American Pain

by John Temple

  Jennifer Turner believed Schwartz was a perfect fit for this case. Not just because he was a warrior, but because he was willing to stray from his niche. Many prosecutors stuck to cases that fit into their realm of experience. But this case was the first of its kind, in many ways. It called for a prosecutor who was not only willing to learn a new field but one who could think creatively about how to apply old laws to a new kind of crime.

  Most of the people who’d worked at the George brothers’ clinics had hired lawyers, tying up many of the most prominent criminal attorneys up and down the Gold Coast. Most of the high-level targets weren’t talking to the federal agents, including Derik Nolan and Chris George. However, the agents had nabbed early interviews with two doctors. Dr. Michael Aruta had met agents from the FBI and IRS at a restaurant the morning of the raid. Dr. Beau Boshers talked to agents two days later. They both said they weren’t aware of illegal activities at the clinic, that they ejected patients they suspected of abusing drugs. Boshers said, yes, Appalachian patients came to the clinic in carloads, but they were just carpooling to save on costs.

  The doctors seemed to believe they’d broken no laws. How could they have broken the law by simply prescribing legal medication? That was their job, after all.

  Schwartz wasn’t accustomed to having to persuade targets that their actions were criminal. Wiseguys knew they were violating the law. For them, lawbreaking was a way of life. They had to be persuaded only that the prosecutors had enough evidence to find them guilty at trial.

  These pill mill people, especially the doctors, were another story. The whole idea that they could have broken the law seemed unacceptable to them. Schwartz knew that before he could educate them about their culpability, he needed to educate himself. He needed to know more about pain medicine than the doctors did.

  He embarked on a self-guided medical education. He read everything he could find: med-school textbooks, academic journal articles, magazine stories. He flew to New York City to grill leading pain management experts. He learned about pain diagnosing and opioid weaning. Schwartz’s colleagues joked that his mother would finally be proud of him, now that he was a doctor.

  Schwartz wasn’t ready to make arrests yet, but the DEA believed it did have enough evidence to revoke the American Pain doctors’ certificates of registration, which allowed them to prescribe controlled substances. All five doctors requested hearings, and the cases were adjudicated in Miami at the same three-day hearing in July 2010.

  At the hearing, DEA special agent Mike Burt testified about the deaths of two patients, based on reports he’d received from Barry Adams, the Rockcastle County deputy sheriff. One was Stacy Mason. The other was a forty-five-year-old man, also from Rockcastle, named Timothy York. Early in January 2010, York had seen Dr. Boshers at American Pain. On the way home, he began to overdose in a car somewhere on I-75 in Tennessee. Panicked, the two women in the front seat tried to find a medical center on their GPS device. The device instead routed them to the Williamsburg Police Department, where police found York in the back seat, dead.

  The hearing’s primary witness was Dr. L. Douglas Kennedy, an expert in pain medicine from the University of Miami. He’d reviewed seventy-eight patient files selected at random, plus the files of Stacy Mason and “Luis Lopez,” the undercover pseudonym of Detective Sergio Lopez. Good pain doctors, Kennedy said, conducted thorough medical histories and physical exams, sought past medical records, modified and reviewed initial diagnoses. But the American Pain charts he reviewed, while stuffed with documents, showed no signs that these activities were occurring. The doctors did take cursory histories, but the operation was a prescription assembly line. His report recommended the DEA bar all five doctors from prescribing controlled substances.

  “Drug diversion most likely caused a ‘mushroom’ effect of increased drug abuse, drug addiction, drug overdoses, serious bodily injury and death in those communities spread over several different states,” he wrote. “(The doctors’) continued ability to prescribe controlled substances will only perpetuate the suffering and be a threat to the public.”

  The DEA also went after wholesalers, shutting down two distributors that had supplied American Pain with oxycodone: Sunrise Wholesale from Florida and Harvard Drug Group from Michigan. Sunrise surrendered its DEA license. Harvard, one of the ten largest wholesalers of generic drugs in the country, didn’t give up so easily and began to work with the DEA to revise its oversight methods.*

  Spooked, many other drug wholesalers immediately stopped selling to Florida pain clinics. By July 2010, the amount of oxycodone doses purchased by Florida doctors had fallen from more than eight million per month to around one million.

  Out of prospects and almost out of money, Derik packed up the big house in Black Diamond Estates in July 2010 and drove back home to upstate New York. His girlfriend and her daughter moved back in with her parents. Derik and his cousin were going to run a sub shop in Lake George, but that plan went bust, and Derik moved back to the farm where he’d grown up with his aunt and uncle. He put a new roof on the barn, mended some fences, shoveled horse manure, and tried to get his head right, forget what was going on in Florida.

  One day, Derik took his aunt to a doctor’s appointment and had a revelation: Her doctor’s office was a pill mill. It was basically American Pain, just a fraction of the size and without the out-of-state patients. The cars in the parking lot all had New York plates, but they were from counties all over the state. The amount of oxycodone his aunt was taking explained a few things, Derik believed, such as why she’d disconnected from his life over time, and his sister’s too, stopped answering the phone or sending birthday cards. She’d been on the meds for years, and Derik had never paid much attention, figured it was OK because a doctor had prescribed it. Like most people, he never questioned it, not until he’d been running American Pain for two years and knew the signs. It made him wonder. How many of these places were out there, doing the same thing as American Pain, just not as aggressively? It would be so easy to fly under the radar, make a lot of money without going all-out like he and Chris had.

  A few weeks after Derik moved up to New York, Mike Burt called his cell phone early in the morning. Derik told the DEA agent to speak to his lawyer. Paul Schwartz, the lead prosecutor, called Derik’s lawyer, and the news wasn’t good. Schwartz said Derik was going to prison for life, that he was a dangerous individual and they had him cold on kidnapping, extortion, and running a drug ring in Loxahatchee. Derik’s lawyer said he was, basically, fucked. He said Derik needed to meet with the feds, if only to find out what cards they were holding. Derik returned to Florida.

  The feds were pressuring Chris the same way. Derik and Chris agreed to meet with the prosecutors individually. Chris went first. The feds told Chris they had three months of wiretaps of his phone, which was actually kind of a relief, since Chris and Derik had been worried that everybody’s phones had been tapped for the past year. Chris refused to give them anything, and they kicked him out.

  Derik met with the feds a week later. Before the meeting, he went over to Chris’s house. Derik was freaking out, and Dianna gave him a handful of Valium, which he downed.

  The meeting was in an eighth-floor conference room in the US Attorney’s Office in downtown Fort Lauderdale, palm trees and sunny boulevards visible far below, through the plate-glass windows. A dozen lawyers and agents crowded around a long table. Derik recognized Mike Burt and the tall blonde FBI agent, Jennifer Turner. He’d seen them before—the day he and Chris had been on the roof of American Pain, looking down at an unmarked car across the street. He and Chris had laughed, wondering why the cops were bothering to surveil. That seemed like a long time ago.

  Now, Derik was prepared for an interrogation or a negotiation or some kind of offer. But the agents and lawyers didn’t ask questions at first. They seemed hostile, like they hoped he didn’t plead guilty, like they wanted him to go to trial, so they could send him away for good.

  Schwartz had a close
-trimmed beard and an intense stare. He said he was going to quote some lines from the wiretap recordings, some things Derik had said to Chris George. One quote was from one of Derik’s lengthy rants about Ethan Baumhoff: “You hate cops. I hate cops. If he was still a cop, he would throw the handcuffs on us.” Awkward to hear those words in a roomful of cops.

  Then, one of the cops asked: Do you hate cops, Derik?

  It didn’t seem like a question from someone who wanted to make a deal. Derik shrugged, said something about how, yeah, man, he hated cops.

  Schwartz read something else Derik had apparently said to Chris, referring to the large crew of Loxahatchee construction workers who’d become American Pain patients: “Loxahatchee is a gold mine.”

  Schwartz said: Did someone discover gold in Loxahatchee, Derik?

  The Valium was starting to penetrate Derik’s brain. The whole scene seemed unreal. He didn’t know what to say.

  A deputy sheriff from Palm Beach, playing the good cop, said: OK, Derik, you need to tell the truth here. This is your one shot.

  Then he started to ask real questions. He wanted Derik to confess to selling pills on the street. They’d heard that Derik had sold a large stash of pills. Derik said he hadn’t sold any pills directly, and the cop lost his temper. Derik got up to leave, and Schwartz barked: Sit down! Derik sat down.

  They asked about a different pill-selling situation, and Derik said they had the story wrong. Derik said he knew what they were talking about, but someone else had done it. They said he was lying.

  The meeting was going in the wrong direction. Derik’s lawyer asked for a moment, and they left the room, went down to a parking garage. Derik nervously lit a cigarette and asked the lawyer why he hadn’t warned him the feds were going to be so aggressive. The attorney said he hadn’t expected it either.

  They went back inside, and Schwartz asked the same question in a broader way: Had Derik ever illegally diverted pills from American Pain?

  Derik said no.

  Schwartz was finished with him. He gave Derik twenty-four hours to get back to him or, he said, they were going to put him away for life. Derik got out of there, feeling wobbly.

  Chris was getting the same pressure. Schwartz called Chris’s new attorney, a well-known Mob lawyer, and asked if Chris was ready to cooperate. The lawyer said no.

  Schwartz said: Well, I’m going to put his ass in jail and see if that will change his mind.

  Over the next few weeks, Derik and Chris kept hearing rumors that one person or another had flipped, including Jeff. They went to a tattoo parlor together and got matching leg tattoos: a rat hanging from a noose. Someone took a picture of Chris’s rat and sent it to some people.

  The feds found out about the rat-tattoo photo, which they believed to be witness tampering, and in mid-October, Schwartz followed through on his threat. The police showed up at Chris’s house and arrested him. Apparently, they weren’t ready to charge him with anything related to American Pain. They did, however, have him cold on weapons charges, based on the guns they’d found in his home on the day of the raids: the two shotguns Chris had asked Dianna to take the fall for, as well as a pistol found in an upstairs bedroom. As a felon, he wasn’t supposed to have guns.

  But the raids had taken place seven months ago. Chris knew the feds were arresting him now only to pressure him to cooperate. He seemed unsurprised by the arrest, but he did complain about the cops hauling him to jail in handcuffs instead of just letting him surrender.

  Chris said: Why didn’t you just call me? I would have come in.

  On the west coast of Florida, Larry Golbom told his radio audience about the downfall of the George clinics. The pharmacist was still doing his talk show about prescription narcotics, but he no longer felt like a voice in the wilderness. American Pain and its counterparts had the whole state abuzz with talk about prescription narcotics. The pill mills weren’t the root of the problem, Golbom believed, but simply an inevitable side effect of the unleashing of legal opium. Nevertheless, the pill mills were bringing attention to the larger problem, and that was a good thing.

  Three years into the show, Golbom had found himself relaxing behind the microphone. He grew looser. Funnier. He stopped channeling the style of other talk radio hosts, stopped shouting. His stomach no longer hurt before shows. He stopped writing out scripts to read aloud. Instead, he went into the studio with a loose outline and a guest lined up. He knew what he believed about the opioid epidemic, and he knew what he wanted to say. Behind the mic, the words just came.

  And there was plenty to talk about. The fact that drug deaths had overtaken traffic fatalities as the leading cause of death in the United States, a trend driven by prescription narcotics overdoses. The new Florida law, signed in June 2010, that barred drug felons from operating pain clinics, required pain clinic doctors to undergo special training and allowed them to dispense only three days’ worth of medication to patients who paid by cash, check, or credit card, instead of insurance.

  Despite the furor, few people paid attention in 2010 when another DEA-approved hike in the oxycodone manufacturing quota took effect, boosting the output from 94,000 kilograms to 105,500 kilograms. This was more than twice the total manufactured in 2005, and almost thirty times the amount manufactured seventeen years earlier. The numbers boggled Golbom’s mind. It wasn’t as if oxycodone was a new drug. It had been developed almost a century earlier. The basic drug hadn’t changed at all, simply the mind-set around how it was prescribed.

  Despite the new pressures, many pain clinics simply evolved and continued to operate. The laws limited the amounts physicians could dispense, but many pill mill doctors continued to write large prescriptions to be filled elsewhere. When the laws required pain clinics to register with the state health department, 1,031 applications poured into the department. The department could find no reason to deny most of the applications; 904 pain clinic licenses were approved, including one for the Oakland Plaza Medical Center, registered to Dr. Rachael Gittens, formerly of South Florida Pain.*

  Golbom had plenty to talk about in late 2010 and early 2011, when Rick Scott, the governor-elect, decided to shut down the state Office of Drug Control and signed an executive order on the day of his inauguration that froze “all new regulations,” which meant that rigorous new pain clinic standards created by the Board of Medicine were shelved.

  Then, everyone was astonished when the new governor cut funding to the state’s long-awaited prescription drug database. Police, fellow Republicans, and the White House drug czar, among others, urged Scott to reconsider. The database was an ounce of prevention, they said, the best way to keep tabs on excessive prescribing. As Broward County sheriff Al Lamberti put it: “We cannot arrest our way out of this problem.” Even pain medicine groups were stunned by Scott’s move.

  “It’s just bizarre,” Paul Sloan, president of the Florida Society of Pain Management Providers, told a reporter. “There’s nobody in the field of medicine trying to kill (the database). It’s the best thing the state has done on pill mills.”

  Kentucky officials, who’d been asking Florida to implement the database for years, were the most infuriated.

  “What they’re doing by this is basically setting up billboards across the country saying, ‘Come to Florida and get your drugs,’ ” said Kentucky lieutenant governor Daniel Mongiardo.

  For a few days, Scott ducked questions about why he’d killed the database. Then he said it was to save money. Then he said it was simply because a government database was intrusive. He did not elaborate, and the issue was locked in a stalemate.

  That’s when Purdue Pharma stepped in and offered $1 million to help Florida set up the drug database. The maker of OxyContin was in a transition period. After paying a $600 million fine three years earlier for lying about the drug’s risks, Purdue had developed a new type of Oxy-Contin pill that was harder to abuse. The company quietly began distributing the new formulation in August 2010. When addicts tried to powderize or dissolve it
, the new pills turned into a gooey mass. Addicts tried filing the pills down to powder, tried cooking them in microwaves. They reported their findings on druggie websites: Nothing worked. Junkies called the new pills “gummies” or “jellynoses” because when they put it in their noses or mouths or needles, the pills caked up. Users who hadn’t built a tolerance could still get high by swallowing the pills. But hardcore users could no longer get the full rush at once.

  The effects were immediate. Brand-name OxyContin vanished from the streets—few addicts wanted it. In Boston, an addict killed his dealer because he thought the dealer had sold him the new OxyContin. Prescriptions of the popular 80-milligram OxyContin dropped 33.6 percent within two years.

  Less of Purdue’s product was going to the black market, and the company had transformed into a crusader for abuse-resistant opioids. It lobbied the FDA to deny other companies from making oxycodone pills with an easy-to-beat formulation. Companies like Mallinckrodt and Actavis, who made the oxycodone 30-milligram pills that were the standard fare offered by Florida pill mills.

  Then the drug company offered to help fund Florida’s prescription database. Governor Scott rejected the offer. Months went by, and the furor grew, and finally, in May 2011, the new governor quietly gave up on his opposition to the drug database and signed off on its funding.