by John Temple
Chris and Derik figured the Sun-Sentinel story had motivated the police to lean on them. Finally, Chris called the station to complain, and two officers came out to the clinic to talk to him and Derik, a regular patrol cop who had pulled over a lot of patients and a lieutenant. Chris and Derik told them they were trying to abide by the laws.
Chris said: Listen, just because they come here doesn’t mean they get pills. They don’t even necessarily get to see the doctor.
The lieutenant seemed to get it, and Chris thought maybe he’d order the junior officer to lay off. But the very next day the guy was still at it, pulling patients over as they left the clinic. Time for a confrontation, Chris thought. So he told a patient what was going on, and hopped in the patient’s car when he was leaving. Sure enough, the cop pulled them over, and Chris dialed his lawyer’s cell phone to report what was happening.
The patrol officer told him to get off the phone, and Chris refused. The cop got annoyed, popped Chris for resisting arrest, and took him to the gigantic concrete Broward County Jail in Fort Lauderdale. It took forever for him to get processed, so Dianna and Derik shared a bottle of tequila at a downtown bar. Derik got hammered and started a fight. They were kicked out of the bar and went to the jail to post bond. Derik caused a scene in the bond unit and almost got arrested right there in the jail. So Dianna drove him home to West Palm at midnight and then went back for Chris, who had to wait for an hour after he got out. Chris yelled at her for making him wait, and Derik felt bad when he heard about it since it was his fault for getting drunk. Chris pleaded no contest to resisting arrest without violence and was sentenced to one day of probation and a fine.
The arrest made up Chris’s mind. It was time to leave Oakland Park Boulevard. He’d been thinking about it for weeks, after everything that had happened that summer. The health department investigator, and the DEA woman who knew his name. The angry neighbors, and the newspaper story. Gittens splitting to open her own clinic, other competitors popping up all over the place. Now, local cops were turning up the heat.
The clinic needed a new home. South Florida Pain had the potential to be a juggernaut, but a juggernaut couldn’t operate out of a shithole bungalow with eight parking spaces.
It was also time to grow and mature. Time to hire more doctors and staff, create some rules, get serious. The clinic was inhaling $40,000 to $50,000 a day. And Chris believed that $250,000 a week was just scratching the surface. Like the railroad-and-oil tycoons of the nineteenth century, or the tech billionaires of the 1990s, Chris and Derik, of all the random people, had enjoyed perfect, exquisite, history-making timing. They’d stumbled into a Bizarro-world, a window of opportunity in which hard drugs were, for the moment, legal. Because if they weren’t legal, how were Chris and Derik able to conduct their business in broad daylight? They had a big sign with red letters saying PAIN CLINIC. They’d been in the Sun-Sentinel, a big color picture of the zombies standing in line. The DEA was receiving their 222 forms every week, tracking their incoming drug shipments. The Florida Department of Health had sent in its inspector to rifle through their patient files. And nobody had shut them down.
But Chris and Derik knew that someone would find a way to end their ride, if they didn’t grow up now. That meant doing something that did not come naturally to them: following the rules. It was time to hire a dog walker, stop bringing Moe in to the clinic. No more fun-and-games, no more letting patients take the neighborhood hostage. No more sloppy record-keeping, letting favored patients slide on their drug tests and MRIs.
And here was the beautiful part: By now, they could afford to be tough on the patients. They could kick anybody out, for the most minor infractions. Because for every one they kicked out, there were five waiting to jump in line.
They were going to make millions, many times over, and they had to protect the operation at any cost, even if that meant going straight.
Footnote
* The health department had not yet issued a report about its June 2008 inspection of South Florida Pain.
PART II
4
Once he’d made up his mind to move, Chris George didn’t waste any time. A few days after his arrest, he leased an office suite for the clinic a couple miles west of I-95 on Cypress Creek Road. The new space was huge, about six times the size of the little bungalow on Oakland Park Boulevard. It was in an office complex called the Cypress Creek Executive Court, which backed up to a row of airplane hangars next to the two-strip Fort Lauderdale Executive Airport. The quiet office park was nothing like the haphazard strip of businesses on busy Oakland Park Boulevard. It included travel agencies, insurance offices, and small law firms, and featured pleasant concrete walks, well-tended palms, wooden benches, and most importantly, lots of parking: about two hundred spaces.
After work on Friday, Chris and Derik Nolan went to Home Depot and ordered materials for a quick build-out. The supplies were delivered to the new office on Saturday, and that day they roughed out a ten-foot interior wall with a doorway and a window, to separate the waiting room from the examination rooms and filing areas. It was a makeshift job, with stapled-on particleboard walls propped up by two-by-fours. It didn’t even reach the ceiling because a real wall would have required them to pull building permits. It looked like a temporary triage clinic in a war zone or something. But it would do. They were only planning to be there for a few months. Some other tenants were scheduled to move out soon, freeing up a nicer space.
Sunday, they rented a U-Haul truck and moved everything from one building to the other—the waiting-room chairs, the examination tables that no patient ever lay on, the gun safes where they kept the drugs. Derik had done an inventory of the drugs a couple weeks earlier. He hadn’t wanted to hand-count each of the thousands of pills, so he’d come up with what he thought was a common-sense solution. He counted out and weighed some pills and then weighed them all and did the math. He wasn’t sure what kind of regulations existed regarding the transport and inventory of controlled substances, but he just wanted to make sure no one was boosting pills. The count came out fairly accurate, give or take.
Monday morning, South Florida Pain Clinic opened in its new location. Chris stationed Dianna at the Oakland Park Boulevard building, where she answered the phone and told callers how to find the new location. When patients showed up in person, she gave them flyers with directions to the new clinic.
At the Cypress Creek location, things were slow for about an hour, and then the patients with Dianna’s directions started pulling into the lot.
New location, new rules. From now on, Chris said, every patient had to have a valid MRI report that was less than two years old, and every patient had to take a drug test before seeing a doctor. No exceptions.
The MRI rule created a small problem. MRIs required a prescription, and having the doctors see patients twice would slow things down. So the doctors gave Derik a pad of blank prescriptions they’d already signed, and Derik would just fill it in, charging $50 per MRI prescription. He’d ask each patient where it hurt. If they said lower back, he’d write, “MRI of lumbar.” If they said it was the neck, he’d write that. They’d go get the MRI done and come back for their doctor’s appointment. Derik wasn’t sure how an MRI machine worked or even what the letters “MRI” stood for. But writing prescriptions was simple, he found, not like something you needed to go to med school for anyway.
Under Chris’s new rules, patients had to take a drug test every three months. Derik gave those patients a small clear plastic cup with a blue lid and a panel on the side. The patient took the cup to the restroom and came out with a full cup. Most of the time, no one actually watched the patients pee. Derik collected the cups, and when there was a trayful, he’d snap on rubber gloves and peel back the stickers on the panel to see which drugs were present in the patient’s system. New patients were supposed to have clean urine, unless they said they had been prescribed something already. Return patients were supposed to be positive for oxycodone, but not ill
egal drugs like ecstasy or cocaine or marijuana.
Patients also were required to fill out numerous pages of paperwork before seeing a doctor, forms and policies Chris and Derik had collected, starting with the documents they’d taken from the other clinic before South Florida Pain opened. There was a pain management agreement, in which patients vowed not to abuse the medication. The one-page agreement instructed the patients to tell their physicians the truth about the intensity of their pain. To not share, sell, or trade pills. To safeguard it from thieves. To not use illegal drugs. To not go to other pain management doctors and South Florida Pain at the same time. Patients who broke the rules would be discharged and no longer welcome at the clinic. One key passage read:
I understand payment of the office visit DOES NOT GUARANTEE MEDICATION. Prescriptions are only written if the Doctor deems it necessary. We reserve the right to deny medication to those we feel are drug seekers or abusers. NO REFUNDS WILL BE GIVEN.
Patients also signed a Diversion Policy, which covered the same territory, more or less. Another form asked whether the patients were Florida residents and, if not, why they hadn’t sought treatment closer to home. A typical response: “They will not give enough to help with pain and when you ask for stronger they look down on you.” Chris created that out-ofstater form himself. If the health department showed up again and asked why they had so many non-Florida patients, he figured he could use the patients’ statements to shield himself.
Chris had found most of the forms and policies online, including the Patient Comfort Assessment Guide, a survey created by Purdue Pharma that asked patients to describe and rate their pain in great detail. (Among other questions, it asked if the pain fit the following descriptions: stabbing, gnawing, exhausting, shooting, burning, nagging, penetrating, miserable, or unbearable, plus a few more. Some patients circled every word.) Chris barely skimmed the documents and never discussed them with the doctors. He just wanted to make sure that each patient’s file was stuffed with paperwork, drug screens, MRI reports, and signed policies. Thick patient files, he believed, would make it more difficult for authorities to claim that South Florida Pain was just a drug-dealing operation.
They needed more doctors. Dr. Gittens was gone, and the new office had much more space. Also, the more doctors Chris had, the more drugs the wholesalers would allow him to order. He wanted a mix of full-timers and part-timers so he could open early and stay open late, be as accommodating as possible. Chris placed another round of job ads on Craigslist, and doctors kept calling.
When interviewing doctors, Chris didn’t want to come off as unprofessional or criminal. He tried to speak well, look successful. But he did want the doctors to understand what they were signing up for. So he didn’t exactly turn on the charm. He wore his typical outfit—torn jeans and a T-shirt. He barely looked at resumes, asked few questions about medical expertise or credentials. The interviews were brief. Chris was a mumbler, had a monotone, monosyllabic way of speaking to outsiders. He’d tell the physicians they would be working to provide services for chronic pain. He’d ask if they had a DEA registration and a medical license and whether they were comfortable prescribing narcotics. If doctors said they lacked experience in pain management, Chris said that didn’t matter, they could learn on the job. He would show the doctor some patient charts to give a sense of the dosages the other doctors were prescribing. And then he’d talk about the pay. At $75 per appointment, South Florida Pain was seeing enough patients to pay doctors between $2,000 to $4,000 a day. Plus $1,000 cash a week for the use of their DEA registration number to order drugs.
The true test came when Chris had an applicant shadow another doctor, to see if he or she could stomach the ceaseless flow of patients receiving prescription after prescription of the same controlled substances. Two interviewees walked out after these observation sessions, saying they couldn’t do it.
But all the other doctors who came in for interviews took the job, no matter what they saw at the clinic. It became a joke between Chris and Derik. The long lines, the desperate patients, none of it seemed to make a difference. The doctors saw what was going on at South Florida Pain, and they were OK with it once they heard they’d be making $75 a patient.
The physicians were a mixed bag: male, female, young, old, black, white, Hispanic, Jewish, US-born, international, gay, straight. Mixed specialties too: gynecologists, plastic surgeons, family practitioners.
The doctors tended to be a little odd. One physician wanted to see only female patients, and it turned out that he was digging into patient files and stalking the good-looking ones. Another had such bad body odor that Derik was forced to talk to him about it, which was awkward. Another left after a few months and started his own pain clinic, as Dr. Gittens had done. Others had gambling problems, or drug problems, or student-debt problems. One belonged to a swingers group and tried to recruit Derik.
It was a great part-time gig, Derik thought, to come in for a couple hours in the evening after your real job, see a dozen patients and walk out with a grand in your pocket. The part-timers clamored for as many hours as they could get, and some wanted to come aboard full-time. Derik had mixed feelings about the medical staffing. The doctors were key to the entire business, of course. But fewer doctors had meant longer lines, which meant more patients handing Derik money to jump the line.
If the doctors struggled with their consciences, they kept it to themselves. Except one, a part-timer, Dr. Patrick Graham, a plastic surgeon in Boca Raton who worked at the clinic in the evenings, maybe once a week. Graham was in his early sixties. He’d interviewed at the Oakland Park Boulevard location, where Gittens had shown him the ropes before she quit. He’d spent half a day shadowing her as she treated about fifteen patients. During the first few appointments Graham observed, Dr. Gittens listened to the patients’ heart and lungs, had them bend over, checked ears, noses, and throats, had them do some range-of-motion exercises. But as the morning wore on, Gittens had spent less time with the patients, her exams growing more cursory. Everybody got similarly large doses of narcotics. By the time Graham was done shadowing Gittens, he believed he understood how things were done at South Florida Pain.
Around Derik, Graham would drop hints that he knew the clinic was a pill mill, that he knew the score. Around the other doctors, he played dumb. Sometimes he’d complain to Derik that Chris had hired a new doctor, worried it would cut down his patient load. Other times, he’d come to Derik and say that there was nothing wrong with a patient and he couldn’t write a scrip for him, like he’d had a sudden attack of conscience. Derik would point out that he’d already written twenty scrips that day for similar patients. Dr. Graham would continue to argue.
Finally Derik would say: Whatever, dude. I guess I need a new doctor.
That’s when Dr. Graham would give up.
Graham would say: Fine, then.
And he’d go write the scrip.
Graham was interesting, Derik thought. It was like he wanted a little push from Derik. To make himself feel better, like he had no choice. So Derik would give it.
Derik didn’t push the other doctors. If a doc wanted him to bounce a patient who had inadequate documentation or infected track marks, he bounced the patient. There was no upside to arguing with the doctors, nothing to be gained by pulling back the curtain and too openly revealing or discussing what they were doing.
Chris and Derik reasoned that the number one problem at the Oakland Park Boulevard location had been the tiny waiting room, which meant the patients roamed the neighborhood, shooting up, nodding off, shoplifting, squabbling, selling pills, and generally acting like junkies. Chris and Derik hadn’t minded this behavior in the early months, even encouraged it sometimes, but after a while it was like they were begging the cops to show up. Which was why they’d been forced to move. Chris didn’t want the same thing to happen again, so the rule at the new location became: no loitering in the parking lot.
They put the homeless man who’d hung around the Oakland
Park Boulevard location in charge of monitoring the new building’s exterior. The vagrant had been arrested for crack possession and was living in a halfway house now, which was a step up from the laundry where he’d previously slept. Chris and Derik had felt bad about leaving their homeless security guard behind when they moved to the Cypress Creek location, so they’d told him they’d give him a promotion if he came with them. The homeless man had happily agreed. They’d see him riding his bike the six miles from Oakland Park Boulevard each day, a scrawny figure in cowboy hat and boots, pedaling his bike in heavy traffic. Derik bought him a walkie-talkie and a shirt that read SECURITY. He instructed the security guard to call him on the walkie-talkie when patients were parking in the other businesses’ spots or pissing in the hedges. But the security guard never remembered to wear the security shirt and couldn’t seem to get the hang of actually communicating through the walkie-talkie. When Derik heard a burst of static on his walkie-talkie, he knew his security guard was trying to reach him, and he’d head out to the parking lot. The guard couldn’t take care of issues himself because the patients didn’t take him seriously. When it became obvious that the homeless man wasn’t getting the job done, Chris and Derik advertised for a new security guard and hired a three-hundred-pound Puerto Rican guy who came for his interview wearing a security guard uniform he’d bought somewhere. The scrawny vagrant and the giant tag-teamed the parking lot with varying levels of success.