AMERICAN PAIN (12 page)

Golbom wasn’t the only one who’d noticed this trend. That same summer, in Fort Lauderdale, a television news reporter named Carmel Cafiero got a tip about pain clinics that serviced out-of-state patients.

Cafiero was an anomaly in the South Florida TV news scene, a pixie-cut redheaded grandmother among younger blown-out blondes and brunettes. She was in her early sixties and had worked for WSVNTV Channel 7 since 1973, producing a weekly investigative segment called “Carmel on the Case.” She specialized in “jump-outs”—on-camera ambushes of pimps, bad cops, crooked businessmen—after she’d gotten the goods on them. She found joy in her job at the family-owned Fox affiliate, and it showed in her big blue eyes and her
hee-hee-hee
chortle.

Cafiero’s source said the biggest pain clinic around was located on Oakland Park Boulevard, so she and a cameraman, Anthony Pineda, drove out to take a look. The clinic was in a small bungalow, lots of people loitering outside. Cafiero and Pineda parked across the street and settled in to watch. The patients waited in a ragged line. Many went shirtless. They all seemed to drink Mountain Dew and smoke cigarettes. There was a guy riding an old bike around the parking lot. He appeared to be the security guard. He also looked like a street bum.

Carmel thought:
Whoa, what
is
this place?

She could have put together a story right away, collected some interviews with neighboring businesses and plugged the package into the weekly “Carmel on the Case” lineup. But she didn’t want to do that. She had a feeling about this strange little clinic. Something big was going on here. She was going to sit on this one for a while, do some digging.

For the next three months, every time Cafiero and Pineda were between assignments in Broward, they’d go to South Florida Pain and shoot video. They used the station’s unmarked silver Dodge Caravan. Pineda had an uncanny ability to pick which pain clinic patient was most likely to do something interesting on camera. The cameraman would park next to the target’s car, and he and Cafiero would move to the rear of the van and draw the curtains behind the front seat. Pineda would shoot through the van’s dark-tinted windows. They got video of patients shooting up, trading cash for pills, leaving children in their cars.

Cafiero also dug into state corporate records and identified the clinic manager as a Christopher P. George of Wellington, Florida. She interviewed local police and the Broward sheriff’s office. She found statistics about drug-dispensing doctors in the state of Florida. The picture began to come together.

Pretty soon, Cafiero would be ready for her jump-out on this Christopher P. George character.

Footnotes

* Both the American Pain Foundation and the Appalachian Pain Foundation have since shut down.

* The promotional efforts of Endo, Janssen, and Cephalon are alleged in the pending lawsuit,
The People of the State of California v. Purdue Pharma L.P. et al.

* In her 2004 book,
The Truth About the Drug Companies
, former
New England Journal of Medicine
editor Marcia Angell reported that in 2001, the top ten American pharmaceutical companies took in an average net return on sales of 18.5 percent. In 2002 alone, 675 pharma lobbyists spent more than $91 million.

3

To Derik Nolan, the whole thing felt like the biggest practical joke ever. Two assholes like Chris and himself could just open a pain clinic, and nobody could do anything about it. Derik figured they were getting away with it because the basic transaction that was taking place—a patient getting a prescription from a licensed doctor—was legal. Whatever the patients did with the pills after leaving the clinic, that was on them.

Same with the doctors. They might be violating the law inside their offices, not following diagnostic guidelines or something. But Chris and Derik weren’t doctors—neither of them even had a college degree—so what they didn’t know couldn’t hurt them. How could they be held responsible for the way people with medical degrees prescribed medicine?

Besides, they weren’t going to quit just as they were starting to make real money. Chris had grown up rich, and Derik had enjoyed some flush years. When Derik was nineteen, making good money as a plumber, he’d bought a $60,000 Mustang Cobra convertible and had his own house. Later, he’d owned his own companies, pulled down six figures in the good years. But this was different. They’d tapped into something big and rich and desperate here, something that made people line up around the block at 6:00 a.m. every morning. The clinic accepted credit cards, but almost nobody paid that way. Cash poured into the clinic so fast that they’d given up on using their register. No cash register could take in $20,000 to $30,000 a day. It took too long to push all those buttons and ring someone up, and the cash drawer was too small. They had to empty it too often, and it was taking time away from processing the patients. So Derik had just grabbed a couple of nine-gallon garbage cans, the kind you see in bathrooms, and stuck one under the customer window. When it filled up, he’d cart it back to Chris’s office to be counted and stick the empty one under the window.

Every day seemed like a miracle. Every day they were amazed by the things they saw. Every day they realized that this thing was bigger than what they’d thought it was just the day before. Oxycodone was growing out of control, like black mold in a Florida bathroom, and they’d suddenly become a major supplier for a half-dozen states.

By summer 2008, they were seeing one hundred patients a day. The little bungalow couldn’t handle that amount of traffic. As the days had grown hotter, they discovered that the two old air-conditioning units cut into the waiting-room walls were completely inadequate for the job. The waiting room had about thirty chairs, and there were sometimes another dozen people standing. At regular intervals, a row of automatic-spray air fresheners on the wall spritzed the lukewarm stench. It didn’t help much. The bathroom was always a mess, so Derik took out the paper towel dispenser and installed an air dryer. The cleaning lady started coming in early to get a head start on the daily cleanup. She found hypodermic needles in the garbage cans, in the parking lot, rattling inside empty soda cans.

Derik and Chris didn’t talk much about what was really going on at South Florida Pain. They talked business, sure, but they only rarely referred to the fact that they’d suddenly become a strange brand of drug dealer. It wasn’t something they wanted to talk about much. Not with each other, and definitely not with the doctors or anyone else. It was partly a precaution, in case anybody was listening, and partly because they were afraid of jinxing their business luck. Derik believed Chris was feeling the same as he was: like a pitcher throwing a perfect game. It was the seventh inning, and they couldn’t talk up what was happening, so they kept their excitement to themselves, maybe shaking their heads or raising an eyebrow at each other when they saw an especially long line of zombies lined up in the morning. Derik wanted to laugh when he remembered how they’d talked about the pain clinic when it was first starting, Chris saying that Jeff might be able to hire Derik for $12 an hour.

No more long hot days at a worksite, covered in sweat and sawdust. Derik was paying every bill and had money left over. This was what all the years of hard work had been for. He couldn’t walk away now. He’d finally made it.

They’d always figured they’d get shut down sooner or later. Now they were beginning to believe they were in the clear. Either way, for now, they’d grab as much as they could.

But, four months after South Florida Pain opened: a wake-up call.

On June 10, a guy came to the clinic, introduced himself as a Florida Department of Health investigator. A smug little sawed-off shit, Derik thought. He spoke street English and generally came off to Derik as more of a Fort Lauderdale city meter reader than a guy with an important state job. Nevertheless, he and Chris were on edge.

The investigator said it was a routine inspection, something they did for all doctors who dispensed controlled substances on-site. He didn’t ask many questions, but Chris and Derik took the opportunity to ask
him
a few things they’d been wondering about. After all, he was a state health investigator. If he didn’t know how a pain clinic was supposed to run, nobody did. They asked him if there was a limit on the quantity of prescriptions they should be issuing for a twenty-eight-day period. For instance, what number of 30-milligram oxycodone pills was considered to be OK? The investigator didn’t seem like he wanted to give a number, but eventually conceded that 240 pills could be considered an upper limit, which matched what Dr. Overstreet had told Chris. They asked what they should do when patients came back to the clinic early and said their prescription had been lost or stolen and they needed an early refill. The investigator said the clinic could replace a portion of the prescription if the patient produced a police report that confirmed the theft. For instance, if there were fourteen days left in a twenty-eight-day prescription, they could write a scrip for half the pills. The inspector wasn’t referring to any documents or using any official-sounding words. In fact, his answers just rambled, like he was making up things as he went, pulling rules out of his ass, whatever he thought made sense. He also kept telling them to refer to the DEA website.

The whole thing felt wrong to Derik, the way the guy seemed reluctant to give solid and specific information. He felt like he was getting set up.

He thought to himself:
You should just walk away. Now. Go back to building houses.

The inspector looked around the building. He wasn’t pleased when he saw Moe, Dianna’s floppy-eared wiener dog. He said it was considered unsanitary to have a dog around medication, even though Moe wasn’t in the dispensary room. He told Chris he wanted to see receipts for the medication the clinic had ordered. Then he started looking through random patient files, making photocopies as he went. He was particularly interested in prescriptions that had been filled in-house, kept pulling them out of the files and piling up the photocopies. Chris and Derik had a bad feeling about this because the doctors usually didn’t completely fill out scrips that were filled in-house. They weren’t trying to hide anything. It was just a time-saving measure. Why bother writing out the patient’s name and address if the scrip was never even going to leave the building? If the patient wanted to fill the prescription elsewhere, the doctors filled it out completely, and Derik or Dianna photocopied it and put the copy in the file.

Derik thought the inspector looked pleased with himself as he put the copies in an envelope and sealed it. It was kind of funny. Chris and Derik were a couple of house builders who had only the slightest idea what they were doing in the pain clinic business, and they had found a way to crank tens of thousands of pills a day onto the street. And the state investigator was fine with that fact. Instead, he knocked them for not including the patients’ names or addresses on some prescriptions. And he didn’t like Moe being there.

The inspector left with his envelope of photocopied prescriptions, and Derik and Chris did what they usually did when they were together: laughed it off. They made fun of the little guy, his street accent and bad grammar.
That
guy was going to bring them down? No way.

Chris took the health department inspection more seriously than he let on to Derik. For one thing, he decided he would no longer rely on the doctors to know the rules and regulations around pain management. Other than her brief stint at One Stop Medical, Dr. Gittens was a family practitioner. Dr. Joseph was a gynecologist. They weren’t pain management specialists, and they probably weren’t even very good doctors, or else why would they be working here? Chris needed to figure things out on his own.

After a local pharmacy began refusing to fill South Florida Pain prescriptions and said it was heeding the advice of the DEA, Chris called the DEA for clarification. He wanted to know, once and for all, what the rules were. He expected to get some kind of runaround, but he got lucky, connected with a woman who was some kind of higher-up in Florida. And then he introduced himself, and the DEA official knew who he was right away. Even knew his address.