January 1, 2024 - How Authorities Are Dismantling Ohio Pain Clinics Prescribing Excessive Pain Pills

Investigation Reports. Unrelenting law enforcement agencies pursue doctors who operate what is known as a pill mill, a pain relief center in which physicians over-prescribe opioid pain pills for profit. State and Federal Authorities are indicting individuals responsible for selling prescriptions for controlled substances, primarily oxycodone, without a legitimate need.

Ohio officers and the federal government continue to arrest and prosecute physicians and pain clinic operators who provide patients with highly addictive prescription opioid painkiller pills that are not medically necessary and that then flood the country’s streets.

IMPORTANT NOTE: Not all pain management clinics are engaged in criminal activity. Many clinics across the state operate legally and employ trained personnel and doctors who treat patients who legitimately suffer from pain.

Ohio Physician Convicted for Unlawfully Distributing Opioids in High-Volume Pain Clinic (Indira Patel, Shore News Network, September 2023)

MARTIN’S FERRY, OHIO – Dr. Thomas Romano, a 73-year-old physician, was convicted by a federal jury for illegally distributing opioids and other controlled substances through his self-named pain management clinic. Dr. Romano charged hefty fees and prescribed dangerous combinations of medication, fueling the addiction of his patients. Between 2014 and 2019, he prescribed over 137,000 pills, including opioids.

According to court documents and evidence presented at trial, Dr. Thomas Romano, 73, of Wheeling, West Virginia, owned and operated a self-named pain management clinic in Martin’s Ferry, to which individuals traveled hundreds of miles to obtain prescriptions for opioids and other controlled substances. Dr. Romano charged $750 for an initial visit and $120 for subsequent monthly visits. The prescriptions Romano issued for opioids and other controlled substances greatly exceeded recommended dosages. They were in dangerous, life-threatening combinations that fueled the addiction of the individuals to whom he prescribed.

Dr. Romano was convicted on 24 counts of unlawful distribution of a controlled substance outside the scope of professional practice and without a legitimate medical purpose.

The DEA, FBI, and HHS-OIG, as well as the Ohio Bureau of Worker’s Compensation and Ohio Board of Pharmacy, investigated this case.

If you are aware of controlled substance violations in your community, you can submit your anonymous tip through the DEA online Tip Line.

Doctor in Pill Mill Case Sentenced to 25 Years in Federal Prison (Joe Gorman, WKBN First News, August 2022)

YOUNGSTOWN, OHIO. Dr. Martin Escobar, 58, was charged with 54 counts of illegally prescribing controlled substances. Court documents said Dr. Escobar was “prescribing controlled substances that were outside the usual course of health care practice,” including to people under 21. Prosecutors said two of his patients died of drug overdoses.

Prosecutors said Dr. Escobar ignored signs that his patients were becoming addicted to the medication and did not document in medical charts the reason for prescribing the controlled substances. Dr. Escobar was also accused of failing to use other treatment options other than opioids, even increasing dosages for prolonged periods without evidence that the treatment plan was working.

Former Doctor Pleads Guilty to Operating a Pill Mill (State of Ohio Board of Pharmacy, August 2021)

COLUMBUS, OHIO. According to court records, Dr. Khaled Amr was operating a pill mill out of his practice, Columbus Pain Specialists, for more than seven years. Dr. Amr was selling oxycodone in exchange for financial kickbacks and staged a break-in at his practice to make a fraudulent insurance claim. Dr. Amr was sentenced to spend five years on probation and ordered to forfeit more than a half-million dollars. He was ordered to surrender his medical license and DEA registration as part of the terms of his probation. Dr. Amr was also ordered to pay a $5,000 fine and forfeit more than $524,000 that were proceeds of his criminal behavior.

What is Oxycodone and How Is It Used (United States Drug Enforcement Administration)

Jury Holds Pharmacies Responsible for Role in Opioid Crisis (John Seewer, Associated Press, November 2021)

CLEVELAND, OHIO—CVS, Walgreens, and Walmart pharmacies recklessly distributed massive amounts of pain pills in two Ohio counties, a federal jury said in a verdict that could set the tone for U.S. city and county governments that want to hold pharmacies accountable for their roles in the opioid crisis.

Lake and Trumbull Counties blamed the three chain pharmacies for not stopping the flood of pills that caused hundreds of overdose deaths and cost each of the two counties about $1 billion. Prosecutors compared the pharmacies’ dispensing to a gumball machine.

Dayton Doctor Pleads Guilty in Federal Opioid Case (Chris Stewart, Dayton Daily News, February 2020)

DAYTON, OHIO. Dr. Morris Brown, 75, admitted writing prescriptions for patients in amounts and for lengths of time that were outside the scope of legitimate medical practice, according to the U.S. Department of Justice.

Dr. Brown, the owner and operator of Dayton Primary and Urgent Care Center Inc. at 301 W. First St. in Dayton, was one of 60 people charged in the largest prescription opioid crackdown in U.S. history.

Dr. Brown owned the building and leased space to Dayton Pharmacy, which was housed off the waiting room. The Justice Department alleged Dr. Brown operated a pill mill, funneling prescriptions to the pharmacy, which dispensed over 1.75 million pills during two years.

He also admitted routinely prescribing controlled substances even though various red flags suggested he should stop writing those prescriptions for patients, change the prescriptions, and/or counsel patients accordingly. Further, Dr. Brown admitted that he prescribed dangerous combinations of drugs known to heighten the risk of overdose and death, according to the Justice Department.

Dr. Brown was charged along with four other men connected to the pharmacy: Ismail Abuhanieh, 50, of Phoenix, Arizona; Mahmoud Elmiari, 44, of Bellbrook; Yohannes Tinsae, 48, of Beavercreek; and Mahmoud Rifai, 50, of Detroit, Michigan.

Dr. Brown continued prescribing opioids “even after learning that some of his patients had experienced overdoses, and in some cases, deaths,” read a federal indictment.

Abuhanieh, Rifai, and Tinsae were all licensed pharmacists associated with Dayton Pharmacy, and Elmiari was the manager, according to court documents.

It was between October 2015 and October 2017 that the government alleged 1.75 million pills went out the facility’s door, including oxycodone, methadone, morphine, fentanyl, alprazolam, endocet, and more, court records showed. Dr. Brown’s medical license was permanently surrendered in 2018.

The height of the Dayton area’s opioid crisis came in early 2017. In May of that year, which remains the deadliest month ever for overdose deaths in Montgomery County, 81 people died. The opioid crisis took 70,000 American lives that year, and Ohio emerged as one of the worst-hit states, behind only West Virginia in terms of overdose deaths per capita.

NBC4 Columbus Digs Deeper into the Growing Issue with Pain Clinics in Southern Ohio (YouTube video)

CLEVELAND, OHIO – For more than 25 years, patients suffering in pain sought out Dr. William Bauer.

SANDUSKY, OHIO. Federal prosecutors accused Dr. Bauer, a neurologist, of illegally prescribing thousands of opioid pills. Bauer practiced in Sandusky and lived in the Port Clinton area. At 83, Dr. Bauer had a practice that cared for many of the same patients for 10 to 20 years. He was charged with 246 counts of distribution of controlled substances and 24 counts of healthcare fraud.

The case of Dr. Bauer, the pain specialist, stands out. He became a licensed doctor in Ohio in 1967. He had offices in Norwalk, Bellevue, and Sandusky and focused on pain management for years.

Dr. Bauer’s patients were a diversified lot: About 1,000 received narcotics for pain. Many came to him after suffering work injuries or car accidents, while others struggled with degenerative issues, according to court records filed by his attorneys, Orville Stifel and Gibbons.

Most of his patients had been referred by other doctors. They had crippling injuries from car crashes and work accidents, chronic headaches, and debilitating spine issues. He also treated residents with multiple sclerosis, Parkinson’s disease, and chronic headaches.

One man, a 25-year patient who suffered a significant injury in a construction accident, said Dr. Bauer used several different treatment options over the years, not just pain pills. “He kept me going,” said one patient. “I don’t know where I would be without him.”

Then, the government showed up. Dr. Bauer was one of a growing number of physicians, many specializing in pain management, who had been charged criminally with distributing excessive amounts of opioids. Since 2017, more than 450 doctors and medical personnel across the country have been accused of opioid-related charges, according to the U.S. Justice Department and published reports.

“This physician is accused of recklessly prescribing thousands of doses of fentanyl and other painkillers to people for no legitimate medical purpose.”

In 2016, the State Medical Board of Ohio investigated Dr. Bauer for giving prescriptions to 13 patients without checking a state database that logged the dispensing of practitioners. Bauer told investigators that the database added too much time to his day and that his own system was better.

The Medical Board reprimanded him and ordered him to pay a $7,500 fine. His practice ran into another issue in about 2018 when corporate pharmacies stopped filling prescriptions of independent pain specialists. The decision forced Bauer’s patients to find smaller, non-chain pharmacies.

A federal grand jury indicted him on distributing charges that accused him of improperly prescribing opioids and other painkillers between 2015 and 2018.

The indictment said he also performed inadequate examinations, failed to consider non-opiate treatment options, and prescribed “high doses of opioids to patients without regard to any improvement in pain level.”

The prosecution’s expert, Dr. King, opined that Dr. Bauer did not sufficiently establish a diagnosis and ignored “red flags.” Each patient had a history of at least two mental health conditions; several had histories of illegal drug use. Dr. Bauer drastically exceeded the recommended thresholds and prescribed opioids together with other controlled substances. One patient died from an accidental overdose. None showed improvement. A drug task force officer alerted Dr. Bauer that a patient was selling his pills. Dr. Bauer did not terminate the patient but provided additional prescriptions. Several pharmacies would not fill his prescriptions. Dr. King opined that “Dr. Bauer prescribed opioids in most cases to support addiction and dependency without a legitimate medical purpose.”

A jury convicted Dr. Bauer of 76 counts of distribution of controlled substances and 25 counts of health care fraud. Dr. Bauer contends that he refused to abandon chronic pain patients and that he did what was necessary to help patients in severe pain. Many of his patients continue to defend him. Dr. Bauer said he remains concerned over the fate of thousands of chronic pain patients: people who suffer from substance abuse disorder and people who need mental health treatment. They are not getting the help they need and can’t defend themselves, he said.

Dr. Bauer was sentenced, at the age of 85, to 5 years in prison. He was also ordered to pay over $464,099 in restitution to the government and $100,000 in community restitution. It was recommended that he give that payment to the Mental Health and Recovery Services Board of Seneca, Ottawa, Sandusky, and Wyandot Counties.

After the indictment, U.S. Attorney Justin Herdman said in a statement that authorities “will pursue doctors who flood our streets with pills and patches just as aggressively as we do the cartels and drug traffickers who seek to profit from the drug epidemic here in Ohio.”

U.S. District Judge Jack Zouhary ordered Dr. Bauer to stop prescribing medications and dealing with patients. In the days after the indictment, his patients struggled to find new doctors who could treat their pain.

More Cases Across Ohio

Authorities charged a handful of doctors in Ohio in major opioid cases.

Troy Balgo, D.O., 53, of Saint Clairsville, the elected county coroner of Belmont County, was charged with one count of health care fraud, one count of conspiracy to commit health care fraud, six counts of unlawful distribution of controlled substance and one count of conspiracy to commit unlawful distribution of controlled substances.

Dr. Troy Balgo, Belmont County, was indicted on federal charges and accused by prosecutors of “polluting the population of Ohio [and] fueling residents with unnecessary prescriptions for addictive opioids for years.” His attorney, Sam Shamansky, has said Dr. Balgo ran a pain-management practice that drew residents from surrounding rural counties who were struggling with such serious pain that they could barely function. Balgo allegedly caused and/or conspired with others to cause submissions for health care services that he did not perform and prescribed controlled substances while he was out of the state or country. Dr. Balgo is the owner and operator of two medical clinics in St. Clairsville.

Freeda Flynn, M.D., 66, of Saint Clairsville, was charged with eight counts of distribution of controlled substances and one count of health care fraud for her alleged participation in the unlawful prescription of controlled substances outside of the course of professional practice and without a legitimate medical purpose, and health care fraud for the submission of claims for services which were medically unnecessary and/or performed below medically-accepted standards. Dr. Flynn owned and operated a solo practice that focused on medical and opioid addiction treatment programs in St. Clairsville.

George Griffin, M.D., 70, of Cincinnati, was charged with 20 counts of distribution of controlled substances for his alleged participation in the unlawful prescription of controlled substances outside of the course of professional practice and without a legitimate medical purpose. Dr. Griffin owns and operates a solo medical practice in Cincinnati.

Dr. Gary Frantz of Mansfield was accused of illegally prescribing tens of thousands of opioids from 2005 through 2017. Prosecutors alleged that Dr. Frantz prescribed thousands of painkillers to a patient who later sold them.

In another case, prosecutors obtained a temporary restraining order in 2018 to keep Dr. Gregory Gerber from prescribing medications. Dr. Gerber had a pain-management practice and was accused of overprescribing painkillers from his Sandusky office.

If you recognize any of these signs, you can submit your anonymous tip through the DEA online Tip Line and report the doctors or facility. Pill mills are a problem. If the citizens of the community report they see signs of suspicious activity and more businesses keep an eye out for the above-mentioned signs as well, hopefully, these pill mills can be limited.

Scioto County doctor sentenced to 7 years in prison for role in pill mill (U.S. Attorney’s Office, Southern District of Ohio, November 2019)

WHEELERSBURG, OHIO – Dr. Margaret Temponeras, 55, of Portsmouth, Ohio, the owner and physician at Unique Pain Management, was sentenced to serve 84 months in prison for conspiring to distribute a controlled substance through the pain clinic and dispensary.

There will never be another medical practice in Ohio like the one Dr. Margaret Temponeras ran in the foothills of Appalachia. It took state lawmakers years to make sure of it.

From 2006 to 2012, Temponeras was able to order more than 1.6 million opioid pills from drug distributors. For many of those years, employees dispensed the doses from an office she set up in her pain clinic in Wheelersburg in Scioto County.

According to court documents, Dr. Temponeras and her father – Dr. John Temponeras, 84, also a doctor at the clinic – saw more than 20 patients daily, who paid cash payments starting at $200 for each medical examination. Many patients received monthly prescriptions for similar combinations of medications, namely, 120-150 pills of 15mg Oxycodone, 120-150 pills of 30mg Oxycodone, and 90 pills of 2mg Xanax.

Patients were referred to Raymond Fankell, 64, of Wheelersburg, Ohio, who owned Prime Pharmacy, to fill their prescriptions.

Dr. Temponeras became aware that some pharmacies in the Scioto County area had declined to accept or fill her prescriptions from Unique Pain Management, so she opened the dispensary Unique Relief LLC from the same location as her clinic to fill her own prescriptions.

Dr. John Temponeras and Pharmacist Fankell also pleaded guilty. John Temponeras pleaded guilty to conspiring to distribute controlled substances and Fankell to conspiring to distribute Oxycodone.

Drug Enforcement Administration and Federal Bureau of Investigation Cincinnati Division

Just days after state and federal agents raided Temponeras’ office in 2011, then-Gov. John Kasich signed a bill that restricted doctors’ handling of pain medication in their offices. In 2016, state lawmakers went a step further. They passed a law that required physicians to be licensed by the Ohio Board of Pharmacy if they kept narcotics in their offices.

Both laws would have prevented Temponeras and other pain clinics in southern Ohio from drawing hundreds of patients from across Appalachia, distributing large quantities of controlled substances and contributing to the region’s opioid-addiction crisis.

Temponeras and other pain clinic doctors in southern Ohio were able to go undetected so long because they were in a small, rural county on the edge of the state line.

“It was a pure money grab, a true criminal enterprise,” said Hall, who now works as an analyst for the High Intensity Drug Trafficking Area, a federal initiative that tracks and analyzes illegal drug trends in the state’s largest counties.

Brad Barbin, Temponeras’ attorney, said there was a lack of guidelines and standards across Ohio and the nation when it came to prescribing opioids from 2008 to 2011. He stressed that the pharmaceutical companies misled doctors about the safety of opioids.

Keith Humphreys, a Stanford University professor who has studied the opioid epidemic, said the medical industry should have known of the hazards of opioids when many of the so-called “pill mills” took hold.

Federal Prosecutors Charged 11 Doctors for Illegally Peddling Opioids in Appalachian States (Bill Chappell, NPR, September 2019)

“The alleged conduct resulted in the distribution of more than 17 million pills” in the Appalachian region, the Justice Department said.

The medical professionals facing charges represent a wide swath of the healthcare industry. Prosecutors from the Appalachian Regional Prescription Opioid Strike Force filed charges against 60 doctors, pharmacists, medical professionals, and others. Officials said those accused in the case were allegedly responsible for issuing more than 32 million pills—enough for an opioid dose for every person in Ohio, Kentucky, Tennessee, Alabama, and West Virginia.

Stark County Doctor Gets 113 Years in Prison for Deadly Pill Mill (FOX8, July 2019)

CANTON, OHIO. Dr. Frank Lazzerini, 41, a physician at Premier Family Practice in Massillon, prescribed opioids and other drugs without a medical reason, according to the State of Ohio Board of Pharmacy. He was convicted on 187 counts, including involuntary manslaughter, aggravated trafficking in drugs, Medicaid fraud, and grand theft.

Doctor Sentenced for Running a Pill Mill (Ohio Attorney General’s Office, August 2018)

DAYTON, OHIO. Dr. David Kirkwood, 62, was sentenced to 70 months in prison and five years of supervised release. According to court documents, David Kirkwood owned and operated Kirkwood Family Practice beginning in 1986.

According to the indictment, Dr. Kirkwood saw up to 100 patients per day, charging $100 per office visit (estimated $10,000 daily).

Dr. Kirkwood distributed nearly 4,000 units of oxycodone outside the scope of medical practice and not for a legitimate medical purpose. All of these units were paid for by Medicare or Medicaid. Dr. Kirkwood and his wife, Beverly Kirkwood, pleaded guilty to healthcare fraud. David Kirkwood also pleaded guilty to one count of unlawful drug trafficking.

“Our mission is to protect Ohio’s families, and we’ve made cracking down on pill mills a priority,” said Ohio Attorney General Mike DeWine. “David Kirkwood prescribed pills that never should have been prescribed and put his own interests above the health and safety of his patients.”

“David Kirkwood’s method of distribution was the prescription pad, but make no mistake: he was a drug dealer,” said U.S. Attorney Glassman. “His prescriptions exposed his ‘patients’ to the risk of overdose and encouraged their addiction.”

Ohio and Kentucky Doctors Among 60 Charged in Pain Pill Bust (Cincinnati Enquirer, April 2019)

Prosecutors said the specialties and methods varied among the accused, but the result in every case was the same: People addicted to pain medication received dangerous amounts of opioids, including oxycodone, methadone, and morphine. They said the illegal prescriptions put as many as 32 million pain pills in the hands of patients. The defendants were accused of writing or filling prescriptions outside the course of medical practices and prescribing them despite having no legitimate medical reasons to do so.

Prosecutors said a physician in Dayton, Ohio, collected $5,000 a month in rent from a pharmacy located in his office, which provided pills after he signed prescriptions. Several doctors were accused of signing blank prescriptions and leaving them for their office staff to fill out when they were unavailable or out of town.

At one of the clinics, Cincinnati Centers for Pain Relief, officials said patients were often prescribed fentanyl, oxycodone, morphine, and other highly addictive drugs without being seen by a doctor.

The range of schemes included sending patients across state borders to see another general practitioner, writing prescriptions at different intervals rather than the originally prescribed number of days, and having patients fill prescriptions at different pharmacies.

The Appalachian region has been hard hit by the opioid epidemic. Ohio was second in the nation for overall overdose deaths, and Kentucky ranked fifth in 2017. West Virginia was first, CDC data show.

“Opioid misuse and abuse is an insidious epidemic,” said John Martin, assistant administrator of the Drug Enforcement Administration. “Unfortunately, Appalachia is at the center of it.

Five Indicted for Running a Pill Mill in Ohio (Drug Enforcement Administration, June 2018)

HAMILTON, OHIO. Dr. Saad Sakkal, according to a 39-count indictment returned in Cincinnati, engaged in the illegal distribution of prescription drugs, including opioids. Dr. Sakkal was charged with being responsible for the deaths of at least two patients who died in 2016 due to complications resulting from drug use.

Dr. Sakkal, who was arrested by federal agents in Florida, began practicing at Lindenwald Medical Association, Inc. in Hamilton, Ohio, in February 2015. He also owned and operated the medical practice Metabolic Care Center in Mason, Ohio.

“According to the indictment, after Dr. Sakkal joined Lindenwald Medical Association, the type of patients changed, with patients waiting long periods of time in order to see him, including waiting outside in the parking lot for the practice to open,” U.S. Attorney Glassman said. Numerous pharmacies refused to fill Dr. Sakkal’s prescriptions, and pharmacists even called Sakkal to warn him of the risks inherent in his prescribing practices.

Dr. Rakesh Sharma, 47, of Alachua, Florida, was the previous owner of Lindenwald Medical Association, Inc. He allegedly directed employees to see as many patients per day as they could, typically between 40 and 60 per provider. He also promised bonuses based on the receivables in the office. It was alleged that patients were given very cursory exams and then prescribed controlled substances.

Dr. Nilesh Jobalia. According to the indictment in this case, Dr. Jobalia, 53, of Cincinnati, owned and operated Cincinnati Centers for Pain Relief in Hamilton, Ohio, from March 2013 through December 2017. Although the practice was not registered as such, it allegedly operated almost exclusively as a pain clinic. The 114-count indictment alleged patients were prescribed fentanyl, oxycodone, methadone, morphine, and other controlled substances on many occasions without actually being seen by the doctor. According to the indictment, at least one patient died as a result of using the prescribed controlled substances. Dr. Jobalia’s practice also billed Medicare, Medicaid, and the Bureau of Workers’ Compensation for medically unnecessary prescriptions.

Drug Enforcement Administration. State Medical Board of Ohio.

THE PILL MILL THAT RAVAGED PORTSMOUTH (Philip Eli, Cincinnati Magazine, July 2017)

How a small-time Chicago doctor came to the southeastern Ohio town of Portsmouth and helped spur an epidemic. Paul Volkman grew up in a working-class Jewish household in Washington, D.C. Volkman was the son of a pharmacist and a clerk at the U.S. Treasury Department. He attended the University of Rochester on a partial scholarship. There, Volkman was a model student. After graduating with honors, he enrolled in a new, federally-funded M.D./Ph.D. program at the University of Chicago called the Medical Scientist Training Program.

By the early 2000s, Dr. Volkman, then in his mid-50s, could not obtain malpractice insurance. And with a $4,000-per-month apartment on Chicago’s Lakeshore Drive and a wife who worked as a public school librarian, he needed to make another career shift. After a maximum of six months of unemployment compensation and brief stints chopping vegetables in restaurant kitchens, Dr. Volkman responded to an internet ad for a pain management clinic in Portsmouth, Ohio. The clinic was called Tri-State Healthcare, and the starting salary was $5,000 weekly. No malpractice insurance was required. Volkman got the job.

Like the other pain clinics in Portsmouth where Dr. Volkman had worked, the clinic only accepted cash—no insurance, no Medicaid. In exchange for $150, patients could expect to receive high doses of pain medications.

The advent of pill mills has been credited to a man named David Procter. A flamboyant, diamond-and-fur-wearing Canadian ex-pat, Procter practiced across the river from Portsmouth in South Shore, Kentucky, and his cash-only, heavy-prescription model would become infamous. “Procter’s business model spread like a virus, unleashing unstable doctors on a vulnerable region,” writes Sam Quinones, author of the award-winning book Dreamland: The True Tale of America’s Opiate Epidemic.

Many of the clinics that followed Procter’s example displayed the kinds of operating procedures described in a 2012 article on pill mills in Kentucky Law Enforcement magazine: “No physical exams are given; only cash is accepted as payment; excessive traffic to and from the doctor’s office; complaints from pharmacists about doctor’s practices; large cash deposits at the bank; [and] patients are in and out of the doctor’s office in minutes.” Volkman’s gig in Portsmouth checked a number of those boxes.

Tri-State Healthcare, which hired Volkman in 2003, was run by Denise Huffman, who had started the clinic two years earlier in South Shore, Kentucky. Huffman had no formal medical education and an employment history that included working in shoelace factories and fast food restaurants. Her experience with chronic pain treatment came primarily as a patient. In a 2006 deposition, Huffman said she “felt it was a good business that’s needed for the area.” Her daughter, Alice, who also lacked medical training, helped with the clinic’s day-to-day operations.

The Huffmans’ medical inexperience and Volkman’s commute were not the only unusual aspects of Tri-State Healthcare. It was a cash-only establishment, with the cost for one appointment reportedly ranging from $125 to $200. It was not affiliated with any of the local hospitals and maintained security measures you might expect more from a bank than a medical office. “As far as security, we have three to four large armed men in the clinic, and video and infrared cameras all about the building,” Volkman wrote in an e-mail at the time to a fellow pain doctor.

In a separate e-mail that was later introduced as evidence in his trial, he described the clinic’s clientele: “We have about 700 patients, most of whom are mine workers, pipe fitters, construction workers, truck drivers, carpet layers, who have been ruined by years of hard work and various wrecks, but who eagerly return to working 60 to 80 hours a week when given enough pain medicine so they can walk.”

Volkman claimed he followed appropriate medical procedures at Tri-State, including conducting physical exams, evaluating patient complaints, and reviewing medical records. He would later describe himself as a “law-abiding, responsible physician and family man with no previous history of violations of law and no history of any actions against him by any state medical board.” However, complaints were made against him almost immediately after he started working in Portsmouth.

In June 2003, a DEA diversion investigator in Columbus received a tip from a pharmacist in Kenova, West Virginia, about the amounts of Lorcet, Soma, Xanax, Lortab, and OxyContin Volkman was prescribing. Over the next 21 months, DEA offices in Louisville, Columbus, and Cincinnati received 10 similar complaints from other pharmacies. “Everybody got the same excessive quantities,” recalled one Kentucky pharmacist at the trial while explaining why he quickly refused to fill Volkman’s prescriptions.

Rebuffed by pharmacies, Volkman and the Huffmans began distributing the pills themselves, becoming equal parts clinic and pharmacy. On-site dispensaries were legal at the time in Ohio, provided that an on-site doctor kept a close eye on operations. This new business model proved profitable; the DEA estimates that between April 2003 and September 2005, Tri-State raked in over $3 million from cash payments for office visits and dispensary sales. But it also attracted unwanted attention.

In August 2003, a medical supply company notified the DEA in Ft. Worth, Texas, that Volkman had recently placed the largest order for the opiate hydrocodone the company had ever seen. That same month, another medical supplier in Connecticut notified the DEA that it had received an order for hydrocodone that exceeded the company’s limits for ordering.

According to the DEA, in 2004, Volkman, acting as a practitioner purchaser, ordered 457,100 dosage units of oxycodone, 106,100 more than the next closest doctor in the United States. Dr. Volkman’s orders accounted for 96% of all the oxycodone sold directly to practitioners in Ohio that year and were 97 times greater than the national average. Some of his prescriptions called for patients to take 30 pills each day. The DEA further found that between June 2003 and October 2005, there were 11 overdose deaths in Kentucky and Ohio that appeared to be linked to Volkman prescriptions. Ten of those overdose victims were under 40 years old.

In September 2005, according to a search warrant, one Portsmouth Police informant stopped in to see Volkman and received prescriptions for 180 oxycodone pills, 180 Lorcet (a hydrocodone-based painkiller) pills, 120 Soma (a muscle relaxer) pills, and 90 Xanax. Two days later, another informant received a prescription for 270 oxycodone pills, 270 Percocet, 120 Somas, and 60 Xanax. The Tri-State Healthcare clinics brought in thousands of dollars in cash and pumped out thousands of pills in a region that was already being described in the Portsmouth Daily Times as “The OxyContin Capital of the World.”

Despite the complaints, unprecedented pill orders, a DEA raid, and patient deaths, Dr. Volkman continued to see patients at Tri-State Healthcare for nearly two and a half years.

After a falling out with the Huffmans in September 2005, Dr. Volkman began writing prescriptions in his Center Street apartment for three weeks until a police raid shut him down. Undeterred, he opened another office 40 miles north of Portsmouth in a double-wide trailer beside Route 23 on the outskirts of Chillicothe. A sign advertised to passing drivers: “Paul H. Volkman, M.D. PAIN MANAGEMENT.” One former employee told the DEA that he believed Volkman took in $9,000 in cash on the Chillicothe clinic’s first day of operation.

In December 2005, a DEA agent surveilled the trailer office for four and a half hours in the middle of the day and saw approximately 25 patients walk in. He noted cars parked from eastern Kentucky and one from 100 miles away in Nitro, West Virginia. According to the employee, some days Volkman would see patients as early as 7 a.m.; others, as late as 2 a.m.

Stoney Carver watched his wife die from an overdose of pills she had been prescribed by Volkman, yet he still continued to go to the doctor. His reason was simple: “I was hooked on drugs.”

The way Dr. Volkman tells it, his practice was a win-win for all parties. He said he felt he was “serving a desperately poor…underserved part of the population, giving them very good service, and making a very good living at the same time.” In a document submitted before his sentencing, he scoffed at any notion of himself as a drug dealer.

In February 2006—nearly three years after Volkman began working in southern Ohio—authorities raided Volkman’s trailer in Chillicothe. A few days later, the DEA revoked the registration that allowed him to prescribe controlled substances. Over the ensuing months, he fought the DEA in court to reinstate that registration but was denied. Instead, on May 21, 2007, around 7:30 a.m., Volkman heard a loud knock on the door of his Chicago apartment. Waiting for him on the other side of the door was what he would later describe in a 2009 interview as “a SWAT team of about 16 DEA agents wearing flak jackets and masks, [with] guns drawn.”

Dr. Volkman was arrested and arraigned on 22 federal counts and temporarily imprisoned in downtown Chicago. He was eventually released and spent most of the next four years awaiting trial as a free man.

All told, Dr. Volkman spent nearly three years working in southern Ohio, and his four offices—three in Portsmouth, one in Chillicothe—stood out despite their plain exteriors. The buildings were patrolled by armed guards, and some were monitored by video cameras; numerous local pharmacies refused to fill Volkman’s prescriptions from inside them, and local and federal law enforcement received a steady stream of complaints.

A prosecutor described the scene at one clinic as “like a Led Zeppelin concert: six to ten cars waiting at 6 a.m.” On Center Street, traffic jumped noticeably during Volkman’s office hours, with some cars bearing license plates from Kentucky and West Virginia. A neighbor remembered seeing a minivan filled with people waiting to see the doctor; one was knitting. On other days, she said, visitors with slurred speech mistakenly rang her doorbell in the early morning hours looking for the doctor or left fast-food wrappers on her lawn. She remembered seeing an armed man patrolling the premises next door.

Inside the house, Dr. Volkman saw patients in one of the bedrooms. The living room and backyard served as waiting areas while patient files were kept in filing cabinets in the kitchen. According to law enforcement documents, two patients died within days of receiving prescriptions written at the house. One, a 30-year-old who had seen Volkman at least five times before, succumbed to what a coroner described as “multiple drug intoxication.” Another, a 39-year-old man, died from “acute multiple drug intoxication (oxycodone and others),” according to his death certificate.

The apparent danger of the house on Center Street did not go unnoticed.

In 2010, an Associated Press article reported that nearly one in 10 babies were born addicted to drugs in Scioto County. In 2011, the town was featured on The Dr. Oz Show with the heading “A Town Addicted to Pain Killers.” When the Volkman trial began on March 1, 2011, the Scioto County Board of Health had declared a public health emergency. Around that time, Portsmouth Health Department public health nurse Lisa Roberts told a crowd of police officers and detectives, “I think it’s the first time, probably ever, in the history of the world that a public health emergency has been declared by a doctor as a result of something that other doctors are doing.”

Few people know the history and extent of Scioto County’s drug problems, as well as Roberts. She described the area as being hit by a “pharmaceutical atomic bomb” over the last 20 years, with “several hundred” overdose deaths and at least 10 doctors or clinic owners convicted of illegal prescription drug diversion. According to Roberts, Dr. Volkman helped “set the stage for this epidemic that we found ourselves in.” She sees him as a link in a chain of corrupt physicians who together represent an era when Scioto County became “a dumping ground for every crazy, disgraced doctor that couldn’t make an honorable living being a doctor anymore and came here and just wrote prescriptions for narcotics.”

After a 10-week trial in Cincinnati in 2011, a jury convicted Dr. Volkman on 18 counts, including one count of firearm possession in furtherance of a drug-trafficking crime, four counts of maintaining a drug-involved premises, eight counts of unlawful distribution of controlled substances, and four counts of causing the death of another by unlawful distribution.

During Volkman’s criminal trial in federal court in Cincinnati, Diana Colley testified about the day she drove to the house to plead with the doctor to stop prescribing pills to her son, a recovering addict who had recently relapsed. She described how she interrupted a visit with a different patient to tell Volkman that her son was an addict. When Dr. Volkman told her that he would take it under consideration, she told him “that if he wrote another prescription in…my son’s name, I had a .38 that would convince him not to.”

Unfortunately, tales of corrupt doctors are nothing new in Ohio or the nation. But even on a long list of such illicit operations, the Volkman case stands out. Between 2003 and 2005, while playing the role of both doctor and pharmacist, he led the nation in purchasing and dispensing the opioid painkiller oxycodone, and a jury would later find him responsible for the overdose deaths of four of his patients. In 2012, Dr. Volkman received one of the longest sentences for prescription drug dealing in American history: four consecutive life terms.

Volkman, meanwhile, believes unequivocally in his innocence. One of his lawyers once described him as an “accomplished, experienced, competent physician working in a rural, under-served area trying to help manage the pain of his patients.” At his 2012 sentencing hearing in Cincinnati, he told the courtroom that he had no regrets about his actions and no apologies to make.

Shawn Ryan, M.D., president of the Ohio Society of Addiction Medicine, said that one of the key triggers of addiction is exposure to the addictive substance, and these clinics “fulfill[ed] that critical component of addiction…en masse.” Meanwhile, prosecutors have said that in southern Ohio, the Volkman operation was “one of the clinics that showed the other clinics how to start.”

According to one DEA official, Volkman was “as bad as any doctor in the country.” His story, and those of other pain clinics, stand as the prologue to a public health disaster.

At one point, there were more than a half-dozen pain clinics in operation for a county with a little over 75,000 people. With the help of Ohio House Bill 93, the anti-pill mill legislation signed by Governor John Kasich, many clinics have been shut down.

Volkman is now part of a legacy of corrupt doctors that swooped into southern Ohio, profited through pill mills, and ended up in prison. That includes physicians like David Procter, who pioneered the business model; John Lilly, a Princeton- and University of Cincinnati–educated former surgeon who pled guilty to corrupt activity; and dozens more both in the region and across the country. Some have served their time in relative silence, others have vocally opposed court rulings. Few have been as bombastic as Volkman in their own self-defense.

It wasn’t just the doctor who wound up facing punishment, either. Denise Huffman, the owner, operator, and founder of Tri-State Healthcare, remained in federal prison with a scheduled release in September 2020. Her daughter Alice pled guilty to operating and maintaining a drug-involved premises and testified at Volkman’s trial; she was sentenced to five years in prison and released in 2016. Harold Eugene Fletcher, a Columbus pharmacist who filled many of Volkman’s prescriptions, received a two-year sentence for distributing oxycodone and filing false tax returns and a lifetime ban from working as a pharmacist.

Meanwhile, the Volkman case has become a study of illegal prescription drug diversion. One of the lead DEA agents on the case delivered a slideshow titled “Pill Mills & Pain Clinics: United States v. Volkman” at the National Conference on Pharmaceutical and Chemical Diversion in Cincinnati in 2012. Slides from the presentation included a photograph of a safe filled with hastily piled cash and copies of a signed patient waiver that Volkman used in an attempt to shield himself from law enforcement.

‘Pill Mill’ Operators Sentenced

CINCINNATI, OHIO. Christopher Stegawski, 65, of Cleveland, and John Randy Callihan, 58, of Portsmouth, were sentenced for running “pill mills.” As many as 40 patients would visit the clinics each weekday. In some cases, customers traveled over 200 miles roundtrip to obtain prescriptions from the doctor. Dr. Stegawski knowingly prescribed large amounts of prescription drugs to drug abusers and addicts, who were charged $200 cash per visit and received at most a cursory examination.

During the tenure of the pain clinics, many local pharmacies refused to honor any prescriptions written by Stegawski due to the “large quantities of narcotics” and his “catering to customers with prior drug abuse and arrest histories.”

According to court testimony, from November 2009 until May 2012, Stegawski and Callihan owned and/or operated a business initially known as Eastside Medical Specialist in Dayton, Ohio. In February 2010, the business moved to Lucasville, Ohio, and the name was changed to Lucasville Medical Specialist. Stegawski took over the ownership of Lucasville Medical Specialist and listed his partner and co-conspirator, Callihan, as an employee.

Stegawski represented himself as a chronic pain management doctor at these clinics and an unnamed clinic located in Southpoint, Ohio. The clinics operated as “pill mills” by selling prescriptions for controlled substances, primarily oxycodone, without a legitimate need for the prescriptions. There was no valid doctor-patient relationship, and many of the prescriptions were openly sold and diverted.

Stegawski had a DEA registration number that allowed him to order controlled substances for the clinics. Stegawski received a medical degree in Warsaw, Poland, in 1977 and was purportedly trained to specialize in anesthesiology. The Ohio Board of Pharmacy suspended Stegawski’s license to practice medicine.

A United States District Court jury convicted Stegawski of one count of conspiracy to distribute and dispense prescription drugs, one count of conspiracy to launder money, and two counts of maintaining a place for illegal distribution of drugs. Stegawski and Callihan were charged in an 11-count-indictment by a grand jury on May 16, 2012. Callihan pleaded guilty to conspiracy to distribute and dispense prescription drugs and money laundering. Stegawski was sentenced to 160 months in prison and 10 years of supervised release. Callihan was sentenced to 60 months in prison and five years of supervised release. Ohio Bureau of Criminal Investigation

Leader of Ohio Pill-Mill Trafficking Scheme Sentenced (Paul Rodzinka, 2News, July 2015)

COLUMBUS, OHIO — Prosecutors said Donald Fraley, 41, ran a pill-mill trafficking ring between Ohio and Florida.

Authorities said Fraley promised addicts and other couriers cash or drugs to travel to Florida and bring back thousands of prescription pain pills for him to sell between 2008 and 2014.

The Columbus Dispatch reported that Fraley pleaded guilty to conspiring to traffic oxycodone. In sentencing Fraley to 12 years and seven months, U.S. District Judge Michael Watson told Fraley he contributed to a “pipeline of death.”

Man Behind OxyContin Plague Sentenced to 14 Years in Ohio Pill Mill Case (Amanda Myers, Akron Beacon Journal, May 2014)

Tracy Bias, 49, of West Portsmouth, pleaded guilty in federal court in Cincinnati to conspiracy to distribute a controlled substance.

Prosecutors say Bias and another man, Bart Journey, operated several pain clinics in southern and central Ohio between January 2009 and June 2011, drawing customers who would travel hundreds of miles and pay $200 per visit for painkillers.

The pill mills raked in an estimated $6.7 million, money that prosecutors said Bias and Journey split after paying doctors around $24,000 a month to write prescriptions. The operation contributed to the deaths of at least two people and plunged countless others deeper into devastating addictions, prosecutors said.

A judge sentenced the operator of several Ohio pill mills to 14 years in prison, calling him a parasite who fed the prescription drug addictions of hundreds of people for profit and contributed to an “OxyContin plague.”

Judge Michael Barrett said, “They were feeding the addictions of hundreds of people. The number of pills prescribed was in the thousands if not millions.”

If you are aware of controlled substance violations in your community, you can submit your anonymous tip through the DEA online Tip Line.

As the fight against the opioid crisis continues, State and Federal Authorities are working to shut down phony Pain Clinics that are really just fronts for criminals who divert pharmaceutical drugs and hook a new generation of people with an addiction.

The new licensing law requires opioid-treatment offices, like pain-management clinics, to be owned and operated solely by one or more doctors authorized to practice in Ohio. The board can, however, waive that requirement, so it’s not yet known how many of those that ultimately obtain licenses will be doctor-owned.

“We face a moment in our country where more than 100,000 of our fellow Americans die each year from drug overdoses,” United States Attorney Christopher R. Kavanaugh said. “We must do all we can to support those battling addiction disorders and prosecute those who prey on this disease.”

The opioid crisis and drug overdoses continue to devastate our states and local communities.

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Pain Killer by Barry Meier

Between 1999 and 2017, an estimated 250,000 Americans died from overdoses involving prescription painkillers, a plague ignited by Purdue Pharma’s aggressive marketing of OxyContin. Families, working class and wealthy, have been torn apart, businesses destroyed, and public officials pushed to the brink. Meanwhile, the drugmaker’s owners, Raymond and Mortimer Sackler, whose names adorn museums worldwide, made enormous fortunes from the commercial success of OxyContin.

In Pain Killer, Barry Meier tells the story of how Purdue turned OxyContin into a billion-dollar blockbuster. Powerful narcotic painkillers, or opioids, were once used as drugs of last resort for pain sufferers. But Purdue launched an unprecedented marketing campaign claiming that the drug’s long-acting formulation made it safer to use than traditional painkillers for many types of pain. That illusion was quickly shattered as drug abusers learned that crushing an Oxy could release its narcotic payload all at once. Even in its prescribed form, Oxy proved fiercely addictive. As OxyContin’s use and abuse grew, Purdue concealed what it knew from regulators, doctors, and patients.

Here are the people who profited from the crisis, those who paid the price, those who plotted in boardrooms, and those who tried to sound alarm bells. A country doctor in rural Virginia, Art Van Zee, took on Purdue and warned officials about OxyContin abuse. An ebullient high school cheerleader, Lindsey Myers, was reduced to stealing from her parents to feed her escalating Oxy habit. A hard-charging DEA official, Laura Nagel, tried to hold Purdue executives to account.

In Pain Killer, Barry Meier breaks new ground in his decades-long investigation into the opioid epidemic. He takes readers inside Purdue to show how long the company withheld information about the abuse of OxyContin and gives a shocking account of the Justice Department’s failure to alter the trajectory of the opioid epidemic and protect thousands of lives. Equal parts crime thriller, medical detective story, and business exposé, Pain Killer is a hard-hitting look at how a supposed wonder drug became the gateway drug to a national tragedy.

Unintended Consequences of Rx Pain Pill Law (NBC4 Columbus, YouTube video)

Pill Mills: Investigations and Consequences (Attorney Michael V. Favia, Chicago, August 2018)

Opioids and Appalachia (Sally Satel, AEI National Affairs, April 2023)