Doctors Behaving Badly: Maryland doctor dispensed painkillers like candy

When a patient has a pain problem, he can seek a doctor who has experience in treating pain through a variety of measures that don't rely solely on addictive prescription drugs.

Or he can find a doctor who acts like a Pez dispenser.

Dr. Daniel M. Howell was a Pez dispenser.

According to the Maryland Board of Physicians, Howell (License No. D02975) saw the same patient in Waldorf and LaPlata, Maryland, for nearly a decade. He fed him increasing doses of addictive painkillers despite clear evidence of drug abuse and signs that he was causing the patient's liver to fail.

The patient, 46, suffered from a degenerative spine. By the time he first visited Howell, he already had become an addict. Howell had his medical records, which showed he had abused alcohol, sedatives, narcotics and IV drugs. The notes even included this red-alert sentence:

He even had an overdose of Percodan at one time and there was some question of whether or not this was a suicidal attempt or gesture.

Yet Howell did little more than pump the patient full of Percocet.

He had been refused addictive drugs by other doctors, but not by Howell. In fact, when a pharmacy took the rare step of calling Howell to say that the patient had been "getting multiple refills for several narcotics from different physicians in the area," Howell kept right on prescribing. He wrote the patient two prescriptions for 20 tablets of Percocet in one week.

Heavy doses of painkillers can wreck a patient's liver, but Howell did not take steps to avoid liver complications, either.

During the 10 years that [Howell] regularly saw Patient A, his notes say almost nothing about referrals to appropriate specialists for Patient A's considerable medical problem. [Howell] documented very little about Patient A's elevated liver function tests for almost 10 years. [Howell] failed to refer Patient A for mental health consultation.

The patient's fiancée complained to the Maryland Board of Physicians in August 2004, providing the board with pharmacy printouts from 2003 to 2004. The fiancée said:

she had asked [Howell] to stop this prescribing but [Howell] told her to hide the pills and he gave her instructions on how to dispense. At the time of the complaint, Patient A was hospitalized in Delaware for detoxification and/or mental health issues.

It took the board nearly four more years to act. It placed Howell on probation in July 2008, told him to take some classes in medical record keeping, prescribing and pain management.

At the same time, the board was investigating a separate complaint about excessive prescribing. In 2007, the board had received complaints from Tidewater Pharmacy in Mechanicsville, Maryland, and "three concerned area pharmacists." At least 16 patients were involved.

Then an ER physician complained that Howell was "overprescribing narcotics to his patients, causing them to overdose." One of these patients was sent home after an overdose and was soon back in the ER after Howell wrote the patient "a very large prescription for Percocet and Xanax." Eight other patients had similar histories.

So what did the board do this time?

More probation. More classes. But Howell also was banned from treating chronic pain patients and ordered to undergo supervision by a board-appointed doctor.

Final question: What should patients do if they think their doctor is acting like a dealer? The first patient's fiancée appears to have taken the best first step by documenting the problem. When health writers are called about a doctor like Howell, they should ask the patient to call all pharmacies that the patient might have used and ask for printouts of their purchases. They might have to persuade the patient himself to consent to having the records released. If the patient has died, often the spouse has the power to ask for those records, and they may also be collected as part of a life insurance claim or lawsuit.