By the time the pharmacist called in April 2009, three patients already were dead.

The pharmacist told the Oklahoma medical board that Dr. Joseph Knight, a Tulsa-based infectious disease specialist, was prescribing some of his out-of-town patients as many as 270 oxycodones per month. He said Knight had come to his pharmacy, appeared to be under the influence of prescription drugs, and tried to fill a prescription he’d written to his wife. The pharmacist refused.

Two weeks after that call, another of Knight patient’s died. Another overdose.

Before 2011 ended, nine of Knight’s patients would be dead from overdoses, medical board records show.

But it wouldn’t be until Dec. 28, 2012, that the board filed its first public complaint against Knight.

By the time the board moved to take action against him in March, Knight’s license had expired.

Nearly five years had passed since his first patient died from an overdose.

He has not tried to renew his license and is not practicing in Oklahoma.

Knight has the highest number of patient overdose deaths among doctors disciplined by the state’s two physician licensing boards in the past five years, an analysis by The Oklahoman and Oklahoma Watch has found.

Because there is no consistent mechanism in place to notify the board or any other regulatory authority of an overdose death, it can take months — if not years — for board investigators to link patient overdoses to a doctor and take action.

In most cases, it’s a public complaint, often from a patient’s family member, that launches an investigation.

In Knight’s case, in addition to the pharmacist, the board also heard from a patient’s mother who contacted them in August 2009 complaining that Knight had prescribed her daughter “huge amounts” of Xanax, methadone and hydrocodone “with no regard to her addiction or well-being.”

Knight treated the woman’s daughter, who isn’t named in the board complaint, for four months for “alleged neck and back pain with sciatica.”

Medical board investigators later found there were “no physical findings to support those diagnosis or reason for the pain nor are there any supporting physician records to support treatment for chronic pain.”

After reviewing the patient chart Knight kept for the woman, the medical board concluded that Knight’s treatment wasn’t safe and that the combination and amount of drugs he prescribed could have caused “potential patient harm.”

The board’s medical expert who analyzed Knight’s patient records came to the same conclusion on the other eight patient deaths.

As part of the same investigation, the board also ordered Knight to undergo a mental health evaluation that recommended he submit to drug screening, meet weekly with a mental health professional and “discontinue the use of narcotics, benzodiazepines and sedative-hypnotics … (and) that his use of Ambien should be tapered.”

Later, investigators found that in 2012 Knight’s office manager had paid a patient to help burn medical records. When investigators searched the patient’s house, they found hundreds of patient files, as well as more than 1,800 doses of painkillers, anti-anxiety drugs and other often-abused prescriptions with Knight’s name on them.

Knight declined to comment on the investigation’s findings, although his attorney, Linda Scoggins, disputes all of the board’s findings and says her client does not have a drug problem.

Scoggins argued that the majority of the cases did not have a clear correlation between the drugs Knight prescribed and the patients’ causes of death.

Scoggins, a longtime Oklahoma City health care attorney, said Knight was a responsible pain management doctor who was thorough in his analysis of each patient’s case.

Over about a six-year period, Knight saw nearly 600 pain and headache patients. Of those, he stopped seeing 232 because they violated the clinic’s pain management contract, Scoggins said.

Scoggins said the “drug overdose” allegation the board makes is easily refuted in six of the cases.

Of the three remaining patients, the cause of death is not clear but “Dr. Knight stands behind his treatment,” she said.

She pointed out that spouses of two of the three remaining patients continued to see Knight for intermittent medical issues after their spouses died.

“In other words, there is a legitimate difference of opinion, at least on the seven that were Dr. Knight’s patients at the time of death, and Dr. Knight relied on his own expertise to treat the patients’ chronic pain,” Scoggins wrote in an e-mail. “Should Dr. Knight choose to submit an application to renew his Oklahoma license which expired on or about Sept. 1, 2013, the board and Dr. Knight have agreed that the differing opinions will be heard at that time.”

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