Dr. Tobias Bacaner was known in New Port Richey for prescribing opioids.
At the cash-only clinic along U.S. 19 where he worked, Bacaner routinely prescribed patients painkillers, tranquilizers and muscle relaxers. Many patients would then fill those prescriptions at a nearby pharmacy he owned, according to a federal civil lawsuit filed February. That suit, filed by the U.S. Department of Justice, claims that Bacaner, who has been a licensed physician in Florida since 1990, may be responsible for as many as 16 drug overdose deaths.
Bacaner prescribed Oxycodone more than any other controlled substance, often at the highest strength possible of 30 milligrams, according to the lawsuit. A national prescription database published by ProPublica shows that while Oxycodone was Bacaner’s most prescribed drug, for his peers it was on average their 59th most prescribed drug.
As he handed out prescriptions for high-dose opioids, Bacaner often ignored signs that patients were suffering from drug abuse, like track marks and urine screens that flagged unprescribed substances, federal officials said.
The lawsuit claims that Bacaner, in his position at Paragon Community Healthcare and as co-owner of Cobalt Pharmacy, violated the Controlled Substances Act by writing and filling illegitimate prescriptions at inflated prices for his own profit. Along with Bacaner, federal officials are suing Timothy and Theodore Ferguson, who own the clinic and co-own the pharmacy.
Paragon Community Healthcare did not accept health insurance and charged patients $230 for an initial visit and $195 for follow up appointments, according to the lawsuit. The clinic was established as a nonprofit by the Fergusons in 2014.
At the pharmacy in Hudson, Bacaner prescribed 68 percent of all controlled substances distributed there, the suit said. The pharmacy is about a 15 minute drive north from the New Port Richey clinic.
“This is clearly a form of abuse where you’re feeding your own business,” said Jay Wolfson, a public health and health policy expert at the University of South Florida. “That creates an unhealthy environment for practicing good medicine.”
Dale Sisco, a lawyer representing the Fergusons, Paragon Community Healthcare and Cobalt Pharmacy, declined to comment about the case. Bacaner did not return multiple calls for comment. His attorney declined to speak with a reporter until after he officially filed a response to the complaint.
The lawsuit claims that from 2013 to 2019, at least 16 patients died from overdose within 40 days of receiving a prescription from Bacaner. In the same time period, 96 percent of Bacaner’s more than 2,300 patients received an opioid prescription, according to the sworn declaration of a Drug Enforcement Administration officer.
Over six years, Bacaner’s top patient received nearly more than 300 pills each month, according to the declaration.
One patient was prescribed opioids with no documentation of a physical exam, and notes were copied from visit to visit, the suit said. Six out of seven tests that revealed the patient was taking dangerous unprescribed drugs, like morphine and buprenorphine, were ignored.
Another patient was given a “cocktail” of opioids, benzodiazepines and a muscle relaxer. The benzodiazepine was prescribed despite documentation that showed the patient did not have anxiety, the suit said.
A different patient told Bacaner that his drugs had been stolen four times, which Bacaner ignored despite it being a blatant red flag of drug abuse, according to the lawsuit.
Wolfson said it’s important for medical professionals to take time with a patient and find ways to avoid prescribing addictive controlled substances or to do so cautiously in rare cases where patients truly need it. Copying notes from one patient visit to another is an obvious deviation from best practices, he said.
“Those who are exclusively prescribing these things are doing it for reasons that may be contrary to the health interests of patients,” Wolfson said.
Despite the Centers for Disease Control and Prevention warning against it, Bacaner would prescribe combinations of opioids, benzodiazepines and a muscle relaxer, according to the lawsuit. Opioids and benzodiazepines in tandem increase the risk of overdose by nearly four times, said CDC guidelines. The drugs, especially when combined with a muscle relaxer, can do harm on the central nervous system, but often create a heroin-like high for drug users.
Common red flags from patients addicted to opioids include when they’re willing to travel a large geographic distance to get to a prescriber or pharmacy, they pay in cash, or seek prescriptions under different names but at the same home address, according to the DEA. Many of these red flags were seen at Cobalt Pharmacy, federal officials said.
The DEA subpoenaed patient records from the pharmacy in August and December of 2019.
Timothy Ferguson told the DEA that Bacaner was no longer with the clinic as of May, the suit said. According to prescription drug monitoring data, the pharmacy no longer filled prescriptions written by Bacaner after August. Bacaner was still dispensing controlled substances elsewhere as of January, the lawsuit said.
When the complaint was filed in February, Bacaner’s medical license still listed Paragon Community Healthcare as his address. It now says he is not in practice. He had no disciplinary action or violations on his medical record, according to the Florida Board of Medicine.
Cobalt Pharmacy’s DEA registration was surrendered in January, but prescription drug data shows no controlled substances were distributed after September.