Wednesday, July 12, 2006

Methadone Doctorl Facing Prescription-Forgery Trial (Portland Press Herald, July 11, 2006)

Methadone Doctorl Facing Prescription-Forgery Trial
Portland Press Herald
Tuesday, July 11, 2006

Four years after a series of overdose deaths drew attention to his Westbrook methadone clinic, Dr. Marc Shinderman will go on trial today in U.S. District Court in Portland.

The nationally known and controversial addiction-treatment specialist is not charged with causing those deaths. Instead, prosecutors say information collected in a 2003 raid of CAP Quality Care offices by armed federal agents created the basis for charges that Shinderman forged prescription slips and made false statements to the government.

If convicted, Shinderman faces up to five years in prison for each of the 16 allegations that he created false medical records, and four years in prison for each of the 52 counts of violating federal regulations on controlled medications. He also would face a $250,000 fine on each count. The business, which is owned by his wife, is the defendant in a civil lawsuit filed by the government.

The trial will also revive the debate about the public risks and benefits of methadone maintenance treatment for opiate addicts, and will bring unwelcome attention to 1,500 licensed clinics that treat 240,000 patients each day, said Dr. Marc Parrino, president of the American Association for the Treatment of Opioid Dependency in New York City.

"It's still strange for some people to embrace the idea that you would use a medication that is itself dependence-producing to treat dependency," Parrino said. "There is a stigma surrounding the whole community, and any news that involves methadone will not be a favorable event."

The trial is expected to begin with opening statements at 8:30 a.m. Testimony in the complex case is expected to last for nine days. The government plans to call as many as 50 witnesses, including patients and former employees of the five-year-old methadone clinic.

According to court documents, Assistant U.S. Attorney Donald Clark will present evidence that Shinderman wrote 15 to 20 prescriptions a week using another doctor's DEA number, and forged the doctor's name and initials on forms.

Shinderman, a psychiatrist with a valid medical license in Illinois, was denied a DEA permit to write prescriptions for controlled substances in Maine because he had only a temporary license to practice here.

In his pleadings, Shinderman's attorneys say he did nothing wrong. While acknowledging the use of Dr. Steven Keefe's drug-prescribing authority, they say Shinderman was engaged in legitimate medical practice with no criminal intent.

Shinderman communicated with federal regulators about his ability to write prescriptions and was "confused" about his status, in part because of instructions he was given that later turned out to be false.

"The government instigated the conduct it now characterizes as a crime and . . . (Shinderman) was completely without predisposition to commit it," wrote attorney Thimi Mina. Later, he referred to entrapment as his "central defense."

Shinderman, 63, has worked in addiction treatment for 30 years, starting methadone clinics in Illinois and Maine.

Methadone is a synthetic drug that can ease the cravings and withdrawal symptoms in people addicted to opiates such as heroin or morphine. Taken in the right dosage, it allows patients to function normally, despite their addiction.

CAP Quality Care opened in October 2001. The following year there were 28 overdose deaths in Greater Portland, and law-enforcement officials questioned whether the area's two methadone clinics, CAP and Discovery House, could have been responsible.

CAP came under special scrutiny for its policies that permitted patients to take home doses for several days, and for Shinderman's published opinion that most clinics' doses were too small to cure an opiate craving and prevent an addict from supplementing his habit.

A state study later found that about half the deaths were related to clinic methadone, and involved clients from both CAP and Discovery House. The rest involved abuses of prescription medication. The clinics tightened their take-home policies in response.

Shinderman remains controversial in the methadone community for his higher-dose recommendations. Parrino said Shinderman's reputation is good, however.

"He's seen as a person who cares about his patients," Parrino said.

On Sept. 9, 2003, agents from the DEA and U.S. Department of Health and Human Services executed a search warrant at
CAP Quality Care offices, seizing records and copying computer files. Last August, a federal grand jury returned the indictment against Shinderman, charging him with falsifying prescription records.

In his brief, Clark said the government would have to rely on hostile witnesses, including Keefe, who still works for CAP.

"Some witnesses may not only be reluctant to testify, they may also be reluctant to tell the truth unless continually prodded with multiple questions," Clark said.

He asked U.S. District Court Judge D. Brock Hornby for latitude to question some of the government's own witnesses more aggressively than usual.

Staff Writer Gregory D. Kesich can be contacted at 791-6336 or at:

Copyright © 2006 Blethen Maine Newspapers Inc.

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