American Pain

by John Temple

  So Chris talked about opening a new clinic in West Palm Beach. Dianna would run it. He told her to set up a corporation in her name on Sunbiz, the Florida Department of State’s website. She did it, but it went no further. Dianna was increasingly unhappy. She didn’t like the cash lying around the house. She didn’t like how Chris was so focused on the money all the time, and not her. Fixated on it, like the more he had the more he wanted. She didn’t like the way the cops had targeted the Oakland Park Boulevard clinic, and the customers at the new location scared her and grossed her out. They were even more zombie-like than before, really strung out and smelly and unkempt.

  She complained to Chris. It wasn’t normal to make this much money, to have cops showing up all the time, to have acquaintances stealing hundreds of thousands of dollars out of your house. She’d worked in strip clubs for years and managed to avoid trouble, which wasn’t easy. Now she was afraid they’d both land in prison.

  Chris told her to not worry so much. The pain clinic was operating in a gray area. It was frowned upon, but there was nothing the authorities could do, because it was legal.

  That October, almost exactly one year after they’d hooked up in West Port, Dianna left Chris and went back to the life. She lived out of her car, crashing at friends’ houses, and got a job dancing at Rachel’s, the strip club steak house in West Palm Beach. Chris put plans for his new West Palm Beach clinic on hold.

  One morning, about a week after the Carmel Cafiero report, one of the security guards told Derik that one of the girls was there for her interview. They needed a receptionist, so Derik had run another “just send picture” ad on Craigslist, got a bunch of modeling headshots and cheesecake photos, and set up interviews. It was early in the morning when the guard approached Derik—they hadn’t even opened yet—and Derik figured the girl must be eager.

  Derik went to the back room and a tall black woman greeted him. Too old for this job, Derik thought. He was aggravated, thinking the woman must have sent in a picture that wasn’t hers, and he gave her some attitude.

  Derik said: Sorry, you’re not the look we’re going for.

  The woman looked annoyed.

  She said: What is this, a doctor’s office or a modeling agency? And what’s up with your parking lot? It looks like a Mercedes dealership out there.

  That was weird, Derik thought. What did she care what kind of cars they drove? But he shrugged it off, let her leave, forgot about it.

  Until the next day, when the guard again approached him before opening hours.

  The guard said: Yo, D. That woman’s here to see you again.

  And Derik turned around to see the tall woman standing in the employees-only area of the pain clinic. With about seven other people. Holding a Drug Enforcement Administration badge.

  She made some smart-ass comment, but Derik was in shock and the words didn’t even register.

  The visitors were a mix of Florida Department of Health, Broward County Sheriff’s Office, and DEA. They said they were there to inspect the clinic.

  A detective from the sheriff’s office said: Shut it down, and get all of your employees together.

  He asked everyone to produce identification, and Derik said he didn’t have a driver’s license, which was true.

  A DEA agent said: You don’t have a driver’s license? That’s odd, considering we just saw you drive up in a Mercedes that costs, what would you say, $100,000?

  Derik said: I guess you got me.

  He asked if they had a warrant, and they said they didn’t need one because it was just an inspection. Derik had no idea whether this was correct, but he got the employees together and gave the agents an ID card that he had obtained after losing his license. The officers and agents split into teams. The female DEA agent took Chris into an office, where they holed up for a long time. They wanted the clinic’s dispensing logs. They told him they were inspecting South Florida Pain because of the quantities of oxycodone that had been ordered in the doctors’ names.

  Another pair wanted to audit the pharmacy, examine purchasing records and inventories to make sure the pills the clinic bought were going to actual patients. Derik definitely didn’t want them doing this; God knew what the pill counts would be. So he pretended to not have keys to the pharmacy, said they’d have to wait for the pharmacy tech. He hoped to head her off, but she showed up.

  Another pair of officers interviewed staffers. Two others interviewed Dr. Joseph, the first doctor to arrive that day. That interview was short. They emerged with the little doctor, and one agent said that Dr. Joseph had volunteered to surrender his DEA registration, which allowed him to prescribe and dispense controlled substances, in exchange for not being prosecuted, and they were going to seize his medications.

  Derik protested. The pills were worth a lot of money. They were just going to take them? Derik said he wanted to transfer the meds to another doctor’s name, and the agents said it didn’t work like that. They were confiscating Dr. Joseph’s drugs.

  Dr. Joseph, the doctor who’d been at the clinic the longest, just walked out the door, probably bewildered because his English wasn’t great. The agents spent an hour questioning another physician, Dr. Beau Boshers. They asked the new doctor how many patients a day he saw, what kind of exams he gave, whether patients came from out of state. Dr. Boshers had worked at the clinic only for a couple of weeks, and he already suspected the place was an unusually well-insulated pill mill, though he certainly wasn’t going to admit it to federal agents. He barely examined his patients, but he believed he was protected by the MRI reports and the diagnostic paperwork he filled out for each patient. He’d earned his medical degree in his mid-thirties and worked for several years as a hospital-based internal medicine doctor. The money had been good, but the hours were long and the work grueling. By comparison, the pain clinic was easy money.

  Derik sneaked away from the agents for a moment and started calling the other doctors, telling them to not come to work. He headed off a couple doctors that way, though one later surrendered his registration just like Dr. Joseph had. The cops kept asking Derik when the other doctors would be arriving, and Derik played dumb, said they were supposed to be here, they must not be coming in.

  He enjoyed the cat-and-mouse game, but he was worried that the clinic’s run was over. While he waited to see what would happen, Derik sat with Dr. Boshers in the waiting room and watched TV. Rambo was playing on one of the big flat-screens. Groups of patients loitered outside in the parking lot, hoping the clinic would reopen. Every once in a while, the bold or desperate ones came up to the door and pressed their faces to the glass.

  Around midday, one of the cops told Derik they’d run his identification and he was in big trouble. Not for the clinic or the drugs, but for driving with a suspended license. Not to mention the fact that he was on probation and wasn’t supposed to leave Palm Beach County. He could be looking at years in prison. Multiple years.

  Derik felt the same way he’d felt when the health department investigator had made copies of the incomplete MRI prescriptions in June. All the shit he was pulling, and these guys were going to violate him on a traffic charge? But he knew the prospect of prison time was real. The memory of his stretch in St. Lucie County Jail, ten months ago, was still fresh.

  But they didn’t arrest him. Around 2:00 p.m., the inspectors and cops just packed up and left. They took Dr. Joseph’s stock of pills with them, and they were mouthy on the way out the door.

  One said: Just remember, Derik, we let you go. But I have a feeling we’re gonna have further business.

  When they were gone, Derik walked outside and addressed the patients.

  He said: Thanks for waiting, everybody. Come on in!

  The patients flowed inside, and Dr. Boshers got to work writing scrips. One doctor down, but back in business.

  Even before the inspection, Chris had decided it was time to make some moves—for the good of everyone. One of the pharmaceutical wholesalers had called Chris after the Carmel
Cafiero report aired and said the company couldn’t sell drugs to South Florida Pain Clinic any longer. The wholesaler specifically mentioned Derik’s presence in Cafiero’s story.

  The wholesaler said: That guy just looks like a drug dealer. We can’t be doing business with you guys anymore.

  The wholesaler also suggested that Chris change the clinic’s name, make a fresh start.

  Chris thought about it and decided the wholesaler was right. First off, the clinic’s reputation was both a blessing and a curse. Their word of mouth had been great. People knew the doctors at South Florida Pain wrote big and the guys made it as easy as possible. Prospective patients still came every day to the old location on Oakland Park Boulevard, months after it had shut down. Derik had hired a guy for $500 a week to just sit there in his car and hand out flyers with directions to the new clinic.

  But after the Sun-Sentinel story and picture and now the Cafiero report, the big red-lettered South Florida Pain Clinic sign on Oakland Park Boulevard had become a symbol of pill mills. They’d changed locations, but the name itself was still a target. They needed a new one.

  And they needed a new face. Despite the improvements they’d made to the business, Chris and Derik themselves had become liabilities. Chris would continue to own the clinic, but he needed a straw owner. It couldn’t be Derik, especially after the Cafiero report. His relationship with Dianna was on the rocks, so she wouldn’t work either. It needed to be someone without a police record. Someone respectable, who could be the face of the clinic. Someone who could start fresh with the wholesalers and the banks.

  Back in North Port, Chris had worked with a guy named Ethan Baumhoff, an ex-cop. Originally from Missouri, Ethan had spent five years in the Army and then a decade as a police officer in various small departments before moving to Florida and going into construction. Ethan was a grown-up, thirty-seven years old and married with kids. He had a clean record, as far as Chris knew, and his background in law enforcement would look good to anyone investigating the clinic. Chris talked to Ethan, who agreed to be the manager of the pain clinic.

  Chris told Derik what the wholesaler had said about him looking like a drug dealer, and Derik was offended.

  Derik said: What the fuck do you want me to do? Get a face-lift? Tattoos removed? Lose the New York accent?

  But he was really outraged when Chris said he was hiring Ethan as manager. He’d never liked Ethan, even back in North Port. Ethan was completely different than Derik and Chris—a rules-oriented guy, a stick-ler with a Napoleon complex. Worst of all, he’d been a cop, which meant that he had cop instincts and cop leanings. He would ruin the freewheeling chemistry of the place that Derik had created by hiring a mixture of friends and hot girls.

  Chris said: That’s the point. He’s a strong representative for the clinic. He’ll really have no say, but we’ll put him out there to make it look like he does.

  Derik didn’t like it, but Chris’s mind was made up.

  During his first few weeks, Ethan Baumhoff spent most of his time in Chris’s office, learning about the clinic’s circulatory system of drugs and money. Chris wanted him to reestablish ties with the wholesalers who had dropped them after the Cafiero story and get the drug shipments flowing again. Chris also wanted to find some more wholesalers who would sell to him. Conveniently, the DEA website had a list of wholesalers, and Chris had Ethan call every one of them.

  Ethan would also handle the money, establishing accounts with the banks and hauling the money back and forth. He carried the cash in a blue duffel bag, and because it contained so much money, he also carried a gun.

  Derik continued to run the rest of the office, herding the patients, keeping an eye on employees, making fun of Ethan. His dislike of the new guy deepened as Ethan spent hours holed up in Chris’s office.

  One of the first things Chris had Ethan do was create a new limited liability company under Ethan’s name and address so no one would be able to connect it to South Florida Pain. He had a lawyer write up a letter that made it clear that Chris was the real owner, but the state records would show that Ethan was the registered agent.

  As soon as one problem was solved, another would emerge. They’d been in the Cypress Creek Executive Court only a couple of months when the office park people said they wanted the pain clinic out in December. Despite Derik’s efforts to keep order in the parking lots, there were too many complaints from the other tenants, and now the once-sleepy office court was a target for journalists and law enforcement.

  The new office complex was just a mile east on Cypress Creek Road, closer to I-95. The tenants of the new location were more industrial, less customer-based, and Chris hoped that meant they’d be less concerned about the activities at the pain clinic. This time, they spent more time and money on the renovation—stone counters, carpeting, artwork. Chris hired a contractor, but they needed the job done quickly, so after the clinic was closed for the night, Derik would go to the new location and work until midnight.

  Chris came up with a new name for the clinic, nothing that he pondered over too deeply. Ethan registered it on the secretary of state website, and when they moved in December to another new location, they started using the new name. They didn’t want or need eye-catching signs at the new location. Their customers would find them. So their new name was listed only in small print in a column, along with all the other tenants, on the red directory sign at the office park entrance:

  AMERICAN PAIN.

  In November 2008, the Florida Department of Health finally issued administrative complaints from its inspection of the Oakland Park Boulevard clinic the previous summer. Derik and Chris remembered the little health inspector with his bad grammar, pleased with himself as he stuffed the photocopied prescriptions into an envelope.

  In writing, some of the violations seemed laughably minor:

  The investigator reported the following deficiencies:

  a. No generic drug sign was displayed.

  b. Several prescriptions were dispensed to patients but contained no patient names or addresses.

  c. Several prescriptions were dispensed to patients but were not initialed and dated.

  d. Several prescriptions were signed by Respondent even though they were not for specific patients.

  Other charges seemed more serious, including claims that doctors had not documented any evaluations of patients before prescribing large amounts of narcotics.

  But the thing was, the complaints were directed at Dr. Rachael Gittens and Dr. Enock Joseph, neither of whom even worked at the pain clinic anymore. Dr. Gittens had left to open her own clinic. And they hadn’t seen Dr. Joseph since the DEA inspection, when the Haitian gynecologist had given up his DEA registration, rendering him useless to the clinic. So it was no great concern to Chris or Derik when they read that the physicians might be facing “restriction of practice, imposition of an administrative fine, issuance of a reprimand, placement of the Respondent on probation, corrective action, refund of fees billed or collected, remedial education and/or any other relief that the Board deems appropriate.”

  And that was it. Neither the DEA nor the health department made a move to shut down the clinic, and this fact bolstered Chris’s confidence. The DEA and the state health department were targeting the doctors, not the people who owned or ran the clinic. Chris and Derik were off the hook. They could always get more doctors.

  And over the next few weeks, Chris did hire two more full-time doctors—Dr. Jacobo Dreszer and Dr. Cynthia Cadet—to replace the doctors lost after the DEA inspection. Dr. Dreszer was a hot-tempered Jewish guy originally from Colombia. He’d been an anesthesiologist for thirty years, which made Chris happy because it looked good to have a guy who actually had some expertise in pain management. Dr. Dreszer had a son who was also a doctor, and the younger Dreszer was also set to start work at the clinic in a couple of months. Roni Dreszer had received his MD from Drexel University four years earlier, but he’d been booted from his surgical residency at a hospital in Phila
delphia. His problems had a lot to do with his love of gambling and Percocets. He owed $300,000 in student loans and approximately $30,000 to credit card companies. His first job as a full-fledged doctor would be working for Chris George’s pain clinic. Derik found this humorous, along with the fact that Roni Dreszer’s mother had driven him to and from his job interview.

  Derik liked all the new docs, but Dr. Cynthia Cadet was the one he connected with the most. She was a small and slender black woman with fine features. She’d attended Cornell University on an ROTC scholarship and had been a major in the Air Force. She was kind and compassionate with the patients, listening to their fears and concerns, as opposed to some of the doctors who barely spoke to them. She never seemed to be in a hurry. Even if it was late at night and everyone else wanted to go home, she’d get absorbed in conversations with patients. Derik had to knock on her door a couple of times to ask her to hurry up. But everyone—patients and Chris alike—loved the fact that she generally wrote big scrips. Even on the first visit.

  Derik didn’t get to know Cadet very well until one evening when he was in the little break room in the rear of the clinic. He’d found some tortillas left over from lunch, and he was conducting a little experiment, covering them with sour cream and tossing them to the ceiling to see how long they would stick up there. Cadet came through the room on her way home, then stopped and stared at Derik like he was crazy.

  She said: What are you doing?

  Derik said: I’m sticking tortillas to the ceiling.

  She said: Oh!

  He said: You want to try?

  She gave it a shot, and after that, Derik and Cadet were friends. He bought Christmas gifts for her two kids. He walked her to her car at night. She seemed like one of the happiest people Derik had ever met, out of her element among the junkies and schemers of American Pain. But she seemed unaware that she didn’t fit in with the other doctors, who appeared to be more clued in to what they were doing, bickering with each other about patient loads. Floating into the office each morning, tottering slightly on her high heels like a girl, singing out, “Hi, Derik!” as she passed his office, a big smile on her face.