Pill Mill Bust
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."