David Laffer and his wife, Melinda Brady, filled prescriptions for almost 12,000 pain pills from dozens of doctors in the four years before he shot to death four people while robbing a Medford pharmacy for painkillers on Father's Day, according to state records.
The documents show:
The couple got about one-third of that total -- 4,251 pills -- in the first six months of this year.
From January to June, 30 of the 36 prescriptions they filled came from three area doctors.
In a spree from June 7 to June 17, Laffer filled six prescriptions for more than 400 pills from five different doctors. In that 11-day period he got a four-month supply. That came after Brady filled a final prescription on May 28 for 120 pain pills.
On June 14, Laffer filled a prescription for hydrocodone, a powerful opiate painkiller, at Haven Drugs.
He returned to the Medford pharmacy, in a small office park, on Sunday morning, June 19, wearing a fake beard and sunglasses. Laffer pulled a .45-caliber pistol from a black knapsack and executed the pharmacist, a 17-year-old cashier and two customers before fleeing with more than 10,000 painkillers, police said. Laffer and Brady both were described by Suffolk police at the time as pain pill abusers.
State records from 2007 through this June reveal the couple's escalating demand for addictive painkillers as they sought more and more drugs in the years, months and days leading up to the murders. Prescription painkiller abuse has exploded in the last several years, with oxycodone contributing to more overdose deaths on Long Island last year than heroin.
State tracking system
The couple went on their extraordinary binge despite a state system intended to track the abuse of controlled substances. Since February 2010, doctors have been able to check an online database maintained by the New York State Department of Health to determine whether their patients received controlled substances from other providers. But because pharmacies don't have to report a given month's records until the middle of the following month, the database may not always be current.
As many as 11 times a month, Laffer and Brady visited medical professionals, from Flushing to Center Moriches, according to the documents, which list the names of doctors who prescribed 11,881 pills beginning in June 2007, the type of pills, as well as quantities and days' supply. The documents show a downward spiral as the drug habits of Laffer and Brady sent them to dozens of doctors in search of powerful narcotics such as hydrocodone and oxycodone.
The pattern -- known as "doctor shopping" -- is familiar to law enforcement officials. Drug addicts, always wary of having their supply cut off, frequently visit different medical professionals and different pharmacies to get and fill prescriptions of controlled substances. Since 1972, the state Health Department has tracked prescription drug use. In 2008, the state began notifying doctors of possible abuse by patients. Then, in February 2010, the state made a Controlled Substance Information system available to doctors. The database only shows if a patient has filled prescriptions for controlled substances from two or more providers at two or more pharmacies in the previous calendar month. Such behavior is considered a possible sign of doctor shopping. The database is not available to pharmacies.
Few docs check database
State officials say that fewer than 1,000 doctors and other authorized prescribers used the system in 2010 -- around 3 percent of the medical professionals the state has identified as regular prescribers of controlled substances. Health Department spokesman Jeffrey Gordon said the department is "conducting a top-to-bottom review of the system and working to expand access to data." He said the department "encourages and expects practitioners to use the tools we are providing to them" as a means of identifying people who misuse prescription drugs.
He said the medical community shares a responsibility to catch doctor shoppers. Dr. Thomas Jan, a Massapequa pain management and addiction specialist who serves on a Nassau County heroin abuse task force, agreed that the medical community needs to do more.
"I will tell you, hands down, without any exaggeration, the current drug epidemic we have right now on Long Island is directly related to doctors and others in the health field prescribing irresponsibly," Jan said. "And it's up to us to fix that."
Laffer, 34, pleaded guilty to the murders, and this month, during an emotional sentencing in a Riverhead courtroom attended by victims' families, he was sentenced to five life terms in prison without parole for the four murders and a count of multiple murders. Brady, 30, who helped plan the robbery and drove the getaway car, was sentenced to the maximum of 25 years in prison for robbery.
As Laffer was sentenced, even he raised the issue of doctor shopping in his statement to Suffolk County Court Judge James Hudson.
"If there is a discussion of doctor shopping and prescription pill abuse, then perhaps some good can come from this," he said in court.
3 doctors wrote the most
In the first six months of this year, 30 of the 36 prescriptions the couple filled came from three area doctors: Stan Li, Eric Jacobson and Mark Charles Kaufman. Jacobson and Kaufman were both disciplined by the New York State Board for Professional Medical Conduct in 2000 for matters unrelated to prescription drugs.
The state suspended Jacobson's medical license after a New Jersey case in which he diagnosed injuries for purported car-accident victims he never actually examined, records show. The suspension was lifted Nov. 1, 2001.
The state revoked Kaufman's medical license for misrepresenting his credentials. The board reinstated his license in 2009 and placed him on probation for three years.
"Whatever was in my past has been totally cleared up," Kaufman said in an interview.
He said he didn't know the state database existed until after the June 19 slayings. The records show that he last prescribed Brady hydrocodone on May 28.
"I saw the lady for about four or five times, monthly. I in no way thought that she was addicted . . . and I was about to discharge her from the practice when this [the shootings] had happened because her behavior had become erratic and I had become concerned."
Records show she filled nine prescriptions for 810 pills from Kaufman between July 2010 and May of this year. After the June 19 killings, "I was very upset, but I'm not surprised," he said. "I'm sure that she was seeing other doctors concurrently," he said, adding that he didn't know that at the time he was treating Brady.
Trail of prescriptions
"She couldn't pay for visits," said Kaufman, who runs a family practice in Bay Shore. "It was like, 'Give me medicine, I don't care if I see you or not.' I said, 'That's not the way it works.' "
Kaufman said that the state notified him after the killings that Brady had been seeing multiple doctors, but declined to provide the date of the notification or a copy of it. Gordon would not say if the agency told Kaufman or other physicians about the couple's doctor shopping because of laws protecting the privacy of Laffer and Brady.
From June 2007 to June 2011, Laffer filled 104 prescriptions from 29 medical professionals, records show.
The largest number of prescriptions were written by Li. He works primarily out of New Jersey but also has office hours in Flushing. Laffer filled 24 prescriptions from Li -- for 2,520 hydrocodone pills -- between October 2009 and June 2011.
Laffer was seeing other doctors at the same time that he was getting prescriptions from Li. Laffer filled a prescription from Li for 90 hydrocodone pills on July 25, 2010, documents show. Three days later he filled a 60-pill hydrocodone prescription from a Huntington physician's assistant. Laffer returned to Li on Aug. 14, according to the records. On that date, Laffer received another prescription from Li for 90 hydrocodone pills.
Li declined to comment, saying patient "information is confidential."
"I can't let the newspaper know and let the whole world know what he is taking," Li said of Laffer. "This is inappropriate. I don't think it's good for the patient."
Brady filled 119 prescriptions from 29 different medical professionals from June 2007 through May 2011, according to records. In addition to oxycodone and hydrocodone, she also filled prescriptions for Xanax, an anti-anxiety drug.
"She was severely anxious," said Kaufman, who said he prescribed her hydrocodone and Xanax.
Records show Brady's most frequent prescriber was Jacobson, who operates offices in Great Neck and the Bronx. Brady filled 18 prescriptions for 2,850 pills from Jacobson between August 2010 and May 2011. That includes multiple refills.
One doctor explains
Health Department records show that Jacobson's patients filled more than 10,500 prescriptions for controlled substances in the first nine months of this year. That total ranks eighth in the state, the records show. Jacobson said in an interview that some of his prescriptions could have been forged. He did not provide details.
Jacobson wrote Brady a prescription for 180 hydrocodone pills on Oct. 6, 2010, with five refills, a six-month supply, according to the records. He saw her again four months later and gave her another prescription for 180 pills with four refills.
Jacobson told Newsday he stopped writing prescriptions for Brady because he suspected she might be doctor shopping.
"After checking the database from the Department of Health regarding controlled substances, I discovered she was getting controlled analgesics from other physicians in addition to my prescriptions," Jacobson wrote in an email to Newsday. "After confronting her, it was clear she was 'doctor shopping' and misusing the medication. I immediately discharged her with resources to seek drug rehab."
Jacobson also treated Laffer. He gave Laffer two prescriptions plus several refills for a total of 900 pills between December 2010 and June 7, according to the records. He said he had no idea that Brady and Laffer were married.
"The database did not reveal he was doctor shopping," Jacobson wrote in the email. "David was a model patient. He was respectful, polite, personable, and soft-spoken. We never had any issues regarding his treatment. I was shocked when I heard the news (of Laffer's arrest) and really didn't believe it at first."
On April 7, Floral Park police visited an office Jacobson was renting in that village after local merchants complained about people loitering as they waited for appointments. Village Police Commissioner Stephen McAllister said officers questioned some of these people and were told they had come from as far away as Brooklyn and Patchogue to pay $300 for a 90-day painkiller prescription.
The commissioner and two detectives confronted Jacobson and "he kind of nodded and said, 'I'm out of here,' " McAllister said. Jacobson grabbed a stack of files, walked out the door and never returned to Floral Park, McAllister said.
Jacobson confirmed that the incident in Floral Park took place, and said he never broke any laws. He said the police violated his and his patients' rights. Jacobson said he left because he already had another office location secured and planned to move anyway.
In the first 10 months of this year, there were about 102,000 searches of the state doctor shopping database, according to Health Department figures. To put that in context: Last year, New York pharmacies filled almost 4.4 million prescriptions for hydrocodone and 3 million oxycodone prescriptions.
Delays in reporting
Fewer than 1,000 prescribers used the system in 2010. Officials said that in spring of last year they began promoting the system to doctors. From the beginning of this year through the end of October, they said 2,061 prescribers used the system.
Even if doctors do check, the information is not always up to date because there is a lag in getting information into the system. Pharmacies don't have to report a given month's records until the middle of the following month. For example, a pharmacy must report on November prescriptions by Dec. 15.
The impact is evident in Laffer and Brady's records.
On June 14, five days before the murders, Laffer filled a prescription from a Port Jefferson Station doctor for 60 hydrocodone pills, a 20-day supply. This came after Laffer filled prescriptions from doctors Jacobson and Li on June 7 and June 11, both for 30-day supplies of hydrocodone.
Any doctor checking the database on June 14 would not have seen the earlier prescriptions because they were not reported to the state until after that date, records show.
Kaufman said the Father's Day killings changed the way he practices medicine.
"I was disgusted, mortified; and it's changed my whole outlook," he said. The murders prompted him to be more careful with his patients he suspects of doctor shopping.
"A lot of patients are going elsewhere," he said. "I don't want those headaches."