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closeA pharmacist who was working for a national retail chain in Macon when Spurgeon Green had a medical practice in Perry testified Wednesday that her colleagues refused to fill Green's prescriptions.
"There were many red flags that came up," said Pam Smith, who worked for a Wal-Mart in Macon in late 2001 and early 2002 when pharmacists working there decided not to fill prescriptions written by Green, she testified.
The suspended doctor, physician's assistant Dorothy Mack and Jack Joseph, a pharmacist whose business was near the doctor's office, are on trial in federal court in Macon for allegedly conspiring to distribute drugs "not for a legitimate medical purpose and outside the usual course of professional practice" from January 2000 to July 2003.
The 118-count indictment charges that Green distributed medications that led to the deaths of seven people as well as serious bodily injury to six other people, who died in instances in which the drugs prescribed were a contributing factor.
Mack is implicated in three of the death charges and two of the serious bodily injury charges, while Joseph is implicated in four of the death charges, according to the indictment.
Smith, who now lives in North Carolina, testified that the "red flags" included the same, or similar, "cocktail" of drugs - Oxycontin, Soma, Loritab and Xanax - being prescribed for almost all of Green's patients.
Smith testified that other pain specialists typically prescribed varied prescriptions and alternative options, such as patches, to tailor medications to the needs of individual patients - as opposed to the "blanket prescription" that Green wrote for his patients.
Green's patients were often prescribed the highest dose of Oxycontin, which is 80 milligrams, even though they did not appear to be "visibly hurting" when they picked up their prescriptions, Smith said. That was another red flag, she said, because the highest dosage is most often reserved for patients in the most severe pain, such as cancer patients.
O. Hale Almand, a Macon attorney representing Green, asked Smith about whether people who are being treated long-term with Oxycontin can build up a tolerance in which the higher dosage is needed for the painkiller to remain effective. Smith said that does happen.
The attorney also asked whether she would expect a person with severe back pain for which the medication was working to be bent over with a cane. Smith answered, "Probably not."
Smith testified that Joseph was a fill-in pharmacist at the same Wal-Mart where she worked. But when questioned by Charlie Cox, a Macon attorney representing Joseph, Smith said she could not pinpoint when Joseph quit working there.
Al McConnell, a pharmacy supervisor for CVS in Atlanta, testified he was working at the national chain's Perry store in spring 2002 when he became concerned about narcotic prescriptions written by Green.
Among the red flags that McConnell noted were multiple patients getting the same or similar drugs, and many traveling together.
McConnell testified he was advised to keep filling the suspect prescriptions by a representative of the Georgia Drugs and Narcotics Agency who told him Green was under investigation.
Under questioning by Cox, McConnell, who was working at the Perry pharmacy in September 2002, testified that he either filled or authorized the filling of five prescriptions, including Oxycontin, for one of Green's patients identified as Thomas Bacigalupo - one of 13 patients under Green's care who died during an 18-month period.
James Benjamin Bartlett, a Perry pharmacist, testified he stopped filling prescriptions for narcotics from Green because he felt a lot of the physician's patients were abusing the drugs.
Bartlett opened the Perry Drug Co. in July 2002 and stopped filling narcotics written by Green within the first two or three months of operation, he said.
One of the red flags noted by Bartlett was that Green's patients often paid cash for the narcotics - plunking down as much as $500 or $600 at a time.
He also noticed that many of Green's patients would "car pool" to the pharmacy. He testified that many came from distant locations - another red flag, the pharmacist suggested.
Bartlett testified he saw track marks on one of Green's patients and saw others who were visibly under the influence of drugs while in his pharmacy.
The pharmacist testified he questioned Joseph once about why he continued to fill prescriptions written by Green for narcotics.
"I told him I felt like he was doing the wrong thing, that he was headed in the wrong direction," Bartlett said.
In spring 2003, he said, he had a verbal confrontation with Green, who showed up at his pharmacy one day and told him he wanted to buy it.
Bartlett testified he told Green he felt like the doctor was "running a dope house." Green responded that he was a legitimate pain specialist who even checked between his patient's toes, the pharmacist said, apparently for needle marks indicating drug abuse.
When questioned by Almand about his license once being placed under a two-year probation, Bartlett testified the probation was the result of his giving antibiotics for a prescription that a patient had had previously for a urinary tract infection. The patient was later arrested and the improperly labeled bottle with the antibiotic was found on the patient, Bartlett testified.
Testimony is expected to continue today.
To contact writer Becky Purser, call 923-3109, extension 243.
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