HAZARD — Dr. Dennis Sandlin gave up higher-paying jobs to fulfill a commitment to his rural patients. He had a gift for treating elderly people and those nearing death. He believed every person deserved comfort and relief from pain and suffering.
Sandlin, known to family and friends as Denny, recognized the problems of his mountain community. The scourge of pill addiction is something all doctors must deal with, Sandlin's family said, and more than once, he had to step in to report threats or stop a patient from becoming violent.
On Tuesday, police say, Sandlin was shot and killed by a patient seeking pain pills at the Leatherwood/Blackey Clinic in a remote area of southern Perry County. The man became angry, clinic employees said, after he was asked to take a drug test as a requirement for a prescription.
John Carles Combs, a Knott County man whose court records indicate a history of drug use and who is thought to have visited several other clinics in the days leading up to the shooting, was arrested that afternoon. He has pleaded not guilty to murder.
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Now Sandlin's family wants something good to come from his death. Leila Smith, Sandlin's youngest sister, said she hopes her community will start to recognize the dangers its health care providers are facing.
"We need to be taking better care of the people who are trying to take care of us," she said.
Friends have told her that some doctors have to call police several times a week because patients seeking drugs get belligerent and out of control.
"More and more people are coming looking for drugs," Smith said.
She said Sandlin's clinic staff had requested security guards and said the newly constructed Breathitt County Health Department has serious locks on doors and a more secure feeling.
State programs that track painkiller prescriptions have been helpful, Smith said, but addicts often have nowhere to go but to remote, insecure clinics like her brother's, places where people know their neighbors and aren't used to feeling suspicious and scared.
Earlier in the week, Mike Caudill, CEO of Mountain Comprehensive Health Corp., the non-profit owner of the clinic, said the company would be reviewing security and policies there. He could not be reached for comment Friday.
Doctors across Kentucky are so frustrated with the dangers of providing pain medication that some are not providing the service at all, a committee under the University of Kentucky's Kentucky Ambulatory Network is finding.
Threats of violence from pill-seeking patients are "a daily occurrence" at family practice clinics, said Dr. William Craig Denham of Maysville, who sits on the steering committee studying prescription drug diversion and pain medication availability across the state.
Formed this fall, the committee is conducting polls of family doctors has found that across Eastern Kentucky, the question of whether to even offer pain medication is the No. 1 concern.
"It's a real tightrope for physicians," Denham said.
Committed to the mountains
Denny Sandlin was born in 1952 at Hurst-Snyder Hospital in Hazard and was one of four children his parents raised in Buckhorn. His father, Steve G. Sandlin Jr., worked for the state health department and was the state's first sanitarian, inspecting food services and training local agencies about clean water and health practices, Smith said.
Steve Sandlin traveled a lot, and he always left chores and gardening work for his two sons to do in his absence. He had an education, so he helped his neighbors who couldn't read and write to fill out paperwork and write letters. There was never a question of if his children would go to college, but where and when.
Denny Sandlin became a doctor because he wanted to please his father, said his mother, Eileen Sandlin Ingram.
He was smart and graduated with honors from Morehead State in three and a half years, Ingram said. After medical school at the University of Louisville, Sandlin became the state's youngest doctor in 1978, Smith said. Their dad was so proud, he had an office picked out and renovated, and even recruited staff, before Sandlin returned to start his private practice in Hazard.
He could have gone anywhere, but he wanted to be near his family and in the mountains.
Sandlin met his wife, Terri, when he treated her mother. They dated but then married other people. After divorcing, they came back together and were married 18 years. Sandlin loved Terri's children and took them as his own.
"He was the best father I think anyone could ever have," Lynna Danielle Sandlin said. She met him when she was 14, a difficult teenager, but he laughed his way into her heart.
She said he would make fun of her gawkiness, singing that she was a "stick of macaroni." When he took the family to the beach, he teased her about her fear of sharks. They tried to one-up each other with funny birthday cards and practical jokes.
The family was planning a trip to India over Christmas — Denny, his mother and Danielle were set to leave on Dec. 24. Denny had visited the country numerous times before, but he was more excited than ever for his daughter to go for the first time. He made plan after plan. They would ride this ferry and that train, see this monument and that rubber plantation. The trip is off now.
When Danielle's brother, Joe, died in a car crash in Lexington, Sandlin was devastated. "My brother worshiped him, too," Danielle said.
She has worked for Toyota for about 10 years and, after she bought a house in Georgetown, Sandlin would call her out of the blue and ask about the security alarm, just checking up on his daughter.
"I spent a lot of time trying to make him proud of me," Danielle said through tears this week.
'He loved his job'
Denny Sandlin had chances to leave the clinic for better-paying jobs, said his sister Katheryn Burns, but he chose to stay because of his commitment to his patients. Denny was nearing retirement and considering a job with Mountain Community Hospice, which was about to open a new inpatient center in Perry County. He was a longtime Hospice volunteer.
"These little old ladies would run up to Denny and pet on him and love him," Burns said.
"It was important to him for folks to be comfortable," Burns said.
Sometimes, Denny — trying to impart lessons about compassion or gratitude — would tell Danielle about his patients, how some would have a particular hardship or special need. After Denny and Terri moved to Leatherwood, their home burned a few years ago. Danielle tried to persuade them to move closer to her, to Lexington or Georgetown. But her dad didn't want to leave his patients.
"The patients would call here needing something, and it never made him angry," Danielle said. "He loved his job."
"He knew that there was a chance with the people that doctor-shopped," she said.
Sandlin didn't talk much about that side of his job, she said, but she knew he thought employment was the answer. People need good jobs in the mountains.
"I want them to see this as an opportunity to get more funding for this area" for in-house drug rehabilitation, for drug counseling and for help with unemployment, she said.
"I'm really hoping that my father didn't die for nothing," Danielle said.