AMERICAN PAIN (47 page)

On Derik’s third day of testimony, Paul Schwartz was angry on his redirect, and Derik was scared he’d lost any chance of getting out of prison before his late forties. Schwartz’s movements were even jerkier than usual, his questions like bullets.

“Sir, yesterday on cross-examination you said the words, ‘There was nobody innocent there, everybody knew what was going on,’ ” Schwartz said. “What were you referring to?”

“Everybody . . . Everybody that I . . .” Derik stuttered, wanting to get this right, correct any damage he’d done to the prosecution’s case yesterday. “. . . knew what was going on. Nobody . . .” Then, simply: “There’s no children here.”

“You say everybody knew what was going on,” Schwartz said. “Explain that.”

“You’ve seen the videos,” Derik said. “It’s hard to comprehend the fact that anybody could
not
know that we were a pill mill.”

“Did you tell the government that she was a criminal?”

“I did, but I tried to downsize her role in it because, I don’t know, I guess I want to take . . . I’d rather take responsibility than pass it off on somebody else.”

“What does that mean?”

“I don’t know,” Derik said. “I try to be a stand-up guy sometimes when I shouldn’t.”

“Did you tell the government she was a criminal?” Schwartz barked again.

“I did.”

“How did American Pain make its money?”

“Selling pills.”

“Was that the plan?”

“That was the plan.”

“Did Dr. Cadet participate in that plan?”

“She did.”

“Could the plan have been carried out without the doctors?”

“Could not have.”

“Were you a drug dealer?”

“I was.”

“Was Christopher George a drug dealer?”

“The biggest.”

“Was the staff at American Pain drug dealers?”

“We all were.”

Extra emphatic: “Were the
doctors
drug dealers?”

“They are.”

“Did you ever sit down with any doctor, including defendant Cadet, and say, ‘We’re operating a pill mill?’ ”

“No.”

“Was it necessary?”

“No.”

The Cadet/Castronuovo trial took two months.

The American Pain gang was reunited during that time, having been called back to South Florida from their various federal prisons and camps. They spent the trial on the two floors of the Palm Beach County Jail that housed federal prisoners. They all had prison-life stories by now, especially about the interminable and inexplicable bus and plane rides from one facility to another, fueled only by bologna sandwiches. Dr. Patrick Graham had faced the toughest stretch. He’d been incorrectly assigned to a Mississippi prison for illegal immigrants, and before his transfer could be worked out, a riot broke out, and his neck was grazed by a bullet. After that, he spent six weeks in solitary confinement. The co-defendants spent long days together and they weren’t supposed to talk about the trial, so they compared notes about their various sentence lengths, about their different prisons, about their kids. And they talked a lot about the future, where they might live when they got out, what jobs they might pursue. In the evenings, they watched the Miami Heat win the 2013 NBA Finals.

Day by day, different individuals were pulled out to testify. Ethan Baumhoff had gone first, followed by Derik Nolan, then some lower-level guys, then Dianna Pavnick, Roni Dreszer, Chris George, Beau Boshers, and Michael Aruta.

After almost three years behind bars, Chris George’s hair was streaked with gray, his build beefier. He looked fifteen years older than the twenty-seven-year-old who’d opened South Florida Pain five years earlier. He was the star witness, of course, and the prosecutors had wanted him to testify earlier. But Ethan Baumhoff had told Jennifer Turner that Chris had had a jailhouse telephone conversation with his father about Ethan’s testimony. Turner had seen John George watching the proceedings from the spectator rows, scribbling in a maroon spiral notebook. The prosecution team dug up a recording of the call and everyone listened to it, John George telling his son what questions he could expect on cross-examination. The defense objected to Chris George being called as a witness. He was clearly doing illegal homework, they said. He wanted to provide the most damning possible testimony against Cadet and Castronuovo, they said, in hopes of winning an extra-large sentence reduction. The judge chewed out John George the next day and pondered the mess for a while before deciding to allow Chris George’s testimony. Chris testified for most of three days, retelling the story Derik and Ethan had already told. Unlike Derik, whose nervousness in the witness box had made him sprawl out and jabber, Chris turned inward. He sat stock-still, and his voice was even more of a monotone than usual.

Alice Mason testified also, her third real trip outside of Kentucky and the first time she’d ever flown. The federal agents had sent her a plane ticket, and when her husband dropped her off at Blue Grass Airport in Lexington, the attendant asked her for an identification card. She hadn’t thought to bring one. She explained that she was going to Florida to testify about her son’s death in a big court case, and she just had to get on that flight, no matter what. The Delta officials asked her a lot of questions and finally, reluctantly, let her on board. The shuddering takeoff scared Alice to death—it just wasn’t natural to be way up in the air—but it was beautiful up above the clouds. Mike Burt met her at the airport in West Palm Beach, took her to her hotel. In the courtroom, Alice saw Dr. Cadet out of the corner of her eye but wouldn’t look right at her. She cried through much of her testimony, which embarrassed her, and the judge didn’t let her tell how she’d gone to American Pain to talk to Cadet. She couldn’t understand half of what the lawyers said, but at the end, gasping through tears, she said what she’d come to say.

“Me and my husband . . .” She couldn’t speak for a moment, then said, simply: “It’s hard on us. And I hope there’s not nary a family that has to go through what I’ve had to go through. I don’t wish it on my worst enemy. I can’t hardly talk about my son without breaking down, and I am so sorry.”

Cadet’s lawyer just wanted this to end. “Ma’am, I’m very, very, very sorry.”

“I know it’s been four years, but to me it’s just like yesterday,” Alice said.

She stumbled climbing down from the witness stand, and Jennifer Turner jumped up to help her. Alice leaned against the tall FBI agent on the way out of the courtroom. Jennifer told Alice she’d done a great job. Alice was glad to get out of there, away from all those people she didn’t know, and go back home.

Paul Schwartz called sixty-four witnesses: ringleaders, staffers, doctors, cops, agents, toxicologists, medical examiners, and pain management experts. By the time the prosecution rested its case, the jury was inundated with details—the important, the trivial, and the lurid—about American Pain and the havoc it had wrought.

The jurors knew a great deal about Cadet’s questionable medical practices. They knew she tended to write higher than the other doctors. They knew she saw an average of seventy-three patients a day toward the end, and spent an average of four minutes and forty seconds with each one.
^*
They knew that the staffers who regularly went into her office couldn’t remember ever seeing her actually examining a patient. They knew that the doctor never questioned the misspellings and dubious statements on the patient forms she used every day.

What they didn’t know for sure was exactly what Cadet knew or believed about what she was doing, whether she was just a bad doctor or a criminal one. The doctor did not testify on her own behalf. And none of the prosecution witnesses offered a smoking gun, a moment when Cadet had said or done something that showed, beyond a reasonable doubt, that she knew she was writing scrips for junkies.

What Cadet did know, according to witnesses, was that American Pain was called out as a pill mill on news reports. She knew that various patients were being investigated for doctor shopping. She knew that patients were ejected on a regular basis for having track marks or dope in their urine. And still she kept seeing more and more patients, pocketing $1,217,125 during her sixteen months at the clinic.

The parts of Derik Nolan’s testimony that had directly concerned Cadet were so tortured and conflicted that, despite the ring of truth in much of the rest of his story, it was unclear what he really thought about the doctor’s culpability.

Detective Sergio Lopez testified about his experiences as an under-cover patient at American Pain—but he’d seen Boshers, not Cadet.

Aruta, Boshers, and Dreszer testified that it hadn’t taken them long to figure out that American Pain was a pill mill. But they also said they’d never had explicit conversations about that subject with Cadet.

The prosecution’s pain management expert, Dr. Rafael Miguel, testified that he studied more than three hundred of Cadet’s patient files and found them to be clearly the work of a pill mill doctor.

The defense’s pain management expert, Dr. Carol Warfield, testified that she’d studied the same randomly selected files, and they looked fine to her.

Paul Schwartz’s closing argument, in a nutshell, was this: The doctor
had
to have known that her patients were lying. Everyone else at American Pain had known. There’s no way she didn’t know. Her actions had directly led to the deaths of seven people, and she deserved a life sentence.

Cadet’s lawyer told the jury that in 2010, the government was in a fight for the very soul of Florida. They had to get the prescription drug problem under control, by any means necessary, and Dr. Cadet had been swept into a dragnet prosecution. But, he argued, the case was already over. For all intents and purposes, the government had won, and the real criminals were already behind bars.

The jurors spent twenty hours deliberating. They decided they couldn’t see inside the doctor’s brain any more than the doctor could see inside her patients’ brains.

Whether or not she truly believed her patients were in pain, Dr. Cadet chose to accept the stories her patients told.

And the jurors chose to accept Dr. Cadet’s story.

Footnotes

* The charges included racketeering conspiracy, money laundering conspiracy, possession with intent to distribute controlled substances, maintaining drug-involved premises, and wire and mail fraud conspiracy.

* It didn’t work. In June 2012, the firefighters were charged with state racketeering violations related to their involvement with the clinics.

* The crash also killed two passengers, but prosecutors decided it would be too difficult to try Cadet for those deaths.

* At least on February 24, 2010, a day the FBI chose to analyze American Pain security-camera video of the patient flow into Dr. Cadet’s office.

Epilogue
Oakdale, Louisiana May 31, 2014

The visitation room at the Federal Correctional Institution at Oakdale contains about 150 beige plastic chairs lined up in rows, armrest to arm-rest. Vending machines and microwave ovens occupy one concrete-block wall, restroom doors and water fountains another. At peak visiting hours, most of the seats are filled with prisoners and their families, and it’s hard to hear over the din. It’s a self-contained ecosphere, a single room designed to confine inmates for hours at a time. It’s weirdly equivalent to the waiting room at American Pain: a handful of guards overseeing dozens of desperate captives. Except, of course, that Derik Nolan was the head warden at American Pain. At Oakdale, he’s just another prisoner.

Derik reported to prison more than two years ago, and this is his first time in the visitation room. No friends or family have made the long trip to central Louisiana. We sit across from each other, and he drinks cranberry juice, sipping it slowly so he won’t have to ask the CO if he can go to the bathroom. I bought the bottle of juice for him from one of the vending machines. He has no money, of course, so I’ve brought a prison-approved plastic bag of quarters so we can get something for lunch. He’s not allowed to get up and get food for himself, so I buy and heat his double cheeseburger.

Derik has gained weight in prison. The food is crap. Anything decent that comes into the kitchen goes into the inmate black market, and most of what’s left is pure starch. So he eats a lot of rice and beans and works out until he can’t move. And he reads, hours every day. He barely cracked a book in his first thirty-five years, but now he blows through three or four a week. It’s a good way to kill time and stay out of beefs with other inmates. He likes crime stories and historical fiction. It’s the only exercise his brain gets, and that, to him, is the worst thing about prison. Out in the world, he had to use his smarts to get by. In prison, he has a roof over his head and three squares a day, and his brain is starting to shrivel.

He and Chris sometimes exchange letters. He doesn’t hear much from his other co-defendants, and none of them are in Oakdale. Chris is in Georgia, Ethan in Arkansas, Jeff in Maryland. Dianna Pavnick George and Denice Haggerty are already back home.