AMERICAN PAIN (29 page)

This atmosphere of greed at American Pain bothered Dr. Aruta, but the pay made up for it. Aruta needed money. Since 2003, he’d operated his own anti-aging, vein care, and appearance enhancement practice in Fort Lauderdale. He invested heavily in the business in 2007, which proved to be a mistake when the economy tanked. A year later, he closed the business more than $200,000 in debt. While searching for a job, he kept running across ads for pain clinics. They were popping up on every corner in South Florida. He knew some pain clinics had been shut down, and he wasn’t sure they were legal, so he didn’t pursue any of the positions at first. But after several months of looking for work, he took a job at a pain clinic called A-Pain in Hollywood. Seeing and prescribing for pain patients was easy. Too easy. He saw only eight to twelve patients a day at $50 a pop. Driving home one day, he saw a billboard advertising another pain clinic in Fort Lauderdale. He grabbed his phone right then and dialed the number and spoke to the clinic’s owner, Chris George. They discussed Aruta’s experience with pain medications, and Chris said he’d pay $75 per patient, plus $1,000 a week for the use of his DEA registration to order medication. Even better, Chris said he’d see at least forty patients a day, which meant $15,000 a week.

Aruta went to the clinic for an interview the next day and was heartened to see the busy waiting room, maybe seventy-five patients milling about. Aruta had worked at the 1,550-bed Jackson Memorial Hospital in Miami and the gigantic Cleveland Clinic. He was used to lots of patients. He
needed
lots of patients.

His interview with Chris George took about ten minutes. Chris glanced at Aruta’s medical license and DEA registration but spent most of the time looking at the security-camera monitors in his office. Chris then handed him off to other staffers, who explained the medication ordering process and gave him a tour of the pharmacy. Aruta also shadowed one of the doctors and saw that the procedures were similar to A-Pain’s.

But Aruta realized pretty quickly that it wasn’t a typical medical practice. For one thing, the staff was juvenile, a bunch of kids in their twenties, constantly causing drama and pulling pranks. Their leader was Derik Nolan, who affected a loudmouth, tough-guy exterior, especially with the patients. But Aruta liked him anyway. Underneath, Derik was funny and affable and intelligent, and when he wanted to be, surprisingly articulate. He was also very skilled at getting rid of problem patients, which Aruta appreciated. Aruta had heard of patients attacking pain clinic doctors who wouldn’t give them a prescription. He began carrying a gun to the clinic, as did Dr. Boshers. They wore their guns under their physician’s coats as they attended to patients. Aruta was a careful man and kept an eye out for problems around the clinic. He called it situational awareness. So when Aruta wanted to get rid of somebody without writing a prescription, he simply excused himself and found Derik, who took care of it from there with minimal drama.

Derik was always making the rounds of the clinic, but Chris George was aloof and typically stayed in his office. When Chris did talk to the doctors, it was usually something critical. Early on, Aruta sometimes told overweight patients that they should improve their diets, stop drinking Mountain Dew, that losing weight helps with many pain problems. Chris told Aruta to knock it off, that patients were complaining and a couple of women had left his office in tears. Aruta knew Chris didn’t want patients switching to another clinic, but it irked him that Chris would try to stop him from giving basic medical advice.

Three times, Aruta was called out to the waiting room to treat patients who were going into spasms. Once, before the doctors could act, a staffer unzipped a convulsing patient’s pants and dumped ice cubes down his underpants, thinking the cold shock would jolt him out of the seizure. Ethan talked to the doctors about assembling a crash cart for these seizure episodes, but it never got done.

Sometimes, there was talk of patients who had died of overdoses, though Aruta hadn’t heard of it happening to any of his patients. There was the man who died in Kentucky before Aruta started working at the clinic, the one whose mother and girlfriend had confronted Dr. Cadet. Any medical practice carried risks, Aruta told himself.

Over and over, Aruta thought about his procedures and convinced himself he was providing appropriate medical care. He and the other doctors talked about this a lot, whether they were breaking the law. They repeatedly assured each other that they were not. Sure, they saw lots of patients, and the visits were short, but that was because the doctors weren’t doing complicated diagnoses. They were simply treating pain. Nobody could ever tell for sure whether someone else was in true pain, so it wasn’t the doctors’ fault if the patients lied. Furthermore, they regularly discharged patients who had track marks, sometimes several a day. The staff also discharged patients if they found they were going to other clinics. The doctors told each other that it was inevitable that some patients would abuse the medications. They were doing what they could to prevent it. If there were illegal activities occurring at the clinic, that was Chris George’s problem. The doctors absolved themselves.

The worst thing Aruta foresaw happening was police shutting down the clinic, leaving him out of work again. Which would be bad, because the money was even better than George had promised. Aruta was making more than $20,000 a week. He’d never earned more than $140,000 in a year, and now he was making more than that every two months. He paid off his debts and started thinking about retirement. It was a great feeling.

Dr. Cadet was the one Derik couldn’t figure out. On one hand, she generally wrote the highest, maybe because she hated to disappoint anybody. But she was a mixed bag, because she also took the longest with each patient, would get deep into conversation with them, perhaps less aware than the other docs of the $75 she was earning per patient. She seemed to care genuinely about their well-being, yet somehow she also justified giving them massive doses of addictive drugs.

One day, Dr. Cadet called Derik back to her office and introduced him to a female patient. Cadet said the woman was three months pregnant and scared to death she was damaging her fetus. This wasn’t the first time American Pain had dealt with this issue. Relatives of pregnant patients had called Derik in the past, furious that the doctors were prescribing heavy narcotics to women about to give birth. A couple of times, cops had called him with the same complaint, saying they’d just arrested a pregnant woman with a scrip from the clinic, asking Derik, how he could live with himself? The answer, of course, was that he thought about it as little as possible. And when he did think about it, he knew what he was doing was wrong, but he told himself that he’d quit as soon as he’d saved up a million bucks or so. And anyway, it wasn’t his fault. The patients were hooked because they weren’t taking the medicine as prescribed.

But this patient was different. She
wanted
to detox from the oxy. Cadet asked Derik to research drug treatment centers and specialists and help the patient wean herself from the drugs. Derik did as Cadet asked, calling the woman’s obstetrician, forwarding medical records, putting in a lot of time helping this one patient. And then he created a new policy that every female patient younger than forty-five years old had to take a pregnancy test.

It was a nice thing to do for the patient and her baby, and Derik did feel good about the new policy. But he didn’t fool himself. It wasn’t like helping this one woman made up for everything else they were doing.

This was Dr. Cadet’s thing. She would write scrips for addicts all day long, but then she would call him back to her office, and show him a nice card that some coal miner had given her, thanking her for helping get him back on his feet. Or she’d introduce him to a patient and tell him a sad story about a problem the patient was dealing with, ask Derik for some kind of help. Derik would comply, and then he’d head back out into the sea of junkie desperation in the waiting room, shaking his head and wondering if Dr. Cadet was for real, actually oblivious to the shitstorm of misery they were unleashing on these people. Derik could laugh about it all, but he couldn’t completely fool himself into thinking he was doing some sort of humanitarian service at American Pain.

Like Dr. Cadet, Chris George sometimes came to the aid of certain patients. Usually this happened when Derik had decided to kick someone out for doctor shopping or trying to sneak in to an appointment early or failing a drug test or something. If the patient somehow managed to get Chris’s attention, Chris would often side with the patient. He’d say Derik was heartless and didn’t understand what it was like to be in severe pain.

But Chris didn’t spend much time dealing with patients. Derik did, and he’d heard too many sad stories, seen too many junkie stunts. He knew exactly what these people were. All of them, no exceptions. Derik was losing his patience with the zombies, not that he’d ever had a whole lot. He didn’t think of them as human beings. The Brazilian girl he’d dated the previous year had taught him that a junkie was a junkie, no matter what she looked like. And the lesson had been reinforced in December, when an elderly couple from Kentucky had come to the clinic two weeks before their appointment. Patients were always trying to scam their way into an early appointment, because they couldn’t make their pills last twenty-eight days. But this couple was different. They weren’t desperate. They seemed like regular folks, nice. A grandfather and grandmother. They said they’d brought their grandkids to Disney, which was why they were early. Someone back home was sick, which was why they’d taken the grandkids on this last-minute trip. Their schedule wouldn’t allow them to come back for their regular appointment, and they asked Derik to help them out.

The doctor agreed to write their scrips early, as long as they didn’t fill them for two weeks. To ensure this, the doctor dated the scrips two weeks from the current date. The couple thanked him over and over, said he’d helped their family out during a tough time.

Less than an hour later, a pharmacy called. The old folks were trying to fill the prescriptions, and the pharmacist was suspicious because the dates were torn off. Derik called the couple, told them off, said he was turning them in to the cops. They seemed scared, but two weeks later, they had the nerve to try to come back on their regular appointment date. Derik told them to beat it.

From then on, he thought of all patients in the same way. No matter how they looked or spoke or dressed, they were all junkies to him. Which made the whole thing easier to stomach. Junkies were gonna get those pills—somehow, someway.

The bigger it got, the more money that poured into Chris’s bank accounts, the harder he’d become to deal with. Over the year, he’d gone from monosyllabic and standoffish to downright mean sometimes, barking at the doctors for being too slow, chewing out Ethan for not keeping the place stocked with drugs, and yelling at Dianna for just about everything. He took to studying patient files each night to make sure the doctors were prescribing high enough. He seemed especially tough on the female doctors. One woman who worked part-time quit after he berated her. Chris also got on Dr. Cadet’s case because she often took time off and left early—3:30 or 4:00 p.m.—to take care of her two young children. Usually, she was a model big writer, but once, in front of staffers, he blew up after looking at Cadet’s file.