Pubdate: Wed, 13 Apr 2005
Source: Times-Picayune, The (LA)
Copyright: 2005 The Times-Picayune
Contact:  http://www.nola.com/t-p/
Details: http://www.mapinc.org/media/848
Author: Michael Perlstein
Bookmark: http://www.mapinc.org/find?232 (Chronic Pain)

AGENTS RAID PAIN CLINICS, ARREST OWNER, 3 DOCTORS THEY'RE ACCUSED OF 
RUNNING 'PILL MILL'

Doctor's visits as brief as 11 seconds. Preprinted prescriptions doled out 
in assembly-line fashion to hundreds of patients in a day, many of them 
with no medical problems. Pharmacies in which up to 88 percent of 
first-time customers in a single day presented identical prescriptions 
written by the same physician.

Those are some of the allegations made by federal authorities against a 
nurse and three local doctors who were arrested Tuesday in a sweeping 
investigation that accuses them of running a highly lucrative "pill mill," 
dispensing dangerous and addictive narcotics to just about anybody who 
complained of aches and pains, some real, some made up.

At dawn, agents with the Drug Enforcement Administration arrested the owner 
and operator of the clinics, Cherlyn "Cookie" Armstrong, at her Eastover 
home. Armstrong, 45, runs three clinics operating as Scherer's Medical 
Center, an outgrowth of a string of weight loss clinics that she started in 
the 1990s. She is a registered nurse who is still facing state narcotics 
charges in Slidell for allegedly dispensing drugs in 2000 without a 
doctor's oversight, authorities said.

Agents also arrested three of Armstrong's staff doctors, sending a seismic 
wave through the local medical community, especially those involved in pain 
management, a controversial new specialty that has mushroomed in the past 
few years to include more than 60 pain clinics in the metro area. The 
unchecked proliferation of pain management clinics, along with allegations 
of shady practices geared at maximizing profits, recently sparked 
moratoriums against such clinics in Orleans, St. Bernard and St. Tammany 
parishes.

The doctors who were arrested Tuesday -- Betty De Loach, 66, of Kenner; 
Suzette Cullins, 43, of New Orleans; and Joseph Guenther, 71, of Metairie 
- -- were ordered along with Armstrong to remain in jail overnight until 
detention hearings can be held today. The government has asked that the 
defendants be held without bail indefinitely because they might be flight 
risks. Federal authorities immediately sought suspension of the licenses of 
the doctors, clinics and pharmacies involved in the case, local DEA chief 
William Renton said.

Millions in cash

The DEA, aided by the FBI, Internal Revenue Service and local police 
agencies, also confiscated more than $10 million in assets. Of that total, 
$4 million was frozen in 17 of Armstrong's bank accounts, acting U.S. 
Attorney Jim Letten said. Another $1.6 million was found in Armstrong's 
home, much of it in stacks of hundred-dollar bills stashed in safes, cans 
and garbage bags.

In the criminal complaint, supported by a 65-page affidavit outlining the 
details of the yearlong probe, each defendant faces a charge of conspiracy 
to illegally distribute controlled substances. Armstrong and Cullins face 
an additional charge of distributing controlled substances to people 
younger than 21. Both drug charges carry a five-year maximum prison 
sentence. Armstrong also faces a money-laundering charge, which carries up 
to 10 years.

Letten noted that 16 others, including doctors and pharmacists, are listed 
by their initials in the affidavit as employees or participants in 
Armstrong's operation. Several of the people listed are members of 
Armstrong's family, including her husband, Steven Prejean, a lawyer who is 
co-owner of the clinics.

"This investigation is by no means over," Letten said. "In fact, this is 
really very much the beginning of a second, much more active phase. . . . I 
can tell you we're looking at everyone involved with these clinics."

After the arrests, agents raided Scherer's clinics in Metairie, Gretna and 
Slidell, loading U-Haul trucks with boxes of records. In Metairie and 
Slidell, steady streams of cars crept past the clinics, some circling the 
block amid the commotion, others speeding away. Agents questioned the 
persistent drivers who pulled into the parking lots of the clinics and 
arrested more than two dozen of them on unrelated charges such as 
possession of marijuana, possession of illegal pharmaceuticals and 
outstanding warrants.

In addition, agents raided four pharmacies, two of them owned by Armstrong 
and located next to her Metairie and Slidell clinics. The other two 
pharmacies that were raided and shuttered are The Medicine Shoppe in 
Slidell and Michael's Discount Pharmacy in Kenner. Armstrong's pharmacies, 
which operate under the name "Mia's," sport the storefront sign "Medicine 
in a Snap."

That logo is the perfect description of what took place inside the clinics, 
Renton said.

"This operation was a sham to make money by dispensing narcotics regardless 
of whether there was any medical necessity," he said.

A tight schedule

The affidavit is full of allegations that support Renton's characterization:

- -- The clinics accepted only cash, $220 for an initial visit and $80 for 
each follow-up visit. The associated pharmacies also operated on a 
cash-only basis, charging $40 for the most commonly prescribed pill 
regimen: hydrocodone (most commonly sold under the brand name Lorcet), 
alprazolam (Xanax) and carisoprodol (Soma). The combination is known on the 
street as the "holy trinity" or "cocktail."

- -- The clinics are run "with the express goal that each full-time doctor 
will see 700 patients per 35-hour work week, i.e. one patient every 3.3 
minutes," the affidavit states.

- -- While patients were usually prescribed a two-week supply of pills, many 
patients amassed much more than that by visiting different clinic locations 
on different days of the week. This practice is referred to in the 
affidavit as "doctor shopping."

- -- The DEA used informants as well as undercover agents to make dozens of 
doctor's visits and high-volume purchases. Most of the visits lasted less 
than 60 seconds and involved little or no medical examination. In one 
instance, Cullins expresses concern that an informant visited her twice in 
four days. In the affidavit, Cullins is quoted as saying, "You need to back 
off from me or you need to go see Dr. Guenther when he's available. Do we 
have an understanding?" The visit lasted 25 seconds.

- -- On a subsequent visit to Guenther a month later, the same informant 
brought in a clean MRI. Guenther looked at the MRI and said, "There's 
really nothing wrong with you. . . . I told you to see an orthopedist a 
long time ago. I can't do much for you." Guenther then signed a prewritten 
prescription for "the trinity," the affidavit alleges. The visit lasted 85 
seconds.

"They're street peddlers with an M.D. after their names," said Dr. John 
Bobear, executive director of the state Board of Medical Examiners.

Bobear and others said unscrupulous clinics pose a dangerous double whammy: 
They illegally provide narcotics to addicts with no underlying medical 
basis, and they tarnish the work of legitimate pain management clinics that 
offer a range of therapies from massage to exercise to graduated doses of 
medicine if needed.

"Prescription drug abuse is the No. 2 class of abuse after marijuana in the 
United States right now," Renton said. "This is a serious, serious problem."

The defendants, handcuffed and shackled in prison-issued jumpsuits, made a 
Tuesday afternoon appearance before U.S. Magistrate Louis Moore Jr.

Moore ordered them to return to Orleans Parish Prison pending a hearing 
today at 2 p.m. to determine their bail amounts or, as requested by 
prosecutors, whether they will be detained until trial. Assistant U.S. 
Attorney Tony Sanders, the lead prosecutor on the case, said he will ask 
for detention for all four defendants on grounds that they are flight risks 
or a danger to the community. Sanders also asked Moore to order all four 
defendants to undergo drug tests.

Begging for bail

Armstrong's attorney, Sal Panzeca, pleaded to Moore that his 45-year-old 
client is the mother of a 12-year-old girl and has never been convicted of 
anything. He added that similar allegations were made against her a few 
years ago, but no charges were filed.

"No way she is a flight risk or a threat," Panzeca said.

Then Armstrong spoke up: "I'm not a flight risk. I would really like to go 
home to my little girl, and I'll be back tomorrow."

Neither Panzeca nor Armstrong mentioned the pending charges in Slidell, 
allegations that in November forced Armstrong to enter into a consent 
agreement with the state nursing board, according to the DEA affidavit.
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