A Battered Doctor, A Slain Patient And A Family鈥檚 Quest For Answers
BAKERSFIELD, Calif. 鈥 The police report is all David Cole Lang鈥檚 family has to describe his last moments on Earth.
Fifty pages of filled with grisly detail, it lacks any explanation for his death. Ten months later, Lang鈥檚 widow, Monique, says she still has no clue as to why the 33-year-old combat veteran and father who struggled with opioid addiction ended up fatally shot by a doctor whom 鈥 as far as Monique knew 鈥 he hadn鈥檛 seen in over a year.
鈥淚 didn鈥檛 understand why he was there,鈥 she said. 鈥淚 still don鈥檛.鈥
On that April evening last year, according to interviews in the report, Lang yelled and cussed at the addiction and pain treatment doctor, Edwin Zong, in his office, and leapt across a desk to punch him repeatedly. Hearing the doctor scream for help, the last patient waiting to see Zong that day ran to open the door. He told police he found Lang standing over Zong, curled in a fetal position on the floor, his face covered in blood and 鈥渢he fear of a child in his eyes.鈥
鈥淗ey!鈥 the patient yelled.
When Lang turned toward the doorway, Zong told police, the doctor opened a desk drawer and grabbed a handgun. He fired three or four times. One bullet tore through the blood vessels in Lang鈥檚 neck. He staggered outside, collapsed in a parking lot and died.
Local authorities concluded that Zong had acted in self-defense, and he faced no charges. In an email to Kaiser Health News, the doctor declined a request for an interview but said he believes he was targeted for robbery. 鈥淚 was lucky I wasn鈥檛 killed,鈥 he wrote. 鈥淭reating addiction is a very tough job, many doctors won鈥檛 do it.鈥
The tragedy that played out in Zong鈥檚 office speaks to a dangerous trend: In many parts of the United States, the number of people addicted to opioids far exceeds the capacity of doctors willing and authorized to treat them. That is particularly true when it comes to professionals like Zong who dispense Suboxone or Subutex, both formulations of buprenorphine聽鈥 widely considered the optimal addiction treatment because it all but erases opioid withdrawal symptoms without creating a significant high.
With tens of thousands of Americans dying annually from opioid overdoses, the Food and Drug Administration recently signaled that it is open to expanding the number of drugs available to ease withdrawal and reduce cravings, but access to prescribers remains a problem even for the drugs that already exist.
One reason for the shortage of providers is that doctors must take eight hours of training to prescribe the medication and apply for a waiver from the federal Drug Enforcement Administration, because the medicine is itself an opiate. Few doctors are willing to check all those boxes and take on the sometimes difficult patients who seek the drug.
Patients addicted to heroin or prescription opioids like oxycodone or fentanyl suffer severe withdrawal 鈥 sweats, tremors, anxiety 鈥 and are often desperate for medication-based treatment to wean them from the drugs or at least quell their symptoms. For the cash-strapped patients, the cheaper the better.
Doctors who accept these patients, whether motivated by profit or compassion, can become overwhelmed, seeing far more than their offices can handle, opening the door to chaos and lawlessness. More problematic is that some clinics, like Zong鈥檚, offer a mix of services 鈥 treatment for both opiate addiction and pain. Patients being prescribed potentially dangerous narcotics are mixed in the waiting area with those struggling to kick addiction.
Several years ago in Vermont, which , some small practices rapidly swelled to 600 or 700 patients each, said Dr. Richard Rawson, an experienced addiction researcher at the University of Vermont. Doctors sometimes prescribed more than their authorized limit, failed to test patients for drug abuse and 鈥 wittingly or not 鈥 fostered illegal sales, Rawson said.
鈥淲e know that when you have those types of practices where you bring large numbers of addicted individuals together it produces a mess,鈥 he said. 鈥淧eople are selling drugs in the parking lot and all kinds of wacky stuff like that.鈥
Inevitably, some patients relapse. Some become angry if they don鈥檛 get what they came for. A solo practitioner like Zong 鈥 who by many accounts had few employees, a tendency to work late on his own and a high cash intake 鈥 faces security risks.
Zong was concerned enough to stow a gun in his desk drawer. 聽鈥淚 keep a gun in my office for self-protection,鈥 he said in his email.
Long Lines, Short Appointments
In California, demand for buprenorphine has only grown with the opioid epidemic and recent changes to Medi-Cal, the state鈥檚 Medicaid program, which have made it easier and quicker for low-income people to get the drug. The program was expanded under the Affordable Care Act to cover more adults (3.8 million) and more drug treatment.
In addition, beginning in June 2015, doctors were no longer required to get prior approval from the Medicaid program each time they prescribed buprenorphine.
Within seven months, claims jumped 100 percent, according to the state.
Zong, an osteopathic physician who had trained in internal medicine in New York, opened his Bakersfield practice in 2007. Situated next to a marijuana dispensary, it was a one-stop shop for pain management, addiction treatment and acupuncture. Though Zong鈥檚 medical training didn鈥檛 focus on those areas, he had the necessary DEA waiver to prescribe buprenorphine by 2010, records show.
Zong had a reputation for writing scripts, cheap and fast, according to numerous interviews with former patients, drug treatment professionals and pharmacy employees in the area. Lines of sometimes-agitated patients stretched from the waiting room into the parking lot, the street and the dirt lot across the road, patients and neighbors said.
If the wait was lengthy, the appointments weren鈥檛, the patients said.
鈥淲hen I walked in the first time,鈥 said Brian Adams, a former patient, 鈥淸Zong] said, 鈥榃hat鈥檚 going on?鈥 I said, I鈥檓 a heroin addict. I need help. He said 鈥極K, I鈥檒l write you a prescription for Suboxone.鈥欌
No intake. No drug testing. No counseling. 鈥淚 was in and out in five minutes,鈥 Adams said.
The price for the visit ranged from $80 to $100 cash to secure the medicine, patients said 鈥 far cheaper than anywhere nearby.
Federal regulators say buprenorphine should be 鈥 that includes counseling and participation in social support programs.鈥
Dr. Edwin Zong closed his practice after the fatal shooting, leaving a handwritten notice on the door. He remains licensed to practice in good standing but says he won鈥檛 return. Neighbors say patients still come by looking for him. (Brian Rinker for Kaiser Health News)
There was an option like that within a few miles of Zong鈥檚 office: which runs opioid treatment clinics closely regulated by the government. The clinics required services including intake, urine testing and counseling for opioid treatment.
From a hard-up patient鈥檚 perspective, Aegis had another downside: It had not yet been approved to accept Medi-Cal for buprenorphine, which was dispensed on-site as take-home pills. The range of services and medication costs nearly $700 for those without insurance, although a limited number of discounts are available to the poor.
Zong鈥檚 Medi-Cal patients had it easier: Their freshly issued scripts were covered at local pharmacies.
Anger And Suspicion
Zong had good reasons to be concerned about security. He鈥檇 had a handful of break-ins at the clinic, his vehicle and home 鈥 one recently,聽according to the police report.
At some point, he became licensed to carry and conceal a firearm. Adams said he once saw him pull it out when Adams got confrontational.
Angry that Zong wouldn鈥檛 prescribe him an anti-anxiety medication, 鈥淚 stood up and was like 鈥楳an, [expletive] you,鈥欌 Adams said. Zong pulled out his gun and placed it on the table in front of him, Adams said, and he quickly sat back down.
Patients and pharmacists said Zong sometimes did add addictive anti-anxiety drugs like Xanax to buprenorphine prescriptions for people presumably seeking to escape addiction. Besides creating the potential for further drug abuse, the combination can be deadly, experts say.
Records of Medi-Cal claims obtained by Kaiser Health News show that, in addition to treating patients with buprenorphine, Zong prescribed significant amounts of highly addictive opioids, including oxycodone and hydrocodone, as well as habit-forming anti-anxiety medications. They do not show what combinations of drugs were offered each patient.
Staffers at three pharmacies in the area said they were concerned about peculiarities in Zong鈥檚 prescriptions or drug-seeking behavior among his patients.
Myron Chang, a pharmacist at the Walgreens at H Street and Planz Road in Bakersfield, said Zong鈥檚 prescriptions 鈥渨ere suspicious.鈥 Staffers noticed odd quantities of pills prescribed 鈥 43, 46, he said. Usually, doctors call for 30 or 60 to match a daily dose for a 30-day month, Chang said.
Chang added that Zong鈥檚 scripts sometimes included a potentially dangerous cocktail of sleeping pills, narcotics and anti-anxiety medications. He showed a reporter one of Zong鈥檚 2013 prescriptions for Subutex and Xanax.
鈥淲e just stopped taking his scripts,鈥 Chang said.
In a 2013 internal memo at a Walgreens pharmacy in Bakersfield, Calif., a pharmacist calls the prescriptions of Dr. Edwin Zong 鈥渟uspicious鈥 and informs staffers the store will not fill his prescriptions. (Brian Rinker for Kaiser Health News)
Not The Same Man
After the killing, police found a ski mask, a black hoodie and a recently used meth pipe in Lang鈥檚 car, according to their report. Witnesses reported to police that Lang came into the offices saying 鈥渟omething about money鈥 or that he was 鈥渨aiting on his money.鈥
Court records show he had pleaded no contest for misdemeanor burglary in 2014 and served three days in jail.
Lang鈥檚 family is skeptical that Lang was trying to rob Zong. They acknowledge, however, that he was not the man he used to be.
When Monique met Cole, as he was called, she was still in high school. He was an outgoing and funny 19-year-old, with beautiful green eyes and a sharp wit. In short order, they married and he shipped out to Iraq. Then came two more tours, in Iraq and Afghanistan. One explosion, then another, nearly killed him.
When he came home to his wife and baby daughter, he 鈥渨as a lot different, especially around family functions,鈥 said Monique Lang. He wouldn鈥檛 want to go, and if he did, he was quiet and remote. 鈥淚 was like, 鈥楾his isn鈥檛 you. What is going on?鈥 He never would say.鈥
In 2009, after Monique discovered money missing from the couple鈥檚 bank account, her husband came clean: He was hooked on opioids. From then on, it was a roller coaster of pills, heroin and rehab. In the middle of it all, they had a son, now 4.
Lang鈥檚 family said the former Marine was in constant pain, physically and mentally. He had a severe back injury. He screamed in his sleep. His daughter, now 10, would sleep on the couch downstairs, to escape the sound.
He secretly wrote suicide notes to his wife and kids.
Monique Lang wears her husband鈥檚 wedding ring around her neck. They met when she was still in high school. She said he was an outgoing and funny 19-year-old, with beautiful green eyes and a sharp wit. (Brian Rinker for Kaiser Health News)
Zong told reporters the day after the shooting that he did not remember seeing Lang before. But the family told police he was seen on occasion between 2012 and 2015, according to their report, and that he received Suboxone for opioid addiction.
In an interview, Monique Lang said she once accompanied Cole to an appointment. She didn鈥檛 like the atmosphere, she said, and didn鈥檛 understand how taking a medication with no other services would help her husband.
But that was history 鈥 or so the family thought. By last April, they believed Lang was sober, getting the support he needed at Aegis.
Another Clinic 鈥極verwhelmed鈥
Zong told police he performed one final task on his clinic鈥檚 last day, with Cole Lang dying outside on the asphalt and squad cars en route: He wiped the blood from his battered face and agreed to write his remaining patient a prescription.
Although Zong 鈥 who also goes by the name Yon Yarn 鈥 remains licensed to practice with , he says he will not reopen his practice.
His departure created chaos as desperate people dependent on his prescriptions struggled to get help elsewhere.
鈥淲e were overwhelmed,鈥 said , regional clinic manager at Aegis. 鈥淲e probably fielded a hundred, 200 calls from patients who were panicking 鈥 鈥業鈥檓 worried about relapse.鈥 鈥業 don鈥檛 know what to do.鈥 鈥楳y prescription is expiring.鈥欌
Even months after Cole Lang鈥檚 death, neighbors said patients still showed up at Zong鈥檚 door, with the scrawled 鈥淐losed鈥 sign on it, hoping to find that the doctor was in.
This story was produced by聽, which publishes聽, an editorially independent service of the聽.