News that Dr. Julio Diaz had been arrested in a federal prescription drug investigation was greeted with relief by many Santa Barbara residents. But the case has also revived concerns about disciplinary oversight by medical professionals.
Over the past decade, numerous local physicians and families have filed complaints about Diaz with the Medical Board of California. According to the board’s records, however, Diaz’s medical license was — and still is — current, and there are no public actions against him.
Diaz, who operates the Family Care Clinic at 510 N. Milpas St., was arrested Jan. 4 by the Drug Enforcement Administration on federal charges of distributing controlled substances without legitimate medical purpose. Although the DEA affidavit cites a medical board investigation currently under way, a medical board spokesman would not confirm the DEA assertion.
The DEA affidavit links Diaz to 11 patient overdose deaths and more than 400 drug-related emergency room visits in a two-year period. The affidavit alleges he prescribed painkillers and other medications so readily that he was called “the Candy Man” by some drug-seeking patients. According to the document, he also allegedly exchanged drugs for sexual favors from some patients.
Medical board spokesman Dan Wood told Noozhawk the agency is “aware of the situation,” but complaints and investigations conducted by the board are kept confidential to protect a doctor’s right to due process.
It is unknown if complaints to the state medical board prompted the DEA investigation, but they were included in the affidavit against Diaz.
In an October interview with the Los Angeles Times, Diaz said he had become more wary in treating pain patients after several overdose deaths in 2009. He told the newspaper he had “kicked out eight of every 10 pain patients from his practice for violating his rules.”
The Times reported that Diaz said he used California’s CURES (Controlled Substance Utilization Review and Evaluation System) database to see if patients were doctor shopping and he said he conducted more drug screenings to test for illegal narcotics.
When the DEA investigated a string of complaints from physicians and parents of patients in 2009, agents found drug-related patient deaths by looking at Diaz’s prescribing histories through the CURES database, which showed he had given some patients thousands of pain pills in a short period of time, the affidavit states.
A medical board investigator made an unannounced visit to Diaz’s clinic on Sept. 9, 2010, and interviewed him a month later, according to the affidavit. The document says Diaz defined addicted patients as people who doctor shop, go to various pharmacies, forge prescriptions or claim to have lost them, and have overdose-related emergency room visits.
“Pseudo-addicted” patients, he told the investigator, are more tolerant to pain medications but still have real pain so they need stronger amounts prescribed, the affidavit says.
“Therefore, when Diaz becomes aware that a patient is a pseudo-addict, Diaz makes the adjusment in the medication so the patient does not buy medication off the street,” the affidavit states.
The investigator asked Diaz about one particular young woman, who had been prescribed 7,000 pills over 15 months, had multiple emergency room visits because of overdoses, had been in and out of rehabilitation, admitted to buying drugs on the streets and used multiple pharmacies. Diaz called the patient “pseudo-addicted,” according to the affidavit.
An Anthem Blue Cross insurance investigation between June 2007 and May 2010 studied the case of that same patient, who billed a total of $235,431.34 for narcotic painkillers like OxyContin and Vicodin during the period.
The patient’s mother called Diaz’s arrest “a wonderful victory for all of us who have worked to shut him down.”
The woman’s daughter ended up in the emergency room last summer after being prescribed 100-milligram tablets of morphine and she crashed her car into a tree. Since then, she’s checked herself into a recovery program and is “doing very well,” her mother told Noozhawk.
“I’m just joyful,” she said. “I was ecstatic when I heard the news.”
The parent reached out to the medical board twice during her ordeal, once in 2009 and once last summer. The first time, she said, a year went by before the board responded to say it had received her complaint about Diaz. She placed a call to the board about Diaz, and was told there were no doctors by that name in the system.
“I think they are pretty much a waste,” she said of the board. “They should have done something years ago, but at least something is being done now.”
While waiting for a response from the board, “I had no idea what was going on,” she said. “I felt that they weren’t proactive ... Everybody knew about him. Even school counselors told me about him years ago.”
In 2011, the board didn’t respond to her letter, but the parent said she was contacted by the DEA, which wanted to interview her daughter.
According to Wood, the medical board spokesman, all incoming complaints to the board are reviewed for validity.
“Obviously, if it’s serious enough, automatically an investigation gets opened,” he said.
Physicians have been filing complaints against Diaz for years, but that doesn’t make a difference when it comes to spurring a medical board investigation.
“Just because a complaint was made by a doctor doesn’t necessarily give it more validity than if it was made by some bum on skid row,” Wood told Noozhawk. “Just because he is a medical professional, just because he went to school, doesn’t make him any more credible than anybody else.”
A medical board investigator and a state deputy attorney general work together until a case is closed for lack of sufficient evidence or accusations are filed, he said.
“They have to take their time and be very careful and make sure all T’s are crossed, all I’s are dotted, because they’re building a case that might ultimately go before the medical board to determine the future of this doctor,” Wood said.
The medical board’s annual report shows the median times to process a complaint for 2010-2011 were 77 days for the complaint unit, 283 days for investigation, 72 days for the state attorney general preparing accusations and 324 days for “other stages of the legal process,” including action after charges are filed.
California’s medical board is under increasing scrutiny after Public Citizen, a nonprofit consumer advocacy organization, issued a report last September that called on Gov. Jerry Brown to take more forceful action to discipline dangerous doctors.
Public Citizen reported that the medical board has failed to take action against 710 physicians, all of whom were disciplined for wrongdoing between 1990 and 2010 by California hospitals, health maintenance organizations, ambulatory surgical centers and other health-care organizations. Of the 710 doctors, none of whom were named, 102 were designated by peer reviewers as an “immediate threat to health or safety” of patients, the watchdog group says.
The medical board received 7,122 complaints in the 2010-2011 reporting period (583 more than the previous year) and opened 1,338 investigations. Additionally, 594 cases were referred to the state Attorney General’s Office for disciplinary action and 41 were referred for criminal action.
Thirty doctors were disciplined for inappropriate prescribing last year, with six licenses revoked and five surrendered.
During research for Noozhawk’s Prescription for Abuse series last year, allegations about Diaz’s prescribing habits could not be independently verified. State databases contained scant information — and no complaints. Santa Barbara County civil court documents revealed a medical malpractice case and another case of negligence, both of which Diaz settled.
While Diaz works with a Spanish-speaking community that is underserved locally, area physicians have long asserted that his prescribing habits are dangerous and they question the medical board’s lack of response.
Diaz was never on a local hospital’s medical staff, so physicians and hospital administrators had no jurisdiction to initiate a peer review process or file record requests.
Dr. Chris Lambert, an emergency room physician, now heads up Cottage Health System’s Frequent Opiate User Program, which monitors patient prescription histories to determine if they’re seeking additional drugs. He remembers colleagues filing complaints about Diaz with the medical board as long as 12 years ago.
They had been “kind of blown off and gave up in frustration,” he said. “There was this big black hole there where we didn’t know what anyone was doing.”
More recently, physicians were also asking the DEA to restrict Diaz’s prescribing license to deal with the perceived overprescribing of controlled substances, Lambert said. Diaz’s registration with the DEA allows him to order, prescribe, administer and dispense controlled substances.
“If we thought of this 15 years ago, there would have maybe been a way to save an otherwise functional physician,” Lambert added.
Even with Diaz’s licenses unblemished, many local pharmacies would not fill his prescriptions. CVS has “blacklisted” his narcotic scripts since 2008 and Sansum Clinic’s pharmacy will not accept them either, according to the affidavit.
In a 2009 complaint to the medical board, other physicians said having one of Diaz’s patients come into the emergency room because of an overdose was a monthly occurrence, at least.
Lambert started working with DEA investigators in 2009 and charted more than 400 emergency room visits among Diaz’s patients in just a two-year period.
“I found that (the medical board) is amazingly closed-mouthed and yet, if you look at their monthly newsletter, some of the things they jump on physicians for, like incorrect entries on records, they pale in comparison to this case,” Lambert said.
“There must be some reason why it didn’t get done; how come there is not a quicker way for physicians, patients, any interested parties to get action on these things?”
Dr. Robert Wright, a pulmonary and critical-care medicine specialist who works with Cottage Health System, had similar sentiments.
“Despite assurances otherwise, this case demonstrates how poorly the Medical Board of California protects patients and consumers, and as a conscientious physician, it’s very disappointing to me,” he told Noozhawk.
On the law enforcement side, the Santa Barbara Police Department has been receiving complaints about Diaz from community members for five years, said Sgt. Aaron Baker, a narcotics supervisor. But he explained that acting on mostly anonymous tips was difficult when the alleged offense didn’t include distributing something that was objectively illegal, but prescribing above the professional standard.
The DEA already knew about Baker when SBPD contacted the federal agency, and police investigators immediately offered to help obtain records from Santa Barbara and Ventura counties and anything else to aid the investigation.
“We have all been waiting for this for years,” said Baker, who added that his office has been flooded with messages from former patients since Diaz’s arrest.
Other DEA agents had started working on the Diaz case, but it took one very dedicated federal officer to get it off the ground, Baker said. It’s not the biggest case, but “he didn’t care, he went full speed.”
“I’d still be subpoenaing people,” said Baker. “It’s nice when someone out of town is willing to help with a local problem, not just ones with a state or national impact.”
He said an added benefit is that federal drug charges have tougher sentences than state charges do.
Diaz, who Baker says was “cooperative” at his arrest and volunteered to accompany authorities to his office, will be arraigned in U.S. District Court in Santa Ana on Tuesday.
If convicted of the charge of illegal distribution of a controlled substance by a medical practitioner, he faces up to 20 years in federal prison.
“I think the community can kind of breathe a sigh of relief,” Lambert said of Diaz’s arrest. “A lot of people were anxious why it was taking so long ... a physician is being dealt with.
“Now we need to learn whatever lessons we need to learn and have a better system in place so it doesn’t take as long next time.”