American Pain
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I tried, usually more than once, to communicate with every defendant who was affiliated with American Pain. Many chose not to speak to me, including Dr. Cynthia Cadet. Others communicated with me briefly, then cut off contact. Chris George answered many questions over prison e-mail but did not agree to an in-person visit or a phone call. He was concerned that helping with the book would make it look as though he was proud of what he did. However, he said he wanted to tell his story so others would avoid his mistakes, and he asked me to put a note to that effect in the book. Derik Nolan and I communicated for many months, exchanging hundreds of e-mails, speaking on the phone more than a dozen times, and talking for two days in person. Derik paid for many hours of time on the prison computers and phones, and I voluntarily sent him small amounts of money several times (about $100 total) to defray those costs. I also tried repeatedly to contact Dr. Rachael Gittens and Dr. Enock Joseph via e-mail, phone, and letter, and neither responded. Other key interviewees described in the book included Jennifer Turner, Kurt McKenzie, Paul Schwartz, Larry Golbom, Dr. Michael Aruta, Alice Mason, Kevin Mason, and Shelby Durham.
Other people I spoke to did not appear in the book but provided enlightening background information. Pete Jackson of Advocates for the Reform of Prescription Opioids and Karen Perry of the NOPE Task Force shared information about their organizations and their personal losses. Florida Board of Medicine member Dr. Steven Rosenberg shared information about the height of the Florida pill mill crisis. Mike Fulton of the Asher Agency and Michael Barnes of the Center for Lawful Access and Abuse Deterrence provided useful perspectives on the national opioid crisis. J. E. “Ned” Crisp, director of Fiveco Area Drug Enforcement Task Force in Russell, Kentucky, and Dan Smoot of Operation UNITE provided background about Kentucky’s fight against prescription painkillers. Dr. Gary Potter, a criminal justice professor at Eastern Kentucky University, shed light on the current and past drug scene in eastern Kentucky. Dr. Hilary Surratt, director of the Center for Applied Research on Substance Abuse and Health Disparities at Nova Southeastern University in Miami, Florida, provided insight into opioid addiction research. My friend Don Robinson, executive vice president and chief operating officer of MVB Financial Corp., answered my questions about banking and money laundering.
To recreate events, I used a combination of sources, including interviews, personal observation, photographs, videos, wiretap tran scripts, court transcripts, and investigative documents. The website www.wunderground.com detailed weather on specific days. When I came across conflicting information, I either left it out or used the version of events I believed was most likely to be accurate. Occasionally, I made minor edits to improve a quote’s clarity or brevity, and I took pains to never alter the meaning of the dialogue.
Major sources for specific sections are cited below.
PROLOGUE AND CHAPTER 1
Primary sources of information were interviews with Chris George, Derik Nolan, and Jennifer Turner; courtroom testimony of George, Nolan, and Dianna Pavnick George; and other court documents. Other key sources:
•Articles in the Sun-Sentinel and the Palm Beach Post and a Florida Traffic Crash Report provided details about the train crash.
•The 2010 National Survey of Drug Use and Health provided the statistics about rates of prescription drug use.
•Stories in the Middletown Times Herald Record and the New York Times provided details about the murders committed by Derik’s father.
•The New York State Office of the Professions provided information about Dr. Rachael Gittens’s medical license.
•The website archive.org allowed me to look back at the now-defunct South Florida Pain Clinic/American Pain website at different points in its existence.
CHAPTER 2
Primary sources of information were interviews with Larry Golbom and Carmel Cafiero, the Prescription Addiction Radio show website, http://prescriptionaddictionradio.com/, and the book Pain Killer, by Barry Meier. Other key sources:
•Florida Board of Medicine records and the Tampa Tribune stories provided information about the case against the doctor who prescribed pills that ended up in the hands of Larry Golbom’s son.
•David Morris’s 1993 book, The Culture of Pain, described the 1950s study that noted differences in the way ethnic background influences how people talk about pain.
•Filings in the lawsuit, The People of the State of California v. Purdue Pharma L.P. et al, and stories in Propublica’s long-running “Dollars for Doctors: How Industry Money Reaches Physicians” series provided information about the promotion of prescription opioids.
•News stories in the Lexington Herald-Leader and the Huntington Herald-Dispatch provided details about the Appalachian Pain Foundation.
•“The OxyContin Panic and Crime Panic in Rural Kentucky,” by Kenneth D. Tunnell, published in Contemporary Drug Problems, Summer 2005, provided information about early OxyContin abuse.
•The Centers for Disease Control and Prevention (CDC) provided information about the rise in drug overdose deaths.
•A Government Accountability Office (GAO) report from 2003 on OxyContin and news stories in the Chicago Tribune and Richmond Times Dispatch provided details about Purdue’s legal fight against personal-injury claims.
•The Federal Register and the Drug Enforcement Administration Office of Diversion Control website, www.deadiversion.usdoj.gov, contained information about oxycodone manufacturing quotas over the years.
•The excellent story by Guy Taylor, “Mills Making the Pills,” published in the St. Petersburg Times on October 30, 2011, as well as other news stories in the Lexington Herald-Leader and the Weekly Standard provided information about the DEA’s quota-setting process.
•The CDC’s Morbidity and Mortality Weekly Report of November 4, 2011, provided the statistic that the United States manufactures enough prescription narcotics for every American adult to take a 5-milligram Vicodin every four hours for nearly a month.
•The 2008 Annual Report of the International Narcotics Control Board provided the statistics about the percentages of the global supply of hydrocodone and oxycodone that are consumed in the United States.
•The 2004 book The Truth About the Drug Companies, by Marcia Angell, provided information about the pharmaceutical lobby.
CHAPTERS 3–4
Primary sources of information were interviews with Chris George, Derik Nolan, John Paul George, Carmel Cafiero, and Juan Ortega; courtroom testimony of George, Nolan, Dr. Patrick Graham, Ethan Baumhoff, Dr. Roni Dreszer, and Dianna Pavnick George; and other court documents. Other key sources:
•Florida Board of Medicine records provided information about the Florida Department of Health (FDOH) inspection of South Florida Pain in June 2008.
•The DEA Office of Diversion Control website provided a copy of the 2006 policy statement entitled “Dispensing Controlled Substances for the Treatment of Pain.”
•FDOH records provided information about the clinic Dr. Gittens opened in 2008.
•Florida court records, accessed through LexisNexis, provided information about Chris George’s arrest in August 2008.
•The Alfred I. duPont Awards channel of Vimeo.com provided the video of Carmel Cafiero’s WSVN-TV report about American Pain. WSVN-TV’s website, www.wsvn.com, contained more information about Cafiero’s interactions with the clinic.
•FDOH records provided information about the administrative complaints against Dr. Gittens and Dr. Joseph.
CHAPTER 5
Primary sources of information were interviews with Alice Mason, Kevin Mason, Shelby Durham, Rockcastle County coroner Billy Dowell, Reverend Tommy Miller, Rockcastle County sheriff Mike Peters, Dr. Gary Potter, Jennifer Turner, and Kurt McKenzie; the courtroom testimony of Alice Mason, Dr. Jennifer Schott, Dr. William Lee Hearn, Dr. George Behonick; and other court documents. Other key sources:
•The “Prescription for Pain” package published by the Lexington Herald-Leader on January 19, 2003, provided a great deal of
information about prescription drugs and corruption in Kentucky.
•News stories in the Lexington Herald-Leader and the Daily Independent of Ashland, Kentucky, and court records provided information about the case of Dr. Roger Browne.
•The article “Country Comfort: Vice and Corruption in Rural Settings,” by Dr. Gary Potter and Dr. Larry Gaines, published in 1992 in the Journal of Contemporary Criminal Justice, provided important details about the drug scene in eastern Kentucky.
•Kentucky Office of Drug Control Policy reports provided statistics about drug overdoses and babies born addicted.
•Orlando Sentinel stories provided information about Jewell Padgett.
CHAPTER 6
Primary sources of information were interviews with Chris George, Derik Nolan, and Dr. Michael Aruta; courtroom testimony of George, Nolan, Dr. Aruta, Dr. Patrick Graham, Dr. Roni Dreszer, Dr. Beau Boshers, Ethan Baumhoff, and Dianna Pavnick George; and other court documents. Other key sources:
•A Broward County grand jury report on pill mills issued in November 2009 provided the statistic that a new pain clinic was opening every three days in the county, on average.
CHAPTER 7
Primary sources of information were interviews with Jennifer Turner, Kurt McKenzie, Barry Adams, Florida Board of Medicine member Dr. Steven Rosenberg, Tina Reed, Derik Nolan, and Chris George; the testimony of George, Nolan, Whitney Summitt, and Detective Nicholas Patriarca; and other court records, including DEA records related to the administrative hearings of American Pain doctors.
•An Orlando Sentinel news story from March 3, 2011, provided the information about the amount of oxycodone distributed by Florida doctors in 2009.
•A Rockcastle County Court arrest report provided information about the first time Barry Adams saw oxycodone 30-milligram pills in Rockcastle County.
•A July 12, 2012, story in the Daily Independent of Ashland, Kentucky, and law enforcement sources provided information about the flights nicknamed “The Oxy Express.”
•The Appalachia High Intensity Drug Trafficking Area’s Drug Market Analysis 2011 report provided details about the Kentucky/Florida painkiller pipeline.
•News stories in the Tampa Tribune and the Sun-Sentinel provided information about the fight to create Florida’s prescription drug database.
•A September 2010 series in the St. Petersburg Times provided information about the analysis of FDOH doctor disciplinary cases.
•The FDOH’s annual report of 2008–2009 provided information about the licensing of medical offices.
•A Palm Beach Post news story on November 1, 2009, “Painkiller Clinics Use Legal Loopholes,” provided information about drug offenders who opened pain clinics.
•A GAO report from August 2011 entitled “Prescription Drug Control” provided the statistic that Florida doctors were purchasing nine times more oxycodone than the other forty-nine states combined.
•A USA Today story on February 24, 2011, entitled “Florida Raids Target Sellers of Pain Pills” contained the statistics about how many doses of oxycodone Florida doctors were buying.
•An Ohio Prescription Drug Abuse Task Force report from October 2010 provided information about how much oxycodone Ohio doctors were buying.
CHAPTER 8
Primary sources of information were interviews with Chris George, Derik Nolan, and Nettie Stephens, operator of a store near the final American Pain location; courtroom testimony of George, Nolan, and Dianna Pavnick George; and other court documents. Other key sources:
•An arrest report from the Jacksonville Sheriff’s Office provided information about the December 2009 arrests of Chris George and Derik Nolan.
•Sun-Sentinel and Palm Beach Post news stories provided information about anti–pill mill measures Florida lawmakers were proposing in late 2009 and early 2010.
•A Wall Street Journal news story provided information about pill mills moving from Florida to Georgia.
CHAPTERS 9–11 AND EPILOGUE
Primary sources of information were interviews with Jennifer Turner, Kurt McKenzie, Paul Schwartz, Lawrence LaVecchio, Larry Golbom, Chris George, and Derik Nolan; courtroom testimony of George, Nolan, Ethan Baumhoff, Dr. Michael Aruta, and Dianna Pavnick George; and other court records, including DEA records related to the administrative hearings of American Pain doctors. Other key sources:
•A Palm Beach Post story provided the quote from Chris George’s attorney.
•Lexington Herald-Leader stories provided information about the death of Timmy York.
•Sun-Sentinel stories provided information about Paul Schwartz’s life and career.
•Stories in Businessweek and the Sun-Sentinel and a 2013 DEA presentation entitled “Prescription Drug Trafficking and Abuse Trends” provided details about the DEA’s shutdown of oxycodone wholesalers.
•The Florida Department of Health Annual Report 2009–10 provided information about the number of pain clinics that registered with the state.
•The Sun-Sentinel and Palm Beach Post provided information about Governor Rick Scott’s proposal to kill funding for the prescription drug database.
•Food and Drug Administration records and the New York Times provided information about the new formulation of abuse-deterrent OxyContin.
•A DEA press release provided information about the Pompano Beach firemen who allegedly started a chain of pill mills.
ACKNOWLEDGMENTS
So many people helped, it’s hard to know where to start.
My writing group pals, including Daleen Berry, Dana Coester, and James Harms, read bits and pieces of the story and gave great notes. Special thanks to the group’s founders, Alison Bass and Benyamin Cohen, who read even more and provided particularly helpful advice and support. Becky Beaupre Gillespie, April Johnston, and Molly Lyons all read the book proposal and gave incisive feedback and leads; thank you all for your early and enthusiastic support. Josh Fershee and Kendra Huard Fershee read an early draft of the entire manuscript and provided excellent notes, especially regarding legal aspects of the story.
Heartfelt thanks to Ron and Leslie Marcus, who let me use their pleasant condo in Palm Beach County as my reporting headquarters for two weeks in the summer of 2013. Joel and Cheri Schwartz, my mother-in-law and father-in-law, helped make that happen, and I am grateful for that, and for their support. To my sister, Laura Hall, and the rest of her family, thanks for the cheery home and comfortable bed when I visited Louisiana.
I’m grateful to Paula McMahon of the Sun-Sentinel, as well as Kevin Nolan and Kim Williams, for helping me track down documents. Many thanks to Kimberly Walker and Christa Currey of the WVU Reed College of Media for their excellent promotional efforts. Thanks to Marlene Fernandez-Karavetsos of the US Attorney’s Office of the Southern District of Florida and Jim Marshall of the Miami office of the FBI for helping to arrange interviews in their respective offices. Anne Beagan at FBI headquarters in Washington, DC, cleared the way for me to be granted additional access and documents.
I owe a great deal to everyone listed in the “Sources” section for lending me their time and knowledge. Special thanks to the following: Alice Mason is one of the most inspiring and courageous people I have ever interviewed. I greatly appreciate her letting me trespass repeatedly on her beautiful farm. Jennifer Turner and Kurt McKenzie spent many hours explaining the FBI investigation of American Pain. Gaining FBI approval for the interviews was a challenge because Dr. Cynthia Cadet’s case was still in appeals. But the special agents made the interviews happen because they wanted the story to be known. And so did Derik Nolan, who spent many months answering my endless questions. He witnessed more of the day-to-day operation of American Pain than anyone else, including Chris George. I appreciate Derik’s willingness to tell the story and the effort he put into remembering and making sense of it.
As dean of the WVU Reed College of Media, Maryanne Reed has always championed my work and once again helped me find the time and resources to pursue this stor
y. Most crucially, she supported my application for a sabbatical in 2013, and that break gave me time to focus exclusively on understanding the opioid epidemic and the case of American Pain. As my friend, she read drafts at different points and provided her usual excellent notes.
A warm thanks to James Jayo, formerly of Lyons Press, and Joelle Delbourgo of Joelle Delbourgo Associates, for backing the book. The same to Keith Wallman of Lyons Press, whose enthusiasm and thorough edits helped so much in the homestretch. Special gratitude to Shari Smiley of the Gotham Group and to Melisa Wallack, for recognizing the potential and significance of this story.
And none of them would have seen it if it wasn’t for Jacqueline Flynn of Joelle Delbourgo Associates, whose cheerful intelligence guided the book from almost the very beginning of the reporting process. Thanks for encouraging me to pursue this story and for always returning my calls!
To my parents, Dan and Loranne Temple, for always being curious about and supportive of my work. To my boys, Gideon and Hank, for reminding me how sweet life can be. And most of all, to my wonderful wife, Hollee Schwartz Temple. You listened so thoughtfully as I rambled for untold hours about my latest problems with this story (even if I did sometimes look over to find you “resting your eyes”). You’re a hell of an editor, and I promise not to forget that next time around. Thanks for all the times when I was debating whether I should take another trip to Florida or Kentucky or Louisiana, and you said, simply, “Go.”
ABOUT THE AUTHOR
John Temple grew up in Chicago, Louisiana, and Pittsburgh. He has worked as a newspaper reporter in Pittsburgh, North Carolina, and Tampa.
Temple is the author of two previous nonfiction books: The Last Lawyer: The Fight to Save Death Row Inmates (2009) and Deadhouse: Life in a Coroner’s Office (2005). In 2010, The Last Lawyer won the Scribes Book Award from the American Society of Legal Writers. More information about Temple’s books can be found at www.johntemplebooks.com.