FREEPORT — For most of two decades, Dr. Robert L. Ignasiak Jr. was the only full-time doctor in this little Panhandle town.
Miles from the nearest hospital, Ignasiak treated sore throats and earaches, minor burns and ingrown toenails.
And he treated pain — the arthritis pain of the elderly, the nagging back pain of blue-collar workers. Over 20 years, the man known as Dr. Bob wrote hundreds of prescriptions for narcotic painkillers like Vicodin and OxyContin.
Was Dr. Bob a compassionate small-town doctor trying to help his patients?
Or, as one prosecutor claimed, was he a drug pusher who "practically addicted an entire community.''
In 2008, Freeport residents were stunned when Ignasiak, who had retired three years earlier, was arrested on 54 counts of health care fraud and unlawfully dispensing narcotics and other controlled substances. Federal authorities said his prescribing caused two deaths.
His trial, which lasted 19 days, would dramatize the struggle to find a balance between stopping prescription drug abuse and assuring that people in pain get the treatment they need.
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In 2004, the federal Drug Enforcement Administration published a list of guidelines for doctors and others dealing with controlled substances. It said that untreated chronic pain was a major public health problem and that opioids like oxycodone can be of "great benefit'' for some patients.
Though the booklet was widely praised, the DEA quickly withdrew it. It was replaced with an "interim policy'' that emphasized enforcement.
Since then, the DEA has declined to issue specific guidelines for doctors on the use of controlled drugs. It said it is up to state licensing boards to regulate physicians and set "standards of care'' for treating pain.
It was against this "chaotic legal landscape,'' as his lawyers put it, that Ignasiak went to trial in 2008.
Prosecutors alleged that from 2003 to 2005 he drew patients from all over the southeastern United States because he would prescribe OxyContin and other controlled drugs with little or no medical justification. He even prescribed for patients he knew were addicted to the drugs, prosecutors said.
Among the government's witnesses was a doctor who assumed part of Ignasiak's caseload after he retired in 2005.
Dr. Gregory Staviski testified that some of Ignasiak's former patients were angry that their new doctor wouldn't prescribe narcotics. So angry, in fact, that Staviski had to wear a bulletproof vest.
Several of Ignasiak's ex -patients also took the stand. Nadean Burke accused him of addicting her to morphine.
"Why, why, why did you do this?'' she wept, looking straight at the 55-year-old doctor.
But the defense team, led by high-profile Miami lawyer Roy Black, said Ignasiak always followed FDA-approved quantity and dosage guidelines for controlled drugs.
Though the jury acquitted him of 11 counts, it convicted him of the other 43. It also found that his prescribing had caused two deaths.
At sentencing, Black said his client had received many letters of support, including some from patients "who truly believe that Dr. Ignasiak helped them.''
But Dana Easterly, whose wife Beverly was one of the patients who died, said Ignasiak's actions devastated his family.
"As far as him not being a drug trafficker, he's worse because he was doing it legally, hiding behind the law,'' Easterly said.
Federal Judge Lacey Collier agreed that Ignasiak had abused his physician's authority.
"The position of trust that you hold puts you in a different category,'' he said, and sentenced Ignasiak to 24 years.
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Freeport Mayor Mickey Marse still can't believe what happened to Ignasiak. "I had some hard feeling about it,'' he said. "I felt like it was a dadgum witch hunt from Day One.''
Marse and others wonder if the government's four-year pursuit of the doctor wasn't spurred partly by his wealth. He had $19 million in the bank, though his lawyers said it was derived largely from the sale of gulf-front property during the real estate boom and not from his medical practice.
As part of his sentence. Ignasiak was fined $1 million, later reduced to $250,000. He also sold his clinic, with the proceeds going to various government agencies.
Ignasiak, now in the federal prison at Yazoo City, Miss., would not comment for this story because his case is on appeal.
His daughter, Karissa, has started a website, savedrbob.com. On it is a letter Ignasiak wrote to a member of Congress:
"I treated patients and tried my best to eliminate the pain my patients suffered from. The judgment of physicians has been replaced by the judgment of federal drug warriors who look upon those in pain as nothing more than junkies and their physicians as street dealers.''
Susan Taylor Martin can be contacted at firstname.lastname@example.org.