The Shadow Practice, Part 6: Doctors sell their souls, and their licenses, on the cheap
When word hit the grapevine that the Madre Maria Ines Teresa Health Center in Santa Ana had prescription painkillers for the asking, the place couldn't keep them in stock.
The center's "medical director," Dr. Harrell Robinson, did not treat patients at the clinic, but he was more than happy to use his status as a physician and his registration with the U.S. Drug Enforcement Administration to buy drugs for the center.
Located in Santa Ana, California, amidst one of the nation's highest concentrations of Mexican immigrants, the center presented itself as a refuge for immigrants. But its owner, Magdalena Annan, was interested primarily in one type of treatment: hydrocodone, usually sold as Vicodin, Lorcet or Norco.
Her business with Robinson made him the sixth largest purchaser of hydrocodone products in California in 2007, a fact that did not go unnoticed by his suppliers. One wholesaler, The Harvard Drug Group, told him that he had reached his 25,000 pill-per-month limit for his clinic. Robinson would not be persuaded, according to the DEA.
"He insisted that his other clinic in Anaheim Hills has not reached his monthly limit and wants his order shipped at that location," the wholesaler told the DEA.
And, according to the wholesaler, Robinson was right. He had only bought a mere 17,500 pills for that clinic. The wholesaler told the DEA it was going to ship him one last crate:
This will be his last shipment for the month. I have explained to him that any additional orders for hydrocodone must be placed with other wholesale distributors as we will not be able to ship any quantity to either of his clinic [sic] until April 1st.
Knowing that there had to be other doctors willing to sell their names for quick cash, Robinson went to Dr. Scott Bickman.
Like Robinson and so many other physicians trying to make a quick buck in immigrant communities, Bickman was yet another physician who had found his name tarnished by slipups in the surgical suite. The anesthesiologist was on probation with the Medical Board of California for negligence that led to the death of a patient. The DEA wrote:
In January 2008, Respondent opened a second account with Harvard, indicating that he owned a second medical clinic whose medical director, Scott Bickman, M.D., would also be purchasing controlled substances under his own DEA registration. While the drugs ordered by Dr. Bickman were to be shipped to the second clinic (145 Chaparral Court in Anaheim Hills), bills were to be sent to Respondent's main office. Respondent was listed on the invoices as the person billed.
You might recall that Robinson was earning $10,000 a month from Annan for this arrangement. He paid a much smaller fee to Bickman: $2,000 a month.
The Chaparral Court location had been the office of Dr. Andrew Rutland, the doctor now accused in the death of Chinese immigrant Ying Chen.
By the end of 2008, Bickman was the new sixth largest California purchaser of hydrocodone, according to the DEA.
A Harvard employee testified that Harvard "sends its local DEA office (Detroit) computer-generated reports of orders that the company considers excessive. He also testified that Harvard "reported" Drs. Robinson and Bickman "pretty much every month from January 2008 onward."
Apparently it took a while for the agency to build a case. And Robinson was always thinking one step ahead. Fully stocked with drugs, Robinson expanded locations. He already had a DEA registration for the main clinic at 1523 North Broadway in Santa Ana, and he added one for another location down the street at 1421 North Broadway, where he enlisted Dr. Thomas Mitchell the same way he enlisted Bickman.
Mitchell, like Bickman, was an anesthesiologist under scrutiny for a patient death. He had faced two public reprimands in the 1990s, one from California and one from West Virginia.
Mitchell was only paid half Bickman's fee: $1,000 a month. That's less than a janitor earning minimum age cleaning up at one of Santa Ana's busy taquerias would earn, but Mitchell didn't have to work as hard.
Both of these clinics were owned by Dr. Joy Johnson, who told the DEA, "she ‘delegated' the responsibility for leasing the premises to Ms. Magdalena Annan, an individual identified as having hired Respondent as the medical director of the clinic on 1523 North Broadway." The DEA wrote:
At the hearing, an Agency Investigator (DI) testified that he visited the 1523 North Broadway location, which was a house converted into a business premises; on the front of the house was a sign indicating the business name as the Madre Maria Ines Teresa Health Center. Although the DI observed the property for between two and three hours, he never saw an individual who appeared to be a patient entering or exiting the premises.
No patients? And yet Annan and Robinson were able to move quite a bit of product. Over just 21 months, they bought more than 1 million doses of hydrocodone products. Even if they were selling painkillers around the clock their purchase patterns would work out to 1,600 doses a day.
Robinson and Annan might have stayed in business, too, were it not for the Medical Board of California.
In February 2009, the DEA attempted to take Robinson's DEA certificate away by filing a temporary suspension order and calling a hearing before an administrative law judge. Robinson asked for several delays, and, when the May 12, 2009, hearing date came, neither Robinson nor his attorney showed up. The DEA called witnesses and presented its case.
The judge recommended four days later to the DEA that Robinson's DEA registration be revoked.
As of July 2009, though, the DEA had not taken action to either adopt the judge's recommendation or reject it.
When the medical board took Robinson's license away that month, things started rolling again at the DEA. The board based the decision on Robinson's history of botched surgeries. The DEA followed suit by taking away his ability to prescribe dangerous drugs. Still, Robinson is listed as a practicing physician on the Web site for Uniworld, an asset holding company, where he serves on the advisory board.
Mitchell had his licenses suspended in December 2008 after having his medical skills assessed by a board-appointed evaluator in an unrelated negligence case.
But neither the Medical Board nor the DEA has taken any action against Johnson, Bickman or Mitchell for their roles in this painkiller scheme.
Related Posts:
The Shadow Practice Part 1: Disciplined doctor found an exile community in immigrant health care
The Shadow Practice Part 2: New owners can't exorcise ghosts of clinic's past
The Shadow Practice Part 3: Immigrant clinic had deep roots in deception
The Shadow Practice Part 4: Doc begs patients for loans
The Shadow Practice Part 5: Drug pushers running this clinic were far from saints
The Shadow Practice Part 7: Punishment for drug-dealing doctors more severe in Arizona
The Shadow Practice Part 8: How one California clinic became a magnet for bad medicine
The Shadow Practice, Part 9: Woman dies during cosmetic surgeries at unlicensed clinic
California governor and medical board should stand accused in patient's death