CINCINNATI -- Federal prosecutors could wrap up their case Friday against Dr. Barbara Temeck, a fired Cincinnati VA official who is accused of illegally prescribing pain pills for the wife of her former boss.
During seven hours of testimony Thursday, jurors heard from four witnesses who explained the rules that doctors are expected follow when prescribing controlled substances in the U.S. Department of Veterans Affairs.
Prosecutors allege Dr. Temeck violated those rules when she prescribed a generic form of Valium and the opioid hydrocodone for Kathleen Hetrick, a former VA nurse who is not a veteran and is the wife of former VA Network Director Jack Hetrick.
The charges stem from an investigation by WCPO and the Scripps Washington Bureau that led to Jack Hetrick’s retirement and the demotion, suspension and firing of Dr. Temeck.
Christopher Kresnak, an investigator for the Drug Enforcement Agency, testified that Dr. Temeck had a fee-exempt registration with the DEA that allowed her to prescribe controlled substances to VA patients only. Kresnak said doctors who want to treat patients outside the VA are required to buy a separate DEA registration for their private practice.
Under cross-examination, Kresnak said “there may be exceptions” that allow VA doctors to treat non-veterans.
“I don’t know those rules,” he said. “That would be up the VA.”
VA physicians are permitted to treat non-veteran patients for humanitarian reasons, in emergency situations and in cases where work-related illness or injuries require urgent attention, said Linda Smith, former director of the Cincinnati VA Medical Center. Smith, who led the Cincinnati VA for 10 years and retired in 2015, said the treatment of non-veterans at VA facilities is rare and tends to involve “one-time, non-episodic care.”
Smith testified that Jack Hetrick recommended hiring Dr. Temeck in 2013 after a series of departures by chiefs of staff. She described Dr. Temeck as “the hardest working employee I ever supervised” and an administrator with high standards for herself and her staff. Smith said she was aware that Dr. Temeck was friends with the Hetricks and sometimes accompanied Kathleen Hetrick to medical appointments.
But she was not aware that Dr. Temeck was prescribing pain pills for her friend.
Neither was Kathleen Schmitt, chief of pharmacy for the Cincinnati VA Medical Center. Schmitt testified that she helped Dr. Temeck renew her DEA registration in the fall of 2013, adding that Dr. Temeck told her via email that she only prescribes in the VA.
Months later, Schmitt said Dr. Temeck approached her to ask how she could remove her ability to provide controlled substances within the hospital but asked her to keep that conversation private.
“She preferred that I would not mention it,” Schmitt said.
Dr. Muhammad Munir said Dr. Temeck initially denied writing prescriptions for Kathleen Hetrick until he presented her with evidence to the contrary. Dr. Munir is a pain management specialist who works part-time for the VA. He met Dr. Temeck when she brought Kathleen Hetrick to his office for an appointment in October 2014, identifying herself as Hetrick’s health care power of attorney.
Dr. Munir said he was concerned when he looked up Hetrick’s pharmacy records on the Ohio Automated Rx Reporting System, or OAARS, because it showed Dr. Temeck and another physician each prescribed a generic form of Valium for Hetrick in November 2013.
“I informed Dr. Temeck that she shouldn’t be prescribing medicine while I was taking care of the patient,” he said. “If the prescriptions have been prescribed by more than one doctor the patients can have an adverse outcome. In that case, basically they can overdose.”
Dr. Temeck was receptive to his concerns and promised not to prescribe again, he said.
Dr. Temeck voluntarily surrendered her DEA registration in March 2016.
Defense attorney Ben Dusing quizzed the government’s witnesses on exceptions to VA rules against treating non-veterans, getting Smith to describe how Dr. Temeck once prescribed Tamiflu for her when a flu outbreak threatened to disrupt hospital operations.
“This was a job-related exposure,” Smith said. “That’s how she got involved.”
Dusing also laid the foundation for a defense strategy that he teased in his opening statement by asking Kresnak if it’s possible for someone to call in a prescription by using a physician’s DEA registration number without the doctor’s knowledge.
“You can do that,” he said. “It’s been done.”
But Kresnak added -- in response to a follow up question by Assistant U.S. Attorney Kyle Healey -- that Dr. Temeck never told him that she didn’t write the prescriptions that led her to surrender her DEA registration.
Healey is expected to wrap up his case Friday by playing a 2016 audio recording of Dr. Temeck’s interview with investigators from the VA’s Office of Inspector General. Agent Todd Springer testified Thursday that the two-day interview started on Feb. 16, 2016, which was three days after the independent investigative agency opened its investigation.