CLEARFIELD – A former Clearfield-area doctor accused of breaking the law took the stand in his own defense on Tuesday.
Dr. Amer Khouri is charged with four counts of obtaining a controlled substance by misrepresentation, fraud, forgery, deception or subterfuge, four counts of prescribing a controlled substance not in good faith and outside the treatment principles accepted by a responsible segment of the medical profession, four counts of possession of a controlled substance, and one count of misbranding a controlled substance. According to the criminal complaint, Khouri habitually prescribed doses of Actiq lozenges in varying strengths to patients fighting cancer and recalled the prescriptions citing dosage error.
Khouri was the first (and only) person the defense called to the stand on Tuesday. He testified as to the activies he is accused of and why he was taking medication from his patients. Khouri, who was born in Jordan and is now a US citizen, testified that good medicine is not thrown away in the country of his birth.
His attorney, Jim Naddoe, asked him his thoughts on throwing away medicine that was still good.
“It’s a crime,” said Khouri, adding that it could be used for people who could not afford it.
One of the main topics in day one of the trial was that Khouri would ask his patients to return unused Actiq, a medicine used to treat breakthrough pain in cancer treatment.
On Tuesday, Khouri testified both under direct examination by Naddeo and cross-examination by Patrick Leonard of the Pennsylvania Office of the Attorney General, that he recycled the Actiq, giving to under-insured, uninsured and people with high co-pays. The question also came up regarding why he did not just give these patients vouchers for the medication. Khouri indicated that he did not always have the vouchers, or that he would run out. He stated that if he had them, he would have given them to the patients in need. He also indicated that he did not always have to ask for his patients to return Actiq, that at least three of them knew he was helping needy patients, so they brought in their unused medication.
Khouri also answered questions about each of the patients brought up in day one. He stated that phone calls between the patients and himself were initiated by both; in some instances, he would call to see how they patients were reacting to new treatments/dosages, the patients, or their family members, would call to tell him if something was wrong.
He stated that when a patient needed a new dosage of Actiq, he would request that the unused portion be brought back to him. He stated that it could happen after business hours, but that he was on call 24/7. He indicated it was not unusual for patients to call him while he wasn’t at work. He stated that patients were prompted to go through the second or back door to avoid a busy waiting area. The medication they brought in was then kept in a desk drawer. Khouri also stated that he realized he was going against hospital policy. He said he did not make his staff aware of what he was doing to protect them.
He also talked about the purpose of changing the prescriptions and strengths of the patients so rapidly. He stated that it was part of managing their pain; one day a patient might react well to a certain dosage, but maybe two days later, and in some instances the next day, they wouldn’t. So, he would write them a new prescription. He stated that this treatment was consistent with guidelines presented in the National Comprehensive Cancer Network, a treatise for treating cancer patients. He also testified that their dosages were smaller at the start of their treatments, but as their diseases progressed, they were prescribed more medication to help manage their pain.
He also testified to peer reviews. The peer reviews were conducted by other oncologists on his work with his patients. In the case of the four patients discussed in day one, the peer reviews basically agreed with Khouri’s management of their treatment. The prosecution questioned whether the peer reviewer knew of Khouri’s taking back of medication, but a clear answer was never indicated.
There were some questions by the prosecution regarding language in Khouri’s reports in the patients’ medical records. He was questioned about what it meant when he recorded a patient discarded medication. He indicated that was when a patient no longer used a prior dosage and brought it to him. When a patient disposed of medication, they threw it away.
Khouri also answered questions regarding the testimony of patients’ family members on the first day of the trail. In the case of Peter Baum, his wife, Bonnie Greene had testified that Khouri called them during an ice storm and asked them to return medication for a hospice patient in the area. She said they could not travel due to the icy conditions, and that Khouri went to their home to get the medicine. Khouri testified that he contacted them to see how Peter Baum was feeling.
“Peter was not doing good,” said Khouri. He added that he was on his way to see a hospice patient in Osceola Mills and that the Baums were on the way. He agreed to stop and write a new prescription, and, as was his practice, left with some of the old, unused Actiq. He testified that he left them some to get them through until they could get to a pharmacy. He denied that the medication was for a hospice patient, and that he never gave the recycled medication to hospice patients.
He also testified in response to testimony by Steve Briskar Jr., who testified on day one that his father, at the urging of his family, sought treatment elsewhere. Khouri said that after the October 2005, Steve Briskar Sr. approached him and asked him to treat him again. Khouri said after he started treating him again, he was not prescribing Actiq to Steve Briskar Sr., but that another doctor was.
The trial picks up again at 9 a.m. at the Clearfield County Courthouse. The defense is expected to call one more witness before closing.