Federal Grand Jury (Indicts) Local Doctor Whose Medical Practice Resulted In The Death Of 6 Patients

[nitpicker]

https://www.justice.gov/usao-wdny/pr/federal-grand-jury-returns-166-count-superseding-indictment-against-local-doctor-whose

Department of Justice
U.S. Attorney’s Office
Western District of New York

FOR IMMEDIATE RELEASE
Tuesday, November 7, 2017

Federal Grand Jury Returns 166 Count Superseding Indictment Against Local Doctor Whose Medical Practice Is Charged With Unlawfully Prescribing Controlled Substantces Resulting In The Death Of Six Patients

BUFFALO, N.Y.-Acting U.S. Attorney James P. Kennedy, Jr. announced today that a federal grand jury has returned a 166-count superseding indictment charging Dr. Eugene Gosy, 56, of Clarence, NY, with the following crimes:

• One count of unlawfully conspiring to distribute and dispense, and to cause to be distributed and dispensed controlled substances, other than for a legitimate medical purpose and not in the usual course of professional practice, resulting in the death of six (6) of his patients;
• Three counts of unlawfully distributing and dispensing controlled substances, including fentanyl, oxycodone, and tapentadol, each resulting in the death of a patient;
• 144 counts of unlawfully distributing and dispensing controlled substances, other than for a legitimate medical purpose and not in the usual course of professional practice;
• Two counts of conspiracy to commit healthcare fraud; and
• 16 counts of healthcare fraud.

(snip)
The indictment alleges that in carrying out the conspiracy, Dr. Gosy and his employees at the Gosy Center, which included nurse practitioners and physician assistants working under Dr. Gosy’s direction and control, issued more prescriptions for controlled substances annually than any other prescriber or prescribing entity in New York State, including hospitals. Specifically, the indictment alleges that Dr. Gosy and his employees carried out their conspiracy by:
• prescribing controlled substances without conducting a physical examination and/or after conducting only a limited and inadequate physical examination;
• prescribing controlled substances in ways that were likely to cause, and did cause, dependence and addiction, and that contributed to existing addictions;
• issuing prescriptions for controlled substances in dosages and/or in combinations dangerous to the health and safety of the patient;
• issuing prescriptions for controlled substances despite indications that patients were abusing and misusing the prescribed controlled substances;
• prescribing controlled substances without monitoring or using objective treatment information;
• recommending a course of treatment, including the prescription of controlled substances, which caused patients to become so addicted to opioid drugs that some eventually utilized heroin and other street drugs, in order to satisfy their addiction;
• issuing prescriptions for controlled substances to patients despite knowing that such patients had overdosed, or had otherwise been hospitalized for conditions relating to misuse of controlled substances;
• continuing to prescribe controlled substances in the same manner, and failing to adapt practices to prevent additional deaths and overdoses, despite having notice that treatment they were following had resulted in obvious drug-seeking behavior and addiction; numerous patient overdoses; and patient deaths;
• signing death certificates, in the absence of an autopsy or medical examination, for deceased patients to whom Gosy and/or his employees had prescribed controlled substances despite aberrant behaviors;
• recommending a course of treatment, including the prescribing of controlled substances, which caused the death of at least six individuals, and contributed to the deaths of others;
• utilizing a telephonic patient prescription renewal process, whereby patients could obtain prescriptions for Schedule II, III and IV controlled substances that were prepared by persons who were not medically trained and issued by mid-level providers who had inadequate knowledge about the prescription and the patient, and without adequate review of the prescription and the patient’s chart;
• Dr. Gosy pre-signing blank prescriptions and permitting other persons to fill out the remaining information for the prescription, wen he would leave the Buffalo area for extended periods;
• Dr. Gosy failing properly to review and sign his own patient file notes, and arranging for other, non-medical, personnel to sign said patient file notes, to make it appear as if he had reviewed them;
• Dr. Gosy failing properly to review patient file notes/reports prepared by mid-level providers working under his supervision and working in collaboration with him, and arranging for other, non-medical, personnel to sign said patient file notes, to make it appear as if he had reviewed them;
• failing adequately to review records provided to the office from other providers, and failing to obtain a complete patient history and information about present illness and conditions;
• prescribing controlled substances to individuals while failing to refer the patient to and/or ensure compliance with drug addiction treatment despite aberrant behaviors, and requests from patients and/or their family members for help with addiction;
• prescribing methadone to individuals exhibiting aberrant behaviors, outside of a methadone clinic setting, and without employing additional safety precautions or referring the patient to addiction treatment;
• Dr. Gosy, beginning in 2008, circumventing state and federal regulations by prescribing buprenorphine for the treatment of narcotics addiction, improperly using his regular DEA number, and sometimes labeling the prescriptions as for “pain management,” even when the drug was being prescribed primarily for the purpose of treating narcotics addiction;
• Dr. Gosy issuing prescriptions to patients for buprenorphine, a Schedule III controlled substance, for the treatment of narcotics addiction, without having completed the required medical training course in order to be a “qualifying physician” to treat narcotics addiction;
• Dr. Gosy failing to complete training requirements, including Continuing Medical Education courses, Worker’s Compensation training, and Infectious Disease Control training, and instead requiring members of his office staff to take the online courses purporting to be the defendant; and
• Dr. Gosy engaging in prescribing patterns whereby high-risk patients that had run out of their prescribed opioids were given buprenorphine until Dr. Gosy could again prescribe other opioids.

According to the indictment, other practices adopted and used in defendant Gosy’s office included the following:
• Mid-level providers (Physician Assistants and Nurse Practitioners) were encouraged to maximize volume of patients seen. Providers who saw certain volumes of patients received monetary bonuses, and/or gifts. Providers who saw less patients were threatened with pay cuts. Providers also earned credit towards bonuses for performing certain, more lucrative procedures on patients.
• Beginning in 2012, a “script line” was established which allowed patients seeking prescriptions, who were not scheduled for an office visit, to call and request a prescription. The “script line” was attended to by individuals with no medical training or certification. They were responsible for drafting the requested prescriptions with the proper drug and dosage, checking the patient’s file for “alerts,” and the New York State iStop program, a Prescription Monitoring Program. Each week a mid-level provider was designated to sign all, or almost all, prescriptions requested through the “script line.” This typically amounted to hundreds of prescriptions per day, many of which were for patients whom the practitioner had never seen and/or with whom the practitioner had little or no familiarity.
• A system was in place for ordering urine drug tests whereby, once the test was ordered, an employee other than the treating practitioner would typically fill out the request form for the laboratory. As a result, the drug screens often tested for the presence or absence of drugs other than those actually prescribed to the patient. However, as part of the usual course of medical practice, urine drug tests should have been ordered and reviewed in consultation with the patient’s medical file, including history and list of current prescribed medications. This is because urine drug testing provided valuable objective information to assist in diagnostic and therapeutic decision making, provided confirmation of compliance with the treatment plan, and provided indication of overutilization of prescribed drugs, diversion/non-use of prescribed drugs, the use of prescription drugs not prescribed to a particular patient, and/or the use of alcohol or illicit street drugs.
• As with the “script line,” toxicology results, including urine drug screens, were reviewed by a mid-level provider, many of whom had never seen the patient and/or with whom the practitioner had little or no familiarity. As a result, tests were often labeled as “consistent,” and not given appropriate attention, even when the tests showed the presence of a non-prescribed drug, or the lack of a prescribed drug.
• Patient records often contained incorrect or insufficient information to justify a diagnosis and warrant treatment. Mid-level providers frequently dictated their office notes, failed to review their notes after transcription, and “batch signed” large quantities of notes without review. In addition, Dr. Gosy rarely, if ever, signed his own notes, and arranged for others to affix his signature to office notes and patient files, in order to facilitate more expeditious billing.
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