Fourteen physicians in southern Florida have been indicted as members of
what one agent with the Federal Bureau of Investigation calls "the
nation's largest criminal organization" involved in illegally
distributing opioid analgesics
such as
oxycodone.
Thirteen of the physicians, along with 19 other individuals, face
federal charges ranging from conspiring to distribute a controlled
substance to money laundering. The fourteenth physician, Gerald J.
Klein, MD, was charged in a state court on August 18 with, among other
things, first-degree murder in the death of a man who overdosed on a
massive amount of hydromorphone
and alprazolam that Dr. Klein had prescribed, according to authorities.
The 14 physicians worked in 4 pain management clinics that the federal
indictment, which was made public August 23, depicts as set pieces in a
gangster movie. Drug addicts and drug traffickers, most from
out-of-state, packed the waiting rooms, and if they were not fighting
each other, they were having drug-induced seizures. Security guards
tried to maintain order. Opioid
analgesics were dispensed and prescribed on an assembly line basis,
and were paid for with cash and credit cards. Clinic employees hauled
their money to the bank in large garbage bags. During a 2-year period,
the clinics raked in more than $40 million from illegal drug sales, a
federal grand jury stated.
The physicians prospered in the process, according to the indictment.
The owners of the clinics paid most of them according to how many
patients they saw, which ranged between 40 and 100 patients per day. The
average physician earned more than $1 million a year this way.
The indictment states that the physicians prescribed opioid analgesics
without a basis in medical necessity, but engaged in subterfuges to make
it look otherwise. Before their visits, for example, patients were
routinely directed to a mobile magnetic resonance imaging facility that
operated 7 days a week past midnight in a strip club parking lot.
The clinic owners were careful to recruit physicians who supported their
business plan, the indictment states. Applicants did not need any
experience in pain management, only a willingness to write scripts every
10 minutes. During employment interviews, "the physicians were asked
whether they would agree to prescribe large quantities of oxycodone,
Xanax, and other controlled substances."
Once hired, physicians would receive instructions from the owners on the
quantity of pain meds that a patient should
receive. They agreed to not wean patients off high dosages or refer them
to detoxification facilities or addiction experts. One unidentified
physician told an investigator that the goal was to keep patients
"happy."
Pain Clinic Owner a Convicted Felon
The criminal organization described in the federal
indictment extended beyond the 4 pain clinics to encompass 2 drug
stores, a pharmaceutical wholesaler that supplied clinic physicians with
pain medications, the magnetic resonance imaging facility, illegal
Internet sales of anabolic steroids, and a fraudulent time share
business. Heading the enterprise, the indictment states, were 2
brothers, Jeffrey George and Christopher George, the second of whom has
spent time in prison on drug charges. The George brothers also launched
a pain clinic in Georgia and may have eyed expanding their operation to
the Midwest, according to the indictment. In the world of South Florida
pain clinics, the George brothers played rough, the grand report
alleges, directing coconspirators to vandalize competing facilities. The
2 brothers, along with 2 coconspirators, were charged with kidnapping
and assaulting a suspected thief. The federal government built its case
against the George brothers and their accomplices in part by recording
conversations with one of the physicians and tapping the cell phone of
Christopher George. "The significance of [the] takedown is that we have
dismantled the nation's largest criminal organization involved in the
illegal distribution of pain killers," said John Gillies, the bureau's
special agent in charge of Miami. Of the 32 defendants, only Christopher
George and Steven Goodman, RPh, owner of the pharmaceutical wholesale
company, have entered pleas as of today, according to federal court
records. Both men have pleaded not guilty.
Criminal Expansion Into Pharmacies
The criminal organization described in the federal indictment
extended beyond the 4 pain clinics to encompass 2 drug stores, a
pharmaceutical wholesaler that supplied clinic physicians with pain
medications, the magnetic resonance imaging facility, illegal Internet
sales of anabolic steroids, and a fraudulent time share business.
Heading the enterprise, the indictment states, were 2 brothers, Jeffrey
George and Christopher George, the second of whom has spent time in
prison on drug charges. The George brothers also launched a pain clinic
in Georgia and may have eyed expanding their operation to the Midwest,
according to the indictment. In the world of South Florida pain clinics,
the George brothers played rough, the grand report alleges, directing
coconspirators to vandalize competing facilities. The 2 brothers, along
with 2 coconspirators, were charged with kidnapping and assaulting a
suspected thief. The federal government built its case against the
George brothers and their accomplices in part by recording conversations
with one of the physicians and tapping the cell phone of Christopher
George. "The significance of [the] takedown is that we have dismantled
the nation's largest criminal organization involved in the illegal
distribution of pain killers," said John Gillies, the bureau's special
agent in charge of Miami. Of the 32 defendants, only Christopher George
and Steven Goodman, RPh, owner of the pharmaceutical wholesale company,
have entered pleas as of today, according to federal court records. Both
men have pleaded not guilty. Criminal Expansion Into Pharmacies In all,
32 individuals were indicted a federal district court in southern
Florida as part of what authorities called Operation Oxy Alley. The US
Department of Justice (DOJ) has recently prosecuted pill mills and their
physician prescribers in other parts of the country, but the Florida
bust ranks near the top in terms of size. Gary Boggs, a supervisory
special agent in the Office of Diversion Control in the US Drug
Enforcement Agency, told Medscape Medical News that Florida is the
epicenter of "rogue pain clinics." One possible reason why Florida is
such a magnet for pill mills is the state's high proportion of elderly
citizens, said David Melenkevitz, a DOJ spokesperson. "That population
would bring about a large medical community — doctors, pharmacies, and
hospitals," Melenkevitz told Medscape Medical News. "So there are a lot
of medical professions for these drug dealers to corrupt." The
indictment notes that during the time frame of the alleged offenses
(from 2006 to March 2010), Florida lacked a prescription drug monitoring
program similar to the kind used in other states to detect drug abuse
and diversion. Florida passed a law in 2009 authorizing such a program,
but the DOJ states on its Web site that as of May 2011, the Florida
program was not fully operational. Another law enacted in 2010 prohibits
felons from owning pain management clinics and limits clinics to
dispending no more than a 72-hour supply of medications to a patient who
pays in cash. The rationale here is that greenbacks are harder for law
enforcement agencies to monitor than credit cards. Making it harder for
Florida pill mills to dispense pain medications has caused their owners
to open pharmacies, noted Gary Boggs. The George brothers' enterprise
included 2 pharmacies, according to the federal indictment. The DOJ is
cracking down on multibranched pill mill operations in other states.
Four physicians, 1 psychologist, and 12 pharmacists working together
with 26 pharmacies in Michigan were indicted earlier this month on
Medicare and Medicaid fraud charges in connection with the illegal
distribution of controlled substances.
Holding Physicians Responsible for Overdoses
The bust in South Florida further demonstrates a willingness of law
enforcement authorities to hold physicians responsible for overdose
deaths caused by their work in pill mills. Several weeks ago, 2
physicians who once practiced in Colorado were indicted in a federal
district court of illegal prescribing that led to 4 deaths. With the
alleged pill mill operation in South Florida, a state grand jury went a
step further and indicted Dr. Klein for first-degree murder on account
of the overdose death of 30-year-old Joseph Bartolucci. Dr. Klein is
accused of prescribing Bartolucci, a repeat patient, with 150 8-mg
hydromorphone pills, 30 2-mg alprazolam pills, and 30 25-mg
nortriptyline pills in 2009. Bartolucci filled the prescriptions for
hydromorphone and alprazolam the same day and was found dead the
following day, according to the indictment. An autopsy attributed the
death to the 2 drugs. The state grand jury charged Jeffrey George with
second-degree felony murder in Bartolucci's death. George, Dr. Klein,
and a third person who is also a defendant in the federal case face
various drug-trafficking charges as well. Federal and state authorities
are aggressively prosecuting physicians said to be pawns of pill mill
operators, but physicians who prescribe opioid analgesics in good faith
to their patients have nothing to fear, said Melenkevitz. "We're not
targeting doctors who make a prescribing mistake on a bad day," he said.
"We're targeting drug traffickers who are operating outside the scope of
regular medicine." "They're just drug dealers in white coats," added
Boggs.
The Power of NO
If you're
stressed,
feel overcommitted, or are simply trying to make a positive change in
your life, the Power No could be just what you need. It is the "no" we
say now to save us from saying "no" over and over later. A Power No
doesn't just positively affect our life in the moment we say it, it also
has a beneficial ripple effect on the future. For example, this strategy
is ideal for helping us improve our eating habits. For instance, if we
are trying to eat healthier, we may cut potato chips out of our diet.
That means that each time we see the bag of chips in the pantry, we must
decide not to devour it. The Power No is the "no" we say at the
supermarket once so that we don't bring the bag home in the first place.
That one "no" saves us from having to say it multiple times a day at
home. We are setting ourselves up for success and creating an
environment in which we don't constantly need to maintain high levels of
willpower. The Power No is also effective when we feel stressed thanks
to a demanding boss. While we can't shrug off all our work
responsibilities, sometimes we need to learn to say "no" to certain
projects because they are too
stressful or time consuming. Telling your boss you'll have to pass
on this one particular request because your plate is too full right now
can have a positive impact on the rest of your life. It might mean more
time to focus on your current workload while still getting home in time
to see your kids. Additionally, research shows that employees who are
not always "yes men" are actually respected more than their pushover
colleagues.
Steps to execute the perfect Power No:
Identify: Take some time to identify an area of your
life in which the Power No could be useful. Is there a social commitment
you need to say "no" to? How about an extra project with the PTA that
could snowball into an all-consuming responsibility? Can you say "no" to
surfing the web for new clothes instead of having to say "no" to each
item you like but can't afford? The key is to identify a moment when
saying it will have the greatest impact.
Prepare: Plan out ahead of time exactly how and when
you will say the Power No. Having a game plan will help, especially if
your will power starts to plummet. Think about the fact that when you
say your Power No, you are doing something good for yourself.
Share: If you feel like you might chicken out when the
moment arises, tell a friend about your plan and ask them to hold you
accountable. Perhaps your friend has a Power No plan of their own, and
the two of you can create new positive habits together!
Certain Mental Illnesses May Affect Men, Women Differently
HealthDay (8/24, Preidt) reports, "Certain types of mental illnesses
affect either men or women more often," according to a study published
online Aug. 17 in the Journal of Abnormal Psychology. "Men are more
likely to be diagnosed with
substance abuse or antisocial disorders, while women are more likely
to develop
anxiety or
depression," the study found. The "findings show the need for
gender-specific prevention and treatment efforts, said the study
authors, who analyzed data collected in 2001 and 2002 from 43,000 people
who took part in a US National Institutes of Health survey."
"The gender differences may be related to how the sexes deal with their
emotions," WebMD (8/24, Mann) reports. "Women are more likely to
internalize their emotions and withdraw, leading to
depression and anxiety.
Men, however, are more likely to externalize their emotions and act
out."
AD/HD Diagnoses Increasing
The Wall Street Journal (8/19, A5, Ramachandran,
Subscription Publication) reports that the number of youngsters who have
received a diagnosis of attention-deficit/hyperactivity disorder (AD/HD)
has risen during the course of a recent 10-year period. However,
significant portions of the diagnosis increases are being attributed to
heightened awareness of the condition, a government report has found.
The Los Angeles Times (8/18, Roan) "Booster Shots" reported that
"according to surprising new data released" Aug. 18 in a survey by the
Centers for Disease Control and Prevention's Human Services' National
Center for Health Statistics, the "percentage of children ages five to
17 ever diagnosed with the disorder rose from 7% to 9% from 1998-2000
through 2007-2009." "As expected, the condition was more common among
boys than girls," the Washington Post (8/19, Stein) "The Checkup" blog
reports. "The prevalence of AD/HD increased from 9.9 percent to 12.3
percent among boys and from 3.6 percent to 5.5 percent among girls."
HealthDay (8/19, Mozes) reports, "The survey also indicated that
previously notable racial differences in AD/HD incidence rates have
narrowed considerably since the turn of the millennium, with prevalence
now comparable among whites, blacks and some Hispanic groups." In
addition, "the current prevalence rate among those living in both the
Midwest and the southern part of the country shared an above-average
prevalence rate of 10 percent." "AD/HD estimates in the report are based
on a survey of parents" from about 40,000 households "who reported if
their child had ever received a diagnosis of AD/HD," WebMD (8/19,
Hendrick) explains.
Experts Call Addiction A Chronic Disease
In continuing coverage, the Time (8/17, Szalavitz)
"Healthland" blog reports, "In 1956, the American Medical Association
declared alcoholism a 'disease.' More than half a century later, the
American Society of Addiction Medicine (ASAM) has proclaimed
addiction, including
alcoholism and
'process' addictions like gambling, to be the same." Now, according to
the "ASAM's definition, published on the group's website on Monday,
addiction is a 'primary, chronic disease of brain reward, motivation,
memory and related circuitry.' This clarification, which was based on
consultations with more than 80 experts, is aimed in part at
de-stigmatizing addictive disorders."