A Henderson physician who says he treated Danny Gans for pain told the Review-Journal on Thursday that the first and last time he wrote Gans a prescription for hydromorphone -- the potent drug determined by the coroner to be the cause of the popular entertainer's accidental death -- was about five years ago.
Dr. Michael Fishell, who said he last examined Gans in March, added that "there was no recorded evidence" that Gans had a current prescription for oral tablets of hydromorphone, or Dilaudid, in Nevada or California.
He said a search of medical documents leads him to believe that none of Gans' other personal physicians in either state had recently prescribed Dilaudid or any other narcotic to Gans.
"I can get information through the (Nevada State) Board of Pharmacy, and there's just no evidence that he had a prescription for that (Dilaudid) or any other narcotic," Fishell said. "And as a personal friend of Danny and Julie (Gans' wife), I know he wasn't the type to get medication without a prescription."
Larry Pinson, executive secretary for the Pharmacy Board, said Thursday that physicians have access to a drug dispensation database through the board's Nevada Prescription Controlled Substance Abuse Prevention Task Force. The database covers the past three years.
Sitting in his Advanced Pain Care office on Seven Hills Drive, Fishell speculated that on the night Gans died, he might have taken medication left over from a prescription he wrote for Gans' pain in 2004 or 2005.
"But I have no way of knowing that," he said.
Fishell, whose specialty is anesthesiology and pain management, said he decided to speak with the Review-Journal because he is disturbed by rumors that suggest his friend was a drug abuser.
"Nothing could be further from the truth," said Fishell, who stressed that he saw Gans only a few times over the past eight years. During that time he either gave the impressionist injections for pain in his shoulder or topical creams for pain.
Fishell said that during a March examination of Gans' sore shoulder, he asked the 52-year-old whether he wanted pain medication. He said Gans declined because the drugs were of no help to the chronic pain condition brought on by sports injuries.
After he prescribed the Dilaudid, Fishell said, Gans told him he stopped taking the drug because it didn't ease the pain and dried out his voice.
Fishell said it is conceivable that Gans, who died May 1 in his Henderson home, could have started "really suffering" from pain in his shoulder and found the leftover medication from the old prescription "in the back of the medicine cabinet" and taken some of it.
The pill strength he had prescribed, Fishell recalled, was either 2 or 4 milligrams, which the Food and Drug Administration reports is typical for a patient new to the drug.
Citing privacy laws, Fishell did not reveal how much of the drug Gans was to take daily.
"I just don't see any way that medication could have caused his death," Fishell said. "That's just not something you find with Dilaudid." The drug weakens in strength if it sits on the shelf, he said, and would have been at about 75 percent potency at the time of Gans' death.
On Tuesday, Clark County Coroner Mike Murphy ruled Gans' death accidental, saying it was caused by toxic levels of hydromorphone in conjunction with heart and blood diseases. Murphy said Gans suffered from hypertensive cardiovascular disease, which causes high blood pressure and thickening of the heart muscle, and polycythemia, a thickening of the blood caused by too many red blood cells.
"I want to be very clear that this is not an issue of drug abuse," said Murphy, who stressed that Gans suffered from chronic pain. "What I'm trying to be clear about is that we have an issue involving Mr. Gans' health and the hydromorphone, and as a result of the combination of those issues, Mr. Gans succumbed to his health conditions in conjunction with that hydromorphone issue."
Murphy would not reveal how much of the drug was in Gans' system, how long he had been taking it or whether it was prescribed to Gans.
Fishell said Gans didn't like pain medication.
"I don't think he ever asked me for medication in the eight years that he was my patient," he said.
Fishell said that when Gans came into his office, he would talk not about his condition or his show, but rather about the community.
"He loved to talk about the work of the Nevada Childhood Cancer Foundation," he said. "This was one of the few entertainers who really cared about the community. I think that is what the community should remember about Danny Gans. I think it's time to drop all this that seems negative about Danny."
Fishell said that when he saw Gans in his office in March, he took X-rays of his shoulder. Considering the damage, "you couldn't believe he did what he did on stage every night," he said.
Fishell said he told Gans he could give him an injection for pain but that it would last a couple of hours only. He said Gans refused the injection as well as his offer to try pain medication again.
Fishell said Gans hoped that orthopedic surgeons he would soon see -- medical professionals that Gans said worked with the Los Angeles Angels baseball team -- could bring him some relief.
In 2006, Gans told the Review-Journal that the cumulative wear and tear from years of baseball, golf, martial arts and the physicality of his nightly show had caught up with him. At the time, Gans couldn't lift his right arm over his head.
The pain eventually disappeared, but Gans said he would reaggravate the shoulder now and then by playing golf.
On Thursday, a phone call made by the Review-Journal to Gans' wife, Julie, was returned by Gans' manager, Chip Lightman.
Lightman said Gans' wife had been stunned by the news that her husband had a narcotic in his system.
"She had no knowledge that he was taking such a thing," he said.
All of the prescription bottles in the house had been removed by the coroner's office, he said, so she had no idea he had a prescription for Dilaudid.
Lightman, who noted Gans took medication for his high blood pressure, said the entertainer played golf on the day he died, had a massage and then went to sleep.
"He must have taken the medication before he went to sleep," he said.
Julie Gans called 911 about 3:45 a.m. when her husband was having trouble breathing.
Dr. Mel Pohl, medical director of the Las Vegas Recovery Program, which has a program that deals with chronic pain management, said Thursday it's possible that a sudden reintroduction of even a single dose of a drug Gans took years ago could cause "respiratory depression." In other words, breathing difficulty.
Dr. Robert Odell, a practicing Las Vegas anesthesiologist and pain management physician, agreed that returning to an old medicine can be dangerous.
"If the body wasn't used to it, he would stop breathing, suffer from respiratory depression," he said.
Fishell said that Dilaudid is a good drug when used correctly.
Gans' death "may have more to do with the heart medication he took," Fishell said. Because of privacy laws, Fishell said he could not talk about Gans' heart medication.
Fishell said he wants to re-emphasize a warning to patients.
"I always tell them if they're not using medications to flush them, that they could have side effects," he said. "That's important for everyone to know."
Contact reporter Paul Harasim at firstname.lastname@example.org or 702-387-2908.