The Junkie in the O.R.(Some doctors are addicted to the very drugs they prescribe. Find out why going under the knife could be more dangerous than you think)
Cole called attorney Richard Silver and was soon plunged into a dark side of medical care that he'd never dreamed existed. Silver began digging and learned that Sadie's anesthesiologist -- Dr. Jay Angeluzzi -- had behaved bizarrely during the procedure. First, he'd failed to recognize that Sadie had stopped breathing, even after the electronic monitor's alarms sounded. Then, instead of examining her, he'd turned off the alarms and left the room. It would be 9 critical minutes before anyone noticed Sadie was not responsive. By the time she was revived, her brain had been oxygen starved and ruined.
So why not just have docs step up to the cup, same as pilots and pro cyclists? One big problem: There's no test for fentanyl, the drug of choice for most addicted anesthesia providers. "We had Abbott Laboratories working on a fentanyl test for more than a year," says Dr. Arens, who had commissioned the project on behalf of the American Society of Anesthesiologists. "But they failed. Every variation showed false positives with antihistamines. So it's easy to call for randomized drug tests, but what do you do if you have no test?"
Writhing agony on the operating table is what finally trapped Dr. Frank Ruhl Peterson, a 45-year-old Pennsylvania anesthesiologist who was sentenced to 10 to 23 months in prison in 1997. "He had more than 200 patients in the couple of months he was there. When I asked him how many of his patients he shortchanged on the drugs, he said, 'Everybody,' " the investigating detective told the Associated Press. "Since the patients were under no anesthetic, they could actually feel the scalpel cutting them, and the operations had to be stopped."
Wait, he thought. What if the drugs are escaping from the patients' breath? The system for delivering drugs may be airtight, but how about the ventilation? Dr. Gold enlisted the University of Florida's nanotechnology group to use its mass spectronomy equipment to test for the presence of drugs above a patient's mouth. They scanned an O.R., and . . . jackpot! Sure enough, narcotics were detected not only in the air, but also on metal trays and tables -- exactly the way vaporized gas would settle. "Fentanyl is extremely potent and active in the air -- that's why the Russians used it to put everyone in the theater to sleep during the Chechen hostage crisis," Dr. Gold explains. "It's also easily absorbed through the skin."
Dr. Gold became aware of how many anesthesiologists were diverting drugs into their own veins while he was assessing 20 years' worth of confidential records at the Physicians Recovery Network, an intervention and rehabilitation organization. He was struck by how often "anesthesiology" turned up as an addicted doctor's specialty, so he began tabulating. Dr. Gold has been an addiction expert for more than 30 years, but even that didn't prepare him for the total: Anesthesiologists are overrepresented by a staggering 500 percent.
"I lost 12 top residents to addiction in 12 years, and I don't know how many others I've missed," concedes James Arens, M.D., chairman of the anesthesiology department at the University of Texas Health Science Center at Houston. "I never confronted a resident who didn't have narcotic addiction, which tells me I didn't confront enough." Translation: If he'd been wrong a few times, Dr. Arens would be more confident he was erring on the side of caution.