Federal prosecutors concluded it was "pure luck" that his reckless prescribing had not resulted in any known deaths.
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.
As part of the plea, Al Bussam has agreed to forfeit more than $450,000 in "proceeds derived from his illegal activity."
As early as 2007, Al Bussam was identified as one of the top prescribers of painkillers and other abused drugs in the L.A. area. A subsequent search of a state database at the request of authorities investigating the doctor revealed that he was the No.1 prescriber of such addictive medications in the entire state over a three-year period beginning in January 2008.
Another top prescriber, Dr. Masoud Bamdad, was sentenced last year to 25 years in prison.
The deaths reviewed by The Times involved people ranging in age from 30 to 49. They were known by friends or loved ones to have abused prescription drugs, illegal narcotics or both. Several had previous drug overdoses or drug-related arrests.
It's unclear why authorities did not discover the patient deaths as part of their investigation. When asked about the deaths, prosecutors declined to comment.
Debbie Evert, whose brother, Gregory Barcus, died of an overdose in his Orange apartment after being prescribed a painkiller and a muscle relaxant by Al Bussam in 2008, said it would have been obvious to anyone that he was an addict.
She said neighbors would routinely find him so drugged up, "he couldn't walk or talk.... He was just a mess."
Ryan Thompson, 30, died on the doorstep of his younger sisters' Costa Mesa home a day after being prescribed methadone pills by Al Bussam, records show. His sisters cared for him while he suffered through a withdrawal, throwing up so often his vomit was streaked with blood. He wanted to kick his methadone habit and had been sober for weeks when he got his last prescription, family members say. Al Bussam wrote him a prescription for 100 methadone pills to be taken three at time three times daily, records show.
Thompson's sister Hailey said he came home obviously high that evening. Upset and saddened by his relapse, she told him they would discuss it in the morning.
When Hailey found her brother sitting cross-legged outside her front door, a friend began CPR, but it was too late. Toxicology tests later revealed methadone, as well as morphine and oxycodone, in his body. The coroner ruled his death an accidental overdose.
Thompson's mother, Niki, said a coroner's investigator told her that if her son had resumed taking methadone at the amount he was used to before kicking the habit, it could have killed him.
"If you know someone is an addict, why in the world would you hand them a bottle of pills and say, 'Here, take three at a time,'" Niki said.
Gluck, Al Bussam's attorney, said he did not believe that Thompson was a patient of his client. Coroner records list Al Bussam as his doctor and show that Al Bussam's office provided medical records to an investigator.
Others who, according to coroner records, died after being prescribed drugs by Al Bussam or while in possession of drugs he prescribed are:
• Christopher Vargas, 47, who overdosed in his Echo Park apartment in May 2007 on a cocktail of prescription drugs, including a commonly abused muscle relaxant sold under the brand name Soma, which had been prescribed by Al Bussam 26 days earlier, according to coroner's records. Vargas had multiple drug-related arrests, the records state.
• Terry Ridgeway, 42, who family members said had been a crack cocaine abuser but had been clean for seven years before developing a prescription drug habit. He was found dead on the kitchen floor of his Santa Monica apartment in December 2008. A pill bottle containing an anti-anxiety drug prescribed by Al Bussam was found in his bedroom. That drug was one of three that caused his death, coroner's records show. The vial bearing Al Bussam's name had a partially torn label, which law enforcement officials say is a sign of illegally traded drugs. Gluck said he did not believe that Ridgeway was a patient of Al Bussam.
• Lisa Vanzandt, 49, who was an aspiring nurse and primary caretaker of her elderly mother, according to coroner's records. Vanzandt had several medical problems, including back pain, her mother said. She was fond of walking along the cliffs of the Palos Verdes Peninsula near where she grew up in Redondo Beach. A friend told coroner's investigators that the family lost their home and that Vanzandt had always dreamed of moving back. The friend said Vanzandt had a prescription drug problem and speculated that she fell off the cliff while intoxicated. Prescription bottles bearing Al Bussam's name were found in Vanzandt's purse. The same drugs as he prescribed — a painkiller and anti-anxiety medication — were among a cocktail of drugs found in her body, coroner's records show. The labels on both bottles were torn. The death was ruled an accident.
Photos: Dr. Nazar Al Bussam