3 Doctors Cited in Taylor Drug Case : Medicine: The physicians receive reprimands for prescribing excessive medication to treat the actress’s pain. Their attorneys say the decision is an exoneration.

Three prominent Los Angeles physicians have been reprimanded by the Medical Board of California for falsifying patient records to cover up the massive amounts of addictive drugs they prescribed to actress Elizabeth Taylor.

The actions, yet to be publicly released, bring to a close the accusations filed against the doctors in 1990 by the attorney general’s office, alleging that the physicians prescribed excessive doses of painkillers to Taylor during the 1980s.

But even as the matter was brought to a close by the medical board, the settlement reignited a long-simmering controversy over the state’s disciplinary system for doctors.

Attorneys for the doctors said the reprimand amounted to an exoneration of three dedicated physicians who were trying to control Taylor’s pain and kept inaccurate medical records only to protect the actress from the prying eyes of reporters for tabloids such as the National Enquirer.

Harland Braun, attorney for Dr. Michael S. Gottlieb, said: “This letter (of reprimand) says nothing. It’s an administrative fig leaf covering the board’s private parts. . . . It ought to be labeled a letter of apology.”

A public interest watchdog group in San Diego questioned whether the reprimand, which is intended for minor infractions, was an appropriate sanction.

Medical board officials said the action was appropriate and avoided the “circus” atmosphere of formal proceedings.

Initially, medical board officials had pressed to suspend or revoke the doctors’ licenses. They had rejected as too lenient an offer by the doctors to go on probation and perform community service. Then, executive director Dixon Arnett decided last month to mete out the mildest punishment possible.

The decision comes as the U.S. Drug Enforcement Administration has initiated legal action to determine whether to revoke the authority of two of the doctors to handle controlled substances. The DEA action against Gottlieb has been dropped.

Gottlieb, of Sherman Oaks, is the immunologist who reported the first AIDS case in the United States. The case also involves his former partner, Dr. Michael J. Roth, and Dr. William F. Skinner, who served until recently as the director of the chemical dependency unit at St. John’s Hospital and Health Center in Santa Monica.

“These are three doctors that have a tremendous reputation in the community and a great background,” said Donald Goldman, Skinner’s attorney.

In addition to her doctor-patient relationship, Taylor shared with Roth and Gottlieb a dedication to the AIDS movement. The actress was not identified in the reprimand or the accusation, but her name was revealed during legal discovery.

Her case was brought to the Los Angeles County district attorney’s office in the late 1980s by officials of a detoxification center where she sought treatment. After an 18-month inquiry, the district attorney declined to press criminal charges but issued a report in April, 1990, stating that “the prescribing practices of these physicians fell below the accepted standard of medical practice.”

Several months later, the attorney general’s office filed a formal accusation charging that the doctors had written Taylor more than 1,000 prescriptions during a five-year period dating back to 1983 for 28 controlled substances, including sleeping pills, painkillers and tranquilizers.

The charges, totaling about 80 pages, include an exhaustive list of drugs prescribed in various combinations, both by tablet and by self-injection. Deputy Atty. Gen. Earl Plowman, who supervised the drafting of the complaint, recalled that when a medical expert first looked at the case, he assumed that the patient must be dead because “the dosages were incompatible with life.”

Plowman recalled: “This was a rather systematic effort by the doctors to keep a patient supplied with drugs. . . . It was a classic case of abuse involving multiple prescriptions, multiple controlled substances at different pharmacies at the same time.”

Taylor, who has undergone several spinal surgeries, has a history of back, neck and leg pain. Her publicist in New York said she was unavailable for comment.

Attorneys said drug dosages that would be excessive for most people were appropriate to combat Taylor’s discomfort and allow her to function.

“Liz Taylor is a different patient, with intractable, long-term, untreatable pain,” Braun said. “She has no life without painkillers.” He added that the doctors did not accurately record the drugs she was given “to protect her from ending up in the National Enquirer.”

Goldman concurred: “You see what comes out in the tabloid press these days and you can see very clearly why they (the doctors) did it.”

By all accounts, this case has taken an inordinately long time to resolve.

The conclusion comes as the board, long criticized for slow and lenient discipline of doctors, is struggling to recover from a 1993 scandal that erupted after disclosures that officials had closed, and shredded, complaints without proper investigation.

Since then, the Legislature has given the board additional tools to discipline doctors, including the ability to cite and fine them and to issue reprimands instead of pressing charges for minor infractions.

In the case of Taylor’s doctors, Julianne D’Angelo, at the Center for Public Interest Law at the University of San Diego, questioned the fundamental legitimacy of the letter of reprimand. She said the board has not yet passed regulations setting forth the criteria for issuing the reprimands. Furthermore, she said, unless the offense is “a minor unprofessional-conduct violation,” a reprimand is an inappropriate sanction.

Without commenting on the final action, Deputy Atty. Gen. Plowman, said: “I certainly wouldn’t have called these charges minor.”

Arnett, the medical board’s executive director, defended the reprimands as appropriate and legally sound. He said the doctors agreed to accept the reprimands as part of the settlement, which is permissible despite the lack of published regulations.

He said the reprimand was appropriate, given the difficulty of prevailing in court as well as his desire to avoid the atmosphere of high-profile proceedings. “We decided a stipulation was better than a circus,” Arnett said.

The reprimands will have virtually no effect on the doctors’ practices. The letters do not have to be posted in their offices and will not be entered into a national database that tracks disciplinary action against doctors. Attorneys said the reprimands will not jeopardize the doctors’ standing with insurance carriers or their privileges at hospitals.

Deputy Atty. Gen. Richard Marino, however, insisted that the reprimands did not exonerate the doctors. He said that “because there is some concern about the amounts of drugs and why they were prescribed in this case, Roth and Skinner will have to pass oral clinical examinations in addiction medicine before his office will retract the accusation filed in 1990. Marino said that charges against Gottlieb have been withdrawn with no requirement for an exam.

Marino, who recommended that the medical board issue reprimands rather than press action in court this fall, said he decided this was the best course after listening to evidence presented by the doctors at a DEA administrative hearing.

The DEA ordered the doctors to show cause at a hearing this spring on why their certificates of registration to handle controlled substances should not be revoked because of their “excessive” prescription of several drugs including Demerol, Valium, Percocet and methadone “without a legitimate medical purpose.”

The DEA has accused Skinner of improperly administering excessive drugs to Taylor from April, 1987, through November, 1988. The accusations against Roth pertain to the period from March, 1988, through December, 1989. Roth also is accused of prescribing excessive drugs to two other unidentified patients from January, 1991, through February, 1993.

An attorney for the DEA, Wayne Patrick, had no comment on the case.

The attorneys for the three doctors said they made a convincing argument at the DEA hearing that the doctors had properly prescribed medication for their patient, Taylor, who had an extremely high tolerance for drugs and very low threshold of pain.

“This is a complicated case,” said Bruce Kelton, the attorney for Roth. “A lot of experts testified. This is something that is not black and white. There’s a debate on both sides about how pain should be controlled through medication.”