American Pain

by John Temple

  Chris met with the owner of QuickPharm and agreed to pay $120,000 for the business, plus power of attorney to use the owner’s DEA license so he could begin ordering and selling drugs immediately. Chris registered Ethan Baumhoff’s brother-in-law, Daryl Stewart, as the president of the company.

  Chris also began building out a second pharmacy in Boca Raton, a nine-hundred-square-foot space. It took six months to start the store from scratch because he lacked a license, a process that involved state and DEA inspections. He didn’t want to be connected to the pharmacy, so he put that one in the name of an old friend, Andrew Harrington. Drew had been begging Chris for a job at American Pain, and he had no criminal record. Chris would put in the money, Drew would do the work, and they’d split the profits down the middle.

  The next rung of the industry, the pharmaceutical wholesaler business, also interested Chris. From what he could tell, it was a tough racket to break into. He was told the two main generic oxycodone manufacturers were not selling to new wholesalers. So he looked into buying a preexisting wholesale company. He had his eye on one in St. Petersburg that had begun selling him oxy a few months earlier. It was called Medical Arts and was run by a pharmacist named Steven Goodman, who’d been in the profession since 1966. Chris made an offer, but Goodman was beginning to realize how much money he could make from selling to pain clinics and rejected it.

  Chris didn’t tell Derik about these plans ahead of time. He just walked into American Pain one day in March and announced that he’d bought a pharmacy and that they should start directing all out-of-state patients to QuickPharm in Orlando.

  Derik was taken aback, but only for a moment. Nothing really surprised him anymore.

  As the flow of patients and cash had continued to rise, Ethan was spending up to six hours each night counting the money. He’d sort it by denomination and wrap bank bands around the stacks. Chris didn’t want to bother with counting one-dollar bills, so he instructed the cashiers to round up all fees to the nearest $10. Eventually Ethan began to check the proceeds from each window against the patient numbers, to make sure the cashiers weren’t just pocketing bills. Ethan carried the cash home each night in a blue duffel bag and then deposited it in one of Chris’s three banks the next morning. One bank was nervous about him holding such large amounts of cash in the waiting room, so they’d usher him to a private room in the back, where he’d count the money and make his deposit. One day, doing his daily deposit at Bank of America, Ethan noticed the bank’s cutting-edge cash-counting machine. He noted the make and model and bought one for the clinic. The cash counter was the size of a toaster oven, lots of buttons and a little digital screen. Everyone enjoyed watching it work; it was a miracle of efficiency, riffling through hundreds of bills in seconds, sorting and counting and occasionally spitting out a note that was damaged or counterfeit.

  The moment Derik realized that price had basically lost its meaning for him was Super Bowl Sunday in 2009. Three days before the big game, he and Chris decided to go, to just wing it, never mind the cost.

  The game was in Tampa, only three and a half hours away, but even so, it wasn’t cheap to go to the biggest sporting event in the country, especially at the last minute. Chris found tickets, five grand apiece. One of the American Pain clerks rented them a floor of a hotel in Tampa—$2,500 a night for three nights. They tried to charter a private jet but couldn’t find one at the last minute, so they just drove. They hit Tampa’s notorious strip clubs, saw comedians, and participated in the NFL Experience at Raymond James Stadium. During the game, Derik had ten grand in his pocket. By the time the weekend was over, they’d blown more than $20,000.

  It just didn’t matter. By now, Chris could afford to blow through $20,000 every weekend and have plenty left over. Each time Ethan deposited money, the banks filed a Currency Transaction Report in his name. During 2009, the three banks filed 147 reports for American Pain deposits in the amount of $14,094,979. And that’s just what the banks took in. Chris had begun stashing cash in his mother’s attic, where he had installed several safes. He had millions up there.

  Chris bought Range Rovers, Mercedes, BMWs, and boats. In January 2009, he bought the three-year-old home he’d been renting for most of 2008. The property was in receivership—the bank suing the developer—so Chris got a great deal. He paid a flat half million for the 5,600-square-foot mansion with its pale yellow stucco exterior, gourmet kitchen, marble countertops, crown molding, and kidney-shaped pool. Later in the year, Chris bought two more unfinished homes in the same development that were also in receivership, one next door and one down the street, for a total of $420,000.

  Over 2009, Derik made a lot of money too. Maybe a million bucks, though it was tough to pinpoint because so much was under-the-table cash—and he spent as quickly as he made it. He dropped a lot on clothes. Maybe twenty pairs of jeans from True Religion and Diesel. Basically every shirt from the Stone Rose collection—“luxury threads for the discerning gentleman”—$150 or so apiece. A Rolex. Nights, he basically lived in strip clubs and the Hard Rock Hollywood. In March, he and his girlfriend moved from their crappy apartment in Tamarac to a nice townhouse in Boynton Beach. Derik went to a furniture store and picked out an entire house’s worth of furniture and had it delivered to the townhouse. Trips to Italy, Vegas, Bahamas, Puerto Rico. Sizable loans for friends and family, money he knew he’d never see again, five grand cash as a wedding gift for an old friend. Breast enhancements for his girlfriend—she, Dianna, and Ethan’s wife all got boob jobs that summer, courtesy of Dr. Patrick Graham, a plastic surgeon who wrote pain-pill scrips part-time at American Pain. Lawyer fees for his one brother who was always in trouble, rehab for an old high school friend. There were times when he had $100,000 in a grocery bag in his car, just sitting there for weeks because he didn’t know what to do with it.

  And the cars! An SUV for his other brother, a Mazda RX8 for his girlfriend. And for himself, a $120,000 Mercedes CLS 63. It was sweet satisfaction when he took his sister—she was actually his cousin, but they’d grown up together after Derik’s dad killed his mom, and they considered each other siblings—to the Mercedes dealership. He’d told her stories about American Pain, and she seemed to think he was exaggerating about the money. Derik wasn’t above embellishing a story for effect or for personal gain, but he didn’t need to stretch the truth about American Pain’s cash flow. When he plunked down $25,000 as a down payment on a convertible, his sister started to believe.

  His party expenses went up a notch too. Derik had always been a drinker, but he was doing more blow than usual. He also took oxycodone, as did most of the others at American Pain. Derik found that the pills took the edge off the cocaine. Oxy filled him with energy, the everyday aches and pains vanished. They made him feel like he could do backflips.

  Derik’s body generally had a number of pharmaceutical chemicals running through it. Oxycodone, for nights out. Anabolic steroids, of course, to keep the machine in prime condition. Adderall, to gun the engine—taking three at once was like snorting a bump of coke. Xanax, to bliss things out. Dr. Cadet wrote him scrips for Viagra and Cialis, which he told his girlfriend he’d gotten for one of the security guards who was too embarrassed to ask for them.

  Most of the employees eventually became patients, and either used the drugs themselves or sold them. Saturday nights, Derik popped oxys with half of his American Pain crew. Monday mornings, the same guys lined up in Derik’s office and he gave them their weekly testosterone injections.

  Some people could handle having total access to any drug they wanted, and some couldn’t. Derik himself did coke and oxy maybe once a week. The father of Derik’s high school girlfriend was a biker and recovering alcoholic with three years of sober time. He wanted to be a drug counselor, but he started working at the clinic in 2008, and his addiction roared back to life. Within a month, he’d gotten a prescription from Dr. Joseph for Percocet 10 milligrams. Just a few weeks and he’d graduated to oxycodone 30 milligrams and was getting high at
work. Dr. Boshers wrote for him even after the staffer told the doc he was an addict. The staffer was making thousands a week, more than he’d ever made, but he was upset when he saw pretty young female patients growing thinner with each monthly appointment, hair thinning, sores on their faces. He finally quit and went to a Veterans Administration rehab.

  Derik’s old friend wasn’t the only one with oxycodone problems. One of the good-looking women they’d hired turned out to be a serious junkie, which was clear from the day she started. She could barely speak half the time. Eventually, she was so much trouble that they stationed her at the closed Oakland Park Boulevard location, giving directions to the new clinic. Eventually, another pain clinic called Derik, saying the employee had been doctor shopping. This was the ultimate taboo at American Pain, not because anybody gave a shit whether employees took drugs but because it was so easy to get caught, which could jeopardize the whole operation. Derik fired her.

  Some days, the party spilled over into the workday, people boozing and doing who knows what else at the clinic. It infuriated Ethan, who didn’t like trying to run herd over a bunch of Derik’s pals. They didn’t believe they answered to him, which suited Derik fine.

  Almost all the doctors wrote Derik or other employees prescriptions at different points.* Jacobo Dreszer wrote Derik scrips for oxycodone 30s. Roni Dreszer wrote him for Adderall and amphetamines, sometimes just because the young doctor didn’t want the drugs in his own name; Derik would fill the scrip in-house and hand the speed over to the young doctor. One employee also gave Dreszer cocaine; Dreszer was writing him scrips. Boshers and Cadet also wrote oxy scrips for other employees, and Boshers was on the stuff himself. The doctor, who was in his mid-forties, had pain from a bad disc in his back. He got oxycodone prescriptions from Dr. Joseph, then the Dreszers, and then Dr. Cadet. Each doctor upped him. When Boshers first came to American Pain, he’d started out taking 130 30-milligram oxycodone each month, and before long, he was taking the maximum Chris would allow the docs to prescribe: 240 of the pills each month, plus another sixty 15-milligram oxycodone for “breakthrough pain.” The pills didn’t help for long, but he did get hooked. Finally, he had an MRI done, and the radiologist told him that the disc in his lower back had ruptured, leaking fluid like a stepped-on jelly doughnut. He needed surgery, not higher and higher doses of narcotics.

  Despite all the drugs and prescriptions exchanging hands, none of the new crop of doctors ever directly addressed what was really going on at American Pain, though little hints slipped out now and then.

  Dr. Boshers was the physician who danced closest to the edge of the charade. A longtime patient would come into his office, someone the doctor felt comfortable with, and he’d joke: Here for your candy?

  Roni Dreszer was an interesting one. When Dreszer first joined his father at the clinic, he wrote only very small amounts, a few dozen pills at a time. When a patient complained, Derik mentioned it to the young doctor, trying to be subtle about it. Dreszer didn’t get it.

  He said: I think some of these people don’t really need as many pills as I’m giving them. It doesn’t feel right.

  Derik and Chris talked it over. They had never encountered this problem—every other doctor who made it through the interview process seemed to get the picture right away. Chris called the young doctor to his office.

  Chris said: I can’t tell you what to do, but people are leaving the clinic unhappy, and you really can’t work here if you’re not going to treat the patients as they want to be treated.

  After that, Roni Dreszer wrote higher. He rarely prescribed more than 180 pills a month, but that was enough to satisfy most patients. Dreszer was kind of like Dr. Boshers, Derik thought—it didn’t seem to bother him when patients asked for more meds or referred to the pills as “blues” or “mallies” or “roxies,” though he did complain to the other doctors when patients offered him bribes. And Dreszer shared Derik’s sense of humor about the whole phony medical scene at American Pain. One day, the young doctor emerged from his office and called out to Derik.

  He said: Dr. Nolan? Dr. Nolan? I need a consult. Can you take a look at this patient?

  Derik played along, followed Dreszer into his office. A male patient was there. Dreszer asked the man to drop his shorts, revealing a scrotum swollen to the size of a softball. Derik recoiled.

  Dreszer said: What do you think of this, Dr. Nolan? What’s your professional opinion?

  Derik: Uh, I don’t know. What’s your professional opinion?

  Dreszer: Well, I think he’s retaining some fluids in his scrotum.

  Derik: Yes, I think you are correct, Dr. Dreszer. He’s retaining fluids.

  Roni Dreszer’s father took the job more seriously. The elder Dr. Dreszer would kick patients out if they asked to be upped or if they called the drugs by their street names. He didn’t seem to like any direct acknowledgment of what American Pain was. He took pride in the fact that he’d had a long career as an anesthesiologist and was actually somewhat qualified to work in a pain clinic.

  Chris was never satisfied, but he knew he couldn’t push the doctors too much. He’d look at Dr. Cadet’s patient intake box, stuffed with patient files, and say to the other doctors: If you wrote the amounts she does, your patient box would look like hers.

  Or he’d tell the docs they needed to see more patients—fifty, seventy-five, eighty-five a day. The numbers kept growing, and the elder Dr. Dreszer, always excitable, pushed back.

  He said: I am a human being, not a machine! If you don’t stop this, I will have to leave!

  Still, the elder Dreszer burned through patients as quickly as the other docs, and like the rest of them, he preferred return patients to new patients. Return patients took five minutes or less. New patients required a lot more introductory paperwork, so it took ten or fifteen minutes to process them, and the pay was the same. Some of the doctors asked Chris and the staff to give them only return patients.

  To speed things up, Derik had a set of prescription stamps made for each doctor. That way, they wouldn’t have to take the time to handwrite the same scrips over and over all day. He ordered stamps for Xanax, Percocet, Valium, and Soma, a muscle relaxant, as well as four stamps with different dosages of oxycodone 30 milligrams: 150 pills, 180 pills, 210 pills, and 240 pills. Derik had a catered lunch delivered to the clinic each day so the doctors could get back to work more quickly. He also hired a company to wash the physicians’ cars, so they would focus on working instead of running errands. These conveniences also had the added benefit of limiting the doctors’ exposure to the patients. Better they saw as little as possible of activities in the waiting room and parking lot. Chris wanted the docs in their offices, writing scrips.

  The $75-per-patient pay system encouraged competitiveness. Once, Dr. Michael Aruta saw Dr. Jacobo Dreszer take a patient file out of Dr. Boshers’s bin and call that patient back. Dr. Aruta considered this stealing, and he confronted Dr. Dreszer. The old man started yelling about how Dr. Aruta was a hack who couldn’t make it in plastic surgery and didn’t care about the patients. The younger Dr. Dreszer held back his father from attacking Aruta, but he told Aruta that he needed to start taking a bigger load of new patients instead of grabbing all the follow-ups. Derik stepped in and split up the doctors, and Aruta and Dreszer were enemies from that point on.

  This atmosphere of greed at American Pain bothered Dr. Aruta, but the pay made up for it. Aruta needed money. Since 2003, he’d operated his own anti-aging, vein care, and appearance enhancement practice in Fort Lauderdale. He invested heavily in the business in 2007, which proved to be a mistake when the economy tanked. A year later, he closed the business more than $200,000 in debt. While searching for a job, he kept running across ads for pain clinics. They were popping up on every corner in South Florida. He knew some pain clinics had been shut down, and he wasn’t sure they were legal, so he didn’t pursue any of the positions at first. But after several months of looking for work, he took a job at a pain clinic called A-P
ain in Hollywood. Seeing and prescribing for pain patients was easy. Too easy. He saw only eight to twelve patients a day at $50 a pop. Driving home one day, he saw a billboard advertising another pain clinic in Fort Lauderdale. He grabbed his phone right then and dialed the number and spoke to the clinic’s owner, Chris George. They discussed Aruta’s experience with pain medications, and Chris said he’d pay $75 per patient, plus $1,000 a week for the use of his DEA registration to order medication. Even better, Chris said he’d see at least forty patients a day, which meant $15,000 a week.

  Aruta went to the clinic for an interview the next day and was heartened to see the busy waiting room, maybe seventy-five patients milling about. Aruta had worked at the 1,550-bed Jackson Memorial Hospital in Miami and the gigantic Cleveland Clinic. He was used to lots of patients. He needed lots of patients.

  His interview with Chris George took about ten minutes. Chris glanced at Aruta’s medical license and DEA registration but spent most of the time looking at the security-camera monitors in his office. Chris then handed him off to other staffers, who explained the medication ordering process and gave him a tour of the pharmacy. Aruta also shadowed one of the doctors and saw that the procedures were similar to A-Pain’s.

  But Aruta realized pretty quickly that it wasn’t a typical medical practice. For one thing, the staff was juvenile, a bunch of kids in their twenties, constantly causing drama and pulling pranks. Their leader was Derik Nolan, who affected a loudmouth, tough-guy exterior, especially with the patients. But Aruta liked him anyway. Underneath, Derik was funny and affable and intelligent, and when he wanted to be, surprisingly articulate. He was also very skilled at getting rid of problem patients, which Aruta appreciated. Aruta had heard of patients attacking pain clinic doctors who wouldn’t give them a prescription. He began carrying a gun to the clinic, as did Dr. Boshers. They wore their guns under their physician’s coats as they attended to patients. Aruta was a careful man and kept an eye out for problems around the clinic. He called it situational awareness. So when Aruta wanted to get rid of somebody without writing a prescription, he simply excused himself and found Derik, who took care of it from there with minimal drama.