January 2, 2024 - How Pain Doctors Massive Opioid Prescriptions Lead to Pain Pill Overdose Deaths

Investigation Reports. Physicians prescribed pain pills outside the bounds of legitimate medical practice. The offenses included a conspiracy to dispense oxycodone and other pharmaceutical drugs without a legitimate medical purpose. These medical doctors distributed copious quantities of opiate-based pills to scores of drug-seeking patients.

The Owners and Operators of these Pain Relief Centers generated mass profits by charging patients cash for appointments during which they issued prescriptions for controlled substances for medically inappropriate and potentially lethal dosages and combinations.

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

Brevard, Florida Doctor Became Known as “The Pill Man” (John A. Torres, Florida Today, November 30, 2023)

Dr. John Gayden, Jr. Indialantic Internal Medicine. In the early 2000s, Dr. Gayden dispensed more opioid prescriptions than the entire state of California.

Lines of addicted people snaked out the front door ready to spend $200 or $400 and leave with more than 100 oxycontin pills. A hot dog vendor set up shop in the parking lot.

According to court transcripts, 10 people whose lives ended because of an opioid addiction were: Frank DeLuca, Andrea Steward, Michelle Jones, Stephanie Whitehouse, Paul Rosaci, Luis Arguelles, Stewart Fraser, Nicholas Giles, Lori Darling, and Korianne Lundstrom.

People flew into Melbourne Airport to get prescriptions, and cars with license plates from as far away as Virginia filled the roadways. Eventually, chain pharmacies like Walgreens and CVS refused to fill any script written by Dr. John Gayden Jr.

And yet, still he was in business.

Police spoke of their frustration at trying to shut the doctor down. They surveilled, sent in undercover agents and wire-tapped willing patients. But it was not so easy to stop the doctor inside.

How do you prove a doctor is practicing bad medicine when the doctor is the presumed expert on what his patients need?

The stakes were high. Beachside residents reported seeing barely coherent teenage girls along the streets, mothers stopped walking their children down sidewalks to avoid the people who lay passed out, homes turned into “ghost” properties where excess pills were shared and sold.

“Whatever you say about a person who is distributing drugs on a street corner, they tend to be fueling an existing problem. They tend to be servicing existing addicts,” said federal prosecutor Dana Hill, who used to be part of a federal Drug Enforcement Administration unit that revoked licenses of doctors committing illegal acts.

“Whereas a doctor who is giving out drugs too recklessly, too freely, too casually is often creating new addicts where none existed before.”

Finally, an opportunity to stop Dr. Gayden came thanks in part to a large bag of marijuana and underage teen girls.

After losing his practice and his medical license, Dr. Gayden faced charges of dispensing oxycodone outside the usual course of professional practice and for no legitimate medical reason. The judge at his trial put it this way: for “poisoning the community.”

It’s debatable whether justice came for the 10 people whose names were read out by U.S. District Judge Carlos Mendoza as he sentenced Gayden to more than 18 years in federal prison.

“Your client is a monster and not just a monster, an arrogant monster,” Judge Mendoza said. And that’s when the judge read those names.

10 people whose lives were lost by opioid addiction. 10 people, who the judge said, are “just some of the people who he profited off of.”

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.

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.

Baltimore, Maryland: Medical Director of Baltimore County Pain Management Clinic Pleads Guilty to Conspiracy to Distribute and Dispense Oxycodone (U.S. Attorney’s Office, District of Maryland, June 16, 2022)

TOWSON, MARYLAND. Dr. Norman Rosen, 84, pleaded guilty to conspiracy to distribute and dispense oxycodone in connection with his operation of Rosen-Hoffberg Rehabilitation and Pain Management Associates, P.A., where he was Medical Director and part owner. Rosen’s partner in the business and the Practice’s Associate Medical Director was Howard Hoffberg.

According to Rosen’s guilty plea, patients were often prescribed high doses of oxycodone, and other opioid medications. Some patients were issued prescriptions for opioids after routinely providing aberrant urine toxicology screens, including positive results for cocaine, heroin, and other street drugs; positive results for controlled substances that were not prescribed by the Practice (which indicated the patient was likely buying medications off the street or was doctor-shopping); and/or negative results for the controlled substances prescribed by the Practice (which indicated prescribed substances were either not taken, being consumed too quickly, or sold by the patients).

Dr. Rosen knew that the Practice received complaints about the behavior of patients, including reports of suspected drug transactions in the parking lots near the Practice. At times, patients were observed “nodding out” in the waiting area. Some patients tried to bring in urine that was not theirs in order to pass urine toxicology screens. Some patients overdosed, some of these patients required hospitalization, and some died.

Several major pharmacies refused to fill any prescriptions issued by the Practice because of the high doses being prescribed. Both Rosen and Hoffberg were aware of the conditions at the Practice and yet continued to prescribe medications to these patients.

As detailed in his plea agreement, as the Medical Director, Dr. Rosen established the rules for the Practice. One of his rules was that the customer, i.e., the patient, is always right. Sometimes, when other providers at the Practice discharged certain patients, Rosen continued to treat the patients at the Towson location. At times, if a patient failed a urine toxicology screen because of illicit substances in their system, such as heroin or cocaine, Rosen declined to discharge the patient and instead required the patient to return to the Practice more frequently for follow-up, sometimes as much as three times a week.

Dr. Rosen admitted that he issued prescriptions to some patients outside the bounds of the usual medical practice and not for a legitimate medical purpose. For example, Rosen prescribed large doses of oxycodone and clonazepam to a patient who had eight toxicology screens that were positive for cocaine and whose children had been taken from her because of her drug problems. Similarly, Rosen ignored the red flags and prescribed oxycodone and methadone to a patient who admitted to illicit drug use, had previously been criminally charged for prescription fraud and drug trafficking, had overdosed, had urine toxicology screens that were positive for heroin, cocaine, and marijuana; and had been accused of selling her pills.

Dr. Rosen faced a maximum of 20 years in prison. United States Attorney Erek L. Barron commended the FBI, the DEA, HHS-OIG, and the Baltimore County Police Department for their work in the investigation.

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

Opioid painkillers such as oxycodone have been identified as one of the primary reasons for the tragic increase in prescription drug overdose deaths, and they are being prescribed in the United States at an unprecedented rate.

Oxycodone was a money-maker for these criminal enterprises operating as pain management clinics or medical clinics. Red Flags: These centers received many patients daily, including people from out of state, accepting cash payments only for prescription pills.

Dr. Mohammad Derani. State Police raid the Dearborn Medical Clinic (YouTube Video)

DEARBORN, MICHIGAN. Dr. Mohammad Derani, Dearborn Medical Clinic. The FBI and Michigan State Police raided the Clinic at Warren and Yinger Avenues after residents complained about disorderly conduct, which prompted an investigation. Months before the raid, community members had sent photos and videos showing the chaos around the clinic. The SAFE Substance Abuse Coalition Board Members also took the initiative and contacted the police, the DEA, the Department of Justice, and State regulators.

One resident who lived near the clinic had reported several complaints to the police, but they told him to keep calling so the case could be built up through his complaints as well as others. “The Chief kept asking us to be patient because something is coming,” he said. The resident told his neighbors to call the police and complain. He even shared photos and videos he took of drug dealing and filth around the clinic with police as evidence.

The resident said the pill mill trashed the area with beer bottles, garbage, alcohol, and crates.

“These patients would line up at 10 p.m. or 11 p.m. until 9 a.m. when the clinic opened. They often brought chairs and milk crates to sit on and wait. The neighbor said they would urinate in his yard since there were no restrooms available at night.

After learning about the raid on Facebook, other community members shared what they had witnessed when passing by the clinic. One witness said, “Every morning, I pass by there, and I always think it’s Black Friday.”

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. U.S. Drug Enforcement Administration

Wisconsin: Pain Clinic Owners Sentenced to Federal Prison for Illegal Opioid Prescribing (December 2021)

WAUWATOSA, WISCONSIN. Lisa Hofschulz and Robert Hofschulz were the owners and operators of Clinical Pain Consultants (“CPC”). Following a 9-day trial in August 2021, a federal jury found Lisa Hofschulz guilty of unlawfully distributing Oxycodone, Methadone, and other opioids outside of a professional medical practice and not for a legitimate medical purpose. The jury also found that Lisa Hofschulz’s unlawful distribution of controlled substances resulted in the death of at least one patient.

The evidence presented at trial established that Lisa and Robert Hofschulz ran CPC as a “pill mill” through which they distributed millions of opioids and other controlled substances throughout 2015 and 2016. The evidence showed that Lisa Hofschulz prescribed opioids and other dangerous controlled substances to 99% of patients, each of whom paid $200 in cash per month for their prescriptions.

For at least one patient, Lisa Hofschulz’s prescriptions resulted in death. According to the trial evidence, during 2015 and 2016, Lisa Hofschulz was the number one prescriber of oxycodone and methadone in Wisconsin, as compared to all Medicaid providers.

“The opioid crisis continues to disrupt lives and cause injuries and overdose deaths throughout Wisconsin,” said Acting United States Attorney Frohling. “For many, the road to opioid addiction began with prescription drugs like the ones that CPC and the Hofschulzes willingly provided in exchange for cash. The Justice Department remains committed to holding accountable individuals who abuse their prescribing privileges to enrich themselves without regard to the damage done to their patients and their communities.”

“With nearly 100,000 Americans dying each year due to opioid overdose, medical professionals who violate their oaths to do no harm must be fully held accountable,” said John G. McGarry, Assistant Special Agent in Charge for U.S. Drug Enforcement Administration-Wisconsin

Former Long Island Doctor Sentenced to 23 Years for Causing the Overdose Deaths of Two Patients and Illegally Distributing Oxycodone (U.S. Attorneys Office, Eastern District of New York, December 2021)

MERRICK, NEW YORK. Dr. Michael Belfiore, 58, of Westbury, NY, a former doctor of osteopathic medicine, illegally distributed oxycodone outside the usual course of professional practice and not for a legitimate medical purpose.

Oxycodone is a powerful and highly addictive drug that is increasingly abused because of its potency when crushed into a powder and ingested. It is a controlled substance that may be dispensed by medical professionals only to patients suffering from significant pain that is documented through medical exams, diagnostic testing—such as x-rays and MRIs—and other objective proof. Although oxycodone is commonly prescribed in five-milligram tablets, the trial evidence showed that Dr. Belfiore wrote thousands of 30-milligram prescriptions for oxycodone in quantities of up to 180 pills per month.

At trial, the evidence established that on February 28, 2013, Dr. Belfiore gave an illegal prescription for 120 30 mg oxycodone pills to 42-year-old Edward Martin. On March 5, Mr. Martin overdosed and died in his bed after snorting the oxycodone obtained from Dr. Belfiore’s prescription.

On April 12, 2013, Dr. Belfiore gave an illegal prescription for 150 30 mg oxycodone pills to 32-year-old John Ubaghs. On April 13, 2013, Mr. Ubaghs was found unresponsive after overdosing on oxycodone prescribed by Dr. Belfiore and was pronounced dead at the hospital. Between March 2013 and August 2013, Dr. Belfiore intentionally dispensed six prescriptions of oxycodone without a legitimate medical purpose to an undercover detective with the NCPD’s Narcotics Vice Squad. Dr. Belfiore created fake medical charts to justify those prescriptions. During office meetings with the undercover detective, Dr. Belfiore’s “treatment” consisted of a discussion of the defendant’s trip to San Diego and his interest in helicopters, yachts, and cigarette boats.

“It is unconscionable that doctors and health care professionals would violate their oath to do no harm and exploit vulnerable patients struggling with addiction,” said Assistant Attorney General Kenneth A. Polite Jr. of the Justice Department’s Criminal Division. “These are not just crimes of greed; these are crimes that make this country’s opioid crisis even worse – and that is why the department will continue to relentlessly pursue these cases.”

Dr. Michael Belfiore—A New York Doctor Charged in the Overdose Deaths of Two of His Patients sat down with Crime Watch Daily to tell his side of the story (YouTube Video, March 2021)

In July 2020, Michael Belfiore was denied a request for a new trial following his May 2018 conviction on 28 federal charges related to his prescribing of opioids.

“During the midst of an opioid epidemic, the defendant chose to use his education and medical training to do harm, and at the expense of two of his patients’ lives,” stated DEA Acting Special Agent-in-Charge Kruskall. “DEA and its law enforcement partners will continue to seek justice for the victims who have been betrayed and have suffered greatly at the hands of those who were trusted with their health and well-being.”

“In violation of his oath to do no harm, Dr. Belfiore intentionally distributed highly addictive and potentially lethal opioids in dosages and quantities that resulted in the overdose deaths of two of his patients,” stated United States Attorney Peace. “Today’s sentence sends a strong message that this Office and its law enforcement partners will fight the opioid epidemic and seek serious punishment for medical professionals like Dr. Belfiore who betray their profession and use their prescription pads to further addiction, rather than as a tool to heal. I want to extend my sincere thanks to DEA’s Long Island Tactical Diversion Squad, who tenaciously investigated this case.”

Nassau Doctor Charged with Five Counts of Murder for Depraved Prescription Abuse (Drug Enforcement Administration, March, 2021)

Dr. George Blatti, a General Practitioner originally licensed to practice medicine in 1976, had no specialized training or accreditation in pain management. For a time, he maintained a makeshift office in a Franklin Square storefront that was formerly a Radio Shack, with a Radio Shack sign and merchandise racks on the walls.

The original indictment alleged that Blatti met customers at his Franklin Square office through 2019, and after he lost access to that space, saw patients in his car, prescribing medications with no examination from the parking lots of the Rockville Centre hotel where he lived and a nearby Dunkin’ Donuts.

The grand jury charged that patients who were addicted to opioids went to Blatti with their requests for controlled medications, and the defendant allegedly prescribed drugs with no medical history review or exam. He billed insurance and accepted cash. In some cases, he allegedly prescribed opioid painkillers at patients’ request to individuals he had never met or spoken to. Blatti used paper prescriptions pursuant to a waiver issued by the New York State Health Commissioner, allowing him to avoid using the state’s secure electronic prescription system, which is generally required, and provides for greater oversight.

“This doctor’s prescription pad was as lethal as any murder weapon,” District Attorney Singas said. “We allege that Dr. Blatti showed depraved indifference to human life, total disregarded the law, his ethical obligations, and the pleas of his patients and their family members when he prescribed massive quantities of dangerous drugs to victims in the throes of addiction, ultimately killing five patients who entrusted him with their care. As we continue to battle the epidemic of opioid abuse that has ravaged our communities, this prosecution sends a strong message to any doctor seeking to profit from vulnerable patients’ addiction: we will hold you accountable to the greatest extent the law allows.”

Dr. Blatti was arraigned on five counts of murder for prescription practices that led to the death of five patients between 2016 and 2018.

The Nassau County Police Department began an investigation into several opioid overdoses, both fatal and non-fatal, in August 2018. That investigation revealed that certain individuals had an inordinate number of prescriptions for opioids written by the same physician, Dr. George Blatti. At that time, NCPD began working jointly with members of the DEA’s Long Island District Office.

According to the superseding indictment, Geraldine Sabatasso began seeing Blatti in 2007 for acute pain following an earlier neck surgery. According to records, Blatti was aware that his patient smoked and suffered from chronic obstructive pulmonary disease dating back to 2008. Beginning in 2010, the defendant allegedly prescribed Sabatasso opioids and continued to prescribe opioids until her death. In February 2016, the victim fell and complained of dizziness and difficulty walking a straight line, and on March 15, 2016, she complained of shortness of breath and feeling weak—clear signs of opioid addiction. Despite presenting these serious symptoms, Blatti prescribed more clonazepam and oxycodone, and tragically, Ms. Sabatasso died seven days later at the age of 50 of acute oxycodone intoxication on March 22, 2016. It is well established that this combination of opioids and benzodiazepines can have potentially fatal consequences for people with decreased breathing capacity.

“This is a tragic story of lives lost at the hands of someone entrusted to save lives,” DEA SAC Ray Donovan said. “This defendant’s alleged conduct was unconscionable. Our fight against the opioid epidemic continues, as evident in this case.

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.

ST. BERNARD PARISH, LOUISIANA. Pharmacist Dan Schneider noticed a high number of people coming into his pharmacy to fill prescriptions for OxyContin. At first, he would simply try to warn patients of the addiction potential for the drug. But eventually, he could no longer ignore the problem. He looked over the pharmacy’s paperwork and made a startling discovery.

Schneider noticed that most of the prescriptions were coming from the same physician, Dr. Jacqueline Cleggett, who was a Pediatrician, but had opened a Pain Management Clinic.

Typically, a doctor would prescribe a patient a lower dose of a painkiller, and increase the dosage as needed. Dr. Cleggett would start patients on a high dosage, typically 40 milligrams of OxyContin. She also prescribed Soma, a narcotic muscle relaxer, and Xanax, an anxiety drug which is often abused. The three medications are known as “The Holy Trinity.”

A DEA agent stated that Clegget had written 182,723 prescriptions distributed among 10 pharmacies over the course of one year. They discovered that Dr. Cleggett did not examine her patients before prescribing them painkillers, and treated as many as 76 patients per day, predominantly during evening hours.

The DEA had sent undercover agents as patients to confirm the legitimacy of the clinic and they observed that the parking lot of her practice was always crowded especially overnight. Investigators reported seeing license plates from Mississippi, Georgia, Alabama, and Tennessee. There were patients who often waited days for an appointment, some even camped out in their cars. Most of the patients received identical prescriptions and paid in cash. Cleggett deposited her profits of $2 million in one year. It was evident that Cleggett was not practicing medicine; she was running a pill mill.

Patients paid $250 to be seen by Cleggett and could pay an extra $150 to be seen quickly. One patient said he waited for 12 hours to be seen. One of his friends, another patient at the clinic, once waited two days in the office to be seen. It was common for patients to resell their prescriptions to those who were waiting. Pills would go for $30 to $80.

Schneider was told that he needed to present solid evidence to the Medical Board to catch Dr. Cleggett. Schneider got the smoking gun he needed when a teenage girl was prescribed Soma®, Valium®, Roxycodone®, and high dosages of OxyContin®. The combination which was commonly known as the “holy trinity”, was a definite overdose for her weight of 100 lbs. To catch Dr. Cleggett in the act, Schneider called her to confirm that she had prescribed the combination, to which she admitted.

Schneider talked to the doctor who had discharged the patient from the hospital and discovered that the patient was discharged on Tylenol® and that Dr. Cleggett was in the wrong.

When presented with the case, the Medical Board took action, which prompted the DEA to take action. Many boxes of prescriptions that were already signed and awaiting to be dated were found in her clinic and taken as evidence against her malpractice.

Dr. Jacqueline Cleggett-Lucas pled guilty to conspiracy to dispense and distribute controlled substances, including oxycodone. Her medical license was later revoked.

The clinic operated at unusual hours, from the late afternoon until 2 a.m. or later, authorities said, adding that there was always a large number of patients at her office regardless of the time of day.

In addition, authorities learned through a joint investigation conducted by the U.S. Drug Enforcement Administration and the Tri-County Narcotics Task Force in Jackson, Miss., that Cleggett had supplied prescriptions for Oxycontin to a group of people who redistributed the drugs throughout Mississippi. A large number of the cars had Mississippi or Florida license plates, and all payments for visits were on a “cash only” basis.

The case was investigated by the Drug Diversion Unit of the Drug Enforcement Administration. DEA New Orleans Division

Although Louisiana has made many changes to prevent substance abuse, the state still has a long way to go. In 2018, the National Institute on Drug Abuse reported 79.4 opioid prescriptions for every 100 persons were written in Louisiana. This was higher than the national average rate of 51.4 prescriptions.

Louisiana was among the top five states in the country for highest rates in 2018. Almost 40% of the reported drug overdose fatalities (1,140) in Louisiana involved opioids in 2018 totaling 444 deaths.

The Pharmacist is a Netflix documentary that showcases Pharmacist Daniel Schneider’s crusade against prescription pain pill abuse. It highlights his discovery of a corrupt doctor who exploited her medical license and destroyed communities in Louisiana.

Pharmacist Daniel Schneider’s story proves that if one person speaks up, a whole system can change.

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 continued prescribing opioids “even after learning that some of his patients had experienced overdoses, and in some cases, deaths,” according to the federal indictment.

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.

“Patients look to physicians and medical professionals for their expertise and knowledge, trusting that they will do what is best to take care of them,” said Assistant Director Luis Quesada of the FBI’s Criminal Investigative Division. “In this circumstance, these medical professionals provided prescription drugs to those with no medical need. It is unacceptable that in this nation’s current opioid crisis, physicians and medical professionals are exploiting the well-being of their patients for profit. Thanks to the diligent work of the FBI and our law enforcement partners, we are able to navigate the important sphere of healthcare fraud and to continue our mission of bringing those who operate these criminal schemes to justice.”

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

Florida’s Pill Mills Were a Gateway to the Opioid Crisis (Terry Spencer, Associated Press, July 20, 2019)

Florida’s pill mills “opened fast and furious because there was very little regulation … and the majority of law enforcement was not trained to handle the movement of legal drugs for illegal purposes,” said Lisa McElhaney, then a sheriff’s narcotics investigator in Broward County, the epicenter of the pill-mill boom.

By the clinics’ peak in 2010, 90 of the nation’s top 100 opioid prescribers were Florida doctors, according to federal officials, and 85 percent of the nation’s oxycodone was prescribed in the state. That year alone, about 500 million pills were sold in Florida. The number of people who died in Florida with oxycodone or another prescription opioid in their system hit 4,282 in 2010, a four-fold increase from 2000, with 2,710 of the deaths deemed overdoses, according to a state medical examiners’ report.

House of Pain: Feds Detail Alleged Pill Mill Scheme at Warren Pain Center (Robert Snell, The Detroit News, February 2019)

MICHIGAN—DR. ERIC BACKOS

Nobody charged in this case prescribed more drugs than Dr. Eric Backos. The 66-year-old Bloomfield Hills doctor prescribed more than 5.9 million pills from 2013 to 2018, according to the FBI. More than 86% of the drugs belong to a category that includes fentanyl and oxycodone.

In a 14-month period, three patients received prescriptions from Dr. Backos and died after leaving the clinic and overdosing, according to the FBI.

Warren resident Marcia Groves was a clinic patient and a pain pill addict after suffering a back injury while working at a Warren stamping plant.

Groves, 53, received treatment from three clinics in 2013, including Pain Center USA, according to court records. On Nov. 20, 2013, Groves met with Backos at the clinic, the government alleged.

After a 15-minute office visit, Dr. Backos prescribed morphine and hydrocodone, according to the FBI agent. Three days later, she was dead.

“I found her dead in her bedroom,” daughter Kara Boyd said. “This has put me through so much pain for so many years.”

The Macomb County Medical Examiner’s Office ruled her mother’s death an overdose due to multiple prescription drugs.

Nine months later, a Ferndale man overdosed on multiple prescription pain medications one day after Dr. Backos prescribed oxycodone, according to the FBI.

On New Year’s Day 2015, a Macomb County man overdosed on multiple prescription medications. State records showed the man received a Xanax prescription from a psychiatrist two days earlier and a hydrocodone prescription from Dr. Backos five days before the overdose.

DR. LAWRENCE CHOY Sentenced to 7 Years for Prescribing Deadly Amounts of Opioids (CBS New York, September 2019, YouTube Video)

FLUSHING, NEW YORK. Dr. Lawrence Choy, former operator of a medical clinic, was sentenced to seven years in prison and two years post-release supervision on 34 counts stemming from illegal sales of prescriptions for controlled substances and the deaths of three patients.

A licensed physician since 1981, Dr. Choy specialized in Internal Medicine and Nephrology (the treatment of diseased kidneys) and operated a full-time medical office at 142-20 Franklin Avenue in Flushing. He was arrested in Sheboygan, Wisconsin, where he had fled after abandoning his New York practice.

In pleading guilty on June 18, 2019, Dr. Choy admitted he illegally sold prescriptions for opioids and other controlled substances in lethal dosages and combinations and failed to perform adequate examinations or follow up on signs of substance abuse. This reckless criminal conduct resulted in the deaths of three patients.

Charges of Manslaughter in the Second Degree relate to the deaths of patients Eliot Castillo, 35, and Michael Ries, 30, both of whom fatally overdosed within three days of receiving prescriptions from the physician. Reckless Endangerment charges relate to five additional patients, including one who fatally overdosed.

Eliot Castillo, a father of two, overdosed and died Feb. 23, 2013. He was found on a couch at his mother’s home in Jamaica, Queens. Following an autopsy, the Office of the Chief Medical Examiner determined the cause of death to be the combined effects of oxycodone (an opioid pain reliever) and alprazolam (a benzodiazepine used to treat anxiety). A bottle of alprazolam found in Castillo’s pocket had been prescribed by Dr. Choy three days earlier. Castillo’s health declined during the 11 months he was treated by Dr. Choy, who frequently provided early prescription refills. Castillo entered a drug treatment program, resulting in a gap in oxycodone prescriptions. However, when Castillo relapsed, Dr. Choy resumed simultaneous prescriptions for oxycodone and alprazolam, the drug combination that caused his death.

Michael Ries fatally overdosed on March 23, 2014, at his family’s home in Hauppauge, Long Island. The cause of death was the combined effects of oxycodone, alprazolam, and carisoprodol (a muscle relaxant), substances known to have a synergistic effect on breathing, increasing the risk of death. Several empty pill bottles at the scene were associated with prescriptions issued by Dr. Choy during the preceding six months. Ries initially saw Dr. Choy for treatment of anxiety and had never before been prescribed an opioid medication. Ultimately, Dr. Choy prescribed Ries the highly dangerous combination of oxycodone, alprazolam, and carisoprodol. Choy increased Ries’ prescriptions even as his condition deteriorated, resulting in a series of accidents. Shortly before Ries’ death, Dr. Choy had issued prescriptions for 24 pills per day, with a total morphine milligram equivalent (MME) of more than triple the maximum amount recommended by the U.S. Centers for Disease Control and Prevention (CDC).

Queens Acting District Attorney John M. Ryan said, “Dispensing opioid drugs like popcorn at a movie theater is partially to blame for the epidemic of deadly overdoses that has gripped this country in the last several years. Dr. Choy’s irresponsible and illegal actions caused the deaths of two of his patients. The prison term ordered by the Court is more than warranted and should serve as a warning to others – whether they be physicians or street dealers – if you distribute deadly drugs, you will be caught, and you will be prosecuted.”

“The gravity of Dr. Choy’s crimes was no doubt the reason why he fled New York in 2017, but justice prevailed with today’s sentencing of seven years in prison,” said DEA Special Agent in Charge Ray Donovan. “This sentence is also a reminder of the dangers prescription drugs pose when they are not prescribed for a legitimate reason under legitimate medical supervision. I commend the New York Strike Force and the Office of the Special Narcotics Prosecutor for their diligent work on this investigation.”

New York State Police Superintendent Keith M. Corlett said, “Physicians take an oath to help their patients, not to harm them, and as such, they should be held to a higher standard. Dr. Choy used the trust of his patients to profit financially by illegally selling prescription drugs. He had no regard for his patients or their well-being, and he put them and the community he served at risk. I commend the hard work of the Strike Force and all of our law enforcement partners for bringing this man to justice. The work they do is vital to keeping drugs off our streets and, in turn, helps to prevent the cycle of prescription drug abuse.”

“The opioid crisis is a national plague that currently claims the lives of thousands of our citizens every year,” said Peter Fitzhugh, special agent in charge of HSI New York City. “This doctor used a position of trust to recklessly feed the addictions of patients across state lines, resulting in deaths and destroyed lives. This is another great example of various law enforcement agencies working in tandem to arrest an individual causing great harm to the community.”

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.

12 Charged in Pill Mill Operation in Southern West Virginia (Wendy Holdren, CNHI News, February 2018)

The indictment charges the owners, managers and physicians associated with HOPE Clinic, which operated as a purported pain management clinic in Beckley, Beaver and Charleston, as well as Wytheville, Va., and a related company with conspiring to distribute oxycodone and other Schedule II controlled substances, not for legitimate medical purposes and outside the usual course of professional practice, from November 2010 to June 2015.

The following individuals were charged in the indictment: James H. Blume Jr.; D.O, Mark T. Radcliffe; Joshua Radcliffe; Michael T. Moran, M.D.; Sanjay Mehta, D.O.; Brian Gullett, D.O.; Vernon Stanley, M.D.; Mark Clarkson, D.O.; William Easley, D.O.; Paul W. Burke, M.D.; Roswell Tempest Lowry, M.D.; and Teresa Emerson, LNP.

“As of today, there are 69 counts. Ten doctors in total. Clinics from Beckley to Beaver, and Charleston to Wytheville. Lots and lots of pills, and even more misery,” said U.S. Attorney Mike Stuart. “Home-grown drug dealers hidden behind the veil of a doctor’s lab coat, a medical degree and a prescription pad are every bit as bad as the heroin dealers from Detroit who bring their poisons to West Virginia. Today’s 69-count indictment is the continuation of our efforts to hold accountable those who prey on the good citizens of West Virginia.”

In addition to the conspiracy charge, the indictment charges defendants Blume and Mark Radcliffe with maintaining drug-involved premises in Beckley, Beaver and Charleston, and includes 62 counts charging several physicians with distribution of controlled substances not for legitimate medical purposes and outside the usual course of professional practice.

The indictment also charges Sanjay Mehta, D.O., a former physician at the Beckley and Beaver HOPE Clinic locations, with two counts of distribution of controlled substances causing death, and charges 10 of the defendants with conspiracy to launder drug proceeds by paying bonuses to HOPE Clinic physicians and employees of Patients, Physicians, and Pharmacists Fighting Diversion, Inc. (PPPFD), to encourage continued prescribing of Schedule II narcotics to customers.

According to the indictment, defendant James H. Blume Jr., D.O., the owner of the HOPE Clinic, entered into a Physician Practice Management Agreement with defendant Mark T. Radcliffe, owner of PPPFD, to be the practice manager of the HOPE Clinic. The indictment alleges that together Blume and Radcliffe operated HOPE Clinic as a cash-based business that prescribed oxycodone and other Schedule II controlled substances to customers, while refusing to accept insurance, charging in-state customers at least $275 for an initial appointment, and at least $160 for each subsequent appointment. Out-of-state customers paid as much as $330 for initial visits and at least $185 for subsequent visits.

The indictment alleges that HOPE Clinic practitioners prescribed thousands of oxycodone-based pills to individual customers and some HOPE Clinic locations, including Beaver and Charleston, averaged 65 or more customers a day during a 10-hour workday with only one practitioner working.

In addition, the indictment alleges that Blume and Mark T. Radcliffe contracted the services of physicians without any knowledge of pain management who consistently conducted cursory, incomplete, or no medical examinations of clinic customers and provided large amounts of Schedule II prescription medications to customers that they knew, and had reasonable cause to believe, were drug addicts.

The indictment further alleges that Mark T. Radcliffe and his son, Joshua Radcliffe, neither of whom had any formal medical education or training, instructed medical practitioners at HOPE Clinic to provide customers with prescriptions for Schedule II controlled substances, sometimes in direct contrast with the practitioners’ clinical opinions.

“We are committed to protecting all those in government health programs,” said Maureen R. Dixon, Special Agent in Charge of the Office of Inspector General for the U.S. Department of Health and Human Services. “Working side by side with our law enforcement partners we will aggressively investigate charges of medical providers needlessly prescribing deadly opioids.”

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.

Drug Enforcement Administration. State Medical Board of Ohio.

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.

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

Dr. Paul Volkman. How a small-time Chicago doctor came to the southeastern Ohio town of Portsmouth and helped spur an epidemic. 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.

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.

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.

DEA ‘Pill Mill Crackdown May Be Causing an Unintended Consequence, Rachel Gotbaum, WBUR, August, 2015)

Chris Young was crushed by a car he was working under. “He was crushed accordion style,” said his wife Lesley. The accident left Young, 45, almost completely paralyzed and in a wheelchair. He does have some sensation in his legs, but that is also where he experiences acute pain. To control the pain, Young was prescribed high doses of narcotic painkillers. But since he moved to Florida, he was having trouble getting his medications. His pharmacy runs out every month. Young’s pharmacist was Bill Napier, who owns Panama Pharmacy in Jacksonville, Florida. Napier said since there has been a major crackdown on illegal narcotics, he can no longer serve customers who legitimately need painkillers. The wholesalers will no longer distribute the amount of medications he needs. “I turn away sometimes 20 people a day.”

Last year, Napier was visited by Drug Enforcement Administration agents who told him he was dispensing too many narcotics. They took all of his opioid prescriptions and held on to them for seven months. Napier hired a lawyer and paid for criminal background checks on his patients taking narcotics to satisfy the DEA.

“We’re being asked to act as quasi law enforcement people to ration medications,” says Napier. “I have not had training of rationing of medications.

Florida was considered the epicenter for the trafficking of illegal prescription narcotics. The DEA and local law enforcement shut down more than 250 so-called “pill mills,” clinics where doctors could sell narcotics directly to people for cash. Now Florida doctors can no longer dispense narcotics directly to patients and wholesalers, which were also fined, are limiting the amount they sell to pharmacies.

Jack Riley, deputy administrator of the DEA, credited a decline in opioid overdose deaths in Florida with an upsurge in law enforcement activity. But he said these efforts cannot be blamed for any claim of rationing of painkillers.

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

OHIO. 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.

Southern California Doctor Sentenced in Overdose Death of 3 Patients (Scott Glover, CNN, February 2016)

LOS ANGELES, CALIFORNIA. Dr. Hsiu-Ying Tseng, 46, was sentenced to 30 years to life in prison. Prosecutors charged Dr. Tseng with second-degree murder for the deaths of Joey Rovero, 21, Steven Ogle, 25, and Vu Nguyen, 28.

Matthew Stavron, Ryan Latham, and Naythan Kenney fatally overdosed in 2007 and 2008 after Dr. Tseng prescribed them drugs. The young men each drove long distances to come to Tseng’s strip mall clinic for prescriptions. Stavron made a two-hour round trip from his parents’ home in San Clemente.

Dr. Tseng received a phone call from the coroner’s office alerting her to each of the deaths, according to court papers. Dr. Tseng regarded such calls as “just FYI” notices and did not perceive them as a problem, her husband, also a doctor, testified in her defense at trial.

Medical experts and law enforcement officials agree that it’s a tiny fraction of doctors who willfully prescribe drugs to patients who don’t need them.

Dr. Tseng catered to young patients who traveled long distances and paid cash for their prescriptions. She wrote prescriptions without performing meaningful medical exams and despite there being no medical necessity for the drugs.

Dr. Tseng ignored pleas from parents and loved ones concerned about the worsening addiction of sons and daughters, husbands and wives, brothers and sisters.

Medical experts and law enforcement officials blame reckless and criminal prescribing of opiate-based painkillers and other potent narcotics by doctors like Dr. Tseng for contributing to the problem.

Dr. Tseng’s lawyer, Tracy Green, defended the doctor as a well-meaning physician who had gotten in over her head in dealing with manipulative, drug-seeking patients.

Dr. Tseng wrote that she lacked sufficient training in prescribing addictive narcotics and was in denial about what was going on in her practice.

“I told myself that my patients’ conduct was beyond my control,” she wrote.

Before sentencing, Defense Attorney Green said that Dr. Tseng bore some–but not all – responsibility for the misery that flowed from her prescription pad. She pointed to the patients themselves, the pharmacies that had filled her prescriptions and other doctors who had also prescribed her patients drugs.

Moments before imposing sentence, Judge Lomeli said Tseng ran a reckless “assembly line” style practice that raked in millions of dollars while patients and their families suffered. He said that while she’d accepted some blame, she was still attempting to deflect some on others.

The operation of a drug trafficking network peddling prescription drugs for profit under the guise of a medical practice not only violates the law, it undermines the public confidence in the healthcare profession.

Some of these money-making schemes were perpetrated through a multi-state network of pain clinics frequented by patients who have an addiction, as well as drug dealers who sought to obtain high-dosage prescription drugs like oxycodone.

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.

American Pain: How a Young Felon and His Ring of Doctors Unleashed America’s Deadliest Drug Epidemic by John Temple

The king of the Florida pill mills was American Pain, a mega-clinic expressly created to serve addicts posing as patients. From a fortress-like former bank building, American Pain’s doctors distributed massive quantities of oxycodone to hundreds of customers a day, mostly traffickers and addicts who came by the vanload. Inked muscle heads ran the clinic’s security. Former strippers operated the pharmacy, counting out pills and stashing cash in garbage bags. Under their lab coats, the doctors carried guns—and it was all legal… sort of.

American Pain was the brainchild of Chris George, a 27-year-old convicted drug felon. Chris George, the son of a South Florida home builder, grew up in ultra-rich Wellington, where Bill Gates, Springsteen, and Madonna kept houses. Thick-necked from weightlifting, he and his twin brother hung out with mobsters, invested in strip clubs, brawled with cops, and grinned for their mug shots. After the housing market stalled, a local doctor clued in the brothers to the burgeoning underground market for lightly regulated prescription painkillers. Pain clinics could dispense the meds in Florida, and no one tracked the patients. Seizing the opportunity, Chris George teamed up with the doctor, and word got out. Just two years later, Chris had raked in $40 million, and 90 percent of the pills his doctors prescribed flowed north to feed the rest of the country’s insatiable narcotics addiction. Meanwhile, hundreds more pain clinics in the mold of American Pain had popped up in the Sunshine State, creating a gigantic new drug industry.

American Pain chronicles the rise and fall of this game-changing pill mill and how it helped tip the nation into its current opioid crisis, the deadliest drug epidemic in American history. The narrative swings back and forth between Florida and Kentucky and is populated by a diverse cast of characters. This includes the incongruous band of wealthy bad boys, thugs, and esteemed physicians who built American Pain, as well as penniless Kentucky clans who transformed themselves into painkiller trafficking rings. It includes people with an addiction whose lives were devastated by American Pain’s drugs and the federal agents and grieving mothers who labored for years to bring the clinic’s crew to justice.

These cases serve as an important reminder that healthcare professionals have a duty to prescribe medication responsibly to ensure the well-being of patients under their care. Failing to do so can endanger patients and undermine critical, ongoing public health measures to address the illegal distribution of opioids.

America’s Pain Mills (American Addiction Centers Editorial Staff, November 30, 2023)

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. 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.