by Mark Friedman on Monday, Mar. 8, 2010 12:00 am
Having his drug-prescribing privileges suspended allegedly prompted Dr. Randeep Mann to detonate a car bomb that nearly killed the chairman of the Arkansas State Medical Board.
But in hindsight, the fact that the board never stripped Mann of his medical license - despite 10 dead patients and at least one allegation that he traded drugs for sex - makes his punishment seem lenient.
The Medical Board started receiving complaints about Mann's prescribing habits in 2001, according to an investigative report in Mann's file at the Medical Board.
Mann, now 51, was the only doctor at the Skyline Medical Clinic in Russellville, where one of his specialties was internal medicine.
Several of his patients had overdosed and two had died, according to the Medical Board's Emergency Order of Suspension & Notice of Hearing on July 9, 2003. He also had "an alleged claim of sex for drugs by one of the overdose victims and another by a minor female," and another female patient felt threatened when Mann flashed photos of his $1 million gun collection, the 22-page 2003 investigative report said.
The Arkansas State Medical Board could have yanked Mann's license in October 2003 but instead sanctioned Mann for prescribing methadone for the treatment of addiction when he didn't have the proper credentials to do it. In addition, the board found that he had violated regulations involving prescribing amphetamines and methamphetamines, but the drugs-for-sex allegation was not proved.
It voted to revoke his license for five years, but the revocation would be stayed as long as Mann surrendered his Drug Enforcement Administration permit to prescribe controlled substances for at least a year. The board also ordered Mann to receive more education on the prescribing of medication and to pay $9,500 for the expenses incurred for the investigation.
But even that limited punishment didn't last a full year. By the next summer, the Medical Board had cut a deal that allowed Mann to get his privileges back.
"If the Medical Board would have pulled his license the first time, instead of making a deal with him, that would have saved some lives," said Phillip Milligan, a Fort Smith attorney who is representing the survivors of a patient in one of two malpractice lawsuits pending against Mann.
William H. Trice III of Little Rock, a private attorney who represents the Medical Board, said it is hard to prove that a prescribing doctor is responsible for a patient's overdose.
"Often when you are over-prescribing, you will end up with a population base of people who are substance abusers," Trice said. "Very seldom do the cases prove out that they can only be attributed to that doctor's judgment."
But in Mann's case, even other doctors had registered complaints. One of them, Dr. Jim Smith of Russellville, told the board in an August 2003 letter that Mann's "medical practice and prescribing practices are a grave concern to myself, other local physicians, and the community as a whole."
After the Medical Board suspended his prescription privileges in October 2003, Mann appealed the board's ruling to Pulaski County Circuit Court. The court affirmed the board's ruling in March 2004. Mann then appealed to the Arkansas Court of Appeals.
On June 3, 2004, the board agreed that if Mann dropped the appeal, he would be found only to have violated the board's regulations involving the prescribing of amphetamines and methamphetamines. And after Mann submitted proof that he had completed a three-day course on prescribing scheduled medication at Vanderbilt University Medical Center, he was allowed to reapply for his permit to write controlled medications.
On July 13, 2004, Mann's license to practice medicine was listed as "unlimited and unencumbered."
In September, just two months after Mann's license was restored, more patients started overdosing on medicines he prescribed.
Dr. George Richison told investigators in early 2005 that he had treated several of Mann's patients for overdoses in the emergency room of St. Mary's Regional Medical Center in Russellville, according to a March 7, 2005, investigative report in Mann's file at the Medical Board.
Richison told investigators that he "could not imagine why a physician would continue to prescribe addictive medications to" drug offenders instead of entering them into a treatment program.
On Aug. 20, 2005, Kevin Allen Curry, 43, of Dardanelle, who suffered from facial pain, saw Mann for the first time. Mann prescribed Norflex, Zoloft, Valium, OxyContin, Percocet, lorazepam, methadone, propoxyphene and doxepin, according to a malpractice complaint Curry's family filed in Yell County Circuit Court.
Curry was already taking Percocet, Valium, Ambien, trazodone, Norflex, Zoloft, Effexor and OxyContin, the lawsuit said.
Four days after seeing Dr. Mann, Curry was dead. An autopsy report said Curry had died from mixed drug intoxication combined with alcohol, although lawsuit claims the amount of alcohol in Curry's system was "negligible."
It wasn't until April 21, 2006, however, that the Medical Board issued an emergency order suspending Mann's license for over-prescribing drugs. Eight deaths in 2005 were blamed on Mann's over-prescribing habits, according to the emergency order.
At a hearing on July 7, 2006, Mann agreed to surrender his certificate to prescribe controlled medications indefinitely, but his medical license was not pulled. And, despite his history, the board held out hope that he could reapply for the permit to prescribe controlled drugs after three years.
Trice said the board agreed to the consent order because without the DEA permit, Mann couldn't "deal in controlled drugs."
Trice said it takes time to impose punishment on a doctor. "We have to gather the records and have them reviewed and the like," he said. "It's not that quick a process."
Seeks Military Service
Without the DEA permit, Mann had a limited practice.
Mann lost "quite a few patients who really needed pain management, but had to find other physicians," Dr. Mann's wife, Sangeeta "Sue" Mann, said in a court hearing.
Dr. Mann kept trying to get his privileges back, in letters that grew more and more desperate. He told the Medical Board in a December 2006 letter that he had contacted military recruiters to see if he could serve as a doctor in Iraq, but his restricted licenses disqualified him from service.
Mann also said his "financial situation, too, has continued to worsen," and he asked the board for help in finding a job with a physician group.
On March 27, 2007, Mann fired off another letter to the board.
"This has not only involved my professional life, but my personal life as well. To be working less than a full schedule has been the hardest feat for me to endure since my graduation from medical school in December of 1980," he wrote.
Mann begged the board to reconsider his case.
"At no time was any action of mine renegade or derelict," he wrote. "I regret the outcomes, of the 3 patients that died of mishandling prescriptions provided by me as well as the 7 others who, at the time of death, had obtained controlled substances from other physicians and/or unknown sources, and always will."
In June 2007, Mann asked the board for another hearing in hopes of restoring his DEA permit. "I would appreciate it if you could help me get some normalcy back to my practice," he said.
But the board denied Mann's request.
On the morning of Feb. 4, 2009, Arkansas State Medical Board Chairman Trent Pierce was getting into his white 2005 Lexus at his West Memphis home when a bomb exploded. Pierce's injuries were life-threatening but he survived.
Within hours, investigators were interviewing Mann, according to a Jan. 6 news release from the U.S. Attorney's Office in Little Rock.
"Mann showed investigators at least one grenade launcher," the news release said.
Officers searched Mann's house in March and found a cache of weapons, including grenade launchers and 110 semi- and fully automatic firearms.
Sue Mann said in a hearing that her husband had a federal firearms license. She also said he collected guns as a hobby. (She would be charged in U.S. District Court with conspiring to obstruct or impeded the proceedings against her husband. She has pleaded not guilty.)
Investigators said they tied 98 grenades that were found near Dr. Mann's house in Pope County. Investigators also found two firearms that were not registered to him.
Mann was arrested in March 2009 and was charged the following month with one federal charge of possessing unregistered firearms. While he was in custody, the investigation continued, and on Jan. 6 he was charged with more crimes, including using a "weapon of mass destruction" against Pierce.
Mann has pleaded not guilty. "We dispute every allegation made against him," his attorney, J. Blake Hendrix of Little Rock, said.
Mann and his wife are set for trial starting July 6.
Mann's medical license, though, hasn't been revoked.
Trice said the board didn't need to yank Mann's medical license now because he was in federal custody. But if Mann were out on bond, the board would take some emergency action against him to prevent him from practicing medicine, Trice said.
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