Maui Doctor Faces Charges of Unlawful Distribution of Hydrocodone

A Maui doctor with a practice in Hilo is facing charges of unlawful distribution of a controlled substance, the US Attorney’s Office reported Thursday afternoon.

Paul A. Kaiwi Jr., 51, of Wailuku, is facing six counts of unlawful distribution of hydrocodone. Kaiwi operates out of Progressive Medical located in Kahalui, Maui and Hilo, Hawai‘i. Each count carries a maximum statutory penalty of 20 years imprisonment and a fine of not more than $1 million if found guilty.

“Today’s charges reflect our ongoing commitment to hold doctors who unlawfully prescribe controlled substances accountable for their misconduct,” said US 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.”

According to an affidavit released Thursday, an undercover Drug Enforcement Administration (DEA) agent 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.

During those visits with the undercover agent, officials say, 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 Hawai‘i 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.