American Pain

by John Temple

  Derik was always making the rounds of the clinic, but Chris George was aloof and typically stayed in his office. When Chris did talk to the doctors, it was usually something critical. Early on, Aruta sometimes told overweight patients that they should improve their diets, stop drinking Mountain Dew, that losing weight helps with many pain problems. Chris told Aruta to knock it off, that patients were complaining and a couple of women had left his office in tears. Aruta knew Chris didn’t want patients switching to another clinic, but it irked him that Chris would try to stop him from giving basic medical advice.

  Three times, Aruta was called out to the waiting room to treat patients who were going into spasms. Once, before the doctors could act, a staffer unzipped a convulsing patient’s pants and dumped ice cubes down his underpants, thinking the cold shock would jolt him out of the seizure. Ethan talked to the doctors about assembling a crash cart for these seizure episodes, but it never got done.

  Sometimes, there was talk of patients who had died of overdoses, though Aruta hadn’t heard of it happening to any of his patients. There was the man who died in Kentucky before Aruta started working at the clinic, the one whose mother and girlfriend had confronted Dr. Cadet. Any medical practice carried risks, Aruta told himself.

  Over and over, Aruta thought about his procedures and convinced himself he was providing appropriate medical care. He and the other doctors talked about this a lot, whether they were breaking the law. They repeatedly assured each other that they were not. Sure, they saw lots of patients, and the visits were short, but that was because the doctors weren’t doing complicated diagnoses. They were simply treating pain. Nobody could ever tell for sure whether someone else was in true pain, so it wasn’t the doctors’ fault if the patients lied. Furthermore, they regularly discharged patients who had track marks, sometimes several a day. The staff also discharged patients if they found they were going to other clinics. The doctors told each other that it was inevitable that some patients would abuse the medications. They were doing what they could to prevent it. If there were illegal activities occurring at the clinic, that was Chris George’s problem. The doctors absolved themselves.

  The worst thing Aruta foresaw happening was police shutting down the clinic, leaving him out of work again. Which would be bad, because the money was even better than George had promised. Aruta was making more than $20,000 a week. He’d never earned more than $140,000 in a year, and now he was making more than that every two months. He paid off his debts and started thinking about retirement. It was a great feeling.

  Dr. Cadet was the one Derik couldn’t figure out. On one hand, she generally wrote the highest, maybe because she hated to disappoint anybody. But she was a mixed bag, because she also took the longest with each patient, would get deep into conversation with them, perhaps less aware than the other docs of the $75 she was earning per patient. She seemed to care genuinely about their well-being, yet somehow she also justified giving them massive doses of addictive drugs.

  One day, Dr. Cadet called Derik back to her office and introduced him to a female patient. Cadet said the woman was three months pregnant and scared to death she was damaging her fetus. This wasn’t the first time American Pain had dealt with this issue. Relatives of pregnant patients had called Derik in the past, furious that the doctors were prescribing heavy narcotics to women about to give birth. A couple of times, cops had called him with the same complaint, saying they’d just arrested a pregnant woman with a scrip from the clinic, asking Derik, how he could live with himself? The answer, of course, was that he thought about it as little as possible. And when he did think about it, he knew what he was doing was wrong, but he told himself that he’d quit as soon as he’d saved up a million bucks or so. And anyway, it wasn’t his fault. The patients were hooked because they weren’t taking the medicine as prescribed.

  But this patient was different. She wanted to detox from the oxy. Cadet asked Derik to research drug treatment centers and specialists and help the patient wean herself from the drugs. Derik did as Cadet asked, calling the woman’s obstetrician, forwarding medical records, putting in a lot of time helping this one patient. And then he created a new policy that every female patient younger than forty-five years old had to take a pregnancy test.

  It was a nice thing to do for the patient and her baby, and Derik did feel good about the new policy. But he didn’t fool himself. It wasn’t like helping this one woman made up for everything else they were doing.

  This was Dr. Cadet’s thing. She would write scrips for addicts all day long, but then she would call him back to her office, and show him a nice card that some coal miner had given her, thanking her for helping get him back on his feet. Or she’d introduce him to a patient and tell him a sad story about a problem the patient was dealing with, ask Derik for some kind of help. Derik would comply, and then he’d head back out into the sea of junkie desperation in the waiting room, shaking his head and wondering if Dr. Cadet was for real, actually oblivious to the shitstorm of misery they were unleashing on these people. Derik could laugh about it all, but he couldn’t completely fool himself into thinking he was doing some sort of humanitarian service at American Pain.

  Like Dr. Cadet, Chris George sometimes came to the aid of certain patients. Usually this happened when Derik had decided to kick someone out for doctor shopping or trying to sneak in to an appointment early or failing a drug test or something. If the patient somehow managed to get Chris’s attention, Chris would often side with the patient. He’d say Derik was heartless and didn’t understand what it was like to be in severe pain.

  But Chris didn’t spend much time dealing with patients. Derik did, and he’d heard too many sad stories, seen too many junkie stunts. He knew exactly what these people were. All of them, no exceptions. Derik was losing his patience with the zombies, not that he’d ever had a whole lot. He didn’t think of them as human beings. The Brazilian girl he’d dated the previous year had taught him that a junkie was a junkie, no matter what she looked like. And the lesson had been reinforced in December, when an elderly couple from Kentucky had come to the clinic two weeks before their appointment. Patients were always trying to scam their way into an early appointment, because they couldn’t make their pills last twenty-eight days. But this couple was different. They weren’t desperate. They seemed like regular folks, nice. A grandfather and grandmother. They said they’d brought their grandkids to Disney, which was why they were early. Someone back home was sick, which was why they’d taken the grandkids on this last-minute trip. Their schedule wouldn’t allow them to come back for their regular appointment, and they asked Derik to help them out.

  The doctor agreed to write their scrips early, as long as they didn’t fill them for two weeks. To ensure this, the doctor dated the scrips two weeks from the current date. The couple thanked him over and over, said he’d helped their family out during a tough time.

  Less than an hour later, a pharmacy called. The old folks were trying to fill the prescriptions, and the pharmacist was suspicious because the dates were torn off. Derik called the couple, told them off, said he was turning them in to the cops. They seemed scared, but two weeks later, they had the nerve to try to come back on their regular appointment date. Derik told them to beat it.

  From then on, he thought of all patients in the same way. No matter how they looked or spoke or dressed, they were all junkies to him. Which made the whole thing easier to stomach. Junkies were gonna get those pills—somehow, someway.

  The bigger it got, the more money that poured into Chris’s bank accounts, the harder he’d become to deal with. Over the year, he’d gone from monosyllabic and standoffish to downright mean sometimes, barking at the doctors for being too slow, chewing out Ethan for not keeping the place stocked with drugs, and yelling at Dianna for just about everything. He took to studying patient files each night to make sure the doctors were prescribing high enough. He seemed especially tough on the female doctors. One woman who worked part-time quit after he berat
ed her. Chris also got on Dr. Cadet’s case because she often took time off and left early—3:30 or 4:00 p.m.—to take care of her two young children. Usually, she was a model big writer, but once, in front of staffers, he blew up after looking at Cadet’s file.

  He said: I’m going to fix that bitch once and for all.

  He stalked over to her office and told Cadet that she needed to get her numbers back up.

  Derik smoothed things over with Cadet. Derik liked Cadet, and she liked him. She laughed at his antics, called him the Original Gangster. She was no longer the happiest person he knew, however. Her marriage was breaking up, and she seemed like a lost woman for a while. The divorce became final in October 2009. She needed help with practical matters. Derik helped her find a new car similar to his, a Mercedes CLS 550, arranging the test drive with the salesman at Mercedes-Benz of Delray and going with her. When she wanted to buy a beach house, Derik made some calls to some real estate people he knew from his construction years. He printed out some good deals, set up appointments for her to see them.

  So Derik didn’t like it when Chris yelled at Cadet. But at this point, Chris and Derik were clashing too. They almost had a fistfight one day because Chris asked Derik to give a deposition in Chris’s lawsuit against Jeff. Derik wasn’t going to put his name on any legal documents. At times, Derik considered quitting American Pain and opening his own clinic. He talked about it with Cadet, who said she would come with him. In fall 2009, he even put down a deposit on an office in Lake Park. But every time he was poised to jump, something stopped him. He and Chris would make amends, and Chris would boost his pay. Besides, Derik had been a key player in the creation of American Pain. He’d helped build a huge operation, and he didn’t want to start over.

  No matter what they called the clinic or where they moved, Carmel Cafiero from Channel 7 would eventually show up. Her cameraman had a knack for getting grainy, ominous B-roll footage of the clinic exterior. Customers counting hundred-dollar bills before heading inside. Or sitting in their cars wielding hypodermic needles. Security guards lumbering thuggishly through the parking lot in their black T-shirts, spitting slow-motion into the grass.

  When cameras showed up, Chris and Derik snuck out the back door. They didn’t need a repeat of the Cafiero report the previous fall, which had been a disaster. Wholesalers had dropped them, forcing Chris to change the clinic name and hire Ethan as his front man. Chris and Derik couldn’t afford to be directly linked with American Pain.

  Still, Derik believed it was his right to know who was in his parking lot, to ask questions about what they were doing, so he occasionally violated his policy of making himself scarce when a camera was around. Sometimes it was hard to tell who was a reporter and who was just nosy. There were the amateurs, unaffiliated with any news organization, who would park outside the clinic and shoot video on their cell phones, including one woman who wore a wig and a hat so she wouldn’t be recognized. Sometimes they’d even come inside and snap some pictures or shoot a short video of the crowded waiting room.

  One day, Derik’s crew chased off a woman who was cruising through the American Pain parking lot, shooting video on her cell phone. Turned out, she was posting the videos on her YouTube account, narrating her adventures as she went: “And now we got two security guys that are gonna come and tell me to get off their lot, maybe, I don’t know.” She shot video of Tennessee and Kentucky license plates, tsk-tsking until someone tapped on her window. “Get away from my car. Get away from my car!”

  Later, Cafiero interviewed the woman for a segment on pain clinics, identifying her as a “citizen journalist.” The citizen journalist looked delighted to be in the studio, a big smile on her face, and told a story about being waylaid by American Pain guards. “One has a knife and the other has a set of keys in between his knuckles. He goes . . .” scowling and deepening her voice, “‘You don’t want any of this! You better come with us.’ ”

  One day at the clinic, some staffers who hadn’t seen Carmel Cafiero’s reports asked Derik about them. Derik found one of the Cafiero videos online and played it for the staff on his laptop. Aruta and Cadet were there too. Aruta was aghast when he saw a patient shooting up in the clinic parking lot.

  Aruta discussed it with Cadet afterward. They both said they hoped the pharmaceutical companies would come up with a narcotic painkiller that couldn’t be abused. But Aruta believed that drug diversion was a problem for the police. The patients were the ones who were violating the instructions printed right there on the pill bottle. How could he be held responsible? He and Cadet agreed: They had no control over what patients did with medication after they left the clinic.

  And, in a way, the news coverage and the proliferation of pain clinics made everyone feel more secure. The clinics were everywhere, ads blanketing page after page of the New Times, billboards up and down I-95. They were operating out in the open, safely aboveboard.

  Another time, Derik was walking to the convenience store across Federal Highway and saw a blonde woman and two men videoing the clinic. Derik approached, and all three strangers jumped into a maroon sedan and peeled out of the parking lot. Derik was suspicious, and curious.

  Chris was leaving the office right at that moment, so Derik flagged him down and they followed the blonde woman’s car in a black Range Rover. Chris called 911 and explained what was happening, and the dispatcher told him to stop following the people. Chris kept going. The car stopped at a gas station, and Derik got out, and the threesome took off again. Finally, headed south on I-95, the car pulled over to the side of the road. Cops showed up and told Chris and Derik that the people in the car were media and to leave them alone.

  And that was that, until a few months later, when the whole scene played out on a forty-seven-minute documentary called The OxyContin Express, which Derik and Chris watched on hulu.com. The blonde woman was a documentary filmmaker named Mariana van Zeller. For the first fifteen minutes of her story, she shadowed a pill addict whose brother had died of an overdose. The guy, who looked familiar to Derik, let the camera follow him as he was rejected from a pain clinic and finally bought pills from a street dealer. He even let her shoot him crushing and smoking a pill off a scrap of tinfoil. Then the focus shifted to American Pain. The blonde woman shot video of the old South Florida Pain location on Oakland Park Boulevard. It had been closed down for almost a year, but the big red-lettered signs were still up and old customers still came by. Derik kept a guy parked out front to direct patients to the Boca location. “So we came here to check out this pain clinic because a lot of the law enforcement and doctors told us that a lot of the prescriptions are actually coming from this one pain clinic,” van Zeller said to the camera. She got a map from Derik’s guy, who sat in a tan Ford Ranger, a towel draped over his window to block the blazing South Florida sun. She followed the map to the clinic in Boca Raton, and that’s when Derik spotted her. As Derik and Chris followed her, van Zeller drove and narrated at the same time, glancing nervously at the rear-view mirror: “So we were filming a pain clinic from across the street and essentially had the camera out for five minutes and this huge black SUV comes up with a guy all tattooed, a huge guy, and starts asking us, ‘What the fuck are you doing? What are you filming?’ ”

  Derik didn’t remember being quite that aggressive. He thought he actually smiled, raised his hands in peace. And he considered himself neither “huge” nor covered in tattoos. But saying a 210-pound man with some ink had approached her wouldn’t have made for good TV. Or won a Peabody Award, like The OxyContin Express did that year.

  Still, it could have been worse. At least the blonde woman hadn’t named him or Chris and had blurred out their faces on the video.

  The Boca Raton police kept an eye on the clinic and regularly pulled over patients leaving the parking lot, but they were friendly enough to Chris and Derik and didn’t give them a hard time. They came to the clinic asking for information on patients they suspected of doctor shopping. Derik helped the cops when he could,
trying to stay on their good side.

  Still, sometimes, Derik would look around at the hundreds of drug seekers in the waiting room and feel a stab of panic. There was no way they’d get away with this.

  Derik would say: Chris, we gotta calm it down.

  Chris would say: Nah, we’re good, we’ll be OK. Until they change the laws, we’re legit.

  Other times, it would be Derik telling Chris there was nothing to worry about. Sometimes they would agree they needed to be more cautious, but then over the course of the conversation, they’d talk themselves out of their own fears. Caution wasn’t natural to either of them.

  In October, Derik flew to Italy for a friend’s wedding. While he was there, he got a phone call from his cousin. A former American Pain employee had been arrested on cocaine and gun charges, a guy named Pedro Martinez who had worked for Derik on and off for years, ever since Derik’s plumbing days. Derik had fired him from American Pain after finding out he was selling pills.

  When Derik got back home, he went to Pedro’s house. Pedro was acting odd. He turned the TV volume up high and whispered as he told Derik what happened after his arrest. Pedro said he’d been held at a police station in Royal Palm Beach until another cop showed up, a deputy sheriff from Palm Beach County. Derik knew the deputy’s name. He knew him well, actually. The cop had come to American Pain a number of times while investigating patients for doctor shopping. Derik had always been cooperative and handed over patients’ medical records. The deputy was a friendly guy, always asking questions about the clinic.