Jackson woman charged with 'doctor shopping'

Throughout 2003 and two months into 2004, a Jackson woman allegedly fraudulently obtained at least 4,800 tablets of Hydrocodone, a strong pain reliever, from more than 100 physicians in 17 Missouri counties as well as in counties in Illinois, Kentucky and Arkansas.

Wednesday, Cape Girardeau County Prosecuting Attorney Morley Swingle charged Theresa L. Amelunke, 41, with fraudulently attempting to obtain the drug from Cape Girardeau doctors. Amelunke is in the Cape Girardeau County jail in lieu of a $50,000 bond.

Amelunke is accused of "doctor shopping," a practice in which people convince more than one doctor to write prescriptions for the same controlled substance in order to get illegal amounts of the drug. Often the people involved use not only numerous doctors but various pharmacies as well.

Doctor shopping is a fairly common way of scoring drugs, said Cape Girardeau physician Dr. Anthony Keele, who has practiced medicine for six years, two in Cape Girardeau. Safeguards are in place to control it, but no system is foolproof, he said.

Pharmacists do alert a doctor when they believe a patient is doctor shopping, Keele said. Some people, however, have figured out how to circumvent the system. They will walk into an urgent care facility or an emergency room complaining of back pain and claiming to be allergic to over-the-counter anti-inflammatory medicines, Keele said.

"A lot of those places just give them the prescriptions," he said.

With a prescription for a strong painkiller in their pocket, the abusers then will go to another emergency room or urgent care facility and make the same claim with the same results. Then they'll fill both prescriptions at different pharmacies. Some emergency room doctors, Keele said, have stopped giving prescriptions to walk-in patients.

If a doctor determines the patient really needs the drug, a shot or dose will be administered on site before the patient is sent away referred to his or her regular physician for follow-up treatment.

Often the drug abusers also abuse Medicaid, which covers the cost of prescriptions. Abusers will get their multiple prescriptions and take one prescription to a pharmacy to be filled and billed to Medicaid. They will take another prescription to a different pharmacy and pay cash. They can afford to do that because they don't always take the pills. Sometimes they sell them.

"There's a huge market in Cape Girardeau for these controlled substances," Keele said.

The Medicaid system computer can track all prescriptions an abuser has filled, even the cash transactions, Keele said. When Medicaid alerts the pharmacy about this abuse, the pharmacist can refuse to fill the prescription and will contact the prescribing doctor.

"If a patient has Medicaid and comes in and pays cash, there's something fishy going on," Keele said.

Some physicians try to control possible abuse by refusing to refill a prescription for a controlled drug over the telephone. Keele said his practice at Doctors Park requires patients on controlled medication to come in once a month for an evaluation before getting another prescription.

His practice also requires patients on controlled medication to sign an agreement listing why the reason why the drugs are needed, verifying with their signature that they need the medicine and will not sell it, agreeing that if they lose the drugs or if the medicine is stolen that they cannot get another prescription until the next regular appointment, and agreeing that they will not try to get an identical prescription from another doctor or from an emergency room.

"If we learn they have violated the agreement," Keele said, "we fire them from our practice."

Despite the checks and balances, the system is not perfect. It does not work across state lines, and building cases against violators is not always a high priority because some states consider it a victimless crime, harming only the person abusing the drugs.

Keele disagrees. "Many patients not only have a drug habit but are reselling the prescription medications," he said. "Our tax dollars are paying for people to have the prescriptions, and they are generating income off of it."

Doctor shopping eventually caught up with Amelunke.

Officers from the Southeast Missouri Drug Task Force and the Missouri Bureau of Narcotics and Dangerous Drugs led the investigation against her. She faces a class D felony of fraudulently attempting to obtain a controlled substance, which carries a range of punishment from one to four years in prison, or one day to one year in the county jail or a fine of up to $5,000.

lredeffer@semissourian.com

335-6611, extension 160