Dreamland (32 page)

Clinic staffers or
locum tenens doctors found work at a pain clinic, learned the business, and then went out on their own. Soon, plain old drug dealers got in on the scam. Kevin Huff, a longtime marijuana dealer, set up a trailer alongside a highway in Chillicothe, Ohio, hired a nurse, and sold so many pills that he had shoeboxes full of cash lying around his home.

Several of the new clinic entrepreneurs had worked for David Procter. Nancy Sadler worked for Procter and then ran Fortune Williams’s clinic. After Williams went to prison, she and her husband, Lester “Ape” Sadler, set up their own pain clinics. Procter’s onetime attorney, Gary “Rocky” Billiter, opened a pain clinic as well.

After Procter’s arrest, his employees Denise Huffman and her daughter, Alice Huffman Ball, opened Tri-State Health Care and Pain Management. A DEA investigation later found that people would drive for as many as ten hours to the Huffmans’ clinic, pay two hundred dollars in cash to sit with a doctor and get a prescription for OxyContin, Lortab, Percocet, and other pain meds. The mother and daughter hired temp-agency doctors and threatened those who refused to prescribe pain medication. Several physicians left immediately.

In April 2003, the Huffmans solved their labor issues when they hired a Chicago chronic-pain specialist named Paul Volkman. Volkman was so prolific that the Huffmans had to open their own pill dispensary in the back of Tri-State after local pharmacies refused to honor his prescriptions. This pharmacy was somehow legal under Ohio law.

By September 2005, Volkman had written prescriptions for a million pills of various kinds. Another million pills were deemed missing due to the lack of any records kept by him or the Huffmans. A DEA investigation estimated that Volkman and the Huffmans took in some three million dollars from patients paying two hundred dollars a visit, and who lined up well before the clinic opened. The Huffmans paid staffers in pills, but staff also accepted bribes (in pills usually) to move patients up in line. Volkman rarely performed anything resembling a diagnosis. Instead, he met with patients briefly, asked them a few questions—one of which was whether they were undercover law enforcement officers. He often ordered urine tests, but ignored them when they showed high levels of opiates. He had one patient sign a “death waiver,” in which the patient acknowledged he might die from taking what Volkman was prescribing. At least twelve patients did die while Volkman worked for the Huffmans. He later opened his own clinic in Portsmouth, then in Chillicothe, and six more patients died.

For a couple months, Volkman even had a clinic in a house on a residential street in Portsmouth’s Hilltop neighborhood. “He was in one of the bedrooms,” said one addict. “The front room was the waiting area, and the kitchen was where you got your blood pressure checked out. He wrote me some crazy amounts of medication, 480 pills one month. No MRIs, no CAT scans, no nothing.”

There were other pill mills. Volkman and the Huffmans were only part of the story in Scioto County.

But not many in the country paid much attention to what was developing in and around Portsmouth. The area was abandoned—by politics and power, and even by many who once lived there. Plus those who remained behind, who were the first to get caught up in the gathering storm, were complicit in their own degradation, so no one paid them much attention.

Folks like those from the Lucasville Bottoms.

I was poking around southern Ohio, trying to understand all this, when I encountered a lawyer named Joe Hale.

Hale has silver hair, a baritone voice, and a Marlboro Red always at the ready. By 1999, he had been a defense attorney for fifteen years in Scioto County. A country boy from the oak of Appalachia, Hale had a client list that was mostly court appointed. The money wasn’t great, but it kept him busy and in the courtroom.

One place Hale made a lot of his money was Lucasville. Lucasville is a small town a few minutes north of Portsmouth along Highway 23. It has a prison that holds Ohio’s death house, where death row inmates are executed. Across the street from the prison is a high school. Lucasville also includes a couple stoplights, a gas station or two, and a few failed restaurants. But to Joe Hale, Lucasville was the Bottoms.

The Lucasville Bottoms are flatlands that flood every decade or so when the nearby Scioto River rises. The rest of the time, the Bottoms provide cheap housing, most of it of the single-wide mobile home variety. Many of its residents are on federal disability. Many of them are small-time criminals. Joe Hale had defended hundreds of Bottoms residents through his career on charges of drug possession, domestic violence, and drunk and disorderly.

The Bottoms are a clannish place, but Hale became well-known there. He got used to the rhythms of the Bottoms, which revolved around government checks on the first of the month. People rarely visited a doctor, and when they did, it was to guys like David Procter, who accepted cash.

In the late 1990s, as David Procter was heavily prescribing OxyContin, a client named Tony Blevins showed up to do some work on Hale’s house with a bottle of pills. Blevins called them OCs. He offered Hale a few. Hale had no interest in the pills, but he noticed that several of his usually energetic construction workers were like zombies. He came to find out people in the Bottoms were crushing the pills and injecting them. Most Bottoms denizens didn’t know how to do that. A profession called “shooters” thrived in the Bottoms for a while. For a free hit for themselves, shooters would inject users who were new to the needle.

“Over the next three, four, five months, [Oxy] was all you heard about,” Hale said. “Some people were very experienced, very well-known, with years as drug users; they started overdosing and dying. Because they were people with criminal records and never made a contribution to society, nobody gave a damn.”

This had been going on for a while, to Hale’s growing alarm, when in April 1999, Jack Burton paid him a visit. Burton was the unofficial godfather of the Lucasville Bottoms, influential among many families, rumored to be involved in crime. A gaunt fellow, Burton drove a white sedan and in it, slunk down behind the wheel, he cruised the Bottoms.

Burton’s daughter, Jackie, had just died of an OxyContin overdose. Hale had defended Jackie Burton after a couple barroom brawls that landed her in court. The first time Jackie Burton was shot up with OxyContin, she nodded off and the shooter who injected her wasn’t paying attention. She was probably dead for an hour before anyone noticed.

Now Jack Burton was in Hale’s office asking what he could do about the company that made the drug.

“Jack,” Hale told him. “You’re asking me to take on a major pharmaceutical corporation.” He turned Burton down. But months passed and the deaths in the Bottoms mounted. Hale kept thinking.

“This is a lawsuit that could mean a lot of money,” he said.

In May 2001, Hale filed what is believed to be the first Oxy-related wrongful-death lawsuit against Purdue Pharma, on behalf of Jackie Burton.

“Purdue Pharma has unleashed a pharmaceutical atomic bomb into the free flow of commerce with absolutely disastrous consequences that they should have foreseen,” he told the
Portsmouth Daily Times
.

A Cincinnati law firm eventually joined Hale’s case, preparing it as a class action lawsuit, and asked Hale to find more plaintiffs. Hale found petty thieves and able-bodied disability recipients—people whose already dysfunctional lives had been further mangled by opiate addiction.

Several months later, the Cincinnati firm withdrew from the suit. “Nobody told me that a class representative shouldn’t have a bunch of felony convictions,” Hale said. “And that there were all these ideals that these class action plaintiffs were supposed to have.”

The Bottoms sure didn’t produce anyone that a TV camera or jury would find sympathetic. After a few court hearings with him at one table and six or eight well-dressed Purdue attorneys on the other, Hale dropped the suit. But he always saw the Lucasville Bottoms as an early warning sign that Ohio and the country ignored at their peril. A Purdue Pharma press release later noted that the company had won every suit filed against it. That didn’t surprise Joe Hale.

“By the time you were in a position to have a lawsuit against Purdue Pharma, you were already likely to have fucked up so badly that you wouldn’t work as a class action plaintiff,” he said as we drove around the Bottoms one spring day, down lanes of narrow mobile homes and junked cars.

But that’s how it was as the opiate epidemic took shape in southern Ohio beginning in the late 1990s. Portsmouth, the Lucasville Bottoms, and other forgotten places of America nearby acted like the canaries in those now-shuttered Appalachian coal mines. Just no one in the country listened much until more respectable types sounded the same alarm and famous people died.

Fifty, Hundred Cases a Month

Olympia, Washington

The state of Washington’s workers’ compensation system is one of only five in the country that hold monopolies on insuring workers. The state insures two-thirds of all Washington’s 1.2 million workers; it oversees the rest, workers at companies large enough to insure themselves.

Thus Labor and Industries—as the system is known—generates enormous amounts of data about worker injuries and deaths. As narcotic painkillers became accepted treatment for chronic pain, workers with on-the-job injuries were mightily affected. Almost alone in the country, L&I, in a three-story glass building off in Tumwater, Washington, far from Portsmouth and the Lucasville Bottoms, sat atop a mountain of data affording a broad vista of what was forming.

Seeing it all, however, would require someone with an abhorrence of disorder.

That described Jaymie Mai.

Mai grew up in postwar Vietnam, the child of a South Vietnamese navy seaman imprisoned in a communist reeducation camp. In 1978, her mother took her six children aboard a small fishing boat with seventy-five other people. They floated aimlessly, besieged by Thai pirates, on a boat crammed with people retching violently, until a Malaysian merchant ship happened by and took them aboard. A year later, Mai and her family were on a plane to Seattle and a new life.

Mai got a pharmacy degree at the University of Washington. She worked as a pharmacist at various hospitals. In 2000, wanting to start a family and looking for more predictable hours, she took a job as L&I’s chief pharmacist, overseeing the cases of workers receiving prescription drugs for injuries.

She came to the job agnostic on the then-increasing use of opiates in medicine. In the hospitals where she worked up to then, opiates were used for broken legs or following surgery, which she believed appropriate.

Mai possessed an intense need for order. Sloppiness and unanswered questions were anathema. She cleaned her house a lot because it helped her destress and think things through, while restoring order. She loved to garden, as much to instill order as for the love of plants. She prized roses and planted them outside the new house that she and her husband bought when she was hired on as L&I’s chief pharmacist.

She would need them. One part of her job involved ensuring doctors were documenting whether the new opiate painkillers were helping to reduce patients’ pain and improve their ability to function. Otherwise, why should the state keep paying for the drugs? There, she saw for the first time how the drugs were used for chronic pain, and grew alarmed.

“It was automatic: ‘You hurt? Let me write you a prescription for opioids,’” she said. “They were treating patients with opioids and the patient would come in with more complaints of pain a month later and they would up the dose. ‘See me next month.’ I could see in the medical record that the provider wasn’t checking to see if the drug was even helping them. The patient would come in every visit complaining of more pain. Nobody ever said, ‘Wait a minute. Time out. Let’s figure out what’s going on.’

“Fifty, a hundred cases a month. But there’s no attempt to document if the drug was working, one, or, two, if they even are appropriate candidates to receive opioids. Did they try a nonopioid first?”

Then, six months into the job, Mai noticed some of these workers began dying from these very painkillers. This didn’t happen. Workers whose original complaint was a sprained back or knee did
not
die. Yet one case after another crossed her desk—all overdosing. In Washington in a typical year fifty or more workers died, but these were from accidents—electrocutions, falls, etc.—or from cancers like asbestosis. Now workers with back sprains were dying as well.

She went to her boss, L&I’s medical director, Dr. Gary Franklin.

“What should we be doing about them?”

Gary Franklin had been an opiate skeptic from the start. He had a master’s degree in public health and several years as a professor of neurology and preventive medicine at the University of Colorado. He took the job as L&I’s medical director in 1988 as the crusade to destigmatize opiates in medicine was getting under way.

Soon, doctors advising L&I were quoting Porter and Jick on the percentage of pain patients addicted when prescribed opiates. “Not more than one percent. They’d say, ‘We don’t think they’re addictive as we used to think,’” Franklin said.

In 1999, Washington, through a state medical commission, removed legal sanctions for doctors for prescribing narcotics in the course of acceptable medical practice—its own intractable pain regulation.

“It meant there’s no ceiling on dose, that the way to treat tolerance is to increase the dose,” Franklin said.