AMERICAN PAIN (26 page)

Finally they called Alice’s name, and they took her back to Dr. Cadet’s office.

Dr. Cadet came in and introduced herself, and Alice was surprised that she was a black woman. And so young and small and quiet. Alice finally asked the question she’d been wondering every moment for the past month.

She said: I want to know, why in the world you gave my son
two
bottles of oxycodone? The same kind of medicine?

Dr. Cadet just stared at the floor. Two men entered the room. They said they were doctors at the clinic. They did the talking for Dr. Cadet, like the little doctor needed to be protected from Alice.

Alice repeated her question, and the men doctors answered, not Cadet. They seemed to know about Stacy, like they’d read his paperwork. They said he was in bad shape with his back and needed medication. But they didn’t say why he needed so much.

Alice asked if they could make a copy of Stacy’s file for her.

The doctors said no.

Alice said: That’s all right. I got all the proof I need at home anyway.

And she left.

Shelby knew the trip was a failure when she saw Alice coming out only a few minutes after she’d gone back to talk to the doctor.

The women got back in Lisa’s Suzuki and headed toward the highway, looking for a place to get the tire fixed. Alice cried and told the other women what had happened. How Dr. Cadet just sat there and stared at the floor, no expression. They’d come all this way and hadn’t learned a thing.

Alice said: It’d be different if the doctor had cried. Or if she’d been upset about what happened to Stacy. But she didn’t care.

Nobody in Kentucky could do anything about Dr. Cynthia Cadet, and nobody in Florida seemed to care.

But just a twenty-minute drive away, a woman named Jennifer Turner was zeroing in on American Pain.

Turner, a special agent of the FBI, was stationed in an unmarked three-story building somewhere in Broward County. The building contained a couple hundred police officers and federal agents of every stripe. The covert multi-agency facility was supposed to provide a physical location where the missions and data and expertise of varied law enforcement organizations could collide and spark. It was a place where a special agent from the Bureau of Alcohol, Tobacco, Firearms and Explosives could easily share coffee with a police detective from Pompano Beach. Where a Broward deputy sheriff could just walk over to the next office suite to pick the brain of an analyst from the Department of Homeland Security.

Until a few months earlier, Turner had investigated health care fraud. Because of its retiree population, South Florida was the center of the universe for this type of crime. Turner had spent years chasing medical equipment manufacturers who offered free products to seniors in exchange for their Medicare numbers, or surveilling corrupt doctors who billed health insurers for services never rendered.

Turner was thirty-eight, tall and athletic, with blonde, shoulder-length hair. She loved being an FBI agent, which had been her goal since she was a young girl. She was talkative and ardent, perhaps even idealistic in her devotion to the bureau. She knew the rules and believed in them, but to both her partners and her targets, she came off as someone who could understand opposing points of view, someone who maybe could be counted on to be in their corner, if they did the right thing. She could be harsh in the interrogation room but then follow it up with a compliment or nice gesture, straightening the tie of a government witness about to testify. She was
nice
. But her eyes—weary and shrewd—kept you guessing.

Turner had recently transferred from health care fraud to organized crime—Russian organized crime specifically—and she hadn’t quite found her footing in the new assignment. She was helping with a few investigations, but she wanted to find something she could really put her arms around, something that would take advantage of her skills and experience. A case of her own.

One day in late 2008, Turner was in the break room of the multi-agency building, half-listening to a conversation between police officers from Davie and Hollywood and the Broward Sheriff’s Office. They were standing near a watercooler, talking about pain clinics. New clinics were popping up all over the place, they said, causing lots of problems.

A police captain said: You know, some of these clinics have Russian doctors in them.

Russian doctors.
Turner turned to the group.

She said: Excuse me?

The captain said: I thought that might get your attention.

Turner pumped him for more information. He said the patients were selling pills, urinating on public property, shoplifting from nearby stores. Many of the patients were from other states. Often, when they got pulled over, the patients had not only pills, but marijuana and cocaine in the car. Local police were trying to crack down on these activities, focusing on the patients, but they weren’t equipped to look into the clinics themselves.

Local police had talked also to the DEA about the pain clinics, but the drug agency considered legal opioids to be the purview of the DEA’s regulatory branch, the Office of Diversion Control. DEA special agents were primarily focused on cocaine and heroin, not pills manufactured by pharmaceutical companies and prescribed by doctors.

Turner was intrigued but skeptical. This could be an investigation that would take advantage of her health care experience but still fit into her current assignment. But where was the crime? Oxycodone was legal, and doctors were allowed to prescribe it. At first blush, the whole thing sounded to her like an exaggeration, a problem that had been blown out of proportion. How big could this possibly be? Yes, it was interstate drug trafficking, but was it truly organized crime or just a few individuals? And how many people would really travel from Kentucky or West Virginia just to go to a doctor?

She decided to look into it. She talked to some local police departments for background and began doing surveillance of the biggest problem clinics. She saw long lines outside the buildings, zombie-like patients wandering around the neighborhoods. She watched Carmel Cafiero’s reports on a place called South Florida Pain and was surprised by the guys who seemed to be running the place. They were so young. She saw billboards advertising pain clinics, notices in the free weekly newspapers.

Turner took her information to an assistant US attorney. Like Turner, the prosecutor wasn’t sure whether a federal case could be built around pill mills, but he encouraged her anyway.

He said: Someone’s making a ton of money here. Let’s keep digging.

6

By early 2009, Chris George was worried. His secret was out. American Pain was still the top dog, but the pack was now a herd.

That was the problem with legitimate business, Chris realized—it was transparent. Everyone could see what you were doing and just copy it. There’d always been individual candymen in Florida, the doctors who’d built a reputation for being loose with the prescription pad. But American Pain had helped turn a handful of clinics into a major growth industry, inspiring shady entrepreneurs and basically handing them a template for the pain-pill business. Some of the new pain-clinic owners had started out as sponsors at American Pain. They’d bring dozens of people to the clinic every month, funding their visits and then collecting half the pills. Making a nice profit, but it was never enough. Pretty soon, they’d start thinking about opening their own places.

The new clinics borrowed Chris’s aggressive marketing techniques: search engine optimization, out-of-state Yellow Pages promotions, advertisements in the
New Times
and
City Link
. Before long, every other billboard seemed to be plugging pain management, as if an epidemic of agony had swept across the state.

The pain clinics kept an eye on each other. One would start promoting half-off specials on certain days of the week, and then a slew of them would do the same in the following week’s
New Times
. Some clinics paid patients $25 for bringing in a new patient; others rewarded new patients directly with $25 gasoline cards. For a while, Chris offered free initial visits to attract new patients, but when others started doing it, patients began simply moving around from clinic to clinic, taking advantage of the special offers on initial visits. So Chris started offering a free
second
visit.

A new clinic was opening every three days, on average, and Chris spent a lot of time driving around, checking out the new guys, trying to figure out who was behind each clinic and whether it was a real threat. Most of the offices were tiny, with a single doctor. Others were strictly small-time, the doctor fearful to hand out narcotics in quantities that would keep patients coming back. Many didn’t have strong wholesaler connections, and couldn’t dispense pills themselves.

Chris wanted American Pain to appear more legitimate than the horde of upstarts. He gave Baumhoff a new title—“compliance officer”—and sent him to Florida Board of Medicine meetings, so they could monitor the latest policies and laws about pain management.

By 2009, the American Pain doctors were regularly receiving letters of inquiry from the health department about overprescribing, usually triggered by complaints from patients’ relatives. Chris didn’t want the doctors worrying about legal problems. He kept an attorney on retainer, and when the doctors received letters, they’d turn them over to Ethan, who would forward them to the lawyer. The doctors would pull the file of the patient in question and write a report about the patient’s treatment.

They joined the American Academy of Pain Management, which involved paying a small fee and getting a membership certificate. Chris displayed the certificate in the clinic. They also paid a law firm $10,000 to write a standard operating procedure manual. Ethan gave copies of the manual to every employee and doctor and told them to read it and sign it and return it to him, so he’d have something to show the DEA if they came back. Everyone ignored his instructions. No one returned the manuals.

Ethan also told the doctors that the DEA targeted clinics that ordered nothing but controlled substances. He asked the physicians to send him lists of medications that he could order so the clinic wouldn’t look like a pill mill. Again, no one followed through.

Chris backed Ethan’s new dress policy, and despite Derik’s opposition, the staff began to follow it: no jeans Monday through Thursday, and collared shirts and medical scrubs were acceptable, as long as they were clean and had no holes.

When patients e-mailed American Pain to inquire about treatment, Ethan responded cautiously: “I cannot and will not guarantee you will be prescribed medication. What I can tell you is that you will have a quality examination done by a qualified physician. If you are interested we take walk-ins from 9–5 Monday through Friday.”

Chris believed American Pain was the biggest pain clinic in Florida, which almost by default meant it was the biggest in the United States and maybe the world. Chris wanted to be even bigger. He wanted clinics across the country, in every state that would allow him to own one. That way, if Florida ever got its act together and successfully banned him from owning one, the money flow would barely be interrupted.