As many as 1.4 million blank prescription forms have been stolen from New York City hospitals since 2008 and are being sold by criminal gangs to drug users seeking prescription painkillers, according to a state Department of Health memo.
The memo, obtained by Newsday, said thieves put the forms through "common computer software and printers," forging a health facility or doctor's name. The memo states that the "primary drug of choice for these counterfeit scripts has been oxycodone," an addictive painkiller.
Oxycodone was linked to more overdose deaths on Long Island last year than heroin, according to figures from the Nassau and Suffolk medical examiners' offices. In June, David Laffer, an admitted prescription pain pill abuser, shot and killed four people in a small Medford pharmacy and then fled with thousands of painkillers.
The blank prescription forms were taken primarily from unidentified New York City Health and Hospitals Corp. facilities and were first thought to be isolated incidents, according to the memo. The Bureau of Narcotic Enforcement -- the health department's drug watchdog -- realized this past summer that the thefts were more widespread.
"BNE has identified a large nationwide organized crime gang known to traffic in illicit and legal drugs as being involved in the distribution of stolen prescription forms," the memo says.
Law enforcement sources familiar with the case told Newsday it appears that the Latin Kings, which operates nationwide, are involved in the trafficking of the forms. The blank forms, which the memo likens to counterfeit currency, are each selling for $100 to $300.
As of July, state narcotics investigators had identified nearly 100 stolen forms, and through analysis of serial numbers on them estimated the loss could be far greater.
"The potential number of prescription forms that may be affected, based on shipments associated with serial numbers from the previously identified 100 counterfeit prescriptions, is estimated at 1.4 million forms," the memo states.
The July 11, 2011, memo from four high-ranking health department officials to Richard M. Cook, deputy commissioner, Office of Health Systems Management, says the forms have appeared throughout New York and in other states and at mail-order pharmacies. Until last week, the health department has never publicly acknowledged the thefts.
While the memo says investigations are under way to catch the thieves, a spokeswoman for the hospitals corporation early last week said the officials there were unaware of the probe. By week's end, however, the state Health Department did inform the hospitals corporation.
The state Health Department has not alerted pharmacies, a department spokesman acknowledged, so they can be on the watch for forged prescriptions.
"It's mind-blowing," said Jeff Reynolds, director of the Long Island Council on Alcoholism and Drug Dependence, a nonprofit working to fight substance abuse. "That much paper getting out into the community, it makes our job harder, but at the end of the day it's taking lives -- in record numbers. It's akin to letting the most virulent virus you can find loose in New York State and not telling anyone."
Department officials say the number of stolen forms could be significantly lower but acknowledge they don't know precisely how many forms were actually taken.
Health department spokesman Jeffrey Gordon said the 1.4 million figure in the department memo was a worst-case scenario.
"At this point of the investigation we estimate the number of prescriptions could be at most several thousand," Gordon said. He provided no details on how that number had been estimated. "They don't know what the scope is," he said.
Late Friday, Gordon said the health department was "engaged in a serious and ongoing investigation" of the thefts and was "conducting a thorough review of policies and procedures for safeguarding forms."
Police: 'Troubling' issue
Det. Lt. Andrew Fal, commanding officer of the Nassau County Police Department's narcotics and vice squad, said regardless of the actual figure, the scenario described in the memo is serious.
"If you had a thousand, it would be an issue," Fal said. "To just have this many prescriptions out there is troubling."
And law enforcement and addiction experts fear the stolen forms could make a bad situation worse.
The number of Long Islanders seeking treatment for addiction to prescription opiates such as oxycodone is surging. Treatment admissions grew from 1,612 in 2005 to 3,626 last year, a jump of 125 percent. The largest bump was from 2009 to 2010, when 752 more admissions were recorded than the year prior, a 26 percent climb, according to the state Office of Alcoholism and Substance Abuse Services.
To make forgeries harder, New York requires physicians to write prescriptions on official, state-issued forms. Individual physicians fill out their prescriptions on preprinted pads. Hospital systems and large practices can get reams of paper forms on which doctors using computers print prescriptions for patients.
It's these forms that started going missing from health and hospitals corporation locations. The agency is one of the largest public health care providers in the country, operating 11 hospitals and numerous clinics throughout the five boroughs.
Eight doctors have been identified as victims of stolen identity in the case, according to the memo, and several people have been arrested after attempting to fill prescriptions using the forms.
John Burke, president of the National Association of Drug Diversion Investigators, which brings together law enforcement, health care professionals and regulators, said he had never heard of such a large theft of blank prescription paper from hospitals.
"It ought to be common sense that these are extraordinarily potentially valuable in the wrong hands and should be safeguarded," Burke said. "The security within these hospitals is obviously inadequate."
Like Burke, health department officials questioned the hospitals' handling of the paper. "It appears that the facilities are not adequately safeguarding the prescription forms and this is contributing to their theft," the memo states.
The memo recommends partnering with the hospitals to "improve safeguarding methods" to deter thefts. It was not until late last week, however, that state Health Department officials notified the hospitals corporation.
"HHC was informed this week by the state Department of Health that there is a broad investigation going on regarding the illegal use of prescription forms," according to a statement the corporation sent late Friday.
State regulations require hospitals to immediately notify the department of the "loss, destruction, theft or unauthorized use," of prescription paper. According to the prepared statement, the hospitals corporation said that since 2008, "nine out of 21 of our major facilities have made reports to the New York State Health Department regarding isolated incidents of missing prescription forms." The corporation declined to provide specifics about the incidents but said a number of losses appear to be "discrepancies" between the number of forms ordered and those received.
As for safeguards, the corporation's statement said its facilities "store printable prescription forms in locked cabinets that can only be accessed by designated personnel," among other security measures. The statement also said that the state's Bureau of Narcotic Enforcement has regularly reviewed the safeguards.
Connecticut's Department of Consumer Protection warned pharmacists in the state just last week to look out for forged prescriptions from New York, a department spokeswoman said. Connecticut authorities say they have turned up bogus prescriptions on paper purportedly stolen from Lincoln Medical and Mental Health Center, a city hospital corporation member in the Bronx.
No alert to NY pharmacists
No similar alert to pharmacists has gone out in New York State, said Craig Burridge, executive director of the Pharmacists Society of the State of New York. He said he knew nothing about the missing paper until a reporter contacted him on Oct. 11, three months after the department memo was written.
Burridge said he then called the Bureau of Narcotic Enforcement. Burridge said he spoke with a supervisor and was told there had been no such thefts. He said he was surprised because normally bureau officials notify his association when they learn that even a single prescription pad has gone missing from a doctor's office. He then sends out an alert to his members.
"Just give us a heads-up," Burridge said. "I have pharmacies that are right across the street from some major hospitals down there."
Nassau County's narcotics and vice squad said state officials did not inform the police department, either.
"It is troubling," said Fal, the Nassau police's narcotics and vice squad commander. "There should be some kind of alert."
Kenneth Post, the former director of the state Bureau of Narcotic Enforcement, criticized top health department officials' handling of the case.
Post clashed with health department officials before stepping down last year. In recent months he has become a public advocate for reforming the bureau.
"The reaction to this should be the reaction to a crisis," Post said.
Gordon said officials did not go public with the loss because it could jeopardize criminal investigations and because the department still does not know the scope of the problem. The memo indicates the federal Drug Enforcement Administration, the Office of the Special Narcotics Prosecutor in New York City, the state's Medicaid inspector general and several other agencies were told of the missing forms.
Reynolds, of the Council on Alcoholism and Drug Dependence, said he was angered by the lack of notification to pharmacies, considering the scope of the prescription pill problem on Long Island. In 2004, oxycodone played a role in 27 overdose deaths on Long Island, according to figures from the counties' medical examiners. Last year the number was 86.
THE PRESCRIPTION FORM PROCESS
WHAT: The Electronic Medical Record Official New York State Prescription forms are blank sheets of paper issued by the New York State Department of Health. The forms have security features like a bar code and heat-sensitive ink.
WHERE: Hospitals and large medical practices often use these forms to write prescriptions for patients.
WHY: A 2005 state law required all New York prescriptions to be written on state-issued forms in an effort to cut down on forgeries. Small practices often use pads of personalized forms. Hospitals, however, often get reams of the EMR paper.
HOW: Using a computer, doctors can type a prescription and then print the order for a patient on one of these special forms.
SECURITY: Medical facilities are required to safeguard this paper under lock and key.
THEFTS: If stolen, thieves can make fake prescriptions using a laptop and laser printer. The thieves forge a real doctor's name and registration number but use a fake phone number. When a pharmacist calls to check on the prescription one of the thief's associates -- using the fake phone number -- pretends to work in the doctor's office and confirms the prescription.
REPORTING: Medical facilities are required to report any theft or loss of the forms to the health department.