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Florida is home to shadowy industry supplying narcotics over the Internet.

Authorities say Juan Antonio Ibanez is part of a “criminal organization’’ that grossed $85 million from Internet drug sales.

Authorities say Juan Antonio Ibanez is part of a “criminal organization’’ that grossed $85 million from Internet drug sales.

Second of two parts

The South Carolina banker was desperate.

After hurting his back in a car wreck, he grew so dependent on narcotic painkillers that his doctor refused to prescribe any more. So he turned to the Internet and found another source — an Orlando doctor named Juan Antonio Ibanez.

The two never met, but for months Ibanez kept his new patient supplied with Vicodin and other drugs shipped from United Prescription Services in Tampa. It was only after his wife found several bottles of pills that the 50-year-old banker entered rehab.

It didn't take.

On a Saturday morning in 2003, he fixed breakfast for his three teenage daughters. Then he went into the back yard and shot himself in the head.

• • •

For people who can't get their prescription drug of choice from their doctor, and don't want to shop for a new doctor or deal on the street level, there's always the Internet.

Just a few years ago, "we used to call Tampa 'Ground Zero' for Internet pharmacies. Most of the Internet pharmacy abuse in the whole country was there,'' said Mark Trouville, special agent in charge of the Drug Enforcement Administration's Miami field division.

Today, most Internet drug shops have moved offshore, largely because of a 2008 federal law that requires at least one face-to-face physical exam by a doctor before drugs are dispensed. But the trade is no less brisk — Internet drug sales are projected to hit $75 billion this year, according to a national pharmacy group.

And the legacy of Florida's virtual drug business lives on, in the form of the physicians who fueled it.

In its investigation of nearly 200 Florida doctors who have come to regulators' attention for misprescribing federally controlled drugs, the St. Petersburg Times found that 10 percent had prescribed over the Internet. Several of those doctors are still licensed to practice, among them:

Ladapo Shyngle of Valrico, arrested after writing more than 3,800 prescriptions for hydrocodone, a powerful narcotic, and the antianxiety drug Valium even though his medical license had expired. Shyngle, who talked to patients only by phone, acknowledged to investigators that this method of prescribing "certainly'' opened the door to drug abuse.

The Nigerian-trained Shyngle pleaded guilty to a misdemeanor charge of practicing medicine without a license. Yet he got a new Florida medical license in 2005.

"I don't have to tell you nothing,'' he said when asked if he is still in active practice.

Osteopath Christopher Pudol, who operated a Miami-based website through which he prescribed OxyContin and other drugs to patients in Alabama. In 2006, he pleaded guilty to a misdemeanor federal charge and was ordered to pay $250,000 in restitution.

The Florida Board of Osteopathic Medicine fined Pudol $10,000 but let him keep his license. He practices at a Tampa clinic, and did not respond to requests for comment.

Mohammed Abdel-Hameed of Orlando, who wrote nearly 1,000 prescriptions for hydrocodone and Valium to Internet patients in 38 states and Puerto Rico. Although the Drug Enforcement Administration revoked his authority to prescribe such drugs last year, the website of the Florida Department of Health doesn't show any state investigation or discipline of him.

Abdel-Hameed, who did not respond to a request for comment, still has his license to practice medicine.

The state boards that regulate doctors say Internet prescribing has not been considered as serious a problem as pain clinics.

"Is it a problem? Yeah,'' said Dr. Fred Bearison, a Board of Medicine member from Valrico. "Is it as big as the pill mills? I don't think it's that big.''

• • •

If the Internet is still the "Wild West'' of prescription drug sales, as it has been called, Florida was once Dodge City.

Among the most notorious operations was United Prescription Services, founded by a Tampa lawyer to fill prescriptions for his personal injury clients. The business took off when it began filling scripts for Ibanez and other doctors prescribing over the Internet. It was a creative enterprise; when the state of Kentucky tried to crack down on its shipments, United started shipping under the name Makes and Models, a magazine featuring exotic cars and bosomy women.

One of United's practitioners was osteopath Robert Reppy. Licensed to practice only in Florida, in just four months he wrote nearly 12,000 prescriptions to "telemedicine" patients, many of them in California, Indiana and other states that required the prescribing doctor to do a physical exam.

Also associated with United was Dr. Elizabeth Jamieson of Tampa. The DEA says she, too, wrote prescriptions for controlled drugs to people in states where she was not licensed.

In 2007, the DEA revoked United's registration, ruling that the pharmacy posed an "imminent danger to the public health and safety.''

But Reppy got to keep his license and his DEA number. The state osteopathic board fined him $12,500 and ordered him to take a course on the "common pitfalls of misprescribing.''

Three years later, Reppy has yet to document that he has completed the course, according to his health department file. He has an active license and is practicing in Brooksville. State records show that between July 2009 and June 2010, he was among Florida's top prescribers of oxycodone, a narcotic painkiller, to Medicaid patients.

Reppy would not comment for this story.

Jamieson escaped with no discipline at all. She has an active license but certified letters the Times sent to her last two office addresses were returned as undeliverable.

Ibanez, who could not be reached for comment, was the only Florida doctor associated with United Prescription who lost his license. But his Internet prescribing went far beyond United. He pleaded guilty in 2007 to multiple federal charges. Authorities say Ibanez was part of a "criminal organization'' that grossed more than $85 million from Internet drug sales.

"He was really a rock star of that community of Internet purveyors,'' said Robert Rikard, who sued Ibanez on behalf of the dead banker's family and won an undisclosed settlement. "He was somebody drug seekers knew would give them painkillers regardless of factual or medical data.''

Ibanez was sentenced to 51 months in prison. He got out in July, after serving barely half of his term.

• • •

Though most Internet drug sites have been pushed offshore, Florida still plays a role in the Internet drug trade.

For $23.95, findrxonline.com provides a list of websites — including some in Florida — that offer to set up phone consultations with U.S.-licensed doctors "so you can get a legal prescription for the medications you need.''

"Phone consultations will only take about five minutes,'' the site says. "The doctor will know your expectations and prescribe what you need without making you feel like a drug addict or giving you a hard time.''

Among the sites listed is Allied Medical Service, whose 727 area code is in the Tampa Bay area. Its website says it has an "ever expanding network'' of doctors nationwide.

The cost of the phone consultation is $119. But to comply with the federal law, the customer must also have a physical exam that costs $219, then pay $119 a month for follow-up calls with a doctor for prescription refills.

But it could be money wasted, as this recent comment on a drug buyers message board suggested:

"Not too long ago they totally took my money, sched my appt, I flew to a diff city and stayed in a hotel to get to this doctor that didn't even EXIST. Just imagine me sitting in that hotel room, out of meds.''

In August, a message purportedly posted by Allied said the company was having problems it hoped to remedy soon. It promised existing patients that "your records and important information are still safe with us.''

Allied did not respond to calls from the St. Petersburg Times.

A reporter also contacted Ist Choice Meds, which has a Broward County phone number. It had no doctors in the Tampa Bay area but said appointments could be made with a Miami doctor who goes to Lakeland about once a month to see patients. Cost: $275 for the exam and $99 each for subsequent phone calls to the doctor for refills.

That setup could be problematic, according to Dr. Allan Escher, a member of the state board that regulates osteopathic physicians.

"My first impression of a pain doc traveling around the state doing physical examinations is that he or she will not have the stability and availability to take care of you as a patient,'' said Escher, who is board-certified in pain management.

For people who are really in pain and need medication, Escher said, the best bet is to forego the Internet and ask a family physician or local medical school to recommend a reputable pain management practice.

"Going to a pain clinic because they advertise, have a flashy website or 800 number is probably the worst thing you could do,'' he said.

Susan Taylor Martin can be contacted at susan@sptimes.com. Letitia Stein can be contacted at lstein@sptimes.com

About this series

These stories are based on documents obtained from the Florida Department of Health, which was asked for records on every doctor disciplined for prescription drug violations since 2005, plus pending complaints. The Times also reviewed actions taken by the federal Drug Enforcement Administration, federal and state courts and law enforcement. The Times interviewed members of state medical boards, health regulators, law enforcement officials and sought interviews, by certified letter, with the doctors whose cases are cited.

Buyers, beware

Consumers should be very wary of buying drugs like Vicodin and OxyContin over the Internet. The 2008 federal Ryan Haight Act — named after a California youth who died from Vicodin he got from an Internet pharmacy — makes it illegal for pharmacies to dispense controlled substances over the Internet without a "valid prescription'' issued for a legitimate medical purpose. That generally means a doctor must conduct at least one in-person medical evaluation of the patient.

Consumers who buy controlled drugs without a valid prescription could be subject to federal drug possession, trafficking and conspiracy charges.

While many Internet drug
sites appear to be U.S.-based, the drugs often are sent from India, Russia and China — "all countries where there are no standards and they could be counterfeit,'' says Carmine
Catizone, executive director of the National Association of Boards of Pharmacy. The association's website (www.nabp.net) offers advice for consumers on legally and safely buying prescribed medications over the Internet.

Florida is home to shadowy industry supplying narcotics over the Internet. 09/26/10 [Last modified: Monday, September 27, 2010 1:08pm]
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