By Seth Klamann
Via Wyoming News Exchange
CASPER — For more than five hours Monday, a federal prosecutor peppered a Casper doctor accused of running a pill mill with questions about his practice and history in an often combative cross-examination, which saw the doctor call people who testified against him “a bunch of liars.”
Shakeel Kahn’s defense team rested its case Monday afternoon after the doctor attempted to deflect questions from Assistant U.S. Attorney Stephanie Sprecher about the high dose of prescription painkillers he routinely doled out to patients and whether he knew they were selling those drugs. Khan faces 21 charges from the federal government, which alleges that he distributed high doses and amounts of controlled substances to patients while charging them high fees. One of those patients, Jessica Burch, overdosed in Arizona. Kahn is also charged in relation to her death.
The prosecution and defense will make closing statements Tuesday, after which the jury will begin deliberating on Kahn’s fate.
As he did Friday when he testified in his own defense, Kahn maintained that he broke no laws, always prescribed drugs for legitimate medical purposes and was unaware that any of his patients were selling the pills he gave them. He rejected repeated questions from Sprecher that he knew that his patients, apparently addicted to the pills, had to sell some to continue affording the large cash fees Kahn charged.
Kahn, who started medical school in Toronto before being expelled for omitting previous degrees he’d earned from his application, finished his medical degree for a Belize school that has offices in Texas and Mexico. He did part of his residency for the University of Wyoming.
Sprecher asked Kahn about a time in his residency here when he was reprimanded for his prescribing habits. He called it a “discussion with his mentor” related to an “overdose” of a patient who — Kahn said — hadn’t adequately described his or her full history.
Throughout the day, Sprecher had to cut off Kahn as he attempted to steer yes-or-no questions into more lengthy answers. At one point, the Judge Alan Johnson instructed him to listen to the question.
The prosecutor detailed other issues Kahn has faced in his past, including a 2009 incident in Arizona where he increased a patient’s prescriptions despite another physician’s instructions to lower the doses. He acknowledged he lost an appeal on that ruling but maintained that he “still disagrees” that he was in the wrong.
Sprecher moved on to 2012 complaints, which Kahn successfully challenged, related to his prescribing. While Sprecher acknowledged Kahn had prevailed there, she asked about the resources he cited in his response to the Arizona Medical Board. Those resources advised starting patients on a low dose and increasing that dose slowly, she said. But Kahn said he didn’t necessarily believe in that.
Then why say in your appeal that you follow the guidelines, Sprecher asked.
Kahn said he followed parts of the guidelines but not all. There were other guidelines — which he didn’t cite in his own defense from the Arizona complaints — to which he apparently gave more credence when starting patients on controlled substances.
“Guidelines are guidelines,” he testified. “They’re not legally binding.”
He maintained that he was “vigilant” in preventing abuse and misuse of drugs in his patients and insisted that he always kept patients aware of the risks they faced from abusing the medications. But no patients testified at his hearings before the Arizona Medical Board, Sprecher pointed out. In that case, is the court just relying on Kahn’s word?
“I was under oath,” he said.
Sprecher, who wanted him to say yes or no, asked again, and Kahn repeated his answer.
Kahn denied that he “falsified” records that he turned over to the medical board, saying instead that he “updated” them. He repeated what he said Friday: It would’ve been less accurate to not include that he’d drug tested his patients than to alter his records to say he did. But Sprecher noted that he had records for patients — like Burch — on days that they couldn’t possibly have been in his office and that he was relying on memory to list specific details in seemingly random charts from years prior.
That would make them not technically accurate, she said.
“I guess not,” he replied.
“You should’ve said, ‘I knew I did a drug screen, I just can’t remember when,’ correct?” Sprecher said.
“I should’ve probably said that,” Kahn agreed.
Despite his claim that his recollections from years prior should be relied upon to accurately — at least in a broad sense — reflect his medical practice, Kahn practically snorted when asked why a patient’s recollection of a conversation about the risks of opioids didn’t match with his own memory.
“Patient recollections ...” he said, starting and then apparently deciding against it. “I couldn’t comment on that.”
He later said patients lied when they testified that Kahn had not adequately described the risks of opioids. He maintained that he told the patients that information in person, even if he didn’t describe those conversations in his records, and that he didn’t give high doses to opioid-naive patients — meaning those who hadn’t previously used the pills.
But he gave an 18-year-old a total of 240 oxycodones in two different strengths, and when she reported later that she was feeling better, he upped the strength of one of the prescriptions. He later testified that he believed she had previously used the pills and had taken them from family members.
Sprecher attempted to show that many of Kahn’s patients were unemployed and couldn’t afford the fees he regularly charged — ranging from $500 to well over $1,000 per month.
She walked through records of several patients who were all unemployed or were on a fixed income. She routinely described Kahn as charging for prescriptions, a phrasing he corrected to note that his patients were paying for office visits, not just pills.
Kahn testified that he would give patients prescriptions even if they hadn’t seen him in the office. They would still pay as if he say them in person but would routinely pick up their prescriptions from his office without seeing him. In at least one case, a patient picked up a prescription in a parking lot. In another, a patient got their meds from a Casper vape shop, where Kahn’s stepchild worked.
Sprecher showed text messages between Kahn and one of his patients that showed, month after month, that the patient was texting Kahn for “appointments” to get his prescriptions — more than 400 pills in each refill — and that Kahn replied that he was out of town. Each time, the patient was advised to go to the office and pick up his scripts. In return, he paid Kahn $1,650 for each “visit.”
Kahn insisted that each time, the patient’s vital signs were taken and forms were filled out. He said that patients who paid more received greater “access” to him and that more meds meant more attention paid to the patient’s risk.
Sprecher also showed Kahn a transcript between Kahn and his wife, in which Kahn said a patient “had better be dying” before they called him. The doctor also expressed anger when a patient asked him about a medical problem.
Kahn later testified he wasn’t that patient’s primary provider and shouldn’t be expected to deal with his other ailments. He did, however, write prescriptions for Xanax, an anxiety medication, and gabapentin, a medication for nerve issues.
He repeatedly denied knowing that any of his patients were selling their pills in order to afford his escalating prices. Sprecher argued that he gave his patients more pills when his prices went up so they could feed their habit and sell the excess pills; the money made from those sales would in turn go to getting more pills from Kahn, and the cycle would continue. Kahn denied that he participated or knew that was happening and said that was not why he raised prices.
In one case, he prescribed a patient roughly 700 oxycodone pills. That patient’s fee was $1,200. The patient told Kahn that he would pay Kahn back for a loan after the patient went to Oregon for “business.”
Sprecher implied the patient was selling his hundreds of pills there. Kahn said he understood that to mean the patient was working with his son in Portland. In any case, Kahn said the prescription was legitimate.
Oxycodone proved to be Kahn’s most-prescribed drug. He wrote scripts for more than 899,000 30 mg oxycodone pills, according to the prosecution. He disagreed when Sprecher said the drug was highly abused, saying hydrocodone was more widely misused. According to both the Centers for Disease Control and Prevention and a study by the American Academy of Pain Medicine, oxycodone is one of the most widely abused prescription opioids.
Asked about his preference for 30 mg oxycodones and how some pharmacists would call that “cookie cutter” medicine, Kahn lashed out at pharmacists (some of whom he had sparred with in Wyoming and in Arizona), saying they should go to medical school if they want to be doctors.
The doctor also denied trying to ensure his patients would stick with him. In a phone with his wife Lyn, Kahn said a competitor won’t give a departing patient “s—-,” referring to pills, and that the patient would come back.
Lyn also called that competitor’s office, describing the patient as having missed appointments, lost prescriptions dubiously and had generally been a bad patient. But the Kahns did not disclose to the competitor that the patient owed them money.
On the stand Monday, Kahn said that was because the money wasn’t important to the patient’s care. But Sprecher argued that if he had included the information about the money, the competitor may have suspected the Kahns were angry at the patient and had ulterior motives.
Kahn also denied allowing his patients to dictate how much to give others. Paul Beland, who took a plea deal in the case and previously testified, said in a phone call that a patient Beland was referring to Kahn should get “120, 120” — meaning the quantity of pills — and then “180, 180.” The patient was ultimately prescribed 120 of one strength of oxycodone and 120 of another dose.
When Beland told Kahn that, Kahn replied, “Yeah” on the phone. Kahn testified he was “noncommittal” later in the call and wanted to get off of the phone with Beland.
He also called patients who had previously testified in the case “a bunch of liars” and continued to defend himself as a doctor who meant well but made the mistake of trusting his patients too much.
As the day wound down and Sprecher prepared to step down, allowing Kahn’s attorney to ask more questions, she asked him if he had ever known his patients were selling their pills and if he would’ve allowed it.
He said it would’ve gone against every “personal, ethical, legal guideline I have internally.”
She asked if she was supposed to just take his word on that.
“On my word and on God’s word above,” Kahn replied.