Psychiatrist Joel Dreyer blames holes in his brain for unlawful prescribing, patient deaths

October 19, 2010

Brett Siciliano drove home to San Clemente from the Riverside Federal Courthouse on Tuesday morning, disappointed once again. A small urn with his twin sister's ashes hung from his neck.

The man he blames for the death of his sister, Jessica Silva, at her Newport Coast home was scheduled to be sentenced to prison for giving out Xanax and OxyContin prescriptions for $100, among other things. 

As he has done several times in the year since he pleaded guilty, Joel Stanley Dreyer got a delay in his sentencing again, this time until Dec. 13, by firing his lawyer and arguing that he had brain damage. Three holes in his frontal lobe affect his sense of smell and judgment, he's told the court. 

The federal prosecutor handling the case, Antoine Raphael, said Dreyer may try to back out of a plea agreement at another hearing Nov. 29. 

Siciliano, 41, came ready to give a victim impact statement, to have his say at last. But the letdown, he said, "sucked the life out of me." 

Siciliano isn't just a grieving brother waiting for justice from others. He launched an investigation that helped lead to Dreyer's arrest. Prosecutors cited Siciliano's independent investigation in court filings. 

Court records link Dreyer not just to Silva, but to Brandon Keating, a 25-year-old who died in a Costa Mesa detox facility in 2007. Dreyer, who lost his psychiatry license this year, was charged with distributing around 150,000 pills of Oxycontin, Xanax, Vicodin, and other often-abused drugs.

He was also accused of taking part in a conspiracy to illegally supply prescription drugs to a Tijuana pharmacy. 

For Siciliano, it started Christmas Day, 2005. 

He was outside Jessica Silva's condo, pounding on the door. 

Silva hadn't shown up for Christmas with the family, even though it was likely to be the last one they'd have with their ailing grandmother. Nobody had heard from her in two days.

Although Siciliano had been clean for three years, his sister was still struggling with pills. So Siciliano went to check on her. He could hear her Maltese, Princess, inside barking, but there was no answer at the door. 

He called the Newport Beach police, who broke a window to let them all in. Silva was lying motionless on the bed, Princess whimpering by her side. 

The coroner's office would determine that the 35-year-old divorced saleswoman had died two days earlier. Police found more than 20 prescription medications in the house; 10 of them were found in her blood, stomach and liver. 

Siciliano noticed that a prescription for 90 Oxycontin pills – filled three weeks before – had been written by Dreyer, raising his suspicion. 

"My grandma was dying of cancer and she couldn't even get a prescription for one OxyContin," Siciliano said. "When I Googled (Dreyer) and found out he was a psychiatrist, I knew. Psychiatrists don't give Oxy. They give Viagra, Lipitor." 

The coroner's office ruled that Silva's death was caused by a reaction between Oxy and four other drugs. 

Siciliano, a former real estate agent and current board game entrepreneur, started trying to set up an appointment with Dreyer. 

"He'd say, 'Call me in a month, call me in month,'" Siciliano said Monday. 

Siciliano never mentioned his sister's name, but he said Dreyer seemed wary. 

"After about nine months of calling him, and him saying he wasn't taking any more patients," Dreyer relented on Siciliano's last attempt before giving up. 

On Nov. 14, 2006, Siciliano visited Dreyer at his Murrieta office, complained of back, neck, and knee pain, and got prescriptions for Norco, Vicodin, and Ambien, according to court records. 

"This doctor had a hole in the wall sharing it with the chiropractor," Siciliano said. "There were strung-out patients in the waiting room. I got eight years in recovery, so I know the look. He told me not to go to the corner Walgreens" to fill the prescriptions. 

Siciliano filled the prescriptions, and drove to the Murrieta Police Department, where he met Det. John Nelson. 

"I went there with my mother, my sister's dog, and my sister's ashes," Siciliano recalled. 

Siciliano dumped out the pills on the detective's desk. He showed Nelson the coroner's report of his sister's death, and gave him receipts for his sister's drug purchases. 

"I'm here to tell you about this Dr. Joel Dreyer," Siciliano remembered saying. 

"Oh, you mean this guy," Nelson responded, pulling out a file Siciliano remembers as four inches thick.

Local patrol officers had been pulling over young people and finding drugs prescribed by Dreyer for some time, Siciliano remembers the detective telling him. 

Over the next several months, undercover investigators from the police, the Drug Enforcement Administration, and California Medical Board wore wires to meet with Dreyer, according to court records. 

Dreyer asked no questions about medical history, conducted no examinations, generally asked what drug the patient was interested in, and then suggested a symptom, according to records. He charged $100 for the visits and wrote a prescription for each investigator. 

Dreyer was charged in federal court in Feb. 2008, and pleaded guilty on Sept. 21 2009. At his plea hearing, he offered a rambling defense. 

"I was humanitarian of the year in Michigan in 1984.... I'm just not this bad guy I'm being painted out to be.... I have brain damage. I have three holes in the frontal lobe of my brain... Two things happen. You can look it up on the computer. Lack of sense of smell....and a lack of judgment. So... I saw patients I didn't know, probably, everything they were telling me, your honor, saw patients in pizza parlors. But did I know the drugs were being delivered on the street? No. Did I make any profit off of it? No.... Did I do a physical exam? No. I haven't done a physical exam since 1963." 

This August, Dreyer was stripped of his medical license. 

Shortly before his arrest, according to published reports, he had been fired from his job as a staff psychiatrist at Oak Grove Institute, a residential treatment center and school for children with problem behavior. 

On New Year's Day, 2006, Brett Siciliano, his mother Hedy Porr, and others buried Jessica Silva. It was her birthday. 

For his family, Siciliano said, the holidays are forever changed. One image is burned in his mind.

"There was a little toddler upstairs opening a Christmas present, as they brought my sister out in a body bag."

Source: Jon Cassidy, "Sister's drug death launches man's quest for justice," Orange County Register, October 5, 2010.