American Pain

by John Temple

  “For almost ten years, at least ten years, the citizens of Florida have waited for our Florida state leaders to effectively do something about the drug distribution in our state,” Golbom said during the introduction of his next show, “and, finally, Friday night was a historic night for the citizens of Florida.”

  In the middle of October 2010, Dr. Cynthia Cadet agreed to meet with federal prosecutors. Jennifer Turner and Mike Burt had gone to her house with a subpoena for a handwriting sample and used the opportunity to urge her to come in. She was looking at criminal charges, Burt had said. Cadet brought along a lawyer to the meeting.

  Paul Schwartz outlined the case against Cadet with unusual breadth and bluntness. The lead prosecutor said the doctor had been part of a pill mill operation that had unleashed millions of addictive pills into the black market, killing numerous patients. If Cadet didn’t cooperate, she would face charges in those deaths. If she cooperated and pleaded guilty to the drug charges, she would likely escape a life sentence. Former coworkers were already cooperating, he said. Cadet had been one of the biggest dispensers of oxycodone in the country, he said, and her former boss, Chris George, was a thug who had Nazi tattoos and a stripper girlfriend-turned-wife. Cadet should have been able to figure out that George was a bad guy and that a pain clinic that kept cash in garbage cans was a pill mill. The prosecutor was indignant and sarcastic, especially when he mentioned how she’d found the job at American Pain.

  Schwartz said: What doctor on Earth would apply for a job on Craigslist?

  In her soft, airy voice, Cadet told Schwartz she knew nothing about Chris George’s private life. Her lawyer added that if Cadet had been a participant, she was an unwitting one. She had a blemish-free legal record. She was a naive and gullible person who had genuinely believed she was acting within the law.

  Schwartz said: She may not have known the extent of what her employers were up to, but she enabled the process by prescribing the medication and getting paid a ton of money to do it. So she is not getting out of this case.

  The meeting ended in a stalemate.

  For Schwartz, one problem was that Chris George had rarely spoken to the doctors on his phone, so the wiretap recordings didn’t offer much concrete evidence that tied the doctors into the conspiracy. The most damning piece of conspiracy evidence the prosecutors had against the doctors was that they’d signed the wholesaler questionnaire Ethan Baumhoff had falsified.

  Before they could indict the whole group, the prosecutors needed at least one of the American Pain doctors to cooperate, to admit that he or she knew the clinic was a pill mill and to describe the clinic’s medical practices. But the doctors still didn’t seem to understand they were in real trouble. Schwartz didn’t mince words in his meetings with the doctors. He told them he knew they’d gone to medical school, but to him they were drug dealers. He said what they’d done at American Pain wasn’t practicing medicine, because anyone could have done it, with or without medical training.

  Some doctors responded arrogantly, rolled their eyes during the meetings, acted bored. Some meetings ended quietly, others with yelling and F-bombs. Some doctors gave general information about their employment at the clinics, but none were willing to accept the idea that they were criminals, even if Chris George was one. Some of the doctors were so sure they were in the clear that they had taken jobs at other pain clinics. Typically, Jennifer Turner was the second most aggressive person in the room, after Paul Schwartz. She knew the doctors were in denial about their actions, that it would take them time to confront their guilt, but her patience dwindled as the months passed. Sometimes she just took a break, walked out of the room for a while.

  The most compelling leverage against the doctors was the threat of death charges. By December 2010, the agents had created a database from the patient records they had seized in the raid of American Pain. The team cross-referenced the names in the patient database with the names of sixteen hundred people who had died of drug overdoses in Florida. More than fifty American Pain patients were on the overdose list. Seven of Roni Dreszer’s patients had died in Florida, seven of Aruta’s, five of Cadet’s, four of Jacobo Dreszer’s, and three of Boshers’s. Because many patients tended to jump from clinic to clinic, not all the deaths were necessarily due to prescriptions received from American Pain doctors, but it was, nevertheless, a lot of dead bodies. Especially when you considered that 87 percent of the clinic’s patients were from out of state. The team wondered how many deaths they would unearth if they began looking in Kentucky and West Virginia.

  At long last, almost a year after the raids, two doctors surrendered. Both Dreszers agreed to talk to the feds, and in separate February 2011 meetings the father and son finally acknowledged that they’d known American Pain was a pill mill, though it wasn’t something discussed or acknowledged at the clinic. Jacobo Dreszer said 98 percent of the patients were drug dealers or addicts and that Chris George pushed him to prescribe higher amounts. Roni Dreszer said he’d known within a month that the place was illegal, and the other doctors must have known too, even if they didn’t speak about it. He’d discussed Carmel Cafiero’s news reports about American Pain with other doctors and staff. All the doctors had received state health department complaints about their prescribing habits. Everyone had seen the police repeatedly coming to the clinic to investigate doctor shoppers.

  Then, four months later, in June 2011, the investigators got the news they’d been hoping for. The ringleader was coming in. Chris George was ready to talk.

  Every Friday, Derik went with Chris’s mother to visit Chris in St. Lucie County Jail. He and Chris vowed to each other that they would stay strong and fight the government. But the months wore on, and more and more people flipped. The feds kept calling Derik’s lawyer, saying they were going to arrest him any day. Derik just got tired. He stopped urging everybody not to cooperate with the feds. He began telling people to do what they had to do. He just wanted it to be over.

  Derik saw Dianna a lot, and even with everything that was happening, she was still obsessing over Chris cheating on her during the American Pain days. She was pregnant with Chris’s son. They’d conceived three weeks before his arrest the previous fall.

  In jail, Chris spent several hours a day for a couple of months listening to wiretap recordings, accompanied by a law student hired by his attorney. It was strange to hear all those calls, to relive his final days as Florida’s oxy king. His attorney asked the federal magistrate judge to quash evidence obtained from the search warrant and wiretap. The wiretap wasn’t justified, the lawyer argued, because wiretaps were supposed to be a last resort. In this case, because American Pain was a public business, not a covert organization, normal investigative techniques would have done the trick. And the search warrant wasn’t justified because it was largely based on evidence from the wiretap. Chris told Derik that the motions were guaranteed to succeed, and the evidence would be thrown out.

  Then, in June 2011, Derik went to visit Chris one Friday, eight months after Chris had gone to jail, and Chris broke the news. Basically everyone was cooperating with the feds, everyone except Dr. Cadet.

  Chris said: It’s over, man.

  Chris had decided to flip, which to Derik seemed like a complete about-face from a few days earlier. Chris told Derik he believed it was his only chance at avoiding a life sentence. They would get long sentences initially, Chris explained, but they could eventually bargain down by testifying against the doctors and drug wholesalers. Factor in time off for good behavior, and, at most, Chris said, they’d do five years.

  Derik wasn’t so sure, but he knew he had no choice but to flip. If he went to trial and Chris and almost everyone else testified against him, he’d definitely get a life sentence.

  Chris met with the prosecutors in early July 2011, just after Dianna gave birth to their son. Derik went in a week later.

  The day before his meeting, Derik called Cadet, who was still holding out, insisting she was innocent. Derik said she should
meet with the feds too and take a plea bargain. No sense in fighting at this point. He said he would try to explain to them that she hadn’t known about his past and the bad things he’d done at the clinic, that he believed she was less to blame than the other doctors. Maybe they’d cut her a break.

  At the meeting, Paul Schwartz and the others were much less aggressive. They didn’t try to make him cop to selling pills. They said they just wanted a general understanding of the operation. He told them all about it. They seemed to be hoping for more direct evidence to offer about the doctors’ culpability. Derik tried to explain: It hadn’t been like that. Even he and Chris hadn’t talked about it openly most of the time. They thought it was legal, more or less.

  Schwartz looked disappointed but seemed to accept Derik’s version of events. The only thing that appeared to ruffle him was when Derik tried to explain that Dr. Cadet was probably the least culpable of the doctors. Schwartz said Derik didn’t want to finger Cadet because he liked her and she’d been nice to him.

  The next day, Derik called Cadet to tell her how it went.

  Derik said: They don’t like you at all. Once I mentioned your name, they got angry and didn’t want to hear it.

  Footnotes

  * At Cadet’s trial, Chris said he earned about $40 million in revenue from the pain clinics, but less than 25 percent of that was profit. In a November 18, 2009, conversation with his father, Chris agreed to see a contact about a Swiss bank account in Belize. Chris says he never set up the account.

  * South Florida Pain opened in February 2008, but July 2008 was the earliest that any of the doctors under investigation worked at the George clinics. Dr. Gittens and Dr. Joseph left the clinics before the federal investigation began, and they were not targets.

  * Forty-three percent of the prescriptions went to patients from Kentucky; 20 percent to patients from Florida; 18 percent to patients from Tennessee; and 11 percent to patients from Ohio.

  * Harvard Drug Group eventually paid a $6 million fine for “failing to have in place an effective system designed to identify suspicious orders of controlled substances, and to report suspicious orders of those substances to the DEA.”

  * However, Gittens soon thereafter closed the clinic and returned home to New York, where she went to work for a nonprofit health organization that offered, among other services, treatment for addiction. She did not respond to multiple phone calls and letters asking for an interview for this book.

  11

  A month after Chris George and Derik Nolan agreed to cooperate, the US Attorney’s Office issued a 123-page indictment that detailed the operation of not only the pain clinics but the steroid clinic and Jeff’s timeshare scam.* The indictment named thirty-two people, including thirteen doctors, eleven of whom worked either full- or part-time at either American Pain or Executive Pain. Two of the doctors were in their sixties, four in their seventies.

  “The significance of today’s takedown is that we have dismantled the nation’s largest criminal organization involved in the illegal distribution of painkillers,” said John Gilles, special agent in charge for FBI Miami. “Up until today, efforts focused on the demand by targeting individual users. Today, we attacked the source and choked off the supply.”

  The indictment included Derik Nolan, the George brothers, their mother, and Chris’s wife, Dianna. Most of the lower-level employees and part-time doctors at American Pain were not indicted. State officials also charged Jeff George with felony second-degree murder in the overdose death of Joey Bartolucci, the case that prompted Jeff’s infamous Lamborghini quote. The state attorney in Palm Beach County said he believed it was the first time a pain clinic owner who wasn’t a prescribing doctor had been charged with murder in an overdose case. He’d also threatened to charge Chris George with murder, but backed off when Chris agreed to plead guilty to federal charges.

  Schwartz made sure the indictment was longer than usual and full of juicy details. He wanted to bring as much news media attention to the pill mill problem as possible, and the newspapers and TV stations lavished attention on the piles of cash, the doctors carrying guns, the expensive cars. As usual, Jeff captured more than his share of the spotlight. The brothers were portrayed as equal partners, never mind that Jeff’s clinics were only a small fraction of the size of American Pain. Though the whole thing had been his idea initially, Jeff was essentially just another of the hundreds of clinic operators who followed in the wake of American Pain.

  Those other clinic operators also paid close attention to the indictment. Two Pompano Beach firemen who owned a chain of six pain clinics and one pharmacy studied public records associated with the American Pain case, authorities said, allegedly using details from the indictment to figure out how to run a pill mill without getting busted.*

  Only one drug wholesaler was indicted—Steven Goodman, owner of Medical Arts Inc. Goodman had ignored the DEA’s warning that American Pain was a pill mill and lied to the DEA about the number of pills he’d sold to the clinic. Other wholesalers who’d supplied American Pain escaped indictment; they hadn’t done anything quite that blatant.

  Everyone had agreed to cooperate, except for Cadet. The other defendants were allowed to turn themselves in. Cadet was arrested at her home in Parkland and taken to jail in handcuffs. Her lawyer told Paul Schwartz that the doctor was willing to submit to an FBI-administered polygraph examination, but Schwartz refused.

  At a detention hearing, Schwartz told a magistrate judge that investigators were still trying to determine how many of Cadet’s patients had died.

  “There are over fifty-three overdose deaths that we have been able to identify with this case alone, just in Florida,” Schwartz said. “Again, we don’t know how many kids died behind barns in Tennessee, Ohio, Kentucky, and West Virginia.”

  That fall, an FBI agent named Kurt McKenzie was given the task of tal-lying Dr. Cadet’s death toll. McKenzie had a background in forensic science, and as a former DNA analyst, he understood evidence-handling procedures. McKenzie ran patient names through the Social Security Administration and medical examiners offices in other states and came up with a number. Fifty-one of the four thousand patients Dr. Cadet had seen at American Pain had died.

  Probably others had died from drugs she’d prescribed, because many of the pills were sold on the street. But even if McKenzie could have tracked down those deaths, it would have been a stretch to charge the doctor with them, so McKenzie didn’t work those cases. Many people also died in pill-related car accidents, but in poor rural jurisdictions in Kentucky, those cases were typically classified as accidents and potential evidence was destroyed.

  So McKenzie built a database of the fifty-one deaths and worked to determine how much time had elapsed between when Dr. Cadet wrote the prescription and when the patient died. It wasn’t pragmatic to charge the doctor with an overdose death that occurred months after she’d last written that patient a prescription, so he threw those deaths out. He also threw out cases in which the patients had seen other doctors or didn’t have lethal amounts of oxycodone in their systems. Mc- Kenzie gathered toxicology reports, autopsy reports, and police reports. He and other members of the task force traveled to Kentucky to interview dozens of local police, toxicologists, coroners, and family members. The fast-talking agents and lawyers stood out in rural Kentucky, especially McKenzie, who didn’t see another black man during his time in Harlan County.

  McKenzie ended up with a list of ten deaths he believed they could take to court, and the prosecutors further narrowed the list to seven: six overdoses and one car crash. The trail of death stretched up the East Coast and into Appalachia.

  In Ashland, Kentucky, a fifty-year-old woman’s heart stopped in an ambulance headed to King’s Daughters Medical Center. She survived for six hours on life support before multiple organs shut down. Two days earlier, Cadet had written her a prescription for oxycodone and Xanax.

  At a truck stop in Fort Pierce, Florida, a fifty-year-old woman from Lexington, Kentucky,
died in her car. Two days earlier, Cadet had written her prescriptions for oxycodone and Xanax.

  In Mount Sterling, Kentucky, a thirty-eight-year-old man died on his couch, an American Pain appointment card in his wallet and a pill bottle with Cadet’s name on it next to his body. Two days earlier, Cadet had written him prescriptions for oxycodone and Xanax.

  Near Daytona Beach, Florida, a thirty-four-year-old man died on the floor of a house, blood oozing from his mouth. Ten days earlier, Cadet had written him prescriptions for oxycodone and Xanax.

  At a Quality Inn in Boca Raton, a forty-two-year-old man from Hamblen County, Tennessee, died, blue-faced, on the floor of Room 265. Pill bottles with Cadet’s name were found near the body. Two days earlier, Cadet had written him prescriptions for oxycodone and Xanax.

  Just south of Jonesville, North Carolina, a twenty-two-year-old man from Racine, West Virginia, died at 4:45 a.m. when his 1989 Camaro smashed into a pickup truck on Interstate 77.* He was high on oxycodone and no skid marks could be found. Pill bottles bearing Cadet’s name were in his pocket. The day before, Cadet had written him prescriptions for oxycodone and Xanax.

  And of course there was Stacy Mason, the first Cadet-related death of the group, and the first one they’d unearthed.

  In Kentucky, Alice Mason knew nothing of the events unfolding in Florida. It had been almost three years since Stacy had died. People said things would get easier. Alice couldn’t say she agreed with that.

  She prayed every day that someone would do something about that lady doctor in Florida. During the summers, she kept track of how many times she mowed the pasture around Stacy’s grave. Each November, on Stacy’s birthday, the Mount Vernon Signal ran a poem Kevin had written about his brother. When December rolled around, Alice couldn’t bear thinking about turning the calendar to January and seeing the date of Stacy’s death, so she’d just turn the calendar a couple months ahead. Kevin was the only one Alice could talk to about Stacy. Her husband still barely spoke about his dead son.