AMERICAN PAIN (15 page)

Patients also signed a Diversion Policy, which covered the same territory, more or less. Another form asked whether the patients were Florida residents and, if not, why they hadn’t sought treatment closer to home. A typical response: “They will not give enough to help with pain and when you ask for stronger they look down on you.” Chris created that out-ofstater form himself. If the health department showed up again and asked why they had so many non-Florida patients, he figured he could use the patients’ statements to shield himself.

Chris had found most of the forms and policies online, including the Patient Comfort Assessment Guide, a survey created by Purdue Pharma that asked patients to describe and rate their pain in great detail. (Among other questions, it asked if the pain fit the following descriptions: stabbing, gnawing, exhausting, shooting, burning, nagging, penetrating, miserable, or unbearable, plus a few more. Some patients circled every word.) Chris barely skimmed the documents and never discussed them with the doctors. He just wanted to make sure that each patient’s file was stuffed with paperwork, drug screens, MRI reports, and signed policies. Thick patient files, he believed, would make it more difficult for authorities to claim that South Florida Pain was just a drug-dealing operation.

They needed more doctors. Dr. Gittens was gone, and the new office had much more space. Also, the more doctors Chris had, the more drugs the wholesalers would allow him to order. He wanted a mix of full-timers and part-timers so he could open early and stay open late, be as accommodating as possible. Chris placed another round of job ads on Craigslist, and doctors kept calling.

When interviewing doctors, Chris didn’t want to come off as unprofessional or criminal. He tried to speak well, look successful. But he did want the doctors to understand what they were signing up for. So he didn’t exactly turn on the charm. He wore his typical outfit—torn jeans and a T-shirt. He barely looked at resumes, asked few questions about medical expertise or credentials. The interviews were brief. Chris was a mumbler, had a monotone, monosyllabic way of speaking to outsiders. He’d tell the physicians they would be working to provide services for chronic pain. He’d ask if they had a DEA registration and a medical license and whether they were comfortable prescribing narcotics. If doctors said they lacked experience in pain management, Chris said that didn’t matter, they could learn on the job. He would show the doctor some patient charts to give a sense of the dosages the other doctors were prescribing. And then he’d talk about the pay. At $75 per appointment, South Florida Pain was seeing enough patients to pay doctors between $2,000 to $4,000 a day. Plus $1,000 cash a week for the use of their DEA registration number to order drugs.

The true test came when Chris had an applicant shadow another doctor, to see if he or she could stomach the ceaseless flow of patients receiving prescription after prescription of the same controlled substances. Two interviewees walked out after these observation sessions, saying they couldn’t do it.

But all the other doctors who came in for interviews took the job, no matter what they saw at the clinic. It became a joke between Chris and Derik. The long lines, the desperate patients, none of it seemed to make a difference. The doctors saw what was going on at South Florida Pain, and they were OK with it once they heard they’d be making $75 a patient.

The physicians were a mixed bag: male, female, young, old, black, white, Hispanic, Jewish, US-born, international, gay, straight. Mixed specialties too: gynecologists, plastic surgeons, family practitioners.

The doctors tended to be a little odd. One physician wanted to see only female patients, and it turned out that he was digging into patient files and stalking the good-looking ones. Another had such bad body odor that Derik was forced to talk to him about it, which was awkward. Another left after a few months and started his own pain clinic, as Dr. Gittens had done. Others had gambling problems, or drug problems, or student-debt problems. One belonged to a swingers group and tried to recruit Derik.

It was a great part-time gig, Derik thought, to come in for a couple hours in the evening after your real job, see a dozen patients and walk out with a grand in your pocket. The part-timers clamored for as many hours as they could get, and some wanted to come aboard full-time. Derik had mixed feelings about the medical staffing. The doctors were key to the entire business, of course. But fewer doctors had meant longer lines, which meant more patients handing Derik money to jump the line.

If the doctors struggled with their consciences, they kept it to themselves. Except one, a part-timer, Dr. Patrick Graham, a plastic surgeon in Boca Raton who worked at the clinic in the evenings, maybe once a week. Graham was in his early sixties. He’d interviewed at the Oakland Park Boulevard location, where Gittens had shown him the ropes before she quit. He’d spent half a day shadowing her as she treated about fifteen patients. During the first few appointments Graham observed, Dr. Gittens listened to the patients’ heart and lungs, had them bend over, checked ears, noses, and throats, had them do some range-of-motion exercises. But as the morning wore on, Gittens had spent less time with the patients, her exams growing more cursory. Everybody got similarly large doses of narcotics. By the time Graham was done shadowing Gittens, he believed he understood how things were done at South Florida Pain.

Around Derik, Graham would drop hints that he knew the clinic was a pill mill, that he knew the score. Around the other doctors, he played dumb. Sometimes he’d complain to Derik that Chris had hired a new doctor, worried it would cut down his patient load. Other times, he’d come to Derik and say that there was nothing wrong with a patient and he couldn’t write a scrip for him, like he’d had a sudden attack of conscience. Derik would point out that he’d already written twenty scrips that day for similar patients. Dr. Graham would continue to argue.

Finally Derik would say: Whatever, dude. I guess I need a new doctor.

That’s when Dr. Graham would give up.

Graham would say: Fine, then.

And he’d go write the scrip.

Graham was interesting, Derik thought. It was like he wanted a little push from Derik. To make himself feel better, like he had no choice. So Derik would give it.

Derik didn’t push the other doctors. If a doc wanted him to bounce a patient who had inadequate documentation or infected track marks, he bounced the patient. There was no upside to arguing with the doctors, nothing to be gained by pulling back the curtain and too openly revealing or discussing what they were doing.

Chris and Derik reasoned that the number one problem at the Oakland Park Boulevard location had been the tiny waiting room, which meant the patients roamed the neighborhood, shooting up, nodding off, shoplifting, squabbling, selling pills, and generally acting like junkies. Chris and Derik hadn’t minded this behavior in the early months, even encouraged it sometimes, but after a while it was like they were begging the cops to show up. Which was why they’d been forced to move. Chris didn’t want the same thing to happen again, so the rule at the new location became: no loitering in the parking lot.

They put the homeless man who’d hung around the Oakland Park Boulevard location in charge of monitoring the new building’s exterior. The vagrant had been arrested for crack possession and was living in a halfway house now, which was a step up from the laundry where he’d previously slept. Chris and Derik had felt bad about leaving their homeless security guard behind when they moved to the Cypress Creek location, so they’d told him they’d give him a promotion if he came with them. The homeless man had happily agreed. They’d see him riding his bike the six miles from Oakland Park Boulevard each day, a scrawny figure in cowboy hat and boots, pedaling his bike in heavy traffic. Derik bought him a walkie-talkie and a shirt that read S
ECURITY.
He instructed the security guard to call him on the walkie-talkie when patients were parking in the other businesses’ spots or pissing in the hedges. But the security guard never remembered to wear the security shirt and couldn’t seem to get the hang of actually communicating through the walkie-talkie. When Derik heard a burst of static on his walkie-talkie, he knew his security guard was trying to reach him, and he’d head out to the parking lot. The guard couldn’t take care of issues himself because the patients didn’t take him seriously. When it became obvious that the homeless man wasn’t getting the job done, Chris and Derik advertised for a new security guard and hired a three-hundred-pound Puerto Rican guy who came for his interview wearing a security guard uniform he’d bought somewhere. The scrawny vagrant and the giant tag-teamed the parking lot with varying levels of success.

The inside staff was growing too. Chris and Derik needed people to handle the increased paperwork. Derik hired several friends, either guys he’d grown up with or had met building houses. Derik’s roommate, who’d come aboard earlier in the summer. Pedro, who’d worked for Derik on and off ever since his plumbing days. The brothers of Derik’s high school girlfriend, as well as her father, a biker who’d been an addict himself but had been clean for a couple of years. When Derik told friends about the money they could make, they quit good jobs—union plumbers, electricians—to be security guards or work the patient window at South Florida Pain. Even one guy who was a mortgage broker talked to Derik about coming to work at the clinic. It felt good to create jobs for friends who needed work, something that made Derik look both bighearted and powerful. And having his own crew strengthened Derik’s grasp on the operation, made him even more essential to Chris.

Most of the guys they hired were good-looking, clean-cut men, jacked up on steroids, wearing tight T-shirts and jeans. So Chris and Derik figured they should hire some good-looking girls too. They put an ad on Craigslist:
Receptionist needed for busy pain clinic. No resume or experience needed. Just send picture.
And they got lots of pictures, some professional headshots and some full-body pictures in swimsuits or lingerie, plus a couple of nasty messages, asking if they were running a doctor’s office or a modeling service. They had a good time deciding which women had what it took to land an interview. One former bikini model and high-end escort immediately caught Chris’s eye. Dianna didn’t like all the women hanging around Chris. They fought more and more, and she stopped coming to the clinic.

Staff-wise, the clinic was less doctor’s office than South Beach club—all tanned biceps and fake boobs. Derik loved it. He wanted the clinic to be a place where people enjoyed themselves—a junkie paradise. He bought black-market copies of movies that were still in the theaters and played them on the waiting room’s massive flat-screen TVs. They installed vending machines, and the staffers flirted with the patients, sweetie-this and honey-that.

Chris didn’t interact with the patients or staff much, so Derik was the center of the frenzy, directing traffic, deciding who got in and who didn’t, like a nightclub doorman. Sometimes he felt like a celebrity. The patients drove him crazy, but he
loved
the power, how they’d do whatever he wanted because he controlled the thing they wanted most. He could tell a patient to put on a blindfold and run across Cypress Creek Boulevard, and the guy would do it, no questions asked.