A doctor who operated clinics on Maui and Hawaii island was sentenced to 48 months in federal prison Monday for unlawful distribution of hydro­codone, an opioid used to treat pain.

Dr. Paul A. Kaiwi Jr. of Wailuku, who owned and operated the Progressive Medical clinics in Kahului and Hilo, was facing up to 20 years in prison, a $1 million fine and up to life on federal probation. “The loss of medical license and receipt of a sentence including a significant term of incarceration are substantial consequences for medical professionals criminally abusing the privilege of prescribing otherwise illegal drugs,” said U.S. Attorney Clare E. Connors in a statement to the Honolulu Star-Advertiser.

Kaiwi, through his attorney Michael Green, entered into a plea agreement in April with the U.S. Department of Justice that allowed him to plead guilty to a single count of distributing and dispensing hydrocodone outside the usual course of professional practice and for no legitimate medical purpose. Initially, Kaiwi was charged in 2020 with six counts of unlawfully distributing hydrocodone.

In return for his guilty plea, approved by Assistant U.S. Attorney Michael F. Albanese, the government agreed to not file additional charge against Kaiwi in connection with “unlawful prescribing of controlled substances from 2015 through 2020,” according to the memorandum of plea agreement.

In addition to surrendering his Hawaii medial license, prior to sentencing, Kaiwi agreed to permanently surrender his DEA controlled-substance registration for cause and to refrain from reapplying for a DEA registration number anytime in the future, according to the agreement.

Green said Kaiwi is now delivering for Door Dash and renting out his family car to tourists. Noting that Kaiwi is an Army veteran, Green told the Star-Advertiser in an interview, “He served honorably in the military, became a doctor. He was the golden boy for his family, and now he’s lost everything.”

Albanese submitted four letters to the court from the family of Diane Kay Webb, a Kaiwi patient who died at age 49 in 2020. Webb’s medical care is not tied to the matter of Kaiwi’s guilty plea.

Webb required several surgeries and about three months of hospitalization after sustaining a crushed pelvis, bladder rupture, elbow and knee fractures as well as a ligament injury, according to a letter addressed to Kaiwi from Webb’s daughter, Sandy Webb.

“From her first visit when you diagnosed her with an opiate dependency to her death on June 12, 2020, you increased her pills from 168 monthly to 246 pills monthly,” Sandy Webb stated in the letter. “These facts do not indicate that you made any attempt to lower her opioid use.” Further, “Diana was never a street drug person. She was a victim of the opiate addiction prescribed to her by the medical community.”

Diana Kay Webb suffered a traumatic brain injury and died in her apartment while intoxicated on prescriptions Kaiwi had provided, Sandy Webb stated in the letter.

On Dec. 10, 2018, undercover DEA agent, posing as a new patient, went to one of Kaiwi’s offices for a clinic visit, equipped with an audio and video recording device, according to federal court documents. The agent told Kaiwi he had chronic back pain for about one to two years and asked for oxycodone, Xanax and carisoprodol prescriptions — a combination referred to as the “Holy Trinity.” It carries a high risk of drug overdose and is often requested by drug abusers due to its “euphoric effect,” according to court records.

In response to the request, Kaiwi told the agent he did not prescribe oxycodone and did not accept patients taking oxycodone. The agent then asked for Vicodin (hydrocodone), and Kaiwi agreed to that prescription.

During the visit Kaiwi asked whether the agent had had any surgeries, and the agent said he had not. Kaiwi then said he didn’t understand how the agent would be able to get a prescription if he had not had surgery because the medication he asked for was usually given to people managing pain from surgery.

Kaiwi told the agent that he didn’t want to waste his time if he could not get the prescription filled because in Hawaii “you need to have documentation of surgery, of broken bones, something major, is what I’m trying to tell you,” according to court documents. “So I would hate for you to have to keep on coming back, and I wouldn’t be able to give it to you because I don’t want the DEA to arrest me,” said Kaiwi.

Nevertheless, Kaiwi prescribed 90 Norco pills. Norco is a brand name for a medication containing hydrocodone combined with acetaminophen.

“So I am going to ask that you, if you need these medications, then try to go ahead to find another doctor,” Kaiwi said.

The DEA Office of Special Intelligence, Document and Media Exploitation Section analyzed state prescription data for prescriptions written by Kaiwi from Jan. 2, 2015, through Jan. 22, 2020. Based on that data, there were 1,276 patients who received prescriptions for opioids, which were the most prescribed controlled substances — accounting for 69% of the prescriptions and 82% of the pills/units dispensed, according to court records. Benzodiazepines (sedatives) and carisoprodal (a muscle relaxer) were the second and third most prescribed drug groups.

Mixing opioids, benzodiazepines and muscle relaxers such as carisoprodal is a favorite of drug abusers, according to a DEA agent affidavit. The combination of an opioid, a benzodiazepine like Xanax and a muscle relaxer is a known drug cocktail dubbed the “Trinity,” which can induce a sense of euphoria similar to heroin and carries a significant risk of drug overdose.

On June 6, 2019, the DEA interviewed a witness identified in court records as “M.M.,” the spouse of “T.M.,” a patient of Kaiwi’s who died from an “accidental acute mixed drug toxicity after he was found with fentanyl, oxycodone, diazepam and mitragynine.

T.M. saw Kaiwi the day before he died, on Aug. 30, 2018, and received a prescription for 168 tablets of Percocet 10-325 milligrams (10 mg oxycodone with 325 mg acetaminophen) and 112 tablets of Valium, a sedative.

M.M. told DEA agents that T.M. “struggled with addiction for several years” and would go through his prescription in the first 10 days of filling it and would be in withdrawal by the time of his next appointment with Kaiwi.

T.M. was introduced to Kaiwi by his mother, who had died in 2014 from an overdose of fentanyl and morphine, which were prescribed to her by Kaiwi.

In a letter of support for Kaiwi, submitted to the court by Miguel Morales, senior pastor of Maui Evangelical Church, Morales told U.S. District Court Judge Derrick K. Watson that when his church went on a 2018 mission to the Philippines, Kaiwi volunteered to help spread the gospel and bring supplies and aid to street children and Indigenous people living in the mountains.

Morales stated in the letter that he had known Kawai for 14 years as a friend and a peer. “I am a witness to his kindness to people, his faithfulness to our lord, and his generous desire to help people in kind and in kindness even when he wasn’t asked to help, starting with his own family,” Morales stated. “He is just a sincere and humble person consistently.”