American Pain

by John Temple

  They had decided to give employee awards at the Christmas party, including a Doctor of the Year award. The selection process didn’t involve secret ballots or patient surveys or anything. Ethan had just told Derik about it one day, and they’d both snickered a bit as they considered the options. Politically, they couldn’t go with the elder Dr. Dreszer or Dr. Aruta, since they hated each other, which more or less ruled out the younger Dreszer too. That left Dr. Boshers and Dr. Cadet, and the choice was obvious. Dr. Cadet was consistently nice to everyone, and no one felt threatened by her. She was the one they had new doctors shadow. Most importantly, she was the patient favorite, for her caring manner and enormous scrips.

  So Ethan had ordered a small gold-bordered wooden plaque that read:

  RECOGNIZING

  2009 DOCTOR OF THE YEAR

  DR. CYNTHIA CADET

  AMERICAN PAIN

  Derik gave a cornball speech, thanking everybody for their hard work. Dr. Cadet seemed touched by the honor. Derik couldn’t believe she was dumb enough to take the award seriously. But it was always hard to tell with Dr. Cadet. Did she believe she was helping people in pain? Or did she get that it was just a money-for-drugs operation? Sometimes, she seemed to understand that things weren’t quite right at American Pain. Like when she asked Derik if she was going to get in trouble for her patient load, which was topping seventy a day. Or was she somewhere in the middle, justifying her actions, grasping at every nugget of favorable evidence, like the doctor-of-the-year plaque, to convince herself that she was still practicing medicine? Derik wasn’t sure, and he wasn’t going to question her about it. People were entitled to their delusions.

  The ankle monitor Derik wore after his Jacksonville arrest was the size of a BlackBerry phone. It was strapped to his ankle, and he was always aware of its presence, which was maybe the point of the thing. It had to be charged like a cell phone, so he would plug it in at night before he went to bed. But he’d thrash around in his sleep, and it sometimes detached from the charger cord, and in the morning, the battery would be low. So then he’d take the charger cord to the clinic and charge it there, sitting at his desk, tethered to the wall outlet like a dog on a leash. Derik was told that his movements weren’t actually being monitored, that the device was designed to alert the authorities only if he got close to the pain clinic in Jacksonville. Which was fine. Derik had no desire to go back there.

  After Jacksonville, Chris and Derik worried that the police had put listening devices in their cars while they were impounded. They remembered how the police there seemed to know a lot about them, and they wondered if Pedro Martinez had been telling the truth back in October and there really was a big DEA chart somewhere with all of their names and pictures on it. They worried their phones were tapped and their offices bugged. One day, Derik came into the office to find the private investigator who had tried to convince Chris to let him launder his money. Ethan was with him. They had a machine and they said they were using it to sweep the office for bugs. Ethan was enamored with the guy, maybe because he used to be a DEA agent and then had gone bad, just like ex-cop Ethan had done. When the guy left, Chris told Ethan to stop hanging around with him.

  Derik’s lawyer on the Jacksonville case was making him nervous. The lawyer said if the feds came after them, they would go after the weakest people first, probably the people who were most connected to society and felt they had the most to lose. Derik figured this meant Ethan and the doctors. The feds would scare the weak ones with the threat of long sentences, hard time, hammer them until they agreed to testify. The lawyer said it would be a racketeering case, because that would be the only way to hold Chris and Derik responsible for what the doctors were or were not doing behind their office doors. RICO was probably their best option, unless they could get Chris and Derik on some other charges, like selling pills out the back door, or the Jacksonville extortion charges.

  Derik and Chris grew even closer after Jacksonville. They made a pact not to turn on each other. They’d sat in jail together, were both looking at up to fifteen years of prison time on the extortion charges, and those things strengthened their connection. They each knew plenty of damaging evidence about the other one, and they trusted each other not to rat.

  After the Jacksonville arrest, Derik once and for all gave up any plans to open his own clinic with Dr. Cadet. He and Chris couldn’t split up now. They had identical black ankle bracelet monitors strapped to their legs. What could bond two guys more than that?

  Their other rival clinic, Palm Beach Pain, wouldn’t give up. Derik kept finding flyers and cards from the nearby clinic on tables in American Pain’s waiting room.

  Finally, Derik summoned his two jumbo-sized Samoan security guards and Chris, and the four of them drove up to Palm Beach Pain. Maybe it was because the Jacksonville criminal charges were hanging over their heads, but the confrontation was all talk and no action. After a while, the Palm Beach Pain guys just called the cops, and the American Pain crew left.

  The aggravation continued. The upstart clinic hired people to pose as American Pain patients, sit in the waiting room and talk to people, hand out cards for Palm Beach Pain.

  The impostors would say: Look how crowded this place is. Don’t wait here, go see this guy. He’ll get you in right away.

  Late one night that January, 2010, Jeff George called Derik. Jeff said he was bored.

  Derik said: Want to go fuck up Palm Beach Pain?

  Jeff picked up Derik, who brought along a slingshot and a bag of ball bearings. In the dark parking lot of Palm Beach Pain, they began blasting away at the plate-glass windows with the slingshot. The ball bearings punched holes in the glass until the windows started crashing down in huge jagged sheets. After destroying every window, Derik and Jeff shot up the copy machines. Finally, the slingshot broke, and they took off.

  Palm Beach Pain was out of business for a week or so. But Chris couldn’t let it go. He was obsessed. He hired a private investigator to put a GPS device on the clinic owners’ cars. He’d get up early in the morning and look at the tracker on his computer, see where they’d been promoting the clinic the previous night. Then he and Derik would go there and steal any Palm Beach Pain signs and flyers. Once, they stuck all the clinic signs in front of a police station. None of it made much sense, but that was Chris. He couldn’t let anyone else win, not even a little.

  By the early months of 2010, as he and Chris prepared for the move to the big bank building on Dixie Highway, Derik was exhausted.

  He was overseeing about twenty people, most of whom were funneling parts of their payoffs to him. For the most part, they did what he wanted because he was in charge of them. The hardest part of the job was working with the people who didn’t directly report to him. And there were more and more of them as the network servicing American Pain patients grew: MRI and labwork companies, pharmacies, the other pain clinics. The largest portion of Derik’s income came from kickbacks from MRI companies, so staying on top of that flow of patients was a priority. Chris and Jeff were starting to work together, after their reconciliation in the aftermath of Jacksonville. While a good thing, it meant that Derik had to keep the pain train running between four clinics, working with Executive Pain as well as Jeff’s two clinics, East Coast Pain and Hallandale Pain. Patients who were kicked out of American Pain got a second shot at Executive, maybe a third at East Coast, and so on to Hallandale, and this process had to be coordinated. If things got too busy at American Pain, Derik would send the overflow to the other clinics. In addition to all of that, police departments and pharmacists were constantly calling American Pain, asking for paperwork on doctor shoppers. Derik was always running, trying to keep everyone happy.

  The clinic was a beehive of suspicion, patients and employees buzzing with rumors and lies about who was wearing a wire, who’d been arrested, who was selling their pills on the street, who was opening their own clinic, who was stealing patients. Derik had to create and run a network of spies. He’d send a confederate to an
MRI company and test its loyalties, try to bribe someone to release the medical records of American Pain patients to a different pain clinic. He’d hire guerrilla marketers to chase down patients leaving other clinics and give them free visits or medication if they switched to American Pain.

  Derik was still living with his girlfriend, the pharmacy tech at American Pain. She needed him to take care of her, and she didn’t ask a lot of questions, and that was enough. A family dinner with her and her little girl, a nice meal and conversation, or going to Fourth of July fireworks with his little makeshift family—sandwiched between the insanity of a workday at American Pain and a coked-up night at Solid Gold, these little breaks were a chance to pretend he was a normal person.

  Derik had a plan to escape the soul-deadening grind. After they moved to the Dixie Highway building, he was going to ask Chris if he could become kind of a roving consultant to the entire empire, leapfrogging from one pharmacy or clinic to the next, making sure things were shipshape. He had to get out of the waiting room.

  Derik knew patients were dying. Once, he’d asked Dr. Aruta about oxycodone. Was it easy to overdose on? Was it hard to get off? Derik recalled Aruta saying the detox was no big deal, that oxycodone was the safest painkiller out there. Derik figured Aruta didn’t know what he was talking about, because he kept hearing about clinic patients overdosing. A medical examiner had called American Pain the previous summer, looking for records for one of Dr. Cadet’s patients who’d died of an overdose. In November, there’d been the front-page story in the Palm Beach Post about the guy who’d overdosed earlier in the year on a prescription from Jeff’s East Coast Pain Clinic. Then, five days after the Lamborghini story, two women from Tennessee died in a train crash, patients at Executive Pain, though Chris and Derik had never heard from the cops about that one. And in January came a malpractice suit against Jacobo Dreszer, filed by the relative of another patient who died after only one visit to American Pain.

  Chris joked to a girlfriend: “First visit. He couldn’t handle pain management.”

  Derik didn’t sit around feeling sorry for the patients either. He wasn’t holding a gun to their heads, forcing them to crush and snort monster quantities of oxycodone. They sought him out. It was their decision. Though sometimes he wondered if that was strictly true, like the time he saw the little boy grasping the pill bottle filled with candy, the kid wanting to be like his daddy. It made him sick. What chance did that boy have?

  The guys kept a close eye on the news. There were stories almost every day about pill mills. Palm Beach County was considering prohibiting cash-only sales and requiring clinics to list the names of clinic owners and operators in state records. Florida lawmakers had proposed four separate bills, each containing different measures. One would require doctors to be in good standing to own or operate a pain clinic. Another would prohibit anyone convicted of a felony from owning or operating a clinic. The toughest bill was one that would prohibit doctors from dispensing more than seventy-two hours’ worth of narcotics to a patient, which would cripple the entire Kentucky-to-Florida pipeline. Luckily for Chris and Derik, the Florida Medical Association and pain-management advocates were fighting the seventy-two-hour idea.

  Chris and Derik believed they’d be able to operate in Florida for another year, maybe two, before new laws squeezed them out. So Chris was researching the laws in other states, especially Texas, Missouri, and Georgia. They also had staffers making lists of patients’ hometowns every day to identify potential locations that already had a concentration of patients. If Florida ever cracked down, he wanted to be ready to move operations. So in February, Chris and Jeff opened a one-doctor clinic called Pain Express in Kennesaw, Georgia. The new clinic was in a suburban strip mall just off Interstate 75 north of Atlanta, nine hours closer to their customer base in Kentucky and Tennessee. Georgia’s laws were about as lax as Florida’s, and Chris believed the state was a potential gold mine. Georgia didn’t license pain clinics either, and nobody was sure how many there were in the state, though the state Drug and Narcotics Agency believed the number to be in the single digits.

  But mainly Chris concentrated on preparing American Pain’s new home. The first floor of the bank building on Dixie Highway was wide open, so it needed a full build-out—doctor examination rooms, offices for Chris and Derik and Ethan, a large work area for the office staff, and a huge waiting room. Majestic Homes did the work. They built a DMV-like system of patient windows—two for new patients, four for follow-up patients, and one where patients would get their medicine. The staff area had desks and banks of file cabinets and twenty phone lines. They bought two hundred nice leather chairs for the waiting room, six flat-screen TVs, and vending machines. They built a service area so Delray Diagnostics could station someone there to arrange MRI appointments for patients on-site. The biggest problem was that there was only one bathroom on the first floor, but they decided to figure that out later.

  Derik loved the second-floor catwalk that would allow him to keep an eye on the waiting room below without actually having to mingle with the zombies all the time. The second floor was connected to an outside porch area with a grill for barbecuing. You could climb up a ladder to the roof from there and survey Dixie Highway and the long flat inland landscape.

  Derik put twenty-five plastic chairs outside so patients could catch a smoke. A tall chain-link fence encircled the lot, and he had plastic slats put in it to keep people from seeing what was going on inside. They would finally have the parking spaces and privacy they needed.

  A month before the move, the staff began telling patients about the new location, giving them flyers with the new address and directions for their next visit. Derik wanted to get off on the right foot with the neighbors, so he went to the junk shop across the street and introduced himself, dropped a couple grand on a few items. He tried to explain what the business would be, using the phrase he and Chris always used: We’re in the medical field. People responded the way they always did, by asking if Derik was a doctor.

  Derik would say: Do you know any doctors who own hospitals? No, because they are owned by investors. This is the same thing.

  Derik wasn’t too sure of these facts, but he gave the spiel many times—to cops, to neighbors, to guys next to him in bars—and people seemed to buy it. Mainly, though, he wanted to prepare the Lake Worth shopkeepers for the deluge without scaring them too much. Derik said if they had problems with traffic or patients, please call him before calling the cops. He would take care of it.

  They opened on Dixie Highway on February 1, 2010. Chris continued to pay the lease on the Boca location even though it was empty. He figured if he stopped renting the space, Palm Beach Pain would swoop in there and try to lure patients who were looking for American Pain.

  Similar to the previous moves, business was slower for a day or so at the new location, but by the end of the week, Dixie Highway was jammed two blocks south, a line of patients trying to pull into the lot, right-turn blinkers on. Derik hired a team of traffic handlers to flag patients into specific parking spots, like concert venues did. Security guards roved the two-anda-half-acre lot on golf carts. Derik stationed guards on the roof to keep an eye on the perimeter of the building, looking for cops and media vehicles.

  The parking lot exited onto a one-way alley, which then took the traffic through a residential neighborhood. Derik didn’t want patients nodding off and running over people. He pondered the problem, then simply took down the one-way signs and had the traffic handlers direct people the other way.

  Inside, they taped arrows on the floor to direct the foot traffic. The building worked beautifully, except for the bathroom problem. The single toilet on the first floor was laughably inadequate, especially since they were trying to process dozens of urine tests at any moment. After a week or two, Derik developed a system in which the employees took five or ten patients at a time to the bathrooms on the second floor to produce their urine samples.

  Bigger place; same deal. A patient
tried to sneak in a bottle full of urine for his drug test, swearing it was Mountain Dew. Derik told him to prove it. The guy grimaced and gulped, and Derik, impressed, moved him to the front of the line. Another patient made the mistake of calling Dianna a bitch. Derik slammed the guy into a wall, grabbed his neck, and started to squeeze. The guy went limp and collapsed, and Derik’s 6'4" Finnish bouncer, who looked like the Russian boxer from Rocky IV, dragged him out. A couple of patients fished out on the floor, just collapsed and started convulsing, and the staff called 911. The woman who owned the junk store on the other side of Dixie Highway, initially friendly, took to screaming across the street at Derik’s security guys. Patients were parking in her small lot, using her restroom to shoot up. Sometimes patients would go into the store and just stand there, glazed over, staring blankly at the same knickknack for five minutes. Once, a middle-aged woman nodded off in her minivan and dropped a lit cigarette in her lap. It burned through her shorts but she didn’t wake up until the shopkeeper pounded on her window. Derik and his guys tried to be responsive, zipping across Dixie Highway on a golf cart to talk to her. The shopkeeper told Derik about the problems, showed him blood spurts on the wall of her bathroom. Derik said his guys would take care of things, but the zombies didn’t listen, and the shopkeeper started calling tow trucks, as well as the cops.

  A doctor at another big pain clinic quit, which sent a flood of new patients to American Pain. That was their biggest day yet. They serviced more than seven hundred patients that day, around $400,000 going into the trash cans and back to the money room.