Four Santa Barbara pharmacists have been accused by the California Board of Pharmacy of ignoring red flags indicating prescription drug abuse among patients, dispensing excessive controlled substances and duplicate pain therapies, filling prescriptions too early, and not keeping track of drug losses and overages.
The accusations of negligence and mishandling controlled substances stem from prescriptions written by a former Santa Barbara physician, Julio Diaz, who in August 2015 was convicted of 79 felony counts related to over-prescribing painkillers. Diaz was sentenced to 27 years in federal prison.
Starting sometime after Diaz’s 2012 arrest, the board investigated Sanjiv Bhalla of the former Medicine Shoppe at 1435 State St.; Peter Caldwell and Abdul Yahyavi of the former L.M. Caldwell Pharmacist of 1509 State St. and 235 W. Pueblo St.; and Steven Cooley, former owner of Sansum Clinic Pharmacy at 317 W. Pueblo St.
Although Diaz’s patients traveled all over Southern California to fill his prescriptions, the four Santa Barbara pharmacies were found to have serviced considerably more than other pharmacies in the city, according to the state board.
Late last year, Caldwell, who owned L.M. Caldwell Pharmacist, agreed to surrender his pharmacy license, as did Yahyavi, who supervised the Pueblo Street pharmacy. Caldwell also paid $15,000 to cover the costs of the board’s investigation and discipline.
Caldwell, who declined to comment for this story, closed both his pharmacies in early January, citing retirement.
Still pending are the accusations against Bhalla and Cooley.
At his trial in U.S. District Court in Santa Ana, Diaz — known to patients, authorities and some pharmacists as “the Candyman” — was found guilty on all 79 charges against him. He has appealed his conviction.
An affidavit accused Diaz of prescribing “profound” doses of drugs, including strong painkillers such as OxyContin, fentanyl and Dilaudid to patients. Authorities linked his prescriptions to 11 overdose deaths and hundreds of drug-related emergency room visits.
In the Board of Pharmacy complaints, the four Santa Barbara pharmacists are accused of ignoring or not adequately checking CURES, a database accessible to all licensed pharmacists in California that tracks controlled-substance prescriptions.
According to investigators, the CURES database showed clear evidence of doctor and pharmacy shopping, multiple pain therapies being prescribed, duplicate treatments, patients driving tens of miles to fill prescriptions, the same or similar prescribing patterns, and proof of other nearby pharmacists filling next to none of Diaz’s prescriptions.
The complaints allege that other red flags were ignored, such as potent drug combinations being prescribed, patients paying in cash for expensive prescriptions, and patients returning sometimes weeks early for refills.
In some cases, the investigations found, patients had no known diagnosis or the accused pharmacist did not know of a diagnosis.
Records and notes were found missing for some prescriptions and for some inventory sales, acquisitions and dispensations.
Although Caldwell surrendered his license in December, the board’s investigation started much earlier, said Virginia Herold, the Board of Pharmacy’s executive director.
She signed the original complaint against him, Yahyavi and the two L.M. Caldwell pharmacies in January 2014, two years after Diaz’s arrest.
“Sometimes it takes a long time to discipline a licensee,” she told Noozhawk. “It’s very much like the court system.”
The investigation found that, between late 2009 and early 2013, the pharmacies could not account for inventory overages of 187,927 tablets of hydrocodone/acetaminophen and 165 tablets of oxycodone.
Over that same period, they could not account for the loss of 14,160 tablets of hydromorphone and 6,050 tablets of oxycodone.
Herold said tiny irregularities in inventory are expected, though nothing near the losses and overages discovered at L.M. Caldwell Pharmacist.
A loss of, say, two pills in six months would show a pharmacist is keeping close tabs on his or her inventory, she said. Many, however, don’t check that closely for such a small loss.
The board requires lost controlled substances to be reported to it within 14 days. Substantial losses must be reported to the U.S. Drug Enforcement Administration within 30 days.
According to the complaint, Yahyavi told a Board of Pharmacy inspector in 2013 that he knew of Diaz’s “Candyman” nickname. It also alleged that Caldwell was aware that Diaz was not a pain-management physician.
Yahyavi, who was the Pueblo Street drugstore’s supervising pharmacist until October 2014, could not be reached for comment.
The investigation into the Sansum pharmacy and Cooley began the month Diaz was arrested. Herold’s complaint, dated May 2015, contends that the store “dispensed one of the highest volumes of controlled-substance prescriptions written” by Diaz — 1,840 prescriptions totaling 269,224 dosage units.
Cooley, who is scheduled to appear at a hearing on May 23 at the Los Angeles location of the California Office of Administrative Hearings, could not be reached for comment.
A Sansum pharmacist told Noozhawk that Cooley had retired a couple of years back and no longer owns the pharmacy.
Herold is seeking to revoke or suspend Sansum and Cooley’s licenses and require them to cover the costs of the investigation and enforcement efforts.
The complaint against Bhalla of the former Medicine Shoppe seeks the same discipline as it does for Cooley and Sansum. That complaint was dated December 2015 and also signed by Herold.
Last December, Bhalla had a settlement conference at the Office of Administrative Hearings, and has further hearings scheduled this week in Los Angeles.
While a Medicine Shoppe at 3605 State St. is still around, Bhalla’s Medicine Shoppe closed abruptly in 2013, and he now works for another pharmacy in Westlake Village.
He, too, declined to comment for this story.
The DEA and the Board of Pharmacy maintain that pharmacists, like doctors, have a responsibility to ensure that prescriptions are filled for legitimate purposes, and that patients’ drug therapies are suitable for them.
“Frequently, in a case where there are substantial violations of corresponding responsibility, (discipline) could be revocation of a license,” Herold said.
She added that, if he wanted to, Caldwell could re-apply after three years to have his pharmacy license reinstated. The board’s recent case against him, however, would have to be considered during the application process.
She confirmed, however, that if pharmacists are not acting responsibly, and no individuals come forward with concerns, improprieties like those found during investigations of L.M. Caldwell, Sansum and The Medicine Shoppe can continue unabated.
If serious misconduct is suspected, the board investigates it, an accusation is filed, and the licensee can either go to an administrative hearing or settle with a stipulation, as Caldwell did when he agreed to surrender his license.
The board then evaluates the charges and the proposed discipline or stipulation, and votes on whether they’re appropriate.
“Unfortunately, Caldwell’s case is not unique,” Herold said. “We find pharmacies where this happens.”
— Noozhawk staff writer Sam Goldman can be reached at sgoldman@noozhawk.com. Follow Noozhawk on Twitter: @noozhawk, @NoozhawkNews and @NoozhawkBiz. Connect with Noozhawk on Facebook.