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Saturday, Oct. 11, 2008

Testimony at Perry doctor trial emotional

Judith Maiolo Thompson broke down in tears Friday at the U.S. District Court in Macon as she read a handwritten note aloud on the witness stand.

It was a note she had written years earlier and gave to a lady at the front desk at Perry Dr. Spurgeon Green Jr.'s office while her friend David Barbari of Wayne County was in the exam room waiting to be seen.

She pleaded in that note for the doctor to stop prescribing narcotic painkillers to her friend, one of 13 patients who died under the care of Green during an 18-month period.

Green, now suspended, his physician's assistant, Dorothy Mack, and Jack Joseph, a pharmacist, are on trial for allegedly conspiring to distribute drugs illegally from January 2000 through July 2003.

The 118-count indictment charges that Green distributed medications leading to the deaths of 13 people.

Mack is implicated in five of the deaths, while Joseph is implicated in four, according to the indictment.

Thompson testified that she had written the note in the waiting room of Green's office where she'd agreed to take Barbari at his mother's request to find out where he was getting the drugs.

Despite her plea, she said Barbari left the office that day with seven prescriptions in his hand.

That note was recovered by Houston County sheriff's narcotics investigators from the doctor's trash bin behind his office.

Also Friday, defense attorneys questioned Dr. Barry Straus of the North Georgia Pain Clinic, who testified last week that Green provided substandard care, including prescribing and dispensing powerful narcotics, that led to the deaths of the 13 patients.

The medical expert's two days of testimony included allegations that Green failed to check medical histories, verify patient prescriptions, did not conduct generally accepted exams, failed to document patient history, ignored red flags of prescription abuse or diversion, failed to offer alternative treatments to narcotics for pain management and/or altered patient records.

Straus also testified that treatment provided by physician's assistant Mack, in conjunction with Green, led to five of those deaths.

Franklin J. Hogue, a Macon attorney representing Mack, questioned Straus about his allegations that Mack participated in the falsification of computerized medical records of patients.

Under Hogue's questioning, Straus testified Friday that he was unaware that Mack was either employed elsewhere, or later on maternity leave when employed by Green, when the computerized records for two patients indicated she was the treating physician.

Straus also was questioned by Hogue about a deposition he'd given in 2005 in a medical malpractice lawsuit that Straus was later dismissed from. In the deposition, Straus testified that a notation was not made in the file about the patient who had initiated the lawsuit declining to set a date to have a diagnostic test.

Straus had testified last week that if a patient's record did not included a notation of an exam or a test, that the rule of thumb in the medical profession is that it didn't happen. Straus testified that since that incident, all records are required to include notations when recommended tests are declined by the patient.

Hogue also questioned Straus about Jack Smith, the retired auto salesman turned undercover operative in the sheriff's investigation against Green, who subsequently became a patient of Dr. Efrim Moore, a partner in Straus' medical clinic. Straus was asked why Moore's chart on Smith, to whom he prescribed narcotic pain medication, was absent of a notation that his previous records were requested. The chart of Smith's first office visit also indicated there had not been a doctor's referral for Smith.

Straus had testified last week that previous medical records and doctor's referrals typically found in the patient records of people suffering from chronic pain were absent in Green's patients files. Straus told jurors Friday that it's impossible to get an appointment with one of the doctors at his clinic without a referral, so there had to be a mistake. He also said what was being looked at in court was only part of the medical file.

Also, Hogue questioned Straus about Moore's current status of probation with the Composite State Board of Medical Examiners in Georgia. Straus testified that Moore's probation in Georgia was related to Moore having to hand in his license in Kentucky in relation to how he verified prescriptions for weight-loss medications while practicing there.

Straus also was questioned by O. Hale Almand Jr., a Macon attorney representing Green, about prescriptions for narcotics for pain that Moore had given Smith "to be filled at a later date," which allowed him to go three months without having to be seen by a doctor.

Almand wanted to know what was the difference in Green allegedly post-dating prescriptions for his patients but requiring them to be seen by a physician's assistant every month in order to get their medications.

Straus testified that "to be filled at a later date" was legal and that post-dating prescriptions to be given out later by a physician's assistant was not. Almand's questioning of Straus also included Straus testimony about how the practice of filling prescriptions at a later date was once outlawed by the federal Drug Enforcement Agency but then reinstated after outcry from the medical profession.

Testimony is expected to continue Monday.

To contact writer Becky Purser, call 923-3109, extension 243.