FOLDER: iSTOCKPHOTO.COM; BUCKWALTER: STEVE MARCUS / LAS VEGAS SUN; DUNCANS: COURTESY PHOTO; LAS VEGAS SUN PHOTO ILLUSTRATION
Wednesday, Oct. 15, 2008 | 2 a.m.
How to make a complaint
- Patients concerned about reckless or illegal prescribing or use of narcotic painkillers or other drugs are required to file a complaint before regulators can investigate. The following agencies can take such complaints:
- • Nevada State Medical Examiners Board: (888) 890-8210, Ext. 229 or 241.
- • Nevada State Pharmacy Board, to complain about a pharmacy: (800) 364-2081.
- • Drug Enforcement Administration, 759-8110.
- • Nevada Public Safety Department, the state law enforcement agency primarily responsible for investigating the illegal use of prescription drugs: 759-8118.
Two days before their first wedding anniversary, Andrea Duncan woke up to find her husband, Clint, beside her, dead of a prescription drug overdose.
It was Sept. 17, 2005, and instead of celebrating their marriage, the 26-year-old was planning her husband’s funeral.
Despondent, she wrote in a note addressed to no one that she wanted to be with her husband, her soul mate, “in heaven.” Her parents believe she wanted to place it in his casket. But she didn’t live that long.
Four days after Clint’s death, Andrea also overdosed on prescription drugs. The coroner ruled the cause of death “undetermined,” not a suicide.
The parents of Andrea and Clint Duncan blame a Henderson physician for their deaths. Dr. Kevin Buckwalter prescribed both patients the narcotics and Xanax that snuffed out their lives.
The parents say he should have seen they were in no condition to be receiving the large quantities of drugs he prescribed. For example, Andrea Duncan was being prescribed more than 150 narcotic painkillers a month and up to 300 Xanax pills at a time. At 2 mg each, the Xanax tablets were four to eight times a typical dose, experts said.
In November 2005, Andrea’s parents, John and Maggie DeBaun of Henderson, filed a complaint against Buckwalter with the Nevada State Medical Examiners Board. The board investigated the case and told the parents there was no evidence of wrongdoing. To this day Buckwalter has a clean discipline record with the medical board.
But four experts who reviewed the medical records detailing the care Buckwalter provided Andrea Duncan said it’s stunning that the medical board did not discipline him. His records of treating her are thin and do not justify the large quantities of controlled substances he prescribed her, the experts said.
Furthermore, two years after Andrea Duncan’s death, Buckwalter gave a sworn deposition about the care he’d provided her. In his own words, under oath, he described the treatment. According to experts who reviewed his testimony, that treatment, as he described it, was incompetent.
Dr. David Kloth, a Connecticut specialist and a past president of the American Society of Interventional Pain Physicians, said Buckwalter was culpable in Andrea Duncan’s death.
“He basically gave her the weapons to kill herself,” Kloth said.
But the medical board did not discipline Buckwalter. Such action might have prevented what happened next.
Two more Buckwalter patients died in 2008. Experts who reviewed their cases said Buckwalter’s substandard care contributed to their deaths.
Dr. Kevin Buckwalter is a significant contributor to what the Sun has identified as Nevada’s prescription narcotics crisis. A Sun analysis in July showed Nevadans consume more hydrocodone per capita than residents of any other state, and rank fourth highest in the consumption of the narcotics morphine, methadone and oxycodone, the primary ingredient in the drug OxyContin.
Experts say one reason Nevadans consume so many narcotics is that some doctors do not know how to prescribe them. Buckwalter is a prime example, according to four pain specialists who reviewed records for four of his patients at the Sun’s request. Kloth and Dr. Andrea Trescot are nationally known experts on the proper use of narcotic medications. Two Las Vegas pain specialists also reviewed the cases, but would comment only on the condition that their names not be used.
The Nevada Medical Examiners Board is again investigating Buckwalter’s prescribing practices, the Sun has learned, even as he continues to see patients in his clinic at a Henderson office park.
The Sun gave Buckwalter the names of the patients in this story and copies of their medical records, and told him the allegations the story would contain, including the observations and conclusions of the four medical doctors reviewing the cases. He would not comment.
Buckwalter went to medical school at Ross University in the West Indies and was licensed to practice in Nevada in 1997. On Sept. 16, the Sun reported that Buckwalter, a pediatrician and family doctor, had prescribed one of his patients more than 17,000 narcotic painkillers in 3 1/2 years, even after the man had overdosed on the pills.
Buckwalter’s name is known to regulators and doctors in Las Vegas. Members of the Nevada Pharmacy Board, local pharmacists, law enforcement agents and pain specialists were aware that serious questions have been raised about the way he prescribes narcotics.
Since the Sun’s September report, 15 more Buckwalter patients or their next of kin have contacted the newspaper to complain about him. Many of them have filed complaints with the medical board and other regulators.
Some patients or their families provided copies of medical records that detail the care Buckwalter provided. For this story, the Sun has examined three of those cases after getting family permission.
In addition to Andrea Duncan, the Sun investigated the care that Buckwalter provided to Staci Voyda and Barbara Baile.
Voyda was an OxyContin addict who was 19 when she went to Buckwalter in February 2007 to get off drugs. Voyda’s journal shows that she was obsessed with narcotics and ashamed of her inability to stop taking the drugs.
The doctor prescribed her large doses of Xanax and methadone, a potent drug that can help addicts stop taking other narcotics. When Voyda overdosed on methadone, Buckwalter stopped prescribing it to her. For the next year he prescribed her Xanax and hydrocodone, a potent narcotic. Then, over an 11-day period this summer, Buckwalter ramped up her narcotics prescriptions, giving her 310 pills of oxycodone, the primary ingredient in her drug of choice, OxyContin. Two weeks later, on Aug. 26, Voyda put a gun to her head and killed herself.
The four experts who reviewed the records of Voyda’s treatment by Buckwalter said the doctor was grossly negligent to prescribe her narcotics when there was clear evidence of drug abuse.
“When you have a patient with an overdose and give them the same medicines again, that’s not conscionable,” said Trescot, a Florida pain specialist who wrote a guide for prescribing opiates for the American Society of Interventional Pain Physicians. “At the very least he needs to have his license pulled now.”
Barbara Baile, 69, began seeing Buckwalter in April 2004 complaining of pain in her hips and back.
In Baile’s medical file, he detailed neither her medical history nor a treatment plan, nor did he list the drugs he was prescribing her or their effectiveness.
Baile died in April, a victim of one of the side effects of narcotics — severe constipation. Her death should have been prevented, experts said. Doctors who prescribe narcotics should know they can turn a person’s stool rock hard, blocking the bowels.
Barbara Baile’s husband of 50 years, Don Baile, sat in on every appointment she had with Buckwalter. He says his wife complained of constant constipation but the doctor never explained that the narcotics he was prescribing could cause the problem. Don Baile does not recall Buckwalter’s ever performing a physical examination of his wife. He says Buckwalter’s only action was writing on his prescription pad.
In February, having gone more than three weeks without a movement, her bowels ruptured. The damage was irreparable and after three months of agony she died of sepsis.
Buckwalter’s records don’t reflect that Barbara Baile was constipated. The experts said that any doctor should have known to manually remove Baile’s blockage or prescribe medications to clear out her system. Don Baile says Buckwalter only mentioned over-the-counter remedies.
Failure to warn a patient that narcotics can cause constipation and failure to provide a remedy for the problem constitute malpractice, the experts said.
In all three cases, the Sun’s experts said the care Buckwalter provided, as detailed in the medical records, was so poor it may have constituted medical malpractice. Each expert said it is imperative that the medical board investigate Buckwalter. Two of them said they do not think he is qualified to practice medicine, and at the very least should lose his license to prescribe controlled substances. After reviewing records, one of the experts called the Drug Enforcement Administration to complain about Buckwalter.
By several measures, including Buckwalter’s own testimony in the Andrea Duncan deposition, his care does not appear to meet the standard expected of physicians who treat pain. Guidelines by the Federation of State Medical Boards, which have been adopted in Nevada, require:
• A medical history and physical examination be obtained, evaluated and documented in a patient’s medical record.
• A written treatment plan for pain management that measures success.
• Special attention to patients at risk of drug abuse.
• Accurate and complete medical records, including the medical history, physical examinations, treatments and treatment objectives and medications.
In each case, the experts said of the four cases they reviewed, the records do not meet the standards required in Nevada.
The allegedly poor level of care offered by Buckwalter may violate the criminal standards outlined in Nevada law. Officials from the Nevada attorney general’s office would not comment on Buckwalter, but said it is a felony if controlled substances are not prescribed for a “legitimate medical purpose” and in the “usual course” of a doctor’s professional practice.
That could be the case, according to officials from the attorney general’s office, if a family doctor is prescribing too many narcotics without medical justification.
Another state law says a doctor is criminally negligent if he acts recklessly, departs from what a prudent person would do in a similar situation and makes decisions for which the consequences could be reasonably foreseen and where the danger to human life was the probable result of the negligent act.
In cases where a criminally negligent act results in death, the minimum sentence under the law is a year in state prison.
Former Buckwalter employees — two medical assistants and a clerk — described him as a kindhearted doctor. But they all quit, they said, because they disagreed with the way he practiced medicine. They said he avoided confrontation by prescribing the kinds of drugs his patients sought, even though he knew that some patients were addicted and overdosing. One medical assistant said she discussed the overdoses with him and urged him to stop prescribing to addicts.
“I like Dr. Buckwalter as a person, but as an M.D. I think he’s unethical,” the former medical assistant said. “What he does is utterly morally wrong.”
One office worker said that about half of his 80 patients a day — about two and a half times the number most family doctors would see in a day — were coming only for prescription refills.
Buckwalter balked at cutting off patients, even when it was clear they were abusing the drugs or selling them to addicts, a medical assistant told the Sun.
“He said, ‘I’m here to help people, I’m a doctor. I don’t want people in pain,’ ” the medical assistant recalled.
So many drug addicts went to Buckwalter for their fixes that the office was a dangerous place to work, the former employees said. Henderson Police records show two calls for service because of belligerent patients in 2007. The conflicts would occur because patients would show up without an appointment demanding prescriptions, the former employees said.
In one instance, a patient pulled a gun and poked it in an employee’s ribs, demanding to see Buckwalter. The patient, identified in a Henderson Police report as Henry Tucker, then barged into the back of the office, ordering Buckwalter to write him more prescriptions. He was arrested outside the office, pleaded guilty to two felonies in connection with the incident and is serving 18 to 48 months in prison.
The former employees said they don’t think Buckwalter was motivated by money, though if he saw 80 patients a day, many of them paying $90 a visit in cash, he would be bringing in more than twice the reimbursements of his peers. Many of his patients flew in from out of state to get prescriptions, the clerk said. In other cases, the employees said, Buckwalter would mail prescriptions for narcotics to patients without examining them.
When new patients came into the practice, Buckwalter did not ask for X-rays or body scans to document their pain, the former employees said. In fact, many patients complained that the doctor never examined them, the employees said. Medical records obtained by the Sun and interviews with patients and their families confirm that he often did not get records or conduct physical exams.
“I don’t think he actually understood the concept of what he was doing,” another medical assistant said. “In his ... mind he was helping. And by helping he gave the patients what they asked for, whether they needed it or not.”
The employees said local pharmacists voiced alarm at the volume of some of his prescriptions. One medical assistant said complaints were made verbally to employees at the Nevada Pharmacy Board and the Drug Enforcement Administration, and the clerk said the Nevada Medical Examiners Board came at least once in 2007 to pull patient files.
But no regulators ever took any action to protect patients, the employees said.
The Drug Enforcement Administration and the medical board declined to comment for this story.
Andrea Duncan’s parents, John and Maggie DeBaun, show a photo of Andrea being swept off her feet by Clint Duncan on their wedding day. “They were such a darling couple, so cute, so in love,” Maggie DeBaun said, smiling.
The marriage to Clint had been a bright spot for Andrea, who suffered a serious brain injury in a September 2000 traffic collision with a drunken driver.
Among other problems, the injury left her susceptible to panic attacks and clouded judgment. She regressed from a confident young woman to being as vulnerable as a child, her parents recall.
Andrea and Clint met online and the DeBauns liked him right away. Clint, clean-cut and polite, worked hard as a bartender’s assistant at a local casino and as a DJ, spinning records.
Each complained of back pain — Clint from his job carrying heavy bottles, and Andrea from her accident.
On Nov. 22, 2004, she made her first visit to Buckwalter.
Buckwalter would not discuss Duncan with the Sun, but in a sworn deposition on Feb. 8, 2007, he described her treatment. (Buckwalter was deposed on Duncan’s behalf in a lawsuit the family filed against the nightclub that served alcohol to the drunken driver who caused her accident. A complete transcript and an edited video of the deposition is available on the Sun’s Web site, www.lasvegassun.com.)
In the deposition, Buckwalter says that on Duncan’s first visit, he did not examine her — which medical experts say is a fundamental requirement of such a patient visit.
Buckwalter said he “did not have time.”
Yet, on the initial visit, Buckwalter prescribed Duncan 150 tablets of the anti-anxiety medication Xanax and 150 pills of the narcotic painkiller hydrocodone, commonly known as Vicodin or Lortab.
Another fundamental tenet of treating pain is verification of patients’ medical history through records from other doctors, tests and physical examinations. Buckwalter said in his deposition that he never ordered records from any other doctors who had treated Duncan and that he “did not think it was necessary” to verify Duncan’s medical history.
Over the next 10 months, he prescribed her higher quantities of pills.
The DeBauns noticed the couple were taking a large amount of medications and did not think that Andrea, with her brain injury, was capable of making the right judgment about which drugs to take. But Andrea assured her parents that she was in good hands with Buckwalter: “I’m in a lot of pain, so my family doctor is prescribing a lot of medication,” they recall her saying.
At the time of their overdoses, the couple were living in the home of Clint Duncan’s mother, Barbara Rich. In hindsight, Rich suspects that both were addicted to the prescription drugs. They sometimes slept most of the day, and Clint would stagger around the house, she said.
Buckwalter prescribed Andrea Duncan hundreds of 2 mg Xanax pills, each many times a typical dose. He said in his deposition that he prescribed her large quantities of pills “because she asked for it.”
A Las Vegas pain specialist, who would speak only on the condition of anonymity, said it seemed clear that Buckwalter was prescribing whatever pain medicines his patients wanted.
“The lack of diagnoses, lack of records, lack of opioid agreements and lack of counseling are all problems,” the doctor told the Sun.
In his deposition, Buckwalter said he does not keep a record of the type or quantity of drugs he prescribes to a patient, “because I usually have a routine of the amount of medications that I write.”
Medical care should be unique to individual patients and there should always be a detailed log of medications, so the doctor can track their effectiveness, said the doctors who reviewed the case at the Sun’s request.
In some instances, Buckwalter made statements that were factually wrong. He says the drug Ultram is an anti-inflammatory. It is not. It’s a narcotic. And he says he never prescribed Duncan morphine, even though her parents still have the bottle of morphine that he prescribed to her, and pharmacy records prove he prescribed her the pills.
Sept. 16, 2005, was the last time Clint and Andrea Duncan saw Buckwalter. He prescribed Andrea 300 doses of Xanax and 90 of morphine, a potent narcotic.
The next day Clint Duncan overdosed on Xanax and narcotics, according to his death certificate. His mother said he was prescribed the drugs by Buckwalter.
Four days later Andrea Duncan overdosed on Xanax and narcotics. She went into a coma and died three weeks later.
Clint Duncan’s mother, Barbara Rich, holds Buckwalter responsible for the deaths of her son and daughter-in-law.
“Dr. Buckwalter has to have known,” Rich said. “The coroner found pills all over the room. He poured down the garbage disposal hundreds and hundreds of pills.”
For Maggie DeBaun, the death of her only child, Andrea, means the end of the family line. “I have my past, but I have no future anymore,” DeBaun said. “It’s just so heartbreaking as a parent. It’s just not the way it’s supposed to be.”
In May, John DeBaun wrote to the medical board again, urging it to reopen the case and look at the deposition that, he says, betrays the doctor’s incompetence and his lie about not prescribing Andrea Duncan morphine.
“I do not want any monetary gain from him, no amount of money could repair the loss that my wife and I have suffered,” John DeBaun wrote to the medical board investigator. “I just want him stopped before more people suffer from his way of prescribing medicine.”
Investigators were not interested in seeing the deposition, but told DeBaun they are pursuing another investigation of Buckwalter.