Families hoping for justice from prescription bribes trial
By ALANNA DURKIN RICHER
Friday, January 25
BOSTON (AP) — Drug company executives weren’t satisfied with sales for their powerful painkiller, so they devised a plan, prosecutors say: Offer cash to doctors in exchange for prescriptions. Soon, the highly addictive fentanyl spray was flourishing, and executives were raking in millions.
Now, the company’s wealthy founder is heading to trial in a case that’s putting a spotlight on the federal government’s efforts to go after those it says are responsible for fueling the deadly drug crisis.
“It really is a day of reckoning,” said Richard Hollawell, an attorney for the parents of a New Jersey woman who died of an overdose in 2016 after she was prescribed Subsys, a drug meant for cancer patients with severe pain.
John Kapoor, the wealthy founder and former chairman of Chandler, Arizona-based Insys Therapeutics Inc., is the highest-ranking pharmaceutical company figure to face trial amid the opioid epidemic that’s claiming thousands of lives every year.
The 75-year-old, who resigned from the company’s board of directors after his arrest, and the four other former Insys employees being tried alongside him are charged with racketeering conspiracy. Kapoor has said he committed no crimes and believes he will be vindicated at trial, which begins Monday in Boston’s federal court.
But two of his top lieutenants, including the company’s former chief executive, are now cooperating with prosecutors and are expected to tell jurors that Kapoor directed the scheme to boost profits.
Massachusetts is one of many states where Insys did business, but the state’s U.S. attorney’s office is known for its success in complex health care cases.
Kapoor’s arrest in 2017 came the same day Republican President Donald Trump declared the opioid crisis a public health emergency. And prosecutors have touted the case against Kapoor and other Insys executives as illustrative of their work to fight the drug epidemic.
Kapoor’s lawyers, meanwhile, have blasted prosecutors for trying to link Insys to the drug crisis, accusing them of trying to poison the jury pool and noting that Subsys makes up a small fraction of the prescription opioid market.
“Despite these uncontroverted facts, the government continues to perpetuate a false narrative in its public pronouncements about this case,” his lawyers wrote in court documents.
The judge has since prohibited both sides of the case from talking to the news media.
Several Insys employees and doctors have already been convicted in other cases of participating in a kickback scheme. A number of states have sued the company, which also agreed last year to pay $150 million to settle a federal investigation into inappropriate sales.
Prosecutors say Insys targeted doctors across the country known for prescribing large numbers of opioids and paid them bribes and kickbacks that were disguised as speaking fees for events billed as opportunities for physicians to learn about the drug.
Insys staffers also misled insurers about patients’ medical conditions and posed as doctors’ office employees in order to get payment approved for the costly drug, prosecutors allege.
Lawsuits filed against the company say patients were given high doses of the potent narcotic even though they didn’t have cancer, weren’t warned of the risks and became addicted before suffering through withdrawal when they were cut off.
“These are normal, everyday, hardworking people who go to a pain clinic because they are suffering from chronic pain and they fell into this trap,” said Michael Rainboth, a New Hampshire attorney who has brought several cases against Insys.
Sarah Fuller was being treated for fibromyalgia and back pain when an Insys sales representative and her doctor met with her at her doctor’s New Jersey office to persuade her to begin taking Subsys, according to a lawsuit her parents filed against Insys, Kapoor and others.
In an order to get Fuller approved for the drug, an Insys employee duped the pharmacy benefit manager into believing that the employee worked for the doctor’s office and that Fuller was suffering from cancer pain, the lawsuit says.
Fuller died of an overdose a little over a year later at age 32.
“Sarah didn’t have cancer, so there was no reason for her to have been on it,” said her mother, Deborah Fuller. “There are a lot of things she should have been able to do, but her life was cut short by people who just don’t care,” she said.
Fuller’s doctor isn’t accused of getting kickbacks and hasn’t been criminally charged. But she lost her license after state officials found she was “indiscriminately” prescribing the drug to patients without cancer.
Prosecutors allege the poorly attended speaking events were merely an excuse for doctors and their friends to have a fancy free meal. One New York doctor charged with getting kickbacks is accused of using marijuana and cocaine before and during some of the speaker programs he led.
They “do not need to be good speakers, they need to write a lot of … (prescriptions for the fentanyl spray),” former Insys sales executive Alec Burlakoff told a colleague, according to court documents. Burlakoff pleaded guilty and is expected to testify against Kapoor during the monthslong trial.
The far-reaching impact of the drug crisis will likely make it a difficult case for Kapoor, said David Schumacher, former deputy chief of the Massachusetts U.S. attorney’s office’s health care fraud unit.
At the same time, there’s typically less evidence incriminating those at the top than lower-level employees who carry out the scheme, said Schumacher, now an attorney at Hooper, Lundy & Bookman.
“The higher up you go in these trials, the harder it is,” he said.
Follow Alanna Durkin Richer on Twitter at http://twitter.com/aedurkinricher
Measles outbreak grows in northwest US, 31 cases reported
By GILLIAN FLACCUS
Saturday, January 26
VANCOUVER, Wash. (AP) — The number of confirmed measles cases near Portland grew to 31 on Friday — an outbreak boosted by lower-than-normal vaccination rates in what has been called an anti-vaccination U.S. “hot spot.”
Public health officials in southwest Washington, just across the Columbia River from Portland, Oregon, said people may have been exposed to the dangerous disease at more than three dozen locations , including Portland International Airport, a Portland Trail Blazers game, an Amazon Locker location and stores such as Costco and Ikea.
Twenty-six of the confirmed patients had not been vaccinated against measles, and the vaccination status of four others who were infected is unknown. One child has been hospitalized. Authorities say nine additional cases are suspected.
One case also has been confirmed in King County, which is home to Seattle and one was confirmed Friday evening in Multnomah County, which is home to Portland.
Most of the cases involved children younger than 10, the Clark County Public Health Department said in a statement. One adult is infected, and the rest are teenagers. Oregon officials didn’t provide the age of the adult infected there.
Washington Gov. Jay Inslee, a Democrat, declared a statewide public health emergency for his state on Friday. Authorities in neighboring Oregon and Idaho have issued warnings.
Inslee said the number of cases “creates an extreme public health risk that may quickly spread to other counties.”
The measles vaccine has been part of routine childhood shots for decades, and measles was declared eliminated in the U.S. in 2000.
But measles is still a big problem in other parts of the world. Travelers infected abroad can bring the virus into the country and spread it, causing periodic outbreaks.
Last year, there were 17 outbreaks and about 350 cases of measles in the U.S.
Officials still are not sure where this Pacific Northwest outbreak began. The first known patient sought medical care on Dec. 31, but it is unknown if other people may have gotten sick before that and did not seek treatment. Public health officials are focused for now on preventing more exposures.
It could be weeks or even months before the “exquisitely contagious” virus runs its course in Washington, Dr. Alan Melnick, the Clark County health officer, said Friday.
People who choose not to vaccinate their children are underestimating the dangers of the illness, said Melnick, who himself had measles as a child, before the vaccine was commonplace.
Before the vaccine, 400 to 500 people died from the measles each year, 50,000 people were hospitalized and 4,000 people developed brain swelling that can cause deafness, he said. Between one and three cases out of every 1,000 are fatal, he said.
“It’s one of the most contagious viruses we have. It can have really serious complications … and it’s entirely preventable with an incredibly cheap and safe vaccine,” Melnick said.
Clark County has already spent more than $100,000 trying to contain the outbreak, and staff is being pulled from other duties, including restaurant inspections, he said.
“It’s all hands on deck. Clearly this is going to cost hundreds of thousands of dollars, and it wouldn’t surprise me if we were in the seven figures by the time we’re done here,” he said. “These costs could have been prevented if we had everybody vaccinated.”
Clark County, which includes the Portland bedroom community of Vancouver, Washington, has a measles vaccination rate of 78 percent, well below the 92 to 94 percent rate required for so-called “herd immunity,” said Marissa Armstrong, the department’s spokeswoman. Herd immunity happens when unvaccinated individuals are protected from infection because almost everyone around them has been vaccinated and is immune to a disease.
The measles vaccination rate for 2-year-olds in Multnomah County, home to Portland, was 87 percent in 2017, according to state data. The measles vaccine consists of two shots, one given by age 2 and the second usually between ages 4 and 6.
Data on Portland’s vaccination rate for both shots wasn’t immediately available.
Two doses of the vaccine in childhood are 97 percent effective and provide lifetime immunity. One dose is about 93 percent effective.
Both Washington and Oregon allow vaccine exemptions for personal and philosophical reasons. The vaccine-exemption rate in Clark County for non-medical reasons was high, at 7.5 percent, Armstrong said.
The incubation period for measles is seven to 21 days, which means that an unvaccinated person who has been exposed could be out in public for up to three weeks before getting sick. Patients remain contagious for four days after they develop the rash.
The virus, spread by coughing or sneezing, can remain in the air for up to two hours in an isolated space. Ninety percent of people exposed to measles who have not been vaccinated will get it, public health officials said.
Every time an unvaccinated person who has been exposed to measles goes out in public, “it starts that clock over again,” Armstrong said.
Earlier this week, authorities were successful in identifying several people who had been exposed but were not sick yet. Those people stayed home and later got ill, Armstrong said.
Those who may have been exposed should watch for early symptoms of fever and malaise and then a rash starting on the head and moving down the body. Serious complications such pneumonia and brain infections can arise from the disease in some cases.
Follow Gillian Flaccus on Twitter at http://www.twitter.com/gflaccus
Timeline shows investigation of alleged pain meds overdosing
By ANDREW WELSH-HUGGINS
Saturday, January 26
COLUMBUS, Ohio (AP) — Investigations are underway into allegations that a doctor working for an Ohio hospital system ordered inappropriately high doses of pain medication to dozens of patients, leading to the deaths of at least 28 people at two hospitals. A review of events so far based on information provided by Mount Carmel Hospital System, details in lawsuits and accounts from patients’ family members:
Oct. 25: Columbus-based Mount Carmel receives formal report related to care provided by Dr. William Husel.
Nov. 19: Mount Carmel receives second formal report related to Husel’s care and broadens an internal investigation.
Nov. 21: Mount Carmel receives a third report and prohibits Husel from providing patient care.
Dec. 5: Mount Carmel fires Husel, notifies the State Medical Board of Ohio and meets with Franklin County Prosecutor Ron O’Brien. Two days later, the hospital notifies the Ohio Boards of Pharmacy & Nursing.
Dec. 11: Mount Carmel begins training staff on changes in procedures and on existing and updated policies.
Dec. 27: Mount Carmel first contacts families of patients affected by Husel’s actions to notify them and apologize.
Jan. 14: The first lawsuit is filed over the deaths, against the health system, a pharmacist, a nurse, and Husel, alleging a “grossly excessive” dosage of the powerful painkiller fentanyl was ordered to hasten the death of 79-year-old Janet Kavanaugh in December 2017.
The same day, allegations against Husel become public as the hospital system releases a statement revealing the deaths of 27 patients who received doses of pain medication that were potentially fatal. The hospital’s President and CEO Ed Lamb apologizes and says they are investigating how it happened. In an internal video released to employees the same day, Lamb said Husel’s orders were carried out by employees who “made poor decisions” and ignored existing safeguards.
Jan. 16: In the first public comments from a family member, David Austin, of Columbus, says he felt “like somebody kicked me in the chest” when he was told of the alleged circumstances of the death of his wife of 36 years, Bonnie Austin, in September. The same day, Mount Carmel says it identified a 28th patient. Attorneys for Hustel issue their first “no comment.”
Jan. 17: The widow of a man treated by Husel says news of the circumstances of her husband’s death left her shocked that such a scenario could happen despite procedural and technological safeguards. Christine Allison, of Columbus, says “the system failed tremendously” in the case of her 44-year-old husband, Troy.
Jan. 19: The Ohio Department of Health confirms its investigation of Husel on behalf of the U.S. Centers for Medicare and Medicaid Services.
Jan. 24: Mount Carmel acknowledges that Husel kept working for four weeks after concern was raised last fall. It also says it is now investigating whether some patients got excessive doses while they might still have had the opportunity to improve with treatment. The hospital raises the total number of patients receiving excessive doses of pain medication to 34.
Jan. 25: State Medical Board suspends Husel’s license, says doctor invoked his right against self-incrimination when he met with representatives this week and was questioned. Two additional lawsuits filed, over the deaths of 69-year-old Joanne Bellisari in May 2015 and 80-year-old Jim Allen in May 2018, bringing the total to six lawsuits as of Friday.
Associated Press writers Kantele Franko in Columbus and John Seewer in Toledo contributed to this report.
Small Florida city honors 5 bank shooting victims with vigil
Monday, January 28
SEBRING, Fla. (AP) — Residents in a small Florida city gathered Sunday and held a vigil to honor the five women killed in a SunTrust branch mass shooting.
People lit flashlights and cell phones instead of candles to honor the victims because heavy rains in Sebring pushed the vigil to an indoor location. Florida Gov. Ron DeSantis had made earlier plans to attend but canceled, saying the weather had affected his travels.
Four SunTrust employees and a customer were killed in the bank’s lobby Wednesday. After a standoff, police say, Zephen Xaver, 21, was arrested and is now facing five counts of premeditated murder. State Attorney Brian Haas has said it is likely that he will seek the death penalty.
Photos of four of the victims were framed together and stood on an easel among funeral wreaths and next to a banner that read “Sebring Strong.”
Sebring police said families of two of the women are raising funds for funerals and other expenses.
One of the victims was Jessica Montague, 31, a mother of three young children and seven stepchildren. She was to have celebrated her husband’s birthday the day of the shooting. Another victim was Ana Pinon-Williams, a mother of three and stepmother of four who had recently begun working at the bank and had been planning a family trip to her native Mexico.
Pinon-Williams’ brother-in-law, Tim Williams, addressed the crowd at Sunday’s vigil.
“Let’s use this opportunity, as our hearts are truly broken, and allow the light to shine in our lives,” said Williams, a pastor.
The other two victims identified were Marisol Lopez, described by friends as a dedicated longtime bank teller. The customer who was shot dead was Cynthia Watson, who got married earlier this month. Authorities withheld the name of the fifth victim at the family’s request in compliance with a new victims’ rights law.
Police said the shooting appeared to be a random act, not part of a robbery, and that Xaver had no connection to any of the victims.
SunTrust spokesman Michael McCoy told media the bank has decided not to reopen the branch that came under attack after hearing from families. Instead, it is considering a different use for that space.
The banks had observed a moment of silence Friday at 12:36 p.m., which was the time on Wednesday when authorities say Xaver called 911 and told dispatchers he had shot everyone inside the bank.
Suspect in Louisiana shooting deaths caught in Virginia
Sunday, January 27
DONALDSONVILLE, La. (AP) — A man suspected of killing his parents and three other people – including a girl he was dating – has been captured after an intense manhunt spanning several states, authorities in Louisiana said Sunday.
Dakota Theriot, 21, was located in Virginia early Sunday after fleeing the day before, according to a statement by Ascension Parish Sheriff Bobby Webre and Livingston Parish Sheriff Jason Ard.
Theriot was arrested by the Richmond County Sheriff’s Office. The statement said he will be brought back to Ascension Parish to be booked on two counts of first-degree murder, home invasion, and illegal use of weapons.
Authorities said Theriot first shot and killed three people – the woman believed to be his girlfriend, her brother and father – in Livingston Parish before taking her father’s truck, driving to neighboring Ascension Parish, and shooting his parents.
Authorities have identified the victims in Livingston Parish as Billy Ernest, 43; Tanner Ernest, 17; and Summer Ernest, 20. Ard said Summer Ernest and Dakota Theriot were in a relationship and that Theriot had been living with her family for a few weeks.
Authorities earlier identified the other two victims as Theriot’s parents — Keith, 50, and Elizabeth Theriot, 50, of Gonzales.
They were shot in their trailer on Saturday morning.
“The father was gravely injured at the time we found him and has since passed away,” Webre said late Saturday. But before he died, Webre said authorities were able to get a “dying declaration from him, and only enough information to let us know that it was his son that committed this act.”
Crystal DeYoung, Billy Ernest’s sister, told The Associated Press that she believes Theriot had just started dating her niece, Summer Ernest.
“My family met him last weekend at a birthday party and didn’t get good vibes from him,” DeYoung said. She said she wasn’t sure how her niece and Theriot met, but that she believed the relationship was relatively new.
Conviction in friend’s shooting death thrown out
WILLIAMSPORT, Pa. (AP) — A judge has thrown out the conviction of a central Pennsylvania man in the shooting death of a friend.
Twenty-four-year-old Da’ran Sears was initially charged with involuntary manslaughter in the July 2013 death of Donte Marks in Williamsport. He said he didn’t know the gun was loaded.
His new attorney contends that his client wanted to plead guilty to the original charge, but held off while his former attorney sought to have a receiving stolen property charge dismissed. Prosecutors later filed a murder charge, and Sears was convicted and sentenced to 21 to 50 years.
PennLive.com reports that a Lycoming County judge has scheduled a March 1 hearing to allow Sears the opportunity to plead guilty to the original charges —and said he can’t be retried on the murder charge.
Information from: Pennlive.com, http://www.pennlive.com