Rogue group of pain managers skirts rulesApr 4th, 2010 | By admin | Category: FLORIDA
The pain management business has been good to Dr. Anthony G. Rogers.
After years of writing prescriptions, Rogers, a board-certified pain manager, amassed the means to acquire a fleet of muscle cars, $2.8 million in real estate — even a secret interest in a Port St. Lucie topless bar, records show.
The Florida Department of Health fined Rogers, 48, for poor record keeping in a 1999 case related to prescribing painkillers, but that was no obstacle to his success.
He’s among at least 60 doctors registered to prescribe drugs from pain clinics in Palm Beach County, a group that includes criminals and physicians fined by regulators for sloppiness or negligence, according to a Palm Beach Post review of county, state and federal records.
Authorities say unscrupulous pain management centers are attracting crime and fueling a spike in drug overdose deaths. In response, Florida leaders, including Palm Beach County commissioners, are calling for laws that would bar felons from running pain clinics. But some legislators, regulators and observers argue rogue physicians are just as serious an issue.
Many pain management doctors prescribe drugs responsibly and offer needed care, but authorities say a subset among them is more interested in making money than in easing pain.
“We’ve got to go after these doctors,” said state Rep. John Legg, R-New Port Richey, who filed a bill in October that would curb doctors who dispense high volumes of painkillers. “We’ve got to let them know that their careers are going to be on the line.”
County and federal law enforcement agencies increasingly are targeting drug users and trafficking operations, both of which largely rely on pills supplied by pain clinics. Doctors, though, make unappealing targets for prosecution and often remain in the clear, safe from state regulators hindered by huge workloads, a mandated deadline for making cases and poor communication with criminal investigators, The Post found.
Pain doctors disciplined
Doctors traditionally are envisioned as benevolent caretakers, men and women with warm smiles and healing hands. Some pain clinic doctors, though, cut a surprising figure: They drive expensive cars, manage off-shore corporations and make multimillion-dollar deals — and sometimes break the rules of the state Board of Medicine.
Records indicate such doctors are practicing here. A quarter of the Palm Beach County pain clinic practitioners identified by The Post have been cited for wrongdoing by the state health department.
In the six months leading up to March, these doctors and others doled out 2.4 million oxycodone tablets in Palm Beach County, according to federal data cited last month in a Broward County grand jury report.
A third of the doctors identified by The Post earned a medical degree outside the U.S., where students sometimes can get into medical school more easily than in America, state medical officials say. They went to schools in countries such as Colombia, Mexico, Ukraine and the Philippines, records show.
One woman, Anne Lynn Morgan, got an M.D. from a Dominican Republic university in 1981. Three years later, the Dominican government shuttered the school after concluding it sold medical diplomas to some students. Morgan, who is registered to prescribe drugs from four pain clinics in Palm Beach County, said she proved to federal investigators and the state Board of Medicine in the 1980s that she completed her course work and training.
She added that she gave up working for pain clinics in September because she wasn’t comfortable with the way her employers were operating.
Only one in six of the doctors identified by The Post reported specialized training in anesthesiology, a common area of concentration for pain management practitioners. The rest pursued a crazy quilt of disciplines, signing on at pain clinics after studying ophthalmology, urology, plastic surgery and other specialties, records show.
Rogers trained in anesthesiology but specialized in liposuction and breast implants. In 2004, he took over Palm Beach Pain Management, a suburban Lantana clinic that now staffs at least three doctors. By then, he was well on his way to buying real estate and classic cars, even as the state health department was pursuing a case against him, documents show.
The Board of Medicine found he failed to conduct physical examinations before prescribing drugs and prescribed drugs “other than in the course of his professional practice,” but that decision was overturned on appeal. He ultimately was fined $1,000 for improper record keeping.
Away from the office, an air of playfulness accompanied his acquisitions. Stamped respectively on the vanity plates of his classic Corvette, his Dodge Viper and his custom Harley-Davidson motorcycle were DRFELGD, DRHLYWD and BRSTD0C .
In 2006, Rogers opened a Port St. Lucie clinic on U.S. 1 directly behind Body Talk Sports Bar, a gentlemen’s club that claims to offer “the area’s premium vixens.”
A trust established in the tiny Caribbean nation of Nevis, and managed by Rogers, secretly joined with corporations managed by Rogers’ roommate and fellow doctor, George Tuttle III, to acquire the adult entertainment venue in 2007, according to corporate filings, county records and sworn statements obtained by The Post.
Rogers didn’t respond to repeated phone and e-mail messages seeking comment.
Records show other Palm Beach County pain clinic doctors, like Ricardo J. Sabates, 60, shared Rogers’ tastes for fast cars and pricey real estate. In 2005, the state health department accused Sabates of over-prescribing painkillers in Broward County. He was fined $10,000 and went on to work at a pain clinic in Delray Beach.
Regulators who followed up in March ultimately suspended his license on an emergency basis after concluding he still was over-prescribing painkillers, records show.
Sabates didn’t respond to messages seeking comment.
Regulators face hurdles
The arm of the Florida health department that took action against Sabates staffs only nine investigators to police 87,750 medical professionals licensed in Palm Beach, Martin, St. Lucie, Okeechobee and Indian River counties. Last fiscal year, 70 health department investigators in 12 field offices conducted 8,382 major probes statewide.
In June, Gov. Charlie Crist signed a bill that allows for the creation of a database to track painkiller prescriptions and the doctors who write them. The law also allows state medical boards to hammer out standards for pain clinic doctors, a process that nearly is complete.
As it is, investigators, who are required by state law and department policy to build cases within 90 days, can be hard-pressed to enforce existing standards, said Bob Gary, chief of the health department’s investigative services unit.
This holds especially true in making complicated cases, which can require filing subpoenas and poring over boxes of records. “Over-prescribing cases, generally you can’t complete them … within a 90-day period,” Gary said.
Regulatory cases brought against doctors and other medical professionals must be completed within six months of an initial complaint. The tight deadline stems from a state law meant to ensure cases against medical professionals aren’t allowed to languish.
Aside from a heavy workload, a lack of communication with law enforcement means state regulators sometimes have no idea what criminal investigators are doing, even though criminal cases against traffickers could help regulators revoke doctors’ licenses.
Gary said law enforcement is communicating with regulators better now than it has in previous years, but added that breakdowns still occur.
Last month, West Palm Beach health investigator Denean Merritts read a newspaper report of a Palm Beach County doctor-shopping ring dismantled by federal authorities.
In the weeks that followed, she tried repeatedly — and failed — to reach representatives of the Palm Beach County Sheriff’s Office, the U.S. Drug Enforcement Administration and the U.S. Attorney’s Office for information about doctors in the case. Merritts wouldn’t comment for this story.
As a result of poor communication, doctors who should have their licenses suspended by state standards sometimes retain them.
Sergio R. Rodriguez, a West Palm Beach pediatrician, was charged with trafficking in oxycodone in 2008. His case is pending in Circuit Court, and he remains in the Palm Beach County Jail in lieu of $2.7 million bail. As he sits in jail, Rodriguez holds a clear and active Florida medical license, state records show.
Doctor prosecutions rare
Rodriguez’s arrest was a rarity.
Making a successful case against a physician requires a tremendous amount of time and resources, search warrants and the seizure of records, said Maj. James Stormes of the Palm Beach County Sheriff’s Office.
“We have to prove that the doctor is breaking the law,” said Stormes, who oversees the sheriff’s detective bureaus. “That’s what I think is very challenging. Can this doctor make the case that what he’s doing is for medical purposes? And if he can, we can’t charge him.”
Not all physicians escape prosecution. In 2008, Dr. Roger A. Browne was convicted in federal court of trafficking oxycodone from his Coral Springs pain clinic to eastern Kentucky.
None of that is reflected in the state health department’s files, which say Browne’s disciplinary record is clean.
The status of his Florida license to practice medicine is listed as “active” but “delinquent” — not because he trafficked painkillers, but because he failed to renew his paperwork from prison.
Staff researcher Niels Heimeriks contributed to this story.
Licensed to prescribe
Doctors who have been cited for violations but can still write painkiller prescriptions in Palm Beach County:
Marvin Reich, ophthalmologist
- Was fined $29,000 and given five years’ probation after the state Board of Medicine in 2006 concluded he broke statutes prohibiting financial exploitation of patients, failed to perform a statutory duty, failed to keep medical records and wrote inappropriate prescriptions.
- Registered to prescribe drugs from Southern Care Pain Management and Wellness Center in West Palm Beach and Boca East Pain Management in Boca Raton.
- Reich didn’t respond to messages seeking comment.
Zvi Harry Perper, obstetrician
- Agreed to pay $10,000 and to complete a records course and 50 hours of community service after the state Department of Health alleged that he botched a 2003 abortion so badly the woman had to undergo a hysterectomy.
- Registered to prescribe from Delray Pain Management in Delray Beach, a business started by a convicted drug smuggler, and from offices in Tampa, Orlando and Ocala.
- Didn’t respond to messages seeking comment.
Robert R. Treuherz, internist
- Agreed to pay a $5,000 fine and submit his practice to a risk manager review after state health inspectors said he failed to follow up on two Pap smears, an oversight that resulted in a woman undergoing a hysterectomy.
- Registered to prescribe drugs from Boca East Pain Management in Boca Raton and from offices in Fort Lauderdale, Tamarac and Pompano Beach.
- Treuherz couldn’t be reached for comment.