Thursday, July 21, 2005
Marty Maldonado, a 42-year-old Soledad resident, lost his right leg to bone cancer nearly two decades ago. An irritated amputation site, along with a debilitated back, have left Maldonado in constant pain, at times so severe that he has been totally incapacitated.
Maldonado’s younger sister Sandy has been his full-time caregiver in the years since her brother’s amputation. Some days, she says, are worse than others.
“I remember it like it was yesterday,” Sandy says. “I went to him, and he was in terrible pain.” Sandy says he was out of prescription medication, so she called the pharmacy to get his prescription refilled. She was told it had been refilled too recently, and Maldonado would have to wait another 20 days to get pain relief.
“It didn’t make any sense to me,” she says. “I knew that couldn’t be right. But I couldn’t worry about it right then. I had to help Marty.” Sandy went to her own medicine cabinet and found some Vicodin that had been prescribed for her long before. “I gave it to him,” she admits, “I had no choice.”
Monterey County Deputy District Attorney Todd Hornik says there were many occasions that Maldonado was unable to get his prescriptions filled. The reason, according to Hornik, wouldn’t be known to the Maldonados or to prosecutors for months.
What eventually unfolded, Sandy says, was as an egregious betrayal.
According to court documents, over a period of months, Marty Maldonado’s own physician, Dr. Nicholas Sasson, had used Maldonado’s identity to obtain pain medications for himself. Sasson would write prescriptions for Maldonado, take them to various pharmacies in the county with Maldonado’s Natividad identification card, have them filled, pay cash, and keep them for his own use.
Maldonado had no idea what was happening or why until a pharmacist called and spoke to Sandy, who normally filled Marty’s prescriptions. “They said Marty’s prescription was no good and that I’d have to get a new one from the doctor,” she says.
It didn’t make sense. The pharmacy calling wasn’t one the Maldonados had ever used. Concerned, Sandy called her brother’s doctor, Sasson, and told him someone had been using her brother’s identity to obtain prescription medication.
“I was so pissed off,” she recalls. “I said, ‘Something fishy’s going on. I want something done.’”
She says Sasson explained that he thought someone had taken his prescription pad, and he’d take care of it for her. “That was the last I heard from him,” she says. “He said he was going to take care of it. We’re so stupid; we trusted him.”
“The jig was up,” Hornik says. “He could have stopped right then and there, knowing they were on to him. But he didn’t. He continued even after that conversation with the patient’s sister. There were something like 30 different instances we found where he’d filled prescriptions in Maldonado’s name.”
Maldonado called the pharmacy back and asked for a description of the person filling prescriptions in her brother’s name. While Maldonado says it didn’t strike her at the time, she says she now knows it was a description of Sasson.
“I took my brother in with his ID so the pharmacist could see it wasn’t him,” she says. “I didn’t think of Dr. Sasson, because who would ever think their own doctor was the one doing something like that?”
In the months that followed, Sasson had the unfortunate occasion to go to one pharmacy where a technician recognized him from a social gathering. The prescription he’d written was filled, Dr. Sasson’s name was called out, and Sasson sat there frozen. The pharmacist told investigators he then called the name of Marty Maldonado, and investigators say that’s when Sasson stood to pick up the prescription. Concerned, the pharmacy called the Drug Enforcement Administration, and the DEA launched an investigation, pulling every prescription Sasson had written countywide.
‘The long years of medical training are characterized by intense competition, excessive workloads and fear of failure, and few occupations face the intense stresses experienced in the daily practice of medicine. In addition, doctors, nurses and others who work in medical settings have knowledge of, and easy access to, many types of drugs.’
—National Addiction Center
Sasson, a third-year resident at Natividad Medical Center, was ultimately convicted of a felony, “obtaining controlled substance by fraud.” While the crime can carry a sentence of up to three years in state prison, Sasson received no jail time. In lieu of prison, Sasson was ordered to provide 1,500 hours of free medical services to a local nonprofit’s patients. He was also placed on five years’ probation, ordered to pay a $1,000 fine, and to participate in counseling and psychiatric treatment.
Natividad placed Sasson on administrative leave during the investigation, and allowed him to come back to complete his residency following his conviction. According to Cherie Stock, Natividad Medical Center’s Public Relations Director, Sasson was advised by hospital staff not to allow himself to be interviewed for this story. Subsequently, Sasson did not return phone calls or e-mails.
His colleagues at the hospital describe Sasson as a good doctor, committed to his patients, to the practice of medicine and to the community. They say he made a mistake and is paying for it, and that he is now clean and sober. They point out that his crime is not entirely uncommon in the medical profession—or in any profession.
But his story, even if it is not unique, demonstrates how a man can succumb to a terrible temptation, and turn a corner toward a bad end.
As part of his disposition in Monterey County Superior Court, Sasson was interviewed by investigators and by the Monterey County Adult Probation Department. That’s where he laid out his years of deception, addiction, and the illegal behavior for which he now stands convicted.
• • •
Nick Sasson was born in Los Angeles just before Christmas 34 years ago. His father, Jack, died in 1999. His mother, Rochelle, still lives in LA.
He told investigators that he has an older brother who’s been in and out of trouble with narcotics. He said his brother, whose name does not appear in the court documents, was serving a stint at the California State Prison at Soledad.
The younger Sasson was not like his brother—at least in the beginning. The 1988 high school graduate was accepted into UC Berkeley and received bachelor’s degrees in both psychology and anthropology.
It was after Sasson was accepted to the University of Southern California medical school, he says in his probation report, that his troubles with drugs began.
Sasson told investigators that during medical school, he suffered from kidney stones and a shoulder injury, which later led to surgery. He explained that during that recovery, he was prescribed narcotic painkillers. He says he continued with prescription meds to treat stress and pain for more than a year, and that doctors refilled his prescriptions for Vicodin for so long as a “professional courtesy” because he was a medical student, and because of what Sasson described as “a commonly held belief amongst medical professionals that those persons schooled in medicine have an innate ability to monitor their own treatment and recovery.”
Sasson still hopped from doctor to doctor in different areas of specialty because, he said, he knew there wouldn’t be a cross-sharing of information between caregivers.
But despite the multiple prescriptions for pain, it wasn’t enough. He explained to investigators that his tolerance level for pain medication had grown, and he says he started going into Mexico to get other prescription medications: Valium, OxyContin and more Vicodin. And still it wasn’t enough.
Sasson excused what happened next to investigators by saying that it was common for medical students to use narcotics and other drugs to help them overcome the intellectual demands of school.
He’d spiraled out of control by then, and says he found a friend who sold prescription drugs on the street. He began to buy on a regular basis—at least until that too wasn’t enough. Sasson says he then turned to heroin.
First he snorted and smoked it; then, six months into it, that was no longer enough either. He told investigators that he found that injecting it was the ultimate high. Still, he says, he was using “just enough to get by.” He carefully covered up his heroin injection sites by wearing long-sleeved shirts or using makeup.
Addicted to heroin and prescription medication, Sasson graduated from the USC School of Medicine in 2001.
Sasson again jumped the border to Mexico to get meds: Valium, and also methadone and buprenorphone—both used in recovery by heroin addicts. He needed them, he says, to help him get sober.
He says he tried more than a dozen times to kick, but couldn’t get off the heroin.
Sasson’s answer was to escape Los Angeles. When he was accepted into Natividad’s residency program, he says, he figured getting away would break the temptation.
It almost worked. For months, Sasson says, he was “white knuckling” his way through recovery. And then the long hours and job stress led to his indulging in painkillers in his downtime once again.
It was then that Sasson began to write bogus prescriptions. He says it started with his girlfriend. While Sasson wasn’t specific as to which medications he was filling for his own use, he was writing her prescriptions for Adderall and Ritalin. Both are commonly used to treat patients with Attention Deficit Disorder to achieve a mellowing effect, but for people without ADD or similar symptoms of hyperactivity, both medications are akin to speed or cocaine.
The pattern of behavior that had escalated in Los Angeles, and tormented him to the point that he’d needed to escape, surfaced again. And then, Sasson says, he stumbled upon Marty Maldonado’s identification card in his office after a visit. Sasson said he knew it was wrong, but the addiction by then had its teeth firmly implanted in him.
Sasson picked up Maldonado’s ID card and slipped it into his pocket. In no time, the Nick Sasson of Los Angeles was back.
• • • •
Marc Tunzi, a Natividad Medical Center Family Practice doctor and Sasson’s supervisor at the time, remembers the day the DEA had him paged while he was visiting a university with his daughter. Recalling the day, Tunzi sits across the table with one hand on his coffee cup. His kind eyes look tired. He has reservations about being interviewed. He’s honest about it. And yet, he is forthcoming about Sasson’s behavior.
“He screwed up,” Tunzi tosses out frankly. “He’s a good man. But he screwed up.”
He says he was shocked to find out how badly his colleague had screwed up.
“I got this page from the pharmacy, and it said that DEA agents were there and would like to see me that day. I drove back immediately.” He laughs ruefully.
“When the DEA calls and you know it’s about one of your doctors, and they want to see you right away, and you have no idea what it’s about, you kind of have to go back.”
Investigators presented Tunzi with their evidence: prescriptions written by Sasson, and patient profiles for Martin Maldonado and for Sasson’s girlfriend. Tunzi was then told that the DEA agents believed Sasson had been picking up the prescriptions himself at various pharmacies throughout the county.
“I was surprised. No, I was shocked,” Tunzi says. Then Tunzi fidgets with his coffee a bit, staring down at his cup, looking lost in thought. “I was disappointed,” he finally says.
But Tunzi’s role wasn’t over.
“Nick didn’t know yet. They suggested it would be easier if I made the call,” he says.
Despite his disappointment and shock, Tunzi says, at that point he was more resolved than anything else. “It wasn’t easy; it was painful. And yet I knew what I needed to do. Clearly there was a problem that had gone on long enough that needed to be addressed.”
And so Tunzi called Sasson into his office. “I said to him, ‘They’re telling me this. Is this right?’”
Investigators, prosecutors and Tunzi all say Sasson was forthcoming from the beginning.
“He started to cry,” Tunzi remembers. “He said, ‘I’m sorry.’”
Tunzi draws his lips tight.
“I’m not a psych; I’m a family doctor,” he says. “People reach out when they’re in trouble. And he was very forthcoming. It took all of less than five minutes.”
Investigators then met with Sasson. They showed him the prescriptions he’d written to his girlfriend and to Maldonado, and told him that the staff at two different pharmacies had positively identified him as the person who’d picked up the medications.
‘There are plenty of egregious violations of public trust that should result in our inability to continue in our profession. This is not a guy who just smoked a joint on the weekend. He clearly violated a trust that every one of us should be able to have in our physician.’
—Todd Hornik, Monterey County deputy district attorney
The Probation Department reports that Sasson was just as forthcoming in their interview. He admitted that he’d written prescriptions and took them for his own personal use, further telling investigators that he was addicted to methadone because it “took away the emptiness” and helped him by “taking the edge off.”
Sasson then went on to explain his prescription writing to his self-described common-law wife. Then Sasson came clean about his own patient, Maldonado. Sasson told investigators of his back problems, his kidney stones, and explained that during his recovery he’d developed “a taste for opiates” that evolved into shooting heroin. He outlined his several attempts for recovery, going “in and out of methadone programs.”
Told that the DEA would begin suspension proceedings against his license to prescribe controlled substances, Sasson opted to voluntarily forfeit his.
Tunzi was involved with what came next. Sasson was temporarily relieved of his duties at the hospital. “It was a decision to protect the hospital and to protect our patients,” Tunzi says.
Sasson didn’t know then that he’d get his job back at Natividad or that he’d keep his license to practice medicine.
For some, like the man who prosecuted Sasson, that’s blasphemous.
“I think the professional classes, of which I am a member, have a bar we have to meet,” Hornik says. “There are plenty of egregious violations of public trust that should result in our inability to continue in our profession. This is not a guy who just smoked a joint on the weekend.
“Frankly, I couldn’t give a damn what he does in his own time. But his actions put people in danger, and he clearly violated a trust that every one of us should be able to have in our physician.”
In order to re-earn that trust, Sasson still had to defy the odds, stay sober, and get on a road to recovery that might actually work this time.
• • • •
Once Sasson was temporarily relieved of his duties at Natividad, in April of 2004, he admitted himself to the Hazelden Springbrook Alcohol and Drug Addiction Treatment Center in Newberg, Oregon, for a three-month inpatient substance abuse treatment program. Hazelden specializes in the treatment of health care professionals. The center says that “54 percent of patients maintain an alcohol and drug-free lifestyle during the entire year after treatment” and “an additional 35 percent significantly reduce their use.”
Hazelden Springbrook exists because of the relative prevalence of drug abuse among doctors and nurses. It exists because Sasson’s story of succumbing to the stress of his chosen field is repeated, with different details, every day. According to the American Medical Association, 10 to 15 percent of medical doctors are addicted to prescription medication. That is about the same as the statistics for non-physician users, but studies suggest that beginning with residency, use of controlled substances increases substantially in physicians relative to the general population.
• • • •
A study conducted by the National Addiction Center concludes that health care professionals suffer from addiction for unique and specific reasons.
Studies suggest that beginning with residency, use of controlled substances increases substantially in physicians relative to the general population.
“The long years of medical training are characterized by intense competition, excessive workloads and fear of failure, and few occupations face the intense stresses experienced in the daily practice of medicine,” the study says. “In addition, doctors, nurses and others who work in medical settings have knowledge of, and easy access to, many types of drugs.”
William Halsted was one such physician. Halsted is credited with being the father of American surgery, a brilliant doctor with a pedigree as stellar as his career: born to a prominent family, and blessed with the best education money could buy. He graduated from Yale, then went on to graduate number one from his New York medical school. He would eventually become one of the founders of Johns Hopkins School of Medicine. Halsted took chances and paved ways for medical science that surgeons to this day celebrate.
But the stress of being a medical superpower overcame Halsted. He developed a taste for cocaine while studying its use as an anesthetic. He eventually and secretly became addicted to morphine. He said it tempered his stress—the stress of saving lives, of being a pioneer, of being the healer and not the healed.
Dr. Abraham Twerski is the founder and medical director of Gateway Rehabilitation Center in Pennsylvania and an associate professor of psychiatry at the University of Pittsburgh School of Medicine. Twerski says that the uniquely stressful role of the physician, compounded by the accessibility of prescription drugs and the ability to write prescriptions for themselves, make physicians particularly vulnerable to addiction. John Burke’s heard the stories, and seen the devastation caused by doctors who abuse prescription medication. Burke’s been in law enforcement for over 35 years, has spent the last decade specializing in pharmaceutical diversion, and is now vice president of the National Association of Drug Diversion Investigators.
“On average, we’re seeing about five physician arrests per year,” Burke says. Five per year nationally isn’t exactly staggering. But the consequences of addicted physicians are more egregious than the average addict, Burke says.
“We had a doctor we recently arrested,” he recalls. “He’d screwed up surgeries and had been prescribing patients things he shouldn’t have been prescribing. It got so bad at one point, a patient lost an arm.”
The day Burke and his team went in to interview the Ohio physician, Burke says, the doctor was so intoxicated, he could barely speak to them. “The worst part was, he’d just finished surgery.”
That doctor had also been using hydrocodone and OxyContin, Burke says.
Part of the problem for physicians lies in the enormous cone of silence that exists over the profession.
“It’s a small community,” says one local physician who declined to be identified. “People will be able to tell it’s me if I talk to you, even anonymously.”
“It happens all the time, but no one ever talks about it,” says another. “And I’m certainly not going to.”
“There are lots of health care professionals in the local diversion program,” one hospital administrator said, also under the condition of anonymity.
Tunzi is willing to talk about the drug diversion program for physicians.
“The medical profession is embarrassed about it,” he says. “[Drug diversion] is not an easy program to commit to.” He says he’s seen it work, and he’s seen it fail.
A thorough review of all 1,235 Monterey County medical doctors licensed by the State of California revealed that no doctor has been prosecuted for crimes similar to Sasson’s. No other MD license in Monterey County has a felony conviction for anything relating to drugs. (Misdemeanors are not disclosed.) There were a plethora of expired licenses, quite a few continuing education hours needed, failures to report changes of address, malpractice judgments and even a couple of sex crimes. A handful were revoked or suspended without any explanation.
Sasson’s record, with “felony conviction” in all caps, stands out as different, remarkable. But a felony conviction doesn’t exactly translate into a deplorable man or an incapable physician.
Tunzi is sitting across the table sharing an uncomfortable cup of coffee for nearly two hours because he wants very much for the other part of the man to be seen, the man who doesn’t exist anywhere in court documents.
Tunzi first met Sasson when Sasson came to Natividad Medical Center as a fourth-year medical student in late 2001 or early 2002.
“I thought Nick was terrific,” he says. “Even as a medical student, he had a good clinical sense. He was good at talking to people and had good clinical judgment. It’s a learnable quality to some degree, but more than that. With some people, it’s inherent, and I thought he had it.”
Tunzi goes on to describe the then-long-haired, hippie-looking doctor as personable, explaining that Sasson is one of the hands-on doctors who gets involved, is empathic, and goes “out of his way to do the right thing with patients.”
Tunzi and Sasson often volunteer their time at Dorothy’s Place in Salinas, an outreach soup-kitchen-style shelter for indigents. “He likes to be involved with the community,” Tunzi says.
Sasson is also taking his recovery very seriously, Tunzi says.
“People in drug diversion have to meet regularly,” he says. “They have to go to NA and AA meetings. They have random, unannounced urine samples that are taken in front of a witness.” The intensive regimen usually lasts for about five years. For Sasson, it’ll be exactly that. The Medical Board of California is requiring the five years’ diversion in lieu of proceedings to suspend or revoke his medical license.
“For his sake and the sake of his patients, I hope it works,” Burke says. “There’s simply no way any physician can be as sharp or as clear-headed as he needs to be when he’s seeing patients if he’s using drugs.”
For Sasson, time will tell. While it may not have felt like it to him, he was one of the lucky ones. He was caught before he could cause any irreparable harm. Sasson graduated from the residency program June 25 but remains at Natividad to complete his residency requirements.
Marty Maldonado is progressing well with another physician. All he and Sandy really want is an apology.
For nearly two dozen other physicians in California, who surrendered their licenses or had them suspended or revoked because of their own addictions or mishandling of prescriptions in the last 18 months, it’s too late for an apology. Most of them have already been given the kind of second chances Sasson got from the courts and the medical board. They failed. For Sasson, it’s not too late.