Several pharmacists stopped filling this doctor's "dangerous" prescriptions

Pharmacist Chad Burks leaned in and locked eyes with a drive-thru customer before delivering a stark warning: "If you take this, it will kill you."

The Southern Indiana patient thanked him for his honesty that day in August 2016, grabbed the prescription slip that was signed by Louisville Dr. Peter Steiner and drove off to fill it at another pharmacy less than 2 miles away.

Bruce Bozian was dead within a month.

The 69-year-old U.S. Marine Corps veteran was one of at least 13 of Steiner's patients who died during a two-year period that federal investigators reviewed as part of the nation's largest crackdown on health care fraud, according to documents obtained by the Courier Journal.

Steiner,a psychiatrist and addiction specialist, isn't charged in any of the deaths. However, he is charged with drug dealing, accused of recklessly keeping some vulnerable patients like Bozian on medicines that can be addictive and lethal.

A pharmacist who reviewed several patients' files in 2014 found that "5 deaths were potentially related to negative outcomes of stimulants" that Steiner prescribed. That was two years before Bozian, who was prescribedAdderall, died of heart problems,according to a Courier Journal investigation.

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Adderall and other stimulants generally aren't used for patients with high blood pressure or serious heart conditions, according to the U.S. Federal Drug Administration. Bozian had both.

"I blame the doctor for his death," said Bozian's wife, Dale Bozian. "He was a big contributing factor."

Steiner maintains his innocence and is awaiting trial. One of his lawyers, David Lambertus, said neither the defense team nor the doctor would comment while the case is pending. Steiner hasn't responded to requests to discuss the allegations.

Louisville Metro Police were investigating an unrelated 2013 crime when they learned troubling details about Steiner's practice.

Uncovering what went on inside the doctor's offices in Louisville and Lebanon, Kentucky, took investigators four years and included undercover agents, hidden recording devices, embedded criminal informants, police surveillance and extensive audits of medical and Medicaid records.

When federal agents surprised Steiner at his St. Matthews office in June 2017, they caught him tossing marijuana hidden in a McDonald's bag into a trash can. The doctor also was clutching two thick envelopes filled with cash, checks and a list of patient names and amounts.

In February, a Jefferson County grand jury indicted Steiner on a charge of misdemeanor drug possession and felony tampering with physical evidence. A federal grand jury indicted the doctor in June on 26 counts, including conspiracy to distribute and unlawful distribution and dispensing of controlled substances beginning in 2014.

The latest indictments accuse Steiner of doling out potentially addictive opioids that weren't needed. Investigators said he even prescribed fentanyl, a man-made drug commonly used by pain specialists or oncologists to ease severe pain for terminal cancer patients. Illicit fentanyl, much more deadly than heroin, is now Louisville and Kentucky's No. 1 killer.

The Kentucky Board of Medical Licensure issued an emergency order in March barring Steiner from practicing medicine while the criminal case is pending, noting it had probable cause to believe Steiner "constitutes a danger to the health, welfare and safety of his patients or the general public."

The doctor, who ran Kentuckiana Mental Health Associates, is fighting the suspension, according to his attorney's written denial of wrongdoing.

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At least nine pharmacists in Louisville, Southern Indiana and Central Kentucky raised concerns about Steiner to investigators. The Courier Journal found pharmacists at additional stores who had stopped filling controlled-substance prescriptions from Steiner long before the federal charges and before the board suspended his medical license.

Louisville police investigators, Kentucky State Police and federal agents with the FBI and Drug Enforcement Administration teamed to investigate Steiner. All, including federal prosecutors, declined to discuss the case. And many documents remain shielded under a federal seal.

Allegations in documents that are accessible, and only recently unsealed, portray a reckless doctor who endangered vulnerable patients as they sought his help battling mental health problems and addiction.

In a 44-page court document, an FBI agent detailed the death of Bozian and other patients, as well as those who felt at risk. The agent convinced a judge to issue a search warrant in June 2017 to inspect Steiner's offices, computers and patient files.

Bozian and five more patients who died were over age 47 — some with serious health problems — and were prescribed stimulants. Those drugs are supposed to be used sparingly because they can elevate blood pressure, speed up the heart rate and contribute to strokes, heart attacks or lethal heart-related illnesses.

Eight other patients who died between March 2015 and January 2017 suffered accidental drug overdoses or poisonings.

Several patients or their loved ones disclosed their fears that Steiner's care could be lethal, according to the federal document filed in June 2017.

One patient told investigators last spring that Steiner prescribed so much medication, he or she would be dead if not for illegally selling the surplus on the streets.

A mother of one of Steiner's patients claimed her adult child overdosed three times on drugs prescribed by Steiner in February 2015, November 2016 and January 2017.

Investigators discovered Steiner prescribed that patient 510 pills — filled in two months at three pharmacies in three cities, including 300 pills the month of the patient's third overdose.

The mother agreed to hide a recorder as she met with Steiner inside his office at 6500 Glenridge Park Place to complain that her child suffered a third overdose and was taking too many of the prescribed medications. Yet a few weeks later, agents said Steiner essentially doubled the patient's daily dose of benzodiazepine or "benzos" with 120 alprazolam pills and 90 amphetamines, as three investigators secretly conducted surveillance.

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Another mother filed a complaint with state medical board officialsand contacted Louisville police about her adult child, treated for five years by Steiner for alcohol addiction. She said her child struggled to hold down a job after becoming a patient of Steiner's and overdosed on prescribed medications. The doctor also gave out his cellphone number so patients had easy access to drug refills, she claimed.

A third mother complained to Louisville police in January 2015 that she believed Steiner was "feeding addictions" of all three of her sons by prescribing benzos to known drug abusers.

An FBI agent noted: "She fears for the lives of her sons from prescription drug overdoses."

Prescribing drugs 'dangerously'

While investigators remained in the shadows building a case against Steiner, the doctor stepped into the spotlight for a big event in Lebanon, about an hour's drive southeast of Jefferson County.

Clutching giant scissors, he posed alongside the head of the hospital, a state senator and Gov. Matt Bevin at a ribbon-cutting ceremony for the opening of a geriatric psychiatry unit at Spring View Hospital, according to posts on the hospital's Facebook page. Steiner, credited with spearheading the project, also was lauded in a local newspaper story.

"They seemed very pleased with his work," said state Sen. Jimmy Higdon, R-Lebanon. Steiner had more than two decades of experience with offices in Louisville and Lebanon.

"I think they were surprised at the charges," Higdon said.

But Steiner's arrest didn't surprise many pharmacists.

The Courier Journal interviewed numerous pharmacists who said they spotted Steiner's dangerous prescribing patterns long ago.

Chris Harlow, a pharmacist at St. Matthews Community Pharmacy, said he had several concerns, including that the doctor frequently allowing patients to get more drugs before their last prescription was used, if taken properly.

"It's extremely odd, a red flag," Harlow said. "I've got to document why it's being filled early — what's the medical necessity?"

Unable to get Steiner on the phone to address concerns, he told the Courier Journal he stopped filling the doctor's prescriptions in January 2017.

"I need to make sure I'm not contributing to the adverse effects on the patient or addiction and illicit use," Harlow said.

The pharmacist also said someone from Steiner's office once visited his store and asked if he would be the sole provider of Suboxone prescriptions. Harlow, worried they were seeking someone who would be glad for the business and wouldn't ask questions, declined.

Ethan Klein, a pharmacist at Rite Aid in the Valley Station area until the store recently closed, stopped filling prescriptions from Steiner two years ago.

Klein warned Steiner's patients: "This doctor, I have found, routinely prescribes outside the use of medical necessity — and dangerously.

"They left immediately: 'OK. I can't get it here. I'll go somewhere else.'"

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He only remembers one patient who wanted to know why he had concerns about the risks to their health.

Indiana pharmacists at Westmoreland Pharmacy in New Albany and Jeffersonville made it a company policy to stop filling Steiner’s controlled-substance prescriptions because of their concerns about the dosage and duration of drugs prescribed by Steiner, as well as the doctor's unavailability.

Also, nine other pharmacists in Louisville, Southern Indiana and Central Kentucky detailed concerns about Steiner to investigators last year, including Kroger on Buechel Bypass, Rite Aid stores on Preston Highway and Bardstown Road, CVS Pharmacy on Antle Drive and Walgreens Pharmacy on Baxter Avenue.

"We're kinda the gatekeepers," said Burks, the pharmacist who refused to fill Bozian's Adderall prescription.

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Concerns about Steiner date back nearly a decade, the Courier Journal has learned.

In 2009, a state medical board inquiry panel opened an investigation of Steiner due to concerns about controlled-substance prescribing and deficient medical record keeping, according to a sworn statement from an FBI agent.

A physician consultant reviewed a random sample of Steiner's patient charts, resulting in a recommendation that the doctor receive additional training.

Steiner agreed, completing training in Nashville, Tennessee, and Denver. The investigation was then terminated in December 2010 without any board action against him.

A few years later, the doctor hit Louisville Metro Police's radar. Police sought help from pharmacist Carrie Gentry, who noticed several problems while reviewing a private state database listing Steiner's prescriptions.

Gentry, a consultant with the state’s Office of Inspector General — which regulates health care facilities — noted several drug-related deaths of Steiner's patients in her 2014 report. That's two years before Bozian's death.

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Gentry also found that several of Steiner's patients were receiving high doses of buprenorphine, used to treat drug addiction, and several of those patients also received benzos — which can be a deadly mix at high doses.

In 2016, a former patient asked for a meeting with the DEA. The patient claimed Steiner was enabling his or her prescription opioid and heroin addiction, prescribing Suboxone, Valium, Xanax, Soma, gabapentin, Klonopin, olanzapine, Lexapro and Adderall.

"Steiner said Adderall was an effective treatment for addiction," the patient said of the drug commonly used to treat ADHD, a diagnosis that was never made.

Dr. Molly Rutherford, a board-certified addiction specialist who is not affiliated with the Steiner case, said "Adderall is not indicated to treat opioid addiction, or any kind of addiction. I can tell you that for sure."

The patient also told agents that Steiner charged $125 to $150 for each office visit, despite being covered by Medicaid insurance, which would be a violation of Kentucky law. Investigators claim Steiner charged "numerous patients" a fee for services even though they had Medicaid coverage. The FBI agent assessed that as health care fraud.

The patient said counseling was rare but prescriptions were regular, even after urine tests the patient expected to fail due to ongoing use of illegal drugs.

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He was familiar enough with the doctor to address him as "Peter," and said he could call the doctor's cell at any time for an early refill on any drug "without question," according to the FBI document.

The patient's mother, brother and roommate also were patients of Steiner. The mother and roommate later died — the roommate from heroin and amphetamines and his mother, who was taking Adderall, from high cholesterol, coronary artery disease and an abnormal heart rhythm.

Pharmacist haunted by patient's death

Two years later, pharmacist Chad Burks remains haunted by Bozian's death.

He knew of the patient's heart problems and of the potential dangers of Adderall. But he knew he had no legal right to hold the prescription when Bozian pulled up to the drive-thru window.

Burks said he wished he had a do-over: "I probably would have held that prescription and dealt with the fallout" to try and prevent Bozian's death.

"It was upsetting to me — so much so, it changed the way I practice," said Burks, who vows to hold on to any future prescriptions that he believes are disturbing.

Both Burks and Bozian's wife, Dale, saw warning signs and tried to intervene.

But Bozian put his faith in Steiner, telling his wife: "He's the doctor. He has all these degrees."

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Bozian, a truck driver who delivered newspaper bundles for the Courier Journal, had become addicted to hydrocodone pain pills after surgery — years before the dangers of opioids were fully known.

His wife, a former hospital nurse tech, prodded him into addiction treatment, which led him to Steiner's office in 2011. She said she could see her husband's health worsening. He became addicted to stimulants, she said, and used meth when he couldn't get enough.

He had heart surgery in April 2016.

Burks said he repeatedly questioned Steiner's office about the safety of prescribing Adderall for Bozian, especially after surgery. He called the hospital where Bozian had been treated and asked if the patient should continue Adderall or any stimulants. He said a doctor told him, "Absolutely not. I discontinued all that."

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Still, Steiner authorized more Adderall.

After Bozian's death, his widow found several love notes he hid for her in their car and throughout the house:

"God blessed me good with you."

"I adore you."

Dale Bozian said she is anxious to see Steiner in court. She has crafted a seven-page victim impact statement about "my Bruce."

In her statement, she says she never refers to Steiner as a doctor.

"He did not deserve it."

Reporter Beth Warren: bwarren@courier-journal.com; 502-582-7164; Twitter @BethWarrenCJ. Support strong local journalism by subscribing today: courier-journal.com/bethw.