Doctor Suspended After IC Patient Dies From Pain Medication Overdose

[icnmgrjill]

This is very sad. An IC patient Tammy Dawn Daniels (age 35) died in 2009 from "toxic amounts of the drugs" (pain medications) in her system. The prescribing doctor, Dr. Mickey Ray Tyrell, was suspended for 30 days and sentenced to 200 hours of community service.

In just three months, the patient was given 990 demerol pills and 120 of oxycontin. It's clear that she was in severe pain but that is shockingly excessive IMHO. That's roughly 330 demerol pills per month, at more than ten a day.. and a whopping 4 oxycontins per day. Folks.. if you're using that amount of medication, it's absolutely time to see an IC specialist AND get yourself into a supervised pain program.

What a tragedy this is. - Jill

Read the full story at: http://www.tulsaworld.com/news/article.aspx?subjectid=14&articleid=20110312_12_A17_VNTiia557925

[bubbe1]

That is a very sad story. Those 30 days just don't seem enough somehow.

[playethic]

One of the things that worries me about this story is the likely outcome. In my opinion the likely outcome is that someone new is going to be in torture-level agony and doctors will be too nervous to prescribe opiates to help her (/him).

Where I live, waits to get in to a pain speciality program are over a year - maybe 8 months for the expedited, triaged appointment.

And an IC specialist has only 4-ish options they can offer patients (Elmiron, heparin/lidocaine/baking soda instills, Uracyst instills, Ranitidene, or a waiting list spot for bladder dilation/fulguration). What if said patient has tried all of those and is still in torture-land?

More patients will have to suffer torture-level pain because doctors will be too afraid to help.

Trying various narcotics is par for the course. My guess is it's likely her doctor wasn't prescribing these to be taken at the same time - perhaps she tried demerol and found it didn't work for the pain so the dr. tried oxycontin and she switched over - perhaps that's why she had both.

There are already so so so many judgements IC patients have to deal with by medical professionals that they are on 'excessive' narcotics. The IC patients know that. They don't even want to be on them. But if she's got that level of pain, she won't survive. Not possible to live with ongoing pain that is literally like a blowtorch. We don't know that she was suicidal. It's quite possible that she desperately desperately needed the pain to stop.

I don't think criminalizing doctors so patients find it harder to get pain control is the answer.

[melanie626]

FYI....Demoral is no longer a good oral agent for chronic pain and is hardly if ever used and it is unclear the dose of oxycontin a day---But I do think it unfair to say that 4 tabs is "whopping" though and it is languege like that that gives oxycontin a bad name:(

I whole heartidly agree with Jill, the best way to manage long term chronic pain is through the evaluation and supervision of a pain clinic or a primary physician who will work with your on your chronic pain and Urologist to treat your IC. Sadly many Uro's will not treat the pain because they don't want to be bothered with the chronicity of the pain medication refills, so I cannot stress enough the vital importance of getting a TEAM of providers and then designate the one to be the point of contact. Advocating is scary and hard and when opiods are involved it can feel extra vulnerable. When in doubt, bring a spouse, friend or contact patient relations if your feeling like your team isn't working for you.

Melanie

[playethic]

One mistake in my earlier post --- clarification in caps:

And the IC specialist [WHERE I LIVE] has only 4-ish options he currently offers patients (Elmiron, heparin/lidocaine/baking soda instills, Uracyst instills, Ranitidene, or a waiting list spot for bladder dilation/fulguration). What if said patient has tried all of those and is still in torture-land?

[playethic]

I agree. Pre-diagnosis and on oxycontin I was on higher levels than 120 - beyond the levels Jill determines to be 'whopping' and 'exceedingly high'. I agree with Melanie's comment on use of language.

Judgements for being on unnecessarily high painkillers makes things more difficult. I'm on less now. If I had been denied that level of painkiller then because someone else said it was too 'whopping', I'd be dead. The pain was not possible to bear. Access to that medication got me through the agony. I got through it and the dose came down. Someone else now may not be given access to enough to manage their pain, and they might not make it.

[ICNDonna]

I have to agree that he was "underpunished" --- and I have to wonder if he should be practicing medicine?

Donna

[kadi]

Maybe I'm reading Jill's comments differently, but it seems to me that it's the amounts of two different strong painkilling drugs prescribed simultaneously that she was noting as high.

[suzannes]

No one knows what else she was taking, ambien, ativan, ect. Could be the combination of all the drugs. As a nurse practitioner I think there really does need to be a balance but I am here to tell you that it is hard for to find that balance.

Suzanne

[dg2901]

That amount of meds seems way out of proportion. Holy smokes! I've been one of the patients suffering from the horrendous pain of this disgusting disease and I've never been given any type of pain meds by my treating physicians. I have however been referred to a pain management Dr though never made the appt. I cant imagine a urologist or primary care physician attempting to manage the pain that IC brings.
It seems strange too that this patient was a nursing instructor who, one would assume, would know better than to take so many meds at such high doses. Something is fishy with this story.

[playethic]

You're right Kadi ... the whole access-to-pain-prescriptions topic hits a nerve for me and I reacted and hit 'post' too quickly. I also noticed that the info about # of pills didn't specify the mg's of pills -- so hers and mine may have been different. At the ER, nurses eyebrows would go up at 'excessive' amounts I was on, so I know it was a lot. I know I didn't want to be on that high, but I know that it was the only way I could survive the pain.

Anyway I realized those things after 'post' and went back to change it but couldn't seem to find an option to edit what I wrote! [that'l teach me... :) ]

[zyphia]

I have had them all.......Oxycontin, MS Contin, Dilaudid, Duragesic patches, you name it, had them all..ONCE...because of severe pain from spinal injuries in addition to IC and other problems with pain....but because of my bummed out liver from a bout with infectious hepatitis and jaundice as a child I cannot metabolize a lot of medications and pain medications are at the top of the list. As a former nurse and an ER nurse for a time, I saw a lot of people on Rx's of Oxy as maintenance for pain and a normal Rx was 10 milligrams twice a day so the Rx the doctor wrote for the young lady for the Oxy was acceptable in some circles for maintenance if she was taking 2 per day @ 10 milligrams a day and had 120 pills (from June 2 to Sept 2), but I don't know about the 990 Demerol. Some Rx's for Oxy are written for up to 60 milligrams per day. I don't understand tho, a nursing instructor taking that combination of drugs. Seems to me she would have known better. I do agree tho, that he was wrong. I would think a red flag should have popped up somewhere along the way with either the pharmacist or the people in the ER. I know it would have if she had been a patient in the ER where I worked. I may have made an enemy for sticking my nose into her business but maybe I would have saved her life. I do know in my case my Rx's for controlled substances are only filled for a period of 30 days so I wonder why there were no questions asked about someone given 990 Demerol tablets in such a short period of time. Of course there are always a lot of "what ifs" when something like this happens. It is so sad and senseless. My pain regimen is a lot different from so many of you on the board because I have to stay away from narcotics but I manage. It isn't fun at times and I do try to live as normal a life as I can. Lately I have become more homebound because the Parkinson's is getting to be more of a bother. It is not so much the typical Michael J. Fox Parkinkson's....I don't skake or tremble..mine is freezing and I am having a hard time getting around so am becoming more housebound which irritates me to no end..grrrrrrrrr. I am living thru my PC these days and am enjoying more and more reading the posts on the board so keep them coming. I am planning a trip to England later this summer....hopefully we will stay at a friends house in Oxfordshire...I won't get to do much, just plod up and down the village lane with my walker...hahaha..but it keeps me busy planning. This will be my last trip to Europe. I have gone every year since 99and it is time to hang up the old traveling shoes. My body is worn out. Oops sorry for the ramble.....:bow:

[bob04951]

This is horrible. It is a step backwards. A doc cannot monitor you every minute of the day, they put their faith in you as you do in them. Gives pain meds yet another bum rap. That is way a lot of pills to be prescribing at one time for ANY patient. Bob only gets an 18 day supply of oxycodone and one month of fentanyl patches, and he cannot renew earlier than 2 days ahead. And doc knows I watch him pretty closely. That doc should maybe not be allowed to even prescribe narcotics for a while. That was a whole lot of medication. What was he thinking??? Woulld be uncomfortable even accepting that many pills and surprised the pharmacy filled the order.

It is a real shame, and who knows where her head was. If she was showing signs of depression a huge red flag would have been flying over her head. Does anyone know if she was on antidepressants as well? If so, he needs a good lashing, and needs to take a few classses on pain meds/interactions, etc.

This is just so discouraging, most of us have a hard time just getting what we need to get through the day, one story like this makes docs paranoid, but on the other hand maybe a bad doc has been weeded out. Feel bad for her family, they were probably against the pain meds to begin with. It's just always a setback, but if we took everything away from a "maybe" depressed patient with which they could do themselves harm, they'd all be living in padded cells. Supervision is the key, and perhaps that is a question docs should ask before they prescribe huge amount of any med to a patient who has a history/signs of depression. That is why I am a firm advocate of always having someone with you for all appts. Depressed patients can hide stuff from loved ones, and they would never know.

Hope we never hear a story like this again, but find it interesting that they actually mentioned she was an IC patient. Where does that put us? That IC patients are drug seeking? If she were a cancer patient everyone would say Ahhh, poor thing, she must have been in a lot of pain. Just an interesting analogy, which lead us to educating our friends and loved ones about how painful this thing can be. Distressing, really, and so very sad.

[zyphia]

Did you read any of the comments made by the readers of the story that were posted at the bottom of the URL that Jill posted? I found them interesting, especially the last one.

[bob04951]

Thank you Zyph, I had not read that, typically do not open up any attachments but did that. Well, you saw her name Tao something which is eastern religion, pretty much organic. Just shows the ignorance some have, if what she said was true, 3/4 of the country would have IC, man, woman and child. Half tempted to respond, but it's just not worth it. You can't educate someone with that mindset. SIGH. Jill, wife of Bob

[zyphia]

:rant:I have always been a mouthy broad, and could not let it pass....afraid I had to say something. I said I thought the statement was a crock. :loco: Never said I was an angel. :angel: The pop-up said the editors would consider my statement. What can I say. :evilsmile

[flowerangela]

Wow.

[zyphia]

No...........not the article...I meant the non-scientific comment the lady made. She had no proof to back it up in my opinion. Did I mislead you? Sorry if my comment did.:bow:

[amaranthe]

First, I want to express my condolences to this patient's family. But, I also want to say that I think that when things like this happen it has the potential to make it alot harder for other suffering patients to get adequate treatment with pain meds. So many Drs will not write r/xes for pain meds at all and many wont write them for chronic pain conditons like IC. So, when something like this happens, it makes it alot harder for those who need pain meds to get them.

Something else too, I remember when I was still on Oxycodone. My pharmacy didnt have 10 mg plls (or they dont make them), so I was told to take 2 5 mg pills every 6 hours as needed. That means I was r/xed 240 of them per month. Well, one time I had to go to the ER and when they asked about my meds, I took them out of my purse to list what I was taking. Well, I had an almost empty bottle in there from the month before along with the new bottle that had just been filled. Well, that ER nurse actually wrote on my record that I had "2 HUGE bottles of oxycodone containing over 480 pills." That was a LIE! She didnt ask me why I had 2 bottles or how many pills were left in the one bottle or anything. She just made an assumption and a judgement and wrote it down without ever even telling me. So, of course, it made me look like some addict. So, I say let's not rush to judgement about this lady. We dont know the reason, or if things were like they appeared to be. I think we should cut her and her Dr some slack since there could be more to her story like there was to mine.

[amaranthe]

No...........not the article...I meant the non-scientific comment the lady made. She had no proof to back it up in my opinion. Did I mislead you? Sorry if my comment did.:bow:

Yes, I saw the last comment in the article Jill linked. (For those of you who didnt see it, basically someone wrote on there that the reason we all have IC is b/c we drank too much coffee or too many sodas a day and that it ate up the lining to our bladders.

Whoever wrote that has no proof of that because researchers still dont know the cause of IC. Many of us have APF that has been tested for and shown positive in our urine. (People without IC dont have this.) Also, alot of us have autoimmune diseases, (like I have Lupus.) Others have positive anti-nuclear antibodies (indicitive of something autoimmune), yet havent been d/xed with anything specific yet. Some can trace IC to bladder injuries or even a long ago infection or UTI. Others believe there to be other causes for their IC. But, the common thread with all of us is that there has not yet been a specific cause to be found. So whoever wrote that didnt know what they were talking about.

[skbird]

I can only speak for myself and my opinion, which is it's horrible that this woman was in so much pain and not being regulated or helped in some other way. I don't think doctors should be afraid to prescribe opiates and other pain meds for this condition, but it seems like this is throwing a lot of medication at one person.

I know that when I am having a flare, sometimes with the meds I take it's hard to keep track of what I took when. About half the month I take half a 5/500 vicodin and spilt a 5mg valium for morning/evening. But during flares, that can triple or quadruple. I also get two preventative instills a month, the week before my period, which are made of Elmiron, heparin, lidocaine, and bicarb. I'm not pain free at all, and I definitely have a lot of urgency issues, but I haven't ever been even offered oxycontin.

In fact, when I asked my doctor about going to a pain specialist, I was told that around my area, the only pain specialists are focused on treating back pain. That seems really useful.

Maybe this woman didn't have access to a pain specialist. Maybe this doctor was doing the only thing he thought would help - though it's pretty horrible and sad. I really hope more information about IC gets out and doctors are more able to help/treat people because this condition really stinks, frustrates, and takes up too much of the lives of those with it, myself included.

:(

Let's hope for more education!

[zyphia]

I have been doing some research about the death of the lady and there are so many unanswered questions. One thing I did find was that she went to Dr. Tyrrell (who apparently practices OB/Gyn) for pain management (?) and he
was suspended for an additional 30 days but allowed to continue to practice obstetrics. I go to a pain management specialist for my pain management, but that is just me. I also ask the urologist to work with me in pain management and he does but my pain management specialist helps a great deal more. Anyway, in one of the articles it also mentioned that:

“At the time of her death, the patient’s body had multiple visible injection sites,”

and I have no idea why or where that tidbit of information came from. What does that mean? Why was that brought up in the article? It seems to me,, as someone said earlier, that there is so much more to the story and there may be something fishy about it. I am not condoning what the doctor did, not at all. It just seems to me there are too many holes and someone needs to *fill in the blanks* in this story and I would like some answers. Also, a statement in the criminal complaint says:

"Daniels (the deceased) a Northeast Technology Center nursing instructor, was being treated by a Tulsa urologist when she started seeing Tyrrell for pain management. She asked Tyrrell for Demerol, which she told him she was taking already. Pharmacy records from June 2, 2009, through Sept. 2, 2009, show Tyrrell prescribed 990 Demerol pills and 120 OxyContin pills.
In the last 35 days of Daniels’ life, she received 630 Demerol pills and 60 OxyContin pills, an average of 18.5 dosage units per day of Demerol."

Well I am just too curious I guess. Always have been. Anyone else have a curious bone? OK I am finished. The End. Byeeee :hi:

:lmao:

[Zygala87]

Due to insurance rules I am only allowed enough percocet to last a month. I rarely need them but when I do (major flare) I need them badly. The way he writes the script I end up getting enough for three months. He knows me & my Husband well. I would never overdose and I tell my Husband when I take one. So he knows not to let me drive in case I forget. Usually one a day is enough to bring me down and put me in enough comfort to sleep. In my State one has to go to his office and receive the perscription in person. That can be a problem for some people. Maybe this Doctor was trying to help her in the same way. I sure do not know. Any medical person knows what an over-dose is. It's a very sad story. So young. OMG it is hard to find a Doctor who will help with pain meds. I hope this story does not stop good helpful Doctors from giving help, being responsible, giving pain meds to those who need relief. Hugs, Ziggy

[suzannes]

This means that on her body they found multiple places where Intramuscular injections were given. No one knows if she gave them to herself or in a doctors office. I believe the majority of MDs are good and caring people. Remember there are two sides to every story.

Suzanne

[zyphia]

I know it means she had injections of some kind. My point I was trying to make is there are too many holes in the story. I think it is time to put it to bed anyway. It is not going to bring her back, nor is it going to change how many feel about the doctor or the quality of care she was given or even how she handled herself.

[Linda May]

I feel for her family God Bless Them.:pray:

[aleet7]

I have to agree with you...no one knows how depressed the patient was to have taken so much(not to put blame on her...clearly the doc shouldn't have written scripts for that many meds)! I hate what the results do for us! Right now I hoard my meds because none of my docs think I should have pain meds for IC! I'm thankful to have two bulging discs in my back with tears in them because it allows me to have pain meds for something that the docs at least thinks requires it! I've never had a script for anything stonger than vicoden and my pain level supercedes 10 a lot of the time! I don't wish IC on my worse enemy and to think that many docs feel like pain meds is out of the question for IC patients. I hope no one has to suffer because of this(my prayers are with this patients family)!

Aleet7

[zyphia]

It is bad enough to have IC but it is even a bigger bother for me with spinal problems. I have IC and have had lumbar spinal problems since I was in my late 20s. I hope you don't suffer like I did (stubborness on my part) with the back problem and ignore it like I did for so long. I finally had to have what is called a pedicle screw fixation done to my lumbar spine because of severe lumbar stenosis. One of the doctors I worked with who was also a good friend made me sit down at his desk at his PC and apply for SS disability online because he knew I would not be able to return to work after the drastic surgery. He was right too. I applied and within 90 days it was approved. Please do NOT ignore your back. I have stainless steel rods and screws in my lumbar spine from L-1 to L-5, having had them all replaced with which are all artificial disk replacements. In addition I have had my cervical spine replaced too, with titanium and the Neurostimulator that is in my right buttock sure makes for a lovely sight when I go thru airport security with the new scanners. I keep waiting to see myself on YouTube. I do feel bad for anyone tho, who suffers from any type pain. When I was suffering from such pain prior to my spinal surgery my doctor would try me on all kinds of pain medications but because of my intolerance to so many and my inability to metabolize them because of my compromised liver, he would ask me to download information off the net to add to my medical records about different medications that were tried to help ease the pain for IC sufferers because he was worried that by chance my records may be pulled for inspection and the inspectors may see the large amount of controlled substances he had written Rx's for me but a closer check would have also eased their minds by talking to me and the local pharmacist and having him tell them that I turned the drugs back in to him for him to destroy them because I could not take them. Also we would put the downloaded infromation in my chart about the different drugs I was using for control of the pain. The duragesic patches I tried were unfortunately not beneficial at all and I had so hoped the would be for the medication did not have to be metabolized thru the liver but was absorbed thru the skin and went into the blood stream but I was unable to handle it. I have tried every drug known, controlled and otherwise and was lucky to have a doctor who cared enough to want to work with me for pain relief. I just wish there were more like him around for the rest of you.

[aleet7]

OMG! Those are some extensive repairs done on your spine....I am so sorry you had to go through all of that! Right now I'm taking Cymbalta for the back pain and vicoden as needed. I also have osteo arthritis in several joints in my spine. The rain and cold puts me in the bed! I know this sounds weird but I'm glad that I can at least get pain meds for the spine issues because I can use it when I'm flaring like I am right now! I've been flaring for almost a week now and my back is in pain also.

I promise not to neglect my spine health...my dad was on a cane at my age(47) and in severe pain from his spine problems! I'm doing everything possible to stay healthy but I can't ignore the horrible flares and spine problems sometimes(I have to learn how to live with it I guess).

I pray that no one has to go through IC without any medical help(pain meds)! It's just not humane!

Best Wishes!
Aleet7

[waterflow]

(Yes, I saw the last comment in the article Jill linked. (For those of you who didnt see it, basically someone wrote on there that the reason we all have IC is b/c we drank too much coffee or too many sodas a day and that it ate up the lining to our bladders. )

Well, they are out of their mind on that one!! I never drank coffee and what little bit of root beer I drank the companies would go under because they could not have made enough money off of me to keep the company going. Where do these people come up with their thoughts on things??? I bet she does not even know what true IC even is. ..Sigh....

[bubbe1]

(Yes, I saw the last comment in the article Jill linked. (For those of you who didnt see it, basically someone wrote on there that the reason we all have IC is b/c we drank too much coffee or too many sodas a day and that it ate up the lining to our bladders. )

Well, they are out of their mind on that one!! I never drank coffee and what little bit of root beer I drank the companies would go under because they could not have made enough money off of me to keep the company going. Where do these people come up with their thoughts on things??? I bet she does not even know what true IC even is. ..Sigh....

That was an aggravting comment that lady made. So much so that I had to answer her. I wasn't going to,but I couldn't stand it. I told her and whoever else reads that forum, that I never drank coffee and almost never drank soda.
It probably wasn't worth my time, but sometimes I just have to shoot my big mouth off! :rant:

[waterflow]

Good, glad you did that. Sometimes it helps to just give them a piece of your mind. Even if they still believe what they say at least you got it off your chest. Unbelivable how some people are. Thinking they know so much about an illness when they don't have it or done any reading on it.

[pookashell21]

Wow, this is a sad article, and sad on many levels. It is sad that this woman met with an untimely death as a result of a probable drug overdose and/or drug interaction. Does anybody know if she took her medications as prescribed? Or whether she had more that one month worth of a medication?

There are so many unanswered questions here it is easy to jump to conclusions and say that the doctor is ultimately to blame. Yes he prescribed, in my opinion, a ton of medication....yet we don't know what other medications she was taking at the time, whether she took the medication as prescribed (and not injecting or snorting her meds), whether she was suffering from depression or was possible suicidal. These are all unknowns, and judgment should be reserved until one looks at all the factors. This article does not provide that information. Perhaps there are reasons why he "got off light", so to speak, that we are not privy to?

What worries me more is the fact that pain, especially for IC patients is largely under-treated and articles like this may not shed enough light on the circumstances surrounding an incident and may in fact chill the prescription of sometimes what amounts to life saving medication for so many people. Indeed, I suffered to the point of contemplating suicide prior to having proper (although sometimes inadequate still!) treatment for my pain.While I am okay now, going through that experience made me deeply aware of the importance of adequate pain control, compassionate and understanding doctors, and the powerful link between mind and body.

If only people would make a bigger deal about all the IC patients who commit suicide every year due to under-treatment and the general poor attitude towards patients suffering from the medical community.

My prayers are with both the patient's family and with the doctor during their grief.

[pookashell21]

Wow, this is a sad article, and sad on many levels. It is sad that this woman met with an untimely death as a result of a probable drug overdose and/or drug interaction. Does anybody know if she took her medications as prescribed? Or whether she had more that one month worth of a medication?

There are so many unanswered questions here it is easy to jump to conclusions and say that the doctor is ultimately to blame. Yes he prescribed, in my opinion, a ton of medication....yet we don't know what other medications she was taking at the time, whether she took the medication as prescribed (and not injecting or snorting her meds), whether she was suffering from depression or was possible suicidal. These are all unknowns, and judgment should be reserved until one looks at all the factors. This article does not provide that information. Perhaps there are reasons why he "got off light", so to speak, that we are not privy too?

What worries me more is the fact that pain, especially for IC patients is largely under-treated and articles like this may not shed enough light on the circumstances surrounding an incident and may in fact chill the prescription of sometimes what amounts to life saving medication for so many people. Indeed, I suffered to the point of contemplating suicide prior to having proper (although sometimes inadequate still!) treatment for my pain.While I am okay now, going through that experience made me deeply aware of the importance of adequate pain control, compassionate and understanding doctors, and the powerful link between mind and body.

If only people would make a bigger deal about all the IC patients who commit suicide every year due to under-treatment and the general poor attitude towards patients suffering from the medical community.

My prayers are with both the patient's family and with the doctor during their grief.

[pookashell21]

Wow, see this article.
http://www.tulsaworld.com/news/article.aspx?subjectid=12articleid=20101117_12_A8_VINITA703792

VINITA - Craig County District Attorney Gene Haynes said Tuesday he won't charge a Vinita doctor who was accused of prescribing more than 1,000 painkillers to a nursing instructor who later died from an overdose.


Dr. Mickey Ray Tyrrell was accused of prescribing excessive amounts of narcotics to Tammy Dawn Daniels, 35, of Vinita, who died Sept. 5, 2009. Tyrrell will have a hearing Jan. 13 before the state Board of Medical Licensure and Supervision.

"In my opinion there is no evidence of criminal violations by Dr. Tyrrell," Haynes said in an e-mail. "A criminal charge would require proof that the actions of Dr. Tyrrell were the direct cause of death."

Daniels died from acute combined drug toxicity from forms of the painkiller Demerol, according to an autopsy report by the state Medical Examiner's Office.

A complaint filed by the state Attorney General's Office states that Daniels' body "had multiple visible injection sites," but the complaint did not elaborate on how Daniels might have injected Demerol when it was prescribed to her in pill form.

Haynes said he could not comment about the evidence, citing confidential medical information.

"In my opinion the actions of Dr. Tyrrell were not the direct cause of the death," he said.

Tyrrell, who worked for Green Country Family Medicine in Vinita, would not comment on the allegations.

According to the complaint, pharmacy records from June 2 through Sept. 2, 2009, show that Tyrrell prescribed 990 50-milligram Demerol pills and 120 20-milligram OxyContin pills to Daniels. Records show that Tyrrell noted only two prescriptions for Demerol in Daniels' chart, when he had written nine prescriptions, the complaint states.

Tyrrell told investigators he authorized the prescriptions but had no explanation as to why he documented only two of the nine.

In the last 35 days of Daniels' life, she received 630 Demerol pills and 60 OxyContin pills, an average of 18.5 dosage units per day of Demerol, the complaint states.

Read more from this Tulsa World article at http://www.tulsaworld.com/news/article.aspx?subjectid=12&articleid=20101117_12_A8_VINITA703792