Case against Murray doc took years

Until police arrived Wednesday at his Murray office, Warren Stack practiced medicine for years without any trouble from the law.

A conviction for soliciting sex did not spur action from the people who are supposed to oversee doctors.

Database entries showing that Stack's prescription writing for pain relievers increased to large levels did not prompt regulators to take action.

Some of the overdose victims investigated by the State Medical Examiner's Office were Stack's patients, but the office raised no questions about Stack, either.

The investigation took time, police and regulators say, because of a question inherent with these types of probes: How much medication is too much?

Also, Utah's controlled-substance database, designed to track prescription use and abuse, cannot by itself tell authorities who is breaking the law.

Stack, 60, was booked into the Salt Lake County jail Wednesday on suspicion of several counts of illegally distributing controlled substances and freed Thursday on bail. Formal charges have not been filed.

The Sheriff's Office this week said Stack prescribed about 3.5 million doses of painkillers and maybe as much as 5 million.

The Utah Division of Occupational and Professional Licensing (DOPL) receives prescription information from pharmacies and inputs it into a database to track patients, physicians and the medications both parties are consuming or prescribing.

"We have a very excellent, up-to-date database that [supplies information to DOPL staff] and those reports are made available to key people," said DOPL Director David Stanley.

Stack, like other doctors prescribing large volumes of medication, did not have an overnight spike in prescriptions, said Stanley. The boost was gradual.

For DOPL staff, that makes it difficult to spot physicians who might be doing something improper, Stanley said. Also, the database does not track a doctor's specialty.

Staff looking at the database to monitor a doctor's prescriptions for pain relievers do not know whether the physician is a chiropractor or a pediatrician without consulting another source. The database also is not programmed to send out alerts, Stanley said. Staff must look for any unusual behavior.

Programming the database to alert staff to increases in a physician's prescriptions would be unreasonable, he said.

"There are people out there who are dying of cancer and they have severe pain problems. . . . And there are doctors out there who will escalate their script writing to manage their pain, and that's their calls."

Reporting all of those, Stanley said, would "probably bog us down."

Lynn Webster, a Salt Lake City physician and president of the Utah Academy of Pain Medication, said if doctors believed their every prescription were being monitored, they would be hesitant to give medications to those in need.

Mike Forshee, commander of the Utah County Major Crimes Task Force, said investigating doctors for drug crimes takes longer than investigating a street dealer because physicians can legally distribute drugs.

Police must prove unlawful behavior, said Forshee. "You have to develop a pattern. . . . It's just a long-term investigation to prove what's going on because there's no law that says you have to be suffering from cancer to get OxyContin."

Forshee said his task force has investigated a couple of doctors in the past year but detectives did not feel they could prove in court a pattern of misuse, Forshee said.

State Medical Examiner Todd Grey said some doctors and medical specialists are more likely to treat people who require pain medication and who are apt to die, making it difficult to determine which doctors are improperly prescribing.

But Utah might be missing opportunities to better sort the good doctors from the bad. Grey said no one has effectively merged data from the medical examiner with DOPL's database and databases from the U.S. Drug Enforcement Administration.

Merging the data, Grey said, could demonstrate trends - and names. "I don't think there's a way set up to [analyze all the data], and I think the reason no way has been set up is because nobody's tried."

Grey said he is not aware of his office ever reporting Stack to regulators or law enforcement for any role in a death. The medical examiner's database is not searchable by which doctor prescribed the medication in an overdose death, Grey said, but the office was determining Friday how much it would cost to program such a query.

Sheriff's detectives have found overdose victims with pill bottles bearing Stack's name, said Lt. Paul Jaroscak.

Assistant Attorney General Daryl Bell said Friday there also is an investigation into possible insurance fraud.

Stack had run-ins with the law before Wednesday. In 1990, he pleaded guilty in Salt Lake City to sex solicitation, court records show. The next year, he pleaded no contest to committing criminal mischief. Both crimes were class B misdemeanors for which Stack did not receive jail time. State law allows DOPL to discipline professionals for offenses of "moral turpitude," but the agency took no action.

Stack's arrest Wednesday occurred after an investigation that lasted "a couple of years," Stanley said. DOPL, the sheriff's office and the DEA all received complaints about Stack and jointly investigated.

Stanley said DOPL had information prior to Stack's arrest that could have allowed the agency to suspend his license. He did not elaborate.

ncarlisle@sltrib.com