April 8, 2014

Addicted Oklahoma: Four Deaths Tied To Talihina’s “No. 1 Prescriber”

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Dr. R. Wayne Mosier of Talihina as he appeared when he applied to practice medicine in Oklahoma.

Photo provided by Oklahoma Board of Osteopathic Examiners/The Oklahoman

Dr. R. Wayne Mosier of Talihina as he appeared when he applied to practice medicine in Oklahoma.

Dr. R. Wayne Mosier set up his own pain management practice in Talihina in 2007, shortly after the Choctaw Indian Nation Hospital dismissed him for over-prescribing controlled dangerous substances.

Mosier’s clinic, Kiamichi Medical, soon had a loyal following. Patients were driving to Talihina in southeast Oklahoma from as far away as Tulsa and Fayetteville. At one point, Mosier was signing narcotic prescriptions at a rate of 13,630 per year. Investigators said he was considered “the No. 1 prescriber of CDS in this area.”

Then, some of his patients began dying. From October 2007 through March 2008 four accidental overdose deaths were linked to prescriptions written by Mosier.

One of the casualties was Mary Lee Garrison of Tuskahoma. Garrison, 56, had a history of seizures, diabetes and depression. She showed up at Mosier’s clinic on Nov. 29, 2007, saying she needed a new doctor and specifying the drugs she wanted.

What happened at the clinic that day is not clear. The patient records are sketchy. Investigators said Mosier’s files contained no record of a doctor examination. Garrison’s medication sheet was signed by a staff member, but it appears the prescriptions were filled out and signed by Mosier. The progress notes, also filled out by the staff member, noted that Garrison was a new patient who “wanted to get refills on her current drugs.”

Investigators said Mosier’s patient files showed no record of a doctor exam. On one surprise visit to Mosier’s office, a narcotics agent found pads of blank prescription forms, and determined that some staff members had been filling out prescriptions and getting Mosier to sign them later.

Garrison left with new prescriptions for hydrocodone and several other controlled dangerous substances, at dosage levels higher than her previous doctor had authorized.

Three weeks later, on Dec. 19, she was found dead in her bed, clutching an electric blanket and wearing a navy blue T-shirt bearing the message: “There’s no place like home, except Grandma’s.” Garrison had eight grandchildren at the time.

Several narcotics were detected in her blood. The medical examiner listed the principal cause of death as hydrocodone toxicity.

Garrison’s son, Rob Garrison, told a reporter last week he did not know his mother’s death had been attributed to a drug overdose. But he knew she was taking large quantities of pain medicine that she received at Mosier’s clinic.

“I know all about him,” the son said.

He said he was driving his motorcycle by Mosier’s clinic one day and spotted his mother’s car in the parking lot. So he stopped there and began talking to some of the people he saw waiting outside. While he was doing that, his sister walked out of the clinic, carrying a bag of prescription drugs she had just received.

“There were people standing out there from Missouri and Nevada and all kinds of places,” he said. “They’d come in and give him some money … He was handing them the bags full of pills right there.”

The next fatality was 37-year-old Kimberly Annette Fulmer of Clayton, who visited Mosier’s office twice. She died on Feb. 9, 2008, from an overdose of methadone, one of the drugs that Mosier had prescribed her.

As with Garrison, there was no record of the doctor actually examining Fulmer. A narcotics agent later testified that one of Mosier’s staff members told him she often filled out prescriptions for the doctor. “The staff member has no formal training in the healing arts and indicated that she fills out the prescription, then Dr. Mosier sees the patient and signs the prescription,” case documents state.

The last known fatality was a 52-year-old chronic pain sufferer in Tuskahoma who died March 23, 2008, from an overdose of several narcotics prescribed by Mosier, including methadone, hydrocodone and diazepam.

Investigators found no evidence in the man’s records of a patient exam and said the prescriptions had been written by staff workers. A check of the online Prescription Monitoring Program showed that the patient had been simultaneously filling prescriptions written by another doctor. It is not known whether Mosier ever checked the patient’s prescribing history.

At some point in 2008, the Oklahoma Bureau of Narcotics and Dangerous Drugs began investigating Mosier’s prescribing practices. An undercover agent went to his office posing as a new patient seeking stimulant drugs. She said she spent nearly six hours in the waiting room before Mosier finally showed up sometime after 5 p.m.

The agent said Mosier told her he could not prescribe her stimulants for weight control, because she wasn’t obese. But he suggested that if she could demonstrate symptoms of attention deficit hyperactivity disorder, he might be able to prescribe ADHD medications, saying “there was ‘good stuff’ out there” he would like to tell her about,” according to case records.

Another agent interviewed Mosier in September. Mosier, an osteopath, admitted that he had no formal training in pain management, although most of his patients were seeing him for pain.

Asked why he had prescribed as many as nine narcotic prescriptions for one patient at one time, Mosier cited “economic reasons.” Asked why he had authorized 720 dosage units of oxycodone for one patient, he replied: “That’s what the insurance companies would pay for.”

In October 2008, a narcotics bureau agent returned to Mosier’s clinic seeking patient records. Mosier was not there. “The clinic was being managed by his non-registered staff members,” case records state.

Mosier eventually showed up and announced his refusal to cooperate with the investigation. He ordered his staffers to not turn over any records.

Three months later, in January 2009, agents returned with a search warrant and seized Mosier’s patient files. Once again, Mosier wasn’t there, and the office was being managed by staff members, two of whom were determined to be dispensing stimulant drugs to each other.

In February, the Oklahoma Health Care Authority suspended Mosier’s ability to write narcotic prescriptions for Medicaid patients.
Mosier appeared at a narcotics bureau hearing on March 2, 2009. He said he had dismissed his attorney and requested a delay in the case. The request was denied.

On April 7—roughly 18 months after the first known overdose death of one of Mosier’s patients—the bureau revoked his narcotic prescribing registration.

On June 18, the Oklahoma Board of Osteopathic Examiners suspended his license to practice. It told him it would reconsider his case if he successfully completed a neuro-psychological evaluation and clinical skills evaluation.

Mosier walked into the June board hearing wearing an empty pistol holster, according to one board official. A guard escorted him outside, patted him down and found two concealed knives. His pistol was in his car.

Asked why he had brought weapons to the hearing, held at OBOE headquarters, Mosier said he thought it looked like a rough neighborhood.

Mosier’s clinic in Talihina is closed. Repeated attempts to contact Mosier were unsuccessful. The osteopathic board said he called several months ago to ask how he would go about getting his license reinstated. The board hasn’t heard from him since.

Mosier’s former attorney, Pat Layden of McAlester, said he has had no contact with Mosier since the March 2009 hearing, which he attended even though Mosier had removed him from the case.

“He dismissed me, like the day before the trial,” Layden said. “I told him we were facing an uphill battle on the case they had. He didn’t like that one bit. He fired me, and that was it.”

Warren Vieth can be reached at wvieth@oklahomawatch.org