WILLIAMSPORT — A former employee of Dr. Raymond Kraynak on Monday testified that she is ashamed she didn’t leave the medical practice until only weeks before the now-suspended Mount Carmel doctor was arrested in December 2017.
Kerry Appel, 64, a former receptionist for Kraynak, described questionable practices in the office by both Kraynak and other longtime staff, aggressive and strange patient behavior and a “chaotic” filing system, on Monday, day four of the federal trial against Kraynak.
Appel worked briefly for Kraynak in the 1990s, worked for the federal Bureau of Prisons for 20 years and then came back to work for Kraynak in 2014.
“I was trying to do good,” she said on Monday afternoon. “I’m ashamed of myself for staying on as long as I did. I was trying to get him on the right track and help him and do the right thing, and get the office in order.”
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.
‘Chaotic’ filing and questionable practices
Appel said she retired from the prison system in 2012 and was asked in 2014 to come work for Kraynak to audit and organize the patient charts in Mount Carmel. She testified she was told the charts needed to be “cleaned up” and the practice needed to get back on track.
The files were incomplete and in “disarray.” Kraynak did not listen to her suggestions, she testified.
“I felt my words were falling on deaf ears,” she said. “They were not appreciated.”
She was soon moved to the Shamokin office to do front desk work. She started witnessing questionable practices, including patients bringing bottles of alcohol for payment, she said.
One patient, who later fatally overdosed, stored her medication at Kraynak’s office because she couldn’t be trusted with controlled substances. That patient would come daily to the doctor’s office for her pills, Appel testified.
Another patient’s husband would pick up his wife’s prescription and was accused of selling it at the bar across the street, she testified.
Another patient came in to request needles, saying she always gets them from Kraynak’s office, she testified.
“It was all so sketchy,” Appel said. She said she refused to participate in any of those practices.
‘Going to war’
Appel testified that patient behavior was strange and often aggressive. Many would show up for appointments an hour or more early. They would be lining up outside the doctor’s office waiting to get in. The waiting room would often be standing room only, she said.
Patients would claim their pills were stolen or lost. They would be verbally abusive or pounding their fists if she told them they couldn’t receive an early refill, she said.
“It was like we went to war every day,” she said.
After the United States Drug Enforcement Administration raided Kraynak’s office in 2016, Appel said there was confusion among the staff.
“Everyone was trying to make sense of it,” she said. “Of what possibly could be going on. Everything was in a state of chaos.”
Kraynak told the employees: “DEA doesn’t have anything,” according to her testimony.
CVS and Rite Aid stopped filling prescriptions from Kraynak’s office. Pharmacies would be calling daily to ask for the legitimacy of prescriptions, she said.
Appel said she is not a disgruntled employee.
“I was calling out what I knew was wrong,” she said. “I may look disgruntled in the eyes of my colleagues who condone this behavior.”
She said she worked with criminals and knew how they behaved when they were addicted. She worked with filing systems and drug screening processes before.
“I know right from wrong,” she testified.
‘Without medical necessity’
Lorraine Boothe, an agent in the special investigations unit of Anthem Insurance who reviews fraud, waste and abuse, testified that she received a referral about Kraynak’s office in January 2015 from the company’s pharmacy benefit manager Express Scripts Network.
The report was “for concerns of inappropriate prescribing of controlled substance medications and prescribing dangerous combinations of medications.” The medications were “in excess and/or without medical necessity,” according to the report.
Of 54,820 medications covered by Anthem Insurance and prescribed by Kraynak between January 2012 and November 2014, 21,561 (or 39 percent) were controlled substances. Of his top 10 medications prescribed, 80 percent were narcotics, according to the report.
Kraynak was responsible for 21.3 percent of all prescriptions for controlled substances in the Express Scripts network. Comparably, Family Medicine Prescribers in Pennsylvania were responsible for 4.63 percent while Family Medicine Prescribers nationwide were responsible for 6.32 percent, according to the report.
“The top 10 medications prescribed by other family medicine practitioners in Pennsylvania were compared to the top 10 medications prescribed by Dr. Kraynak,” according to the report. “Dr. Kraynak’s prescribing habits differ from the family medicine practitioners in Pennsylvania as controlled substances did not appear in their top 10.”
Prior to this report, Kraynak in 2012 signed a settlement agreement with the State Board of Osteopathic Medicine in which he admitted no wrongdoing but acknowledged that he must conform to acceptable prescribing practices. He was ordered to attend medical courses for 31 hours, had to provide patient contracts for pain management, use one pharmacy and do urine and toxicology tests on his patients. He was also ordered to pay a $2,500 civil penalty.
Boothe testified the “red flags” of Kraynak’s case are seen in specific patterns “over and over again” in other criminal prescribing cases.
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.