Lac Courte Oreilles Band struggling with widespread prescription drug abuseThe Lac Courte Oreilles Band of Ojibwe is struggling with what its leaders call a widespread problem with prescription drug abuse and have terminated the doctor who the band says made narcotic painkillers too readily available to his patients.
By: John Lundy, Duluth News Tribune
The Lac Courte Oreilles Band of Ojibwe is struggling with what its leaders call a widespread problem with prescription drug abuse and have terminated the doctor who the band says made narcotic painkillers too readily available to his patients.
Dr. Paul Strapon III, who until Jan. 10 practiced at the Lac Courte Oreilles Health Center near Hayward, also had his right to prescribe narcotics removed both by the Wisconsin Medical Examining Board and the federal Drug Enforcement Agency.
Although Strapon acknowledges some blame, he said in an interview this month with the News Tribune that he has been “trashed” and made a scapegoat by tribe members with a political agenda. At 70, he said he’s looking for work and would consider returning as a doctor to the tribe under certain conditions.
John Vaudreuil, the U.S. Attorney for western Wisconsin, said his office executed a search warrant of the tribe’s health center in April 2011 and found what seemed to be an excessive number of prescriptions for painkillers.
Vaudreuil said he had a medical expert review the files, and the conclusion was “very clear.”
“My assessment, based on the expert report, (was) what was happening was that rather than solving people’s pain problems and trying to work through a pain management program … that people were just becoming chemically dependent,” Vaudreuil told the News Tribune.
Strapon subsequently agreed to surrender his right to prescribe narcotic drugs both with the state of Wisconsin and the DEA, Vaudreuil said.
No criminal charges have been filed, Vaudreuil said, but the case remains open.
Abuse of prescription painkillers is a national issue. Overdoses of prescription painkillers have more than tripled in the past 20 years, the Centers for Disease Control and Prevention reports, with more than 15,500 deaths in the U.S. in 2009.
A MetLife Foundation survey released last week by The Partnership at Drugfree.org said just under one in four U.S. teens admitted misusing or abusing prescription drugs at least once. That represented a 33 percent increase over five years, the partnership reported.
It’s pervasive on the Lac Courte Oreilles reservation, 76,465 acres of forest, lakes, bogs and villages southeast of Hayward in Sawyer County, with a population of about 3,000.
Nine tribal members died of causes related to controlled drugs last year, tribal Chairman Gordon Thayer wrote in the Lac Courte Oreilles Band’s February 2013 newsletter.
In that newsletter, Thayer cited an investigation of the center conducted last July by the Indian Health Service’s Bemidji office. The health service found that 268,241 Vicodin pills had been prescribed at the Lac Courte Oreilles Health Center from October 2011 through June 2012, an average of 85 Vicodin pills for each patient seen, the newsletter said. Vicodin is a combination of acetaminophen and the narcotic pain reliever hydrocodone.
It also found that Strapon had prescribed four times as much Vicodin as the next-highest prescriber at the Lac Courte Oreilles Health Center, the newsletter said.
Dr. Dawn Wyllie, chief medical officer for the Indian Health Service in Bemidji, declined to speak to the News Tribune for this article except to say that the Lac Courte Oreilles Band is addressing the problem.
Strapon acknowledged he made mistakes but said, “I’m a damn good doctor who’s given the best 18 years of my recent life” to the tribe.
Strapon said he accepts “full blame” for prescribing too many pills to one patient, but he says it was because he was duped. The patient would claim that he lost his prescription, or that the prescription had gone through the wash, or that he had been able to pay for only part of the prescription and that it had run out, Strapon said.
“I never knowingly prescribed a narcotic pain pill to anybody that I thought was diverting,” he said.
Former director’s view
The Lac Courte Oreilles Health Center’s former medical director alleges that Strapon did not manage prescriptions well.
Gaiashkibos, 62, who goes by a single name, said in general he considers Strapon a good doctor.
But Gaiashkibos said he became aware of a problem in November 2011. The health center’s pharmacist, Curt Silvis, told him he had been notified by three Hayward pharmacies about “five members of a prominent Native American family on the reservation” obtaining multiple narcotic prescriptions.
Asked to comment, Silvis responded by e-mail that this was an “internal matter,” and he referred questions to Don Smith, the health center’s interim health director. Smith did not return calls from the News Tribune.
Gaiashkibos said that after investigating and discussing the matter with the tribe’s attorney and the county Sheriff’s Office, he suspended Strapon on April 25, 2012.
Gaiashkibos said he planned to lift Strapon’s suspension on May 7, 2012, under certain conditions. Instead, the tribe’s health board reinstated Strapon on May 7 with no conditions, Gaiashkibos said.
Placed on leave
Gaiashkibos said he later recommended to the tribal governing board that Strapon be fired. Instead, Gaiashkibos received a letter on June 26 placing him on “investigative leave.” The leave status was extended several times, and in January of this year, Gaiashkibos was informed his contract wasn’t being renewed.
Strapon said Gaiashkibos blamed that on him and worked against him behind the scenes. He also said that when Gaiashkibos suspended him, he “ranted and raved.”
Gaiashkibos denied that. “I’ve never ranted and raved at anybody,” he said.
Instead, Gaiashkibos said, his only concern was Strapon’s ability to serve his patients.
Thayer, the tribal chairman, did not return calls from the News Tribune. But in the February newsletter article, he wrote that the governing board voted 4-3 on Jan. 10 to terminate Strapon and voted to end Gaiashkibos’ contract on the same day. On Jan. 28, the governing board voted to disband the health board, also on a 4-3 vote, the newsletter said.
Strapon said he might well have prescribed more than 85 Vicodin pills for some individuals, but said he didn’t believe the average was that high. Strapon said he also was by far the most experienced doctor at the center and saw the most difficult cases, and therefore prescribed the most painkillers.
Moreover, he said, the need for painkillers is greater on the reservation than it is in other places. American Indians, as a whole, suffer a higher rate of traumatic injuries from assaults, gunshots and automobile accidents than the general population, he asserted. They are more likely to be overweight and have diabetes, meaning they are more likely to have joint pain.
Dr. David Brown disagrees that the need for painkillers is greater on the reservation.
“I practice in downtown Cleveland, at the Cleveland Clinic,” said Brown, who is chairman of the clinic’s Institute of Anesthesiology. “I could make the same argument about Cleveland.”
Brown has a vested interest in the region, because he and his wife own a second home in the Hayward area and plan to retire there. He spoke at a forum on prescription drug abuse on March 30 at the Lac Courte Oreilles Convention Center.
“Here’s the nuance that I would make about that,” Brown said in a telephone interview. “Just because somebody has joint pain doesn’t mean they have to go on narcotics. I have joint pain. I blew out a knee playing football 45 years ago, and it hurts like crazy. And yet narcotics aren’t going to help it that much.”
Brown said that because of the liberal use of prescribing narcotics by some physicians, some patients will “doctor shop” and get prescriptions from multiple pharmacies, take some and sell the rest.
“It’s actually pretty lucrative,” Brown said. “Oxycontin, which is the drug that has received the most notoriety, it’s a dollar a milligram on the street.”
Strapon described himself as a soft touch who was lied to. He said he came to the realization late last year in discussions with interim health center director Smith that he shouldn’t be prescribing narcotic drugs.
Tackling the problem
Wisconsin has belatedly taken a step to address the problem, Brown said, by starting a prescription drug monitoring program this year. Already established in 44 other states, it requires pharmacies and other dispensers of frequently abused prescription drugs to report the information to make it easier to track abusers. It won’t be fully operational until June 1.
Julie Snow, a tribal member whose 39-year-old daughter died two years ago of a drug overdose, said the Lac Courte Oreilles could better address the problem by placing a drug treatment center on the reservation. The idea has gotten lip service but no action, she said.
“We’ve got a funeral home,” Snow noted. “To me, we’re telling the spirits that we are getting ready for death. Why don’t we get a nursing home or a treatment center to prevent death?”
Vaudreuil said he has seen a change in the Lac Courte Oreilles since the investigation began.
He spoke at the tribe’s general membership meeting in August 2011 and encountered anger over the investigation into the health center, Vaudreuil said.
At the same type of meeting in February of this year, he said, there was both an acknowledgement of the problem and an eagerness to tackle it. There’s a new clinic director and new physicians, he added.
“These are exactly the things that you would hope to see when a group of people really take accountability to help themselves and solve the problem,” he said.
Neither Strapon nor Gaiashkibos is necessarily out of the picture.
Strapon still can prescribe blood-control medicine, diabetes medicine and other drugs, he said, and he’s not ready to quit practicing.
Strapon said a tribal election in June may well change the council’s makeup in his favor.
But he might face at least one implacable opponent. Gaiashkibos said he’s running for the tribal council.
“I have a voice and they’re not going to silence me,” he said.