Opioid lawsuit targets doctors
In Purdue Pharma fight, state turns attention to prescribers
HARTFORD — After a car accident in 2005, Sarah Howroyd visited Dr. Ellen Malsky for treatment of her minor neck and back pain.
At her office in Stoneham, Mass., Malsky prescribed Howroyd 120 milligrams of the powerful opioid painkiller Oxycontin. Born in Manchester, Howroyd was a college graduate in her mid-20s. For the next 10 years, she would also be an opioid addict.
What Howroyd didn’t know in 2005 was her doctor was a “high-value target” of Purdue Pharma, the Stamford-based opioid maker fighting thousands of state and local lawsuits for its alleged role in fueling the opioid crisis.
Indeed, according to an amended complaint filed by the Connecticut Attorney General’s office Monday, Purdue Pharma maintained a secret list of doctors who were suspected of overprescribing opioids. Purdue Pharma has denied all allegations in the lawsuits.
Purdue sales representatives made numerous calls to those on the list of doctors to ensure they kept up the high volume of prescriptions, the complaint alleges. They were central to Purdue’s multibilliondollar profit strategy. They were responsible for nearly 10 percent of sales.
Purdue Pharma even gave this list of doctors a code name, “Region Zero.” Malsky was on the list. So too were “several Connecticut prescribers,” according
to Connecticut’s amended complaint.
At the moment, the Attorney General’s office will not name the Connecticut prescribers, nor reveal how many there were. But the state may take action against them.
The Attorney General’s office has no powers to bring criminal charges, so it has sent the Region Zero list to the state Department of Consumer Protection, which investigates prescribing complaints, said Kim Massicotte, special counsel for opioids in the Attorney General’s office.
“Rest assured that we have shared that list in Connecticut,” said Massicotte. “The Department of Consumer Protection is aware of those doctors and I am certain they will be paying close attention and doing whatever is necessary — if there is anything that can be done at this point.”
Massicotte declined to say whether the list had been shared with the state Department of Public Health, which oversees licensing for health care providers, but said the list was given to “all appropriate authorities.”
A DCP investigation into a doctors’ prescribing habits could result in a move by DPH to revoke his or her license, said Lora Rae Anderson, spokeswoman for DCP.
The Attorney General’s office got the Region Zero list as a part of a “trove of documents” available to states suing Purdue Pharma, Massicotte said. But the list must be kept confidential due to an order from a federal court in Ohio that is handling “multidistrict litigation” from multiple towns and counties suing the company.
If the state conducts its own investigations into Region Zero doctors in Connecticut resulting in criminal proceedings or license revocations, the doctors’ identities and other information may become public.
It is possible the state was already aware of the Connecticut-based Region Zero doctors through DCP’s prescription monitoring program. Controlled substances are entered into the program when they are dispensed by a pharmacist, Anderson said. It’s a way for doctors, pharmacists and regulators to keep eyes on a patients’ medication intake and flag dangerous or illegal prescribing.
The Attorney General’s office did not confirm whether the Connecticut Region Zero doctors have ever been subject to a DCP investigation or had their licenses revoked before filing its amended complaint, said Elizabeth Benton, spokeswoman for the Attorney General.
By contrast, when Massachusetts filed a lawsuit against Purdue Pharma last July, it included the names of many Region Zero doctors in its complaint and details on how they were targeted by Purdue Pharma. The doctors Massachusetts named had been convicted of crimes or had their licenses revoked.
The Massachusetts documents shows how Purdue Pharma went after doctors who engaged in inappropriate prescribing and pressured them to keep pushing opioids. The same tactics may have been used with Connecticut doctors.
Connecticut’s complaint shows between 2007 and
2016, Connecticut prescribers increased prescriptions of Purdue’s opioids by 67 percent.
Purdue Pharma promoted opioids to Malsky, who gave Howroyd her Oxycontin prescription, from at least 2006 to April 2011, the Massachusetts lawsuit states.
“My doctor’s office had office space for the drug reps,” Howroyd said at the Connecticut Attorney General’s office Tuesday. “I asked her point-blank if these drugs were addictive. She said no.”
Purdue’s records show that red flags about Malsky’s prescribing habits were apparent at least as early as March 2006, about a year after Howroyd’s visit.
“Purdue’s sales representative recorded a note that Malsky ‘has issues with legal use of prescribing,’ and again, in May
2007, when Malsky raised concerns about attracting too much attention to her prescribing,” the Massachusetts lawsuit says in part.
In December 2009, one of Malsky’s patients died from an overdose, a Purdue sales representative noted.
Purdue recorded when Malsky lost her affiliation with Blue Cross Blue Shield for prescribing too many opioids. The representative specified that “75 percent of those [Blue Cross] patients switched to other plans in order to stay in her practice.” Purdue kept asking Malsky to prescribe more of its drugs, the complaint states.
Purdue did not stop pushing Malsky to prescribe until a sales representative went to her office in 2011 to find it closed, according to the complaint.
“On April 22, 2011, Purdue finally told its sales representatives to stop promoting opioids to Malsky because she had surrendered her medical license,” the lawsuit says.
Malsky committed suicide 13 days later.
Howroyd, who now lives in West Hartford, wants Purdue Pharma held accountable for its role in pushing doctors to prescribe addictive painkillers.
“Purdue Pharma took away over a decade of my life,” she said. “They took away my innocence. They took away my dignity.”
There’s one more thing Howroyd lost to opioids. Her fiancé, whom she declined to name, was in the same car accident Howroyd was. He also saw Malsky. He also became addicted to opioids. In February 2016, Howroyd’s fiancé died from an overdose.
It was a long road, Howroyd said, but she is now sober and working on durg addiction prevention in Connecticut.
“Most people don’t come back from the darkness that I came back from,” she said.