By Roger Alford
The Associated Press

PIKEVILLE, Ky. - A growing list of doctors who were once welcomed with open arms into medically underserved Appalachia have been taken away in handcuffs.

In eastern Kentucky alone, seven small-town doctors are in prison or on their way there for illegally supplying drug addicts with prescriptions for powerful narcotics such as OxyContin. At least six others have been rounded up in the hills of West Virginia, Virginia, and southern Ohio.

Advocates for the mountain region say the loss of so many doctors ordinarily would have left a void. In these cases, they say, the departures can only improve medical care.

"As badly as we need more physicians, we certainly don't need the type that will violate their oaths and do much more harm than good," said Ewell Balltrip, executive director of the Kentucky Appalachian Commission.

Federal and state law enforcement agencies began cracking down on wayward physicians in Appalachia in 2000, after OxyContin, a powerful painkiller intended for cancer patients and others suffering from severe pain, began showing up in large quantities on the black market.

The first eastern Kentucky physician snared in the crackdown - Dr. Ali Sawaf, 61, of Harlan - turned to illegally prescribing OxyContin and other painkillers after he lost his $250,000-a-year job at a regional clinic.

Assistant U.S. Attorney Roger West said at the time that Sawaf was desperate for money and opened an office in a Harlan mall where he handed out prescriptions almost as quickly as he could write them.

The latest physician to plead guilty, Dr. David Procter, 52, of South Shore, traded pain killers for sex. He admitted to a federal judge that he had sexual relations with two female patients after he got them hooked.

Assistant U.S. Attorney Pat Molloy said most of the doctors caught in the past two years had been recruited to come to the region to help care for rural residents.

"They may not have stepped over the line before they got here, but clearly they were corruptible," Molloy said. "I don't think they were of high moral character when they got here."

Authorities blame the abuse of OxyContin for scores of overdose deaths in the Appalachian region and beyond.

If taken properly, the drug's ingredients are released slowly into the body. But abusers circumvent the time-release by crushing the pills and inhaling or injecting the powder to get the same kind of euphoric high that heroin brings.

Larry Bailey of Grayson, Ky., said he thinks his son, who became hooked on painkillers and died from an overdose, would still be alive if unscrupulous doctors had not been so willing to feed his addiction.

At first, his son, Paul Bailey, 35, had a legitimate need for medication to ease severe back pain. The last time he visited Dr. Rodolfo Santos of South Shore, he left with prescriptions for painkillers, tranquilizers and muscle relaxants. It was a combination of those pills that claimed his life.

So when Santos went on trial last month for over-prescribing drugs, Larry Bailey sat quietly in the courtroom day after day, hoping the doctor would be convicted on the charges. The conviction came last month, making Santos the seventh doctor in eastern Kentucky to fall.

"Being angry doesn't solve anything," Larry Bailey said. "But I was thrilled to see him being put out of business. My son tried to break the addiction. He had moved himself into a treatment center at Ashland, and did well for a few months. The desire came back, and he could get drugs freely from Santos."

A jury recommended in April that Santos, who was recruited to work in eastern Kentucky, serve 16 years in prison. He could be eligible for parole in a little more than three years.

Procter, the physician who owned the clinic where Santos worked, pleaded guilty in April to one count of conspiracy and two counts of illegally prescribing controlled substances. Procter faces 10 to 12 years in prison.

Others in eastern Kentucky who have either pleaded guilty or been convicted of over-prescribing drugs include two physicians in Paintsville, one in Garrison and another in South Shore. Some of those individuals saw as many as 150 patients a day, ushering them into and out of examination rooms in as little as three minutes.

Lewis County Sheriff Bill Lewis said no one in Garrison was sorry to see the arrest of Dr. Fortune Williams, the only physician in the community of 800 people, because of the large number of addicts he created and attracted.

In southern Ohio, two doctors have been convicted over the past two years for writing unnecessary prescriptions for pain killers, as have two from West Virginia and two from southwest Virginia.

In an effort to get more doctors in rural Appalachia, area leaders pushed for and got a medical school. The Pikeville College School of Osteopathic Medicine will have graduated 168 doctors as of this month.

The idea is to ease the shortage of primary care doctors with homegrown physicians.

Dr. John Strosnider, dean of the Pikeville college, said the new doctors will immediately begin to narrow the physician-to-patient ratio, easily replacing the physicians who have been sent to prison.

"Those numbers I don't even worry about," he said. "If we have physicians who are unethically writing prescriptions and selling narcotics, they're not practicing medicine anyway."

The first 53 graduates are scheduled to complete residency training in July of next year, at which time they'll be opening offices throughout eastern Kentucky.

"Five years from now, we should see hundreds of new primary care doctors in these communities," Strosnider said.