As California's top prescriber of narcotic painkillers and other commonly abused drugs, Dr. Nazar Al Bussam made hundreds of thousands of dollars feeding the addictions of strung-out patients who packed into his offices in Downey and Los Angeles, according to authorities.

Federal prosecutors concluded it was "pure luck" that his reckless prescribing had not resulted in any known deaths.

A Los Angeles Times review of coroners' records, however, reveals that at least three of the doctor's patients died of drug overdoses in 2007 and 2008. Two other people died — one from an overdose, the other by falling off a cliff — with drugs in their systems and pill bottles bearing Al Bussam's name in their possession.

Photos: Five who died

A judge is expected to sentence Al Bussam on Wednesday. Prosecutors have asked for nearly 20 years in prison for the 71-year-old physician, arguing that his conduct was worse than that of a street corner drug dealer.

"Unlike a street dealer, defendant well understood the effects of the poison he peddled," wrote Assistant U.S. Attys. Ariel A. Neuman and Benjamin R. Barron.

Al Bussam, who graduated from the University of Baghdad College of Medicine in 1963 and began practicing in California more than three decades ago, is the latest in a string of Southern California physicians accused of violating their oaths by dealing drugs. The charges come amid a prescription drug epidemic that recently pushed drugs ahead of traffic accidents as a cause of death nationwide.

Al Bussam was arrested last October after a three-year investigation by the Drug Enforcement Administration. He was accused of operating a so-called pill mill in which he wrote prescriptions in exchange for cash, regardless of a patient's true need for the drugs.

He collected $3,000 to $3,500 in cash payments on an average day at his office in Downey, prosecutors say. Over a two-year period, he deposited $1.8 million in cash into multiple bank accounts.

He prescribed to at least three suspected drug dealers, and drugs prescribed by him have been seized by law enforcement officials as far away as Texas, according to court and coroner records.

In secretly recorded conversations with DEA agents posing as patients, Al Bussam can be heard coaching them to make up reasons for why they need medications and ignoring obvious red flags such as a "patient" admitting he was taking painkillers for recreational purposes.

Four of the five deaths identified by The Times occurred after the DEA's inquiry into Al Bussam began.

Al Bussam, who lives in a $1.3-million home in a gated community in the hills above Newport Beach, refused to meet with reporters Friday evening. "He said he's too busy," a security guard said. "He told me to make you go away."

Al Bussam's lawyer, Benjamin N. Gluck, said Tuesday that neither he nor the doctor had been informed by investigators of any patient deaths connected to Al Bussam's practice. Coroner records show that investigators contacted the doctor's office and obtained medical records for two of the deaths identified by The Times.

Gluck said the doctor had reported to police that some of his prescription pads had been stolen and that some prescriptions had been falsely attributed to him in the past. The lawyer suggested these factors could result in his being falsely linked to a person's death.

The federal case against Al Bussam was based in part on information provided by Ricardo Moran, who was a medical assistant in the doctor's office for seven years and began cooperating with the government to avoid prosecution. In a sworn declaration, Moran said he noticed a change in the doctor's patient base around mid-2008. The vast majority paid in cash and were there to get refills of painkiller prescriptions, Moran said.

"They were dirty and unkempt in a way I now believe may have indicated they were drug addicts," Moran said.

A medical expert who reviewed some of Al Bussam's patient files for prosecutors said the doctor prescribed drugs in such quantities and combinations that they were at times potentially lethal even if taken as directed. Moran said that pharmacies would call several times a week complaining about Al Bussam's prescriptions but that Al Bussam would brush the complaints aside.

Al Bussam entered a conditional guilty plea to federal drug-trafficking charges in July after a judge barred a defense expert from testifying that it was technically legal for Al Bussam to prescribe to addicts the very drugs they were abusing, so long as it was being done to mitigate pain, even the pain of withdrawal. Once he is sentenced, Al Bussam may appeal the judge's ruling, and if he prevails, his guilty plea can be withdrawn.