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Maui Physician Charged with Unlawful Distribution of Hydrocodone

Paul A. Kaiwi, Jr., 51, a medical doctor and resident of Wailuku, Hawaii, was charged by a criminal complaint unsealed today with six counts of unlawful distribution of the controlled substance hydrocodone. 

As described in the affidavit in support of the criminal complaint, in December 2018, an undercover agent of the Drug Enforcement Administration (“DEA”) sought an appointment with Kaiwi by posing as a new patient seeking prescriptions for opioid medications.  Between December 2018 and May 2019, the undercover agent saw Kaiwi over the course of six patient visits at Kaiwi’s medical practice, Progressive Medical, located in Kahului, Hawaii on Maui.  Kaiwi also operates a Progressive Medical office in Hilo, Hawaii. 

During the patient visits with the undercover agent, Kaiwi conducted little or no medical history or physical examination, and often provided a prescription within minutes of entering the examination room.  In each of the six visits, Kaiwi provided the undercover agent a prescription for between 84 and 90 pills of hydrocodone.  Hydrocodone is a moderately potent, orally available opioid that, in combination with acetaminophen, is widely used for treatment of acute or chronic pain

Medical experts conducted a review of the undercover agent’s patient medical records created by Kaiwi and maintained by Progressive Medical.  That review showed not only that the information in the medical records was inadequate to justify the hydrocodone prescriptions, but also that the medical records contained false and fabricated information regarding the patient visits.  For example, while medical records indicate that Kaiwi performed a musculoskeletal examination during six of the undercover agent’s patient visits, video footage reveals no examination at all during four of the visits and only a partial examination during two visits.

Law enforcement analysis of Kaiwi’s prescription data from approximately 2015 through 2020 revealed that 88% of his patients who received prescriptions for controlled substances obtained an opioid prescription, and that Kaiwi frequently prescribed opioids in conjunction with other medications, such as benzodiazepines and muscle relaxers, all of which are controlled substances often sought by illicit drug users and such combinations increase a patient’s risk of overdose.  DEA analysis of State of Hawaii prescription data for prescriptions written by Kaiwi reveal that 277 of his patients received prescriptions with an aggregate MME (morphine milligram equivalents) of twice the upper limit recommended by the Centers for Disease Control (CDC).  DEA analysis also revealed that 66 of those patients received prescriptions with aggregate MME per day of five times the upper limit recommended by the CDC.

“Today’s charges reflect our ongoing commitment to hold doctors who unlawfully prescribe controlled substances accountable for their misconduct,” said U.S. Attorney Kenji M. Price.  “As many Americans struggle to free themselves from the bondage of opioid addiction, the federal law enforcement community will do its part to hold those who unlawfully feed the addiction accountable for their criminal conduct.”

The charges include six counts of unlawful distribution of a schedule II controlled substance, for which each count carries a maximum statutory penalty of 20 years and a fine of not more than $1,000,000.

A criminal complaint is merely an accusation, and the defendant is presumed innocent unless proven guilty.

This case is being investigated by the Drug Enforcement Administration and the Department of Health and Human Services – Office of the Inspector General.  It is being prosecuted by Assistant U.S. Attorneys Michael F. Albanese and Mohammad Khatib.

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