by Jim Markson
Very quickly, Ricardo Blanchard became one of Mike’s biggest fans, but he insisted on keeping the investigation very low profile and was reluctant to bring in additional investigators. Mike was initially tasked with identifying the networks inside of the pain clinic industry, which was, if the pain clinics were connected to each other, a task that involved numbing but non-alerting research through public databases such as business licenses and incorporation documents. The work was done concurrent with Mike’s more traditional investigatory work, and he did not tell his coworkers or his supervisors about his activities with Blanchard. It took approximately six months to uncover what he thought were three large networks, each consisting of at least twenty multiple pain clinics in South Florida. He had sent his source into several clinics from each of the networks, and it was confirmed that there were operational commonalities across facilities of each network that seemed to bind them together, and also served to differentiate them from the other networks. One of the most obvious connections was that many of the facilities within a given network would have the same physician, who would travel from one office to the other on different days of the week, making it easier for those who had lost all their worldly belongings to the effects of the addiction, to simply walk in and obtain some more, rather than have to endure the arduous bus ride across town. It also appeared that the networks shared cultural bonds; one seemed to employ primarily Pakistani/Indian medical professionals, while another seemed to favor medical professionals from Laos and China.
Nine months after their initial meeting, with three apparent major networks mapped out, Blanchard took the first of his official actions on the case, issuing subpoenas for the banking records associated with the networks. At the same time, he opened the case up a little further by meeting with the regulatory side of the Drug Enforcement Administration. While the DEA was most well-known for the Special Agents that kicked down doors and captured drug lords overseas, a larger portion of the Agency’s budget was actually spent on regulatory activities, and these regulations could be a treasure trove of information for anyone investigating the illicit distribution of Class II controlled substances.
Of course, a State prosecutor making inquiry of a federal agency like the DEA frequently provoked more questions than positive results, and it was no different in this case. Shortly after making the inquiry, Blanchard was visited by one of the DEA Supervisory Special Agents assigned to the CNTF who was not shy in asking about the background of Blanchard’s inquiry and politely noting that things would likely be better received if Blanchard had routed such a request through the Agents assigned to the CNTF. Blanchard feigned an apology and explained his recent receipt of reports indicating the existence in South Florida of networks using licensed physicians to distribute synthetic opiates; Blanchard deliberately avoided mentioning Mike’s involvement in the investigation.
Upon receipt of the briefing, the senior DEA Agent almost immediately lost interest but agreed to support Blanchard’s request. “Good luck with that…” was his exact response once he realized that the investigation involved licensed physicians. Beyond the fact that such investigations simply lacked the adrenaline potential of more traditional drug investigations, the Agent made reference to an incredible number of hurdles deliberately built into the bureaucracy and specifically designed to protect physicians from the second-guessing inquiries of perceived gun-toting, unsophisticated Special Agents.
There were already more classic drug distribution cases than the Task Force could handle; cases involving tons of heroin and marijuana imported from abroad, many involving terrorist connections. These cases were easier to prosecute, the Agents were more familiar and comfortable with the investigative tools and, at the end of the day, such cases produced the ever-persistent demand for metrics that drove both personal promotion and organizational budgets. The Agent admitted he was aware of a rapid increase in the trafficking of Oxycodone, and even reports of exponential price increases due to demand, but explained that it was an issue that lacked political legs. Pursuit of a bunch of foreign doctors, with minimal expectation of successful prosecution, was simply not something the Agent wanted to invest his career potential in. If Blanchard had the time and interest, the Agent wished him the best of luck, indicating he would help where possible.
The first trove of prescription issuance records arrived at Blanchard’s office about three months after the initial request. Mike had been called in by an excited Blanchard to look at the histories of the physicians identified within the networks. The documents, in and by themselves, seemed so compelling it was hard to imagine anything but an easy prosecution. Blanchard had the forethought when he made the initial request to also ask for comparisons against which he could gauge the activities of the pain clinics under investigation. It turned out that every one of the physicians under investigation exceeded the national average issuance of Oxycodone prescriptions by at least twenty-fold. As they sat in the office, Blanchard smugly commented that, if his understanding of the reporting was correct, the physicians Mike had identified were the most prolific scrip writers for opiates in the entire country. In fact, Blanchard noted with incredulity, it seemed almost every one of them had individually issued more scrips for Oxycodone than all the other doctors outside of Florida … combined.
It was an “Ah-hah” moment of silent satisfaction. The proverbial smoking gun lay in front of them in black-and-white, indisputable statistics. They, on their own, had identified a true scourge of society. They, alone, had persevered where others had relented, and had found the proof of a growing epidemic.
Nine months later, the bloom of enthusiasm had faded to cold gray as Blanchard slowly came to appreciate the prosecutorial complexities and obstacles forewarned by the DEA Supervisory Special Agent. While civil lawsuits alleging malpractice could have been won easily based on the evidence available, there were not likely to be any such lawsuits where the ostensible “patients” were in practical collusion with the physicians who were feeding their addiction. And criminal prosecution of the physicians required a much higher threshold, essentially requiring the prosecutor to demonstrate the same level of apparent intent on the part of the physician as that of a trafficker who concealed bales of marijuana on a fast boat and secretly unloaded them on US shores under cover of darkness.
The Controlled Substances Act regulated the dispensing of drugs like Oxycodone, but left an enormous amount of wiggle room for any competent defense attorney. The regulation’s amorphous wording specified that prescriptions could only be issued for “legitimate medical purpose” by an authorized medical professional within the usual course of professional practice. Establishing that the involved physicians had deliberately issued prescriptions beyond the medicinal needs of their patients was a very difficult threshold to cross.
Research into relevant case law had established that many of the practices employed by the suspect physicians would effectively mitigate any prosecutorial efforts. The mere act of performing a quick medical examination, or requiring an X-ray, however inconclusive it might turn out to be, served to establish an adequate defense that the physician was pursuing the patient’s medical needs. And even in the absence of these acts, prior prosecution of physicians had generally required some additional act to indicate positive intent, such as warning the patient not to fill multiple prescriptions at the same pharmacy, or deliberately misdating multiple prescriptions to the same patient.
Everything that had been collected in Mike’s investigation thus far indicated that the physicians in the South Florida networks had paid close attention to prior case law, and had taken action accordingly. While they had dispensed more Oxycodone than all physicians outside of the state of Florida combined, they appeared to always perform at least a perfunctory physical examination, sometimes even asking for X-rays of a claimed injury. While they could not deny the overwhelming amount of prescriptions they had written for opiates, this would never meet the prosecutorial requirement to prove that they were intent
ionally distributing the opiates for non-medicinal purposes.
The realizations and disheartening conclusions had been assimilated in a piecemeal manner. Blanchard eventually indicated that the investigation would need to be re-focused on the physicians’ income, deducing that they had to be receiving a share of the profits from the prescriptions they wrote. The risks these doctors were taking logically had to be justified by proceeds exceeding the small Medicaid reimbursements they received for seeing the patients. The identification of the as-yet unidentified source of this income, and the associated financial records, would be the missing link that connected the physicians more directly to the drug distribution activities and more firmly establish their criminal intent. But issuing subpoenas for physicians’ financial records, no matter their place on the medical hierarchy, was not something that the government undertook lightly. It would be years before a successful prosecution was scored.
In the meantime, Mike had continued his successful career trajectory, enthusiastically accepting an offer to become a Special Agent with the Federal Bureau of Investigation. It was certainly the most significant step in his career and, while he had done his fair share of moaning about prima donna, big-ego, FBI Special Agents while he had worked for County and State law enforcement, he had always secretly wanted to carry the badge that represented the pinnacle of law enforcement, and even more secretly hoped to finally be able to go to sleep at night sated with a sense of accomplishment and satisfaction at the work he had done.
VI
Within a couple of uneventful hours, Mike and John had the boat headed east, with the wind at their back, as they slipped easily through Longboat Pass into the intercoastal waters of Sarasota Bay. They made good time as they then turned almost due south on a close reach, averaging over four knots, passing under the Ringling Causeway and then Siesta Drive Bridge and into the muddy waters of Roberts Bay. It was easy sailing, essentially keeping the Florida mainland on the left, and a series of barrier islands on the right, with an ever-vigilant and distrustful eye out for big boats with motors. By late afternoon they had made it to Little Sarasota Bay. Its abundance of shallows and sandbars, combined with the waning sun, caused them to refocus their attention on navigation, hoping to avoid running aground and damaging their dagger board or rudder.
While this was the second day of the race, and virtually all of the real competitors would have already made it to the first checkpoint just north of Charlotte Harbor, the brothers had quietly agreed while looking at the charts earlier in the morning that they’d be lucky to make it to Venice. What went unsaid was the mutual understanding that they were not competing with anyone else in the race and, given the events of the prior evening, they were both inclined to avoid any night sailing if at all possible.
As the sun began to set, they pulled the boat through some mangroves to the back side of a boat ramp and set up a primitive camp, unseen by the many boaters who were washing their boats before heading home. Mike pulled out two spaghetti MREs, and the boys ate quietly as they watched the last of the boats pack up and leave. A park ranger responsible for locking up the boat ramp was the only one who noticed them and headed in their direction but, half-way there, stopped and turned around without ever saying a word. He locked the gate on his way out, and the boys were alone. They started a small fire and unpacked the small sleeping bags that had somehow survived the capsizing of the prior evening.
Mike, who had consciously avoided drinking during the afternoon to avoid aggravating his brother, pulled out one of the bottles of Wild Turkey and had a few swigs. John refilled the water bottles from the hose at the fish-cleaning table and declined an invitation to share the whiskey when he returned. Mike shrugged, but was glad to see that the reappearance of the bottle didn’t seem to vex his brother. Okay, he thought, I guess the rule is, it’s okay to drink on dry land during vacation, but he whispered not a word of the thought to his older brother.
The spaghetti MREs were military grade, and although they inevitably brought back memories of some very difficult situations for John, they tasted good and, being warm, were quickly eaten and well appreciated. No matter how many times Mike made one of these meals, he couldn’t stop himself from experiencing some level of awe as he poured water into the heavy duty plastic bags and watched them magically heat the meals to a level that was too hot to hold. It was a model of efficiency, and although they never quite met the threshold of delicious, it was pretty damn efficient for anything associated with the government. And, if you were hungry enough, Mike supposed the meals could quickly slip over the threshold and slide into the category of delicious.
As the evening turned cold, the brothers drew closer to the small fire, sitting cross-legged and staring into the flames as men are wont to do, as if somehow hypnotized by the simple flickering flame. John commented with pleasure on the lack of mosquitoes but Mike did not respond, having another slow pull off the bottle without taking his eyes off the fire.
“Do you think you have PTSD?” Mike asked his brother without explanation, never taking his gaze off the fire’s flames.
“I assume so …” John responded without hesitation but also without certitude. “Yeah, probably…”
“What the fuck does that mean? ‘Yeah, probably…’? Don’t you have to take tests and stuff before you come back to civilization to make sure you’re at least mostly squared away?” Mike asked with genuine, if not exactly empathetic, disbelief.
“Always you and the F-word,” John retorted. “Don’t you have to take some type of test to make sure you have a vocabulary sufficient to write an investigatory report without resorting to the use of profanity?”
Mike was back in the mix with his brother, assuming the voice of so many defense lawyers he had observed over the years. “Nice attempt to misdirect; now, please answer the question: Were you, or were you not, required by the US Military to submit to psychological evaluation subsequent to your latest combat tour; said evaluation being made in an attempt to determine whether you were suffering from Post-Traumatic Stress Disorder and/or other mental/emotional illnesses typically associated with the violence of combat?”
“No sir, I was not required to take any such testing,” John responded, playing along as if he were being questioned in court.
“Well, if not required, was such psychological testing and evaluation at least made available to you at the end of your combat tour?”
“Yes sir. The US Army provides for full psychological assessment and treatment of its soldiers at all times, not just at the end of a combat tour. All personnel are encouraged to be alert to the possible negative psychological and emotional consequences of combat, and to take full advantage of the services offered” John responded with a regimental voice of authority that had complete confidence in its ability to break all issues down into matters made either black or white. There were no shades of gray in official policy and the voice knew that, when the shadows of dusk grew long, hiding things known only to those who there at the time, there was sometimes comfort and reassurance to be found in the clarity of military orders and regulations.
“So, you did not avail yourself of these services?”
“No sir, I did not.”
“And doesn’t that, by logic, dictate that you were probably in need of such treatment and, by extension of the same logic, indicate that you are now probably as crazy as a fucking loon?”
“Sir, I am once again offended by your language.”
“I apologize. Now please answer the fucking question.”
“No sir, I did not take advantage of the psychological evaluation services offered by the US Government” John answered as Mike sat back with a buzz from the bourbon and a smugness at winning the contest, the ultimate point of which he could no longer remember.
But after only a few seconds of respite, John couldn’t stop himself. “You know, since you seem to want to talk about emotional and psychological issues, perhaps you’d like to expand on your current drinking habits and when,
exactly, you began your own dance with the demons of night.”
It was a long period of silence that followed, somehow empty and yet, at the same time, legion with painful scars, fears, and doubts common to both of these blood brothers, yet never mentioned aloud at night or in the light of day, in accordance with some unknown rule imprinted on their souls at birth.
“Goodnight John-Boy,” was Mike’s only response, harkening back to the TV show The Waltons that they had watched together as kids, surrendering the battle rather than risk broaching all the issues associated with John’s question. They had both spent many evenings wrestling with the banshees of the dark, and they each suspected the same specters had visited the other, but to speak of it out loud might give the ghosts an even greater power. Out of fear, the fears themselves were buried deep in the belly.
Mike had a few more pulls off the bottle, and the two fell asleep in the cool of the night.
VII
The brothers awoke peacefully to the sounds of the shorebirds about an hour before dawn. They ate granola bars and drank as much water as they could force themselves to drink as they packed up their bags and stowed their gear back into the small boat. They spread the laminated nautical maps out on the wet camp grass and studied them using a unique form of flashlight that Mike had found on-line: a simple plastic cap that slipped over a 9-volt battery and powered a small but effective LED light that seemed to last forever.
There was not much to talk about. The course for the day was pretty simple and clear. They would enter the man-made Venice Canal and, depending upon the winds, sail or row the following five miles before entering back into the natural ICW at Lemon Bay. They would then sail the following fifteen nautical miles with a little more room to maneuver, including the ability to tack into the wind if needed, but still without much opportunity to make any significant navigational mistakes. At the bottom end of Lemon Bay was Don Pedro Island State Park, the first check-in point of the EcoLoco challenge, where some of the faster boats would have likely passed through at the same time Mike and John were upside down off Ana Maria Island. The check-in post was scheduled to have closed the prior evening, but it was possible there would still be someone there, and the boys agreed they would stop and check, just in case.
