RUSKIN — At 67, Gary Lazar was a very sick man. His heart was failing, and so were his kidneys and his liver. He was diabetic and could barely walk. In the summer of 2011, specialists said they could do little for him.
Yet what killed him on Feb. 27, 2012, an autopsy showed, was a mix of three powerful painkillers. Two had been administered by Dr. Betty Jo Carter, who described herself to sheriff's deputies as Lazar's friend as well as his physician. She had slept on his couch, fed his dogs and, hours before he died, sprinkled crushed oxycodone on his ice cream.
Nearly two years after Lazar's death, the Florida Department of Health is accusing Carter, 69, of medical malpractice, saying she administered medications to Lazar in "an inappropriate combination," provided end-of-life care without the proper training and violated the boundaries of the doctor-patient relationship.
The Hillsborough County Sheriff's Office investigated the death, but no criminal charges were filed. Carter, who specializes in addiction recovery and family medicine, refused to comment. She said she did not want to jeopardize a potential agreement with the Florida Board of Medicine that would allow her to keep her medical license.
These days, many patients complain that they don't get enough time with their doctors. But the Ruskin case highlights why medical students are taught to maintain professional boundaries.
Rebecca Dresser, a law professor who teaches medical ethics at Washington University in St. Louis, said doctors can lose sight of their limitations when treating people close to them.
"The reason the boundaries are there is to protect patients and try to promote good, objective medical care," Dresser said.
Professional guidelines recommend against treating family members but are silent on friends, said William Allen, director of the University of Florida's program in bioethics, law and medical professionalism. However, treating friends can pose problems. What if, for instance, a well-meaning doctor tries to "protect" a friend from bad news?
"It's essentially a conflict of interest," Allen said. "You've already got one relationship, and now you're complicating it with another one."
Lazar had been a patient of Carter's since early 2002. She later hired him to do odd jobs around her walk-in clinic, which she runs out of her small ranch home. She told detectives they became friends but gave no additional insight into the relationship.
Not long before he died, Lazar put Carter's name on his bank account. She told detectives that Lazar lived off Social Security disability payments and had less than $200 in the account.
In the summer of 2011, Lazar qualified for hospice care because of multiple organ failure, according to state officials. Carter told investigators she took over his home care after he "fired" hospice workers, even though she is not trained in palliative medicine.
Each day, she said, she checked on him at his apartment in a gated seniors complex near her clinic/home. While she was at work, she told detectives, she paid a former patient $100 a day to take care of Lazar. That former patient told detectives he was indebted to Carter because she had helped him beat a drug addiction.
Carter told authorities she began prescribing Lazar painkillers to help him deal with his ailments around November or December 2011. She said she started sleeping over on Feb. 19, 2012, after Lazar's condition worsened.
On Feb. 26, she said, Lazar complained of pain and nausea. Carter told investigators she gave him morphine sulfate three times after 1 p.m. She said she crushed two oxycodone pills and put that on his ice cream. Then she gave him a Valium about 10 p.m.
Lazar woke up coughing blood about 5 a.m. on Feb. 27, and she gave him another Valium. She told detectives she left the apartment to pick up the man who looked after Lazar. When they returned, Lazar was unresponsive. They called 911.
Autopsy results showed that Lazar died as a result of the combined effects of morphine, oxycodone and oxymorphone.
Those medications "have a significant interaction and a high propensity to cause central nervous system and respiratory depression," the Department of Health says in its complaint. Carter acknowledged prescribing and administering only the morphine and the oxycodone.
The Sheriff's Office could not determine the origins of the third drug.
When deputies got to Lazar's apartment, they found no morphine. Carter later told detectives she had taken it with her so that he could not take any more. She denied overmedicating Lazar.
Carter has been before the Florida Board of Medicine once before, in 1992. She was seeking to get her state medical license restored after serving a 14-month sentence in federal prison on Medicare fraud charges. She signed a deal that included a fine and probation. Her license has been clean since then.
Times researcher John Martin contributed to this report. Jodie Tillman can be reached at firstname.lastname@example.org or (813) 226-3374.