Joan Thomas is several hundred thousand dollars richer today than she was last year. The money will make a huge difference for the small grandmother, who has depended on about $400 a month from her late husband's pension for the past 20 years.
Thomas can thank her attorney for her recent financial windfall. Her attorney and her tape recorder.
On May 28, 2004, from the black phone in her Mocks Crest living room, she called her psychiatrist, Dr. William Lee Newton. Then she pressed "record."
During the call, the patient and her doctor conversed about all manner of things, from his new terrier to his plans for a golf lesson. Then Newton got to the point: "Do you have some Oxy's?"
Thomas, 57, mumbled, "Umm."
"If you don't, it's fine," Newton said. "But you owe me some."
Last month, a Multnomah County jury awarded Thomas nearly $600,000 in malpractice damages, finding that Newton had been negligent in his treatment of his patient. During the trial, Newton admitted to prescribing Thomas a number of medications, and then taking some pills for his own use. He also said he'd paid her to obtain OxyContin, a powerfully addictive prescription pain medication, and allowed his professional boundaries to collapse.
Newton's case underscores the risks of addiction among physicians, who are, according to the Journal of the American Medical Association, far more likely than the general population to become dependent on prescription drugs. Psychiatrist Marvin Seppala, the Newberg-based medical director of Hazelden, one of the oldest U.S. substance-abuse centers, says doctors often succumb to the delusion that drugs in bottles are safe.
"There's this cavalier sort of casual attitude about it: 'I'll just treat myself because I don't want the hassle,'" Seppala says. "But the risks are so significant."
Today, Newton continues to treat about 60 patients, including recovering addicts, in a stately white house at 2386 NW Hoyt St. that he shares with 10 other psychiatrists.
Perhaps more disturbing, the state-mandated board responsible for licensing and disciplining doctors has neither conducted an investigation nor sanctioned Newton, even though Thomas says she complained to the board almost two years ago.
The Oregon Board of Medical Examiners has faced recent criticism for failing to act on complaints about a former Portland surgeon who now faces charges of manslaughter in Australia (see page 11). In Newton's case, the board insists it never received a complaint.
"I have absolutely no doubt that they are concealing their knowledge of this case," says lawyer Greg Kafoury, who represented Thomas. "It's clear that the board exists to protect doctors and that they derive their power...by pledging to protect consumers."
Slouched in a chair in his second-floor office—his walls crowded with Japanese poster art and watercolors—Newton seems distracted by the view out his window. The 60-year-old psychiatrist has neatly trimmed white-gray hair and rimless glasses. A glass case engraved with the words "Knowledge Is Better Than Rubies" is filled with books and bird figurines.
"I just can't talk about it," he says. He throws his hands in the air and flutters his fingers. Rising to show his guest the door, his 6-foot-2-inch frame wavering unsteadily as he walks, he adds, "Nothing like this has ever happened to me."
"This" is the trial he has just endured, an ordeal that has created an unwanted bit of notoriety in an otherwise successful career. Newton graduated from Ohio State University's med school in 1971 and moved to California for his internship, residency and private practice. He relocated to Portland in 1992 with his new wife, Nelda, 16 years his junior, and bought a $669,000 home on Southwest Montgomery Place.
One of his first clients was Joan Thomas, a widowed mother of three who came to him in 1993 with a lifetime of unsolved problems, from anxiety and panic attacks to a history of drug addiction.
Thomas was looking for guidance after finally kicking a 10-year addiction to Xanax, a habit-forming anti-anxiety drug meant to be used in eight-week intervals.
Her dependence on prescription drugs had started in the early '70s, when a gynecologist performed a hysterectomy—later determined to be unnecessary—and gave her Percocet, Percodan, Valium, morphine and Dilaudid for her pain and anxiety In 1978, after years of abusing pills and even heroin, she checked herself into detox at Woodland Park Hospital. She struggled to stay clean for the next 14 years, relying heavily on Xanax after kicking methadone in 1985. She returned to Woodland Park in July 1992 to purge her system once again.
"Being dependent is terrible," Thomas says. "One day you wake up and you find out it's not a choice, it's a necessity. It will ruin your life."
Thomas had been clean for more than six months when she arrived in Dr. Newton's office in March 1993. Over the next 11 years, she would visit almost every week, sometimes twice, and ring up nearly $100,000 in fees.
From the beginning, the relationship between Thomas and Newton had the intimacy of a friendship. Thomas says she came to know quite a bit about her quirky psychiatrist, who often called her at home just to chat.
"With me he would just, you know, let it all hang out," Thomas says. "He was comfortable."
She knew his grooming and shopping habits: pressed-sesame oil for his skin and the men's half-yearly sale at Nordstrom. And how he got his entertainment: cocktails at Fernando's Hideaway or the Veritable Quandary. She knew how happy he was when the Multnomah Athletic Club finally accepted his application in the late 1990s.
Thomas was always looking for cultural outlets, like speaking on a panel discussion about the 1975 movie One Flew Over the Cuckoo's Nest or strolling through the Classical Chinese Garden downtown.
"They were hip people," Thomas says of her doctor and his wife.
Newton led intimate sessions with Thomas. The therapeutic purpose was not always obvious: They would comb through the New Yorker magazine looking for interesting stories and spent several visits writing haiku poems, including one about a brown leaf falling from a tree onto a car windshield.
Newton would occasionally ask Thomas to hold their sessions outside the office, in Southeast's Crystal Springs Rhododendron Garden or the Japanese Garden at Washington Park, where she met him once with her grandson.
Such outings are not typical of psychiatry.
Seppala, of Hazelden, says psychiatrists are trained with an expectation, if not specific rules, that they won't behave in ways that turn the professional relationship into a friendship. That means not sharing personal information and avoiding recreations that have no therapeutic purpose.
"You need to gain information from the person who comes in, and it's a remarkable privilege," he says, "which comes with incredible responsibility. You have to treat that person as a patient and not as a friend, and yet you need to have empathy and be able to put the person at ease. A doctor has to maintain those boundaries. "
While Newton's relationship with Thomas may have been atypical, he crossed an entirely different line when it came to his aggressive use of prescription medications as therapy.
Newton confided early on that he enjoyed recreational drug use.
Thomas says he told her he was sad Quaaludes had been taken off the market and said he'd taken pills with other young doctors back in California. "If he had a martini and a Xanax," Thomas says he once told her, "it was a pretty nice ride."
Although Thomas had a history of dependence on Xanax, Newton put her back on it the same month she arrived in his office—adding several additional mood-altering drugs. "He told me I would always be on something," Thomas says.
According to the medical records submitted at trial, Newton kept Thomas on a steady diet of the powerful anti-anxiety drug, adding layers of anti-depressants and occasionally anti-psychotics, including Prozac, Ativan and Wellbutrin. On at least two occasions, Thomas filled two Xanax prescriptions during the same time period. According to the Oregon Board of Pharmacy, which monitors the dispensation of controlled substances, the prescriptions wouldn't have drawn the attention of authorities unless an individual pharmacist noticed the irregularity and called the BME.
There's no question psychiatry relies heavily on the use of medication. Over the past 40 years, the field has shifted from its roots in Freudian and Jungian psychotherapy toward a heavy reliance on pharmaceuticals to help combat anxiety, depression, sleeplessness and deeper psychoses.
But, according to a psychiatrist who analyzed Newton's records for trial, the physician violated industry standards in his use of prescription drugs. Even after Thomas recovered from a brief dependency on OxyContin in 2001, Newton prescribed more strong narcotics, including clonidine, Tylenol 4 and Vicodin. He also gave her so much Xanax that he had to give her brain stimulants, including Provigil and Gabitril, to counteract the depressive effect of the anti-anxiety medication.
In addition, it wasn't clear how much therapy or psychoanalysis was taking place. According to Dr. Gary Jacobsen, a psychiatrist who reviewed Thomas' medical records and testified on her behalf, the doctor's notes of his sessions with Thomas were often only one or two words long.
Dr. Randall Green, a clinical psychologist who also analyzed Thomas' medical records, wrote in a forensic report prepared for the trial that Thomas "suffered significant negative consequences as a result of" Newton's care.
"Dr. Newton appears to have engaged in conduct that seriously undermined her continued abstinence from addictive substances through his prescriptive practices, communications to the patient and solicitations of drugs from her," Green wrote.
As Newton continued to increase his patient's daily intake of Xanax and other drugs, Thomas says she grew increasingly lethargic and depressed, often refusing to leave the house for days.
Then, in 2000, Newton wrote a prescription for Percocet, a narcotic painkiller. His chart notes make no mention of why his patient needed the medication. There are no specific rules prohibiting psychiatrists from prescribing medications that have nothing to do with mental health—including the painkillers Newton prescribed for Thomas.
The volume of drugs Newton prescribed may have exceeded the norm, yet until 2000, his actions were not so unusual as to attract attention. But sometime that year, Newton's treatment took on an entirely new dimension—he started asking his patient to give him pills.
Thomas testified that during sessions, her doctor would ask to see the bottles she kept in her purse—bottles of Xanax and Percocet he had prescribed. He would open the bottle and shake 10 to 20 pills into his hand. "He said, 'Do you mind?'" she remembers. She said under oath that when she asked him why he needed the pills, he told her, "For my back."
Thomas says her doctor took a dozen or more pills from her almost every week for the rest of her time under his care.
In November 2001, she confided to Newton that a friend had given her some OxyContin and said she feared she had developed a dependence. He wrote her a prescription for the narcotic and instructed her how to taper off of the drug.
Months later, Thomas says, her doctor asked, "You got any more of those?"
He was asking for OxyContin, which she began to supply, obtaining them through a friend who she says had a prescription. In addition, she continued to let him skim from the Xanax and Percocet he prescribed for her.
Over the next two years, she made at least a dozen deliveries of OxyContin pills. The doctor paid her with cash or discounted her visits, according to court testimony.
In a deposition taped on Sept. 15, 2005, Newton admitted to many of Thomas' allegations, including taking Xanax from bottles he prescribed for her and asking her to find OxyContin. He said he couldn't remember whether he'd taken any other drugs from his patient.
Newton explained he needed the drugs because he was recovering from a back injury. Asked why he didn't get his own doctor to prescribe a pain reliever, he said: "I don't know if I have a clear answer that I can explicitly even tell myself ... Partially it was a whim. I had never had OxyContin, and I didn't even know what they would be like. So it was a whim; bad judgment, but a whim."
Neither state law nor the Board of Medical Examiners' administrative rules prohibit doctors from writing their own prescriptions, but the board strongly discourages the practice. While Oregon is one of 29 states without a monitoring system for prescription drugs, individual pharmacists can and do report physicians who appear to be abusing their prescription-writing privileges to the medical examiners' board, which investigates an average of 35 doctors on prescription-related cases a year.
In late April 2004, Thomas' close friend Kathleen Borrusso, 65, went to Newton's office to express concern about the number of drugs the doctor had prescribed for her friend—which by now included several prescriptions for Vicodin, another narcotic painkiller. When Borrusso touched on news of Rush Limbaugh's addiction to painkillers, Borrusso says, Newton ended the conversation.
"He just got me out of the office real quick, like, 'Your meeting's over with,'" Borrusso said recently. "And that blew the whole case up right there."
On May 15, 2004, Thomas called Newton at home. Still sore over Borrusso's visit, Newton erupted at Thomas. He screamed that she had interrupted his daughter's birthday and told her he was firing her as his patient and would have her arrested if he came to his office.
Two weeks later, she called him at his office and taped the phone conversation in which he asked her for OxyContin. Twenty months later, a jury found in her favor.
This might have been the end of the story. A doctor with a drug problem and a patient who enabled him.
Except for the fact that in 2004, Thomas says, she called the Board of Medical Examiners.
One morning in late May, Thomas and her friend Julie Peters say, they met a stout woman from the board at Thomas' house. They both describe her as a short woman with close-cropped hair and conservative clothes. Sitting in her back yard, Thomas described her relationship to Newton and how he had been taking drugs from her. When Thomas started talking about her doctor's drug use, she says the investigator turned stone-cold.
"She said I should get a lawyer, that I was making serious allegations," Thomas says. Thomas says the woman left without ever taking notes.
Jeannie O'Hara, another friend, arrived halfway through the interview. But she caught the important part: "The end message was, 'Well, you better get an attorney because you've been engaged in illegal activities,'" O'Hara says.
Doctors who take pills without a prescription can be charged with breaking state and federal drug laws. They may also have violated the BME's standards for acceptable treatment. Yet BME director Kathleen Haley says there has never been an investigation of Thomas. She said no one at her agency recalls the 2004 meeting with Thomas.
It would be hard for the board to prove that no one visited Thomas' home. Record-keeping duties are minimal for the board's three full-time investigators. There are no requirements to make a written log of incoming phone calls or of field visits to interview patients who have not filed written complaints.
Today, Thomas is waiting to receive her check from Newton's malpractice insurer and trying to find a new psychiatrist. She shares her North Portland home with a roommate and three birds.
And Newton? In 2004, not long after her husband's deposition, Nelda Newton filed for divorce. She also won a restraining order against William, citing prior physical abuse. The psychiatrist, who still has a busy workload, lives in an apartment on Southwest Vista Avenue.
According to Newton's deposition, he now attends Alcoholics Anonymous, Al-Anon and a codependency meeting. While physicians are required to notify the BME if they become impaired by substance addiction, they can avoid official sanction by participating in a diversionary process called the Health Professional Program.
The BME, meanwhile, will soon receive official notification of the malpractice suit from Newton's insurance provider. Then the board, perhaps for the second time, will have an opportunity to open an investigation.
The board refuses to say whether it will do so.
THE LORDS OF DISCIPLINE
Of 329 investigations opened last year, the State Board of Medical Examiners disciplined 44 doctors and sent corrective orders, which typically require doctors to undergo extra training, to another 12. About 35 cases of inappropriate prescribing were investigated annually in the past three years. The board issued orders for discipline or corrective actions in eight cases last year involving improper prescription-writing.
Most of the state Board of Medical Examiners' investigations concern violations of "the standard of care," a broad definition of acceptable treatment. The board decides whether standards have been met on a case-by-case basis with the input of expert testimony from other doctors.
Newton may be in violation of state and federal laws including Oregon laws against the posession of a controlled substance and sections of the federal Controled Substance Act that ban diverting prescription drugs.
The Oregon Board of Medical Examiners is required by law to report any criminal activity—such as the illegal use or sale of controlled substances—to prosecutors or the police.
OxyContin is a time-released tablet with 10 to 160 milligrams of the narcotic oxycodone; the same painkiller is used in drugs like Percodan, but in much smaller amounts. Like heroin and other opiates, it causes the reward center of the brain to produce increased levels of dopamine, producing a feeling of peace and well-being. Unlike heroin, the time-released formulation allows users to function normally.