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About The daily Astorian. (Astoria, Or.) 1961-current | View Entire Issue (Jan. 1, 2018)
7A THE DAILY ASTORIAN • MONDAY, JANUARY 1, 2018 Armed with new data, officials target ‘drug-dealing’ doctors By SADIE GURMAN Associated Press PITTSBURGH — The pain clinic tucked into the cor- ner of a low-slung suburban strip mall was an open secret. Patients would travel hun- dreds of miles to see Dr. Andrzej Zielke, eager for what authorities described as a steady flow of prescriptions for the kinds of powerful painkill- ers that ushered the nation into its worst drug crisis in history. At least one of Zielke’s patients died of an overdose, and prosecutors say others became so dependent on oxy- codone and other opioids they would crowd his office, some- times sleeping in the wait- ing room. Some peddled their pills near tumble-down store- fronts and on blighted street corners in addiction-plagued parts of Allegheny County, where deaths by drug overdose reached record levels last year. But Robert Cessar, a long- time federal prosecutor, was unaware of Zielke until Jus- tice Department officials handed him a binder of data that, he said, confirmed what pill-seekers from as far away as Ohio and Virginia already knew. The doctor who offered ozone therapy and herbal pain remedies was also prescrib- ing highly addictive narcot- ics to patients who didn’t need them, according to an indict- ment charging him with con- spiracy and unlawfully distrib- uting controlled substances. Zielke denied he was over- prescribing, telling AP he prac- ticed alternative medicine and many of his patients stopped seeing him when he cut down on pain pills. His indictment in October was the first by a nationwide group of federal law enforce- ment officials that, armed with AP Photo/Keith Srakocic Assistant U.S. Attorney Robert Cessar shows a map illustrating the rates of opioids pre- scriptions by county during an interview in Pittsburgh. The Justice Department is giving federal prosecutors in 12 regions ravaged by the opioid abuse epidemic a trove of data officials say will help them stop over-prescribing doctors. new access to a broader array of prescription drug databases, Medicaid and Medicare fig- ures, coroners’ records and other numbers compiled by the Justice Department, aims to stop fraudulent doctors faster than before. The department is provid- ing a trove of data to the Opi- oid Fraud and Abuse Detection Unit, which draws together authorities in 12 regions across the country, that shows which doctors are prescribing the most, how far patients will travel to see them and whether any have died within 60 days of receiving one of their pre- scriptions, among other information. ‘Shines a light’ Authorities have been going after so-called “pill mills” for years, but the new approach brings additional fed- eral resources to bear against the escalating epidemic. Where prosecutors would spend months or longer build- ing a case by relying on erratic informants and only limited data, the number-crunching by analysts in Washington, D.C., provides information they say lets them quickly zero in on a region’s top opioid prescribers. “This data shines a light we’ve never had before,” Ces- sar said. “We don’t need to have confidential informants on the street to start a case. Now, we have someone behind a computer screen who is help- ing us. That has to put (doc- tors) on notice that we have new tools.” And Rod Rosenstein, dep- uty attorney general, told AP the Justice Department will consider going after any law- breaker, even a pharmaceu- tical company, as it seeks to bring more cases and reduce the number of unwarranted prescriptions. Attorney General Jeff Sessions has been in lock- step with President Don- ald Trump about the need to combat the drug abuse prob- lem that claimed more than 64,000 lives in 2016, a prior- ity that resonates with Trump’s working-class supporters who have seen the ravages of drug abuse firsthand. The presi- dent called it a public health emergency, a declaration that allows the government to redi- rect resources in various ways to fight opioid abuse. But he directed no new federal money to deal with a scourge that kills nearly 100 people a day, and critics say his efforts fall short of what is needed. The Republican-con- trolled Congress doesn’t seem eager to put extra money toward the problem. While the effectiveness of the Trump administration’s broader strategy remains to be seen, the Justice Department’s data-driven effort is one small area where federal prosecutors say they can have an impact. The data analysis provides clues about who may be break- ing the law that are then cor- roborated with old-fashioned detective work — tips from informants or undercover office visits, said Shawn A. Brokos, a supervisory special agent in the FBI’s Pittsburgh division. Investigators can also get a sense for where displaced patients will turn next. Authorities acknowledge there are legitimate reasons for some doctors to prescribe large quantities of opioids, and high prescribing alone doesn’t nec- essarily trigger extra scrutiny. What raises red flags for inves- tigators are the dentists, psy- chiatrists and gynecologists who are prescribing at surpris- ingly high rates. The effort operates on the long-held perception that drug addiction often starts with pre- scriptions from doctors and leads to abuse of more dan- gerous black market drugs like fentanyl, which, for the first time last year, contributed to more overdose deaths than any other legal or illegal drug, sur- passing pain pills and heroin. But that focus can cause law-abiding physicians to abandon disabled patients who rely on prescriptions, for fear of being shut down, said University of Alabama addic- tion researcher Stefan Kertesz. Those patients will turn to harder street drugs or even kill themselves, he said. “The professional risk for physicians is so high that the natural tendency is to get out of the business of prescription opioids at all,” he said. Another addiction expert, Dr. Andrew Kolodny, founder of Physicians for Responsi- ble Opioid Prescribing, said prosecutors’ emphasis on “drug-dealing doctors” is appropriate but inadequate on its own. “It’s just not really going to have that much of an impact on an epidemic,” he said. The bigger change will come from a stronger push for preven- tion and treatment, he said. And, he added, “They should go after the bigger fish … the legal narcotics distributors and wholesalers who have literally been getting away with mass manslaughter.” $250 a visit Investigators said Zielke charged $250 a visit and made patients pay in cash. But Zielke said prosecutors unfairly tar- geted him. Instead of more prosecutions, he said, the gov- ernment “should promote more alternative therapies,” he said. “And they should find out why so many people have pain.” A second indictment by the anti-fraud unit involved a cardiologist in Elko, Nevada, accused of routinely pro- viding patients fentanyl and other painkillers they did not need. Justice officials hope to expand the data-driven work nationwide. Will it work? As Soo Song, who watched addiction warp communities while serving as acting U.S. attorney in western Pennyslvania, put it: “The best measure of success will be if fewer people die.” Keeth: Memorial set for Saturday at Camp Rilea Continued from Page 1A Pacific National Monument, told The Oregonian ear- lier this year there are likely fewer than 2,000 Pearl Har- bor survivors left. Keeth joined the Army at 16 and was stationed at Schofield Barracks in Hono- lulu. He was on kitchen duty at the time of the attack on Dec. 7, 1941. “He went out to dump potato peelings, and he heard unexpected sounds of planes,” Barnett said. “Then he looked up, and saw the rising sun on the planes.” Her father didn’t talk about the attack much, she said, besides that he watched several of his friends die. Keeth served in the Pacific during World War II, includ- ing battles at Guadalcanal and in the Solomon Islands. In a 1944 interview with the the Yakima Herald, Keeth described surviving nearby shell explosions, a 19-day siege and being shot at and missed from 3 yards away. “He could have touched me with his rifle,” Keeth told the newspaper of his run-in with the Japanese soldier. “I don’t know how he happened to miss.” After the war, Keeth mar- ried Ruby, and the couple had four children and nine grandchildren. Most of the family still resides in Yakima Valley, Barnett said. Keeth attended Perry Trade School and learned to be a mechanic who specialized in bodies and fenders. “Dad was so handy,” Barnett said, describing her father taking apart a surplus house at Fort Vancouver, Washington, and reassem- bling it as the family home in Wapato. “He self-taught himself to do everything.” Keeth strung together jobs picking fruit, baking and working at local auto- motive shops before spend- ing 30 years as the shop fore- man servicing vehicles on the federal Wapato Irriga- tion Project in the Yakima Valley. After retiring, Keeth volunteered at local parks and drove buses part time for the school district and fruit farmers. Ruby Keeth cared for her husband until falling and breaking her hip, after which he moved to Hammond. Keeth was quickly embraced by local veterans and other volunteer organizations, who outfitted Barnett’s house with ramps for Keeth’s wheelchair and a specialized shower. He became especially popular at Camp Rilea Armed Forces Training Center, where he once visited for a doctor’s appointment and ended up having lunch with an entire troop. “There were so many people wanting to meet him,” Barnett said. “Some grown men, my age, would walk away crying. He would remind them of someone in their family. They’d be so touched by meeting dad. “At the end, they all said, ‘Thank you Mr. Keeth for joining us today.’ Camp Rilea was just amazing to dad.” A memorial for Keeth will be held Saturday at Camp Rilea. The Daily Astorian Local brewers and distillers will reap some of the savings in the Tax Cuts and Jobs Act recently passed by Congress. Tax plan: ‘Long overdue for the spirit industry’ Continued from Page 1A Most Oregon-based brew- eries fall well under the thresh- old of the tax cut. Fort George Brewery, the largest in Clat- sop County, sold fewer than 14,000 barrels in the state last year, according to the Oregon Liquor Control Commission. Jack Harris, co-owner of Fort George, said the tax cut for craft brewers has been a long time coming. “That was good news that it passed, but unfortunate that it passed with so many other controversial issues,” Harris said. Bob Pease, CEO of the Brewers Association in Boul- der, Colorado, represent- ing small and independent craft brewers, said he has been working on cutting bar- rel excise taxes for nearly a decade. “It’s significant, because the current (excise tax) rate has been in place since 1976,” he said. “Our belief is that breweries will take the sav- ings and reinvest them in their businesses.” The association would have liked the alcohol legislation to be passed on its own but were told that was unrealistic, Pease said. Lawrence Cary, co-owner of Pilot House Distilling, said the reduction in liquor taxes will help with his company’s expansion. “It’s long overdue for the spirit industry,” Cary said, adding he’d like keep his opin- ions on the overall tax plan to himself. “With this, you might see a little boom in our production.” Wyden, a co-chairman of the Senate Bipartisan Small Brewers Caucus, introduced the Craft Beverage Modern- ization and Tax Reform Act in 2015 to reduce taxes and compliance rules for brewers, cideries, vintners and distillers. The bill was a combination of previously attempted legisla- tion to help the industries and had broad, bipartisan support. The Los Angeles Times reported that including pro- visions of the bill in the tax plan was part of an unsuc- cessful effort by Republicans to curry Wyden’s favor and vote. Wyden spokesman Hank Stern told Willamette Week the effort was a non-starter. Wyden and other Senate Dem- ocrats opposed the tax plan. “Senator Wyden was and is proud to lead the fight against a bill that showers corpora- tions with goodies and raises taxes on over half of the mid- dle class,” Stern said. Fryberger: Background includes jobs in nonprofits, database management Continued from Page 1A Oceanside, near Tillamook, but for a while she thought Hood River would become her next home. Those plans changed and, after some test visits, she made the leap to Astoria. She brought a tech job with her, but she hoped to land a local job, perhaps in data- base management. The search proved to be harder than she’d expected. She landed at Coast Community Radio as a vol- unteer. When former mem- bership specialist J.D. Wells announced he would be leav- ing the job for health reasons, Joanne Rideout, the former station manager who transi- tioned to a news director role in November, suddenly had an opening on the station’s small staff. Fryberger got the job. “We take it quite seri- ously when we hire someone, because we are a small group and work closely together,” Rideout said. She consid- ers Fryberger to be part of a “wonderful renaissance” at the station. “(Fryberger) is smart, wise, efficient and full of new, great ideas,” Rideout said. “In the short time she’s been with us, she’s made great strides in raising reve- nue and strengthening con- nections to our members. But, best of all, she’s a delightful co-worker — a great person to spend time with. She’s a terrific addition to our team.” For Fryberger, whose background includes diverse jobs in nonprofits, database management, bookstores, event production and tech, the station is the community hub she was looking for. And for- get Hawaii, she says, Astoria is her paradise.