AMERICAN PAIN (27 page)

Meanwhile, he kept hiring until he had five full-time doctors, plus a number of part-timers and a staff of about twenty. Parking-lot security guards, who were paid in cash. Inside, more security, cashiers, pharmacy techs, and receptionists, all on the payroll. And the cleaning woman, an independent contractor.

Fort Lauderdale code enforcement officers began to pressure the clinic, and in March, Chris moved for the third time, this time to Boca Raton, where they stayed for the rest of 2009, the longest the clinic had ever remained in one place. They took over the lion’s share of a strip mall, about ten thousand square feet, with a huge waiting room that could seat 150 patients. The Boca location looked great, not like the seedy little clinics popping up everywhere. Boca had artwork and big flat-screen TVs on the walls, potted palms, high ceilings with exposed trusses and beams, and nice off-white carpeting they had to switch out every few months after the zombies had ruined it with spilled Mountain Dew and smuggled urine.

More patients meant more problems. In Boca Raton, seizures became a weekly occurrence. If the patient looked really bad, Derik called one of the doctors to help. The rest of the time, he just called 911. The parking lot became a sex-for-drugs zone, patients trading pills for back-seat blow jobs. Derik heard about these encounters regularly from his security team, and he witnessed them himself a few times. He couldn’t bear to interrupt another guy’s moment; he just walked away. Next door to the clinic was an Italian restaurant called the Basil Garden. Shortly after the clinic moved in, the restaurant stopped offering lunch, and Derik believed it was because they preferred to wait until American Pain was closed to start serving patrons so they wouldn’t have to deal with the pain clinic clientele. Some neighborhood residents took advantage of the situation and began charging $20 to park in their yards.

The same month that American Pain moved to Boca Raton, Chris opened a second, smaller clinic in Dianna’s name. Their breakup had lasted only a couple of months. But Chris had begged her to come back, and eventually she had. She believed she had nowhere else to go, and she was ready to fully embrace Chris’s pain clinic venture.
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The clinic in her name was called Executive Pain. It was in an office plaza in West Palm Beach, sandwiched between another medical clinic and a dental office. Starting out, the staff was just two part-time doctors and two non-medical employees, Dianna and Ethan Baumhoff’s wife.

At first, Chris saw Executive Pain as a backup location, in case American Pain got chased out of Boca. He also wanted to keep Dianna busy and happy running her own place away from American Pain. He knew it was smart to stake a claim in West Palm Beach. Broward County was overrun with pain clinics, and the commerce was moving north into Palm Beach County.

As time passed, Chris gradually figured out how best to utilize the second clinic. As American Pain had become more stringent with its patients, maybe one in ten patients walked out the door without a prescription. Derik and his staff rejected patients for failing drug tests, and the doctors kicked them out for having track marks, for openly jonesing, for begging the doctor for drugs, whatever happened to make that doctor uncomfortable. But Chris hated to lose a patient. So Executive Pain became a second chance for the patients he called “dirtbags”—the 10 percent who didn’t pass muster at American Pain.

Over time, they developed a cover story for these referrals. When they bounced an American Pain patient for track marks, the official rationale was that they were sending the patient to Executive for treatment. The clinic paid for a doctor to take an online class in drug detoxification. They bought some Suboxone, an opiate-detox drug, and put lettering on the door that said D
ETOX
A
VAILABLE.
Only one patient ever asked for it. The rest of the patients referred from American to Executive simply asked for pain meds when they got to the new clinic.

By the end of 2009, Executive Pain had hired several more doctors and was servicing eighty patients or more a day, pulling in between $15,000 and $40,000 a day: much less than American Pain, but still one of the bigger clinics around.

The atmosphere at Executive Pain was loose. Some of the doctors called the patients “pillbillies” and joked about the ones with lots of track marks. They came up with a nickname for the flow of patients from American to Executive: “The Pain Train.” Two employees snapped pictures of themselves rolling in piles of cash in Dianna’s office.

A few months in, Chris offered his mother, Denice Haggerty, a clerical position at Executive Pain. Previously, she’d worked at a large property management firm for twelve years, working her way from bookkeeper to vice president of administrative services, and then she’d worked for the twins’ father at Majestic Homes, but she left when her ex-husband’s company was facing bankruptcy. Since then, she’d been bored at home, so she took the job at Executive. Friends later speculated that it was because she was trying to get closer to Chris.

Derik almost never went to Executive, but he had a hard time picturing Denice there, a pleasant middle-aged Wellington housewife type among all the dirtbags. Derik knew he didn’t have the most normal family, but he thought of Denice as the classic mom figure. Nicest lady in the world, even if she drank a few too many glasses of wine at night. After her divorce from John George, she’d married a firefighter, but she and Chris’s dad seemed to get along. Sometimes John came to the big family get-togethers Denice hosted regularly at her house, up to thirty-five people at a time. She also donated to animal shelters and hospices and crocheted afghans for a homeless shelter in Youngstown, Ohio. How on earth she’d ever brought Chris and Jeff into the world and ended up working at Executive, Derik would never understand.

Chris had his full-time doctors sign a power of attorney so Ethan could use their DEA registrations to order pills. Ethan bought pills as fast as he could, but it was never enough for Chris. American Pain had a year’s head start on most of the new clinics, and he and Ethan had developed relationships with a dozen or so wholesalers. Chris had realized his access to pills was his key advantage over other pain clinics, and he told Ethan to protect his relationships with the wholesalers and keep them to himself.

In early 2009, the wholesalers were saying their supplies of oxycodone were running low due to the glut of new pain clinics in South Florida. Which meant that American Pain’s dispensary was “dry” more often. When that happened, Chris took it out on Ethan, shouting: You’re costing me $5,000 a day!

When they did have to send patients to outside pharmacies, they tried to direct them to ones that wouldn’t cause problems. Pharmacists, especially those in other states, constantly called the clinic to make sure the prescriptions were from a legitimate doctor and not a stolen prescription pad. Derik believed he usually could tell by their tone of voice whether they were just calling to cover their asses—so they could say they did their due diligence—or if they were really trying to verify whether the scrip was legitimate. Over time, Chris and Derik learned which pharmacies to avoid. Large chain pharmacies tended not to carry large enough quantities of controlled substances to meet the demands of hundreds of patients a day. They would also eventually red-flag American Pain patients. Independent mom-and-pop pharmacies were hit and miss, so Derik was always keeping an ear out for the ones that stocked a lot of oxy and would fill painkiller scrips without asking questions. Derik put up signs in the clinic ordering patients not to fill scrips at Walgreens and CVS. He went down through the listings in the phone book, calling pharmacy after pharmacy and asking if they stocked oxycodone and accepted patients from other states. If those questions didn’t seem to raise a red flag with the pharmacist, it was a safe bet that patients wouldn’t run into problems there.

But it was a lot of work, and Chris began thinking about investing in a larger chunk of the pharmaceutical supply chain. Sending patients to outside pharmacies was not only a pain in the ass, it was lost revenue. Also, he assumed Florida would eventually outlaw the dispensing of drugs from pain clinics. All of these factors led him to a conclusion: He wanted his own pharmacy.

He found one for sale in Orlando, a place called QuickPharm. The pharmacy had a DEA license and a staff pharmacist who wanted to stay on. Best of all was the location. Patients driving back home to Kentucky, Tennessee, and West Virginia passed through Orlando on the Florida Turnpike, so it was a convenient place to send them to get their scrips filled. The pharmacy wasn’t making much money, but Chris wasn’t worried. American Pain would supply the patients.

Chris met with the owner of QuickPharm and agreed to pay $120,000 for the business, plus power of attorney to use the owner’s DEA license so he could begin ordering and selling drugs immediately. Chris registered Ethan Baumhoff’s brother-in-law, Daryl Stewart, as the president of the company.

Chris also began building out a second pharmacy in Boca Raton, a nine-hundred-square-foot space. It took six months to start the store from scratch because he lacked a license, a process that involved state and DEA inspections. He didn’t want to be connected to the pharmacy, so he put that one in the name of an old friend, Andrew Harrington. Drew had been begging Chris for a job at American Pain, and he had no criminal record. Chris would put in the money, Drew would do the work, and they’d split the profits down the middle.

The next rung of the industry, the pharmaceutical wholesaler business, also interested Chris. From what he could tell, it was a tough racket to break into. He was told the two main generic oxycodone manufacturers were not selling to new wholesalers. So he looked into buying a preexisting wholesale company. He had his eye on one in St. Petersburg that had begun selling him oxy a few months earlier. It was called Medical Arts and was run by a pharmacist named Steven Goodman, who’d been in the profession since 1966. Chris made an offer, but Goodman was beginning to realize how much money he could make from selling to pain clinics and rejected it.

Chris didn’t tell Derik about these plans ahead of time. He just walked into American Pain one day in March and announced that he’d bought a pharmacy and that they should start directing all out-of-state patients to QuickPharm in Orlando.

Derik was taken aback, but only for a moment. Nothing really surprised him anymore.

As the flow of patients and cash had continued to rise, Ethan was spending up to six hours each night counting the money. He’d sort it by denomination and wrap bank bands around the stacks. Chris didn’t want to bother with counting one-dollar bills, so he instructed the cashiers to round up all fees to the nearest $10. Eventually Ethan began to check the proceeds from each window against the patient numbers, to make sure the cashiers weren’t just pocketing bills. Ethan carried the cash home each night in a blue duffel bag and then deposited it in one of Chris’s three banks the next morning. One bank was nervous about him holding such large amounts of cash in the waiting room, so they’d usher him to a private room in the back, where he’d count the money and make his deposit. One day, doing his daily deposit at Bank of America, Ethan noticed the bank’s cutting-edge cash-counting machine. He noted the make and model and bought one for the clinic. The cash counter was the size of a toaster oven, lots of buttons and a little digital screen. Everyone enjoyed watching it work; it was a miracle of efficiency, riffling through hundreds of bills in seconds, sorting and counting and occasionally spitting out a note that was damaged or counterfeit.