother. Nobody had heard from her in two days.

Although Siciliano had been clean for three years, his sister was still struggling with pills. So Siciliano went to check on her. He could hear her Maltese, Princess, inside barking, but there was no answer at the door.

He called the Newport Beach police, who broke a window to let them all in. Silva was lying motionless on the bed, Princess whimpering by her side.

The coroner’s office would determine that the 35-year-old divorced saleswoman had died two days earlier. Police found more than 20 prescription medications in the house; 10 of them were found in her blood, stomach and liver.

Siciliano noticed that a prescription for 90 Oxycontin pills – filled three weeks before – had been written by Dreyer, raising his suspicion.

“My grandma was dying of cancer and she couldn’t even get a prescription for one OxyContin,” Siciliano said. “When I Googled (Dreyer) and found out he was a psychiatrist, I knew. Psychiatrists don’t give Oxy. They give Viagra, Lipitor.”

The coroner’s office ruled that Silva’s death was caused by a reaction between Oxy and four other drugs.

Siciliano, a former real estate agent and current board game entrepreneur, started trying to set up an appointment with Dreyer.

“He’d say, ‘Call me in a month, call me in month,'” Siciliano said Monday.

Siciliano never mentioned his sister’s name, but he said Dreyer seemed wary.

“After about nine months of calling him, and him saying he wasn’t taking any more patients,” Dreyer relented on Siciliano’s last attempt before giving up.

On Nov. 14, 2006, Siciliano visited Dreyer at his Murrieta office, complained of back, neck, and knee pain, and got prescriptions for Norco, Vicodin, and Ambien, according to court records.

“This doctor had a hole in the wall sharing it with the chiropractor,” Siciliano said. “There were strung-out patients in the waiting room. I got eight years in recovery, so I know the look. He told me not to go to the corner Walgreens” to fill the prescriptions.

Siciliano filled the prescriptions, and drove to the Murrieta Police Department, where he met Det. John Nelson.

“I went there with my mother, my sister’s dog, and my sister’s ashes,” Siciliano recalled.

Siciliano dumped out the pills on the detective’s desk. He showed Nelson the coroner’s report of his sister’s death, and gave him receipts for his sister’s drug purchases.

“I’m here to tell you about this Dr. Joel Dreyer,” Siciliano remembered saying.

“Oh, you mean this guy,” Nelson responded, pulling out a file Siciliano remembers as four inches thick.

Local patrol officers had been pulling over young people and finding drugs prescribed by Dreyer for some time, Siciliano remembers the detective telling him.

Over the next several months, undercover investigators from the police, the Drug Enforcement Administration, and California Medical Board wore wires to meet with Dreyer, according to court records.

Dreyer asked no questions about medical history, conducted no examinations, generally asked what drug the patient was interested in, and then suggested a symptom, according to records. He charged $100 for the visits and wrote a prescription for each investigator.

Dreyer was charged in federal court in Feb. 2008, and pleaded guilty on Sept. 21 2009. At his plea hearing, he offered a rambling defense.

“I was humanitarian of the year in Michigan in 1984…. I’m just not this bad guy I’m being painted out to be…. I have brain damage. I have three holes in the frontal lobe of my brain… Two things happen. You can look it up on the computer. Lack of sense of smell….and a lack of judgment. So… I saw patients I didn’t know, probably, everything they were telling me, your honor, saw patients in pizza parlors. But did I know the drugs were being delivered on the street? No. Did I make any profit off of it? No…. Did I do a physical exam? No. I haven’t done a physical exam since 1963.”

This August, Dreyer was stripped of his medical license.

Shortly before his arrest, according to published reports, he had been fired from his job as a staff psychiatrist at Oak Grove Institute, a residential treatment center and school for children with problem behavior.

On New Year’s Day, 2006, Brett Siciliano, his mother Hedy Porr, and others buried Jessica Silva. It was her birthday.

For his family, Siciliano said, the holidays are forever changed. One image is burned in his mind.

“There was a little toddler upstairs opening a Christmas present, as they brought my sister out in a body bag.”

Source: Jon Cassidy, “Sister’s drug death launches man’s quest for justice,” Orange County Register, October 5, 2010.

Psychiatrist Jack Gray lost medical licenses in Florida and Tennessee; still licensed in Oklahoma?

On August 16, 2010, the Tennessee Department of Health revoked the medical license of psychiatrist Jack K. Gray, Jr. Tennessee’s action against Gray was based on Gray’s voluntarily relinquishment of his license to practice medicine in the State of Florida.

The reasons for the Florida action are as follows:

From 1997 through August 27, 2004, Gray provided treatment to a 55-year-old male patient with a history of chronic back pain and depression due to a work-related accident from 1987 which resulted in four crushed vertebrae. The patient was then treated with Prozac and later started on Oxycontin to manage his low back pain.

Gray’s medical records do not contain a record of an initial evaluation or examination or any notes that would indicate a reason why Gray chose the treatment plan that he did. Treatment started monthly until 2002 and moved to every three to four months.

Gray prescribed various psychotropic medications including the antidepressant medications Effexor and Prozac, as well as a benzodiazepine Valium for management of spasms associated with his painful condition. Gray provided prescriptions for Soma, as well as Ambien, a sleep-inducing medication.

The core of the treatment and the only medication taken throughout the entire course was the opiod agonist oxycodone in the long-acting form of Oxycontin. The patient was escalated from an initial 80 mg twice daily to 480 twice daily for several years until his death. The patient also received an antipsychotic medication, Seroquel, given to him for the purpose of treating insomnia as well as “agitation.”

The patient was not asked to sign a controlled substance agreement authorizing Gray to be the only treating physician prescribing antidepressant and pain medications. There was no documentation of urine toxicology screens, pill counts, or pharmacy surveillance having been performed. Gray postdated several prescriptions for schedule II medications, those with a high potential for abuse and severe psychological and physical dependence.

The patient last saw Gray on August 27, 2004 and a follow-up appointment was scheduled for January 7, 2005, however the patient died on October 16, 2004. The coroner found excessively high levels of oxycodone in the patient.

Among other things, Gray failed to:

Prepare any documentation following physical examination of the patient, including instances when the patient reported worsening or other change in the severity of his condition.

Set reasonably frequent follow-up visits given the treatment included the use of opiods. (The patient weighed 120 pounds and was taking over 900 mg of Oxycodone daily. A prudent physician would have considered seeing such a patient at a minimum of every other month.)

Assess the presence of aberrant drug behavior and opiod therapy-related side effects as expected of a prudent physician.

Sufficiently document the process of obtaining informed consent from the patient covering the risk of treatment with controlled substances.

In summary, the Florida Board found that Gray failed to practice medicine with the level of care, skill and treatment of the patient as recognized by a reasonably prudent physician.

The website of the Oklahoma Board of Medical Licensure and Supervision shows that, despite the loss of his Florida and Tennessee licenses, Gray still has an active license in Oklahoma.

Source: Entry on Jack K. Gray in Disciplinary Action Report, Tennessee Department of Health, July 2010, pg. 2 and Final Order, Department of Health, Petitioner vs. Jack K. Gray, Jr., M.D., Respondent, DOH case no. 2004-37880, license no. ME0057877.

Content used with permission of Citizens Commission on Human Rights Psychcrime.org website.

Psychiatrist Joel S. Dreyer loses license following federal drug conviction

On August 13, 2010, psychiatrist Joel Stanley Dreyer surrendered his license to the Medical Board of California.  This action was in response to charges issued by the Board against Dreyer, of which he admitted to “the complete truth and accuracy of every charge and allegation” in four of the eleven Board charges against him–most of which relate to a federal criminal conviction for the unlawful distribution of controlled substances.

On September 21, 2009, Dreyer was was convicted of possession with intent to distribute the oxycodone and unlawful distribution of oxycodone/Percocet [USA v Dreyer, USDC Central District, Eastern Division, Case No. EDCR 08-00041(A) SGL] .

These drugs are dangerous and addictive narcotics whose distribution is controlled by the U.S. Drug Enforcement Administration.

In July 2007, Dreyer was arrested for unlawfully prescribing controlled substances in exchange for cash.  The drug-dealing psychiatrist had been prescribing large amounts of addictive drugs such as Oxycontin, Vicodin and Xanax to seemingly young and healthy patients for $100 per prescription, not only from his office but also after meeting them at places such as parking lots and restaurants, where he would fill out the prescriptions.

According to an affidavit in support of the federal criminal complaint, Dreyer’s practice was “permeated with fraud” and he prescribed drugs such as oxycodone, hydrocodone, fentanyl and steroids for no legitimate medical reason.

At least two people prescribed powerful drugs by Dreyer died of overdoses.

Source: Stipulated Surrender of License and Order, in the Matter of the First Amended Accusation Against Joel Stanley Dreyer, M.D., Physician and Surgeon Certificate C31198, Case No. 09-2005-165184, Medical Board of California.

Arizona psychiatrist David A. Ruben placed on probation, prohibited from prescribing painkillers for a year

On May 21, 2010, the Arizona Medical Board issued a public censure of psychiatrist David A. Ruben and restricted him from prescribing and any opioid drugs for a period of one year.

He was additionally placed on probation with terms and conditions for two years.

According to the Board’s order, Ruben deviated from the standard of care with twelve patients to whom he prescribed controlled substances and other dangerous drugs without doing one or more of the following:

• conducting evaluations
• ordering lab studies
• obtaining past medical records
• obtaining a history of alcohol or substance abuse
• obtaining a past psychiatric history
• performing a functional assessment to support the diagnosis and prescription

In one particular case, Ruben diagnosed an 18-year-old girl with ADHD and prescribed her Adderall.  She had presented to him complaining of moodiness and irritability.  There was no documentation of the prescription in the patient’s record.

Ruben subsequently provided the patient with “frequent, early and escalated doses” of Adderall without documenting any rationale for doing so.

There was no documentation in the patient’s record that Ruben investigated the patient’s rationale for seeking early refills.

He further prescribed her Prozac, Cymbalta, lorazepam and Zoloft without documenting a rationale for the prescriptions or whether he discussed the risks and benefits of the these drugs.

There was also no evidence in the record that he ordered any laboratory tests to support the continued prescribing of Adderall or to determine if the patient was taking the drug as prescribed and/or any illicit substances.

The Board placed Ruben on one year probation in April 2009 for unprofessional conduct regarding his prescribing of narcotics to a patient with chronic pain, such as continuing to prescribe Oxycontin and Oxycodone even after he’d discovered the patient tested positive for cocaine and non-prescribed methadone and he continued to prescribed them even after the patient had successfully completed inpatient opioid detoxification.

Source: Order for Decree of Censure, Practice Restriction, Probation and Consent to Same in the Matter of David A. Ruben, M.D., Holder of License No. 11382 For the Practice of Allopathic Medicine in the State of Arizona, Case Nos. MD-09-013A, MD-09-0250A, MD-09-0926A, MD-09-1263A and MD-10-0100A, Before the Arizona Medical Board.