A former Newton doctor who was facing hundreds of years in federal prison for more than 100 counts of illegal dispensing of controlled substances, as well as charges of health care fraud and illegal dispensing of controlled substances resulting in death, will likely go to prison for a small fraction of that time after pleading guilty to two of the charges Friday in U.S. District Court.
Lafayette James Twyner, 64, pleaded guilty to one count of health care fraud and one count of illegal distribution of a Schedule III controlled substance resulting in death during a change-of-plea proceding Friday at the U.S. Courthouse in Des Moines. The change of plea was the result of a plea agreement arranged between his attorneys and federal prosecutors.
The agreement calls for Twyner to serve five years in prison and three years of home and/or community confinement. He was released to await sentencing in mid-May due to health concerns.
“The illegal distribution and abuse of prescription drugs is a significant problem,” U.S. Attorney for the Southern District of Iowa Nicholas Klinefeldt said. “Our office, and the federal, state, and local law enforcement agencies that assisted with this prosecution, take seriously our duty to protect the public from such practices.”
Federal law permits doctors, pharmacists, and other health care professionals with U.S. Drug Enforcement Administration registrations to lawfully dispense controlled substances if they are doing so in the usual course of their professional practices and for a legitimate medical purpose, but makes it illegal for them to knowingly issue a prescription to someone who is abusing or diverting a drug.
According to court documents, Twyner admitted that he knowingly distributed and dispensed Schedule II and III controlled substances to patients during the period of Dec. 27, 2007, and April 6, 2011, "outside the ordinary course of professional practice and not for legitimate medical purpose, to patients who had not legitimate need for the drugs and patients who were abusing such drugs and others."
He further admitted to failing to conduct adequate medical evaluations, such as routine physical examinations, obtaining thorough medical histories and histories of prior drug abuse or addiction, or required diagnostic testing. He also admitted to failing to treat the causes of patients' alleged pain, treating instead only the pain.
Twyner also admitted to "prescribing controlled substances in a manner that was likely to cause, and did cause, dependence and addiction, such as prescribing early refills." He also admitted to failing to require — or ignoring entirely the results of — drug tests.
He also admitted to not changing his prescribing practices when given evidence to suggest patients were abusing or were addicted to the drugs he was prescribing.
Twyner also made admissions with regard to a patient identified in court documents as "RL," who is likely Roy E. Long II. Long's death has been the subject of wrongful death lawsuits filed in Jasper County District Court.
Long's wife, Deserae filed a lawsuit claiming Twyner was negligent in his care of her husband — prescribing narcotics that contributed to his death — on Dec. 2, 2011. Twyner filed a counterclaim that Long's wife's failure as caretaker, not negligence on his part, contributed to Long’s death.
According to court records, Long’s official cause of death was an overdose of narcotic painkillers intensified by the consumption of alcohol. They also state he was suicidal, intoxicated and admitted he was addicted to drugs during a visit to Skiff on March 6, 2010.
He was admitted to the Newton hospital, and later Broadlawns Hospital in Des Moines, under court order for suicidal thoughts and depression that day and was released two days later. His instructions from doctors were to take medication for blood pressure and depression with an order to avoid other drugs and alcohol.
Twyner alleged in his counterclaim that Long's wife aided him in obtaining narcotics three days prior to Long's death and she witnessed her husband consume alcohol in the days leading to his death. The case was dismissed with prejudice — meaning it cannot be renewed at a later date — by Deserae Long's attorney in September of 2012 after an out-of-court settlement.
In his stipulation of facts as part of the plea agreement with federal prosecutors, Twyner admitted to distributing and dispensing controlled substances "outside the ordinary course of professional practice and not for legitimate medical purpose" to Long. Specifically, he admitted to:
• prescribing controlled substances to Long in quantities and frequencies that conflicted with the instructions on the prescription labels;
• ignoring the preventive medicine questionnaire in Long's patient file, which disclosed a history of IV drug abuse and recreational drug abuse dating back to July of 2000;
• being aware Long requested refills on controlled substance prescriptions after using the "red flag excuse" his medication had been stolen;
• never referring Long to a specialist for diagnostic testing or imaging, even though he complained of neck and back pain;
• not conducting physical exams of Long, which would have revealed he had been injecting opiates daily for a year;
• only planning to treat Long by keeping him on painkillers;
• ignoring the fact, which he knew, that Long was taking controlled substances in greater amounts than prescribed — 10 pills a day — and by continuing to prescribe them to Long even though he asked for help his addiction; and
• ignoring a prior warning on March 11, 2010, from Long's wife that he was abusing the drugs.
Twyner admitted to knowingly and intentionally distributing and dispensing more than 1,700 hydrocodone pills and/or tablets to Long, which resulted in the Newton man's death.
Also as part of the plea agreement, Twyner admitted that during the period of Dec. 18, 2007, through March 3, 2010, he knowingly and willfully "executed a scheme" to defraud Medicare and Medicaid by submitting false and fraudulent claims for prescriptions and services "represented to have been in the usual course of medical practice and for a legitimate medical purpose." He admitted to doing so with the intent to defraud.
He also admitted to doing so in connection with the payment of health care benefits.
Twyner was previously cited July 26, 2012, by the Iowa Board of Medicine for “engaging in a pattern of willful and repeated violations” of Iowa medical laws and procedures. He voluntarily surrendered his license to practice medicine and was ordered to pay a $10,000 civil penalty as part of an agreement with the board.
He then was named in a sealed federal indictment handed down Oct. 23, 2012, by a grand jury. That indictment was unsealed Nov. 5, 2012, in U.S. District Court in Des Moines. He made an initial appearance in federal court that day, and was granted a conditional release to await trial.
Twyner was charged with 105 counts of illegal distribution or dispensing of controlled substances, eight counts of health care fraud and one count of illegal distribution or dispensing of controlled substances resulting in death. Those charges stem from an April 5, 2011, search warrant executed at Urgent Care Clinic in Newton, where he was in practice.
The search involved the U.S. Department of Health and Human Services, the U.S. Drug Enforcement Administration, the Federal Bureau of Investigation, the Jasper County Sheriff’s Department, the Newton Police Department and the Mid-Iowa Narcotics Enforcement Task Force.