AMERICAN PAIN (44 page)

Golbom had plenty to talk about in late 2010 and early 2011, when Rick Scott, the governor-elect, decided to shut down the state Office of Drug Control and signed an executive order on the day of his inauguration that froze “all new regulations,” which meant that rigorous new pain clinic standards created by the Board of Medicine were shelved.

Then, everyone was astonished when the new governor cut funding to the state’s long-awaited prescription drug database. Police, fellow Republicans, and the White House drug czar, among others, urged Scott to reconsider. The database was an ounce of prevention, they said, the best way to keep tabs on excessive prescribing. As Broward County sheriff Al Lamberti put it: “We cannot arrest our way out of this problem.” Even pain medicine groups were stunned by Scott’s move.

“It’s just bizarre,” Paul Sloan, president of the Florida Society of Pain Management Providers, told a reporter. “There’s nobody in the field of medicine trying to kill (the database). It’s the best thing the state has done on pill mills.”

Kentucky officials, who’d been asking Florida to implement the database for years, were the most infuriated.

“What they’re doing by this is basically setting up billboards across the country saying, ‘Come to Florida and get your drugs,’ ” said Kentucky lieutenant governor Daniel Mongiardo.

For a few days, Scott ducked questions about why he’d killed the database. Then he said it was to save money. Then he said it was simply because a government database was intrusive. He did not elaborate, and the issue was locked in a stalemate.

That’s when Purdue Pharma stepped in and offered $1 million to help Florida set up the drug database. The maker of OxyContin was in a transition period. After paying a $600 million fine three years earlier for lying about the drug’s risks, Purdue had developed a new type of Oxy-Contin pill that was harder to abuse. The company quietly began distributing the new formulation in August 2010. When addicts tried to powderize or dissolve it, the new pills turned into a gooey mass. Addicts tried filing the pills down to powder, tried cooking them in microwaves. They reported their findings on druggie websites: Nothing worked. Junkies called the new pills “gummies” or “jellynoses” because when they put it in their noses or mouths or needles, the pills caked up. Users who hadn’t built a tolerance could still get high by swallowing the pills. But hardcore users could no longer get the full rush at once.

The effects were immediate. Brand-name OxyContin vanished from the streets—few addicts wanted it. In Boston, an addict killed his dealer because he thought the dealer had sold him the new OxyContin. Prescriptions of the popular 80-milligram OxyContin dropped 33.6 percent within two years.

Less of Purdue’s product was going to the black market, and the company had transformed into a crusader for abuse-resistant opioids. It lobbied the FDA to deny other companies from making oxycodone pills with an easy-to-beat formulation. Companies like Mallinckrodt and Actavis, who made the oxycodone 30-milligram pills that were the standard fare offered by Florida pill mills.

Then the drug company offered to help fund Florida’s prescription database. Governor Scott rejected the offer. Months went by, and the furor grew, and finally, in May 2011, the new governor quietly gave up on his opposition to the drug database and signed off on its funding.

“For almost ten years, at
least
ten years, the citizens of Florida have waited for our Florida state leaders to effectively do something about the drug distribution in our state,” Golbom said during the introduction of his next show, “and, finally, Friday night was a historic night for the citizens of Florida.”

In the middle of October 2010, Dr. Cynthia Cadet agreed to meet with federal prosecutors. Jennifer Turner and Mike Burt had gone to her house with a subpoena for a handwriting sample and used the opportunity to urge her to come in. She was looking at criminal charges, Burt had said. Cadet brought along a lawyer to the meeting.

Paul Schwartz outlined the case against Cadet with unusual breadth and bluntness. The lead prosecutor said the doctor had been part of a pill mill operation that had unleashed millions of addictive pills into the black market, killing numerous patients. If Cadet didn’t cooperate, she would face charges in those deaths. If she cooperated and pleaded guilty to the drug charges, she would likely escape a life sentence. Former coworkers were already cooperating, he said. Cadet had been one of the biggest dispensers of oxycodone in the country, he said, and her former boss, Chris George, was a thug who had Nazi tattoos and a stripper girlfriend-turned-wife. Cadet should have been able to figure out that George was a bad guy and that a pain clinic that kept cash in garbage cans was a pill mill. The prosecutor was indignant and sarcastic, especially when he mentioned how she’d found the job at American Pain.

Schwartz said: What doctor on Earth would apply for a job on Craigslist?

In her soft, airy voice, Cadet told Schwartz she knew nothing about Chris George’s private life. Her lawyer added that if Cadet had been a participant, she was an unwitting one. She had a blemish-free legal record. She was a naive and gullible person who had genuinely believed she was acting within the law.

Schwartz said: She may not have known the extent of what her employers were up to, but she enabled the process by prescribing the medication and getting paid a ton of money to do it. So she is not getting out of this case.

The meeting ended in a stalemate.

For Schwartz, one problem was that Chris George had rarely spoken to the doctors on his phone, so the wiretap recordings didn’t offer much concrete evidence that tied the doctors into the conspiracy. The most damning piece of conspiracy evidence the prosecutors had against the doctors was that they’d signed the wholesaler questionnaire Ethan Baumhoff had falsified.

Before they could indict the whole group, the prosecutors needed at least one of the American Pain doctors to cooperate, to admit that he or she knew the clinic was a pill mill and to describe the clinic’s medical practices. But the doctors still didn’t seem to understand they were in real trouble. Schwartz didn’t mince words in his meetings with the doctors. He told them he knew they’d gone to medical school, but to him they were drug dealers. He said what they’d done at American Pain wasn’t practicing medicine, because
anyone
could have done it, with or without medical training.

Some doctors responded arrogantly, rolled their eyes during the meetings, acted bored. Some meetings ended quietly, others with yelling and F-bombs. Some doctors gave general information about their employment at the clinics, but none were willing to accept the idea that they were criminals, even if Chris George was one. Some of the doctors were so sure they were in the clear that they had taken jobs at other pain clinics. Typically, Jennifer Turner was the second most aggressive person in the room, after Paul Schwartz. She knew the doctors were in denial about their actions, that it would take them time to confront their guilt, but her patience dwindled as the months passed. Sometimes she just took a break, walked out of the room for a while.

The most compelling leverage against the doctors was the threat of death charges. By December 2010, the agents had created a database from the patient records they had seized in the raid of American Pain. The team cross-referenced the names in the patient database with the names of sixteen hundred people who had died of drug overdoses in Florida. More than fifty American Pain patients were on the overdose list. Seven of Roni Dreszer’s patients had died in Florida, seven of Aruta’s, five of Cadet’s, four of Jacobo Dreszer’s, and three of Boshers’s. Because many patients tended to jump from clinic to clinic, not all the deaths were necessarily due to prescriptions received from American Pain doctors, but it was, nevertheless, a lot of dead bodies. Especially when you considered that 87 percent of the clinic’s patients were from out of state. The team wondered how many deaths they would unearth if they began looking in Kentucky and West Virginia.

At long last, almost a year after the raids, two doctors surrendered. Both Dreszers agreed to talk to the feds, and in separate February 2011 meetings the father and son finally acknowledged that they’d known American Pain was a pill mill, though it wasn’t something discussed or acknowledged at the clinic. Jacobo Dreszer said 98 percent of the patients were drug dealers or addicts and that Chris George pushed him to prescribe higher amounts. Roni Dreszer said he’d known within a month that the place was illegal, and the other doctors must have known too, even if they didn’t speak about it. He’d discussed Carmel Cafiero’s news reports about American Pain with other doctors and staff. All the doctors had received state health department complaints about their prescribing habits. Everyone had seen the police repeatedly coming to the clinic to investigate doctor shoppers.

Then, four months later, in June 2011, the investigators got the news they’d been hoping for. The ringleader was coming in. Chris George was ready to talk.

Every Friday, Derik went with Chris’s mother to visit Chris in St. Lucie County Jail. He and Chris vowed to each other that they would stay strong and fight the government. But the months wore on, and more and more people flipped. The feds kept calling Derik’s lawyer, saying they were going to arrest him any day. Derik just got tired. He stopped urging everybody not to cooperate with the feds. He began telling people to do what they had to do. He just wanted it to be over.

Derik saw Dianna a lot, and even with everything that was happening, she was still obsessing over Chris cheating on her during the American Pain days. She was pregnant with Chris’s son. They’d conceived three weeks before his arrest the previous fall.

In jail, Chris spent several hours a day for a couple of months listening to wiretap recordings, accompanied by a law student hired by his attorney. It was strange to hear all those calls, to relive his final days as Florida’s oxy king. His attorney asked the federal magistrate judge to quash evidence obtained from the search warrant and wiretap. The wiretap wasn’t justified, the lawyer argued, because wiretaps were supposed to be a last resort. In this case, because American Pain was a public business, not a covert organization, normal investigative techniques would have done the trick. And the search warrant wasn’t justified because it was largely based on evidence from the wiretap. Chris told Derik that the motions were guaranteed to succeed, and the evidence would be thrown out.

Then, in June 2011, Derik went to visit Chris one Friday, eight months after Chris had gone to jail, and Chris broke the news. Basically everyone was cooperating with the feds, everyone except Dr. Cadet.

Chris said: It’s over, man.

Chris had decided to flip, which to Derik seemed like a complete about-face from a few days earlier. Chris told Derik he believed it was his only chance at avoiding a life sentence. They would get long sentences initially, Chris explained, but they could eventually bargain down by testifying against the doctors and drug wholesalers. Factor in time off for good behavior, and, at most, Chris said, they’d do five years.

Derik wasn’t so sure, but he knew he had no choice but to flip. If he went to trial and Chris and almost everyone else testified against him, he’d definitely get a life sentence.