Reckless Prescribing in LA

Dr. Carlos Estiandan (Liz O. Baylen / Los Angeles Times)

Stories of drug addiction and overdose, reckless prescribing, and failures in medical oversight takes center stage in the latest LA Times investigative report, which outlines prescription practices of Dr. Carlos Estiandan, an LA area doctor accused and imprisoned for prescription abuse.

He prescribed powerful painkillers to addicts who had no medical need for them, conducted sham examinations and appeared to be a key supplier for drug dealers, according to court records.

He wrote more prescriptions than the entire staffs of some hospitals and took in more than $1 million a year.

Worse, one of Estiandan’s patients had fatally overdosed on drugs he prescribed, a board investigator learned. The investigator said in her report that she confronted the doctor and told him the death was “the inevitable result” of giving narcotics to an addict.

Unknown to the investigator, two other Estiandan patients had suffered fatal overdoses. More deaths would follow.

By the time the medical board stopped Estiandan from prescribing, more than four years after it began investigating, eight of his patients had died of overdoses or related causes, according to coroners’ records.

It was not an isolated case of futility by California’s medical regulators. The board has repeatedly failed to protect patients from reckless prescribing by doctors, a Los Angeles Times investigation found. LA Times, 9 Dec 2012.

For family members dealing with the loss of a loved one due to these types of crimes, legal justice is often hard to obtain. Estiandan was charged with 13 felonies, all related to illegally prescribing controlled substances, none related to the deaths of his patients. He served half of his five-year sentence before being released, and refers to his prison time as a “vacation.”

Obstacles to civil suits include limits to malpractice insurance, bankruptcy, and the level of perceived and actual responsibility of the victim. In the case of multiple plaintiffs, malpractice insurance limits are quickly reached. Civil suits involving addiction are difficult to win unless a sympathetic jury is chosen. If the case is successful, but the defendant can successfully conceal assets or declares bankruptcy, it will be difficult to collect on any damages ordered by a court.

There is a possibility of including pharmacies in a suit, but only if it can be proven that a single pharmacy was knowingly filling prescriptions for addicts.

In this case, there is clearly some fault on the regulators, but generally, governmental entities are immune from liability for their discretionary decisions about how to conduct investigations like these.  While it is absolutely true that governmental regulators often fail to see the forest for the trees, those types of judgment calls fall squarely within the immunity that they have for discretionary acts.