David Marlon was running a local drug-rehabilitation program when he realized that a large proportion of the population that needed help wasn't getting it.

The program had been very successful but served about the top half of the population, on a socioeconomic basis, Marlon said.

"I noticed there was a big need in the lower half," he said.

Make that needs, such as awareness, education, prevention, treatment and recovery. And so, in 2006, The Solutions Foundation was born -- with emphasis on those five areas.

"The purpose is to educate individuals about drug and alcohol abuse," said Samra Dayani, the foundation's director of marketing, "so they can avoid engaging in illicit behaviors and, if they already were addicted, so they could get help."

Marlon, who's founder and president of the foundation, first obtained status as a nonprofit. He got the foundation licensed by the Substance Abuse Prevention and Treatment Agency as an education and prevention provider. He put together a board of 14 people -- "all very well-connected, long-term Las Vegans who can get things done."

The foundation's first big project was to help with the Crystal Darkness campaign for kids in grades seven through 12, assisting with funding, the printing of booklets and bringing in volunteers to do training.

The booklets, Dayani said, stressed the dangerous consequences of using crystal meth, thus improving awareness.

"Subsequently, there has been a reduction of the amount of crystal meth that has been reported," Marlon said.

The other side of the coin: "There's been a corresponding increase in opiate use."

And so the battle continues, always. The foundation's substance-abuse targets, he said, are "really the full gamut -- alcohol issues, illegal drugs as well as prescription drug challenges."

Marlon said he thought the foundation's emphasis would be on kids, but then he realized that it was impossible to make a clear delineation between them and their parents.

"As soon as you start talking about kids, you start talking mothers," he said. And with fetal alcohol syndrome being such a problem, "it really goes below 0" on the age range.

Plus, he said, "when you get kids whose parents are using drugs, it harms the children. We really need to educate and promote awareness to all ages on this terrible issue."

Particularly troubling to Marlon are reports of kids taking prescription pills they steal from Mom and Dad's medicine cabinet or obtain on the street.

"They're using medication, not knowing what it's for," Dayani said. At punch-bowl pill parties, she said, various medications are dumped into a bowl and the kids just take whatever they grab, in whatever combination.

"Those can have lethal consequences," she said.

Another big problem: "Kids who are buying what they call opium, but it's really black-tar heroin," Marlon said. "Little $10 balloons. It's really heroin, which is terribly addicting."

Currently, he said, the foundation is working on a parental tool kit. Marlon said parents frequently call, asking: "one, 'How do I talk to my kid about not taking drugs?'; two, 'What are the signs that my kid is using drugs?'; and three, 'What do I do, because I know my kid's addicted?' " It will be an Internet resource, he said, "so they can do it without being embarrassed."

The foundation is supported by private donations and by fundraising events such as a recent golf tournament. It accepts volunteers, who go into schools to share their experiences with various types of drugs, or work with teachers in educating students about drugs. Other volunteers help with special events.

For more information on The Solutions Foundation, or to volunteer or make a donation, visit www.solutions-foundation.org or call 228-8520.

The myth of addicts’ power over actions

Chemical dependency is a disease, medical experts say, and should be treated as such

By Marshall Allen

LAS VEGAS SUN

Thu, Nov 6, 2008

We don’t consider it a moral failure if a diabetic can’t control her blood sugar level.

And no one finds it shameful when someone with diarrhea can’t control his bowels.

So why do people blame addicts for taking their substance of choice?

The answer highlights one of the greatest myths and misunderstandings about addiction, according to medical experts.

People who think addicts are making willful decisions to ingest their substance of choice don’t know the science behind the disease of addiction, said Dr. Mel Pohl, a Las Vegas addiction expert and author of the book “A Day Without Pain.”

“It’s a medical disease,” Pohl said of addiction. “There isn’t any medical organization that doesn’t understand that. It really is a lack of information that commits people to believing that it’s a choice that’s related to self-will.”

And yet, the myth is propagated incessantly, evident by readers’ reactions to an ongoing investigation by the Las Vegas Sun that has identified a prescription narcotics crisis in Las Vegas. A Sun analysis of Drug Enforcement Administration data showed that Nevada ranks No. 1 among states for per capita consumption of hydrocodone, the drug in Lortab and Vicodin, and No. 4 for per capital consumption of methadone, morphine and oxycodone, the active ingredient in OxyContin.

Readers are quick to blame prescription drug users for their addictions.

One reader, claiming to be a pharmacy technician, wrote on the Sun’s Web site of one addict: “No one forced her to take so many meds that she OD’d. Addiction is a CHOICE. No one and nothing forces ANYONE to pop a pill, shoot a balloon of heroin, snort a line of coke, take a drink, etc. Regardless of ANY doctor’s actions, the ultimate responsibility lies with the patient.”

Pohl said he can understand why people hold such opinions, but they are wrong. Many people abuse substances without becoming addicted, but an estimated 15 percent of users — no one knows exactly how many — become addicted. Addicts have a genetic predisposition to a short circuit in their brain that allows their rewards system to be hijacked by certain substances.

The reward system of an addict’s brain drives the person to consume the drugs at the expense of anything else, even eating or sleeping, he said.

Dr. Jim Marx, a Las Vegas addiction and pain management specialist, said scientists have done addiction experiments in which animals will give themselves doses of medicine — and ignore the food by their side — until they starve to death.

“That’s the issue with addiction,” Marx said. “It will overpower any other urges you have. At that point, does the person have a choice? I guess they do have a choice to a certain extent, but the chemistry will override that.”

Pohl, who has worked with thousands of addicts, said it’s common for family members and friends to blame the drug addict because the behavior has had such a negative effect on so many people. Drug addiction destroys relationships, he said, because the addict will do anything — lie, steal, break laws — to get the drugs.

Addiction is a chronic disease that can’t be cured, Pohl said, because an addict still craves the drug when it’s absent.

When addicts overdose on prescription drugs the doctors who wrote the prescriptions don’t directly cause the death, but they are complicit in it, Pohl said. That’s why doctors must screen for addiction and survey patients to ensure they’re taking them in a manner that won’t cause harm, Pohl said. When prescribing potentially addictive and deadly drugs such as narcotics, he said, doctors should have a plan to ween the patient of the drugs.

“I don’t think most doctors do that,” Pohl said.

Daly says night in jail a misunderstanding

November 04, 2008

THE ASSOCIATE PRESS

Darren Stewart is learning to live without alcohol and cocaine for the first time in nearly 20 years, having recently replaced the vices with trees and cool mountain breezes.

"I'm learning how to do things that are different," the 40-year-old said on Wednesday. "All my activities before involved drinking. Now, I can get the same enjoyment other ways and remember it the next day."

For the past few months, Stewart has been a resident of WestCare's Harris Springs Ranch near Mount Charleston, a residential substance abuse treatment center for men and boys.

The facility less resembles a rehab than it does a family campground, with its collection of comfortable cabins, beautiful views and occasional visits from deer.

Residents stroll along pathways marked "Recovery Rd." and "Sobriety St.," toss horseshoes during their free time at a small central park, or have lunch at D's Diner, where the motto is, "We serve second chances." There's even playground equipment for visiting youngsters.

Despite the laid-back atmosphere, the addicts at Harris Springs are hard at work getting sober.

The men who live at the wooded ranch endure a strict daily schedule, rising each morning at 5:30, completing daily chores, attending numerous therapeutic "groups" and a nightly 12-step program meeting, and doing homework. They have very little free time each day, and must be in bed by 10:30 p.m.

They can't smoke or drink caffeinated beverages. Phone calls and family visits are limited and must be earned.

Still, most feel lucky to be there.

"I don't want to go back to sleeping in the park, to eating out of Dumpsters," said Jesse Plascencia, a 38-year-old crack cocaine addict and father of three who has been at the ranch about five months.

Plascencia, a former gang member, begged a judge after his last Las Vegas arrest to let him try WestCare instead of jail.

After months of sobriety, he hopes to become a youth counselor some day.

"I want to redeem myself for selling drugs to women and kids," he said. "I need to pay the price."

Forty men live at the ranch at any given time, each for about six months. Sixteen boys are housed in a separate cabin and have no contact with older residents.

The 35-year-old WestCare is one of a dwindling number of options for poor or homeless addicts who don't have insurance and can't afford private rehabilitation services. There is a waiting list of up to six months to get in.

The nonprofit has had to fill the gap in services created by recent cuts to Salvation Army addiction programs, and worries about sustaining programs in a tough economy and with ever-shrinking funds.

"For years, we have relied on a steady stream of grants and other sources," said Kirby Burgess, vice president of WestCare. "We've been truly blessed in terms of giving."

The agency is preparing to launch a year-long campaign to raise about $10 million nationwide to help fill coffers.

WestCare began in 1973 as a small facility for male heroin addicts called Fitzsimmons House. Since then, it has expanded across the state and into several other states. At its four Las Vegas campuses, it offers drug treatment, housing and other services for 6,000 men, women and children each year.

"We see folks who fall through the cracks," Burgess said. "If we were not around, folks would continue falling."

WestCare's statewide budget for Nevada is $9 million.

At the ranch, residents work with staffers such as Andre Hughes, a single father who has been sober seven years. Many who work at the ranch are in recovery themselves.

"It keeps me in touch with where I came from and lets me give back," Hughes said.

He spent years as a local "crackhead" and "Fremont (Street) rat," he said, racking up dozens of arrests on drug charges until he hit bottom one hot summer day following an arrest behind the El Cortez.

"I went through so much crying," he said. "I was flooded with emotion."

Hughes says he's uniquely qualified to work with fellow addicts.

"My job is sharing my experiences," he said. "I never lie to the men."

Stewart said he also hopes to someday become a drug counselor.

He came to Las Vegas a year and a half ago from Minnesota, thinking a change in environment would help him straighten out his life. He was wrong.

"The rats will find the rat hole," he said with a smile. "I gravitated toward the things I knew: drugs."

Not long ago, Stewart was arrested on charges of drug possession with the intent to sell. While in jail, he found WestCare in the phone book.

Many of the men at the ranch are referred there by the Clark County District Court system as a condition of their parole or probation. Others, like Stewart, find their way there on their own.

Stewart, who has a 3-week-old son, said he knew it was time for things to change.

"I don't ever want my son to see me go through the destruction and chaos I went through," he said. "He will never see his dad messed up. I am done."

The local Salvation Army has suspended its inpatient addiction rehabilitation services for women, citing tough economic times.

"We have more people coming to us than ever before, and less resources," Charles Desiderio, a spokesman for the agency, said Tuesday. "I don't know what other options there are."

The program that provides substance abuse and gambling addiction treatment services to about 1,600 men and women annually has been operating in the red for years. Its deficit added up to about $2 million over the past five years, Desiderio said.

About a quarter of those who enroll in the agency's 35-year-old adult rehabilitation program are women, he said. Services for men will continue.

Increased expenses, a slowdown in thrift store sales and cuts in government grants have contributed to budget woes at the agency.

"When you start adding it all together, the losses are huge," Desiderio said.

The Salvation Army's adult rehabilitation program provides free addiction services to those who cannot afford to pay, including the homeless. People generally stay five or six months for treatment.

The agency has stopped accepting women into the program. Six women currently enrolled will be allowed to stay until they graduate from the program, Desiderio said.

The Salvation Army hopes to resurrect the program for women in better times.

Options for poor or homeless addicts were already limited before the Salvation Army's decision.

"We're one of the few agencies left," said Kirby Burgess, vice president of WestCare, which operates its own addiction treatment program.

WestCare will try to fill the gap left by the Salvation Army's decision, he said. But its beds are usually full, and there is a waiting list of up to six months.

"We try to take these folks as early and as quick as we can," Burgess said. "But if we don't have space for them, these are folks who could end up on the street, in a hospital emergency room or in jail."

WestCare might be able to offer increased outpatient counseling until beds open up, he said.

But, like other local charities, the agency is struggling to meet increased demand through difficult economic times.

"Needs have expanded," Burgess said. "Given the economy, we're starting to see more folks who need services. But like everybody else, we've had to tighten our belts."

The agency had to lay off dozens of people last year.

The Salvation Army earlier this year announced it no longer would provide free inpatient addiction rehabilitation services to people referred there by the Clark County District Court system as a condition of their parole or probation.

The agency said tough economic factors were also to blame in that decision.

When drugs bring harm not healing

By Marshall Allen

Wed, Oct 15, 2008

Two days before their first wedding anniversary, Andrea Duncan woke up to find her husband, Clint, beside her, dead of a prescription drug overdose.

It was Sept. 17, 2005, and instead of celebrating their marriage, the 26-year-old was planning her husband’s funeral.

Despondent, she wrote in a note addressed to no one that she wanted to be with her husband, her soul mate, “in heaven.” Her parents believe she wanted to place it in his casket. But she didn’t live that long.

Four days after Clint’s death, Andrea also overdosed on prescription drugs. The coroner ruled the cause of death “undetermined,” not a suicide.

The parents of Andrea and Clint Duncan blame a Henderson physician for their deaths. Dr. Kevin Buckwalter prescribed both patients the narcotics and Xanax that snuffed out their lives.

The parents say he should have seen they were in no condition to be receiving the large quantities of drugs he prescribed. For example, Andrea Duncan was being prescribed more than 150 narcotic painkillers a month and up to 300 Xanax pills at a time. At 2 mg each, the Xanax tablets were four to eight times a typical dose, experts said.

In November 2005, Andrea’s parents, John and Maggie DeBaun of Henderson, filed a complaint against Buckwalter with the Nevada State Medical Examiners Board. The board investigated the case and told the parents there was no evidence of wrongdoing. To this day Buckwalter has a clean discipline record with the medical board.

But four experts who reviewed the medical records detailing the care Buckwalter provided Andrea Duncan said it’s stunning that the medical board did not discipline him. His records of treating her are thin and do not justify the large quantities of controlled substances he prescribed her, the experts said.

Furthermore, two years after Andrea Duncan’s death, Buckwalter gave a sworn deposition about the care he’d provided her. In his own words, under oath, he described the treatment. According to experts who reviewed his testimony, that treatment, as he described it, was incompetent.

Dr. David Kloth, a Connecticut specialist and a past president of the American Society of Interventional Pain Physicians, said Buckwalter was culpable in Andrea Duncan’s death.

“He basically gave her the weapons to kill herself,” Kloth said.

But the medical board did not discipline Buckwalter. Such action might have prevented what happened next.

Two more Buckwalter patients died in 2008. Experts who reviewed their cases said Buckwalter’s substandard care contributed to their deaths.

•••

Dr. Kevin Buckwalter is a significant contributor to what the Sun has identified as Nevada’s prescription narcotics crisis. A Sun analysis in July showed Nevadans consume more hydrocodone per capita than residents of any other state, and rank fourth highest in the consumption of the narcotics morphine, methadone and oxycodone, the primary ingredient in the drug OxyContin.

Experts say one reason Nevadans consume so many narcotics is that some doctors do not know how to prescribe them. Buckwalter is a prime example, according to four pain specialists who reviewed records for four of his patients at the Sun’s request. Kloth and Dr. Andrea Trescot are nationally known experts on the proper use of narcotic medications. Two Las Vegas pain specialists also reviewed the cases, but would comment only on the condition that their names not be used.

The Nevada Medical Examiners Board is again investigating Buckwalter’s prescribing practices, the Sun has learned, even as he continues to see patients in his clinic at a Henderson office park.

The Sun gave Buckwalter the names of the patients in this story and copies of their medical records, and told him the allegations the story would contain, including the observations and conclusions of the four medical doctors reviewing the cases. He would not comment.

Buckwalter went to medical school at Ross University in the West Indies and was licensed to practice in Nevada in 1997. On Sept. 16, the Sun reported that Buckwalter, a pediatrician and family doctor, had prescribed one of his patients more than 17,000 narcotic painkillers in 3 1/2 years, even after the man had overdosed on the pills.

Buckwalter’s name is known to regulators and doctors in Las Vegas. Members of the Nevada Pharmacy Board, local pharmacists, law enforcement agents and pain specialists were aware that serious questions have been raised about the way he prescribes narcotics.

Since the Sun’s September report, 15 more Buckwalter patients or their next of kin have contacted the newspaper to complain about him. Many of them have filed complaints with the medical board and other regulators.

Some patients or their families provided copies of medical records that detail the care Buckwalter provided. For this story, the Sun has examined three of those cases after getting family permission.

In addition to Andrea Duncan, the Sun investigated the care that Buckwalter provided to Staci Voyda and Barbara Baile.

Voyda was an OxyContin addict who was 19 when she went to Buckwalter in February 2007 to get off drugs. Voyda’s journal shows that she was obsessed with narcotics and ashamed of her inability to stop taking the drugs.

The doctor prescribed her large doses of Xanax and methadone, a potent drug that can help addicts stop taking other narcotics. When Voyda overdosed on methadone, Buckwalter stopped prescribing it to her. For the next year he prescribed her Xanax and hydrocodone, a potent narcotic. Then, over an 11-day period this summer, Buckwalter ramped up her narcotics prescriptions, giving her 310 pills of oxycodone, the primary ingredient in her drug of choice, OxyContin. Two weeks later, on Aug. 26, Voyda put a gun to her head and killed herself.

The four experts who reviewed the records of Voyda’s treatment by Buckwalter said the doctor was grossly negligent to prescribe her narcotics when there was clear evidence of drug abuse.

“When you have a patient with an overdose and give them the same medicines again, that’s not conscionable,” said Trescot, a Florida pain specialist who wrote a guide for prescribing opiates for the American Society of Interventional Pain Physicians. “At the very least he needs to have his license pulled now.”

Barbara Baile, 69, began seeing Buckwalter in April 2004 complaining of pain in her hips and back.

In Baile’s medical file, he detailed neither her medical history nor a treatment plan, nor did he list the drugs he was prescribing her or their effectiveness.

Baile died in April, a victim of one of the side effects of narcotics — severe constipation. Her death should have been prevented, experts said. Doctors who prescribe narcotics should know they can turn a person’s stool rock hard, blocking the bowels.

Barbara Baile’s husband of 50 years, Don Baile, sat in on every appointment she had with Buckwalter. He says his wife complained of constant constipation but the doctor never explained that the narcotics he was prescribing could cause the problem. Don Baile does not recall Buckwalter’s ever performing a physical examination of his wife. He says Buckwalter’s only action was writing on his prescription pad.

In February, having gone more than three weeks without a movement, her bowels ruptured. The damage was irreparable and after three months of agony she died of sepsis.

Buckwalter’s records don’t reflect that Barbara Baile was constipated. The experts said that any doctor should have known to manually remove Baile’s blockage or prescribe medications to clear out her system. Don Baile says Buckwalter only mentioned over-the-counter remedies.

Failure to warn a patient that narcotics can cause constipation and failure to provide a remedy for the problem constitute malpractice, the experts said.

In all three cases, the Sun’s experts said the care Buckwalter provided, as detailed in the medical records, was so poor it may have constituted medical malpractice. Each expert said it is imperative that the medical board investigate Buckwalter. Two of them said they do not think he is qualified to practice medicine, and at the very least should lose his license to prescribe controlled substances. After reviewing records, one of the experts called the Drug Enforcement Administration to complain about Buckwalter.

•••

By several measures, including Buckwalter’s own testimony in the Andrea Duncan deposition, his care does not appear to meet the standard expected of physicians who treat pain. Guidelines by the Federation of State Medical Boards, which have been adopted in Nevada, require:

• A medical history and physical examination be obtained, evaluated and documented in a patient’s medical record.

• A written treatment plan for pain management that measures success.

• Special attention to patients at risk of drug abuse.

• Accurate and complete medical records, including the medical history, physical examinations, treatments and treatment objectives and medications.

In each case, the experts said of the four cases they reviewed, the records do not meet the standards required in Nevada.

The allegedly poor level of care offered by Buckwalter may violate the criminal standards outlined in Nevada law. Officials from the Nevada attorney general’s office would not comment on Buckwalter, but said it is a felony if controlled substances are not prescribed for a “legitimate medical purpose” and in the “usual course” of a doctor’s professional practice.

That could be the case, according to officials from the attorney general’s office, if a family doctor is prescribing too many narcotics without medical justification.

Another state law says a doctor is criminally negligent if he acts recklessly, departs from what a prudent person would do in a similar situation and makes decisions for which the consequences could be reasonably foreseen and where the danger to human life was the probable result of the negligent act.

In cases where a criminally negligent act results in death, the minimum sentence under the law is a year in state prison.

Former Buckwalter employees — two medical assistants and a clerk — described him as a kindhearted doctor. But they all quit, they said, because they disagreed with the way he practiced medicine. They said he avoided confrontation by prescribing the kinds of drugs his patients sought, even though he knew that some patients were addicted and overdosing. One medical assistant said she discussed the overdoses with him and urged him to stop prescribing to addicts.

“I like Dr. Buckwalter as a person, but as an M.D. I think he’s unethical,” the former medical assistant said. “What he does is utterly morally wrong.”

One office worker said that about half of his 80 patients a day — about two and a half times the number most family doctors would see in a day — were coming only for prescription refills.

Buckwalter balked at cutting off patients, even when it was clear they were abusing the drugs or selling them to addicts, a medical assistant told the Sun.

“He said, ‘I’m here to help people, I’m a doctor. I don’t want people in pain,’ ” the medical assistant recalled.

So many drug addicts went to Buckwalter for their fixes that the office was a dangerous place to work, the former employees said. Henderson Police records show two calls for service because of belligerent patients in 2007. The conflicts would occur because patients would show up without an appointment demanding prescriptions, the former employees said.

In one instance, a patient pulled a gun and poked it in an employee’s ribs, demanding to see Buckwalter. The patient, identified in a Henderson Police report as Henry Tucker, then barged into the back of the office, ordering Buckwalter to write him more prescriptions. He was arrested outside the office, pleaded guilty to two felonies in connection with the incident and is serving 18 to 48 months in prison.

The former employees said they don’t think Buckwalter was motivated by money, though if he saw 80 patients a day, many of them paying $90 a visit in cash, he would be bringing in more than twice the reimbursements of his peers. Many of his patients flew in from out of state to get prescriptions, the clerk said. In other cases, the employees said, Buckwalter would mail prescriptions for narcotics to patients without examining them.

When new patients came into the practice, Buckwalter did not ask for X-rays or body scans to document their pain, the former employees said. In fact, many patients complained that the doctor never examined them, the employees said. Medical records obtained by the Sun and interviews with patients and their families confirm that he often did not get records or conduct physical exams.

“I don’t think he actually understood the concept of what he was doing,” another medical assistant said. “In his ... mind he was helping. And by helping he gave the patients what they asked for, whether they needed it or not.”

The employees said local pharmacists voiced alarm at the volume of some of his prescriptions. One medical assistant said complaints were made verbally to employees at the Nevada Pharmacy Board and the Drug Enforcement Administration, and the clerk said the Nevada Medical Examiners Board came at least once in 2007 to pull patient files.

But no regulators ever took any action to protect patients, the employees said.

The Drug Enforcement Administration and the medical board declined to comment for this story.

•••

Andrea Duncan’s parents, John and Maggie DeBaun, show a photo of Andrea being swept off her feet by Clint Duncan on their wedding day. “They were such a darling couple, so cute, so in love,” Maggie DeBaun said, smiling.

The marriage to Clint had been a bright spot for Andrea, who suffered a serious brain injury in a September 2000 traffic collision with a drunken driver.

Among other problems, the injury left her susceptible to panic attacks and clouded judgment. She regressed from a confident young woman to being as vulnerable as a child, her parents recall.

Andrea and Clint met online and the DeBauns liked him right away. Clint, clean-cut and polite, worked hard as a bartender’s assistant at a local casino and as a DJ, spinning records.

Each complained of back pain — Clint from his job carrying heavy bottles, and Andrea from her accident.

On Nov. 22, 2004, she made her first visit to Buckwalter.

Buckwalter would not discuss Duncan with the Sun, but in a sworn deposition on Feb. 8, 2007, he described her treatment. (Buckwalter was deposed on Duncan’s behalf in a lawsuit the family filed against the nightclub that served alcohol to the drunken driver who caused her accident. A complete transcript and an edited video of the deposition is available on the Sun’s Web site, www.lasvegassun.com.)

In the deposition, Buckwalter says that on Duncan’s first visit, he did not examine her — which medical experts say is a fundamental requirement of such a patient visit.

Buckwalter said he “did not have time.”

Yet, on the initial visit, Buckwalter prescribed Duncan 150 tablets of the anti-anxiety medication Xanax and 150 pills of the narcotic painkiller hydrocodone, commonly known as Vicodin or Lortab.

Another fundamental tenet of treating pain is verification of patients’ medical history through records from other doctors, tests and physical examinations. Buckwalter said in his deposition that he never ordered records from any other doctors who had treated Duncan and that he “did not think it was necessary” to verify Duncan’s medical history.

Over the next 10 months, he prescribed her higher quantities of pills.

The DeBauns noticed the couple were taking a large amount of medications and did not think that Andrea, with her brain injury, was capable of making the right judgment about which drugs to take. But Andrea assured her parents that she was in good hands with Buckwalter: “I’m in a lot of pain, so my family doctor is prescribing a lot of medication,” they recall her saying.

At the time of their overdoses, the couple were living in the home of Clint Duncan’s mother, Barbara Rich. In hindsight, Rich suspects that both were addicted to the prescription drugs. They sometimes slept most of the day, and Clint would stagger around the house, she said.

Buckwalter prescribed Andrea Duncan hundreds of 2 mg Xanax pills, each many times a typical dose. He said in his deposition that he prescribed her large quantities of pills “because she asked for it.”

A Las Vegas pain specialist, who would speak only on the condition of anonymity, said it seemed clear that Buckwalter was prescribing whatever pain medicines his patients wanted.

“The lack of diagnoses, lack of records, lack of opioid agreements and lack of counseling are all problems,” the doctor told the Sun.

In his deposition, Buckwalter said he does not keep a record of the type or quantity of drugs he prescribes to a patient, “because I usually have a routine of the amount of medications that I write.”

Medical care should be unique to individual patients and there should always be a detailed log of medications, so the doctor can track their effectiveness, said the doctors who reviewed the case at the Sun’s request.

In some instances, Buckwalter made statements that were factually wrong. He says the drug Ultram is an anti-inflammatory. It is not. It’s a narcotic. And he says he never prescribed Duncan morphine, even though her parents still have the bottle of morphine that he prescribed to her, and pharmacy records prove he prescribed her the pills.

Sept. 16, 2005, was the last time Clint and Andrea Duncan saw Buckwalter. He prescribed Andrea 300 doses of Xanax and 90 of morphine, a potent narcotic.

The next day Clint Duncan overdosed on Xanax and narcotics, according to his death certificate. His mother said he was prescribed the drugs by Buckwalter.

Four days later Andrea Duncan overdosed on Xanax and narcotics. She went into a coma and died three weeks later.

Clint Duncan’s mother, Barbara Rich, holds Buckwalter responsible for the deaths of her son and daughter-in-law.

“Dr. Buckwalter has to have known,” Rich said. “The coroner found pills all over the room. He poured down the garbage disposal hundreds and hundreds of pills.”

For Maggie DeBaun, the death of her only child, Andrea, means the end of the family line. “I have my past, but I have no future anymore,” DeBaun said. “It’s just so heartbreaking as a parent. It’s just not the way it’s supposed to be.”

In May, John DeBaun wrote to the medical board again, urging it to reopen the case and look at the deposition that, he says, betrays the doctor’s incompetence and his lie about not prescribing Andrea Duncan morphine.

“I do not want any monetary gain from him, no amount of money could repair the loss that my wife and I have suffered,” John DeBaun wrote to the medical board investigator. “I just want him stopped before more people suffer from his way of prescribing medicine.”

Investigators were not interested in seeing the deposition, but told DeBaun they are pursuing another investigation of Buckwalter.