As the only doctor in a 30-mile swath of Appalachia, Dennis Sandlin was committed to using a tracking system designed to curb prescription drug abuse, an epidemic in the area he had served for nearly two decades.
Officials say it was a disgruntled patient denied a narcotics scrip hours earlier who shot him to death in a hallway Tuesday as he reviewed a medical chart, his pen still in hand.
"If he didn't think you were legit, he just told you, 'No,'" said Verlon Banks, the pharmacist at the Leatherwood-Blackey Medical Clinic, where Sandlin had worked since 1990. "Sometimes, that causes disagreements."
Banks said he did not remember ever seeing John Combs, 46, who is charged with murder in Sandlin's death. He said he also did not recall filling a prescription for Combs, who pleaded not guilty Wednesday and remained jailed on $10 million bond.
Banks and three pharmacy employees were inside the pharmacy when the shooting happened.
"One of the girls was yelling, 'He's got a gun, he's got a gun.' Then we heard a shot," Banks said.
They closed and locked the pharmacy door, then waited for an hour until police arrived and told them they could come out. When they did emerge, he learned the community had lost its only doctor.
"He is about it down here for 30 miles any way," Banks said. "He was pretty vital."
Those who knew the 57-year-old Sandlin said he was a kind, charitable man who donated money to buy Christmas presents for children in the community but was also frank with his patients about their needs.
"He was a community-minded person who really cared about his patients," said Estella Brashear, coordinator for volunteers at Appalachian Regional Healthcare hospital, where Sandlin worked before the clinic. "He would tell you what it was and that may have happened here."
Perry County District Judge Leigh Anne Stephens ordered Combs to give a blood sample to be tested for controlled substances. The phones at the public defender's office were busy and calls to Combs' home went unanswered.
Police don't yet have a motive for Sandlin's killing, Kentucky State Police Trooper Tony Watts said.
But Perry County sheriff's deputy Sam Mullins said they do know Combs had asked the clinic for narcotics Tuesday but was required to give a urine sample, which he refused to do.
"From that point, he got real angry, he just went crazy, and he made a threat he was going to come back and blow up the building," Mullins said.
Clinic officials did not want to press charges, so the deputy left.
Authorities say Combs returned several hours later with a gun _ Watts would not say what kind _ and shot Sandlin in the head. No one else was injured and Combs was arrested at his home.
Lt. Gov. Daniel Mongiardo, a physician in Perry County, knew Sandlin and said he was loved by his patients and worked at the clinic to be closer to where people needed health care.
The gates were closed and locked with chains Wednesday, but Banks said it might reopen next week with a temporary doctor.
Dan Smoot, law enforcement director for Operation UNITE, a drug task force in Kentucky's Appalachian region, painted Sandlin as a hero for not giving in to the demands of someone seeking pills. He said the killing was the most senseless act he'd seen in his career.
"I don't think very many of us understand the force of full-blown addiction," he said.
Police arrested hundreds of people in eastern Kentucky some two months ago on charges of selling illegal drugs from Florida, where people began going to obtain narcotics after Kentucky implemented a prescription tracking system to combat its epidemic.
But Dave Keller, deputy director of the Office of National Drug Control Policy's Appalachian High Intensity Drug Trafficking Area, said that did not cut off the pill pipeline.
"It's a tip of the iceberg," he said.
And Malcolm Neace, whose wife used to be a patient of Sandlin's, said the shooting was unsettling.
"If you aren't safe at a doctor's office, where are you safe?" Neace said.
Associated Press Writers Roger Alford in Frankfort and Brett Barrouquere in Louisville contributed to this report.