'Saddened' Luyao gets 50-year prison term



May 1, 2006 - FORT PIERCE Asuncion Luyao has remained quiet through two trials, but with the possibility of spending the rest of her life in prison before her, the former Port St. Lucie doctor broke her silence Friday.

"I'm saddened by the fact that those that I tried to help so hard, to improve their lives, to reduce their suffering, turn against me and make me look like the devil," said Luyao, 64. "What I have done for 25 years in this country, I only did to help people ... for all those that needed me, I was there for them."

Senior Circuit Judge Dwight Geiger sentenced her to 50 years in prison after she was found guilty by a jury last month of racketeering, five counts of trafficking in oxycodone and manslaughter in the death of one of her patients. She also was ordered to pay $1.3 million in fines on the trafficking charges. "I'm disappointed that it was not the barest minimum," said defense attorney Joel Hirschhorn. "It's a death penalty for her because she's 64 years old ... I think she's in a state of shock, understandably so."

The lone death jurors found she caused was that of longtime patient Julia Hartsfield, 52, who died March 3, 2001, of a methadone and alprazolam drug overdose. Husband Robert Hartsfield was in court, but did not wish to address the judge and left immediately after sentencing.

Connie Velie, who lost daughter Tina Smith, 27, and son Frank "Tony" Barnard Jr., 26, to drug overdoses, did speak. While Luyao was not charged in Barnard's death and was acquitted by the jury in Smith's, she still felt Luyao's care was a contributing factor.

"I feel that she should get the most that you can give her," Velie told the judge. "I have two children, your honor, that I'll never see again ... the only way I get to see them is at the graveyard."

Assistant State Attorney Erin Kirkwood asked the judge for a 60-year sentence, while Hirschhorn urged him to impose the 25-year minimum. While not absolving drug addicts of personal responsibility, Kirkwood said Luyao was "flooding the streets of the Treasure Coast" with prescription pills.

"This defendant fed their addictions with doses and amounts that are unattainable on the streets," Kirkwood said. "It became more apparent when she was shut down ... the time has come now for her to be punished."

Hirschhorn read from several letters written in support of the doctor, including from the head of the local Filipino-American association, another doctor and former patients. They described her as a compassionate physician, a doctor who made house calls and treated patients like friends, and a caring person.

Her trusting nature was ultimately her downfall, as it led patients to manipulate her, family members said. They declined to speak after sentencing.

"I know she is a trusting person and that is probably her biggest mistake. She trusts people," said Luyao's sister, Erlinda Nunn. "She helps people. She doesn't think of herself, she thinks of her patients."

Jurors acquitted her of five other counts of manslaughter and another count of trafficking in oxycodone at trial. Her first trial ended in a hung jury last June and her second trial, which began in February and ended in early March, lasted about a month.

Luyao's medical license was suspended after her arrest and it now is "null and void," according to state health records, meaning she has failed to renew the license for two renewal cycles.

At trial, prosecutors argued Luyao's negligent care caused patient overdoses and her Port St. Lucie medical practice was a criminal operation that freely dispensed powerful painkillers with few exams or diagnostic tests. The defense countered that other factors, not Luyao's care, caused the deaths and she broke no laws in treatment of patients.

Geiger denied defense motions for an acquittal on all charges and for a new trial. Hirschhorn argued that evidence introduced about gambling trips Luyao made to Palm Beach County was prejudicial and not relevant at trial.

Her family is "penniless" as a result of the case, Hirschhorn said, and the judge said she qualified for a public defender for her appeal.

Geiger allowed her to visit briefly with her family members, one at a time, after sentencing before she was returned to the jail.


What happened

Asuncion Luyao was sentenced Friday to 50 years in prison on charges of racketeering, trafficking in oxycodone and manslaughter in the death of one of her patients.


What's next

She will remain in prison while appealing her case, as she does not qualify for an appeal bond.


The case

Dec. 6, 2001: A search warrant is served at Dr. Asuncion Luyao's office in Port St. Lucie after a six-month investigation reveals "tremendous" amounts of painkiller prescriptions being written.


March 26, 2002: Luyao is arrested on drug trafficking, racketeering and Medicaid fraud charges, which are later dropped. The state Department of Health suspends her medical license, citing complaints that drugs she prescribed contributed to patient deaths.


June 24, 2002: Luyao is arrested again on four counts of manslaughter in connection with the deaths of patients and freed again on bond. Two more charges of manslaughter are later added.


May 9, 2005: Jury selection begins in her first trial.


June 3, 2005: Mistrial declared after jurors can't agree on a verdict on any of the charges.


Feb. 7, 2006: Jury selection begins in the retrial.


March 6, 2006: She is found guilty of manslaughter, trafficking in oxycodone and racketeering after about 3 1/2 days of deliberations.


April 28, 2006: Luyao is sentenced to 50 years in prison.


About Asuncion Luyao

Luyao was born in the Philippines and graduated from the University of Santo Tomas in 1965 before performing her internship and residency in New York. She practiced medicine in New York for 10 years before coming to Port St. Lucie, where she became a citizen in 1991 and had been practicing medicine for more than two decades when she was arrested.

She didn't know her husband before they were wed as part of an arranged marriage, and they have been together for 40 years, according to her defense attorney. She has four children, some of whom were with her in court, and four grandchildren.






Luyao case part of wider debate



March 12, 2006 FORT PIERCE With the conviction of Dr. Asuncion Luyao this week, a courtroom drama years in the making finally came to a close.

Her arrest four years ago brought the issue of prescription drug abuse to the forefront on the Treasure Coast and similar cases around the country have sparked a national debate about pain management among patients, physicians and law enforcement agencies.

Since then, awareness of drug abuse and the black market for painkillers, especially OxyContin, has brought changes in how doctors prescribe narcotics and how detectives try to reduce the problem.

Luyao, 64, was convicted Monday of trafficking in oxycodone, racketeering and manslaughter in the death of a patient. The Port St. Lucie physician, whose license has been suspended since her arrest, could spend the rest of her life in prison when she is sentenced in April.

The immediate, local impact after Luyao's arrest was tremendous, as former patients reported that it was nearly impossible to find a doctor willing to take them.

"As soon as they heard the name Dr. Luyao, they didn't want anything to do with me," former patient David Gough said in a March 2002 interview.

The aftershocks continued for months. One former patient came to the sheriff's office on Midway Road begging them for help with his addiction. The state Department of Children & Families reported 20 to 30 times more calls than usual seeking help for drug abuse in the month after Luyao's arrest and set up an emergency screening program to field applicants.

The sheriff's office attributes some of its subsequent progress in dealing with prescription drug abuse to its drug diversion unit. While it has been around for a decade, it is only in the last five years that the unit increased to two full-time detectives from one, said St. Lucie County Sheriff's Office Lt. Charles Scavuzzo.

Though there was an increase in doctor shopping after Luyao's arrest, it has become harder for addicts to get painkillers like OxyContin. Buying the drug on the street has gotten more expensive, with pills costing about $50 to $75 apiece compared with about $20 a pill when Luyao was still practicing, Scavuzzo said.

Cooperation has increased in recent years among doctors, pharmacies and law enforcement, especially in the realm of doctor-shopping. When an arrest is made by the sheriff's office, that person's name is faxed to about 100 area doctors and pharmacies to determine if the person visited them, too, he said.

There have been no other manslaughter cases brought against physicians on the Treasure Coast since Luyao's arrest and criminal charges against doctors remain rare. Awareness has spread about prescription drug abuse, but problems with fraudulent prescriptions and doctor shopping still persist, Scavuzzo said.

"Unfortunately with the growth of our population, it's still a continuing problem," he said.

At Lawnwood Regional Medical Center & Heart Institute, the growing awareness of overdoses linked to OxyContin and other painkillers has led to a change in hospital operations, staff said.

"Physicians have become very cognizant," said Brenda Dupree, director of emergency services at Lawnwood. "It's even changed the way we assess for pain."

When trying to gauge discomfort, physicians and nurses keep more detailed records about the level of pain patients report and the type of treatment given, with low doses at the start and a gradual step-up if needed, according to Cheryl Goforth, chief nursing officer at Lawnwood.

New technology has gone hand-in-hand with adding more protections around narcotics. For instance, computerized work stations at Lawnwood, St. Lucie Medical Center and Martin Memorial require a nurse to sign in and record when a narcotic is removed from the hospital supply, who it is being given to and why, all steps that prevent someone from stealing or misusing those strong medications.

Emil Varelli, director of pharmacy at Martin Memorial Medical Center, said there has been a "tightening up" in recent years on how and why painkillers are used.

Where OxyContin might have been used more frequently in the past for short-term pain (such as from surgery or an injury), it is now concentrated more in end-of-life and chronic pain treatment, he said.

"It works wonders for those who have that chronic pain," he said. "In the wrong hands, it's definitely a drug that's abused."

In the wake of high-profile physician prosecutions in the past five years, there has been a backlash from patients' rights groups who feel it has become harder for people with pain to find treatment.

Prosecutions against doctors around the country have made physicians less likely to want to deal with pain management or prescribe narcotics, leaving those with legitimate, chronic pain in the lurch, said Siobhan Reynolds, president of the New York-based advocacy group Pain Relief Network. This erodes the doctor-patient relationship and leaves questions to law enforcement that would be better made by physicians about what is proper treatment for pain, she said.

"What I'm seeing is a panicked medical community and not just in pain management," said Reynolds. "We have to ask ourselves, 'Is this an OK way for the government to be behaving towards its citizens?' "

Her group advocates having state medical boards investigate complaints and discipline physicians rather than having law enforcement involved, a position also supported by the Baltimore-based consumer group American Pain Foundation. Pain remains a major problem for people across the country and finding good doctors willing to aggressively treat chronic pain is a problem, said Will Rowe, the organization's executive director.

"It's a public health crisis that not many people know is there," he said.

http://www.tcpalm.com/tcp/local_news/article/0,2545,TCP_16736_4534289,00.html






Jurors: Deciding Dr. Luyao's fate was 'difficult, emotional'



March 9, 2006 FORT PIERCE It wasn't easy being a Luyao juror. Complex medical testimony, dueling experts, emotional stories of loss and addiction the Port St. Lucie physician's retrial had it all, not to mention more than 50 witnesses and hundreds of pieces of evidence to ponder. Plus, they couldn't take notes.

"The whole experience was probably one of the most difficult things I've had to endure, to be honest with you," said juror George Dietz, 54. "Sometimes it got pretty emotional in there between the six of us."

Despite the obstacles, the jury of four men and two women came to a unanimous agreement Monday that Dr. Asuncion Luyao, 64, was guilty of manslaughter, racketeering and five counts of trafficking in oxycodone after 3 1/2 days of deliberating.

In the days after the verdict, jurors began to talk about their experiences.

Early on, the jury decided to take the charges in order, beginning with racketeering and ending with the six manslaughter counts, talking things out on each individual charge before moving on to the next one, said juror Alexandra Sanders, 34.

The manslaughter counts took up a large part of their time, though neither Sanders nor Dietz could recall exactly how much time they spent on each patient's death or what order they discussed them.

"We took each one and just tore them apart," Sanders said. "We were like six college students researching a paper."

Sanders recalls counting pills in bottles at one point and passing around autopsy records, medical charts and pharmacy notes so each could read the evidence and give their opinions. Voices sometimes were raised and arguments did occur, but they worked through their differences, Dietz said.

In the end, the death of Julia Hartsfield, 52, was the only manslaughter charge they felt Luyao was responsible for causing and Dietz said it probably was the one they spent the most time discussing.

Luyao saw Hartsfield longer than any other patient, beginning in December 1996 through her death in March 2001. According to testimony from a prosecution expert who reviewed her files, the doctor gave her ever-increasing doses of painkillers without legitimate reasons noted in the files.

"All the evidence they put before us, it just added up," Sanders said. "On the other five, it wasn't 100 percent. We could only go on the evidence they gave us."

Jurors rejected the defense claim that a heart condition unrelated to Luyao's care killed Hartsfield, but they felt there was reasonable doubt for other patients' deaths.

Dietz specifically recalled that the combination of drugs found in the system of Janice Byers and her history of recreational drug use raised questions about the doctor's culpability. In the case of Bradley Towse, who was released from a Palm Beach Gardens hospital on the morning of his death, Dietz noted the failure of doctors to take blood after he died created doubt in the jury's mind about what killed him.

The drug trafficking counts based on the work of an undercover agent who visited Luyao's office with phony pain complaints took less time to reach an agreement on because there was less paperwork and fewer exhibits to sort through. Jurors gave Luyao the benefit of the doubt on the agent's first visit, noting the doctor only gave the man a limited prescription and asked him to come back in two weeks with records, Dietz said.

When the agent brought in irrelevant medical files and the doctor continued to increase prescriptions, jurors felt Luyao crossed the line into drug trafficking, Dietz said.

Prosecutors also introduced Luyao's legal gambling trips to a casino boat in Palm Beach County as a potential motive for her criminal actions, something that did not come in during the first trial. Sanders said it didn't seem like Luyao was losing enough money in gambling for that to matter and both she and Dietz agreed it had little impact in the jury room.

Jurors are not told about the potential penalties a defendant could face Luyao could spend the rest of her life in prison when she is sentenced in April and both jurors said they felt sympathy afterward for the families of the deceased patients and for the Luyao family.

Ultimately, they said they couldn't let sympathy play a role in their final decision. By methodically reviewing all the evidence and combing through the files, Sanders said jurors came out of the process feeling that they did as thorough a job as possible.

"The main thing is we wanted to be able to come out of there and sleep at night," she said.






Jury convicts Luyao
of manslaughter in a patient's death



http://www.tcpalm.com/tcp/local_news/article/0,2545,TCP_16736_4518898,00.html

FORT PIERCE Dr. Asuncion Luyao could spend the rest of her life in prison after being found guilty Monday of drug trafficking, running a criminal enterprise and manslaughter in the death of one of her patients.

It took the jury of four men and two women about three and a half days to come to a unanimous decision on the doctor's case. They found the Port St. Lucie physician guilty of manslaughter in the death of longtime patient Julia Hartsfield, racketeering and five counts of trafficking in oxycodone.

The charges amount to a virtual life sentence for the 64-year-old, as she faces a mandatory minimum of 25 years in prison on two of the drug trafficking charges and up to 195 years in prison on all of the counts taken together when she is sentenced April 21.

She was found innocent of five other counts of manslaughter and another count of trafficking in oxycodone. It was the second time Luyao was tried on the charges after a hung jury resulted in a mistrial in her first case last June.

Relatives of two of the six patients who died were present for the verdict and had mixed feelings after hearing the jury acquit the doctor of manslaughter in their loved ones' deaths.

"That really broke my heart because I felt she caused my daughter's death," said Connie Velie, mother of deceased patient Tina Smith. While Velie said she didn't feel she gained justice in her daughter's death, she felt it was important that Luyao was convicted.

"We get her off the street where she can't be a doctor anymore," she said.

Members of the jury either declined to comment or could not be reached after the verdict.

Assistant State Attorney Erin Kirkwood, who prosecuted Luyao in both trials, said it was difficult to put the families and everyone else through the case a second time. "We've very pleased with the verdict," she said. "I think (the jury) worked hard. They took their job very seriously."

Prosecutors argued Luyao was running a criminal enterprise from her doctor's office, giving out powerful pain killers without exams or diagnostic tests and that her negligent care led to the overdose deaths of six patients.

After the verdict, Senior Circuit Judge Dwight Geiger ordered Luyao be taken into custody by the sheriff's office.

Defense attorney Joel Hirschhorn said he plans to ask for a new trial and will fight for Luyao to be free while she is waiting for an appeal.

Hirschhorn described the jury's decision as an "odd verdict" as he felt there was a strong defense for the manslaughter charge and the trafficking counts were based on the work of an undercover agent who lied to the doctor about pain.

On the manslaughter counts, the jury found Luyao guilty in the death of Hartsfield, 52, who died on March 3, 2001.

To find Luyao guilty of manslaughter, the jury needed to find she was "culpable negligent" in the deaths, even if she didn't intend to cause them.

Chief Treasure Coast Medical Examiner Dr. Roger Mittleman ruled Hartsfield's death was a drug overdose caused by substantial amounts of methadone and alprazolam, known by the brand name Xanax. A toxicologist from the University of Florida found there was a toxic level of methadone in her system and two medical experts who reviewed Luyao's files found her care of Hartsfield was likely to lead to serious injuries or death.

Luyao saw Hartsfield, who sold antiques on eBay, longer than any of the five patients, which might have contributed to the jury's decision, prosecutor Kirkwood said.

Dr. Asuncion Luyao will be sentenced April 21 by Senior Circuit Judge Dwight Geiger on five counts of trafficking in oxycodone which brings a maximum of 30 years each (two counts carry a 25-year mandatory minimum)




PSL doctor found
guilty of manslaughter



March 06, 2006 A jury this afternoon found a suspended Port St. Lucie doctor, accused of doling out powerful pain killers with few questions asked, guilty of one count of manslaughter and five trafficking charges.

Dr. Asuncion Luyao, 64, whose license to practice medicine has been suspended since her 2002 arrest, also was convicted of one count of racketeering. After hearing the verdict, prosecutors said they were pleased. Luyao's trial last year on the same charges ended in a mistrial.

She waited four days while the jury deliberated the 12 charges filed against her: one count of racketeering, six counts of trafficking in oxycodone and six counts of manslaughter in the drug -related deaths. They mulled over more than 200 pieces of evidence and nearly two weeks of testimony. Lawyers gave the jurors two very different versions of Luyao's practice to ponder.

Prosecutors argued a motivation to make money drove Luyao to stop functioning as a legitimate medical doctor and became a "drug dealer." Her defense attorney said she was a caring and compassionate physician, who was "taken in" by some of her patients who lied to her in order to get prescriptions.

Prosecutors said Luyao essentially ran a "pill mill" from her office in the old Village Green plaza, where she gained a reputation as a doctor who would prescribe large doses of powerful, addictive narcotics with little to no examinations. If her patients were addicted, prosecutors argued, they would continue to pay a required $80 fee for each return visit required for a refill. That practice, they said, eventually lead to the six deaths.

Her attorney, Joel Hirschhorn, argued there were too many other factors involved to directly link Luyao to those deaths. He pointed to an independent medical examiner's testimony that two of the patients died of natural causes and that suicide could not be ruled out in others.

The doctor did not intentionally hurt her patients or act with a reckless disregard for their safety, Hirschhorn said.

She will be sentenced on April 21.








2/14/06
Friends,

One might note two things contained in this article:
1. The evidence is weak and circumstantial. Flimsy evidence is one of the hallmarks of a witch trial. Convictions result from the accusation alone.
2. One might think that the stench of police perjury, revealed by the doctor's attorney cross examination, would have a favorable effect on the jury. Don't count on it. In these affairs, good cross examination serves only to validate the process as a legitimate trial, while it is in actuality a public lynching.
Frank Fisher





Audiotapes of office visits

played at trial of doctor charged in deaths



http://www.palmbeachpost.com/localnews/content/local_news/epaper/2006/02/14/ m1b_slluyao_0214.html

February 14, 2006 FORT PIERCE The jury with the task of deciding whether a suspended Port St. Lucie doctor should be convicted of manslaughter in the deaths of six patients heard her speak for the first time Monday, via scratchy audiotapes secretly recorded inside her exam room by an undercover agent.

Thomas Watterson, an investigator with the Florida Attorney General's Office, posed as a one of Dr. Asuncion Luyao's patients, who reported that he had fallen off a scaffolding and jammed his hip. During some of his six visits to her office, he arrived with a recording device in an attempt to collect evidence to back allegations that she had gained a reputation for issuing excessive prescriptions for powerful narcotics.

He told a jury Monday that over the course of five months, he always left Luyao's office with prescriptions, including ones for the addictive painkiller OxyContin, even though she didn't thoroughly examine him, and he never gave her any prior medical records to verify his nonexistent injuries.

She never even touched his hip, he testified.

The audiotapes played to the jury Monday morning were of extremely poor quality and sometimes no voices could be heard above the background static. But at times, Luyao's voice could be heard talking to Watterson about his medication. At one point, the doctor expressed frustration to Watterson about her new younger clientele, saying they liked "to play her."

"She said the patients were getting younger and she felt like they were treating her like a clerk, telling her to 'Write me this, write me that,' " Watterson said.

Luyao is charged with six counts of trafficking oxycodone in connection with Watterson's visits. She also faces six counts of manslaughter and one count of racketeering. Prosecutors allege she wanted to keep her patients addicted to the painkillers so she could continue to collect an $80 fee for each return visit required for a refill.

But defense attorney Joel Hirschhorn countered that copies of the audiotapes that had been enhanced to improve the sound quality revealed much more about Watterson's visits.

He said a transcript of the enhanced tapes shows that Luyao consistently warned Watterson about the dangers of the painkillers, especially if he mixed them with alcohol. The enhanced tapes also show she told him not to accept prescriptions from outside her office, he said.

When Hirschhorn asked Watterson why his reports did not reflect those warnings, he said the reports were a summary of the conversations.

Watterson also testified that during one of the visits, Luyao told him that if he was late to his next appointment he would "run out of dope."

But Hirschhorn pointed out that comment was not captured on the tapes, but the tapes do show she referred to "meds" and "refills."

Hirschhorn maintains that Luyao was a caring and prudent doctor who did not deal drugs or intentionally harm her patients.

The jury also on Monday heard from a former patient who said Luyao was compassionate and even allowed her to live for free in a home the doctor owned but she watched Luyao's clientele change over the years. Prosecutors allege her practice attracted drug addicts from across the state.

Cynthia French, who had been Luyao's patient since the mid 1990s, said the waits to see the doctor became longer during the months before Luyao's 2002 arrest, and the patients became younger and more raucous.

When she expressed concerns about this to Luyao, the doctor told her to mind her own business, French testified.

"One time I went in to pick up my prescription and certain people were standing around getting real loud and pushy,"French said. "Dr. Luyao told them to stop doing that... or she would close down her shop. They backed off for a while."

Luyao's trial continues today.





Former patients take stand at Luyao retrial Physician faces drug trafficking, manslaughter, racketeering charges



http://www.tcpalm.com/tcp/local_news/article/0,2545,TCP_16736_4459040,00.htm l

February 11, 2006 - Defense attorney Joel Hirschhorn shows an enlarged copy of the standard form patients signed agreeing not to abuse drugs, during opening arguments in the first day of the retrial of Dr. Asuncion Luyao, foreground, at the St. Lucie County Courthouse on Friday.

One patient had legitimate back pain that quickly morphed into an addiction. The other had no pain and sought the pills out only for the high they gave.

Though their stories were different, both were drawn to Dr. Asuncion Luyao for the same reasons her reputation as an easy source of pain medication. Two of her former patients were among the first witnesses to take the stand Friday as Luyao's retrial began on charges of racketeering, trafficking in oxycodone and manslaughter following a deadlocked jury in her first trial last June.

"She was the seller and the demand was huge, ladies and gentlemen," said Assistant State Attorney Erin Kirkwood in her opening statement. Kirkwood led her argument with words Luyao, 64, allegedly told one patient: "You'll be back. They all come back." She used a Powerpoint presentation to show how Luyao wrote prescriptions for oxycodone, hydrocodone, morphine and other painkillers without doing full exams, ordering extra tests or coming up with treatment plans for patients.

The trafficking charges are based on the visits of an undercover investigator who lied about injuries and received painkillers without proper medical records to back up his story or further tests to find the source of his pain. Kirkwood also summarized the six deaths at the heart of the manslaughter charges, all of which occurred in a 20-month period.

Racketeering, more commonly used in organized crime cases, applies here because her Port St. Lucie office was a criminal enterprise and the trafficking and manslaughter charges are the criminal acts committed there, Kirkwood said.

Defense attorney Joel Hirschhorn took Kirkwood's points head-on, countering that Florida law allows doctors to prescribe painkillers even to addicts if they believe they are helping to treat pain. Luyao ran a small-town, store-front office and kept much of the information she didn't write on charts in her head because she knew her patients well, he said.

"She wasn't in the pharmacy business. She was in the pain care, patient-protecting business," he said. Hirschhorn also went through the six manslaughter counts, but laid out different reasons including natural causes and suicide that could not be ruled out as possible causes of death. In the end, the state's evidence is not enough to convict, he said.

"I suspect the state will not be able to fan it into a fire," he said of the charges.

Both sides used the cases of her former patients to illustrate their arguments, the prosecution saying their stories were evidence of Luyao's non-existent treatment while the defense said they showed she was manipulated by the lies patients told.

Michael Callocchio, 44, said he was injured at work in a fall from a truck in the late 1990s and eventually became addicted to the OxyContin he was prescribed. He never had a problem getting medication, even when he told her he was fresh out of rehab for his pill abuse, and at one point received more than 1,500 pills in four months.

Another patient, Christina Brown, had no ailments and came to Luyao solely for the drugs. She described crushing OxyContin and injecting it into her veins in order to counteract the time-release nature of the pills and get a quicker high.

Weaning off of painkillers was an excruciating process for both of them, they said.

"You get extremely sick, throw up," Brown said. "It was the most uncomfortable feeling I have ever had."

Other witnesses who testified Friday included a sheriff's office investigator who participated in a search of Luyao's offices and the undercover investigator whose work is the basis for the trafficking charges. He will continue testifying when the trial resumes Monday morning.





Luyao money problems may delay trial



July 20, 2005 FORT PIERCE Prosecutors said Tuesday they want to re-try Dr. Asuncion Luyao in November, even as her attorney cast doubts on whether she would be ready by then.

Luyao's first trial began in May and ended in a mistrial June 3 after jurors said they could not agree on the charges of racketeering, manslaughter and trafficking in oxycodone against her. During a hearing Tuesday, the prosecution pushed for a November trial date, while the defense asked for the case to begin in February 2006 instead.

Defense attorney Joel Hirschhorn's professional and personal commitments make him unable to try the case in September or October, though he could be ready to move forward in mid-November, he said.

The larger problem is Luyao's financial status. The first case cost approximately $40,000 and Luyao is working on raising money from family and friends for the new trial, he said.

Putting aside his fee, a large amount of money is required simply to pay expenses during a retrial, including fees for expert witnesses, transcribing testimony and other legal expenses, he said. Luyao, 63, will not have any funds ready until November, he said.

She occasionally works in her family's grocery store, but has not practiced medicine since her license was suspended shortly after her arrest in 2002. Her home ownership disqualifies her for a public defender, he said.

"I have no other means," Luyao said in court. "I have no other means except for friends and family."

Senior Judge Dwight Geiger was scheduled to take the case, but was only available during September and October, said Circuit Judge James McCann, who presided over the hearing. McCann said he will look into whether another senior judge would be available in November to try the case.

Both sides will meet again in August for a status hearing and a firm date for trial could be set then.

During the first trial, which was presided over by Senior Judge C.P. Trowbridge, prosecutors argued Luyao didn't follow proper medical procedures and recklessly prescribed painkillers at her Port St. Lucie office, causing the overdose deaths of six patients. The defense countered she was a caring physician who was duped by lying addicts, and other factors not Luyao's care led to the patient deaths.





Mistrial in doctor's manslaughter case Jurors locked after 5-day deliberation



June 4, 2005 FORT PIERCE - Four jurors claimed the jury foreman was the lone holdout who caused a deadlock Friday after five days of deliberations in the trial of former physician Asuncion Luyao.

Senior Circuit Judge C.P. Trowbridge declared a mistrial after the jury of four men and two women told the judge they were unable to agree on the charges of racketeering, trafficking in oxycodone and manslaughter against her. Prosecutors said they will retry the case, with Luyao's next court date set for July 21.

"I don't know if I'm happy or not," Luyao told TV crews as she left the courtroom. She later declined to comment as did her daughter-in-law, who sat in court throughout the trial.

"It shows it's a very difficult case," said defense attorney Joseph Gosz, who stepped in as defense counsel this week after Luyao's regular attorney Joel Hirschhorn left for another trial. "We're happy to live to fight another day."

Assistant State Attorneys Erin Kirkwood and Lev Evans said they would likely return for the second trial, though Trowbridge said he was unlikely to preside over the trial again.

"They worked hard and we'll do it again," Kirkwood said.

Trowbridge told jurors their five days of deliberations likely set a record for a criminal trial in the 19th Judicial Circuit and court officials said it was likely one of the longest deliberations in St. Lucie County history. He asked the jurors to come to the courtroom shortly before 3 p.m. Friday after they sent him a note that read, "We are hung on all counts."

"Your honor, we can't even agree that we disagree," jury foreman Paul Cahoon said.

Outside the courthouse, four of the jurors said they would have been able to return a verdict on some, but not all of the counts. If Cahoon had not been the lone holdout, they would have likely found Luyao guilty of racketeering, two or three manslaughter counts and two or more trafficking charges, said jurors T.J. Clanton, Anena Propst, Linda Starcher and Gregory Tonnis.

The other jurors would have likely acquitted Luyao in the death of Tina Smith and said they were evenly split on whether Luyao caused the death of patient Bradley Towse. On some of the charges, the jury was split 4 to 2, 5 to 1 or 3 to 3.

"We saw she was guilty on some counts, but not guilty on others," Propst said.

Clanton said the manslaughter counts were probably the hardest to reach a decision on. Even if they had all finally agreed on some of the charges, they would not likely have reached a decision before Friday, Propst said.

Cahoon, who left the courtroom before the other jurors, said the discussions inside the jury room were intense. "We just had different opinions," Cahoon said. "We beat each other up."

Juror David Bise, who walked out with Cahoon, said the work was difficult and he did not envy another jury having to take up the task.

"If they do, they're going to have their work cut out for them," he said. Friday's mistrial came more than three years after Luyao's initial arrest and about four years after the investigation began into her practice.

The case was slow to come to trial in part because of the thousands of pages of medical records attorneys had to sort through during discovery and the dozens of depositions they had to conduct.

More than 50 witnesses eventually spoke during 11 days of testimony in the case.

During closing arguments May 26, attorneys painted two very different pictures of the doctor, whose license was suspended by the state Department of Health after her arrest.

Prosecutors argued she freely gave pills to drug addicts and an undercover agent without following proper medical standards and recklessly caused the overdose deaths of six patients.

The defense countered she was a caring physician duped by lying addicts. Mistrial declared in drug trafficking case against Dr. Luyao





Jury Deadlocked



June 3, 2005 - The jury deliberating the fate of Port St. Lucie Dr. Asuncion Luyao deadlocked on all the charges against her, resulting in a mistrial Friday afternoon.

Entering their fifth day of deliberations, jurors told Senior Circuit Judge C.P. Trowbridge shortly before 3 p.m. that they couldn't come up with a verdict on the trafficking in oxycodone, racketeering and manslaughter charges the 63-year-old faced in connection with six patient deaths.

Prosecutors said they intend to re-try Luyao. The trial began on May 9, and jurors heard from more than 50 witnesses during 11 days of testimony.





Jury still debating
Ex-PSL doctor's fate



June 3, 2005 FORT PIERCE - Jurors in the Asuncion Luyao trial told a judge Thursday they agreed on some of the charges against her, but were not unanimous by day's end.

They will begin their fifth day of deliberations today. Luyao, 63, a former Port St. Lucie physician, is charged with trafficking in oxycodone, racketeering and manslaughter in connection with six patient deaths.

The jury of four men and two women sent a note to Senior Circuit Judge C.P. Trowbridge about 10:30 a.m. asking what they should do if they agreed on some, but not all of the charges. Trowbridge sent a note back telling them they should try to be unanimous, but if they could not agree, he would accept their verdict.

Trowbridge brought the jurors back around 4:45 p.m. to see if they were close to reaching a verdict, and the jury foreman said the group was working extremely hard to reach a decision. "It's taking a toll, but we're not ready," he said.

Defense attorney Joseph Gosz told Trowbridge he intended to move for a mistrial if the jury becomes deadlocked on any of the counts or did not reach a verdict by the end of the day. Trowbridge asked to see case law supporting such a move and refrained from making any ruling.

Jurors began deliberating in the case last Friday and resumed again on Tuesday after the Memorial Day holiday. They spent most of the day Tuesday listening to recorded testimony from an undercover agent, whose visits are the basis for the trafficking charges against the doctor and sent the judge two questions Wednesday asking about evidence in the patient deaths.

The trial began on May 9, and jurors heard from more than 50 witnesses during 11 days of testimony.

The state has argued Luyao gave addicts powerful painkillers with only minor medical exams, and recklessly caused the overdose deaths of six patients. Her defense has countered she was a responsible doctor who was manipulated by addicts who lied in order to get pills and other factors, not her care, led to the patient deaths.





Jury still deliberating in trial of Port St. Lucie doctor



May 2005 - Asuncion Luyao, 63, who had practiced medicine in Port St. Lucie since 1977, is on trial on six counts of manslaughter, six counts of drug trafficking and one count of racketeering. Prosecutors allege she was so negligent in her prescriptions of powerful, addictive narcotics, such as OxyContin and methadone, that her "reckless disregard for human life" caused the deaths of six patients: Bradley Towse, 23, of Palm Beach Gardens; Rona Kay, 35, of Pembroke Pines; Robert Gustaf Jr., 40, of Jensen Beach; Julia Hartsfield, 52, of Fort Pierce; Janice Byers, 41, of Vero Beach and Tina Smith, 27, of Sebastian.

Some former patients testified that she was so unscrupulous and lax in her examinations that addicts from across the state traveled to her Port St. Lucie office for pain pill prescriptions. Prosecutors say she essentially stopped functioning as a legitimate medical doctor and became a drug dealer.

Luyao's defense attorney said she was a caring doctor who was manipulated and lied to by her patients. He said she always acted in good faith when caring for patients.

Before they left for the weekend, the jurors on Friday told Senior Judge C. Pfeiffer Trowbridge they wanted to listen to a recording of the testimony of an undercover investigator for the state attorney general's office a key witness for the state. They will listen to that tape on Tuesday morning.

The investigator testified that he posed as a painter who had fallen off a scaffold and jammed his hip, and asked Luyao for a prescription for OxyContin. He said he received prescriptions over the course of five months for OxyContin, Roxicodone, Xanax, Viagra and Cipro even though she never thoroughly examined him and he never gave her medical records to document his nonexistent hip and back injuries.







Jurors asked to decide if Port St. Lucie doctor ran 'pill mill'



May 27, 2005 FORT PIERCE At first blush, even her defense attorney acknowledged Thursday the sheer size of the case against suspended Port St. Lucie Dr. Asuncion Luyao can appear overwhelming: Three weeks of testimony from more than 50 witnesses many former patients and nearly 200 exhibits.

But when the jury begins deliberating today whether Luyao is guilty of manslaughter, drug trafficking and racketeering, her attorney urged them Thursday to "look beyond the surface."

"You have to deal with not what appears to be, but what really is," attorney Joel Hirschhorn said during closing arguments.

The six jurors are tasked with deciding whether prosecutors are correct in their belief that Luyao stopped functioning as a legitimate medical doctor and became a drug dealer who essentially ran a "pill mill" from her office in the old Village Green shopping plaza.

Her motive, they say, was greed keep her patients addicted to powerful pain pills and they would keep paying her $80 office visit fee, required for a refill.

"This was her tool," Assistant State Attorney Erin Kirkwood told the jury as she held up one of Luyao's prescription pads. "She made a whole lot of money with it."

Or the jury could side with Luyao, who Hirschhorn says wasn't a good judge of character but was a caring doctor who was manipulated and lied to by her drug-seeking patients.

He argued that the state has failed to prove that Luyao, a 63-year-old grandmother, did not act in good faith when treating her patients and did not abuse her position.

"She did what she thought in her own professional judgment was best," Hirschhorn said. "She might not have been right, but that certainly doesn't mean she was criminally liable."

She is charged with manslaughter in the drug-related deaths of six of her patients.

Several of her former patients testified she had a reputation on the streets as a doctor who would give patients whatever they asked for with few questions asked. One patient said the price of OxyContin on the street quadrupled after Luyao's license was suspended.

Others said they went to her with legitimate pain and ended up getting addicted.

Prosecutor Kirkwood said Luyao's files were replete with cases where she prescribed addictive narcotics without a thorough physical exam, without a treatment plan for the reported pain or referrals to specialists. She said Luyao issued prescriptions to patients who showed obvious signs of addiction and who even admitted to snorting or injecting the medication.

"The patients ran her office," Kirkwood said. "And the customer is always right."

Kirkwood pointed out during closing arguments that two pain management experts described Luyao's practices as "astonishing," "unbelievable" and "unheard of."

Hirschhorn, the defense attorney, argued it would be hard for any doctor to live up to the standards of the prosecution's two out-of-state experts, who he said treat a very different clientele than Luyao's. An expert Luyao hired testified that she did not deviate from an acceptable standard of care.

"We say this is a case about sadness, about manipulation, about a place where people who are desperate go because they have no place else to go," Hirschhorn said.

He left the jury with this image: "The woman you are looking at is in the lowest, darkest moment of her life. Her future is in your hands."

Prosecutors sent a different message.

"Her drugs killed six patients in 20 months," Kirkwood said. "She was not practicing medicine."





Specialist assails Luyao's treatment



May 24, 2005 FORT PIERCE - Astonishing. Inconceivable. Unbelievable. Those were a few of the words used by an addiction specialist to describe former Port St. Lucie physician Asuncion Luyao's practice during the eighth day of testimony in her trial. Luyao is charged with manslaughter, racketeering and trafficking in oxycodone and accused of contributing to the deaths of six patients.

Dr. Theodore Parran, of St. Vincent Charity Hospital in Cleveland, Ohio, was the second doctor to testify that Luyao's practice didn't seem to meet the normal medical standards of care.

Three of the deceased patients sought Luyao's help in beating addictions and Parran said her decision to treat them using narcotics at her office, instead of sending them to rehab or to an addiction specialist, was unwise. "It can be life-threatening and, in several circumstances here, it was," he said.

Parran, who works in addiction medicine and pain management, reviewed more than 125 patient files and found strong painkillers were too often prescribed without a full physical exam or past medical history. Luyao also seemed to ignore or not properly treat clear signs of addiction in patients, he said. He described addiction as a disease largely determined by genetics that affects probably 10 to 15 percent of the population. The way that Luyao dispensed prescriptions was likely to attract addicts "like flies to a peanut butter and jelly sandwich," he said.

Trial testimony is expected to continue into next week.





Former patients take stand against Luyao
for OxyContin abuse charges



May 19, 2005 FORT PIERCE - When Lucy Deturo finally decided to stop seeing Dr. Asuncion Luyao and quit OxyContin, she remembers what the doctor told her.

"You will be back. They all come back," Luyao allegedly said.

Deturo was one of several former patients who spoke Wednesday about how addiction brought them back again and again to the Port St. Lucie physician who is on trial on charges of manslaughter, racketeering and trafficking in oxycodone.

Deturo said she began taking painkillers in 1993 after a legitimate injury, but began abusing medication over the next several years. The Palm City woman faked injuries in front of Luyao to get pills and eventually received OxyContin after she told Luyao her regular medication wasn't strong enough.

OxyContin took hold of her unlike any other drug, she said.

"I could not stop. I just didn't feel good without them," she said.

Luyao prescribed Deturo methadone to help break the addiction, but after the medication didn't seem to be working, the doctor suggested she go back on OxyContin. After telling Luyao she was done with her in the spring of 2001, Deturo kicked her painkiller addiction and has been clean since, she said.

Jurors heard from five other patients Wednesday, including several inmates, who all shared similar stories about painkillers. In several cases, family members confronted Luyao about her treatment as they worried she was turning their loved ones into addicts or was furthering their addictions.

During cross-examination from defense attorney Joel Hirschhorn, many patients described Luyao as a caring, kind physician and some admitted to disobeying her instructions on how to use their pain medication. The defense has argued Luyao followed all proper medical procedures and had her patients sign a promise not to abuse drugs or visit multiple doctors and pharmacies, a promise some patients broke.

Testimony in Luyao's trial began last Wednesday and about three dozen witnesses have testified for the prosecution so far. The trial continues today and is expected to last about two more weeks.





Trial begins for PSL physician




5/11/2005 - More than three years after her arrest, Dr. Asuncion Luyao finally is getting her day in court.

While detectives paint a picture of a physician who recklessly prescribed potentially lethal doses of painkillers, her defense attorney counters she was a responsible doctor who broke no laws in making diagnoses.

The Port St. Lucie physician is charged with continuing a criminal enterprise, six counts of trafficking in oxycodone and six counts of manslaughter in connection with the death of six patients. Opening statements will be delivered today in her trial after two days of jury selection.

"Dr. Luyao made a conscientious effort to treat her clients. She treated them all with respect and dignity. As a physician she is entitled to rely on what the patient tells her," said defense attorney Joel Hirschhorn. "It's unfortunate that the state has decided to target Dr. Luyao."

Assistant State Attorney Erin Kirkwood, who is prosecuting the case, declined to comment.

The case has been slow to come to trial, in part because of the wealth of information attorneys had to sort through during discovery, including tens of thousands of pages of medical records and other documents. Prosecutors have issued subpoenas for more than 170 witnesses in the case, though how many of those people will testify is unknown.

The trial tentatively is scheduled to last about three weeks.

THE PROSECUTION

The first public action against Luyao came on Dec. 6, 2001, when the sheriff's office raided her office in the former Village Green shopping center and took patient files, financial records, prescriptions and other evidence as part of an investigation into prescription fraud. But the investigation actually began six months earlier as a joint effort between the Medicaid fraud unit of the state Attorney General's office and the St. Lucie County Sheriff's Office, according to an affidavit filed in the case.

During a July drug sting that summer, detectives learned it was common knowledge that Luyao would write any prescription a patient asked for. An undercover agent visited the office six times between June 2001 and October 2001, getting about 570 tablets of oxycodone without a physical examination or medical documents to back up the use of the painkillers, the affidavit states.

Those undercover visits are the basis for the six trafficking charges Luyao now faces. After the search warrant, detectives used medical information and interviews with six patients to help build their case against the doctor.

Investigators had a doctor review 10 of Luyao's files and found none of the patient visits was signed or initialed by Luyao, she liberally was prescribing OxyContin and Xanax and there was almost no physical exams or patient histories in the files to justify prescribing the drugs.

All of the patients, including the investigator, paid cash for Luyao's services. Investigators said they found $63,000 in cash in a filing cabinet in her office, supporting claims Luyao took cash in exchange for prescriptions.

Luyao was arrested in March 2002 and her license was suspended by the state Department of Health, based in part on complaints filed by the medical examiner's office. Treasure Coast Medical Examiner Dr. Roger Mittleman told the agency he had concerns about the deaths of 12 of Luyao's patients.

Months after Luyao's initial arrest, manslaughter charges were added after prosecutors found there was evidence her actions contributed to the deaths of some of her patients. The six manslaughter counts she faces now stem from the deaths of patients Janice Byers, Robert Gustaf, Julia Hartsfield, Tina Smith, Rona Kay and Bradley Towse.

In the years since her arrest, Luyao has settled several civil lawsuits filed by former patients and the families of deceased patients.

THE DEFENSE

Luyao was born in the Philippines and graduated from the University of Santo Tomas in 1965 before performing her internship and residency in New York. She practiced medicine in New York for 10 years before coming to Port St. Lucie, where she became a citizen in 1991 and had been practicing medicine for more than two decades when she was arrested.

Hirschhorn argues that although Luyao was treating each of the alleged victims, she was not the one responsible for their deaths.

The deceased patients all signed forms saying they would only take their medications as prescribed and would not go to more than one pharmacy, a promise some broke, he said. There also are other medical issues and other drug use linked to the deaths of some patients.

"The state of Florida has made it clear that even those who are addicted to drugs are entitled to the benefit of medical attention," Hirschhorn said. "Dr. Luyao was entitled to rely on what her patients told her."

He points to positive statements from other patients, many who continue to inquire about the doctor's case, as evidence to the positive effect Luyao had on many patients. Luyao had many patients without insurance, which is why cash and checks were often common forms of payment.

"She misses her practice. She loved her patients and loved her practice," Hirschhorn said.







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