Diverted: How some Arizona doctors and nurses misuse drugs
PHOENIX (AZFamily) —We trust doctors and nurses to provide medical care in our best interests. It’s why providers diverting drugs, or legally prescribed drugs that end up being misused, seem incredibly wrong.
Arizona’s Family Investigates reviewed 36 of these cases in Arizona since 2018 and found some concerning trends.
Arizona’s Family Investigates found providers high on the job, two of them prescribing hundreds of opioids, and perhaps most surprising, even after this conduct was identified, most of these providers are still involved in your medical care.
“I’m the secretary,” Dr. Steve Fanto said when Arizona’s Family Investigates stopped by his north Scottsdale office.
“You’re the secretary?” Arizona’s Family Investigator Amy Cutler questioned. “I’m not a practicing provider,” he responded.
Dr. Fanto was a licensed doctor for 24 years, specializing in pain management. Arizona’s Family asked if a nurse practitioner worked at the practice.
“You don’t help her with any of the services?” she continued. “No, you’re misinformed. Okay. Just very misinformed. Clearly, I’m a secretary, sitting right here,” Dr. Fanto said.
Fanto can’t practice medicine because his license was suspended in 2017.
Yet Arizona’s Family Investigates found more than half a dozen online reviews for him. Some are as recent as late last year. Most praise his work.
A man who answered the phone at Dr. Fanto’s practice, Absolute Rehabilitation and Pain Management, said an appointment was a five-week wait.
He said a new nurse practitioner started in the last few days. But the doctor turned secretary still managed to afford a nearly $2 million home in north Scottsdale.
Property records show he bought the home with a woman in 2022.
In 2017, the Arizona Attorney General’s Office filed a lawsuit against Insys Therapeutics and three doctors; Fanto is one of them.
They claim these providers accepted money from Insys — in the form of “sham speaker fees.”
In exchange, they wrote lots of prescriptions for Subsys — a highly addictive fentanyl spray that, at the time, was only approved for cancer patients.
The lawsuit alleges Fanto ignored that, writing “his prescriptions accounted for 75% of all Subsys sales in Arizona.” Fanto agreed to pay the state more than $400,000 as part of a settlement.
When asked why he would agree to the settlement if he did nothing wrong, he said, “I know you’re just trying to do your job.”
Fanto isn’t alone.
After reviewing these cases, Arizona’s Family Investigates found providers with substance abuse problems themselves, drug diversions that fueled pill mills, and pharmacies that refused to fill prescriptions for specific providers.
None of this surprised Lisa McGiffert with the Patient Safety Action Network, who says it’s part of a bigger problem.
“There’s way too much secrecy about these professionals. We put our lives in their hands,” she said.
The Drug Enforcement Administration investigates some of these cases, determining if criminal charges are warranted.
Of the Arizona cases analyzed, only five of the 36 resulted in charges.
“We look at each case from both sides, from the diversion piece and the criminal piece,” Cheri Oz, the special agent in charge of the DEA’s Phoenix office.
“Sometimes there’s just not enough criminal behavior, not to say that there weren’t medical mistakes, but there wasn’t a misuse issue,” she said when asked why only a few cases end up in criminal charges.
In recent years, the state has added additional layers of oversight.
The Arizona State Board of Pharmacy runs the Prescription Monitoring Program, which reports providers suspected of inappropriately prescribing to the Medical Board and State Board of Nursing.
“Addiction is still on the rise,” said Kam Gandhi, the executive director of the pharmacy board and a pharmacist himself.
“You got healthcare professionals that know about addiction and potential of these medications; and how dangerous they can be and how closely they need to be monitored,” Gandhi said.
He stressed they only flag a tiny percentage of providers.
“We’re not here to dictate how an individual practices, and some cases are subjective,” Gandhi explained.
The decision to discipline doctors in Arizona or revoke their license is made by the Arizona Medical Board, which has eight of the 12 members being doctors. They declined an interview.
“Boards are very reluctant to take actions that will restrict members licenses,” McGiffert said.
When looking up Dr. Fanto’s license on the medical board’s website, there’s no mention of the settlement or three medical malpractice lawsuits filed with Maricopa County Superior Court.
In August, he appeared before the board to get his license back.
“I have completely been humbled and forced to acknowledge the mistakes I have made,” Dr. Fanto said.
The board responded with a decree of censure or a formal public reprimand, citing four of his patients. They wrote that he deviated from the standard of care, starting them on high doses of opioids without proper documentation.
“People believe that someone, the board, they might not know who the board is, but someone is making sure that doctors who pose a danger to patients are not able to practice,” McGiffert said.
The medical board confirms Dr. Fanto has an application pending to get his license back but declined to provide any more information.
In response to questions, the Arizona Medical Board wrote:
The nurse practitioner in Dr. Fanto’s office has a valid nursing license and no disciplinary action. As far as Arizona’s Family Investigates could tell, she has no experience in pain management, but that is legal in the state.
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