two unique approaches_final
DESCRIPTION
Law Enforcement Track: Two Unique Approaches National Rx Drug Abuse Summit April 2-4, 2013 Dr. Gary Martin and Jason ParmanTRANSCRIPT
Two Unique Approaches Dr. Gary Mar7n
Homicide Detec7ve, Palm Beach County (FL) Sheriff’s Department
Jason Parman Assistant U.S. AJorney, London, KY
April 2 – 4, 2013 Omni Orlando Resort at ChampionsGate
Lesson Objec7ve
1. Outline inves7ga7ve priori7es in building an overdose death prosecu7on.
2. State the benefit of building strategic coopera7on between federal and state law enforcement agencies.
3. Demonstrate how law enforcement can work together with community preven7on programs in inves7ga7ons.
Overdose Suppression Project: A Comprehensive Response
• Law Enforcement
• Public Awareness
• Quan6ta6ve Research
• Reviewing each overdose death inves7ga7on. • Applying all relevant statutes to the circumstances.
• Forwarding all narco7cs intelligence. • 19.3 % of the case reviews generated narco7cs intelligence.
• Overdose and poisoning should be ruled out in all cases of non-‐violent deaths.
• Scene Inves7ga7on • Physical Examina7on of the Decedent
• Autopsy Results • Toxicology Findings
If a person dies of an apparent drug overdose:
(1) A law enforcement agency shall prepare a report iden7fying each prescribed controlled substance listed in Schedule II, Schedule III, or Schedule IV of s. 893.03 which is found on or near the deceased or among the deceased's possessions. The report must iden7fy the person who prescribed the controlled substance, if known or ascertainable. Thereaeer, the law enforcement agency shall submit a copy of the report to the medical examiner. (2) A medical examiner who is preparing a report pursuant to s. 406.11 shall include in the report informa7on iden7fying each prescribed controlled substance listed in Schedule II, Schedule III, or Schedule IV of s. 893.03 that was found in, on, or near the deceased or among the deceased's
possessions.
• All prescrip6on drug containers (including empty containers) should be photographed, seized, and then individually described on a property receipt.
• All unfilled prescrip6on authoriza6ons “scripts” should be photographed, seized, and individually described on a property receipt.
• All illegal drug containers (plas6c baggies, film vials, e.t.c.) should be handled in such a way that poten6al trace evidence could be extracted.
• Within reason, samples of drinking fluids discovered within the immediate area of the suspected overdose death should be collected.
Evaluate physical evidence of prescrip7on drug abuse and diversion by the decedent:
• Appointment cards • Address/phone books • Cell phones/caller id • Personal computers • Calendars • Prescrip7on vials • Unfilled scripts • Pharmacy receipts • Drug warning documents
• Forging coopera6ve rela6onships with families who have lost loved ones to drug overdose death.
• Providing overdose risk awareness programs to students and parents.
• Designing a mul6media public service campaign focusing on the risks associated with prescrip6on drug misuse and abuse.
• Seeking legisla6ve ac6on to discourage doctor shopping and prescrip6on drug diversion.
“All Bets Are Off”
The Cri7cal Point
Ineffec7ve Remedies
• Do NOT put them in an ice cold bath.
• Do NOT inject them with salt water or milk. • Do NOT give them s7mulants (like cocaine, methamphetamine, or Adderall).
• Do NOT give them food or water or induce vomi7ng (they could choke)
• Do NOT leave them alone. • If you must leave, call 911 first and leave them in the recovery posi7on.
Recovery Posi7on
• A Drug Overdose Interven7on Strategy.
• Offers-‐limited immunity from criminal prosecu7on for person(s) who, in good faith, seek medical aJen7on during a drug-‐related medical crisis.
• Intent-‐reduce the number of drug overdose deaths by removing the fear of arrest as a barrier to seeking emergency medical assistance.
911 Good Samaritan 893.21 Drug-‐related overdoses; medical assistance; immunity from
prosecu6on.
• (1) A person ac7ng in good faith who seeks medical assistance for an individual experiencing a drug-‐related overdose may not be charged, prosecuted, or penalized pursuant to this chapter for possession of a controlled substance if the evidence for possession of a controlled substance was obtained as a result of the person’s seeking medical assistance.
• (2) A person who experiences a drug-‐related overdose and is in need of medical assistance may not be charged, prosecuted, or penalized pursuant to this chapter for possession of a controlled substance if the evidence for possession of a controlled substance was obtained as a result of the overdose and the need for medical assistance.
• (3) Protec7on in this sec7on from prosecu7on for possession offenses under this chapter may not be grounds for suppression of evidence in other criminal prosecu7ons.
• This act shall take effect October 1, 2012.
• Collec7ng extensive demographic and circumstan7al data from each overdose death inves7ga7on.
• Designing a prac7cal overdose death database.
• Exposing overdose correla7ons and trends.
Case Examina6ons
• 353 overdose death cases • Palm Beach County, Florida
• Selected by chronological occurrence
• Data derived from: Police and paramedic reports Autopsy and toxicology findings
Family and friend interviews
Medical records
Decedents’ Average Age
40.08 Years
• Age breakdown
• White
• Male • Approximately 40 years old
• High School Diploma or GED • Employed
• History of substance abuse • History of drug related arrests • History of substance abuse treatment
• History of mental health treatment
• History of non fatal drug overdose • Under physician’s care at 7me of death
• Died at home • Discovered by family member • Last act is sleeping • Found unconscious • Others present at death scene • Other recognized distress • Died from accidental mul7ple drug toxicity • Most likely combina7ons are alprazolam, oxycodone, cocaine, and methadone.
Detec7ve Gary Mar7n Violent Crimes Division – Homicide Unit Palm Beach County Sheriff’s Office West Palm Beach, Fl 33406 561-‐688-‐4058 [email protected]
Or
Gary Mar7n, Ed.D. Associate Dean For Student Life Lynn University Boca Raton, Fl 33431 561-‐237-‐7157 [email protected]
Two Unique Approaches
April 2 – 4, 2013 Omni Orlando Resort
at ChampionsGate
Learning Objec6ves
• 1. Outline inves7ga7ve priori7es in building an overdose death prosecu7on.
• 2. State the benefit of building strategic coopera7on between federal and state law enforcement agencies.
• 3. Demonstrate how law enforcement can work together with community preven7on programs in inves7ga7ons.
Disclosure Statement
Controlled Substances Act covers overdose deaths
21 USC 841(A)(1): 1. Knowing distribu7on of controlled substance
2. Death results from use of controlled substance
21 USC 846: 1. Two or more people must conspire to distribute a controlled substance
2. Death results from use of controlled substance
Inves7ga7ve Priori7es
What caused the death?
• Medical examiner’s report essen7al – work to develop rela7onships with coroners
• Toxicology report helpful, but not disposi7ve
• Do NOT have to prove intent to kill, recklessness, foreseeability, or other mental state rela7ve to the death
• The element that must be proven is “Did death result from the use of the controlled substance?”
• Distributed drug does not have to be exclusive or primary cause of death, only had to have played a part.
Who did it?
• Witnesses who observed drug distribu7on to the deceased?
• For prescrip7on overdoses, tracking the paper trail is useful
• Standard drug inves7ga7ons is important parallel
“Tradi7onal” TARGETS
Sponsors, Brokers, Direct Distributors
• Developing sources of informa7on / cooperators key
• Establish rela7onships between targets rela7ve to date of distribu7on
• Was target in the chain of distribu7on that led to the death
• Tracking the line from the end user to the drug source reveals poten7al targets (All in the chain are poten7al defendants as long as distribu7on to end user was reasonably foreseeable)
POTENTIAL TARGETS
Doctors / Pharmacists
• Need to show target prescribed / filled medica7on without legi7mate medical purpose outside the usual course of professional treatment
• PaJern of pa7ents help to establish unlawful distribu7on
• Cash only clientele • Superficial examina7ons • Expert review of records • Cooperators beneficial • Conspiratorial rela7onship between
providers (warning pa7ents where to or not to fill scripts)
“Death Resul7ng” Penal7es
Statutory Penal6es 21 USC 841(b)(1)(A)-‐(C)
• Mandatory Minimum 20 years with Life max
• Applies to all Schedule I and II Controlled Substances (oxycodone, methadone, etc.)
Sentencing Guidelines U.S.S.G. § 2D1.1
• Deaths from Schedule I or II with prior convic7on for trafficking with similar drug is 43 (360 – life)
• No prior convic7on is 38 (235-‐293)
• Deaths from Schedule III and IV (ie: hydrocodone, alprazolam) start at 30 (97-‐121) with prior convic7on and 26 (63-‐78) without convic7on
• All ranges assume no criminal history
• Ex: Criminal History I with a 38 (235-‐293) is (360 to life) with a Criminal History VI
United States v. McIntosh DEA inves6ga6on with State
partnerships
• What made it work?
• First responders treated call as a crime scene vs. an accident
• Autopsy that established oxycodone as a contribu7ng factor in the death
• DEA later implicated McIntosh in a large oxycodone conspiracy through cooperator statements and local law enforcement’s street level buys
• Crucial leads in the inves7ga7ve report from 10 months prior
• Knew the Who, What, When and Where and it was documented
Result ?
• McIntosh sentenced to 327 months for distribu7on resul7ng in death (guideline range of 292-‐327) Lowest criminal history category
Who collaborated? • Kentucky State Police • Local Law Enforcement • County Coroner • State Medical Examiner • DEA
Benefits to “death resul7ng” prosecu7ons
“Tradi6onal” Drug Dealers
• Dealing is ul7mately a decision
• “The nega7ve has to outweigh the posi7ve”
• Reality is Rx diversion is a profitable revenue plan for many
• These prosecu7ons send a simple, powerful message
• Distribute prescrip7on drugs, you will be held responsible for the consequence
“Professional” Drug Dealers
• Doctors, Pharmacists, etc. • Enormous profit margins for pain clinic
owners, doctors, pharmacists • $100,000 cash in one day, for example
• Violate your duty, responsible for the consequence
• Given the harm produced from prescrip7on diversion, must target those with “keys to the castle”
• Treats the source = to a drug dealer
Ques7ons/Comments
Jason D. Parman
United States AJorneys Office
Eastern District of Kentucky
606-‐864-‐5523 Ext. 117