Sep. 15—WILLIAMSPORT — When the United States Drug Enforcement Administration came knocking on the doors of Burch Drug Store in Elysburg to ask the owner whether any area doctors had questionable prescribing practices, pharmacist Karen Boltinghouse had only one name spring to mind: Dr. Raymond Kraynak.
On the fifth day of the federal trial against Kraynak on Tuesday, Boltinghouse, the owner of the drug store in Elysburg, testified that she had already banned Kraynak's patients from filling prescriptions at her business if it involved controlled substances. She said she was the type of person who saw red flags and even offered to counsel a customer who admitted he was addicted.
"After a while, it seemed more and more people were coming in with a prescription for opioids, in higher doses and more frequently, or their doses changed frequently," said Boltinghouse. "It was all jumbled up."
Federal agents arrested the now-suspended Mount Carmel doctor on Dec. 21, 2017. Kraynak, 64, was charged with 12 counts of illegal distribution or dispensing, five counts of illegal distribution or dispensing resulting in death and two counts of maintaining a drug-involved premises for his offices in Mount Carmel and Shamokin. The prescription practices resulted in the death of five people, authorities said.
The indictment states Kraynak allegedly prescribed more than six million opioids, such as Oxycontin, Vicodin and fentanyl, between May 2012 and July 2017. Prosecutors seek to hold him responsible for the overdose deaths of five patients that occurred between October 2013 and May 2015. No doctor in all of Pennsylvania prescribed more doses of opioids in the 19 months leading into July 2017 than Kraynak's 2,792,490.
Patients 'not happy'
Before the complete ban, Boltinghouse said she would often refuse to fill Kraynak's patients' prescriptions because they were too high in doses or patients would attempt to get early refills. She also would refuse to fill certain combinations of drugs due to their lethality if mixed. She wouldn't let customers pay in cash either if their insurance wasn't covering the painkillers.
"They were not happy," Boltinghouse said of patients' reactions.
One customer admitted he was addicted to Oxycodone. Boltinghouse testified she sat down with him and came up with a plan to wean him off his medication. However, she said he came in soon after with a prescription from Kraynak for a refill. She said she refused to fill it and she stopped filling for that patient altogether.
Boltinghouse created a log book for customers to sign to acknowledge that certain medications are habit-forming and it was illegal to give or sell to others. The document had customers acknowledge that they would not hold the pharmacy responsible in the event the medication was not used correctly.
CVS banned prescriptions
Susan Plante, the senior manager for professional practices at CVS Health Corporation, testified that CVS Pharmacies in July 2017 would not fill any more prescriptions of controlled substances written by Kraynak.
Of the 29,136 monthly opioids prescriptions filled by CVS for Kraynak's patients, 18,063 were Oxycodone, 6,421 were Hydrocodone, 3,632 were Tramadol, and 1,020 were Buprenorphine, making the doctor the highest or among the highest prescriber of that controlled substance in the CVS network, Plante testified.
One in 10 Oxycodone
One in ten prescriptions written by Kraynak was Oxycodone at CVS. One in three Kraynak patients were receiving only controlled substances, Plante testified.
About 75 percent of patients who were prescribed opioids by Kraynak were from Mount Carmel, Shamokin, Coal Township, Kulpmont and Ashland, she testified.
There were also multiple instances of prescriptions for drug combinations that are deadly if mixed together, she testified.
When questioned by CVS, Plante testified that Kraynak told them the Centers for Disease Control and Prevention had no business controlling how physicians prescribe medication. He did not appear concerned, he defended his prescribing practices and said he was the only doctor willing to treat pain in Northumberland County, she said.
Two Weis pharmacists testify
Two other pharmacists, Andrea Boyer, who used to work at the Coal Township Weis, and Michael Shirk, who used to work at the Shamokin Weis, both testified that they would often run out of narcotics in the middle of the month due to the volume of prescriptions filled out by Kraynak. Patients would often be waiting at 8 a.m. in lines of 10 to 12 people deep to get into the Weis Pharmacy, they said.
Boyer said she would hear the patients talking about getting their prescriptions written out by Kraynak at the bar the night before. She would listen to patients whispering about trading pills in the parking lot after they were filled. They said patients would constantly be trying to fill their prescriptions early or coming in with two prescriptions — one for narcotics and another for antibiotics, but leaving without the antibiotics.
Many patients offered cash if their insurance wouldn't cover the refills or quantity. Many prescriptions from Kraynak were turned down, they testified.
"It wasn't right," Boyer testified.
Shirk testified that he was straight out of college when he assumed the role of pharmacist at the Shamokin store in August 2015. The stress of the job got to be so much that he resigned after only a year.
"I feared for patient safety," he said.
Shirk said he was worried that he might refuse a prescription of someone who might legitimately need it or fill a prescription of someone who might be addicted who would later hurt themselves. He said he also didn't want to risk his license if he made the wrong choice.
"I found another opportunity (at Evangelical Community Hospital) and got out," said Shirk.
Shirk said in the year he was there, the pharmacists in the Coal Region shared an "unspoken bond." If there was a problem patient who was causing issues, wanted an early refill or had recently filled a prescription in a large quantity, the pharmacists would call each other and warn them of the patient, he said.
Patient: 'My drug dealer'
Former patient David Bohner, 53, of Elizabethville, testified that he only stopped being an addict because Kraynak was arrested in December 2017. An addict since 1993 after a construction accident, he went to Kraynak in 2013 in order to get a prescription of methadone.
"It was never about the health," said Bohner. "He was my drug dealer. Just being honest."
He added, "Him getting arrested saved my life. I had to quit cold turkey."
The withdrawal from methadone made him comtemplate suicide, he testified.
Kraynak is free on $500,000 unsecured bail. His medical license is suspended indefinitely by the State Board of Osteopathic Medicine until the conclusion of the criminal case, according to the Department of State.
The trial continues today at 9:30 a.m. The trial is anticipated to last approximately four weeks, excluding Sept. 17, Sept. 24 and Oct. 1.