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    29 Aug 2016

    'It was a conspiracy': recovering addicts wage legal battle over prescription use - Groundbreaking lawsuit unfolds in West Virginia as ‘pill-pushing’ doctors and pharmacists are being accused of colluding with medical industry to get rich

    Wilbert Hatcher admits he broke the law.
    In the depths of a decade-long addiction to prescription opioid painkillers, the father of two fed his craving by buying blackmarket pills on the streets of his small West Virginia town. He finally shook the addiction three years ago. But now Hatcher, 50, an assistant manager at Walmart, is at the heart of a groundbreaking legal battle with the medical industry over whether he is a criminal or a victim.
    “I’m a well-rounded, educated individual who thinks that I don’t have an addictive personality. But when you go to the doctor and they’re pushing the drugs, and they feed and feed the addiction,” he said. “What is it going to take before we as a nation accept that we are the victims for the most part and the doctor, the pharmacist and pharmacies are the perpetrators feeding off the lives of others?”
    Hatcher is among 29 survivors of opioid addiction or relatives of those who overdosed on painkillers who accuse doctors, pharmacies and distributors in a rural corner of West Virginia of pushing the powerful and highly addictive drugs, which have properties similar to those of heroin.
    The lawsuit alleges that “a veritable rogue’s gallery of pill-pushing doctors and pharmacies” grew rich on the back of patients who sought medical treatment only to have their lives wrecked by addiction.
    “It was a conspiracy,” said Jim Cagle, the lawyer for Hatcher and other plaintiffs. “Doctors and pharmacies were keeping them hooked. They were feeding the addiction.”
    Some of the physicians and pharmacists involved have been jailed and stripped of their medical licences while several drug distributors agreed in June to pay West Virginia millions of dollars for flooding the state with opioid pills, contributing to an addiction epidemic and the highest death rate from drug overdoses in the US.
    The case is expected to go to trial later this year after the West Virginia supreme court rejected a claim by lawyers for the accused doctors, pharmacists and drug stores that former addicts should not be able to sue because they admit abusing drugs.
    But lawyers for the accused parties maintain that the fault lies with the addicts. They claim that Hatcher and other plaintiffs are criminals who only became hooked because they illegally abused the drugs – a position backed by pharmaceutical manufacturers who could face a hit to their multibillion dollar market.
    That argument met with derision from one of West Virginia’s US senators, Joe Manchin, who likened attempts to blame the victims for their addiction to the tactics of cigarette manufacturers.
    “That’s the same argument that the tobacco industry used. They can’t go down that path,” he said. “It’s an epidemic because we have a business model for it. Follow the money. Look at the amount of pills they shipped into certain parts of our state. It was a business model.”

    Rapidly escalating doses

    Hatcher received his first opioid prescription after he fell down steps working at a motel in 2003. The state workers’ compensation fund referred him to a busy pain clinic, the Wellness Center in Williamson, a declining coal town of about 3,000 people.
    The clinic was run day-to-day by Dr William Ryckman, who formerly worked as a physician at a federal prison. Ryckman said in a deposition that he was hired to work in Williamson in 1997 by a prisoner he befriended, Henry Vinson, who served five years for running a gay prostitution ring in Washington DC. Ryckman described the former prisoner as “setting up the practice” and recruiting doctors. Vinson said he did no more than manage the building.
    Hatcher’s first consultation was with another early recruit to the clinic – Dr Katherine Hoover. She moved to West Virginia in the midst of a legal battle to keep her medical licence in Florida after she was accused of having asked a 17-year-old patient to have sex with her son.
    Hatcher said Hoover immediately prescribed him opioids and rapidly increased the dosage. He said he was alert to the dangers because he once counselled drug addicts but he trusted the doctor and assumed he would be safe if he diligently followed the prescription. Yet within six months he was addicted to the opioids.
    “I had to have that pill every morning to get out of bed, to function. To go without it, the physical pain. Oh gosh. Your hands is jerking. You feel the cramps in your arms and your legs. The anxiety. You’re trying to figure out, what am I going to do here? It’s real bad. I’ll tell you, it’s the worst time of my life,” he said.
    Hatcher said his head told him he needed to get off the drugs and he hoped the doctor would reduce his prescription. Instead, he found that Hoover barely examined him and then stopped bothering to see him at all – instead leaving prescriptions for him to pick up for cash without a consultation.
    “When you’re taking them, you’re not going to fight the doctor giving them to you when you’re addicted to them. You’re not going say stop giving them to me,” he said. Like many of those hooked on opioids, Hatcher needed ever-increasing doses to satisfy the addiction. Eventually, he looked to the black market to top up his prescriptions. “You can go out on the streets and get it. I’ve done it. There are people in my life that I would never have associated with. There are people that couldn’t get five minutes of my time because I knew what they were doing. These were drug dealers. But now these people are in my circle because they have the pills I need,” he said. “You knew who had them. This is my town. This is where I grew up. You knew who they were.”
    The drugs took over much of his life. They were costing him large amounts of money but also time with his children because he would spend hours waiting for dealers. His answer was to quit a well-paying but demanding position as assistant manager at Walmart and take a $10-an-hour job in an auto parts store.
    Hatcher weaned himself off the drugs with the help of counseling in 2013. He got his job back at Walmart but regards those years as a lost decade.
    “I could have been the store manager by now. But when your mind is not functioning correctly, you’re not thinking clearly, you lose that opportunity,” he said.
    Lawyers for the doctors, pharmacies and pain clinics named in the legal action claim that Hatcher’s addiction was his own fault. They say he and other addicts abused the drugs by buying some illegally, grinding them up to get a more powerful high or “doctor shopping” in search of several prescriptions at once.
    “The very core of (their) alleged claims stem from their own criminal, illegal and immoral activity,” the defendants said in court papers.
    Cagle does not deny that some, but not all, of his clients misused drugs before their opioid addiction. But he said that neither justifies prescribing them opioids for years on end nor the circumstances of other plaintiffs who never touched illegal drugs and only became hooked on painkillers after seeking treatment for work injuries or car accidents.
    Cagle contends that the doctors and pharmacists knew just how addictive the drugs were but kept on prescribing and dispensing them in large quantities because they were making big profits. Hatcher says the claim he became an addict because he abused drugs is back to front. He and others say they became addicted while following the prescriptions and only once they were hooked did they abuse drugs. “It’s a circle. You go to the doctor and they bill you. The pharmacy, they’re a part of it because they were giving out a whole bunch of pills. It’s business,” he said. “This is spit town. How many pills were they selling? Enough for a major city. This is ridiculous.”

    ‘No medicine was practiced at her office’

    The Wellness Center, later renamed Mountain Medical Care, was shut down after a federal raid in 2010. Federal prosecutors who convicted some doctors and an administrator at the clinic described it as a moneymaking machine, raking in more $4.5m a year as word spread beyond Williamson that opioid prescriptions could be had with ease. In legal papers to seize Hoover’s assets, federal officials said she prescribed more pain medication than any other doctor in West Virginia during the 2000s.
    Among her other patients was Willis Duncan, who worked as an electrician in coal mines for more than 30 years until he was referred to the clinic after he suffered a crushed sternum and broken ribs in a work accident.
    “You’d get to the clinic at five o’clock in the morning. They didn’t open till eight o’clock, but at five o’clock there would be a hundred people there waiting,” he said. “You could tell them your dick hurts and they would write you a script. The doctor’s signature was already on it when you went in.”
    Federal investigators said the doctors frequently did not even see the patients they were writing prescriptions for. Hatcher and Duncan both noticed that after handing over cash they picked up prescriptions signed by a Dr William Ryckman, who had never examined them. Ryckman, one of Vinson’s first hires, lived nearly 300 miles from the clinic in Pennsylvania and was later convicted of sending blank prescriptions to the clinic which assistants filled in with patients’ details. He was jailed for six months and lost his medical licence. The authorities also found a bank account with Ryckman’s name on it and more than $1m in cash deposits but he denied knowledge of it.
    Another Williamson doctor, Diane Shafer, who Ryckman said in his deposition was married to Vinson, at one time wrote more painkiller prescriptions than some hospitals in West Virginia.
    “Shafer simply handed out prescriptions in exchange for cash, even pre-signing scripts for patient files,” said the lawsuit against her for allegedly contributing to the death of a patient. “No medicine was practiced at her office.”
    Shafer was arrested, admitted to illegally prescribing opioids and was sentenced to six months in federal prison. She has been barred from practicing medicine after surrendering her licence.
    Hatcher, Duncan and the other plaintiffs contend that the doctors were only part of the problem. They allege the pain clinics were working in league with drug stores, which also made large profits from selling the opioids. The lawsuit calls them “among the most grossly negligent pharmacies in America”.
    One was a small stone building on Williamson’s main street, Tug Valley Pharmacy, which became notorious in the town for the long lines of out of state cars at its drive-through window. Its owner, Randy Ballengee, said in a deposition that he filled up to 200 prescriptions a day from the Wellness Clinic but did not know that it was widely spoken of locally as a “pill mill”. Witnesses testified that drug deals were openly made outside the pharmacy and that prescriptions were refilled early for cash.
    Hatcher used another pharmacy in the neighbouring town of South Williamson, just across the border in Kentucky. Its owner, Larry Ray Barnett, who has since died, also claimed in a deposition not to know about the pain clinic’s reputation. But federal authorities said both pharmacies made large profits off of opioids. Duncan was earning $2,500 a week working in the mines but estimates he was spending close to a $1,000 on pills.
    “These people messed a lot of people up. Me being a dumbass hillbilly, I didn’t understand what was going on. I didn’t think that they would hurt you and make you keep wanting and wanting,” he said. “They all worked together. The doctors. The pharmacies. They didn’t give a rat’s fuck. If you paid cash, you get your stuff. There was never no doctor who said we want to cut you on this one, cut you on that. More, more, more, more, more, more, more. Just kept increasing.”
    Hatcher said he believed doctors and pharmacists got away with it for years because people in the state have been “stereotyped for years as barefoot, toothless and inbred hillbillies to now welfare drug abusers”.
    He said the exploitation was perpetuated by the stigma around drug addiction.
    “People that are affected by this treat it just as sexual abuse once was treated, as the public has made it to be something that is shameful and dirty,” he said.

    ‘Handing out drugs like candy’

    By the time the Wellness Center was shut down in 2010, Henry Vinson had been in and out of prison for a second time after pleading guilty to aiding and abetting one of the clinic’s doctors, Armando Acosta, in evading taxes by keeping patients’ payments off the books. Vinson today denies he did anything of the sort but said he pleaded guilty to protect his mother because a “malicious” federal government threatened to indict her too. Vinson’s mother, Joyce Vinson, owned the building with the clinic until she died in 2006 and Henry inherited it. Four years later he agreed to relinquish the $1m property to the government in return for a guarantee that he would not be prosecuted for whatever criminal activities may have taken place at the Wellness Center.
    Today, Vinson denies having any direct role in setting up or running the clinic. “I have never been in the clinic business. I have never been in that practice. I would think it’s a doctor’s responsibility to see patients and if there’s a patient care issue, I would think that’s between the physician and a patient,” he said.
    Hoover left the US for the Bahamas. Federal authorities seized her assets and she was stripped of her medical licence over the allegations she pressured a patient to have sex with her son. Hoover has defended the prescriptions as legitimate.
    A similar pattern played out across West Virginia. By the 2000s, the Sav-Rite pharmacy in Kermit, a town half an hour’s drive north of Williamson with a population of little more than 300, was among the top 25 dispensers of hydrocodone opioid pain medication in the entire country. Federal investigators later accused the pharmacist, James Wooley, of working in concert with the owner of a local medical centre, Debra Justice. The pair allegedly “hatched a get rich(er) quick scheme to open a pain clinic that would refer all of its prescriptions for controlled substances to Sav-Rite Kermit”. Investigators said the clinic and pharmacy were “handing out drugs like candy”.
    At its peak, Sav-Rite was selling more than 3m dosages of hydrocodone a year, earning $6.5m, in an impoverished town of a few hundred people. Investigators said there was so much cash receptionists had difficulty closing the till.
    Key to the success of the scheme was to find doctors prepared to cooperate. One of them was Dr Donald Kiser. Among the prescriptions he wrote was one for $500 worth of opioids and valium for William Preece, a former coal miner who had been injured in a work accident.
    Preece overdosed on the drugs the next day. It came just two weeks after Preece had received an earlier prescription for opioids originally prescribed for an injury as a coal miner after he was caught in a rock fall.
    Preece’s sister, Debbie, said he fought hard to shake the addiction, including attending a methadone clinic. But he kept returning to the pills and the pain clinic kept giving him prescriptions. “I get emotional about it because I can’t get over it,” she said, her voice breaking. “After he was not able to work in the mines, he opened a little store for a living. Then he ended up losing his home, his store, everything he had due to the addiction ... Wooley’s clinic, the Sav-Rite, was a like a circus. They even handed out popcorn to people waiting in line. You would see licence plates from everywhere. Virginia. Ohio. Tennessee. Kentucky.” 
    Kiser was sent to prison for seven years for violations of federal drug laws and lost his medical licence. Prosecutors said the doctor earned $4,000 a day churning out prescriptions and on occasion exchanged drugs for sex. The judge in the case called Kiser a “danger to the community”. In 2012, Wooley pleaded guilty to illegally selling prescription medication and conspiracy, and was sentenced to six months in prison.
    The West Virginia authorities say none of this would have been possible if it had not been for distribution companies pouring drugs into the state. The attorney general’s office has sued a dozen firms which between them delivered more than 200m opioid pills to West Virginia in the five years to 2012. The lawsuits alleged that the companies knew large numbers of the drugs were sold by “notorious pill mills” but were more interested in profit.
    “It is this whole chain of manufacturers, doctors, distributors, wholesalers,” said Francis Hughes, the state’s former chief deputy attorney general who was instrumental in the legal actions. “We were seeing drugstores that were located in a town where the population is 365 running millions of dollars a month through the drugstore selling opiates. You would have to know if you are a distributor that there was something going on and they would not fulfill their duty to report this to the proper authorities. It goes all the way up the chain, people having duties and responsibilities.” 
    This year, six drug wholesalers agreed to a $6.7m settlement with West Virginia over accusations that they flooded the state with millions of prescription opioids. But several others continue to fight the accusation, including the country’s largest pharmaceutical distributor, McKesson Corp, which shipped nearly 100m opioid pills to West Virginia. Its clients included Tug Valley Pharmacy in Williamson. McKesson cut off deliveries to the pharmacy after the state lawsuit was filed against it in January.

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