Fatal O.C. overdoses were fueled by prescription drugs The Orange County Register

March 13, 2011

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Fatal O.C. overdoses were fueled by prescription drugs

By TONY SAAVEDRA

03/12/2011 10:27 PM

Sadness swallowed Jarrod Barber.

His friend had just died of cancer. He was smoking more and more marijuana and

experimenting with pills.

On the eve of his friend's funeral, Barber, 19, passed out on the family couch

in Laguna Niguel while watching a late-night movie.

Slumped in a corner, it looked to friends as if he was sleeping. He was actually

dying.

Barber fatally overdosed Jan. 8, 2010, on a cocktail of Opana, a narcotic pain

killer, Seroquel, an anti-psychotic and Clonazepam, an anti-convulsant often

used to treat anxiety, coroner's records show.

Abuse of prescription drugs has risen nationally among teens and young adults,

experts say, because these drugs are easy to get and seen as a " safe " high. The

names of doctors who are an easy touch for prescription narcotics spread quickly

among teens. Some users get huge prescriptions and then sell pills on the street

to finance their own habit.

Here in Orange County, coroner records show that accidental fatal overdoses rose

steadily from 130 in 2003 to 266 in 2009. Preliminary figures for 2010 show at

least 240 overdoses although final toxicological findings are still pending in

some of the cases.

Barber didn't have a prescription for the Opana. Jarrod's mother, Jodi Barber,

believes he purchased it from a now-deceased friend who was a patient of Dr.

Tseng of Rowland Heights – an osteopath under state and federal

investigation. There's no mystery about the other drugs: Dr. D. Corona of

Laguna Niguel prescribed the Clonazepam, and a few months later, the Seroquel.

Coroner's records show that drugs prescribed by Tseng – including Xanax,

methadone and morphine – were found in the bodies of at least three fatal

overdose victims in Orange County since 2000. Additionally, the parents of two

other dead youths, Jarrod Barber and Winter, blame Tseng for the drugs that

led to their overdoses. Jodi Barber says she has taken her suspicions to the

federal Drug Enforcement Administration.

In August, after discovering that Tseng had written more than 27,000

prescriptions over a three-year period, federal agents revoked Tseng's license

to prescribe narcotics. DEA investigators alleged in court papers that Tseng was

operating " outside of the ordinary course of a professional practice. "

Meanwhile, the state Board of Osteopathic Medicine is working to revoke her

medical license, officials confirm.

Unlike Tseng, Corona, who specializes in the treatment of mood disorders, has

not been named as a target by state medical investigators or federal drug

authorities. But records show that Corona is on five years probation with the

state medical board for using drug samples to treat his own manic disorder.

Additionally, a lawsuit filed in Orange County Superior Court in 2007 accuses

him of negligence and wrongful death for his treatment of a woman who crashed

her car while driving under the influence of prescription drugs, killing a young

mother. Corona calls the suit " nonsense. "

In an interview, Corona described himself as the " guru " of prescribing

mood-stabilizers to treat substance abusers; a regimen he says is effective at

relieving the underlying depression or anxiety often at the root of addiction.

He says he rarely prescribes pain killers. An author and former radio

personality, Corona's message is that psychotropic medicines are invaluable in

healing the mind and, consequently, the body.

" I am the top prescriber of psychotropic medications around, " Corona said.

" Ninety-five percent of my patients are very happy. The fact anyone would put me

in that category (as Tseng) is laughable. "

Corona is praised by some local doctors, but a psychiatric expert who testified

in the 2007 lawsuit said that Corona has no formal training in psychology and

acted outside the scope of his training as a general practitioner. Two addiction

experts interviewed by The Register criticized Corona's wide use of psychotropic

drugs to treat people already hooked on controlled substances.

Dr. Harry Haroutunian, physician director at the famed Betty Ford Center in

Rancho Mirage, says it is especially dangerous to prescribe drugs with sedative

qualities when treating addicts in an out-patient setting, where they might

score more drugs on the street.

" If he is telling you he is the highest prescriber, " Haroutunian said, " that

would be a dubious distinction by my measuring stick. "

Psychotic breakdown

Corona's personal and professional lives have weathered considerable chaos over

the last several years, public documents show.

On Dec. 17, 2007, Orange County Sheriff's deputies were sent to Corona's Laguna

Niguel home and found him in his backyard having a " psychotic breakdown " and

threatening suicide, an accusation from the Medical Board of California shows.

" Respondent was acting bizarre and was very aggressive, yelling and screaming

incoherently. The officers had to taser respondent several times in order to

subdue him, " said the report by the medical board. Corona was hospitalized for

nearly a month for psychological observation.

It was the same year that he published a book about treating mood disorders,

entitled " Healing the Mind and Body. "

In a 2008 interview with the Medical Board, Corona said he suffered an episode

of hypomania three years prior. State documents say that he was prescribed

Seroquel by his psychiatrist, but admitted to self-medicating from his sample

drugs after his psychiatrist moved away.

" His disorder has impacted his ability to practice safely and led to his

hospitalization for a psychotic breakdown, " the state complaint said.

Corona was put on probation for five years in 2009.

Since opening a new office in 2008, Corona has focused on treating

neuro-chemical imbalances that prevent the brain from reaching what he calls the

" Wonder of Optimal Well-being " or the WOW state.

Sporting a flattop haircut and a Hawaiian shirt, Corona sees about 500 patients

a month at his two-room suite, in a non-descript business center off Ivy Glenn

Drive. Instead of a Rolodex, he keeps his phone numbers on a wrinkled piece of

paper crammed inside his desk drawer.

Before his 2007 hospitalization, Corona said he had a 10,000-square-foot office

with three other doctors. The practice foundered about the same time as his

mental problems appeared. In 2008 he opened the solo practice.

Patient Madelyn Picascio, 72, of Laguna Niguel, said Corona brought her out of a

deep depression.

" He is way better than any psychologist, " Picascio said. " There's always a loony

who will accuse the doctors of something. All I know is he helped me. "

Dr. Montano, head of the drug rehabilitation center at Hoag Hospital in

Newport Beach, says he often refers addicts to Corona. Montano estimated that up

to 75 percent of the addicts he sees require drugs to stabilize their mood

swings.

" Dr. Corona is a wonderful mental health physician, " Montano says. " He gets

referred some of the worst cases. "

But not all experts in this field agree with such an approach – or that general

practitioners like Corona should be treating mental patients.

Addiction specialists agree the limited use of drugs can be necessary,

especially for addicts so physically dependant that removing all drugs could be

fatal. But they say some doctors are now too quick to prescribe a chemical

course rather than let the brain stabilize itself.

With these cases comes the danger – especially in an out-patient setting – that

the addicts will supplement their prescriptions with street drugs, unbeknownst

to the doctor, as in the case of Jarrod Barber.

" It's very dangerous out there, " Haroutunian says.

Dr. Stefan Kruszewski, a burg, PA, psychiatrist who specializes in

addiction, agrees that fewer psychotropic pills and more exercise, better food

and therapy is the best way to heal the brain.

" It's better for the brain than adding more chemicals, " says Kruszewski. " You

need to let the brain establish itself and detoxify and you can't do that by

adding more chemicals. You get more complications and more adverse effects when

you administer more drugs. You can facilitate the brain's restoration with time,

support and healthy living. "

" Ludicrous " standard of care

Corona was one of the doctors treating a mentally ill woman, Janene K. s, in

August 2006. s fell asleep at the wheel with sedatives in her system,

killing a young mother in Newport Beach, public documents show.

The family of the victim, Candace Tift, 31, is suing Corona and s' other

physician, Dr. Barke, for wrongful death. Although none of the drugs

prescribed by Corona were in s' system, according to a toxicological report,

the family's attorney alleges her doctors should have hospitalized s or

otherwise prevented her from driving because of the severity of her illness.

Attorney Sidney , who is defending both doctors, said “I don’t think there

was any negligence of any kind on the part of Dr. Barke and Dr. Corona.”

Court papers say s displayed a series of bizarre behaviors, such as stating

that the shower in her home was causing cancer and that the voice of her

recently deceased husband was passing messages through the television. s

started filling one-gallon bottles with water and placing them throughout her

house, for fear of disaster, documents say.

s' daughter took her to their family practitioner, Barke, who referred them

to Corona as a " specialist in mood disorders, " court documents charge.

Dominick Addario, a psychiatrist and professor at University of California, San

Diego, testified in a declaration for the lawsuit that Corona has no formal

training in psychology or psychiatry.

Corona's " assessment, care, treatment and handling of Ms. s' situation

....was not simply below the standard of care, but rather it was ludicrous, "

Addario testified.

For example, Addario testified, Corona did not perform any type of psychiatric

evaluation of s. He did not document the history of the patient's behavior.

He incorrectly assumed that s had stopped taking Ambien. He did not assess

how much Xanax s was taking.

Corona prescribed Seroquel, which is commonly used for treating schizophrenia,

and gave her a two-week supply from his samples, court documents say.

" Dr. Corona should have realized that Ms. s was in the midst of a psychotic

breakdown and that she was irrational and her judgment impaired, " Addario

testified. " At minimum, Dr. Corona should have instructed/insisted that Ms.

s be seen by him in a minimum of 3 days and that she not be left alone, not

drive, and have her medication administration strictly supervised. "

Addario said the accident would not have happened if Corona had been more

diligent.

" It was ludicrous to assume that Ms. s could safely and reliably administer

medication, drive a car, or be left alone, " Addario says.

In a deposition in response to the lawsuit, Corona testified that he didn't

recall talking to s about the details of her psychotic breakdown. He added

her drug use would have been detailed in a questionnaire that his office gives.

In an interview, Corona labeled the lawsuit " lawyer fishing. "

" It's nonsense, there was absolutely no basis for her hospitalization, " Corona

says. " You can't go back later and say, 'You should have known.' "

s is serving a 6-year prison sentence for gross vehicular manslaughter while

intoxicated.

The Tifts' lawsuit is scheduled for trial in June.

A Bad Mix

Seeking help for their marijuana-abusing son, Jodi and her husband, Bill, were

referred by a local psychologist to Corona in October of 2009. Corona prescribed

Clonazepam, at Jarrod's request, the anti-depressant Pristiq and, later, the

anti-depressant Cymbalta, according to a treatment chronology that Corona sent

to the Register.

Corona saw Jarrod again two days before his death. He prescribed Seroquel

because " it is not addictive and is safe, and could potentially help to resolve

or decrease his anxiety and help to improve his sleep and appetite, " the

chronology says. The document notes that Jarrod told Corona he wasn't taking

Clonazepam " as much over time. "

Jarrod came out of Carona's office loaded up with Seroquel samples, so he could

get started right away, Jodi Barber says.

Haroutunian as well as Kruszewski questioned why a doctor would prescribe

Seroquel to someone taking Clonazepam – since both can act as sedatives.

" You're getting unintended adverse consequences from taking Seroquel and

Clonazepam. And when you mix them with more sedatives, you can end in overdose, "

said Kruszewski, who has testified against the makers of Seroquel for marketing

uses not approved by the federal government. Seroquel-maker AstraZeneca this

week signed a $68.5 million settlement with attorneys general in California and

37 other states who had accused the company of marketing off-label uses for the

drug.

Seroquel's government-approved use is for schizophrenia and bi-polar disorder,

but Corona – as other doctors do – was using it off-label to help Jarrod sleep

and eat. It's legal for doctors to prescribe drugs for off-label uses, but

illegal for drug-makers to promote them.

Haroutunian called Seroquel and Clonazepam " a bad mix. "

" Both depress the central nervous system. Together they can have an addictive

effect, " Haroutunian said.

Monitoring her son's drug intake, Jodi said she confiscated the drug samples

from Jarrod, but missed a four-pill box of Seroquel. Jarrod apparently took

three pills the night he died, which was the prescribed dosage, along with the

illegally obtained Opana, the pain-killer. He also had Clonazepam and marijuana

in his system, according to a toxicological report in the coroner's records.

Corona says he didn't mean for the Clonazepam and the Seroquel to be taken

simultaneously.

" If they choose to do it anyway, against my advice, look what happens, " he said.

Corona says he is being vilified by a small group looking to displace blame.

" It's disheartening when a few comments sway this completely imbalanced view of

what I do by people who don't know what I do, " Corona said.

Jodi Barber disagrees.

" He knew what he gave Jarrod, " said Jodi Barber. " I'm horrified; just

devastated. "

The Diamond Plaza

Opana is a prescription drug relatively new on the street. A time-release pain

killer, essentially synthetic morphine, it can induce euphoria but can also

depress the respiratory system. Coroners weren't finding it in Orange County

overdose cases until 2009; since then it's appeared in six cases.

Recovering addict Dimitri Zarate, 32, of Dana Point, said he got his Opana from

Dr. Tseng.

" The hardest part was the drive to (her office in) Rowland Heights, " says

Zarate. " Once you got in the room, it took five minutes. " Zarate said he paid

$300 for the visit and got prescriptions for drugs with a street value of

$4,000. His plan was to sell half the drugs and keep the other half – a typical

pattern among abusers. Zarate entered a Dana Point recovery center late last

year.

Tseng remains under investigation by the DEA, which searched her " AAA Advance

Care Medical Center " in August and revoked her ability to prescribe

federally-controlled narcotics. The osteopathic board is working with the state

attorney general's office to revoke her license, officials said. Until then, her

clinic remains open.

The Register visited Tseng's clinic earlier this month, but Tseng declined

through a nurse to be interviewed. She provided the name of a lawyer, Mark

Mermelstein of Los Angeles, but he also declined comment.

On one recent weekday night, her clinic remained busy, handling flu patients and

young athletes seeking a quick physical.

Meanwhile, Dr. Corona is putting the finishing touches on his second book on

treating addiction and mood disorders. Aimed at physicians, it will be titled,

" Healing the Mind and Body, Part 2. " He hopes to finish his probation with the

medical board early.

Contact the writer: tsaavedra@... or (714) 796-6930

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March 13, 2011