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Rx for pain: 20 years of trouble

By Carol Gentry
3/12/2009 © Florida Health News

For 20 years, Dr. Mark Kantzler has been getting into trouble with prescription painkillers, records show.. Sometimes it’s from his own addiction, sometimes from the prescriptions he writes. 

He’s been suspended from practice twice. A newspaper featured him in a 2003 series on dangerous over-prescribers. He paid a $700,000 settlement in 2003 for a patient’s death from a drug overdose and now is being sued in another death. 

The plaintiff's attorney, Vince Barnett of Tallahassee, says Kantzler prescribed several kinds of painkillers and anti-anxiety drugs that interact in dangerous ways, a "drug soup that would have stopped an elephant."

Kantzler, who practices in the prosperous Pinellas County community of Seminole, denies responsibility. His attorney in the civil suit, Glenn Burton, praises the doctor’s courage and caring, saying Kantzler takes on the toughest cases, trying to alleviate pain in patients who have many different illnesses simultaneously. “He really cares about people,” Burton says. 

Health professionals can look at the same set of circumstances and disagree on whether a doctor has breached the law or ethics. Daniel Buffington, a pharmacology Ph.D. in Tampa, submitted an affidavitin the most recent suit against Kantzler saying the doctor "adhered to the standard of care." 

Some see the situation as evidence that state health authorities don’t do a good job of tracking and constraining doctors who prescribe large doses of narcotics for chronic pain patients, many of whom start out or become addicted. 

“Regulatory bodies in Florida continue to protect those who put our loved ones at risk,” says Clearwater pharmacist Larry Golbom, host of Prescription Addiction Radio

Florida has had several chances to set up an electronic database for prescribing of controlled drugs that could prevent prescribing to "doctor-shopping" addicts and pushers who pose as pain patients, but the Legislature has rejected it on the grounds of privacy. This year, several lawmakers -- including Sen. Mike Fasano (SB 462) and Rep. Kelly Skidmore (HB 583) -- are trying again.

Criminal prosecution, seen as a last resort, often backfires. On Thursday, the South Florida Sun-Sentinel reported, a jury in Miami-Dade acquitted Dr. Ali Shaygan of Miami Beach of illegally prescribing narcotics to addicts. Charges had been filed following the death of a patient from West Palm Beach.

A high-profile case that’s back in the news is that of the late Anna Nicole Smith, who died in Florida of an accidental drug overdose two years ago. Her Los Angeles doctor was charged on Thursday with illegally prescribing controlled substances to an addict.

Three boards that regulate Florida health professionals – Medicine, Osteopathic Medicine and Nursing -- met a few weeks ago to discuss how to deal with the problem. They agreed to support the prescription database and education efforts for health professionals and the public, but emphasized that they don’t want to scare doctors from prescribing pain medicine for cancer patients and others who desperately need it. 

Kantzler has not been been faced with any criminal charges. Instead, he’s had to deal with lawsuits and administrative complaints by the Department of Health. He is currently practicing on probation, with indirect supervision, on a January 2008 order from the Florida Board of Osteopathic Medicine following DOH charges of illegal prescribing in the care of six patients. (Kantzler accepted a settlement, neither admitting nor denying responsibility). 

One of the six patients, who died in October 2006 at age 48, was John Neckerauer of Largo. Last month his widow Colleen sued Kantzler and his practice, West Coast Personal Injury and Family Medicine in Seminole, citing negligence and over-prescribing as the cause of death. Kantzler’s attorney has filed a reply denying any responsibility.

Court documents and DOH records say that in 2003 Neckerauer went to Kantzler, who then was practicing in Madeira Beach, seeking help for back and neck pain after a traffic accident. Records show the doctor or his physician assistant prescribed large amounts of prescription painkillers, anti-anxiety medications and other drugs. An autopsy showed the amount of drugs in his system was two to three times the level that would have been toxic, the suit claims..

Kantzler’s difficulties with painkillers date back at least to 1989, state records show, when he entered an inpatient drug-treatment program for health professionals. A few months later, he returned to practice. Records show a urine screen in 1991 detected a drug similar to morphine in his system, and the state filed an emergency suspension of his license.

When Kantzler appeared before the osteopathic medical board a few weeks later, a psychologist from PRN , a private, state-sponsored program for impaired health professionals, said Kantzler could practice safely as long as he stayed in counseling and kept submitting to random urine screens.

Without admitting any wrongdoing, Kantzler agreed to pay a $2,500 fine and complete a course of drug rehabilitation. For the rest of the 1990s, DOH records indicate no trouble in his practice.

According to state insurance records, Kantzler has settled two malpractices cases, including one that claimed a patient died from an overdose of prescription drugs. Records show a settlement in 2003 for $700,000.

In December 2003, Kantzler was named one of the biggest prescribers of controlled drugs in the state by the Sun-Sentinel. Reporter Fred Schulte, who analyzed Medicaid records and other documents, wrote that eight of Kantzler’s patients had died of drug overdoses in the preceding three years.
State investigators began looking into his practice and filed a series of complaints charging over-prescribing in the cases of six patients, including Neckerauer (DOH records do not name patients except with initials, but the date of death and details of the case are the same as in the court complaint.).

In November 2007, Kantzler came before the osteopathic medical board and was offered a settlement that included a year’s suspension with six months’ stay, in effect putting him out of practice for six months. After negotiations, Kantzler agreed to a one-month stay. The agreement included five years’ probation with indirect supervision by another doctor who checks Kantzler’s records periodically; 200 hours of community service; some courses, including one on prescribing controlled drugs; and payment of an $18,000 fine and DOH costs of $19,500. Kantzler also had to return to screening and counseling with PRN, the Professional’s Resource Network.

Since the order went into effect in January 2008, Kantzler has been in full compliance with his probationary requirements, said Eulinda Smith, a spokeswoman for DOH. “He’s doing very well,” she said. “He’s made a turn for the better.” 

--Carol Gentry can be reached via e-mail or at 727-410-3266.