Vas STATE OF INDIANA MARION COUNTY, ss: FILED @ ave 05 205 httpe://marion.inpcms.org/ IN THE MARION SUPERIOR CRIMINAL COURT 6 CRIMINAL DIVISION, ROOM W306 STATE OF INDIANA “Thies. a Chacslap) Cause No: 49G06-1508-FC-027608 ‘cusracov ree hw enum ooUeT ¥. ) ) JOBN K. STURMAN W/Male DOB 1/25/1946 INFORMATION COUNTI RECKLESS HOMICIDE LC. 35-42-1-5 ACLASS C FELONY COUNT I RECKLESS HOMICIDE LC, 35-42-1-5 ACLASS C FELONY COUNT HI RECKLESS HOMICIDE LC, 35-42-1-5 ACLASS C FELONY COUNT IV ISSUING INVALID PRESCRIPTION FOR LEGEND DRUGS BY A PRACTITIONER LC, 16-42-19-20(b) ‘ACLASS D FELONY COUNT V ISSUING INVALID PRESCRIPTION FOR LEGEND DRUGS BY A PRACTITIONER LC. 16-42-19-20(b) A CLASS D FELONY COUNT VI ISSUING INVALID PRESCRIPTION FOR LEGEND DRUGS BY A PRACTITIONER LC. 16-42-19-20(b) A CLASS D FELONY COUNT Vit ISSUING INVALID PRESCRIPTION FOR LEGEND DRUGS BY A PRACTITIONER LC, 16-42-19-20(b) A CLASS D FELONY COUNT VI ISSUING INVALID PRESCRIPTION FOR LEGEND DRUGS BY A PRACTITIONER L.C. 16-42-19-20(b) 8/5/2015 12:39 PMhttps: /marion.inpems.ore/ ACLASS D FELONY COUNT IX ISSUING INVALID PRESCRIPTION FOR LEGEND DRUGS BY A PRACTITIONER LC. 16-42-19-20(b) ACLASS D FELONY COUNT X ISSUING INVALID PRESCRIPTION FOR LEGEND DRUGS BY A PRACTITIONER LC. 16-42-19-20(b) ACLASS D FELONY COUNT XI ISSUING INVALID PRESCRIPTION FOR LEGEND DRUGS BY A PRACTITIONER LC. 16-42-19-20(b) ACLASS D FELONY COUNT XT ISSUING INVALID PRESCRIPTION FOR , LEGEND DRUGS BY A PRACTITIONER LC. 16-42-19-2000) ACLASS D FELONY COUNT XHI ISSUING INVALID PRESCRIPTION FOR LEGEND DRUGS BY A PRACTITIONER LC. 16-42-19-20(0) ACLASS D FELONY COUNT XIV ISSUING INVALID PRESCRIPTION FOR LEGEND DRUGS BY A PRACTITIONER LC. 16-42-19-20(b) ACLASS D FELONY COUNT XV ISSUING INVALID PRESCRIPTION FOR LEGEND DRUGS BY A PRACTITIONER LC. 16-42-19-20(b) ACLASS D FELONY COUNT XVI ISSUING INVALID PRESCRIPTION FOR LEGEND DRUGS BY A PRACTITIONER LC. 16-42-19-20(b) ACLASS D FELONY COUNT XVII RIB 19015 19-20 BAehitps://marion.impems.ore/ ISSUING INVALID PRESCRIPTION FOR LEGEND DRUGS BY A PRACTITIONER LC. 16-42-19-20(0) A.CLASS D FELONY COUNT XVII ISSUING INVALID PRESCRIPTION FOR LEGEND DRUGS BY A PRACTITIONER LC. 16-42-19-20(6) ACLASS D FELONY COUNT XIX ISSUING INVALID PRESCRIPTION FOR LEGEND DRUGS BY A PRACTITIONER LC. 16-42-19-20(b) A CLASS D FELONY On this date, the undersigned came before the Prosecuting Attomey of the Nineteenth Judicial Circuit and, being duly swom (or having affirmed), stated that in Marion County, Indiana COUNTI Between May 10,2010 and August 6, 2010, JOHN K. STURMAN did recklessly kill another human being, to wit: D.B.H., by writing and/or issuing prescriptions to D-E.H.for Methadone, Dilaudid, and/or ‘Valium without medical legitimate purpose and outside the usual course of practice; COUNT II Between July 25, 2011 and December 20, 2011, JOHN K. STURMAN did recklessly kill another ‘human being, to wit: M.K.C,, by writing and/or issuing prescriptions to M.K.C. for Dilaudid, and/or Xanax and/ot Feniany! without legitimate medical purpose and outside the usual course of practice; COUNT III Between July 1, 2009 and October 26, 2011, JOHN K. STURMAN did recklessly kill another human being, to wit: T.A.V,, by writing and/or issuing prescriptions to T.A.V. for Fentanyl and/or Oxycodone ‘without legitimate medical purpose and outside the usual course of practice; COUNT IV Between July 25, 2011 and December 15, 2011, JOHN K. STURMAN, a practitioner, did knowingly BIS /9018 19-20 PMhttps: //marion.inpems.ore/ issue an invalid prescription or drug order for Dilaudid, a legend drug, to M.K.C,, without a legitimate medical purpose and outside the usual course of practice; COUNTY Between July 25,2011 and December 13, 2011, JOHN K. STURMAN, a practitioner, did knowingly issue an invalid prescription or drag order for Xanax, a legend drug, to M.K.C, without legitimate ‘medical purpose and outside the usual course of practice; COUNT VI between July 25,2011 and September 13, 2011, JOHN K. STURMAN, a practitioner, did knowingly issue an invalid prescription or drug order for Morphine, @ legend drug, to MK.C., without legitimate medical purpose and outside the usual course of practice; COUNT VII Between October 12, 2011 and October 15, 2011, JOHN K. STURMAN, a practitioner, did Jenowingly issue sn invalid preseription or drug order for Fentanyl, a legend drug, to M.K.C., without a legitimate medical purpose and outside the usual course of practice; COUNT Vill Between July 7, 2009 and October 19, 2011, JOHN K. STURMAN, a practitioner, did knowingly issue an invalid prescription or drug order for Fentanyl, a legend drug, to T.A.V., without a legitimate medical purpose and outside the usual course of practice; COUNT IX Between August 20, 2009 and October 19, 2011, JOHN K. STURMAN, a practitioner, did knowingly issue an invalid prescription or drug order for Oxycodone, a legend drug, to T.A.V., without a legitimate medical purpose and outside the usual course of practice; COUNT X RISIDN1S 19-20 PMaf? https: / /marion.inpems.org/ Between January 15, 2009 and September 7, 2010, JOHN K. STURMAN, a practitioner, did ‘knowingly issue an invalid preseription or drug order for Methadone, a legend drug, to L.D-F,, without a legitimate purpose and outside the usual course of practice; COUNT XI Between May 20, 2009 and July 19, 2010, JOHN K. STURMAN, a practitioner, did knowingly issue an invalid prescription or drug order for Oxycodone, a legend drug, to L.D-F,, without a legitimate ‘medical purpose and outside the usual course of practice; COUNT XIE Between December 11, 2009 and August 21, 2010, JOHN K. STURMAN, a practitioner, did knowingly issue an invalid prescription or drug order for Xanax, a legend drug, to L-D.F., without a legitimate medical purpose and outside the usual course of practice; COUNT Xi ‘Between March 9, 2012 and May 17, 2012, JOHN K. STURMAN, a practitioner, did knowingly issue an invalid prescription or drug order for Oxycodone, a legend drug, to R.GR,, without a legitimate medical purpose and outside the usual course of practice; COUNT XIV Between December 16,2009 and December 14, 2010, JOHN K. STURMAN, a practitioner, did ‘knowingly issue an invalid prescription or drug order for Fentanyl, a legend drug, to Z.A.R., without a legitimate medical purpose and outside the usual course of practice; COUNT XV Between January 6, 2010 and August 26, 2011, JOHN K. STURMAN, a practitioner, did knowingly issue an invalid prescription or drug order for Morphine, a legend drug, to Z.A.R., without legitimate ‘medical purpose and outside the usual course of practice; COUNT XVI 8/5/2015 12:39 PManttps: //marion inpems.ore/ Between February 8, 2010 and October 5, 2011, JOHN K. STURMAN, a practitioner, did knowingly ‘issue an invalid prescription or drug order for Oxycodone, a legend drug, to Z.A.R., without a legitimate medical purpose and outside the usual course of practice; COUNT XVI Between April 26, 2011 and September 26, 2011, JOHN K. STURMAN, a practitioner, did knowingly issue an invalid prescription or drug order for Dilaudid, a legend drug, to Z.A.R., without legitimate medical purpose and outside the usual course of practice; COUNT XVIII Between March 29, 2010 and April 26, 2011, JOHN K. STURMAN, a practitioner, did knowingly issue an invalid prescription or drug order for Valium, a legend drug, to Z.A.R, without legitimate medical purpose end outside the usual course of practice; COUNT XIX Between April 27, 2010 and March 31, 2011, JOHN K. STURMAN,, a practitioner, did knowingly issue an invalid prescription or drug order for Methadone, a legend drug, to Z.A.R., without legitimate medical purpose and outside the usual course of practice; all of which is contrary to statute and against the peace and dignity of the State of Indiana. swear or affirm under penalty of perjury as specified by LC. 35-44-2-1 that the foregoing representations are true. August 5.2015 Date TERRY R. CURRY Marion County Prosecutor State's Witnesses: 19th Judicial Circuit ‘WAYNE SHELTON, IMPD oe ZAR DR. TIMOTHY KING RISTIBIR 19:39 PYhttps://marion.inpcms.org/ DR. MICHELE GLINN Deputy Prosecuting Atiomey DR ROLAND KOHR DR. THOMAS SOZIO DR. JOYE CARTER DR. JOHN CAVANAUGH KOR AIT LABORATORIES KOR INDIANA STATE DEPARTMENT OF HEALTH KORIU HEALTH KOR CVS KOR KROGER KOR TARGET KOR WALGREENS KOR WAL-MART KORIUSCC KOR PARKSIDE KOR MILBURN HEALTHMART KOR RUSHVILLE PHARMACY Tof7 8/5/2015 12:39 PW.FLED ‘AFFIDAVIT @) aug 05 205 FOR PROBABLE CAUSE “7*Y™ @s Ebdacaiged CURIS OF axeEENeROMEE COUR STATE OF INDIANA, COUNTY OF MARION, 8S: Detective Wayne Shelton ‘swears (affirms) thet On April 14, 2014, Jessica Krug, Deputy Attomey General, Indiana Office of Attorney General (OAG) contacted Detective Wayne Shelton, Indianapolis Metropolitan Police Department and provided a | summary of a case her office was reviewing involving Dr. John K. Sturman MD, DAG Krug said Dr. John Sturman isa physician licensed to practice medicine in Indiana who is alleged to have prescribed a large amount of narcotics to pain management patients in his clinic located at IU Hospital, $50 University Boulevard, Indianapolis Indiana 46202 from 2008 - 2012. Ail prescriptions issued/vritten by Dr. John ‘Sturman to the patients mentioned in this probabfe cause affidavit occurred at the above mentioned location in Indianapolis, Indiana. DAG Krug said Dr. John Sturman came to the’attention of the OAG through complains filed with the Licensing Fnforcement Section. ‘Three separate complaints were filed. ‘Two complaints were from former patients and the remaining complaint is from a local addictions counselor who had concerns about the large number of narcotic prescriptions Dr. John Sturman was giving to patients. Those investigations began in 2012 and were assigned to DAG Krug for completion. Below is a table listing legend drugs commonly referred to in this Probable Cause affidavit: Scientifie Name Common Brand Category ‘Schedule eet Name(s) ‘Alprazolam Xanax Benzodiazepine iV Hydrocodone Vicodin, Lortab, Noreo, | Opioid i Tussionex Oxyeodone ‘Oxycontin, Percocet, | Opioid 1 | Percodan, Tylox Diazepam Valium Benzodiazepine WV Colazepam Klonopin ‘Benzodiazepine v Hydromorphone Dilaudid, Exalgo Opioid i es Methadone “Methadose/Methadione | Opioid hh Carisoprodol ‘Soma ‘Muscle relaxant WV i] ‘Amphetamine [Adderall Stimulant nt He Phenobarbital Barbiturate Vv Fentanyl Fentora, Duragesic, | Opioid 1 Actiq Morphine ‘Oramorph SR Opioid ia | swear (affirm), under penalty of perjury as specified by IC 35-44-2-1, thatthe foregoing representations are true Ate DATED: August 4,2015 ast = Ayfge FE - DEPOTY PROSECUTING APTORNE) TUDGEAffidavit for Probable Cause From: Detective Wayne Shelton Indiana Code § 16-18-2-199 defines a legend drug as a drug that is: (1) subject to 21 U.S.C. 353(0X() {any dtug that requires a prescription, including controlled substances}; or (2) listed in the Prescription Drug Product Listas: (A) published in the United States Department of Health and Human Services, Approved Drug Products with Therapeutic Equivalence Evaluations, Tenth‘Esition, (1990); and (B) revised in United States Department of Health and Human Services, Approved Drug Products with ‘Therapeutic Equivalence Evaluations, Cumulative Supplement to the Tenth Edition, Number 10 (1990), INSPECT REPORT ‘An INSPECT report summarizes the controlled substances a patient has been prescribed, the practitioner who prescribed them, and the dispensing pharmacy. Each time a controlled substance is dispensed, the dispenser is required to submit biographical data about the patient as well Has the drug, the quantity prescribed and the number of days for which the drag is to be taken. The information required to be included on a prescription label must also be included in the report to INSPECT. ; A review of Dr. John Sturman’s prescribing practices reveals a large number of prescriptions for medication combinations, including the frequent prescribing of “the holy trinity” (common street reference to the simultaneous use of benzodiazepine, opiates and soma), as well as large amounts of medication for patients that is notin line with the relevant standards of medical care, Benzodiazepines are a class of psychoactive drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. Opiate drugs are narcotic sedatives thet depress activity of the central nervous system, reduce pain, and induce sleep. Soma is a muscle relaxer that works by blocking pain sensations between ‘the nerves and the brain. Dr, John Sturman received his Indiana Medical License on February 26, 2008. He is board certified in Neurology (1979) with a sub-specialty in pain management (2001). Prior fo practicing in Indiana, Dr. John Sturman practiced in California from 1984 2008. On 03/28/2003, the California Medical Licensing Board filed a Public Letter of Reprimand against Dr, John Sturman for Failure to obtain supporting documentation for conditions producing chronic pain, and failure to document a treatment plan for patient's addiction to a Schedule IV controlled drug. In 2008, Dr. John Sturman joined IU Health Physicians group in Indiana as an employee and bogan treating pain patients at a clinic located in IU Health Hospital in Indianapolis, In 2013, Dr. John Sturman renewed his Indiana Medical License. As part of the routine renewal process, Dr. John Sturman was required to answer a series of questions regarding his conduct during the prior two years. One question asked whether he had been disciplined, lost medical privileges at a hospital, or been ‘terminated by an employer since he last renewed his license. Dr, John Sturman answered "yes" to that 1 sweat (affitm), under penalty of perjury as specified by IC 35-44-2-1, that the foregoing representations are true. AFL DATED: 4, _@ GED Nf ey ‘ EPUTY Baad eae JUDGE o (RINETEENTEFODICIAL CIRCUFTAffidavit for Probable Cause From: Detective Wayne Shelton question. As a result of his positive response, Dr. Jobn Sturman was requited to personally appear in front ofthe Indiana Medical Licensing Board (MLB) and explain his response. In that personal appearance, Dr. John Sturman stated he had lost his medical privileges at Indiana University in 2012 after he failed to complete medical charting/documentation of patient visits, a gross deviation from the recognized standard of care. At the conclusion of his appearance with the MLB, his medical license was renewed. As pattof its investigation, DAG Krug sent Indiana University a subpoena to determine why Dr. John ‘Sturman's privileges had been revoked. While peer review materials are generally confidential, those ‘materials may be provided to the OAG in connection with an investigation into a licensed practitioner; however, IU Health chose to not provide the relevant documents regarding Dr. John Sturman's joss of privileges. Dr. John Sturman stopped working for IU Health and Hospital in July of 2012. Dr. John Sturman remained unemployed from July of 2012 until February of 2014. Dr. John Sturman's INSPECT report for 2009-2012 for all of the controlled substance prescriptions filled in Indiana was examined by the OAG. The information from those INSPECT reports was then isolated to include all of the unique names of patients on that list. That list of patients was provided to the Indiana State Department of Health (ISDH), Vital Statistics department, and they provided the OAG death information for any names on that list. The list revealed 35 patients died and 5 of those patients died from drug intoxication, overdose, or related causes of death and had filled a prescription from Dr. John ‘Sturman within 30 days immediately prior to death. DAG Krug requested death certificates, Coroner’s reports and autopsies regarding these 15 patients. DAG Krug also issued subpoenas to various Pharmacies where Dr. John Sturman’s patients had their prescriptions filled. Detective Wayne Shelton obtained a subpoena requesting DAG Krug provide him with all the evidence slte had received reference this investigation; including autopsy reports, toxicology results, and prescriptions issued/written by Dr. John Sturman of those 15 deceased patients. DAG Krug and Detective Wayne Shelton worked together to ensure all records recovered were complete and accurate, Detective Wayne Shelton obtained a subpoena requesting patient fies/charts from Indiana University Health Ine; including but not limited to any records from IU Hospital or Methodist Hospital for the above ‘mentioned patients of Dr. John Sturman. Indiana University Health Inc. provided patient files for the following patients: 1 AIL 03/18/1963 2. RLP 05/10/1965 3. PSV uiizyt9s2 1 sweat (affirm), under penalty of perjury as specified by IC 35-44-2-1, thatthe foregoing representations are true DATED: August.2015 —_ Pay) _BEPUTY PROSECUTING ATPORREY NINETRENTH JUDICIAL CIRCUITAffidavit for Probable Cause From: Detective Wayne Shelton 4. TAV 07/25/1965 5. PDM — 02/19/1957 6 DEH 11/06/1968 7. SL 05/22/1984 8. LDF 01/04/1960 9 CLD 07/01/1963 10. MKC 08/02/1967 HL. JSM 04/05/1966 12. JEF 11/14/1959 13. KVE 12/19/1961 14. LSM 05/26/1967 15. MLN 02/18/1964 16. RGR 09/27/1960 Detective Wayne Shelton discovered additional patients of Dr. John Sturman by reviewing INSPECT Reports. Detective Wayne Shelton obtained a second subpoena requesting Indiana University Health Ine. provide the patient files for the following patients: 1, BDG 01/02/1963 2. ZAR 03/28/1980 3. IDB 09/14/1972 DAG Krug provided contact information for Dr. Timothy King M. D., a physician with a medical specialty in Anesthesiology and a Subspecialty in Pain Medicine. DAG Krug provided copies of patient files, autopsies and the INSPECT reports to Dr. Timothy King for his review, Dr. Timothy King reviewed all the records provided to him and separately provided an opinion on the medical care, examination and controlled substances prescribed as provided by Dr. John Sturman. DAG Krug provided contact information for Dr. Michele A. Glinn, PhD, F-ABFT. who has areas of professional experience as a Laboratory Director, Consulting Laboratory Director: Forensic Toxicology Program, Consulting Laboratory Director: Pain Management Programs and Consultant in Forensic Toxicology. DAG Krug provided copies of patient files, autopsies, toxicology results and the INSPECT reports to Dr. Michele A. Glinn for her review. Dr. Michele A. Glinn reviewed all the records provided to her and separately provided an opinion regarding the toxicology as it relate: tothe cause of death of Dr. ‘ohn Sturman’ patients nt DEH I sweat (affirm), under penalty of perjury as specified by 1C 35-44-2-1, thatthe foregoing representations are true. A DATED: . cree wa DEPUPY PROSECUDING ATPORI = JUDGE NINETEEN CIA iT (Paged)Affidavit for Probable Cause From: Detective Wayne Shelton INSPECT reports showed Dr. John Stirman prescribed 10 prescriptions for controlled substances fo patient DEH from 04/23/2010 — 07/29/2010. Detective Wayne Shelton verified the information located on the INSPECT report by recovering the actual prescriptions from the pharmacies where patient DEH hhad them filled. The following is a chart of the actual prescriptions for controlled substances ‘ssued/written by Dr. John Sturman: Name | Date Issued _| Date Filled | Drug RX/Prescription'# | Schedule DEH | 5/10/2010 _| 6/2772010 _| Methadone _| N0245751 1 eH | 4/23/2010 | 5/4/2010 __| Methadone _| 2100220-810932_| IL DEH | 4/23/2010 _| 4/27/2010 _| Dilaudid | 2100109-810932_| it eH | son010 [5/24/2010 __| Dilaudid | 2100492-810932_| IT DEH | s/io2010 | 6/18/2010 | Dilaudid | 2100852-810932_| I DEH | 5/2010 | 6/1010 | Methadone [NIA : | DEK | 5/10/2010 | 5/27/2010 | Valium | 4484120 Vv DeH__| 7292010 | 7292010 _ | Dilaudid | 2101363-810932 | ben | 7/292010 | 7/29/2010 _| Methadone _| 2101364-810932 | It DEH | 729,010 | 927010 | Valium | 4527870 v Detective Wayne Shelton reviewed the autopsy report for patient DEH, Roland M. Kohtr, M.D. Forensic Pathologist with the Terre Haute Regional Hospital Department of Pathology performed Autopsy Number ‘NC10-198 on 08/07/2010 at 1:00pm. Patient DEH was found non-responsive on the evening of (08/06/2010 at 815 N. Ohio St. Shelburn Indiana 47879, He was transported to the Regional Hospital BR in full arrest, where resuscitation efforts were unsuccessful. Past medical history is remarkable for prescription drug abuse, diabetes and pancreatic surgery. Due to the circumstances of the death, the Coroner's office was notified and the autopsy was authorized. ‘The cause of death was listed as “Pharmacologic Intoxication” The manner of death was listed as “Accident” The anatomic findings were listed as the following; 1, History of prescription drog abuse. 2, Pulmonary congestion and edema, marked, with lobar pneumonia and abundant pigmented intra-alveolar histiocytes. 3, Left ventricular hypertrophy (450 gm). : 4. Roux-en-Y small bowel anastomosis with choledochoduodenostomy. 5. Remote craniotomy. 1 swear (affirm), under penalty of perjury as speified by IC 35-44-2-1, hat the foregoing representations are true Yj — FF] Sees 8 ery DEPUTY PROSECUTING ae NINETEEN(H JUDICIAL.GIRCUITDATED: August 4,2015——— Affidavit for Probable Cause From: Detective Wayne Shelton AIT Laboratories, 2265 Executive Drive, Indianapolis Indiana 46241 was responsible for the testing and toxicology results. The Autopsy report listed the following substances detected under the Toxicology section: Phenobarbital 15.1 ugiml (Ther 15-40) Diazepam 102 ng/sal (Ther 200-1000) ‘Nordiazepam 206 ng/ml (Ther 60-1800) Methadone 269 ng/ml (Ther 50-1000) 4 Hydromorphone 6.6 ng/ml (Ther 0-50) Urine positive for temazepam, oxazepam, methadone, hydromorphone, phenobarbital ayaynn ‘The next three indented paragraphs include Dr. Timothy King’s opinion after his review of the 3,486 pages of medical records from the requested dates of 01/01/2008-12/31/20 2 of patient DEH. Dr. Timothy King's opinion is that DEH’s medical chart demonstrates a prescriptive pattern of high dose polypharmacy for purposes of addiction and not for the treatment of chronic pain. Addiction behaviors, substance abuse and alcoholism are clearly décumented in the chart, but Dr. John Sturman continues to prescribe methadone, Dilaudid, and Valium without a legitimate ‘medical purpose and outside the usual course of medical practice. A legitimate medical diagnosis is not established. On the initial office visit Dr. John Sturman lists diagnoses of “pancreatitis and ‘musculo-ligamentous back pain”. The pancreatitis is secondary to long-term abuse of alcohol, and except for DEH’s claim of abstinence, there is no verification that alcohol abuse has ended. The ‘back pain is secondary to a chronic limp caused by previous gunshot wound to the knee. Neither of these conditions merits the use of opiates for pain control, The chronic use of controlled substances to treat pain of episodic pancreatitis is not medically acceptable. Back pain from an abnormal gat is treated with techniques of physical medicine, but not with opiates and benzodiazepines. Dr. John Sturman does not establish a legitimate medical foundation for the use of high dose narcotics and benzodiazepines. Chart documentation shows obvious addiction behavior, DEH makes claims about “intending to get admitted to get IV Dilaudid.” He confesses to his aunt and to case management consultants that he abuses opioids. He consumes a month’s worth of Dilaudid and methadone over the course of one week. Multiple ER visits and hospital ‘admissions are caused by overconsumption of prescribed opiates followed by withdrawal, vomiting, and dehydration, He th medical care, fails to responsibly maintain his feeding tube, refuses to accept outpatient-nursing care, and is discharged from VNS (Visiting Nurse Society) because of methadone abuse. Multiple opiate related side effects are noted in the medical record. General surgery consultation identifies abdominal pain as secondary to “opioid induced gastroparesis.” Dr. John Sturman notes that an oral pain regimen is difficult because “vomiting prevents absorption of oral meds.” DEH admits to medication non-compliance as documented in multiple medical record entries. DEH is | swear (affirm), under penalty of perjury as specified by 1C 35-44-2-1, that te foregoing representations are fe eo Noftige” (Page 6)Affidavit for Probable Cause From: Detective Wayne Shelton ‘a no-show for an office appointment, cancels a re-scheduled appointment, but still requests medication refill. These observations define a pattern of behavioral, non-compliance, abuse of controlied substances, and evidence of addiction. DBET is not a candidate for the use of chronic opioids for treatment of abdominal or back pain. Dr. John Sturman demonstrates willfal blindness with the continued prescriptive use of high dose methadone, Dilaudid, and Valium in the face of obvious evidence of abuse and medical noncompliance. A proper treatment plan for DEH should rationally include substance abuse consultation, non-opioid treatment options, and elimination of controlled substances. However, there is no evidence that Dr. JohniSturman considered psychiatric or substance abuse counseling as part of the treatment pian. The treatment plan is ‘entirely opiate centric. Clinical observations indicate worsening function, continued elevation of pain scores, and on-going hospital admission for complaints of abdominal pain. It is clear that ‘opiates do not improve the pain condition, but contribute to side effects and support on-going, addiction. A prudent practitioner would not have initiated opiate therapy for this patient, and ‘would have exercised an exit strategy promptly after hearing DEH!s statement to seek hospital admission explicitly for the purpose of obtaining IV Dialudid. DEH needs drug rehab consultation and does not need 2 regimen of high dose methadone, Dilaudid, and Valium. It is Dr. John Sturman’s responsibility to recognize these mental health and substance abuse risk factors, and formulate an appropriate and safe treatment plan. Dr. John Sturman fails to maintain the standard of care in his use of opiates for the treatment of chronic pain, Aleoho! induced pancreatitis and gait-induced back pain are not legitimate diagnoses for the use of chronic opiates. A high dose regimen of methadone and Dilaudid, equal to 384 mg morphine equivalent (MEQ), puts the patient into a high-risk category for overdose death. Risk of death is i ignificantly with the co- prescription of Valium 40 mg per day. This polypharmacy mn of multiple opiates plus methadone plus benzodiazepine is recognized as a street popular and lethal combination of prescription medication. It is a sought after medication combo that leads to respiratory depression and death. It is not a medically legitimate regimen, and Dr. Join Sturman should not have prescribed this regimen to DEH who has a known history of ‘lcohol and prescription drug abuse. Failure to establish a legitimate diagnosis, failure to formulate a medically acceptable treatment plan, and failure to perform risk management are Dr. ‘Tohin Sturman’s major areas of deviation from standard of care. Obvious behaviors of addiction ‘and continued substance abuse are ignored. The patient is non-functional, has a history of alcohol related disability, demonstrates on-going evidence of addiction, is non-medically compliant, and should not have been maintained on a polypharmacy combination of medication associated with overdose and death. Dr. John Sturman prescribes controlled substanees without regard for patient safety, without a legitimate medical purpose, and outside the usual-course of medical practice. 1 wear (aim), under penalty of perjury a specified by IC 35-44-21, thatthe forego DATED: August 4, 2015 DEPUTY PROSECUTING AEFORNEY JUDGE NINETEENTEBUDICY (Page)Affidavit for Probable Cause From: Detective Wayne Shelton Dr. Michele A. Glinn reviewed the INSPECT reports, autopsy and toxicology findings of DEH. Dr. Michele A. Glinn’s opinion is that patient DBH’s death could be considered the result of toxicity from prescribed medications, Dr. Michele A. Glinn said patient DEH was prescribed doses of methadone that were very high compared with a usual adult daily dose. Patient MKC INSPECT reports showed Dr. John Sturman prescribed 17 prescriptions for controlled substances to patient MKC from 07/25/201 1 — 12/15/2011. Detective Wayne Shelton verified the information located ‘on the INSPECT report by recovering the actual prescription from the pharmacies where patient MKC had them filled. The following is a chart of the actual prescriptions for controlled substances issued/written by Dr. John Sturman: nee es —, Name _| Date Issued __| Date Filled | Drug RXIPrescription# | Schedule MKC _| 7/25/2011 725/201 | Dilaudid __|NO413370 u MKC _| 7/25/2011 7ASMON | Xanax 0413372 Wv [Ke _|7/2smo1i | 7/25/2011 | Morphine __|'NO413371 a | MKC _| 7/25/2011 7a9noit__|Dilaudid | N0414498 u MKe_| 8/18/2011 8/24/2011 | Dronabinol_| €0420619 m MKC _| 9/13/2011 9132011 {Dilaudid | NO425749 i ‘Oramorph MKC _| 9/13/2011 9/3011 _| SR 10425748 it MKC _| 9/13/2011 913011 | Dilaudid | NO425747 ut MKC _| 9/13/2011 9/1301 | Morphine |N0425751 | MKC _| 971372011 9/13/2011 | Xanax €0425750 W. mxc_| 9372011 | 9/13/2011 | Dronabinot_| C0425752 im mike _|io/i2011 | 10/15/2011 _| FentaNYL _ | NO434233 1 Mke_[ii70i1 [11212011 | Dilaudid | N0443921 in mKe_ | ui/i7mori | 11/252011_| Dilaudid _| Noaaso07 u uke [inion | 11/2501 audi __| 1NO445006 in Kc | 12/13/2011 | 12/13/2011_| Xanax 60449912 Vv mKe_|i2nsmon | 12/157011 did _|['N0450666 n | swear (affirm), under penalty of perjury as specified by IC 35-44-2-1, thatthe foregoing representations are true. ANFIAY DATED: August 4.2015 NY Wry c n—eK jie _ Bipure FROSECOTNGATTOR ina (RINETEENTH JODIolal Cgcet® age 8)Affidavit for Probable Cause From: Detective Wayne Shelton Detective Wayne Shelton reviewed the autopsy report for pationt MKC. Charity Banks MDI, Coroner of Decatur County reported patient MKC was feeling weak after her shower on 12/20/2011. Patient MKC asked her husband to help her to the bed. Once patient MKC was in the bed she explained that her lower abdomen hurt, she was having chest pain and her heart was pounding. Patient MKC’s husband said her i speech became slurred, but he thought she was just drifting off to sleep. Patient MKC’s husband | described her as taking several staccato type breaths and going unresponsive, He attempted to get her to respond and she did briefly, before taking several staccato type breaths and going unresponsive agai ‘The husband called 911 and began CPR. Clarksburg Fire Department and Decetar County EMS arrived at 1619 N. County Road 600 Bast, Greensburg Indiana 47240, and began ACLS protocols. Patient MKC ‘was transported to the ER at Decatur County Memorial Hospital, 720 N Lincoln St, Greensburg, IN 47240, Ail efforts to resuscitate patient MKC were unsuccessful. Coroner Chasity Banks and Deputy Coroner's Chip and Lisa Schlemmer conducted the death investigation, Patient MKC’s husband stated that she had been admitted to IU Medical Center approximately two weeks prior with a very low blood count. Patient MKC had been dealing with gastrointestinal issues for the past 12 years. Patient MKC had bbeen to several doctors and had many tests conducted. According to patient MKC’s husband, they were not able to pet 2 diagnosis. Autopsy number OC-11-0094 was performed at the Marion County Coroner's, Office by Thomas J. Sozio, D.O. Forensic Pathologist on 12/21/2011 at 10:00am. The autopsy listed pationt MKC’s cause of death as “Polydrug Intoxication” and the manner of death as “Accident” The anatomic findings were listed as the following; Bilateral pleural effusions. Osteoporosis. Focal mild nephrosclerosis. Gastric contents in larynx. Bilateral rib fractures (status post CPR). No blunt or penetrating trauma, Postmortem toxicology positive for multiple drugs. AIT Laboratories, 2265 Executive Drive, Indienapolis Indiana 46241 was responsible forthe testing, and toxicology results. The Autopsy report listed the following substances detected under the Toxicology section: . 1. Alprazolam 19.8 ng/mt (Ther 10-40) 2. THC 1.6 ng/ml 3, Fentanyl 3.0 ng/ml (Ther 1-3) 4, Hydromorphone 124 ng/ml (Ther 0-50) ‘The next two indented paragraphs include Dr. Timothy King’s opinion after his review of the 2,619 pages of medical records from the requested dates of 01/01/2008-12/31/2012 of petient MKC. | swear (affirm), under penalty of perjury as specified by IC 35-44-2-1, thatthe foregoing representations are true. DATED: August 4.2015 aaa) WM ViAa ne DEPUPY PROSECUT) (C AMORNEY JUDGE r oe NINETEENTHLWBICIAL Ci (Pages)Affidavit for Probable Cause From: Detective Wayne Shelton Dr. Timothy King said MKC was initially seen as a pain consult in the hospital. Dr. John Sturman made several recommendations including statting Effexor, Neurontin, and increasing morphine to 30 mg tid. The patient followed up in the Pain Clinic 2 months later. He saw her for atotal of 3 clinic visits, mairtained the Dilaudid and morphine, trialed Fentanyl patches 50 meg, and ordered an EMG. A legitimate diagnosis was never established, Her primary complaint of abdominal pain never had an established somatic diagnosis. Her past history showed behaviors clearly consistent with somatoform iliness, possible factitious disease. She never responded to opiate therapy in the past, as far back as 2008. Her pain was diagnosed as "muscle wall pain” at that time, in-hospital behaviors show early requests for Dilaudid, and evidence of symptom ‘magnification and falsification, (Bates 2001). Heer history shows presence of multiple psychosomatic symptoms inclusive of headaches, chest pain, racing heart, abdominal pain, childhood fibromyalgia, unexplained vaginal bleeding, and unsubstantiated seizures. The patient was physically and verbally abused as a child. Psych consultation during the same visit 2s Dr. John Sturman's initial hospital visit, concluded with diagnoses of major depression, possible opioid abuse, possible benzo abuse, somatization vs factitious disorder. These findings were ignored by Dr. John Sturman when he defined his, working diagnosis and formulated his opiate treatment plan. Dr. John Sturman’s physical exam and EMG did not define a legitimate pathology that warranted the use of escalating opiates. The patient's pain syndrome was psychosomatic, and consistent with her well documented history of child abuse, non-responsiveness to chronic opiate therapy, suggestions of somatic/fictitious disorder, normal GI and GYN exams, progressive pain needs, and escalating use of medical resources. Her complaints of nausea, vomiting, insomnia, and mood instability are common side effects of chronic opiate therapy. Dr. John Sturman did not adequately assess these indicators of opiate side effect, and continued to trial additional opiates. Adequate risk assessment was not performed, Medical co-morbidity risks (sleep apnea, anemia) were ignored. Mental health diagnoses of severe depression and anxiety were ignored. Urine drug tests were not performed. Functional assessment was not evaluated at any time. Opiates continued to be recklessly prescribed/escalated for pain of psychological origin, Dr. John Sturman prescribes controlled substances without a legitimate medical purpose and outside the usual course of medical practice, Dr. Michele A. Glinn reviewed the INSPECT report, autopsy and toxicology findings of MKC. Def Michele A. Glinn's opinion is that patient MKC’s death could be considered the result of toxicity from prescribed medications. The amount of Hydromorphone in the postmortem toxicology was noted to be toxic, Patient TAY. 1 swear (affirm), under penalty of perjury as specified by IC 35-44-2-1, that the fordgoing representations are true, PFI DATED: August4, DEPUTY PROSECUTIN NINETEEN SH JU NY OTE (TTORNI JUDGE ‘CIRCUI (Page 10)Affidavit for Probable Cause From: Detective Wayne Shelton INSPECT reports showed Dr. John Sturman prescribed 81 prescriptions for controlled substances 0 patient TAV from 04/16/2009 — 09/21/2011. Detective Wayne Shelton verified the information located on the INSPECT report by recovering the actual prescription from the pharmacies where patient TAV hac them filed. The following is a chart of the actual prescriptions which included controlled substances issued/written by Dr. John Sturman: Name _| Date Issued _| Date Filled_| Drug RX/Prescriptiont’_| Schedule tav__| 7/2009 | 712009 __| METHADONE | 904512-1 it i tav | 7/7009 | 7/8/2009 | Duragesic 2201437 iat Tav__ | 7/23/2009 {7/23/2009 | Duragesic 2201451 It Tav__| 7/23/2009 | 7/23/2009 | Vicodon ES _| 4408060 ui TAV | 8/2072009 | 8/27/2009 _| Duragesic 2201485 i TAV [97162009 | 9/16/2009 | Lyrica ‘| 4408443 Vv Tav | 9/1672009 | 9/26/2009 | FentaNyL [2201526 | tav__| 9/6009 | 971672009 | oxYcoDONE | 919409-1__. in | Tav | 10/15/2009 | 10/15/2009 | OxyCodone | 2201551 u TAV | 10/15/2009 | 10/15/2009 | FENTANYL | 925766-1 ti TAV__| 11/13/2009 _| 11/13/2009 | OXYCODONE | 931570-2 ju | av | 11/13/2009 | 11/15/2009 | FENTANYL _ | 931818-1 iL | TAY [11/13/2009 | 12/1072009 | FENTANYL | 936877.2 i Enna ‘av | 11/13/2009 | 12/10/7209 | OXYCODONE | 9368761 im TAV__| 1782010 __| 1/8/2010 _ | OXYCODONE: | 9427341 0 Tav__|isn0i0 [1112010 | FENTANYL | 942851-11 in TAV | 1/8/2010 2/572010 | FENTANYL _| 949297-1 Lt i TAV__| 1/8/2010 | 2/5/2010 _ | OXYCODONE | 949296-3 i Tav__|2anmo [24010 | LYRICA 949340-1 y Tav | 22010 | 3/8/2010" | LYRICA 949340-2 v Tav__| 2/2010 | 4/9/2010 | LYRICA 9493403 v Tav__|3/s2010 | 3/S/2010 | FENTANYL __| 955657. U Tav__| 3/5200 [3/5/2010 | oxycoDONE | 955660-1 u | Tav__| 3/2010 | 4/2/2010 | FENTANYL. | 961015-2 un | swear (affirm), under penalty of perjury as specified by IC 35-44-2-1, that the foregoing representations are true AFF = auf wg OE mona 3 JUDGE (Page 11)Affidavit for Probable Cause From: Detective Wayne Shelton tav__|3/52010 | 47272010 _| OXYCODONE | 961017-1 1 TaV__| 542010 | 5/4010 | FENTANYL _ | 967177-1 a Tav_| 5/2010 | 5/42010 | LYRICA 967178-1 Vv Tav__[s/anoi0 | 5/4/2010. | OXYCODONE | 967176-1 a | Tav__|5/42010__| 6/72/2010 [LYRICA 9671 78-2 Vv TAV | 5/42010 [7/6/2010 _| LYRICA. 9671783 v_ tav__| 6/8/2010 | 6/8/2010 | FENTANYL | 973705-1 n Tav | 6/8/2010 | 6/8/2010 __| OXYCODONE | 973706-2 1 Tav__[osnoi0 | 7/sa010__| FENTANYL [9784-14 TAV | 6/8010 | 7/5/2010 | OXYCODONE | 978483-2 it TAV | 8/2010 | 9/4/2010 | Oxycodone _| NO216435 1 TAY | 8/62010 | 8/6/2010 __[ Oxycodone __| N0213690 0 TAV__| 8/62010 | 8/62010 | FENTANYL | 984488-4 a TAV_| 8/62010 | 8/62010 _| LYRICA 9844586-1 v TAV__ | 8/6/2010 9/4/2010 __| FENTANYL _| 989884-1 im Tav__| 9/6n010 | 9/11/2010 | LYRICA gaeag62 |v TAV__| 862010 | 9/292010_| LYRICA 9844863, v | tav | 962010 | 10/272010 [LYRICA 994486-4 Vv TAV__| 62010 | 11/15/2010 | LYRICA 994486-5 v TAV | 962010 | 12/13/2010 | LYRICA 984486-6 v Tav | 10/4010 | 10/4/2010_| FENTANYL _ | 995319-1 ul Tav | 10/4/2010 | 10/4/2010 | oxycopone | 995318-1 u Tay | 11242010 | 12/30/2010 | Oxycodone _| NO227197 eae) TAV | 1142010 | 1202011 | Fentanyl. | 2208239 u [rav [11/24/2010 | 11/30/2010 | FENTANYL | 1005567-1 uw TaV__[11/242010 | 1130/2010 | OXYCODONE | 1005565-1 | Hl Tav {11242010 [1230/2010 | FENTANYL _| 1010522-1 ni TAY | 1iaa2010 | 1a2m011 | OXYCODONE | 1014870-1 1 Tav | iono | 1112011 [ LYRICA 1012576-1 v Tav__|if6n0u | 2ne2011 | oxyCODONE | 14532201 | Tav [16011 | 292011 | FENTANYL | 1020138.2 u | swear (affirm), under penalty of perjury as specified by 1C 35-44-2-1, tha the for — DEPUTY, secure P NIN TAL CIRCUIT NY wy e re JUDGE (Page 12)Affidavit for Probable Cause From: Detective Wayne Shelton TAV 1/26/2011 3/6/2011 LYRICA 1017987-3 Vv TAV 3/22/2011 SAT2011 FentaNYL 2219646, I av [37220011 | 422011 [FENTANYL | 1468716-1 1 TAV 3/22/2011 4/22/2011 OXYCODONE | 1468714-1 i TAV__| 3/22/2011 | 3/22/2011_| FENTANYL _ | 1026029-1 W TAV 3/22/2011 3/22R2011 OXYCODONE | 1026030-1 a Tav__ [3222011 [3/31/2011 _[ LyRICA 1027864-1_ v TaV [32011 | 442011 _| LYRICA 1027864-3 Vv TAV 3/22/2011 5/13/2011. LYRICA 228539-2 Bie tav__|3/227011 | s/aa/zoit_| OXYCODONE | 228881-1__,__| IL TAV 3/22/2011 6/10/2011 LYRICA 228539-5 Ae TaV__[3/22R011 | 782011 __| LYRICA 228539-8 v tay [322n011 | 7/3172011_| LYRICA 228539-10 lv | TAV 6/13/2011 T2011 FENTANYL 1488692-1 no TAY [6/1301 | 7/12/2011 | OXYCODONE | 1488691-1 ta TAV | 6/13/2011 | 82011 | FENTANYL _ | 1495507-1 u TAV | 6/13/2011 _ | 8/9011 | OXYCODONE | 1495506-1 0 Tay | 824n011 {9/8011 | FENTANYL _| 1502699-1 TAV. 8/24/2011 9/8/2011 OXYCODONE | 1502700-1 I Tav [ono [onan [LYRICA 15036042 Vv TAY [9/2im011 | 922011 FENTANYL _ | 1506497-1 i TAV 9/21/2011 9/21/2011 LYRICA. 1506496-1 bi TAV_[92in011 | 9/2101 | OXYCODONE | 1506495-1 tL TAV 9/21/2011 10/17/2011 _| LYRICA 1506496-2 Vv TAV 9/21/2011 10/19/2011_| FENTANYL 4514272-1 IL TAV, 9/21/2011 10/19/2011_| OXYCODONE | 1514271-1 tL Detective Wayne Shelton reviewed the autopsy report for patient TAV. Patient TAV’s autopsy number MC-11-1275 was performed by Ashley Inman, MD and John E. Cavanaugh, MD both Forensic Pathologist with the Marion County Coroner’s Office. The autopsy was performed on 10/27/2011 at 9:00am, The autopsy reports states patient TAV was found on 10/26/2011 at 11:26am by her daughter “unresponsive in bed but breathing. The daughter tried to make her mom responsive with a wet towel but I swear (affirm), under penalty of perjury as specified by IC 35-44-2-1, thatthe foregoing representations are true. DATED: Augui4,2015 aS iE _ BEG ip OSEDANE — NINE CIAL CIRCUIT (Page 13)Affidavit for Probable Cause From: Detective Wayne Shelton ‘was unsuccessful. Medics found the decedent lying supine in bed pulseless with no signs of rigor. ‘Medical intervention was attempted for approximately 30 minutes with no success, Patient TAV was pronounced nonviable at 12:04 pm on 10/26/2011. Patient TAV was last seen alive at approximately ‘midnight on 10/26/2011. At that time, she had been complaining of pain in her upper body. Patient TAV has a past medical history of diabetes, gout, hypertension and chronic pain for which she took multiple medications. The cause of death was listed as “Fentanyl Toxicity” and the manner of death was listed as “Accident”. ‘The anatomic findings were listed as the following; 42 year old black female found unresponsive at home. Postmortem drug soreen positive for fentanyl, 4-14x “normal therapeutic” range. Prior history of drig overdose; probable fentanyl. Remote myocardial infarction of interventricular septum, Cardiomegaly. Pulmonary edema, Evidence of medical intervention. No evidence of penetration or blunt force trauma SR AVaSNE AIT Laboratories, 2265 Executive Drive, Indianapolis Indiana 46241 was responsible for the testing and toxicology results. The Autopsy report listed the following substances detected under the Toxicology section: Fentanyl 13.9 ng/ml (Ther 1-3) The next three indented paragraphs include Dr. Timotiy King’s opinion after his review of the 1,857 pages of medical records from the requested dates of 01/01/2008-12/3 1/2012 of patient TAV. Dr. Timotiy King said according to the patient files, TAV was initially presented to Dr. John ‘Sturman with complaints of arm and leg pain. Dr. John Sturman began a regimen of hydrocodone and methadone, and cventually escalated medications to high dose fentanyl patches and oxycodone. Her daily narcotic dose was initially 30 MEQ (morphine equivalents) but was escalated to > 1000 MEQ. This dose is excessive; particularly given her multiple medical problems (steep apnea, morbid obesity, asthma, COPD, home oxygen) and mental health co- morbidities (panic attacks, depression). Opiate doses greater than 100 mg per day are associated with 10x increase in risk of respiratory depression and death. Her diagnoses of diabetic neuropathy and fibromyalgia are subjective, and do not merit an exclusive opiate treatment regimen. Dr. John Sturman ignores clearly defined opiate risk factors including hospitalizations for excessive medication use, inconsistent urine drug testing results, and medication noncompliance. Opiates are prescribed without a legitimate medical purpose and outside the usual course of medical practice. TAV has a history of excessive hydrocodone use, “T what 1 swear (affirm), under penalty of perjury as specified by IC 35-44-21, thatthe foregoing representations are tue EPUTY PROSECUTING ATTOR} ‘NINETRENTH JUDICIAL C1ReGER———— (Rage 14)Affidavit for Probable Cause ‘From: Detective Wayne Shelton she has to do to control her neuropathy pain” (Bates 1665). She suffers from muscle pain (Bates 14, 195), abdominal pain (Bates 41), pelvic inflammatory disease, and migraines. At multiple times she is in the emergency room or hospital because of complications related to her various ' medical conditions (Bates 1842, 1805, 1772, 1721, 1551). She is morbidly obese (5°5” 254#), is in poor pulmonary health (Bates 1049, 464), continues to smoke (Bates 14,22), requires home ‘oxygen (Bates 1415), is disabled/unemployed (Bates 22, 1617), fails to respond to pain injections (Bates 355), and suffers frora sleep apnea (Bates 502). Dr. John Sturman fails to factor these medical and historical risk factors into formulation ofa legitimate and safe treatment plan. Fentanyl and oxycodone ate-prescribed at high and dangerous doses for pain complaints that do not merit exclusive opiate treatment. Her pain symptoms require treatment with exercise, physical therapy, smoking cessation, and weight loss. Opiates are prescribed without a legitimate medical purpose. ‘The patient record documents 2 hospitalizations secondary to excesive consumption of opiates. Tin both cases the patient required Narcan administration to reverse the effects of excessive opiates, respiratory depression, and cognitive impairment (Bates 406, 784, 229). She runs out of medication early (Bates 214), requests early medication refills frequently (Bates 208, 210, 286), and misses maultiple office appointments for exam and medication refill (Bates 317, 318, 304). She is absent for a S-month period because of “transportation issues” (Bates 287), but Dr. John Sturman continues to prescribe opiates in spite of her lengthy absence. Her diabetes is not under control (Bates 1062), she continues to gain excessive weight (Bates 334), and she refuses to participate in mental health counseling (Bates 214), Dr. John Sturman fails to limit her narcotics, fails to enforce non-opiate treatment options (aerobic conditioning, physical therapy, weight loss), and fails to implement an opiate exit strategy after more than 27 months of failed opiate therapy. Several urine drug screens are apparently ordered by Dr. John Sturman, but no results are documented on the chart. Dr. John Sturman enters a note on 8/6/10 (Bates 371) indicating that the “UDS at last visit showed metabolites of clonazepam as well as unprescribed lrydrocodone and hydromorphone... Her urine also lacked fentany! metabolites but was positive for oxycodone.” She should have had only fentanyl and oxycodone in her urine. These findings constitute a major compliance violation, and suggest that she is illegally obtaining clonazepam (a benzodiazepine) and hydrocodone, and using her fentany! patches in a non-prescribed manner. This is particularly ‘dangerous because her fentanyl is prescribed at a high dose (100 meg) and can cause significant respiratory depression in combination with oxycodone, hydrocodone, and benzodiazepines (Clonazepam/Klonopin). The continuation of opiate prescriptions after this finding of medication non-compliance is outside the usual course of medical practice. In summary, the medical chart reveals that Dr. John Sturman prescribes multiple high dose opiates based on subjective patient complaints and without additional medical evaluation (EMG 1 swear (affirm), under penalty of perjury as specified by 1C 25.44-2-1, that the foregoing representations are tue. DATED: August4, 2015 NY ie} é re ree a a (Page 15)Affidavit for Probable Cause From: Detective Wayne Shelton testing, of consultation with physiatry, rheumatology, or endocrinology). He fails to incorporate medical and mental health risk factors into formulation of aa appropriate and safe treatment plan. Opiate centric treatment is the only option pursued. The patient exhibits medication noncompliance (abnormal urine drug testing), is admitted fo the hospital multiple times for excessive use of narcoties, and demonstrates no functional or pain management improvement after 27 months of opiate treatment. Dr. John Sturman continues to prescribe narcotics, escalates the dose to exceedingly high levels (MEQ >1000mg morphine/day), and ignores signs of ‘medication misuse. The patient’s daily function remains suboptimal (1062, 229, 903, 784, 1551, 1038), she remains depressed (Bates 287), and she continues to suffer from psychosocial stress (Bates 135). Dr. John Sturman is medically inappropriate in his use of controlled substances in the care of TAV He prescribes opiates without a legitimate medical purpose, and outside the usual course of medical practice. Dr. Michele A. Glinn reviewed the INSPECT report, autopsy and toxicology findings of TAV. Dr. Michele A. Glinn’s opinion is that patient TAV's death could be considered the result of toxicity from prescribed medications. The only drugs found in patient TAV’s at her time of death were the drugs prescribed by Dr. John Sturman. Dr. Michele A. Glinn said patient TAV was prescribed doses of oxycodone that were very high compared with a usual adult daily dose and the amount of Fentanyl in the postmortem toxicology was noted to be toxic, In summary, Dr. Michele A. Glinn said most of the patient records she reviewed indicated the patients ‘were prescribed multiple medications, including two or more opioids and s benzodiazepine concurrently. Patient MKC and DEH were noted to have histories of known or suspected alcohol or drug misuse. The patients were prescribed medications, most commonly oxycodone above the usual adult maximal daily dose, and all were prescribed in combination with other central nervous system depressant drugs. Patient MKC was prescribed oxycodone in spite of reported gastrointestinal distress, although providers were not able to pinpoint the cause. Patient TAV, DEH and MKC’s death were likely the direst result of toxicity Indiana Code §35-42- |-5 provides that a “person who recklessly kills another human being commits reckless homicide, a class C felony.” “A person engages in conduct ‘recklessly’ if he engages in the ‘conduct in plain, conscious, and unjustifiable disregard of harm that might result and the disregard involves a substantial deviation fiom acceptable standards of conduc.” Ind. Code §35-41-2-2. In Barber ¥, State, the court of appeals held that other factors may contribute to a death, so fong as the reckless ‘conduct was the proximate cause of the death. 863 N.E.2d 1199, 1204 (Ind. Ct. App. 2007), ‘The court | swear (firm), under penalty of perjury as specified by IC 35-44-2-1, thatthe foregoing representations are tue DATED: August 42015 iC DEPUTYPROSECUT ae JUDGE NINE’ (Page 16)Affidavit for Probable Cause From: Detective Wayne Shelton ‘went further and noted that “[sJurrounding circumstances can make otherwise lawful conduct reckless.” ia. In the context of dealing cases, a physician may be held criminally liable for dealing where he or she issues prescriptions for controlled substances “with no legitimate purpose, or not in the usual course of his practice as a licensed physician.” Alarcon v, State, S73 N.E.2d 477, 480 (Ind. Ct. App. 1991). In Burrage v. United States, the U.S, Supreme Court considered the causation required to show that distribution of a Schedule I or II drug caused “death or serious bodily injury” for purposes of a sentence enhancement under the Controlled Substance Act. 124 S. Ct. 881 (2014). The Court held “at least where use of the drug distributed by the defendant is not an independently sufficient cause of the victim's death or serious bodily injury, a defendant cannot be liable under the penalty enhancement provision of 21 U. S. C. §841(6)(1)(C) unless such use is @ but-for cause of the death or injury.” Id. at 892. Patient LDF INSPECT reports showed Dr. John Sturman prescribed 77 prescriptions for controlled substances £0 patient LDF from 01/15/2009 — 08/23/2010. Detective Wayne Shelton verified the information located on the INSPECT report by recovering the actual prescription from the pharmacies where patient LDF had them filled. The following is a chart of the actual prescriptions which included controlled substances issued/written by Dr. John Sturman: Name | Date Issued _| Date Filled_| Drug RX/Preseription# | Schedule LoF__| wis009_| 1/17/2009 _| Methadone __| N290431N LU LDF __ | 2/11/2009 | 3/9/2009 | Methadone _|'N294734N 1 LDF __| 5/20/2009 _| 6/19/2009 _| Percocet [N302469N TL LDF | 5/20/2009 | s/2072009 | PERCOCET | 1118266-1 u ube | 5/20/2009 | 6/1/2009 _| METHADOSE | 1120875-2 1 LDF | 5/20/2009 | 62972009 _| METHADOSE | 1127709-1 1 LDF __| 5/20/2009 | 5/20/2009 | PERCOCET _| 1118266-1 i LDF | 5/20/2009 | 6/1/2009 | METHADOSE | 1120875-2 in | LDF __| s/20/2009 | 6/29/2009 | METHADOSE | 1127709-1 ul LDF | 7/20/2009 _| 72072009 _| METHADONE | 815580-1 u LDF _ | 7/20/2009 | 7/20/2009 | METHADONE | 815580-1 ia I swear (affirm), under penalty of perjury as specified by IC 35-44-2-1, that the foregoing representations are true. paren; sagas aug DEPUTY PR@SECU: PrORNEY JUDGE NINETEENTH TODICIAL CIRCUIT (Page 17)Affidavit for Probable Cause From: Detective Wayne Shelton Lor _| 8/18/2009 _| 9/17/2009 _| Oxycodone __| N220582 u pr __| 8/18/2009 _| 9717/2009 | Oxycodone __|N220582 tL pF _| 8/18/2009 _| 8/18/2009 __| METHADONE | 822827-1_ a LDF __| 8/18/2009 _| 8/18/2009 __| OXYCODONE | 822825-1 I LDF _ | 8/18/2009 _| 9717/2009 _| METHADosE | 2187902 ia [upr _| s/1g/2009_| 8/18/2009 | METHADONE | 822827-1 W LDF __| 8/18/2009_| 8/18/2009 | OXYCODONE | 822825-1 iE LpF__|-8/18/2009 | 9/17/2005 | METHADOSE [2187902 it | LDF __/ 10/14/2009 | 11/12/2009 | Oxycodone _|1N0233706 a LDF __| 10/14/2009 | 10/14/2009 | Oxycodone | N416846 Lor | 10/14/2009 | 11/12/2009 [Oxycodone | N0233706 HL LDF __| 10/14/2009 | 10/14/2009 | Oxycodone _| N416846 ul | LDF __| 10/14/2009 | 10/14/2009_| METHADONE | 838950-1_ | TI LDF | 10/14/2009 | 11/12/2009 | METHADOSE | 225101-1 0 Lor __| 10/14/2009 | 10/14/2009 _| METHADOSE | 838950-1 i Lor __ | 10/14/2009 | 11/12/2009 _| METHADOSE | 225101-1 ub LDF | 12/11/2009 | 12/11/2009 _| XANAX. 855280:3 v pF | 12/13/2009 | 12/11/2009 _| METHADONE | 855279-1 1 | pe __| 12/11/2009 | 12/11/2009 | OXYCODONE | 855278-1 in | Lor __| 12/11/2009 | vsi2010 | METHADOSE | 1179897-2 in LDF _ | 12/11/2009 | 1872010 | OXYCODONE | 1179895-1 0 tor | i2sio09 [132010 | XANAX —_| 1180211-4 Vv LDF _| 12/11/2009 | 12/11/2009 _| XANAX 8552803 Vv LpF | 12/11/2009 | 12/11/2009 _| METHADONE | 855279-1 u Lpr__| 12/11/2009 | 12/11/2009 | oxycoDonE | 855278-1 IL LpF__| 12/11/2009 | 1/8/2010 __ | METHADOSE | 1179897-2 i LF | 12/2009 | 1a2010 | OXYCODONE | 1179895-1 | TL Ebr ___| 12/11/2009 | 1713/2010 _| XANAX 11802114 Vv pF | 2/572010 | 3/5/2010 | Oxycodone | NO597022 WL LDF __| 2/5/2010 __| 2/5/2010 _| Oxycodone __| N0441255 Law Lr [ 2/5/2010 13/5/2010" | Oxyeodone | Nos97022_— | | | swoar (affirm), under penalty of perjury as specified by IC 35-44-2-1, thatthe foregoing representations are true. DATED: Avgust4,2015 : Nye Oe tae ‘NINETERNTEIUDICIA! RN TUDGE UIT (Page 18)Affidavit for Probable Cause From: Detective Wayne Shelton. LpF__| 2/5010 _| 2/512010__| Oxycodone _| No441255 WL wor | 2/200 | 2/5010 __| XANAX 871843-2, Vv LDF | 2/52010 | 2/5/2010 | METHADOSE | 871842-2 i Lor | 2/2010 | 4/2010 _| METHADOSE | 1203745-1 IL Lor | 2/2010 | 4/2010 _ | OXYCODONE | 1203744-1 i Lor _| 252010 | 3/52010__| XANAX 2383341 Vv pr | 2/500 | 3/5/2010 | METHADOSE | 238397-2 [Ieee EE LpF | 2/52010 | 4/2010, | XANAX 2383342 v Lor | zsaoi0 | 2/5/2010 __| XANAX | 871843-2 WV Lor _ | 2/5010 | 2/5010 | METHADOSE | 871842-2 w pF | wsno10 [3/5010 | XANAX | 238334-1 W Lor | 2/sno10 | 3/5/2010 __ | METHADOSE | 238397-2 im Lor __ | 252010 __| 4/2010 | METHADOSE | 1203745-1 1 Lor | 2sa010 | an0i0__ | oxvcopone | 12037441 | uF | 2/sroi0 | a/ao10 | XANAX | 238334-2 v [pF | 4/27/2010 | 4/27/2010 | Oxycodone | NO459314 1 Lor | 4272010 [4/27/2010 _| Methadose | 1N0459313, 0 pr | 4/27/2010 | 4/27/2010 | Oxycodone | 190459314 tl Lor [427010 | 47272010 _| Methadose __| NO459313, iL pF | 427010 | 5/23/2010 | METHADOSE | 1217592-2 1 Lor | 4/272010 | s/23/2010 _ | OXYCODONE | 1217593-1 it tor | 472010 | 4/29/2010 _| XANAX 2448633 Iv LDF | 4727n010 | 2772010 | XANAX 2448634 Vv Lor | 427010 | 6/26/2010 _ | XANAX 248863-5 v LoF [4/27/2010 _| 4292010 _| XANAX. 244863-3 | v. | [EDF | 4r7n010 | 5232010 _ | METHADOsE | 1217592-2 ns Lor | 4/27/2010 _| 5/232010 _ | OXYCODONE | 1217593-1 i _| LDF | 4/27/2010 _| 5/27/2010__ | XANAX. 244863-4 Iv { upr__|4/7mni0 | 6/26/2010 | XANAX ____| 244863-5 Vv LDF__| 5/2200 _| 7/19/2010 | OXYCODONE | 253653-1 W Lupe | s7222010 _[7is2010 | ox¥conone | 253653-1 fa 1 swear (affirm), under penalty of perjury as specified by IC 35-44-2-1, thatthe foregoing representa Niger DATED: August 4, 2015_. DEPUTY PROSECUEING ATTORNEY JUDGE NINET! MBICIAL CIRCUIT (Page 19)Affidavit for Probable Cause From: Detective Wayne Shelton LDF | 6/22/2010 _| 7/19/2010 _| Methadose 2315535-1762_| I LF __| 8/20/2010 _| 8/20/2010 __| Methadose 2315685-1762 | I LpF__| 9/20/2010 _| 8/21/2010 _| Xanax 4422538-1762_| IV. Lor | 8/232010 [972010 _| Methadone __[2315707-1762__| ‘The next three indented paragraphs include Dr. Timothy King’s opinion after his review of the 306 pages of medical records from the requested dates of 01/01/2008-12/31/2012 of patient LDF. Review of the medical chart reveals that LDF was under Dr. John Sturman’s pain management care for 18 months, but showed no improvement in pain status, continued to suffer from depression, and ultimately died secondary to “intoxication with multiple pharmaceutical products.” Dr. John Sturman’s escalation of potent opiates in combination with multiple sedative hypnotics did not improve her medical condition, were responsible for multiple behavioral side cffects, and placed LDF at risk for overdose death. Diagnoses of fibromyalgia and degenerative spine disease were made on the first clinical visit. These diagnoses are subjective and are not ultimately established as a legitimate cause of her chronic pain. Repeated observations of “diffuse tendemess” do not qualify as a medically legitimate foundation for establishment of a diagnosis ‘or as a rationale for the use of high dose chronic opiate therapy. A legitimate diagnosis to support the use of opiates is not established. ‘The history and physical exam is diagnostically unhelpful. The patient has ¢ finding of foot drop, but this observation is noncontributory to establishment of a legitimate pain diagnosis, Previous examination by a neurologist, elong with lumbar MRI and EMG, do not support a spinal contribution to her pain. The consultant neurologist indicates that she suffers from “diffuse muscle pain.” Overall, the vague, subjective, and multifaceted interpretation of her pain does not support the use of multiple controlled substances for pain controt. Significant mental health risk factors exist and are major red flags forthe use of chronic opiates, Dr, John Sturman ignores past ‘medical history wher he initiates LDF’s opiate treatment plan. She has # well-documented history of alcohol abuse, consumption of illegal substances (marijuana), bipolar disorder, chronic anxiety, and obsessive-compulsive disorder. Knowing that mental health disorders are often the underlying cause of a chronic pain condition, Dr. John Sturman should not have started a regimen of chronic opiate therapy without first consulting a mental health expert, LDF was under the care of a mental health provider, but Dr. Jobn Sturman did not consult with that practitioner. It is known that opiates contribute to depression, impairment of judgment, and insomnia. As such, they are contraindicated as a primary chronic pain treatment option when accompanied by ‘coexistent mental health conditions. It is outside the standard of care to use opiates without a ‘complete assessment of mental health risk factors. Dr. John Starman fails to perform and incorporate this vitel assessment. Multiple opiate side effects are documented, but Dr. John I pwear(affitm), under penalty of perjury as specified by IC 35-44-2-1, that the foregoing representations are true. DATED: 4,2 —PEUTY F) UTD ApORNEY JUDGE NINETEESITH (AL (Page 20) Ney eyAffidavit for Probable Cause From: Detective Wayne Shelton Sturman docs not identify them as side effects secondary to his opiate treatment regimen, Various chart notes by consultants and practitioners show presence of muscle tremors, memory loss depression, insomnia, and depression of menstrual cycle. These obscrvations are consistent with the use of opiates, but are not acknowledged or acted upon by Dr. John Sturman. Instead, opiates azo escalated over an 18-month timeframe without regard to presence of side effects or absence of clinical improvement. In spite of receiving over 1200 mg morphine equivalent (MEQ) each day, LDF's function does not improve, pain scores do not improve, and she continues to be depressed. LDF receives a huge daily dose of opiate that is associated with a 10 x increase in risk of overdose death, made disproportionately worse with co-prescriptive Xanax ~a further respiratory depressant. Dr. John Sturman is unsafe in his use of medications and dosages, prescribes controlled substances outside the standard of care, and fails to establish a legitimate medical purpose for the use of opiates. Standard of care requires that a legitimate pain diagnosis be established and supported by an objective medical evaluation prior to initiation of chronic opiate therapy. The treatment plan must be multidisciplinary, individualized, and shown to provide clinical improvement. Co-morbid ‘medical and mental health conditions must be documented and incgrporated into the treatment plan. Patient compliance must be monitored, preferably with use of periodic drug testing, In his care of LDF, Dr. John Sturman fails to establish a legitimate diagnosis, fails to incorporate mental health and medical risk factors, fails to adequately monitor patient compliance, and fails to exercise an opiate exit strategy when his opiate-centric treatment plan fails to improve the clinical condition. A prudent practitioner would not initiate or persist in the use of high risk, high dose methadone, oxycodone, and Xanax in a patient who has a history of substance abuse, mental health disability, and medical co-morbidities. Dr. John Sturman prescribes controlled substance medications without a legitimate medical purpose and outside the usual course of medical practice. Patient RGR INSPECT reports showed Dr. John Sturman prescribed 6 prescriptions for controlled substances to it GR from 03/09/2012 — 05/16/2012. Detective Wayne Shelton verified the information located P ‘on the INSPECT report by recovering the actual prescription from the pharmacies where patient RGR had them filled. ‘The following is a chart of the actual prescriptions which included controlled substances issued/written by Dr. John Sturman: Name RGR Date Issued_| Date Filled _[ Drug RX/Preseription#t_| Schedule gy92012 [4/6/2012 | Oxycodone _ | N0928160 1 { swear (affirm), under penalty of perjury as specified by IC 35-44-21, that the foregoing representations are true. DATED: August 4.2015 Se Ngo BEAUTY papseC NG aTTORNeZ TUG L CIRCUIT (Paget)Affidavit for Probable Cause From: Detective Wayne Shelton RGR__| 3/9/2012 _| 5/3/2012 _| Oxycodone __| NO97I816 ul RGR__|3/92012 [3/9/2012 | Oxycodone __| NO963450 i RGR__|3/92012 | 3/92012 | Oxycodone _| 1N0963450 1 RGR__| 5/16/2012 _| 5/31/2012 _| Oxycodone _|'N0975938 o RGR__ | 5/16/2012 | 5/17/2012 | Oxycodone _| NO421885 ‘The next nine indented paragraphs include Dr. Timothy King’s opinion after his review of the 5028 pages ‘of medical records from the requested dates of 01/01/2008-12/31/2012 of patient RGR, Roview of the clinical chart demonstrates a 4-year history of medication noncompliance, early refill requests, stolen medication, and lack of clinical progress. RGR has significant medical and rental health co-morbidities that contraindicate the use of potent opiates forthe treatment of chronie pain, He suffers from PTSD, anxiety, depression, insomnia, cognitive impairment, and traumatic brain injury. His ability to use opiates in a safe and responsible manner is severely diminished because of these diagnoses. He was maintained on moderate doses of oxycodone for 4 years prior to consulting with Dr, John Sturman. Dr. John Sturman rapidly escalated narcotics in spite of documentation that the patient is irresponsible in his behavior, medically compromised ‘with heart and hung disease, and demonstrated no functional improyement with previous opiate tials. Dr. John Sturman violates the standard of care for the use of opiates in the treatment of chronic pain. He prescribes narcotics outside the course of usual medical practice by failing to ‘establish 2 legitimate medical foundation for the use of oxycodone in the treatment of RGR. RGR’s pain management history begins as a result of a 2003 motorcycle injury that resulted in severe head injury, acetabular fracture, and chest injury. Since that time RGR itas complained of chronic daily headaches, neck, back, hip, and generalized muscle pain. He is given a diagnosis of post concussive syndrome with severe headache and cognitive impairment (Bates 21). His caregivers in 2008 recognized that his memory was significantly compromised and his behaviors raised concerns about pain medication abuse (Bates 356). As a result, his opiates were maintained at a modest 5 mg Percocet 3/day. This was an appropriate dose given his compromised mental health status Psychiatry consultation was ordered in 2009 because of concems related to post traumatic stress disorder. RGR declined psychiatric consultation but continued to manifest symptoms of “left sided shaking” and “violent headaches” that were thought to be consistent with a mental health disorder. He was again referred for psychiatric consultation in 2010 (Bates 723), and was formally diagnosed with major depression and PTSD. His Percocet continued to be maintained at modest levels even though he was heavily focused on his pain condition and routinely requested I swear (affirm), under penalty of perjury as specified by IC 35-44-2-1, that the foregoing representations are true. Y atria) lug ES JUDGE (Page 22)Affidavit for Probable Cause From: Detective Wayne Shelton additional pain medication, It was recognized that his medication expectations were “too high” (Bates 609) and that his headaches “were related to underlying psychiatric issues” (Bates 999) RGR continued to demonstrate irresponsible and noncompliant behaviors throughout the time frame of medical care. Multiple examples are documented showing early refill requests for Percocet, Vicodin, and clonazepam. He runs out of Percocet, clonazepam, and “all pain meds” multiple times. Examples of medication and care noncompliance are numerous. He misses or refuses to attend ortiopedie consultations and primary care appointments. Medications are “stolen” on several occasions. He does not take his antidepressant as prescribed. A psychiatric note indicates that he “took 70 Percocet over 2 days” (Bates 872). Additional documentation suggests, “there arc concems about overuse of Percocet” (Bates 2559). All these behaviors indicate that an exclusive opiate treatment regimen forthe treatment of chronic pain is unsafe, dangerous, and medically inappropriate. As a result, his primary care doctor limited opiate consumption, and did not escalate Percocet above 10mg, 4 per day. RGR demonstrates no improvement in function even after long-term opiate therapy. He consumes additional Percocet “because of high anxiety” (Bates 1612), takes more Percocet than prescribed (Bates 1677), fails multiple interventional pain treatments for neck and back pain, and continues to demonstrate a confrontational, rude, and non-cooperative attitude with his medical providers (Bates 2316, 2733). Psychiatric consultation prior to RGR’s first appointment with Dr. John ‘Sturman identifies “marijuana use more often than he’s admitting to” (Bates 3561), and concerns about somatization disorder (Bates 3634). Medical evidence indicates that ROR’s pain condition is affected/defined by his mental health status, use of illegal drugs, and multiple non-compliant behaviors. Long term and high dose opiate therapy is not indicated for RGR's specific pain condition, RGR’s initial consult with Dr. John Sturman is on 1/23/12. RGR complains of “multiple areas of pain’ He indicates he is “not inclined to repeat (pain) injections”, He scores his pain at a maximal level of 10/10. Dr. John Sturman notes that he is “dressed indifferently and not bathed recently”. Clinical testing (SOAP) indicates an increased risk of meditation misuse. In spite of these indicators, along with a well-documented history of medication misuse, mental health issues, and non-compliance, Dr. John Sturman inappropriately initiates an escalating regimen of oxycodone. He discontinues Percocet and prescribes oxycodone 15mg, 5 per day. A targeted diagnosis is not established. A medically useful physical exam is not performed. Opiates are rapidly and inappropriately escelated without establishing a legitimate medical foundation. RGR was taking 40 mg oxycodone per day prior to his first visit with Dr. John Sturman, Dr. John Sturman escalated the oxycodone dose to 75 mg per day. This dose is equivalent to 110 mg | swear (affirm), under penalty of perjury as specified by IC 35-44--1, thatthe foregoing representations are true. DATED: August 4, 2015 wut ge a (Page 23)Affidavit for Probable Cause From: Detective Wayne Shelton ‘morphine equivalent (MEQ), and is associated with a 10x increase in risk of overdose and possible drug related death. It is outside the standard of care to prescribe this dose of medication, particularly in combination with an additional sedative (clonazepam), bocause of the risk of respiratory depression and death. Dr. John Sturman was aware of the co-prescribed clonazepam because it was clearly indicated on the INSPECT report. Use of these co-prescribed medications and doses in a patient with a history of medication misuse and non-compliance is outside the course of usual medical practice. ‘The second appointment with Dr. John Sturman occurs 2 months later. Dr. John Sturman fails to document any clinical improvement with the increased oxycodone, Pain continues to be described as “extreme” (Bates 4713). Physical exam is superficial, non-targeted, and non-diagnostic, Exam does not address the patient’s complaint of “extreme low back pain”. Clinical testing supports “ongoing diagnoses of severe depression, non-restorative sleep, and severe anxiety. A somatic (tissue based) source of pain is not identified. Past medical records and current exam is consistent with somatoform illness, mental illness, and behavioral sources of pain. Opiates are contraindicated in the treatment of pain secondary to mental illness because of alterations in mood, sleep pattem, depression, and cognition. Nevertheless, Dr. John Sturman further escalates oxycodone to a combination of: © oxycodone IR 30mg I tab q4h (6/day) ‘© oxycodone IR 15mg I tab q4h (6/day). t ‘The additional 30mg oxycodone is equivalent to 170mg morphine per day (MEQ), This is an excessive dose for a patient suffering from severe heart disease (low blood pressure, unstable angina), lung disease (multiple admissions for pneumonia, COPD, low oxygen concentration), cognitive deficiency (altered mental status due to medications, traumatic brain injury), and ‘multiple mental health diagnoses (PTSD, depression, anxiety, mood disorder). RGR has a clear history of medication and medical care noncompliance, and it is outside the standard of care to farther escalate oxycodone for treatment of his pain syndrome. His pain condition is not opiate- responsive, RGR fails to show clinical improvement, and has previously failed 4 years of opiate ‘tial. Dr. John Sturman’s prescriptive use of opiates is outside the standard of care. Dr. John Starman prescribes opiates without establishment of a legitimate medical purpose and outside the usual course of medical practice. Patient ZAR The next six indented paragraphs include Dr. Timothy King’s opinion after his review of the 2485 pages of medical records from the requested dates of 01/01/2008-12/3 1/2012 of patient ZAR 1 swear (affirm), under penalty of perury as specified by 1C 35-44-2-1, thatthe foregoing representations are true. FL ee DATED: August 2015 Nfnge—O DEPUTY PROSECUTING ATpERINE? JUDGE NINBTEENTH JUBTCIAL CIRCUIT 4 (Page 24)Affidavit for Probable Cause From: Detective Wayne Shelton ‘The care of this patient represents a classic example of controlled substance misuse in the treatment of chronic pain. ZAR has a childhood history of substance abuse, but Dr. John Sturman ignores this risk factor and institutes a regimen of chronic opiate therapy. ZAR has a history of opiate treatment failure from the Chronic Pain Center in Chicago and from Primary Care at IU Health, but Dr. John Sturman ignores this treatment failure history, and proceeds to experiment with multiple high dose opiates over the next 20 months. ZAR suffers from every side effect commonly associated with opiates, fails to demonstrate pain improvement, suffers from progressive deterioration of function, undergoes multiple hospitalizations, and finally is entered into an outpatient detoxification program that allows for recovery from his iatrogenic induced state of opiate disability A legitimate pain diagnosis is never established. It is assumed that the pain is related to “degenerative disc disease”, but the MRI and physical exam do not support a disabling degenerative spine condition, On the inital visit to Dr. John Sturman, opiates were escalated 3 fold, but a proper diagnosis’ was not established. In spite of having been treated with opiates over ‘the previous yoar, there was no documentation that the pain condition had improved o contributed to an improved quality of life. At one point documentation indicates, “He (ZAR) ‘would like to reduce dosing - he thinks he is on too much medication.” Instead of reducing ‘medication the dose was increased. Significant medication side effects were noted at each office visit. Additionally, email communication between ZAR and Dr. John Sturman further docuntents medication intolerance. ‘The fentanyl patch was supposed to be applied for 3 days, but was replaced every 2 days because of adherence problems and persistent dermatitis. OxyContin caused GI upset, nausea, and stomach invitation, Morphine caused difficulty urinating, stomach problems, and inadequate pain relief. The combination of fentanyl and oxycodone caused excessive sedation, low energy, anhedonia, and depression. Methadone caused sedation and erectile dysfunction. Hydromorphione caused dysphoria without adequate pain relief. All the medications contributed to sedation, depression, insomnia, and low testosterone. These are recognized side effects of opiate therapy and directly contradict the goal of functional improvement. These medications were prescribed in a repetitive manner, at variable morphine equivalencies, and without achieving pain improvement. : ‘The patient underwent multiple instances of drug withdrawel secondary to inappropriate opiate dosing, ZAR progressed fiom being an athlete to needing a eane, requiring crutches, and ultimately becoming wheelchair dependent. All these disabling factors disappeared when ZAR finally underwent detoxification from all opiate and benzodiazepine medication, He regained the ability to ambulate without assistance and was ultimately able to control his pain with non-opiate I swear (affirm), under penalty of perjury as specified by IC 35-44-21, thatthe foregoing representations are tru. DATED: 4, NINEICENTiCnent CRoee— eaeAffidavit for Probable Cause From: Detective Wayne Shelton medication options. The controlled substances previously prescribed by Dr. John Sturman were issued without a legitimate medical purpose and outside the usual course of practice. In summary, a medically legitimate pain source was never established. A proper mental health risk assessment was never performed. Functional goals were never defined, reviewed, or ssessed for treatment efficacy. Medication side effects were treated with repetitive opiates, variable MEQ dosing, and additional poly pharmacy administration for constipation, nausea, depression, insomnia, and sexual dysfunction. A prudent practitioner would have recognized the relationship between worsening pain and function in proportion to increased medication. A prudent practitioner would have exercised an opiate exit strategy before treatment led to emergency 100m visits and hospitalizations. Dr. John Sturman did not issue controlled substances for a legitimate medical purpose, Inconsistent MEQ dosing caused symptoms of intermittent drug withdrawal. Medication side effects were not properly treated. Progressive polypharmacy caused worsening pain management problems, resulting in multiple hospitalizations severe enough to require ICU care and ventilator breathing assistance. ZAR suffered from medical problems caused by inappropriately prescribed medication. Dr. John Sturman did not follow the standard of care for the use of controlled substances in the treatment of chronie pain. Medications were issued outside the usual course of medical practice and without medical foundetion. Patient ZAR was inthe care of Dr. John Starman for chronic pain management between December 16, 2009 and October 2011. Dr. John Sturman prescribed ZAR a variety of controlled substances during the course of treatment, Detective Wayne Shelton interviewed ZAR on April 29, 2014, In that interview, ZAR reported receiving prescriptions fora variety of pain medications from Dr. Joho Sturman, fling and taking those medicines. Detective ‘Wayne Shelton received ZAR's medical records from Indiana University pursuant toa subpoena, Detective Wayne Shelton has obtained a subpoena to obtain copies ofthe actual prescriptions from pharmacies visited by ZAR. Indiana University’s records reflect the following visits/interactions with Dr. John Sturman and the following prescriptions relevant to tis investigation issued and/or written by Dr. Join Sturman: + 12/1612009 — office vist - Fentanyl 75 meg/nour, Norco 10 mg, promethazine, + 1/6/2010 office visit— Fentanyl 50 meg/hour, Morphine 30 mg, promethazine, Noreo 10 mg: + 1/20/2010 office visit —Fentanyl 100 meg/hour; : ‘+ 2/8/2010 ~ email exchange — Oxycodone 15 mg; * 2116/2010— office vsit— Fentanyl 100 megyhour, + 3/29/2010~ chart note-Valium 5 mg; + 41612010 ~ office vist — Fentanyl 100 meg/hour, Valium 5 mg, Oxycodone 15 mg, Fentanyl 25 ma + 427/2010- chart note-Methadone 20 mg; + 519/2010 - office visit Kadian (morphine sulphate) 100 mg, Oxycodone 15 me; | swear (affirm), under penalty of perjury as specified by IC 35-44-2-1, thatthe foregoing representations are tue. LZ she (Page 26)Affidavit for Probable Cause From: Detective Wayne Shelton + 5/21/2010 —email exchange - OxyContin 80 mg; ‘+ 5/23/2010 - office visit Oxycodone 30 mg; ‘+ 6/8/2010 — office visit- Fentanyl 100 mog/hour, Oxycodone 30 mg: ‘+ 11512010 — office visit— Fentanyl 100 meg/hour, hydomorphone 8 mg; + 1/28/2010 ~ office visit — Fentanyl 75 megy/hour, Oxycodone 30 mg; + 8/21/2010 ~ oftice visit — Fentanyl 150 meg/bour, Oxycodone 30 mg: + 10/8/2010 — office visit — wean down Fentanyl from 150 meg/hour to 50 meg/hour over next 20 days, ‘Oxycodone 30 mg, OxyContin 80 mg; ‘+ 11/4/2010 - office visit - Oxycontin 80 mg, Oxycodone 30 mg, Fentanyl 25 meg/hour; ‘+ 12/13/2010-chart note —Featenyl 75 meg/hour; ‘+ 1/6/2011 — office visit- Opana 10 mg, Oxycontin 80 mg, valium 10 mg; + 1/31/2011 ~email exchange ~ methadone 10 mg; + 3/11/2011 ~ office visit— methadone 20 mg, baclofen 10 mg, valium 10 mg; # 3/31/201-chartnote- methadone 10 mg; + 4/26/2011 ~ office visit—Dilaudid 8 mg, Valium 10 mg, zmorphine 60.mg: * 6/8/2011 - office visit - Dilaudid 8 mg, morphine 100 mg, morphine 30 mg; + 8/26/2011- chart note- morphine 100mg, momphine 30 mg; + 912672011 — office visit ~ Exalgo (hydromorphone) 16 mg, Dilaudid 8 mg; + 10/5/2011 ~ office visit OxyContin 80 mg, ‘The State contends thet the Defendant's actions and initiation ofthe scheme to itgelly dispense controlled substances is but one continuous crite eng although is initiation may have begun during atime bered by the statute of imitations, those acts are stil proper facts for inquiry in establishing the nature and intent of the scheme and are properly included in the charging and presentation of evidence. ‘Based on the information above Det, Wayne Shelton has probable cause to believe that Dr. John Sturman has committed the offenses of Reckless Homicide and Unlawful Presciption, all of which occurred in Marion County. | swear (affirm), under penalty of perjury as specified by IC 35-44-2-1, thatthe foregoing representations are true. DATED: August 4.2015 S fg slols Se ATYORNEY JUDGE od (Page27)