Valley Doctor in Drug Case Fights for License

The night his girlfriend died in his bed of a massive cocaine overdose, Dr. Stan Azen’s long affair with drugs finally capsized his life.

The veteran emergency-room physician later was arrested and convicted of possessing cocaine. His $400,000 house was seized under federal anti-drug laws. And he admitted in a public hearing that he was an addict who had abused drugs for 20 years.

Yet Azen managed to cling to his career. He swore off cocaine, enrolled at the Betty Ford Center and passed numerous random drug tests. Meanwhile, he worked at two San Fernando Valley hospitals that serve many low-income people, earning high praise from colleagues.

“He is definitely one of the best ER physicians I have ever known. . . . He is a kind, compassionate physician in the best sense,” said Dr. Jonathan Serebrin, emergency-room chief at the Medical Center of North Hollywood, where Azen worked for nine years.

But late last month, nearly four years after his girlfriend’s death, the state Medical Board opened trial-like hearings that could cost Azen, 42, his license to practice. The board charges, among other things, that Azen gave his girlfriend cocaine the night she died, that he was under the influence of drugs and alcohol when he tried to resuscitate her and that he continued to buy, sell and use drugs after her death.

Azen denies the allegations. And in an unusual twist, he is drawing vocal support from other doctors who believe he is clean and sober and should be allowed to continue caring for low-income and minority patients in the east San Fernando Valley.

“It seems inappropriate to remove a . . . board-certified, American-trained physician from a population that rarely has access to such quality of care and competence,” said Dr. Val Warhaft, who heads the emergency department at Pacifica Hospital of the Valley, a Sun Valley facility that cares for many poor Latinos and where Azen worked until recently.

Azen’s case poses a dilemma for the medical board, which must decide how severely to punish an admitted onetime drug abuser who also is seen as a talented physician dedicated to helping a clientele often under-served by medical professionals. The board can revoke Azen’s license, suspend it or place him on probation.

Azen says he has not touched drugs in three years and no longer has any desire for them. He insists his years of drug abuse never affected patients. And he is angry that the medical board chose to take disciplinary action against him, rather than place him in a diversion program.

“I never had a malpractice suit. I never had an accusation of drug use at work,” he said in an interview. “They had people in diversion that were drunk during operations. There was one doctor who left a twin in (during delivery) while using Demerol. There were people shooting up in their office and seeing patients while impaired. I was convicted of one count of using cocaine at my house.”

Since his girlfriend’s 1990 death, Azen has been buried beneath an avalanche of legal and personal problems.

His former Westside home and Jeep Cherokee were seized under federal asset forfeiture laws, although the Jeep was later returned.

In March, the U.S. Drug Enforcement Administration revoked his certificate of registration, a crucial permit for emergency-room physicians to prescribe pain-killing narcotics like codeine.

The DEA said in a written decision that it was “inconsistent with the public interest” to let Azen keep his certificate in light of his lengthy history of drug abuse, including his admitted use of cocaine with his girlfriend on the night she died.

The revocation cost Azen his job at Pacifica Hospital, which he had held since September, 1991. Before that, his arrest and ensuing legal difficulties cost him jobs at the Medical Center of North Hollywood and at Westside Hospital.

In hearings last year that led to loss of his DEA license, Azen, who now lives in Sherman Oaks, testified that he began experimenting with marijuana and cocaine in the 1970s and became “a regular cocaine user” in the 1980s.

A graduate of Loma Linda University medical school, Azen was hired in 1982 in the emergency room at the Medical Center of North Hollywood, where he quickly learned to cope with waves of shootings, stabbings and car-crash victims.

By 1987, he was working up to 90 hours a week, collecting $240,000 a year. And there was a romantic bonus: At the hospital he had met a quiet, young auditor, Donna Lynn Miller, who soon moved in with him.

But with a fat paycheck and a high-stress job, Azen also had developed a serious cocaine habit, according to his DEA testimony.

Sometimes he snorted it. Sometimes he sprinkled it on marijuana cigarettes and smoked it, a combination known in drug circles as “coco puffs.”

As his cocaine intake escalated, he tried to ration himself, methodically weighing out half-gram doses on a scale at his home.

“As my habit got worse, I didn’t want to, in quotes, abuse it, in my mind, and therefore I would weigh out certain amounts to use on a daily basis,” he testified.

Azen denied using drugs on the job. But a longtime friend told state investigators the physician had a “high tolerance” for cocaine and used it to stay awake during his long hours at work.

After Miller moved in, Azen’s house became a constant gathering spot for several of their friends, who often barbecued, played volleyball and used drugs together “for days on end,” Azen said.

“We were kind of like a little family together,” he testified, adding that he supplied some of the cocaine for group parties.

Then came the night of Sept. 20, 1990.

Azen said he came home from work, ate dinner with Miller and watched TV. The couple snorted cocaine, smoked marijuana and had a couple of drinks apiece. Then they made love and went to sleep.

Azen told police Miller later got up and went to the bathroom. When she returned to bed, however, something was wrong. She had two seizures and lost consciousness.

Azen said he performed cardiopulmonary resuscitation on Miller, but she did not respond. He later dialed 911. By the time paramedics arrived, just after 3 a.m., Miller, then 28, was dead.

A pathologist estimated that she had 20 times a fatal dose of cocaine in her system.

In an interview, Azen described Miller as an addict and alcoholic who had “a death wish” and had once tried to kill herself. At the time of her death, he said, she was attending a Westside community college and drinking heavily.

“She had no self-esteem. She wasn’t working,” he said. “She was obviously a very diseased person.”

Azen said although he and Miller had used cocaine together in the past, he did not supply her drugs on the night she died. She had her “own sources,” he said, and also possessed a key to a wall safe where he stored cocaine.

No criminal charges were filed against Azen in connection with Miller’s death. But in April, 1991, he was arrested for allegedly selling cocaine to Miller’s sister, who had been asked by police to try to buy drugs from Azen. Police said they searched his home and turned up 61 grams of cocaine, scales and packaging materials.

A judge, however, said later the bust was questionable because police had not thoroughly searched the sister to make sure she was not carrying drugs before she entered Azen’s house.

In a plea bargain that got him off the hook on a more serious charge of possessing cocaine for sale, Azen was convicted of one count of simple possession of cocaine and sentenced to six months in jail. He served only two days before being placed in a work furlough program.

Shaken by Miller’s death and the crush of problems that ensued, Azen said he decided to stop using drugs. He enrolled in a Los Angeles outpatient clinic of the Betty Ford Center, a renowned Rancho Mirage substance-abuse treatment facility. Also, as part of the plea bargain, he was placed on probation for three years, requiring him to submit to random drug tests.

Azen said he has repeatedly passed the tests since his arrest. He offered to let the medical board take his license away without a legal fight if he ever tested positive for drugs again in his life.

A county probation officer testified at the DEA hearing that between December, 1991, and December, 1992, Azen passed 22 random drug tests. Azen said he has passed more probation tests since, as well as tests ordered by Betty Ford counselors.

But state officials argue that the issue is not whether Azen is drug-free now, but whether he broke drug laws and committed serious errors in medical judgment in the past.

Deputy state Atty. Gen. Robert McKim Bell, who is prosecuting Azen, said he was negligent in not seeking help for his addiction and for continuing to treat patients while addicted.

He said Azen broke the law by providing drugs to Miller and others. And by giving cocaine to Miller, who had a history of seizures, Azen risked her health because the drug has seizure-inducing properties, Bell said.

“His girlfriend had misused drugs to the point where her nose had been partially eaten away, and to have allowed her to continue to worsen her situation, contrary to medical advice she had received from her plastic surgeon, seemed to us antithetical to the general objectives of good medicine,” Bell said.

Bell also charged that Azen performed CPR on Miller while impaired by drugs and alcohol, and waited 30 minutes after she stopped breathing before dialing 911 for paramedic assistance.

“It’s important to determine whether Dr. Azen is a risk to the client population he serves, and it’s also important to deter other physicians from getting engaged in similar misconduct,” Bell said.

Azen said he had eaten dinner and slept for a while before Miller’s seizure, and was sober. He said he did not call 911 because the telephone was in the kitchen, several rooms away. Running to it would have meant stopping CPR, which is not supposed to be interrupted once begun, he said.

Only days before the medical board hearings opened, Azen lost his third job since his arrest when he was terminated at Pacifica Hospital for not having a DEA license.

Although the DEA revoked his permit March 3, he continued to practice at the hospital without it until May 15. Azen said patient care was not compromised because he still could get narcotic medications from the hospital pharmacy, which has its own DEA certificate.

Azen said not having the permit slowed him down on the job but did not cripple him. But in an appeal to the U.S. Supreme Court, his lawyer wrote that Azen would be “unable to work as an emergency room physician” without the permit.

Pacifica Executive Director Ermanno Mariani said Azen was dismissed because he could not function properly in the emergency room without his drug license. But he added that Azen was a good doctor he would gladly take back if his legal problems are resolved--a sentiment repeated by others with whom Azen has worked at the hospital.

Located across from the railroad tracks in a dusty, mostly Latino neighborhood, Pacifica is a small community hospital best known as the place Rodney King was treated after he was beaten by police three years ago.

The neighborhood is a poor one, and Pacifica’s busy ER could double as the set for “St. Elsewhere.” More than 1,400 sick people are seen there each month, many of them uninsured or on Medi-Cal. The clientele includes a hefty share of squalling babies as well as gang members with bullet or knife wounds.

Unlike their colleagues who practice in more leisurely surroundings, ER doctors describe what they do as “gut medicine”--making snap decisions in life-or-death situations. And among Pacifica’s ER physicians, Azen is known as a gut-medicine star.

“I’ve heard other doctors call him a doctor’s doctor,” said Warhaft, Azen’s former boss, as he sat in a tiny doctor’s lounge just off the emergency room.

“He’s probably one of the 10 or 20 best clinicians in the country,” said Dr. Rick Key, another ER physician who sprawled on a nearby cot, lunching on takeout.

Key and Warhaft told several stories about how Azen’s incisive diagnosis and creative treatment saved lives.

Key, who has known Azen for 10 years, recalled one incident in which a man overdosed on digitalis, a heart stimulant. The man’s heart was beating in a rapid, uncoordinated way, a potentially lethal condition.

Azen tried the standard treatment, electroshock paddles, but the man’s heart kept convulsing wildly. Switching strategy, Azen injected the man with a big dose of potassium, stopping the heart. Then, using a pacemaker, Azen restarted it, and its beat returned to normal.

“That’s as brilliant as you’ll ever see in medicine, to do that on the spot,” Key said.

Key and Warhaft said they never saw Azen impaired at work and would love to see him return. The medical board action against him, they said, doesn’t make sense.

“The government is spending bread in the six figures to, if they succeed, remove a very good doctor from doing good work in a charity area,” Key said.

“Stan liked working in a third world hospital and doing things for people who otherwise would never have the chance. That’s the bottom line with Stan. He’s a really nice guy. That’s what makes this even worse.”