The Saga of Bill Carter, Part 2

Editor's Note: The following short series involves a case in which the author was involved.

Part 2: Madness Falls and Fading Days

Bill Carter’s son was dead.

Dr. Carter was tortured by the thought that he might have caused his son’s death. By placing the fentanyl patch on Connor, Bill reasoned, he had unintentionally caused an opiate overdose resulting in respiratory depression and cardiac arrest. The depths of Dr. Carter’s anguish were bottomless. Bill considered suicide. It was only by acknowledging his responsibility to the rest of his family, his faith, and the love and support of his friends and community that his dark thoughts didn’t become dark actions.

Bill soon learned that his nightmare was just beginning.

Shorty after Connor’s death, Bill was notified that the Lancaster County District Attorney’s office was considering charges of manslaughter and narcotics trafficking against him. Bill’s oldest son is an attorney and had become aware of the DA’s actions through professional contacts, so Bill sought the advice of an attorney and after some legal investigation was told, “Someone wants your medical license.”

Dr. Carter’s attorney asked for Connor’s autopsy results and was denied access to them. The coroner’s office, either under orders from the DA’s office or through their own volition had refused Bill Carter’s request to see his own son’s autopsy.

Bill’s attorney was told, however, that the levels of narcotics in Connor’s blood were “sky high.” The official cause of Connor’s death was recorded as “multiple drug toxicity,” and the manner of death was ruled “homicide.”

The District Attorney proposed felony drug charge and a mandatory 10-year medical licensure suspension. Bill’s defense counsel recommended surrender of his DEA certificate, and Pennsylvania medical license in order to strike a plea deal and avoid jail time for Dr. Carter. Dr. Carter’s defense attorney was a local lawyer from Lancaster County who felt the need not to antagonize the District Attorney’s office. Bill’s repeated requests to see the autopsy results were denied, but he was told through his legal representatives that there was no question that Connor died of a massive drug overdose and that the post-mortem levels of fentanyl and oxycodone were “astronomical.”

The DA was charging Bill with violation of PA State Controlled Substances Law Section 780-113, subsection (14) which involves “The administration, dispensing, delivery, gift or prescription of any controlled substance by any practitioner unless done, (i) in good faith in the course of his professional practice; (ii) within the scope of the patient relationship; (iii) in accordance with treatment principles accepted by a responsible segment of the medical profession.” Taking a medication that was prescribed for one patient and giving it to another patient is technically “drug diversion” and is a violation of this law.

Conviction of violation of PA 780-113 carries with it a mandatory five-year prison term and an automatic 10-year loss of medical licensure. Bill was boxed in and saw no alternative but to surrender his medical license and DEA certificate in order to avoid going to jail.

I first heard about Bill’s ordeal from a group called Doctor’s Advocate. They are a fun group of guys to hang around with. Dr. Elliot Menkowitz, an orthopedic surgeon and the president of Doctor’s Advocate, and his band of medical crusaders love to stir up trouble and come to the aid of doctors who are being harassed and threatened, mostly by lawyers. Dr. Menkowitz heard about Dr. Carter, met with him, and asked me to look into the toxicology reports to see if there was anything in them that might help Bill Carter.

Since Dr. Carter had indicated that he was willing to surrender his medical license and DEA certificate, the coroner released the toxicology reports, but still refused to release the full autopsy.

I received Connor’s postmortem serum toxicology report in January of this year and began an analysis of the levels of the various substances that the fluid had been tested for, comparing it to previously published data of similar deaths involving the same substances.

What I found came as a shock to everyone.