Opinion ID: 613517
Heading Depth: 2
Heading Rank: 4

Heading: Death of Patient Victoria Ross

Text: Before patient Victoria Ross first saw Webb, she ran her own business and supported her family. Before she first encountered Webb professionally, Ross took Lortab for her back pain, but neither the medicine nor the pain interfered with her ability to function. Ross's sons testified at trial that they noticed changes in her appearance and behavior after she became Webb's patient and he prescribed her OxyContin. Ross stopped caring as closely for her son, lost significant amounts of weight, and even lost her business. These changes were evident not only to Ross's family, but to outsiders as well. According to her husband, Ross eventually became addicted to the oxycodone Webb prescribed and injected it intravenously. Ross routinely asked for and received early prescription refills, despite Webb's notations in Ross's file that he would refuse to issue early refills. Over the course of treating Ross, Webb became aware that Ross was seeing and getting drugs from other doctors, but relied on her representations that she would see only Webb going forward. Pharmacists also gave Webb indication that his prescription practices might be contributing to Ross's misuse of drugs. However, when one pharmacist refused to fill a prescription because it was too early, Webb called another pharmacy to have the prescription filled there. Webb also continued to call in prescriptions for Ross after a pharmacy alerted him to the possibility that Ross may have altered a prescription for OxyContin. Webb failed to contact a family doctor who a pharmacy told him was also prescribing OxyContin and Lortab for Ross. Although Webb knew that Ross had been hospitalized for endocarditis, a heart valve infection that can indicate IV drug usage, he did not request medical records from her hospitalizations. Those records would have revealed that the cause of Ross's endocarditis was in fact IV drug usage. However, when Ross got out of the hospital and asked Webb to prescribe the same drugs she was on prior to her hospitalizations, Webb wrote that he had `no problem with that' because Ross was a responsible and compliant patient. After being absent from early 2004, Ross returned to Webb's office in the summer of 2004 complaining of increased lower back pain. Webb took no additional history, but simply prescribed 28 tablets of OxyContin 40 mg, 28 tablets of Percocet 10 mg, 30 tablets of Xanax 2 mg, the highest available strength, and 30 tablets of Soma. Although he was not referring specifically to Ross, the government's expert explained that it is dangerous to prescribe the same amount of drugs to a patient following a gap between visits without documentation of someone else... prescribing in the intervening period and the patient still [having] the same tolerance because of the risk that a patient has lost their tolerance for the medication, which could cause an accidental overdose. Ross filled the August 15 prescriptions on August 15 and 16, 2004. Ross collapsed on August 25, 2004, and died at the Fort Walton Beach Medical Center on August 27. The medical examiner determined that the cause of death was acute oxycodone intoxication. Despite the fact that Ross had an unhealthy heart, the medical examiner determined that an accidental drug overdose was the more likely cause of death because: (1) of Ross's long history of drug abuse and (2) Ross's heart was restored to a normal rhythm after she collapsed, which is unusual in cases of heart death. Dr. Parran stated that Webb's prescription practices as to Ross were inconsistent with the usual course of medical practice and appear[] to be for other than legitimate medical purpose and, to within a reasonable degree of medical certainty, [were] direct contributor[s] to [Ross's] death.