Case study: Dr. Howard Diamond

Case study: Dr. Howard Diamond
Dr. Howard Diamond is booked into a Texas jail after his on July 11.
  • Dr. Howard Diamond
  • Practice: Diamondback Pain & Wellness Clinic, Paris and Sherman, TX
  • Specialty: Physical medicine and rehabilitation
  • Opioid prescriptions paid by Medicare 2013-2015: 34,369
  • Costs to Medicare: $5.4 million
  • Discipline: federal indictment and medical-license revocation
  • Sentence: pending

(RNN) - For three years, health insurance companies, pharmacists and patients' families were sounding the alarm bells about Dr. Howard Diamond.

They knew that the physical medicine and rehabilitation doctor was writing dangerously high levels of opioid prescriptions.

Yet regulators - the state's medical board and law enforcement - were slow to act against the doctor, who was a top prescriber of opioids in Texas, state and federal records show.

Federal investigators know of at least 22 of his patients who died of prescription-drug overdoses since 2012. An untold number of others became addicted to opioids he prescribed.

Even after his arrest in July, Diamond refused to surrender his license to prescribe drugs and at least seven prescriptions for opioids were issued under his name during his incarceration.

Federal court records detail the lengthy investigation into his operation and the missteps by the state medical board, which could have shut him down long before the federal Drug Enforcement Agency did on July 11.

The DEA was tipped off to Diamond in 2014 by the family of Terah Holley, a 39-year-old mother who overdosed 10 days after receiving opioids prescriptions from him. A toxicology report showed she had consumed a lethal dose of morphine.

In 2015, the Texas Department of Public Safety made a futile attempt to interview Diamond about his prescribing practices after a pharmacist complained about him. The state resolved the issue when Diamond agreed to a remedial plan after a review of patient files showed a lack of details about the need for treatment. He agreed to take a class on medical-record keeping.

At the same time, officials from five different health-insurance companies flooded Diamond's office with letters questioning why he was prescribing high doses of opioids to their patients. The DEA search of his office last spring found some 100 letters from the insurers.

By then, the DEA was deep into its investigation.

Agents interviewed staff members who admitted that "they were legal drug dealers," court records say.

The agents talked to former patients. One told them that when he researched the oxycodone he was getting from Diamond, he realized it was more than cancer patients receive at the end of life. The patient sought out another doctor "to get off the drugs."

Agents also reviewed the state's prescription monitoring database and found that between January 2014 and last April, Diamond prescribed 6 million opioid pills.

The state medical board launched investigations in early-to-mid 2017 upon receiving complaints from a pharmacist and a mother whose son had repeatedly overdosed on pills prescribed by Diamond.

The board revoked his medical license in October – three months after he was indicted and nearly four years after the DEA began investigating.

Dr. Howard Diamond Links:

Sources: Texas medical board and federal court records

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