Sadness swallowed Jarrod Barber.
His friend had just died of cancer. He was smoking more and more marijuana and experimenting with pills.
Jodi Barber, Jarrod's mother, posts a flyer at the Fatburger in Aliso Viejo recently. She is going from store to store hoping to put up as many placards as possible around her community of Laguna Niguel. She wants to remind young people and their parents to be wary of prescription drug overdosing.
H. LORREN AU JR., THE ORANGE COUNTY REGISTER
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On the eve of his friend's funeral, Barber, 19, passed out on the family couch in Laguna Niguel while watching a late-night movie.
Slumped in a corner, he looked to friends as if he was sleeping. He was actually dying.
Barber fatally overdosed Jan. 8, 2010, on a cocktail of Opana, a narcotic painkiller, Seroquel, an anti-psychotic and Clonazepam, an anti-convulsant often used to treat anxiety, coroner's records show.
Abuse of prescription drugs has risen nationally among teens and young adults, experts say, because these drugs are easy to get and seen as a "safe" high. The names of doctors who are an easy touch for prescription narcotics spread quickly among teens. Some users get huge prescriptions and then sell pills on the street to finance their own habit.
Here in Orange County, coroner records show that accidental fatal overdoses rose steadily from 130 in 2003 to 266 in 2009. Preliminary figures for 2010 show at least 240 overdoses although final toxicological findings are still pending in some of the cases.
Barber didn't have a prescription for the Opana. Jarrod's mother, Jodi Barber, believes he purchased it from a now-deceased friend who was a patient of Dr. Lisa Tseng of Rowland Heights – an osteopath under state and federal investigation. There's no mystery about the other drugs: Dr. Paul D. Corona of Laguna Niguel prescribed the Clonazepam, and a few months later, the Seroquel.
Coroner's records show that drugs prescribed by Tseng – including Xanax, methadone and morphine – were found in the bodies of at least three fatal overdose victims in Orange County since 2000. Additionally, the parents of two other dead youths, Jarrod Barber and Ryan Winter, blame Tseng for the drugs that led to their overdoses. Jodi Barber says she has taken her suspicions to the federal Drug Enforcement Administration.
In August, after discovering that Tseng had written more than 27,000 prescriptions over a three-year period, federal agents revoked Tseng's license to prescribe narcotics. DEA investigators alleged in court papers that Tseng was operating "outside of the ordinary course of a professional practice." Meanwhile, the state Board of Osteopathic Medicine is working to revoke her medical license, officials confirm.
Unlike Tseng, Corona, who specializes in the treatment of mood disorders, has not been named as a target by state medical investigators or federal drug authorities. But records show that Corona is on five years probation with the state medical board for using drug samples to treat his own manic disorder. Additionally, a lawsuit filed in Orange County Superior Court in 2007 accuses him of negligence and wrongful death for his treatment of a woman who crashed her car while driving under the influence of prescription drugs, killing a young mother. Corona calls the suit "nonsense."
In an interview, Corona described himself as the "guru" of prescribing mood-stabilizers to treat substance abusers; a regimen he says is effective at relieving the underlying depression or anxiety often at the root of addiction. He says he rarely prescribes pain killers. An author and former radio personality, Corona's message is that psychotropic medicines are invaluable in healing the mind and, consequently, the body.
"I am the top prescriber of psychotropic medications around," Corona said. "Ninety-five percent of my patients are very happy. The fact anyone would put me in that category (as Tseng) is laughable."
Corona is praised by some local doctors, but a psychiatric expert who testified in the 2007 lawsuit said that Corona has no formal training in psychology and acted outside the scope of his training as a general practitioner. Two addiction experts interviewed by The Register criticized Corona's wide use of psychotropic drugs to treat people already hooked on controlled substances.
Dr. Harry Haroutunian, physician director at the famed Betty Ford Center in Rancho Mirage, says it is especially dangerous to prescribe drugs with sedative qualities when treating addicts in an out-patient setting, where they might score more drugs on the street.
"If he is telling you he is the highest prescriber," Haroutunian said, "that would be a dubious distinction by my measuring stick."
PSYCHOTIC BREAKDOWN
Corona's personal and professional lives have weathered considerable chaos over the last several years, public documents show.
On Dec. 17, 2007, Orange County Sheriff's deputies were sent to Corona's Laguna Niguel home and found him in his backyard having a "psychotic breakdown" and threatening suicide, an accusation from the Medical Board of California shows.
"Respondent was acting bizarre and was very aggressive, yelling and screaming incoherently. The officers had to taser respondent several times in order to subdue him," said the report by the medical board. Corona was hospitalized for nearly a month for psychological observation.
It was the same year that he published a book about treating mood disorders, entitled "Healing the Mind and Body."
In a 2008 interview with the Medical Board, Corona said he suffered an episode of hypomania three years prior. State documents say that he was prescribed Seroquel by his psychiatrist, but admitted to self-medicating from his sample drugs after his psychiatrist moved away.
"His disorder has impacted his ability to practice safely and led to his hospitalization for a psychotic breakdown," the state complaint said.
Corona was put on probation for five years in 2009.
Since opening a new office in 2008, Corona has focused on treating neuro-chemical imbalances that prevent the brain from reaching what he calls the "Wonder of Optimal Well-being" or the WOW state.
Sporting a flattop haircut and a Hawaiian shirt, Corona sees about 500 patients a month at his two-room suite, in a non-descript business center off Ivy Glenn Drive. Instead of a Rolodex, he keeps his phone numbers on a wrinkled piece of paper crammed inside his desk drawer.
Before his 2007 hospitalization, Corona said he had a 10,000-square-foot office with three other doctors. The practice foundered about the same time as his mental problems appeared. In 2008 he opened the solo practice.
Patient Madelyn Picascio, 72, of Laguna Niguel, said Corona brought her out of a deep depression.
"He is way better than any psychologist," Picascio said. "There's always a loony who will accuse the doctors of something. All I know is he helped me."
Dr. Carlos Montano, head of the drug rehabilitation center at Hoag Hospital in Newport Beach, says he often refers addicts to Corona. Montano estimated that up to 75 percent of the addicts he sees require drugs to stabilize their mood swings.
"Dr. Corona is a wonderful mental health physician," Montano says. "He gets referred some of the worst cases."
But not all experts in this field agree with such an approach – or that general practitioners like Corona should be treating mental patients.
Addiction specialists agree the limited use of drugs can be necessary, especially for addicts so physically dependant that removing all drugs could be fatal. But they say some doctors are now too quick to prescribe a chemical course rather than let the brain stabilize itself.
With these cases comes the danger – especially in an out-patient setting – that the addicts will supplement their prescriptions with street drugs, unbeknownst to the doctor, as in the case of Jarrod Barber.
"It's very dangerous out there," Haroutunian says.
Dr. Stefan Kruszewski, a Harrisburg, PA, psychiatrist who specializes in addiction, agrees that fewer psychotropic pills and more exercise, better food and therapy is the best way to heal the brain.
"It's better for the brain than adding more chemicals," says Kruszewski. "You need to let the brain establish itself and detoxify and you can't do that by adding more chemicals. You get more complications and more adverse effects when you administer more drugs. You can facilitate the brain's restoration with time, support and healthy living."
'LUDICROUS' STANDARD OF CARE
Corona was one of the doctors treating a mentally ill woman, Janene K. Johns, in August 2006. Johns fell asleep at the wheel with sedatives in her system, killing a young mother in Newport Beach, public documents show.
The family of the victim, Candace Tift, 31, is suing Corona and Johns' other physician, Dr. Jeffrey Barke, for wrongful death. Although none of the drugs prescribed by Corona were in Johns' system, according to a toxicological report, the family's attorney alleges her doctors should have hospitalized Johns or otherwise prevented her from driving because of the severity of her illness.
Attorney Sidney Martin, who is defending both doctors, said “I don’t think there was any negligence of any kind on the part of Dr. Barke and Dr. Corona.”
Court papers say Johns displayed a series of bizarre behaviors, such as stating that the shower in her home was causing cancer and that the voice of her recently deceased husband was passing messages through the television. Johns started filling one-gallon bottles with water and placing them throughout her house, for fear of disaster, documents say.
Johns' daughter took her to their family practitioner, Barke, who referred them to Corona as a "specialist in mood disorders," court documents charge.
Dominick Addario, a psychiatrist and professor at University of California, San Diego, testified in a declaration for the lawsuit that Corona has no formal training in psychology or psychiatry.
Corona's "assessment, care, treatment and handling of Ms. Johns' situation ...was not simply below the standard of care, but rather it was ludicrous," Addario testified.
For example, Addario testified, Corona did not perform any type of psychiatric evaluation of Johns. He did not document the history of the patient's behavior. He incorrectly assumed that Johns had stopped taking Ambien. He did not assess how much Xanax Johns was taking.
Corona prescribed Seroquel, which is commonly used for treating schizophrenia, and gave her a two-week supply from his samples, court documents say.
"Dr. Corona should have realized that Ms. Johns was in the midst of a psychotic breakdown and that she was irrational and her judgment impaired," Addario testified. "At minimum, Dr. Corona should have instructed/insisted that Ms. Johns be seen by him in a minimum of 3 days and that she not be left alone, not drive, and have her medication administration strictly supervised."
Addario said the accident would not have happened if Corona had been more diligent.
"It was ludicrous to assume that Ms. Johns could safely and reliably administer medication, drive a car, or be left alone," Addario says.
In a deposition in response to the lawsuit, Corona testified that he didn't recall talking to Johns about the details of her psychotic breakdown. He added her drug use would have been detailed in a questionnaire that his office gives.
In an interview, Corona labeled the lawsuit "lawyer fishing."
"It's nonsense, there was absolutely no basis for her hospitalization," Corona says. "You can't go back later and say, 'You should have known.'"
Johns is serving a 6-year prison sentence for gross vehicular manslaughter while intoxicated.
The Tifts' lawsuit is scheduled for trial in June.
A BAD MIX
Seeking help for their marijuana-abusing son, Jodi and her husband, Bill, were referred by a local psychologist to Corona in October of 2009. Corona prescribed Clonazepam, at Jarrod's request, the anti-depressant Pristiq and, later, the anti-depressant Cymbalta, according to a treatment chronology that Corona sent to the Register.
Corona saw Jarrod again two days before his death. He prescribed Seroquel because "it is not addictive and is safe, and could potentially help to resolve or decrease his anxiety and help to improve his sleep and appetite," the chronology says. The document notes that Jarrod told Corona he wasn't taking Clonazepam "as much over time."
Jarrod came out of Carona's office loaded up with Seroquel samples, so he could get started right away, Jodi Barber says.
Haroutunian as well as Kruszewski questioned why a doctor would prescribe Seroquel to someone taking Clonazepam – since both can act as sedatives.
"You're getting unintended adverse consequences from taking Seroquel and Clonazepam. And when you mix them with more sedatives, you can end in overdose," said Kruszewski, who has testified against the makers of Seroquel for marketing uses not approved by the federal government. Seroquel-maker AstraZeneca this week signed a $68.5 million settlement with attorneys general in California and 37 other states who had accused the company of marketing off-label uses for the drug.
Seroquel's government-approved use is for schizophrenia and bi-polar disorder, but Corona – as other doctors do – was using it off-label to help Jarrod sleep and eat. It's legal for doctors to prescribe drugs for off-label uses, but illegal for drug-makers to promote them.
Haroutunian called Seroquel and Clonazepam "a bad mix."
"Both depress the central nervous system. Together they can have an addictive effect," Haroutunian said.
Monitoring her son's drug intake, Jodi said she confiscated the drug samples from Jarrod, but missed a four-pill box of Seroquel. Jarrod apparently took three pills the night he died, which was the prescribed dosage, along with the illegally obtained Opana, the pain-killer. He also had Clonazepam and marijuana in his system, according to a toxicological report in the coroner's records.
Corona says he didn't mean for the Clonazepam and the Seroquel to be taken simultaneously.
"If they choose to do it anyway, against my advice, look what happens," he said.
Corona says he is being vilified by a small group looking to displace blame.
"It's disheartening when a few comments sway this completely imbalanced view of what I do by people who don't know what I do," Corona said.
Jodi Barber disagrees.
"He knew what he gave Jarrod," said Jodi Barber. "I'm horrified; just devastated."
THE DIAMOND PLAZA
Opana is a prescription drug relatively new on the street. A time-release pain killer, essentially synthetic morphine, it can induce euphoria but can also depress the respiratory system. Coroners weren't finding it in Orange County overdose cases until 2009; since then it's appeared in six cases.
Recovering addict Dimitri Zarate, 32, of Dana Point, said he got his Opana from Dr. Lisa Tseng.
"The hardest part was the drive to (her office in) Rowland Heights," says Zarate. "Once you got in the room, it took five minutes." Zarate said he paid $300 for the visit and got prescriptions for drugs with a street value of $4,000. His plan was to sell half the drugs and keep the other half – a typical pattern among abusers. Zarate entered a Dana Point recovery center late last year.
Tseng remains under investigation by the DEA, which searched her "AAA Advance Care Medical Center" in August and revoked her ability to prescribe federally-controlled narcotics. The osteopathic board is working with the state attorney general's office to revoke her license, officials said. Until then, her clinic remains open.
The Register visited Tseng's clinic earlier this month, but Tseng declined through a nurse to be interviewed. She provided the name of a lawyer, Mark Mermelstein of Los Angeles, but he also declined comment.
On one recent weekday night, her clinic remained busy, handling flu patients and young athletes seeking a quick physical.
Meanwhile, Dr. Corona is putting the finishing touches on his second book on treating addiction and mood disorders. Aimed at physicians, it will be titled, "Healing the Mind and Body, Part 2." He hopes to finish his probation with the medical board early.
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