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Until convicted, suspect doctors can keep prescribing drugs

TAMPA — Dr. John Mubang wears an ankle monitor so police can track his every move. Free on bond, the words "escape risk" are stamped on his arrest warrant.

Undercover detectives say he prescribed them enough addictive narcotics to meet the legal definition of drug trafficking.

Medical examiner records show Mubang, who works out of two Hillsborough clinics, prescribed drugs to at least five people who died of accidental overdose.

Yet as Mubang awaits his August trial on felony charges of trafficking in illegal drugs and prescribing controlled substances without medical necessity, he is free to keep seeing patients and dispensing drugs. His state Health Department license record consumers can see online shows not one single blemish — no complaints, no discipline.

Law enforcement has scored well-publicized crackdowns like raiding a Tampa clinic last month that drew hordes of customers at all hours. It remained closed because it was not registered with the state.

But two years after his arrest, the Mubang case shows how hard it can be to take the prescription pad of a physician accused of using it for harm and profit.

New laws, regulations and a long-awaited prescription drug tracking database should help to better protect the public. But they aren't available yet, delayed by years of controversy and lack of funding. Even when they are operating, they may not fully address the communication gaps and red tape that can stand in the way of action.

The Mubang investigation was the first successful operation of its kind by the Hillsborough County Sheriff's Office and the first such case being prosecuted by the State Attorney's Office.

"This is new, uncharted territory," said Bruce Grant, director of the Governor's Office of Drug Control. "These doctors, and there are only a few of them, are really nothing more than criminals and drug dealers with white coats."

• • •

The calls started coming into the Hillsborough County Sheriff's Office in fall 2006 from people whose loved ones had died or were addicted to prescription drugs. Over and over, the same doctor was mentioned.

Mubang, 59, a native of the west African Republic of Cameroon, was medical director of the Hillsborough County jail system before buying a private practice in 2003. He's cited in at least five medical examiner files as the prescribing practitioner in accidental overdose deaths.

The Times repeatedly requested an interview with Mubang for this story, but his attorney, Arthur Eggers, said the doctor would not speak before his trial.

In court documents, undercover detectives describe their 13 visits to his Seffner office in the first half of 2008. They paid between $110 and $150 in cash for each visit, each time observing a full waiting room.

One detective met a patient who offered to sell her some of his pills.

"The atmosphere in the patient lobby was a social event," an affidavit states, "with everyone involved in conversation about how easy it is to get prescriptions from Dr. Mubang."

One detective said he found himself in a room with no medical supplies or examining table. Before the doctor came in to see him, two prescriptions were already filled out with his name and the date.

Another detective who said he had bumped his arm told the doctor he had been taking his friend's Vicodin for pain and liked it. Mubang wrote a quantity of 30, but when the detective asked how many he was prescribing, the doctor changed the number to 90.

Yet another detective went in for stiffness in the neck. Mubang touched her lower back and said, "you have pain here." The doctor didn't seem to care when she corrected him. She left with a prescription for 90 tablets of Vicodin and 45 tablets of Roboxine.

The visits continued. The prescriptions kept coming.

"Why are you taking Xanax?" Mubang asked one detective of the anxiety drug, the affidavit says. "You seem very calm."

"I like them!" the detective replied.

He got his refills.

Mubang was arrested in July 2008. Officials at University Community Hospital revoked his privileges there upon hearing of the arrest, but he continued his clinic work.

Nearly two years later, Hillsborough County sheriff's Cpl. Phillip Williams says detectives know he's still soliciting new patients and prescribing. He has advertised in publications such as the Times' free daily tabloid, tbt*, touting his willingness to see patients without an appointment.

"It's an ongoing battle," Williams said. "He's still free to work. He has not been convicted of anything yet. . . .

"It's going to take them taking his license away in order to get him to stop."

• • •

Between January and May this year, the Florida Department of Health took emergency action against 18 physicians related to pain management clinics around the state. Locally, they suspended the license of Dr. Michelle Lee Snyder of Largo, accused of prescribing nearly 95,000 tablets and other controlled substances to five patients over about 2 1/2 years.

Mubang was not among the sanctioned physicians.

But stories about doctors facing similar accusations come up in phone calls to the Governor's Office of Drug Control from grieving parents, asking how the doctor they blame for their child's death can still practice medicine legally.

"That's a heck of a hard question to answer," said Grant, the director.

So many different agencies are involved in cracking down on pain pushers that the lieutenant governor convened a task force to address the issue.

At the Department of Health, officials say law enforcement doesn't always notify them when a doctor gets arrested, and sometimes health investigators are asked to hold off until a criminal case is completed. And even if a practitioner's license appears clean in public records, that doesn't mean he's not being scrutinized. Legally, the department can't say they're investigating until they've made their case.

But the agencies are trying to work more closely, Grant said, pointing to the health investigator embedded with law enforcement in Broward County, the epicenter of the state's prescription drug crisis. Health officials say they have six investigators working full or parttime with law enforcement around the state, and the agencies have partnered for years.

Still, the push for timely action has limits. In disciplinary proceedings and the criminal justice system, physicians have a right to due process.

"Conviction of crime is where our grounds for discipline would come into play, not just an arrest," said Eulinda Smith, spokeswoman for the state Department of Health, adding that the department tries to obtain evidence of alleged wrongdoing before the criminal case concludes but can't force law enforcement to turn it over.

"In our society, as it should be, you are innocent until proven guilty," Grant said. "There is great reluctance to pull a doctor's license until you have enough information to have it hold up in court, because you don't want to go ahead and end up with a nasty lawsuit that you will lose because you have taken away somebody's right to practice."

• • •

Gov. Charlie Crist on Friday signed legislation to give health officials more authority to regulate clinics like Mubang's. It prohibits pain clinic practitioners from handing over a more than 72-hour supply of addictive drugs to cash-paying customers, although doctors still can write long-term prescriptions, a loophole advocates hope to close.

Under a 2009 law that created the drug-tracking database expected to be online in December, pain clinic rules are being developed by the boards that discipline physicians. They propose to require doctors to be trained in pain management and to receive continuing education.

The proposal, vetted Friday at a Board of Medicine hearing in Fort Lauderdale, would also require drug tests for pain clinic patients before a controlled substance is prescribed, followed by twice-a-year random testing.

And pain clinics would have to report how many new and repeat patients they treat, as well as how many are living out-of-state.

But the sudden avalanche of regulations, some fear, could limit legitimate doctors' abilities to help patients suffering from chronic pain. To some board members, the concerns being raised by those who could find it harder to run pain clinics in Florida is a sign of how seriously they are taking the issue.

"They're tough. The rule is very tough," said Dr. Lisa Tucker, a Pensacola obstetrician-gynecologist who has been working on the regulations. "It's not like we've been sitting here twiddling our fingers. Three to four years ago, one of our board members said we have a problem and it's taken this long to get statutory authority to start working on it."

Dr. Steven Rosenberg, a West Palm Beach dermatologist on the board, echoed her frustration at how long it took lawmakers to address the crisis.

"The situation is that physicians are still entitled to legal opportunities that, unfortunately, delay our ability to hear the cases,'' he said.

"We as a board have made this our No. 1 issue for three years and it's taken a long time for the Legislature to address it."

• • •

Carl Hyder died in 2006 at age 21 of an accidental overdose from a combination of alcohol, alprazolam and hydrocodone. Mubang prescribed both drugs, according to the Hillsborough Medical Examiner's Office.

Tammy Hyder said the prescribed doses of alprazolam, better known as Xanax, were so high, her son would act drunk. She said she told Mubang to stop prescribing the drugs, but the doctor said her son was over 18 and could do what he wanted.

She said she knows Mubang is still prescribing and wants to know why.

"He has been caught in the act," she said. "That should be enough."

Alexandra Zayas can be reached at azayas@sptimes.com or (813) 226-3354. Letitia Stein can be reached at lstein@sptimes.com or (813) 226-3322.

On the web

To see recent Times articles about pain clinics, go to our Health page at www.tampabay.com/health

Until convicted, suspect doctors can keep prescribing drugs 06/04/10 [Last modified: Saturday, June 5, 2010 10:44pm]
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