TAMPA — When Dick Rivett remembers his son Dean, he sees him immobile in a hospital bed after one of his many prescription drug overdoses.
He sees Dean a few months later slumped on the bathroom floor, head between his legs.
And then he sees himself in a pharmacy called Next Dose, begging the pharmacist to stop filling Dean's prescriptions.
He did everything he could to interrupt his son's addiction. Nothing worked.
But here's what makes a grieving father yell and curse in disbelief:
How could a pharmacist fill prescriptions from 10 doctors for more than 1,300 pills in just three months and not wonder whether Dean Rivett might die?
• • •
The pharmacist was but one cog in Dean Rivett's addiction. The pills were prescribed by doctors. No one forced Dean to swallow them.
"I hate to admit this," his father says, "but I think he was weak."
But Dick Rivett wonders what role the pharmacist plays in feeding an addiction. Dean's pharmacist, Randolph McEwen, knew him by name. McEwen had access to his prescription history, including how many doctors he had seen and how many pills he had been prescribed. He knew Dean was fighting an addiction.
Prescription drug overdoses are epidemic. Florida has no prescription drug monitoring system, although one is in the works. Doctors don't always know how many other doctors a patient has seen.
Pharmacists like McEwen — who says he only wanted to help Dean Rivett — are the last link between the addict and the pills.
Pharmacists know their industry has a problem. They know customers obtain forged prescriptions. They wonder why doctors prescribe 300 high-dose oxycodones a month. Many are refusing to carry oxycodone at all.
But they are in a delicate position. Pharmacists have an obligation to help the people who walk in their door.
"We are required to fill the prescription unless there is a really good reason not to fill it," said Michele Weizer, chairperson of the Florida Board of Pharmacy and a pharmacist from Palm Beach County. "This is health care. It's a patient safety reason more than anything else."
Pharmacists can turn someone away if they think the prescription is a fake. They are encouraged, but not required, to call physicians to make sure the prescriptions are real.
Some take this more seriously than others. Vikas Ghiya, owner of Prime RX Pharmacy in Seminole, has Pinellas County drug detectives on speed dial.
If he gets an oxycodone prescription, he calls the doctor. He has helped police make arrests.
"As a pharmacist," Ghiya said, "I just want to do the right thing."
But Ghiya was not Dean Rivett's pharmacist.
• • •
Dick Rivett is tall and burly and cantankerous. He's a former Tampa homicide investigator who has worked for the last 30 years as a private investigator. His son worked for him as a process server.
Dick didn't notice when his son started using prescription drugs. He later learned that it started after a car accident in 2004.
Dean had lots of charisma. He had always wanted to play professional football, but he hurt his knee the first week in college. He badly wanted to be part of that professional sports crowd.
"My son lived in an imaginary world his whole life," said Dick Rivett. "He liked hanging around celebrities."
Dick watched as professional wrestlers with names like Test and Crush began hanging around his son. But then Crush succumbed to a prescription drug overdose. So did Test. Then Dean's stepbrother died the same way.
Soon Dick was running to the hospital every other month for Dean's overdoses — more than a dozen in all.
One time, Dick Rivett stood at the foot of the hospital bed, grabbed his son's big toe.
"You know if you don't get off this s---," he told him, "you are going to die."
"Dad," Dean said, "I'm not going to use anymore."
Dick started going through his son's belongings, looking for his pill bottles. He found the pharmacy bags in Dean's Hummer. Then he drove to the pharmacies and the pain clinics and ordered them to stop giving his son drugs. He made threats. Once, he visited one of Dean's doctors carrying a gun. The doctor wasn't at the office. Dick slinked away, still feeling the metal in his pocket.
Earlier this year, Dick noticed bags from a place called Next Dose Pharmacy off E Fletcher Avenue in Tampa. He stopped in and asked to speak to the pharmacist, Randolph McEwen.
Dick told McEwen to stop giving his son oxycodone, to call him if Dean Rivett ever showed up with another prescription.
He said McEwen promised him he would.
• • •
It is difficult for Dick Rivett to describe what it was like to find his son lying on the edge of his bed, chest still.
He was dead and it broke Dick's heart and his wife screamed and the medical examiner carted away his son's body and a whole bag full of prescription bottles and that was it.
A day later, Dick made a phone call.
"Why didn't you call me?" he asked the pharmacist, McEwen. "You promised."
McEwen didn't have an answer.
Rivett started cursing again.
"Murderer," he screamed into the phone.
• • •
The medical examiner ruled Dean's death an accidental overdose. He had combined too much oxycodone, antianxiety pills, other pain relievers and muscle relaxants.
A few weeks after Dean's death, his family obtained a snapshot of his addiction.
It was a list of every drug he had picked up at Next Dose Pharmacy from Jan. 28 to April 26 — two days before he died.
The three-month snapshot may or may not have been complete. Dean had prescription bottles from at least three pharmacies, said his wife, Debra Rivett.
Next Dose Pharmacy filled 21 prescriptions for more than 1,300 pills. Of those, more than half were for oxycodone or OxyContin, a name-brand version of the same drug. The rest were muscle relaxers, antianxiety pills and other pain relievers.
On at least one occasion, the pharmacy filled oxycodone prescriptions two days in a row — each from a different doctor.
The Times called all 10 doctors who prescribed Dean pills. Dean had a knee replacement in March and at least two of the doctors prescribed him pills for that. Two other doctors work at Tampa Pain Relief Center, a clinic next to Next Dose Pharmacy. They did not return phone calls. Two doctors who prescribed oxycodone said Dean wasn't even their patient. Another doctor said he hadn't seen Dean in more than a year.
Two days before he died, Dean got a stack of prescriptions from Dr. Hector Cases: 120 oxycodones, 60 OxyContin, 90 antianxiety pills and 90 muscle relaxers. He filled them at Next Dose.
Dr. Cases said he saw Dean only one time and he had a legitimate pain complaint. He would not discuss why he prescribed so many drugs or both oxycodone and OxyContin together, but he said it was based on a physical examination and the information Dean provided him.
"I'm flabbergasted," said Dr. Cases, who is board certified in neurology and pain management. "My reputation is quite the opposite. I'm quite harsh in terms of prescribing."
He said he wished the pharmacist had notified him of all of Dean's prescriptions. He would have stopped the prescription then and there.
• • •
Pharmacist Randy McEwen's Next Dose Pharmacy is on the first floor of a tall brick building off Fletcher Avenue.
When asked about Dean Rivett, his first inclination was to point the finger at the doctors who prescribed the drugs. Then he said he didn't have time to talk.
In a phone call a few days later, he said: "It was the end of the year probably when Dean fell off the wagon. (Dick) asked me to help him and keep a close eye on him."
He says he never promised not to fill prescriptions. He knew Dean had had a knee replaced and had a legitimate need for pain medication. McEwen said Dean went to a pain clinic that has four or five physicians, and that might explain the multiple doctors.
"I would do anything I can to help anybody," he said. "This stuff gets all twisted and turned around and that's not right."
He said he wanted to talk to Dean's father to clear things up. "I'm not trying to get money off someone's addiction or something like that," he said. "To drag me into something like this, it's just not right. I did everything to help."
Last week he visited his lawyer and decided not to comment further. "He is not authorized to release protected health information," said his attorney, Dale R. Sisco. "However, your inquiry ought to include an analysis of the relationships between the various doctors who issued prescriptions for the patient and their access to common information regarding prescriptions issued by others in the same facility."
Before McEwen moved to Florida, he worked in Louisiana. Records show that in 2006, McEwen's pharmacy in Louisiana was disciplined for violations that included filling prescriptions for patients who had filled out a questionnaire in lieu of a doctor's visit.
The Louisiana Board of Pharmacy suspended his license for five years and permanently barred him from owning a pharmacy there. The Florida Board of Pharmacy reviewed the Louisiana case in 2007. They placed him on probation for five years.
Last Saturday morning, McEwen showed up unannounced at Dick Rivett's office.
According to Dick, McEwen told him he was sorry about Dean.
Why didn't you call the doctor? Dick asked him. Why didn't you call me?
The pharmacist just shook his head.
Times researcher Shirl Kennedy contributed to this report. Leonora LaPeter Anton can be reached at firstname.lastname@example.org or (727) 893-8640.
This article has been revised to reflect the following correction: The pharmacy owned by Randolph McEwen is Next Dose Pharmacy. The story gave an incorrect name.