DANNY GANS REPORT RAISES QUESTIONS FROM PAIN SPECIALISTS

The explanation for what killed Danny Gans raises more questions than it answers, medical experts said Wednesday, opening the door to speculation about the entertainer with a squeaky-clean image.

Clark County Coroner Mike Murphy announced Tuesday that Gans died because of toxic levels of hydromorphone — best known as Dilaudid — in conjunction with other medical conditions. Murphy termed it an accidental death with no indication of drug abuse.

But the lack of details by the coroner is allowing questions of drug abuse to be raised. And four independent medical experts interviewed by the Sun question the coronerÕs explanation of GansÕ death, which could be verified if the family authorizes the release of additional information.

ÒThere are too many gaps in the informationÓ to support the coronerÕs explanation, said Dr. Jim Marx, a Las Vegas pain specialist. ÒThe bottom line is: The guy died of an overdose.Ó

Dr. Andrea Trescot, a Seattle pain specialist who has written national guidelines on prescription narcotics, said hydromorphone toxicity means the drug was either prescribed incorrectly or not properly taken.

ÒEither he took more than was prescribed, in which case itÕs an accidental overdose, or it was prescribed in an inappropriate dose, and that makes it potential malpractice,Ó Trescot said.

Addiction specialist Dr. Mel Pohl said he does not understand how Gans could have suddenly died if the drugs were prescribed responsibly and taken as the doctor ordered. The coroner said Gans suffered from chronic pain syndrome.

ÒThe key thing is: How come it happened that night?Ó Pohl said. ÒYouÕve got to figure he took more than he usually takes to cause this reaction.Ó

The 52-year-old impressionist, who headlined at the Encore, was an

evangelical Christian who held prayer meetings before shows. He died in his sleep early in the morning of MayÊ1 at his Henderson home, after his wife called paramedics saying he was having trouble breathing.

GansÕ death is the highest-profile example yet of a growing problem in Clark County — deaths in which prescription painkillers are a contributing factor.

A Sun analysis in 2008 showed that more deaths in Las Vegas were associated with prescription drugs — at least 258 in 2007 — than street drugs or automobile crashes. The rate of fatal prescription drug overdoses more than doubled between 1998 and 2007.

GansÕ family is not making further inquiries about the cause of his death — even though it knows neither the levels of Dilaudid found in GansÕ blood nor whether he was legally prescribed the drug, said Chip Lightman, the entertainerÕs manager and representative of the family.

ÒThey are at peace to go with what the coroner told them,Ó Lightman said.

Lightman said in a separate interview with the Associated Press that he is haunted by the question: ÒWho gave him that prescription?Ó

The family can learn who prescribed Gans the drug through the Nevada Board of PharmacyÕs prescription drug database. It tracks every prescription for narcotics written in the state by doctor and patient name.

Publicly releasing that information and other details, including the amount of the drug in his blood, could answer lingering questions about the celebrityÕs death and, if necessary, bring accountability to the doctor who prescribed the medication.

The coroner, who is bound by patient-privacy considerations, would not say whether Gans was prescribed the highly potent medication and, if so, how much; the amount of the drug that was in his system; or whether any other drugs or alcohol were in his system.

ÒWe have an issue involving Mr. GansÕ health and the hydromorphone, and as a result of the combination of those issues, Gans succumbed,Ó Murphy said in his news conference.

A 2008 Sun analysis of Drug Enforcement Administration data found that Nevadans ranked seventh nationally for per-capita use of hydromorphone in 2006, the latest year statistics are available. (For that same year, Nevada ranked first and fourth nationally for per-capita use of hydrocodone, better known as Vicodin and Lortab, and oxycodone, best known as OxyContin.)

Hydromorphone is at least three times more potent, milligram for milligram, than morphine, experts said. ItÕs rarely prescribed — an average of 4.47 milligrams was consumed per Nevadan in 2006 — compared with hydrocodone, which was consumed at an average of 242.6 milligrams per Nevadan, according to government data.

Hydromorphone is not commonly prescribed, doctors said, not only because it is extremely potent but because itÕs short-acting, lasting only a few hours.

Marx, the pain specialist, said he canÕt remember the last time he wrote a prescription for hydromorphone, but that doesnÕt mean itÕs inappropriate. Any drug thatÕs not used properly can have unintentional consequences, he said.

Usually, other factors — such as alcohol, or the anxiety remedies Xanax and Valium — are involved in deaths involving prescription narcotics, Marx said. He said heÕs skeptical that the single drug caused Gans to stop breathing.

ÒItÕs not like he took an extra pill and stopped breathing, particularly if he took them in the past,Ó Marx said.

The coroner said the effect of the drug was magnified by GansÕ hypertensive heart disease and a condition called polycythemia, which thickens the blood, decreasing the amount of oxygen flowing to the body.

Marx said he would label the death an overdose because it sounds like it was the drug that caused him to stop breathing.

Las Vegas pain specialist Dr. Michael McKenna said the take-away message should be that such drugs should be taken with caution, according to doctorsÕ orders. McKenna said there seems more to the story than the coronerÕs explanation.

ÒGiven no other changes in his medical condition and that he was taking the same dose he normally took itÕs unlikely that the medication would cause him to die,Ó McKenna said. ÒUnder excellent medical care, with excellent monitoring and compliance by the patient, this type of thing should not happen.Ó

The answer to whether Gans took too much Dilaudid would be found in the amount of the drug in his blood, and thatÕs not publicly known, McKenna said. And knowing the dosage he was taking would answer whether the drugs were properly prescribed, he said.

ÒThere may be a combination of things that led to this unfortunate outcome,Ó McKenna said. ÒBut without the details we canÕt state whether his care was appropriate or inappropriate.Ó

Sun reporter Alex Richards contributed to this story.

Marshall Allen canbe reached at 259-2330or at [e-mail].