by John Temple
The following week, Chris asked Derik to spend another day guarding the clinic, a Friday. Derik agreed, though he already couldn’t stand Overstreet. The doctor seemed arrogant, cocky, thought he was some kind of gangster. Derik saw Overstreet popping Vicodin, which he kept in the gun safe along with some Viagra and the rest of the clinic’s drugs, and meeting with shady-looking people next to his Land Rover after closing time.
When it was time to split the week’s cash that night, Overstreet insisted that Derik leave the room. Derik left, irritated, and when Over-street came out, he was carrying a large stack of cash, thousands, which he pretended to conceal, but Derik could tell Overstreet wanted him to see the money. Overstreet said he was going on a trip and needed the cash. Fishing or something.
Overstreet split the money he and Chris had made in the third week of business at South Florida Pain—his half of the profits was $24,000—and flew to the Republic of Panama. He was taking a weeklong vacation, going fishing.
Overstreet had planned the trip in advance, and a doctor named Rachael Gittens had agreed to cover for him during his absence. Gittens had worked with Overstreet briefly at One Stop Medical. She was planning to work for Jeff’s clinic in West Palm Beach, if he ever got it up and running.
Chris couldn’t get ahold of Overstreet all week. Yes, the doctor was on vacation, but he never called in. No one knew where he was. Chris wondered if he had been scared off, thinking he was under investigation or something. Or maybe he just wanted to leave everything behind. Who knew?
The mystery was solved when Overstreet’s wife called Jeff. She had some bad news: The doctor was not just missing. He was dead.
During his vacation in Panama, he’d somehow flipped his Jeep into a ditch. It had taken the local authorities some time to figure out who he was and get in touch with his wife. It seemed like she hadn’t even known where he had gone until the consulate called saying he was dead.
So Overstreet was gone for good. A strange feeling. And bad timing. The clinic had been open only three and a half weeks, and Chris had lost his only doctor. But Chris had no intention of closing—not when the place was just beginning to show its potential.
Dr. Gittens said she was happy to just continue working at South Florida Pain; she liked it there.
Rachael Gittens was a family practice doctor who had gone to med school at the State University of New York, graduating in 1998. Despite her lack of experience in pain management, she wasn’t afraid to write big prescriptions. Sometimes she wrote even higher than Overstreet had, up to 360 oxycodone 30 milligrams, a few times. The patients loved her.
Chris wanted to expand, but he had no idea how doctors found jobs. When they’d been building houses in North Port, Derik had introduced Chris to Craigslist.org, the free classified advertisements website. Very few of the other job postings on Craigslist’s medical/health jobs section were for doctors—they tended to be for physician assistants, front desk staff, nurses, physical therapists. But they’d used the site to sell houses, so they figured, why not use it to hire doctors? Chris wrote and posted an advertisement, something along the lines of: “MD with DEA license needed for busy pain clinic, make up to $400 an hour.”
Dr. Enock Joseph responded to the ad, and after a brief interview, Chris hired him. Dr. Joseph was an older guy, short, not much more than five feet tall. Like Gittens, he was black. Heavy cologne, glasses, thick Haitian accent. He’d gone to the State University of Haiti in the 1960s, then did an obstetrics/gynecology residency in Harlem in the 70s. Spoke French and Creole. Most importantly, Dr. Joseph had worked at a clinic named Art of Pain that paid doctors $35 per patient. Chris offered $75 per patient, and Dr. Joseph jumped at the raise.
Pretty soon, Chris realized he didn’t need Overstreet. He’d already learned enough about the business to get by. The doctors were interchangeable, one as good as the next, as long as they were willing to write big numbers. Dr. Gittens sometimes took too much time with the patients, which meant they had to stay open late to accommodate the crowds, but she was an adequate replacement. Same with Dr. Joseph.
And another thing. Chris paid the new doctors $75 a patient, which was half what the clinic charged for a doctor’s visit. Meanwhile, he kept the money he made from selling the meds, offering the docs a $1,000 weekly fee for the use of their DEA registrations, which allowed him to order the drugs. All in all, a much better deal than the 50/50 split on total profits that he’d had with Overstreet.
As the weeks went by, more and more of the patients came from out of state, especially hill-country states like Kentucky and Tennessee, where authorities had cracked down on narcotic painkillers. They were white country people, mostly, and they stood out in South Florida in their pasty winter skin and camouflage baseball caps, scrawny as crack fiends or spilling out of their T-shirts and cutoff jeans shorts. They usually drove down in groups, and they looked and smelled like people who had spent a long time in a car, with their rumpled clothes and sour breath. Some looked sick, sweaty, like they had the flu.
The new doctors liked having Derik around. Things seemed to run better, and he made them feel safe.
One night, Dianna drove Derik home and asked him if he would come on board full-time. The place was growing. They needed him.
Derik wasn’t sure. He’d always made good money in construction, but he wasn’t sure whether he could make ends meet going solo. He still didn’t have a driver’s license, and getting to worksites was tough.
Dianna said: Don’t worry about the money. We’ll give you whatever you want.
So Derik started working every day at South Florida Pain. Chris paid him $1,000 a week to start out. Derik was good with the patients. He came up with ways of dealing with the constant overflowing parking lot, kept order in the waiting room, developed systems for the paperwork. He figured it was a short-term gig. He’d make a little money and return to construction when he got his driver’s license back.
At first, Derik kept mixing up the name of the primary drug they were selling. Dr. Overstreet had told Chris to order generic versions of Roxicodone instead of the better-known but more expensive OxyContin. They were basically the same drug—oxycodone—but Overstreet also believed OxyContin prescriptions were more closely monitored than the generics. Plus, a lot of recreational users seemed to prefer roxies, especially the little blue ones made by Mallinckrodt, which were supposed to be easiest to crush, dissolve, and inject. Derik kept calling them RoxiContins, which apparently didn’t exist, and the others busted his chops about it.
In those early days, everything was loose and easy, and everything was funny. Dianna brought her wiener dog, Moe, to the clinic each day, because they usually stayed open late. When Derik got a phone call from someone he didn’t want to talk to, he’d say that the caller needed to talk to the clinic’s office manager, Moe, but he was sorry, Moe wasn’t available right at that moment. Or he’d put Moe’s name on paperwork. Derik and Chris flew remote control helicopters in the parking lot, and zapped each other with stun guns. Derik kept the fridge in a back room stocked with cold Bud Lights. When the lines in the waiting room got too long and people were getting impatient, Derik would buy a meal for the whole room. The toilet at South Florida Pain was always out of order, so they’d put up a sign directing patients to use the restrooms at C.C.’s Fish Camp across the street. Two hours later, when that bathroom was destroyed, they’d put up a new sign telling people to go to McDonald’s to relieve themselves. People would drive by and see the long lines outside and think the Christian radio station in the bungalow next door was doing a giveaway promotion. Parking was a problem from the get-go. They rented four extra spots from the podiatrist to their east, but that wasn’t enough. Patients parked in neighboring businesses’ lots, wherever they could find a spot. It was chaos, and the most fun place Derik had ever worked.
Neighbors complained, of course. They rarely came over to the clinic, but they did call the cops from time to time. The neighborhood was an odd mix, Derik thought.
The clinic sat just inside the border of Wilton Manors, which had gentrified little ranch houses and a significant gay population. But Oakland Park Boulevard itself was more blacks and street people. With either crowd, the white hill folk coming to South Florida Pain stood out.
Chris and Derik learned that certain patients were more valuable than others because they would organize and bankroll entire groups. Cops and druggies called these people “sponsors.” One woman in the neighborhood would go down the street to a free HIV clinic and round up patients, usually homeless people. She’d haul them to the clinic and hand each of them enough money to pay for the doctor’s visit and the pills. Derik would greet the woman in the waiting room, and she would tell him: I got ten new ones for you today, Derik. Best of all, they didn’t even have to offer a group discount for her people. When everyone was done, she’d would just collect the patients’ pills and pay them each $200. Everybody won: the clinic, the woman, her “patients.” It was crazy.
Derik threw himself into recruiting patients and sponsors. He was at a bar or casino or strip club most nights, knew lots of people. When he ran into acquaintances or met someone new, he told them to stop by the clinic. Over the last decade, he’d worked with hundreds of contractors and subcontractors. Many were out of work now and weren’t opposed to earning some money by becoming a patient at South Florida Pain and then selling their pills. They began coming in droves, dozens of them, many from Loxahatchee, where Derik had spent years. The clinic staff called them the Loxahatchee Crew.
The customers kept coming. Thirty a day. Fifty. They opened earlier and earlier, and even at 6:00 a.m. there’d be a line snaking down the street. They’d roll up and the patients would be roaming the neighborhood, causing havoc, but as soon as they saw Derik or Chris or Dianna, they’d snap to attention like dogs looking for a treat, run to grab their places in line. The line got longer every day, and the sight of it each morning amazed Derik. At the end of business hours, there’d still be dozens in the waiting room. Chris didn’t want to turn anyone away, so they never seemed to close up shop before 8:00 p.m. Overstreet had sometimes spent ten or fifteen minutes with patients, but the visits kept shrinking until the new doctors were spending just enough time with the patients to fill out the paperwork.
Derik controlled whether patients got to see the doctors, and he was learning how to turn that power into cash. If the patients wanted special treatment, it came at a price. Patients who’d driven all the way from Kentucky often didn’t want to spend three or four hours waiting to see the doctor, so they’d offer Derik $50 or $100 to be moved to the front of the line. The longer the lines, the more patients were willing to pay. Fifty bucks here, $100 there—it added up to an additional grand or two a week in Derik’s pocket. Before long, he was making more from these payoffs than he was from his base salary.
Nine o’clock one night, Derik was outside smoking a cigarette. It was one of those warm South Florida nights when the bathwater air almost dripped with possibility. Inside, the waiting room was still packed, more patients hanging out in the parking lot, more money to be made. Derik had just ordered pizza for everybody. He was feeling good, magnanimous.
A truck went by, a guy checking out the action, how busy the clinic was that late at night.
The guy yelled: Gimme some roxies, dude!
And roared away. Like Derik was a king, the guy who had everything, the guy making the decisions. Figuring out who got what.
Chris and Derik laughed about it the rest of the night.
Every so often, a patient went away unhappy.
One day, an out-of-state patient submitted a forged medical record, and Derik kicked the guy out. A few minutes later, Derik was catching a smoke in the parking lot, and several things happened, one right after another. A smacking sound on the asphalt of the parking lot a couple feet to Derik’s left, followed by a crack of gunfire from somewhere nearby. Without thinking, Derik was moving toward the building. Another bullet rapped the stucco wall behind him, shoulder height, way too close. Derik crouched behind the big plastic garbage can and saw a battered blue pickup swerve out of CC’s Fish Camp parking lot across the street. Derik realized the garbage can wasn’t going to protect him. He stood up and moved toward the door. The truck sped away—no more gunfire.
Derik went inside, jumpy with adrenaline, laughing his loud laugh. He told Chris and Dianna what had happened. After a while he went back outside. The slug had knocked a little stucco and paint off the wall, but the building wasn’t in great shape anyway, and the bullet hole was barely noticeable. A couple of patients were standing by their cars, and they gaped at Derik.
One asked: Was someone just shooting at you?
Derik just laughed it off and went back to work.
Derik and Chris tried to shield the doctors from incidents like that. And they never had a frank conversation with Gittens or Joseph about what was really happening at South Florida Pain, what the patients were doing with the pills. Why broach the subject? It might make the doctors feel uncomfortable or guilty, and that was the last thing they needed.
Derik couldn’t tell what the doctors thought about the clinic and its customers. Gittens and Joseph were fast, yet still more cautious than Overstreet, who would write for basically anybody over eighteen. The new doctors sometimes turned down patients who were incoherent or had obvious needle tracks from shooting up. But it was difficult to say no to a desperate addict who would beg or threaten. So they’d just leave the room and tell Derik, and he’d bounce the patient, no problem.
Dr. Gittens made a big deal of these ejections, pitching a little fit, as if she was shocked and disappointed that one of her patients was using the drugs for the wrong reasons. She told Chris that she believed that some of the patients were lying to her, and it troubled her that they all asked for oxycodone. Derik didn’t buy it. He believed her scenes served a psychological purpose: to justify her actions to herself, to prove she was still a good doctor, despite the fact that she was churning out oxycodone prescriptions all day long for $75 a patient.
Dr. Joseph was a little different, Derik believed. He rejected fewer patients than Gittens. And when a major problem did arise with a patient, Derik noticed that he didn’t make trouble. He would simply instruct Derik to refund the patient. He seemed to just want the problems to go away.
You’d have to be an idiot, Derik believed, to not figure out that virtually every patient was either using or selling the drugs, often both. Or else why would the majority of them drive across four states to get legal medications? Why were they so desperate? Why were so many of them nodding out in the waiting room?
Derik believed the doctors had to know the score.
Dr. Gittens told Chris the clinic needed to beef up its diagnostic procedures, or at least its paperwork. She wanted the clinic to require patients to bring in MRI reports, something South Florida Pain could put in its patient files. Something to show they weren’t just writing scrips based on the patients’ word that they were in pain.
Chris understood. It was asking for trouble to have no real diagnostic paperwork in the patient file. What if the Florida Department of Health showed up? Or, God forbid, the DEA?
But procedure and paperwork created a problem on the customer-relations side of things. The entire business philosophy of South Florida Pain, the thing that gave them an edge, was customer service, making it easy for patients to get what they wanted. Chris didn’t want to tell every patient, including walk-ins who had just driven fifteen hours across four states, that they had to go get an MRI before seeing the doctor. Dr. Over-street had referred some patients to an MRI service, but only every once in a while. That diagnostic company took three days to turn around the MRI reports, which wasn’t going to work for most of South Florida Pain’s out-of-state patients. So Chris and Derik would give the patients one free pass but told them they had to bring an MRI to their next visit, twenty-eight days later, which gave them time to get it done at home. Of course, being junkies, they usually didn
’t do it. So they’d give the patients another month, but say that this was the last time, they absolutely had to bring an MRI report to their next appointment.
Derik discovered there was competition in the MRI world. Half a dozen MRI services were fighting for South Florida Pain business, representatives visiting the clinic, handing out leaflets. Certain companies were willing to kick back fees to Derik in exchange for referring patients to them. Before long, Derik was making a grand or two a week just from the MRI companies.
One guy said he could match the prices of the company the clinic was currently using, but he would turn around the reports in twenty-four hours, which would make things much more convenient for South Florida Pain’s out-of-state patients. The interesting thing about this company was that its MRI machine was located inside an eighteen-wheeler trailer, and the unmarked trailer was parked behind a strip club called Goldfinger Gentlemen’s Club, a place up in Lake Park that Derik had never patronized. A line of people stood and sat in the strip club parking lot all day and night, holding red medical folders, waiting their turn to pay two or three hundred bucks to climb up into the trailer and onto the MRI machine inside.
Most of the reports noted some slight abnormality or other finding, and Derik noticed something funny. Say a patient had complained of neck problems early on, but then the MRI of the neck region showed nothing out of the ordinary. The patient would just get a couple more body regions scanned until some protrusion or compression or extrusion was discovered, maybe in the lower spine this time. Then the patient would return to South Florida Pain, now complaining of lower back pain. Derik never saw the doctors make an issue of this shifting pain, as long as the paperwork was in order.