SALT LAKE CITY -- Federal prosecutors told a jury Wednesday that a Brigham City doctor prescribed millions of pain pills to people without adequately evaluating their conditions or providing even basic physical examinations.
That recklessness led to the death of two patients, Assistant U.S. Attorney Richard Daynes said during opening statements in the trial of Dr. Dewey C. MacKay III in Salt Lake City's U.S. District Court.
Prosecutors have focused the case on 12 specific patients, but Daynes suggested MacKay's office had a revolving door of hundreds of people who sought pain medications from the one-time orthopedic surgeon. Court papers filed in the case say MacKay saw up to 120 patients per eight-hour workday between 2005 and February 2007. From March 2007 to October 2009, prosecutors contend MacKay saw 59 patients per five-hour day.
"Two to three minutes, five minutes, they'd be in and out," Daynes said as he described MacKay's office to jurors. "The fact is the treatment they received was little to none."
In some cases, Daynes said, MacKay also continued to prescribe painkillers after he knew patients had developed an addiction or overdosed.
MacKay, 64, is expected to testify in his own defense.
He has pleaded not guilty to 85 combined counts of illegally prescribing and distributing a controlled substance. The first two counts of the indictment relate directly to the deaths of patients. If convicted on those charges alone, MacKay could spend up to 35 years in prison and be ordered to pay $2.5 million in fines.
The other charges each carry penalties of up to 20 years in prison and a $1 million fine.
Prosecutors originally charged MacKay with 130 counts, but dropped 45 of the charges Monday, the same day the jury of nine women and three men were selected.
State records shows MacKay issued more than 37,700 prescriptions for hydrocodone and oxycodone between June 2005 and October 2009, totaling more than 3.5 million pills.
Defense attorneys on Monday said MacKay wasn't "operating as a drug trafficker or a drug dealer" as he is accused by prosecutors, but rather as a "caring physician trying to do what he could to help people."
Peter Stirba said MacKay required all of his patients to sign a contract stating they understood MacKay's methods for pain treatment and the risks of pain medications like Oxycontin, Lortab, and Methadone, which are frequently prescribed to those suffering from chronic pain. MacKay stopped providing care to those patients who broke the conditions of the contracts, Stirba said.
One of the conditions was that MacKay refused to give patients refills of the powerful pain medications and instead required them to make frequent office visits, so that he could assess how they were responding to the drugs.
All of the 12 patients on which prosecutors have built their case were suffering from similar problems, including degenerative diseases affecting the discs of the spine and chronic back pain, Stirba said. All had also seen other physicians and received the same diagnoses and medications from other doctors as they did from MacKay, he said.
Doctors are trained to believe their patients and prescribe medications by using their best judgment and considering the needs of individual patients, Stirba said.
"Pain is subjective," he reminded jurors. "It's not something you can test, it's not something you can see."
U.S. District Judge Dee Benson said Wednesday that the trial could last between four and five weeks. Prosecutors said as many as 80 witnesses might be called.