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Licensed for Life: Aging Doctors Find Retirement Bonus in Pill Mills

Licensed for Life: Aging Doctors Find Retirement Bonus in Pill Mills

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What do Dr. Charles Neuringer, Dr. Riyaz Jummani, and Dr. Michael Fronstin have in common?

They all have worked in Florida.

They all have been caught overprescribing painkillers in what prosecutors describe as pill mills.

And they all have been practicing medicine for more than 40 years.

Jummani graduated from medical school in 1970. Neuringer in 1967. Fronstin in 1964.

I’ve been watching this phenomenon play out across the country as local police and federal agents raid painkiller clinics and bust doctors for creating – or feeding – addicts when they should be treating pain. I’m reminded of what Dr. William Norcross at the UC San Diego School of Medicine told me: “As physicians get older, we modify what we do for a living so that it's more commensurate with our abilities and our stamina. Everybody knows that medical groups and hospitals shield doctors who are impaired.”

In some cases, it seems, this means stepping out of the healing arts altogether and becoming a fulltime prescription writer.

But why?

Neuringer’s case provides at least one good reason.

Paula McMahon at the Florida Sun-Sentinel reported that the 73-year-old Neuringer was forced to fork over $477,000 he earned in fees and bonuses for his work at Coast to Coast Healthcare Management Clinic in Florida.

How long did he have to work to earn that kind of money?

140 days.

Let’s be generous and assume he put in long – 10 hour – days. That works out to $340 an hour, which may be a little cheap for a highly specialized physician doing important work that requires a lot of intellect and technical dexterity. A cardiologist, perhaps. Or a pediatric oncologist. The average starting salary for anesthesiologists in 2012 was $334,916, according to Becker’s Hospital review. And that was for a full year of work.

So what did Neuringer have to do to earn $340 an hour? According to federal prosecutors who spoke to the Florida Sun-Sentinel, not much:

Neuringer's job at the clinic involved "little more than writing prescriptions" and the operator of the clinic told him to prescribe levels of pain medications at levels that were "high enough to keep patients happy and low enough to avoid scrutiny" from authorities, federal prosecutors said.

Neuringer was good at it, too. He averaged more than 40 patients per day and sometimes saw as many as 70, McMahon wrote. During that 140 days, he saw 5,669 people, although some were undoubtedly repeat customers. The incentive was a $75 fee for every patient. After 40 patients, he would have earned enough to buy a plane ticket to Paris. But speed doesn’t allow for conscientious treatment of a patient’s real needs. McMahon wrote:

Undercover agents said he failed to do adequate examinations and that he wrote prescriptions for pain pill and anti-anxiety medicines for them based on "nebulous" physical complaints.

There are young doctors who have been caught working in pill mills, too. Along with Fronstin, 74-year-old Gabriel Sanchez was arrested but so was 33-year-old Dr. Khanh Van Kim Dong.

I would encourage health writers to ask prosecutors and medical boards for the ages of physicians found overprescribing. And take the next step, too. Find out what they were doing before. They probably didn’t start their careers doing nothing but writing prescriptions. Understanding the path to the pill mill could help stop more of them from popping up.

Image by Robson via Flickr.


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Hey... what's so different about that..... compared to a regular doctor's visit these days? (Not much)..My last visit with my PCP was a total of 5 minutes. He made eye contact with me once for a brief second, then left the room and came back and handed me a prescription and replied " Come back if you're sick"... no follow up , no teaching, no assessment... nothing..... Oh and by the way, The insurance company paid him 274.00 for that visit. I actually felt worse after leaving his office... not better.

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The only problem with this article is that it reads like the DOH is doing their job. They are not too many deaths have occurred while too many doctors (drug dealers), clinic owners, pharmacies, and of course the drug manufacturers rake in the dollars. A pill mill could not operate if they didn't have a doctor in their writing the scripts. Janet Colbert stoppnow

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The bottom line is the failure of the FL agencies designed to protect the public health safety. Failure by the Department of Health and the Board's of Medicine/Osteopathy. They have had the tools to stop this, and chose to continue to ignore. Failed peer review and more.

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One obvious way to address this is to legalize and make available over the counter the opiates that now require a presciption. Yes, people will overdose and die, but that happens already and many if not most of the pill prescribed by the pill mills end up on the wide open black market as it is.
If we put them over the counter, we eliminate much of the black market. We can regulate as needed.
As a prescriber, I am very uncomfortable with the role I currently fill, with a patient trying to convince me of the legitimacy of their pain and my conscience telling me that what is in their best interest is not going to satisfy that patient at this point in time. I am caught in the middle and I don't want to be here. I don't like feeling like I need a lie detector in the exam room, to keep myself from being scammed and having pills I prescribed end up on the street.


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