Doctors Behaving Badly: Indiana drug mill kept patients happy and hooked

Wikipedia has no entry for the term "drug mill."

Antidote offers the following: A physician's office where people suffering from injuries or chronic diseases are given high doses of addictive drugs to keep them returning for more and where people already addicted to painkillers can obtain drugs with no questions asked.

Exhibit A is the Bloomington, Indiana office of Dr. Larry Dean Ratts.

Ratts was caught in 2008 by the Drug Enforcement Administration (DEA) moving massive amounts of addictive drugs through his office, not only through his own prescriptions but also through his staff, who were not licensed to write these prescriptions. According to documents filed by the Indiana Professional Licensing Agency, he did this by pre-signing prescription sheets. The DEA found 10,600 pre-signed prescriptions sitting in an unlocked cabinet in Ratts' office.

The office was a model of drug mill efficiency. Ratts told the DEA that patients were scheduled in five-minute increments.He wrote 120 narcotic prescriptions daily, and his staff used his pre-signed sheets for even more. Ratts also had his signature stamped on office visit sheets that were kept on hand in case anyone – like a DEA agent – wanted to see whether these drug-addled patients had ever actually seen a doctor.

Ratts told the DEA "that he usually started on schedule and his patients appreciated how quick he is." He also said that "he thought all of his patients were addicted or will become addicted to narcotics," but added that "he attempted to taper his patients off of narcotics and reduce the amount they receive; however, he had not been very successful with that process."

So instead of telling them that he was going to stop giving them addictive drugs, he just gave them other drugs and charged them for the more expensive painkillers. In a controlled, scientific setting, this might be called giving the patients a placebo. It is more properly termed a bait-and-switch.

While the DEA was sorting out what to do with Ratts, he made a smart move. He sold his practice to Monroe Hospital in Bloomington.

In October 2008, Ratts surrendered his DEA privileges to prescribe drugs. The DEA took no further action against him, though. Despite news stories about Ratts' troubles and malpractice lawsuits against him, the state of Indiana did nothing.

Ratts must have thought he had evaded the state's notice. To keep his medical practice going, Ratts renewed his license with Indiana but did not renew his Indiana controlled substances registration. By doing so, he was not forced to disclose that he had given up his DEA privileges.

The Indiana Professional Licensing Agency finally took action against Ratts' license in May 2010, when it filed a complaint against him. For now, though, nearly two years after the DEA raid, Ratts has a fully functioning Indiana medical license.

Final question: Why aren't medical boards automatically told of actions taken by the DEA? The process could be entirely automated and not require an extra minute of staff time or one additional taxpayer dollar.