1 00:00:00,010 --> 00:00:04,790 In this episode of American Greed, 9 -1 -1, what is your emergency? 2 00:00:05,230 --> 00:00:08,530 Americans are dying by overdose in record numbers. 3 00:00:10,810 --> 00:00:14,330 Victims of the worst opioid addiction epidemic in history. 4 00:00:15,530 --> 00:00:21,830 And in Mobile, Alabama, two doctors, Patrick Couch and Shulu Ran, are serving 5 00:00:21,830 --> 00:00:23,710 heavy doses of the dangerous drugs. 6 00:00:28,680 --> 00:00:30,840 One drug they prescribe is brand new. 7 00:00:31,160 --> 00:00:35,520 Made by a multi -billion dollar drug company that is paying the doctors to 8 00:00:35,520 --> 00:00:36,519 its product. 9 00:00:36,520 --> 00:00:38,640 Fifty times more potent than heroin. 10 00:00:39,340 --> 00:00:42,440 That's more like a lethal weapon than a medicine. 11 00:00:42,700 --> 00:00:46,740 And some of their patients who want relief from chronic pain descend into a 12 00:00:46,740 --> 00:00:47,740 living hell. 13 00:00:48,120 --> 00:00:50,020 It said on the pack you may become addicted. 14 00:00:50,340 --> 00:00:52,320 It should say you will become addicted. 15 00:00:52,740 --> 00:00:57,100 But the drug maker and these doctors are unrelenting, turning patients' pain 16 00:00:57,100 --> 00:00:58,940 into enormous profits. 17 00:00:59,440 --> 00:01:03,140 This case was a pill mill that was also a money mill. 18 00:01:03,380 --> 00:01:07,960 And some of the families of patients who die hold the doctors responsible. 19 00:01:08,360 --> 00:01:12,300 He lost his life because he was seeing a doctor that prescribed him that 20 00:01:12,300 --> 00:01:14,900 medication, and he winds up dying under his care. 21 00:01:32,360 --> 00:01:35,360 In Mobile, Alabama, in the spring of 2014, 22 00:01:36,100 --> 00:01:40,500 Patrick Chaussé heads to class at the University of South Alabama. 23 00:01:41,100 --> 00:01:46,000 Chaussé is an Army veteran, home from two tours of duty in Iraq, where he 24 00:01:46,000 --> 00:01:48,620 made time to check in with his girlfriend, Amanda. 25 00:01:49,320 --> 00:01:53,380 He called me every single day, every single day while he was over there. 26 00:01:53,760 --> 00:01:54,920 He made it a point. 27 00:01:55,240 --> 00:01:57,280 But today, something is wrong. 28 00:01:57,700 --> 00:01:59,940 Patrick is not returning Amanda's calls. 29 00:02:00,810 --> 00:02:03,650 Worried, she races to campus and finds his truck. 30 00:02:04,270 --> 00:02:07,850 Inside, Patrick is passed out, apparently not breathing. 31 00:02:08,169 --> 00:02:11,730 I screamed and screamed and screamed and screamed for help. 32 00:02:12,190 --> 00:02:13,810 Somebody came, called 911. 33 00:02:15,010 --> 00:02:18,510 Just 27 years old, Patrick Chaussé is dead. 34 00:02:18,970 --> 00:02:21,350 News of his death sweeps across campus. 35 00:02:21,630 --> 00:02:25,010 Students are asking, what killed Patrick Chaussé? 36 00:02:25,430 --> 00:02:26,930 I don't wish that on anybody. 37 00:02:28,200 --> 00:02:34,300 I don't want anybody to ever feel, ever feel what I had to go through. 38 00:02:36,800 --> 00:02:42,520 The private story of Patrick Chaussé's last days is found in a dark chapter 39 00:02:42,520 --> 00:02:43,520 in Mobile. 40 00:02:44,040 --> 00:02:49,200 This is a place that prides itself on its old world southern charm with a busy 41 00:02:49,200 --> 00:02:51,760 commercial port and peaceful waterfront. 42 00:02:52,320 --> 00:02:58,180 And in 1997, a young doctor from Georgia moves here and opens a pain clinic. 43 00:02:58,620 --> 00:03:02,120 He is Patrick Couch, an anesthesiologist. 44 00:03:02,420 --> 00:03:07,960 He calls his clinic Physicians Pain Specialists of Alabama, eventually known 45 00:03:07,960 --> 00:03:08,980 PPSA. 46 00:03:10,140 --> 00:03:13,580 Early on, Couch and his clinic earned a good reputation. 47 00:03:14,240 --> 00:03:18,400 I would say that Patrick Couch was an influential member of the community. 48 00:03:19,450 --> 00:03:22,110 a well -respected doctor at some point in his career. 49 00:03:22,330 --> 00:03:23,990 He was a very competent doctor. 50 00:03:24,690 --> 00:03:26,350 Everybody thought highly of him. 51 00:03:26,590 --> 00:03:32,010 In 1999, Brian Bechtel takes his wife, Teresa Odom, to Couch's Clinic. 52 00:03:32,350 --> 00:03:37,450 Teresa is paralyzed following a car accident and suffers from spasms in her 53 00:03:37,450 --> 00:03:42,110 legs. She would be in her wheelchair, and her legs would just kick, and it 54 00:03:42,110 --> 00:03:47,410 hurt her. When you don't feel most of your body, the pain you do feel is 55 00:03:47,410 --> 00:03:48,410 extreme. 56 00:03:48,650 --> 00:03:53,430 Couch has the answer, a pump that delivers an anesthetic to her spine. 57 00:03:53,930 --> 00:03:57,430 It's exactly what we were looking for. She was comfortable. 58 00:03:57,710 --> 00:03:59,350 Everything seemed to work fine. 59 00:03:59,710 --> 00:04:04,590 Couch operates on his own for seven years and then brings in a partner, 60 00:04:04,590 --> 00:04:05,590 Ran. 61 00:04:05,730 --> 00:04:11,110 Born in China, Ran is educated in the U .S. He is the author of multiple 62 00:04:11,110 --> 00:04:15,850 articles in medical journals and claims to be a world record holder for board 63 00:04:15,850 --> 00:04:16,850 certifications. 64 00:04:17,440 --> 00:04:22,820 Under Ron, PPSA expands and a new marketing campaign is launched. 65 00:04:23,440 --> 00:04:27,900 At Physicians Pain Specialists of Alabama, we don't treat pain. We treat 66 00:04:27,900 --> 00:04:32,300 patients who are suffering from pain. And it is clear to many that Ron is 67 00:04:32,300 --> 00:04:33,300 running the show. 68 00:04:33,660 --> 00:04:36,200 Dr. Ron could persuade Dr. Kautz to do anything. 69 00:04:36,580 --> 00:04:40,220 Lori Carver -Linder is the PPSA clinic manager. 70 00:04:40,700 --> 00:04:44,320 Dr. Ron had the run of the practice, especially when it comes to the money 71 00:04:44,320 --> 00:04:46,780 to the billing. It was always up to Dr. Ron. 72 00:04:47,400 --> 00:04:51,380 And by all appearances, Ron is exceedingly concerned with money. 73 00:04:51,800 --> 00:04:56,940 The overarching goal for Dr. Ron, regardless of what drug he was 74 00:04:57,060 --> 00:05:02,040 was how do I maximize profit? What is going to be the most amount of money we 75 00:05:02,040 --> 00:05:04,000 can squeeze out of every single patient? 76 00:05:04,360 --> 00:05:09,360 And to keep profits high, it is best to insist that patients have insurance. 77 00:05:10,410 --> 00:05:13,710 Many of the medications they prescribed were extremely expensive. 78 00:05:13,950 --> 00:05:18,310 And by ensuring that your patients have insurance, you know that you are going 79 00:05:18,310 --> 00:05:19,189 to get paid. 80 00:05:19,190 --> 00:05:23,010 But really big money is made when a clinic has its own pharmacy. 81 00:05:23,310 --> 00:05:28,890 And so Couch and Ron opened CNR Pharmacy, immediately adjacent to PPSA. 82 00:05:29,510 --> 00:05:35,610 CNR was really critical to Ron and Couch's ability to churn out money the 83 00:05:35,610 --> 00:05:36,269 they did. 84 00:05:36,270 --> 00:05:41,080 Without CNR Pharmacy, They could prescribe drugs, but they would be 85 00:05:41,080 --> 00:05:45,580 Walgreens or CVS or a local drugstore. And that local drugstore is then the one 86 00:05:45,580 --> 00:05:48,740 that gets the reimbursement from insurance companies. So it's the 87 00:05:48,740 --> 00:05:49,740 makes the money. 88 00:05:49,800 --> 00:05:55,360 Several years after Ron arrives, PPSA is a big operation, eventually serving as 89 00:05:55,360 --> 00:05:56,700 many as 8 ,000 patients. 90 00:05:57,100 --> 00:06:00,760 But some of Couch's long -term patients are not impressed. 91 00:06:01,980 --> 00:06:04,700 After Dr. Ron came, things started to change. 92 00:06:04,980 --> 00:06:10,640 Every time we went there, the office was full, and there would be people coming 93 00:06:10,640 --> 00:06:16,540 in of questionable character, coming in hollering, wanting their refills, and it 94 00:06:16,540 --> 00:06:17,580 was terrible. 95 00:06:17,880 --> 00:06:21,780 And for Bechtel, Dr. Couch is conspicuously absent. 96 00:06:22,580 --> 00:06:24,700 Eventually, we never seen Dr. 97 00:06:24,960 --> 00:06:26,940 Couch. The nurse would fill her pump. 98 00:06:27,550 --> 00:06:31,890 And go out of the office and come back with the prescriptions. At some point, 99 00:06:31,890 --> 00:06:37,910 became almost disassociated with what he was doing. He just kind of checked out 100 00:06:37,910 --> 00:06:41,650 of being a doctor and wanted to do other things like play in a band. 101 00:06:42,290 --> 00:06:47,570 Couch actually does have a band, appropriately called Midlife Crisis. 102 00:06:47,890 --> 00:06:51,170 And he makes it clear to many that this is where he wants to be. 103 00:06:51,510 --> 00:06:54,130 Because his main goal was he wanted to be a rock star. 104 00:06:54,550 --> 00:06:55,710 But that did not. 105 00:06:56,280 --> 00:06:57,680 You know, support his lifestyle. 106 00:06:57,940 --> 00:06:58,940 The doctor indeed. 107 00:06:59,780 --> 00:07:04,100 And that lifestyle includes a million -dollar house on Mobile Bay. 108 00:07:04,620 --> 00:07:06,960 This is what a doctor's income buys. 109 00:07:07,620 --> 00:07:12,900 But according to Carver Linder, Couch's disdain for a doctor's work is no 110 00:07:12,900 --> 00:07:13,900 secret. 111 00:07:14,140 --> 00:07:17,860 He'd have his patients laying on the table waiting for their procedure. 112 00:07:18,560 --> 00:07:23,360 All passed out, sedated and everything, sometimes for two and three hours to 113 00:07:23,360 --> 00:07:26,260 where we'd have to re -sedate them before we could ever do the procedure. 114 00:07:26,720 --> 00:07:31,140 And so Couch comes up with a way for others to do his work. 115 00:07:31,520 --> 00:07:37,860 Nurse anesthetist Stacey Madison and nurse practitioners Bridget Parker and 116 00:07:37,860 --> 00:07:38,980 Justin Palmer. 117 00:07:39,400 --> 00:07:44,920 I would probably see on average about 32 patients a day. 118 00:07:45,550 --> 00:07:47,930 Some days I would see more. 119 00:07:48,770 --> 00:07:52,830 There were a few days I saw 50 or 60. 120 00:07:53,770 --> 00:07:56,510 Many patients assume Palmer is a doctor. 121 00:07:56,730 --> 00:07:59,330 After all, he is signing their prescriptions. 122 00:08:00,050 --> 00:08:06,790 I was given blank, pre -signed prescription pads, or if I needed to, I 123 00:08:06,790 --> 00:08:07,790 forge his name. 124 00:08:07,890 --> 00:08:13,070 It works for the nurses and the doctors, but for the patients, it's dangerous. 125 00:08:13,720 --> 00:08:17,700 Because the supervision over what they were prescribing and what they were 126 00:08:17,700 --> 00:08:19,380 was almost nonexistent. 127 00:08:19,780 --> 00:08:24,480 And under that limited supervision, they prescribed very powerful, dangerous 128 00:08:24,480 --> 00:08:28,740 narcotics. Opioids to patients like Teresa Odom. 129 00:08:29,100 --> 00:08:33,080 She had all this pain medication beside her in the drawer. And I said, Teresa, 130 00:08:33,360 --> 00:08:37,299 look at this pain medication you got. This is one month prescription. 131 00:08:37,919 --> 00:08:42,280 If anybody took this as prescribed, they would not function. 132 00:08:42,890 --> 00:08:43,890 They wouldn't be alive. 133 00:08:45,530 --> 00:08:50,410 Hydrocodone, hydromorphone, oxycodone, oxymorphone, and fentanyl. Dr. Ron, Dr. 134 00:08:50,570 --> 00:08:54,930 Couch were in the top ten in the state of Alabama for each of those drugs. For 135 00:08:54,930 --> 00:08:59,430 most of those drugs, for most of the years in question, they were the number 136 00:08:59,430 --> 00:09:01,390 and number two by a long shot. 137 00:09:01,670 --> 00:09:04,150 And how is that serving their patients? 138 00:09:04,860 --> 00:09:07,260 Opioids are not good medicines for long -term pain. 139 00:09:07,620 --> 00:09:12,300 Dr. Andrew Kolodny is the Director of Physicians for Responsible Opioid 140 00:09:12,300 --> 00:09:17,220 Prescribing. Because of tolerance to the effects, the only way to continue 141 00:09:17,220 --> 00:09:20,000 getting pain relief is if your dose keeps going up. 142 00:09:20,200 --> 00:09:25,720 And as the dose gets higher, you'll often see that the patient's level of 143 00:09:25,720 --> 00:09:27,720 functioning begins to decline. 144 00:09:28,240 --> 00:09:32,180 And of course, as the dose gets higher, it becomes much more... 145 00:09:33,099 --> 00:09:38,440 And while several of Couch's and Ron's nurse practitioners provide easy access 146 00:09:38,440 --> 00:09:43,180 to opioids, what is most alarming is that they are also helping themselves. 147 00:09:44,240 --> 00:09:47,520 Bridget Parker becomes addicted as a pain patient herself. 148 00:09:48,140 --> 00:09:51,820 She admitted that she would rifle through patients' purses when they were 149 00:09:51,820 --> 00:09:55,260 getting their blood pressure taken, and that when patients brought back 150 00:09:55,260 --> 00:09:59,320 medication, it should have been returned or destroyed, but Bridget would keep it 151 00:09:59,320 --> 00:10:00,700 for herself for her own personal use. 152 00:10:01,230 --> 00:10:07,910 And she is not the only one. When I interviewed initially, I was very 153 00:10:07,910 --> 00:10:12,450 with Dr. Couch that I'd previously been to treatment for opioid addiction. 154 00:10:12,710 --> 00:10:17,270 And I did continue to do the right thing, maybe about a year. 155 00:10:18,570 --> 00:10:22,970 And then I started using narcotics again. 156 00:10:23,560 --> 00:10:27,500 Palmer's choice of opioid is Dilaudid. And he would shoot it up. 157 00:10:27,720 --> 00:10:34,440 And he gave testimony at trial that he injected over 600 milligrams of Dilaudid 158 00:10:34,440 --> 00:10:35,279 a day. 159 00:10:35,280 --> 00:10:39,660 And he told the jury that it was enough to kill everyone in this courtroom. 160 00:10:40,200 --> 00:10:41,900 That's how bad of an addict he was. 161 00:10:42,340 --> 00:10:46,980 And what few people at the clinic know is that the problem extends to one of 162 00:10:46,980 --> 00:10:48,060 men in charge. 163 00:10:48,620 --> 00:10:50,700 You know, Couch had a substance abuse problem himself. 164 00:10:51,120 --> 00:10:52,900 He had been to Narcotics Anonymous. 165 00:10:53,480 --> 00:10:54,620 and Alcoholics Anonymous. 166 00:10:54,840 --> 00:10:59,400 And on some occasions, he did meet some of these nurse practitioners in 167 00:10:59,400 --> 00:11:00,600 Narcotics Anonymous. 168 00:11:00,860 --> 00:11:04,860 And he actually recruited some of these nurse practitioners to come work with 169 00:11:04,860 --> 00:11:06,740 him inside of the pain clinic, mind you. 170 00:11:06,980 --> 00:11:10,120 By 2012, the money is pouring in. 171 00:11:10,320 --> 00:11:14,120 But Patrick Couch's pain clinic has become a recipe for disaster. 172 00:11:15,320 --> 00:11:19,440 Up next, a spray 50 times more potent than heroin. 173 00:11:19,680 --> 00:11:22,240 A pharmaceutical company's answer to pain. 174 00:11:22,800 --> 00:11:26,160 And we believe this platform is very important for the future of drug 175 00:11:37,300 --> 00:11:42,880 In 2012, the epidemic of opioid addiction is building across the 176 00:11:43,580 --> 00:11:46,920 Deaths from prescription opioids are skyrocketing. 177 00:11:47,280 --> 00:11:50,660 And against that backdrop, insists therapeutics. 178 00:11:51,080 --> 00:11:55,420 A pharmaceutical company in Arizona announces a new product made from one of 179 00:11:55,420 --> 00:11:59,600 most addictive and dangerous substances in medicine, fentanyl. 180 00:12:00,460 --> 00:12:07,120 Fentanyl is about 50 times more potent than heroin. A tiny dose can cause 181 00:12:07,120 --> 00:12:08,840 someone to stop breathing and die. 182 00:12:09,660 --> 00:12:14,500 John Kapoor, a billionaire drug entrepreneur and the founder of Insys 183 00:12:14,500 --> 00:12:19,100 Therapeutics, is betting on fentanyl with a new product called Subsys. 184 00:12:20,940 --> 00:12:23,540 Instant release fentanyl that comes in a spray. 185 00:12:24,160 --> 00:12:29,220 The drug is FDA approved for cancer patients who need extra pain prevention. 186 00:12:29,540 --> 00:12:32,060 It is marketed as easy to use. 187 00:12:32,460 --> 00:12:36,840 Squeeze your fingers and thumb together to spray subsist under your tongue. The 188 00:12:36,840 --> 00:12:38,340 company has high hopes. 189 00:12:38,580 --> 00:12:42,600 Tell us what it is about Insys that has investors so excited. 190 00:12:42,900 --> 00:12:47,240 The device that I brought with me today allows the patient to simply, with no 191 00:12:47,240 --> 00:12:49,640 priming, spray the drug underneath their tongue. 192 00:12:50,060 --> 00:12:53,640 in a plume geometry, and we believe this platform is very important for the 193 00:12:53,640 --> 00:12:54,680 future of drug delivery. 194 00:12:54,980 --> 00:12:58,920 But Subsys, as FDA approved, has a limited market. 195 00:12:59,200 --> 00:13:04,300 There isn't very much money to be made with a medicine that's only going to be 196 00:13:04,300 --> 00:13:08,340 prescribed to patients at the end of life with pain from cancer. 197 00:13:08,600 --> 00:13:13,220 Sure, no, we're in it for the long term. And so executives at Insys Therapeutics 198 00:13:13,220 --> 00:13:16,140 reach out to pain doctors like Couch and Ron. 199 00:13:16,960 --> 00:13:21,140 We know that before that substance even came on the market, that Insys had flown 200 00:13:21,140 --> 00:13:25,220 Dr. Ron and Dr. Couch out to where their headquarters was, and they were on the 201 00:13:25,220 --> 00:13:29,540 advisory board for substances prior to this drug even hitting the market. 202 00:13:29,880 --> 00:13:32,260 Imagine what you could do if you were pain -free. 203 00:13:32,540 --> 00:13:36,880 With an inside track at the drug company, Ron and Couch start writing 204 00:13:36,880 --> 00:13:40,040 prescriptions for off -label use for substances. 205 00:13:42,440 --> 00:13:49,370 Treating common chronic pain conditions with... Any opioid is probably not 206 00:13:49,370 --> 00:13:56,030 appropriate, but to prescribe fentanyl for those problems is totally 207 00:13:56,030 --> 00:14:00,530 unacceptable. The immediate -release fentanyl products, like the fentanyl 208 00:14:00,530 --> 00:14:05,230 substance spray, that's more like a lethal weapon than a medicine. 209 00:14:05,890 --> 00:14:11,110 Camison Witherspoon has a close encounter with substance after abdominal 210 00:14:11,110 --> 00:14:13,190 leaves her with severe pain. 211 00:14:13,820 --> 00:14:18,880 Before surgery, I was a woman of God in church, married, mother of four, 212 00:14:19,080 --> 00:14:23,420 daughters all good students, husband, great job. 213 00:14:23,960 --> 00:14:26,800 But then she makes an appointment at PPSA. 214 00:14:27,200 --> 00:14:31,780 She sees nurse practitioner Bridget Parker, and she says she is immediately 215 00:14:31,780 --> 00:14:33,920 given a prescription for substance. 216 00:14:34,600 --> 00:14:38,960 She didn't, you know, feel to see how the pain was, where the pain was, or 217 00:14:38,960 --> 00:14:42,560 anything like that. She just gave me these prescriptions and told me to take 218 00:14:42,560 --> 00:14:45,770 them. I didn't know. I thought maybe that's how pain clinics work because I 219 00:14:45,770 --> 00:14:47,470 never been to a pain clinic before. 220 00:14:47,790 --> 00:14:52,250 What should have occurred was the doctor sitting down and saying, I understand 221 00:14:52,250 --> 00:14:56,470 that this is a cancer drug for end -of -life cancer pain. 222 00:14:56,690 --> 00:15:01,010 You don't have that. However, nothing else is responding well to your pain. 223 00:15:01,010 --> 00:15:05,090 I truly believe that this is something that may provide you the relief that you 224 00:15:05,090 --> 00:15:07,570 seek. But those conversations weren't happening. 225 00:15:08,250 --> 00:15:12,210 Witherspoon is simply told to follow directions on the box. 226 00:15:12,970 --> 00:15:16,370 The first day I took it, I felt the jump up. 227 00:15:16,730 --> 00:15:18,910 It said on the pack you may become addicted. 228 00:15:19,270 --> 00:15:22,950 It should say you will become addicted because right away I think I was 229 00:15:22,950 --> 00:15:27,910 to it. And while patients are becoming addicts, Ron maintains the use of 230 00:15:27,910 --> 00:15:32,030 substance for chronic pain of all kinds is just good medicine. 231 00:15:32,680 --> 00:15:36,460 He was a cutting -edge doctor that thought he knew the best way to treat a 232 00:15:36,460 --> 00:15:40,900 patient. And providing substance, this fentanyl product, in his mind he thought 233 00:15:40,900 --> 00:15:43,260 it would be faster and better pain relief for the folks. 234 00:15:43,840 --> 00:15:48,420 And so the boxes of substance are flying off the shelves at CNR Pharmacy. 235 00:15:49,120 --> 00:15:53,280 For several months after the drug comes on the market, Ron and Couch are among 236 00:15:53,280 --> 00:15:57,000 the top prescribers of the drug in the entire United States. 237 00:15:58,170 --> 00:16:01,990 And according to federal prosecutors, that makes them very important to 238 00:16:01,990 --> 00:16:04,170 executives at Insys Therapeutics. 239 00:16:04,450 --> 00:16:08,730 Dr. Ron was powerful enough that what Dr. Ron wants, Dr. 240 00:16:08,950 --> 00:16:09,909 Ron gets. 241 00:16:09,910 --> 00:16:15,170 When Insys asked Ron who he would like Insys to hire as his sales rep, Ron 242 00:16:15,170 --> 00:16:16,970 suggests a woman he wants to date. 243 00:16:17,410 --> 00:16:22,750 Natalie Perhax, a medical equipment salesperson. And immediately, Perhax is 244 00:16:22,750 --> 00:16:23,750 hired. 245 00:16:24,110 --> 00:16:28,790 She later testifies in trial that she has no experience in drug sales, has no 246 00:16:28,790 --> 00:16:33,310 idea what fentanyl is, but sure enough, because she gets a recommendation from 247 00:16:33,310 --> 00:16:34,970 Ron, she gets the job. 248 00:16:35,810 --> 00:16:40,450 And that job is making sure Ron and Couch keep writing prescriptions for 249 00:16:40,450 --> 00:16:41,450 substance. 250 00:16:41,750 --> 00:16:46,830 Natalie Perhax was in PPSA's clinic roughly five days a week. She was there 251 00:16:46,830 --> 00:16:48,490 almost every single day. 252 00:16:48,690 --> 00:16:51,350 So she was very on top of what was being prescribed. 253 00:16:52,200 --> 00:16:53,620 And at what quantity? 254 00:16:53,860 --> 00:16:58,360 And to help perhaps motivate the two doctors to prescribe substance, Insys 255 00:16:58,360 --> 00:17:01,420 Therapeutics has a proven incentive, cold cash. 256 00:17:02,140 --> 00:17:06,760 Insys calls the money paid to the doctors a fee for giving speeches to 257 00:17:06,760 --> 00:17:08,319 doctors about substance. 258 00:17:08,920 --> 00:17:13,380 Having speaker programs is not illegal. That is something that most drug 259 00:17:13,380 --> 00:17:14,380 companies do. 260 00:17:14,940 --> 00:17:20,280 But there has to be a legitimate benefit to it. And according to PPSA employees, 261 00:17:20,500 --> 00:17:26,060 in the case of Couch and Ron, the speeches amount to lunch out with the 262 00:17:26,540 --> 00:17:31,840 It was a free meal. That's what it was about. Nobody cared about. 263 00:17:32,350 --> 00:17:33,009 The drug? 264 00:17:33,010 --> 00:17:35,890 And the speaker engagements were the biggest boondoggle there ever was. 265 00:17:36,110 --> 00:17:40,930 They would have these meetings at restaurants in the local area, and only 266 00:17:40,930 --> 00:17:45,590 staff would come to these meetings. And these doctors would be paid $2 ,000 for 267 00:17:45,590 --> 00:17:49,310 that small amount of time, and it would be money sent to their personal 268 00:17:49,310 --> 00:17:54,550 accounts. Over the course of three years, big prescribers Couch and Ron 269 00:17:54,550 --> 00:18:00,770 collect more than $250 ,000 in speaker fees from Insys Therapeutics. 270 00:18:01,400 --> 00:18:06,360 The overriding purpose of why Insys Therapeutics was paying our doctors this 271 00:18:06,360 --> 00:18:10,260 amount of money was in exchange for them to continue prescribing the substance. 272 00:18:10,880 --> 00:18:15,260 And that may explain, in part, why Tammison Witherspoon can get as much 273 00:18:15,260 --> 00:18:17,380 substance as she says she wants. 274 00:18:17,780 --> 00:18:21,360 I told them, I said, I'm running out of my medicine. And they was like, what are 275 00:18:21,360 --> 00:18:25,100 you doing? Are you using it? I said, yes, I'm using it more than I'm supposed 276 00:18:25,100 --> 00:18:27,660 because I feel like I need it. 277 00:18:28,250 --> 00:18:32,890 So their remedy was to bump me up from 200 micrograms to 400 micrograms. 278 00:18:33,290 --> 00:18:37,870 And not surprisingly, her life on substance has become miserable. 279 00:18:38,510 --> 00:18:44,210 My kids, they would find me passed out from taking so much medicine. 280 00:18:44,790 --> 00:18:50,330 I turned into a monster because it makes you, when you don't have it, you are a 281 00:18:50,330 --> 00:18:54,470 monster. She remembers one incident that was particularly terrifying. 282 00:18:55,270 --> 00:19:00,020 One night, I had taken all my meds. And I fell asleep on a heating pad. 283 00:19:00,400 --> 00:19:05,400 And when my girls came in, they were like, Mom, you bleeding. 284 00:19:05,700 --> 00:19:11,120 And I was like, what do you mean? And I looked down and on both my breasts, I 285 00:19:11,120 --> 00:19:15,140 burned a hole in them. And I ended up having to go to the emergency room 286 00:19:15,140 --> 00:19:18,860 I was on so much pain meds, I didn't feel it at all. 287 00:19:20,280 --> 00:19:25,780 And for a woman who was once a model of success, the shame of her addiction is 288 00:19:25,780 --> 00:19:31,270 excruciating. I never used drugs. I never even drank alcohol. I've never had 289 00:19:31,270 --> 00:19:32,430 alcohol in my life. 290 00:19:32,810 --> 00:19:39,390 And here I am, total drug addict from something that I could go get 291 00:19:39,390 --> 00:19:40,390 legally. 292 00:19:40,790 --> 00:19:44,410 One of our biggest commitments is to remain profitable and cash flow 293 00:19:44,610 --> 00:19:49,450 And she has no idea that behind her addiction is a pharmaceutical company 294 00:19:49,450 --> 00:19:50,810 is raking in millions. 295 00:19:51,910 --> 00:19:56,210 In May 2013, Insys Therapeutics goes public. 296 00:19:56,700 --> 00:19:59,840 With what will be the most successful IPO of the year. 297 00:20:00,060 --> 00:20:07,000 Insys Therapeutics up 400%. Up next, for doctors Ron and Couch, when profits 298 00:20:07,000 --> 00:20:08,920 are big, so are the toys. 299 00:20:09,520 --> 00:20:10,520 Bentleys, Mercedes, 300 00:20:11,360 --> 00:20:14,200 Porsches, cars I can't even pronounce. 301 00:20:25,290 --> 00:20:30,430 In Mobile in October 2013, PPSA has an astounding month. 302 00:20:30,810 --> 00:20:34,550 Couch and Ron write 110 prescriptions for substance. 303 00:20:35,010 --> 00:20:39,510 The prescriptions are filled at CNR Pharmacy, and insurance companies pay a 304 00:20:39,510 --> 00:20:42,330 whopping $572 ,000. 305 00:20:43,910 --> 00:20:50,310 One month, one drug. The doctors are taking the term pill mill to a whole new 306 00:20:50,310 --> 00:20:55,470 level. Over the years, Pill mills are evolving and continue to evolve. 307 00:20:55,970 --> 00:21:01,250 They're not the walk -in, pay cash, get handed a script that they were some 308 00:21:01,250 --> 00:21:02,229 years ago. 309 00:21:02,230 --> 00:21:06,110 This case was a pill mill that was also a money mill. 310 00:21:07,610 --> 00:21:11,110 That is something Tim Burns understands well. 311 00:21:11,490 --> 00:21:16,110 His wife, Kathleen, becomes Ron's patient after a car accident leaves her 312 00:21:16,110 --> 00:21:17,190 serious back pain. 313 00:21:17,490 --> 00:21:19,730 Dr. Ron puts her on subsys. 314 00:21:21,070 --> 00:21:27,510 I didn't find out what kind of drug it was until I talked to my sister -in 315 00:21:27,950 --> 00:21:33,910 She told us, both of us, that it was a cancer medicine for cancer patients that 316 00:21:33,910 --> 00:21:37,470 are dying to get relief from the pain they're in. 317 00:21:37,970 --> 00:21:43,730 In fact, sepsis is so dangerous that most insurance companies will only pay 318 00:21:43,730 --> 00:21:48,230 the drug for its FDA -approved use for cancer patients who are tolerant to 319 00:21:48,230 --> 00:21:49,230 opioids. 320 00:21:49,530 --> 00:21:54,550 Kathleen Burns does not have cancer, but her insurance company thinks she does. 321 00:21:54,870 --> 00:22:00,170 Why? The answer may be found in the discovery by federal investigators that 322 00:22:00,170 --> 00:22:05,410 employees at Insys Therapeutics have misled insurance companies about 323 00:22:05,570 --> 00:22:09,890 diagnoses. Criminal indictments and public reporting show that Insys has 324 00:22:09,890 --> 00:22:14,210 manipulated the insurer approval process. In September 2017... 325 00:22:14,800 --> 00:22:19,160 A U .S.-centered investigation details its findings on how insurance companies 326 00:22:19,160 --> 00:22:20,160 have been deceived. 327 00:22:20,640 --> 00:22:24,740 Incest techniques have included the falsification of medical histories for 328 00:22:24,740 --> 00:22:28,840 substance patients and the concealment of the company's role in intervening 329 00:22:28,840 --> 00:22:30,780 the insurers and pharmacy benefit managers. 330 00:22:31,340 --> 00:22:35,320 Incest puts responsibility on mistakes by its employees. 331 00:22:35,900 --> 00:22:40,600 But at PPSA, it is understood that in order to get insurance company approval 332 00:22:40,600 --> 00:22:45,450 for a cancer -free patient like... Kathleen Burns, the staff can simply go 333 00:22:45,450 --> 00:22:48,050 the INSA sales rep, Natalie Perhax. 334 00:22:48,510 --> 00:22:54,410 I would call the rep and say, I'd like to give this patient 335 00:22:54,410 --> 00:23:00,430 sepsis, but it's not being approved. Can you help me? 336 00:23:00,790 --> 00:23:06,870 And they would. I've seen some really slimy behavior by pharmaceutical 337 00:23:06,870 --> 00:23:10,130 companies, but that sets a new bar. 338 00:23:11,180 --> 00:23:15,040 And the price that is paid by cancer -free patients is tremendous. 339 00:23:15,840 --> 00:23:22,120 What had happened, she was getting into that drug, and she would just use it 340 00:23:22,120 --> 00:23:23,500 every time she got a chance. 341 00:23:24,420 --> 00:23:27,960 And I'd find her laying in the floor on the couch. 342 00:23:28,680 --> 00:23:34,540 I tried hiding it. I locked it in a cabinet with a chain around it, a file 343 00:23:34,540 --> 00:23:39,960 cabinet. But that just pushes Kathleen out, looking for whatever she can find. 344 00:23:40,650 --> 00:23:43,190 Well, she'd be out in the streets buying more drugs. 345 00:23:43,810 --> 00:23:50,730 And it was horrible to sit there and watch a beautiful, fine woman go down to 346 00:23:50,730 --> 00:23:51,730 nothing. 347 00:23:51,830 --> 00:23:56,650 Like many patients at a pain clinic, Kathleen Burns is given a urine test to 348 00:23:56,650 --> 00:24:01,610 make sure that the prescribed drugs, and only the prescribed drugs, are in her 349 00:24:01,610 --> 00:24:05,890 system. And month after month, Kathleen Burns fails the test. 350 00:24:06,750 --> 00:24:09,930 It's clear she needs help, not more opioids. 351 00:24:10,520 --> 00:24:13,560 She should be turned away by the clinic. She should be fired. 352 00:24:14,160 --> 00:24:18,720 But Ron's attitude about firing addicts is explained in an email obtained by 353 00:24:18,720 --> 00:24:19,720 federal investigators. 354 00:24:20,480 --> 00:24:23,320 He says, we fire patients rather infrequently. 355 00:24:23,540 --> 00:24:26,840 In private practice, the more you fire, the more revenue you lose. 356 00:24:27,100 --> 00:24:29,500 So he's basically equating patients to revenue. 357 00:24:29,880 --> 00:24:33,220 And so Kathleen Burns continues to receive substance. 358 00:24:33,720 --> 00:24:38,020 Her insurance company pays $150 ,000 for her prescription. 359 00:24:38,800 --> 00:24:42,200 But then the company, HealthSprings, discovered the truth. 360 00:24:43,100 --> 00:24:48,480 HealthSprings contacted the Burns' and asked about her cancer treatment, to 361 00:24:48,480 --> 00:24:51,480 which the response was, I don't have cancer. 362 00:24:51,800 --> 00:24:57,320 And a letter was then sent to Dr. Ron saying, we're no longer going to approve 363 00:24:57,320 --> 00:25:00,960 her receiving substance prescriptions as she doesn't have cancer. 364 00:25:01,340 --> 00:25:05,780 And that is when Dr. Ron finally asks Kathleen Burns to get out. 365 00:25:06,340 --> 00:25:07,560 Kathleen Burns... 366 00:25:08,140 --> 00:25:12,300 was profitable to him, and while she was profitable, he was going to keep her on 367 00:25:12,300 --> 00:25:16,800 as a patient. But as soon as he could no longer prescribe her this $10 ,000, $15 368 00:25:16,800 --> 00:25:22,420 ,000 a month drug, then she's not worth it to him to keep on anymore. 369 00:25:22,760 --> 00:25:25,260 And profits do matter to Couch and Ron. 370 00:25:25,880 --> 00:25:28,280 Theirs is a very successful clinic. 371 00:25:28,720 --> 00:25:30,320 It was extremely profitable. 372 00:25:30,660 --> 00:25:34,760 They saw a massive number of patients. They did a number of procedures. 373 00:25:36,560 --> 00:25:40,800 Received monies from the CNR pharmacy connected to their building, massive 374 00:25:40,800 --> 00:25:44,760 amounts of monies there. And they received kickbacks, so they were 375 00:25:44,760 --> 00:25:46,240 money on top of money. 376 00:25:46,480 --> 00:25:50,640 And a very good measure of the money they are bringing in is found in their 377 00:25:50,640 --> 00:25:52,420 collection of sports cars. 378 00:25:53,080 --> 00:25:54,080 Bentleys, Mercedes, 379 00:25:54,960 --> 00:26:01,360 Porsches, cars I can't even pronounce, Lamborghinis, high -end cars, well 380 00:26:01,360 --> 00:26:05,620 -maintained. One Porsche that had a Payne MD tag on it. 381 00:26:06,090 --> 00:26:11,630 Not far from where the doctors showcase their luxury cars, Tim Burns is watching 382 00:26:11,630 --> 00:26:13,810 his wife's drug addiction take its toll. 383 00:26:14,250 --> 00:26:18,870 She went from this vibrant woman down to nothing. 384 00:26:19,130 --> 00:26:23,190 And then in the winter of 2015, Kathleen Burns dies. 385 00:26:24,250 --> 00:26:28,850 The morning I woke up, she had passed away sitting up. 386 00:26:30,930 --> 00:26:32,730 That was pretty rough there. 387 00:26:35,630 --> 00:26:37,870 Yeah, I figured I'd be the one to go first. 388 00:26:41,010 --> 00:26:44,590 Up next, Couch and Ron suddenly have a new favorite drug. 389 00:26:44,850 --> 00:26:49,010 It shows a massive spike in prescribing, where it goes from virtually no 390 00:26:49,010 --> 00:26:54,270 micrograms per month to Dr. Ron spiking at over 2 .5 million micrograms per 391 00:26:54,270 --> 00:26:55,270 month. 392 00:27:04,240 --> 00:27:08,800 In Iraq in 2007, Sergeant Patrick Chaussé is on patrol. 393 00:27:09,100 --> 00:27:14,820 A time when roadside bombs like this one were the number one killer of American 394 00:27:14,820 --> 00:27:15,880 soldiers in Iraq. 395 00:27:16,180 --> 00:27:21,720 And one of those IEDs blows up a truck in Chaussé's convoy. He suffers injuries 396 00:27:21,720 --> 00:27:22,760 to his knee and back. 397 00:27:24,000 --> 00:27:29,520 After two tours in Iraq where Chaussé is awarded numerous medals, including the 398 00:27:29,520 --> 00:27:34,640 Global War on Terrorism Service Medal, He makes it home to Mobile, enrolls at 399 00:27:34,640 --> 00:27:38,840 the University of South Alabama, and marries his girlfriend, Amanda. 400 00:27:40,060 --> 00:27:44,340 He proposed to me on a dock out in Daphne on the other side of the bay, and 401 00:27:44,340 --> 00:27:47,500 still in his uniform, so it was great. 402 00:27:47,940 --> 00:27:52,500 But the pain from his injuries continues, and he makes an appointment 403 00:27:52,500 --> 00:27:54,380 specialist, Patrick Couch. 404 00:27:54,840 --> 00:27:56,420 Of course, we didn't see him. 405 00:27:56,720 --> 00:27:58,220 We saw Stacy, 406 00:27:58,940 --> 00:28:01,260 and she was nice. 407 00:28:02,360 --> 00:28:08,260 understanding of you know his pain and immediately nurse anesthetist stacy 408 00:28:08,260 --> 00:28:13,600 madison starts patrick on the usual load of medications in no time the pain is 409 00:28:13,600 --> 00:28:19,200 gone but so is the patrick amanda married it was horrible because he would 410 00:28:19,200 --> 00:28:25,280 be doped out of his mind and and it was just a a cycle of him not being there 411 00:28:25,280 --> 00:28:28,680 anymore this is what it came down to he wasn't there anymore 412 00:28:29,520 --> 00:28:33,700 But that does not stop Patrick from getting more and more narcotics 413 00:28:33,700 --> 00:28:37,340 by a nurse who Amanda believes does not listen. 414 00:28:38,240 --> 00:28:41,380 I let Stacy have it. I was like, you have to take him off this medication. 415 00:28:41,880 --> 00:28:42,880 It was crazy. 416 00:28:43,080 --> 00:28:49,860 I have heard of the situation before where despite family members 417 00:28:49,860 --> 00:28:55,220 plea telling a prescriber, you're going to kill my loved one, please stop, the 418 00:28:55,220 --> 00:28:56,220 prescriber just... 419 00:28:56,480 --> 00:29:02,360 And it's very hard to understand what would motivate that behavior, why 420 00:29:02,360 --> 00:29:08,240 not trying to help that patient get into addiction treatment. And it does make 421 00:29:08,240 --> 00:29:11,120 you wonder if what's behind this is greed. 422 00:29:11,460 --> 00:29:16,740 And that question is amplified in the fall of 2013, when Couch and Ron start 423 00:29:16,740 --> 00:29:18,340 looking at investment opportunities. 424 00:29:19,440 --> 00:29:24,460 So Dr. Ron and Dr. Couch discussed, what company can they buy stock in? 425 00:29:24,940 --> 00:29:29,080 where they can essentially move the needle. This is a big pain practice, and 426 00:29:29,080 --> 00:29:30,080 they own their own pharmacy. 427 00:29:30,340 --> 00:29:34,440 What company could they have an impact on the stock price through their 428 00:29:34,440 --> 00:29:39,800 prescribing? The answer they come up with is Galena Biopharma, the maker of a 429 00:29:39,800 --> 00:29:43,400 drug called Abstral, another instant -release fentanyl. 430 00:29:43,740 --> 00:29:46,360 It is a direct competitor to substance. 431 00:29:47,260 --> 00:29:51,500 Ron writes Couch, this is the product. We can play a big role. 432 00:29:52,060 --> 00:29:53,060 Couch agrees. 433 00:29:53,630 --> 00:29:58,470 And beginning in December 2013, they eventually purchased close to $800 ,000 434 00:29:58,470 --> 00:30:01,390 worth of Galena Biopharma stock each. 435 00:30:02,150 --> 00:30:06,650 And then they start cranking out prescriptions for, you guessed it, 436 00:30:07,330 --> 00:30:11,650 So one of the things that we did was we graphed out certain of the drugs the 437 00:30:11,650 --> 00:30:16,190 doctors prescribed. DEA investigators chart the micrograms of Abstro 438 00:30:16,190 --> 00:30:19,550 by Couch and Ron following the stock purchase. 439 00:30:19,870 --> 00:30:24,720 What's particularly stark about this Abstro chart, is it shows a massive 440 00:30:24,720 --> 00:30:29,020 in prescribing, where it goes from virtually no micrograms per month to Dr. 441 00:30:29,260 --> 00:30:33,760 Ron spiking at over 2 .5 million micrograms per month. That spike 442 00:30:33,760 --> 00:30:38,460 directly with the time period that Dr. Ron and Dr. Couch were talking about and 443 00:30:38,460 --> 00:30:41,940 ultimately buying large amounts of stock in Galena Biopharma. 444 00:30:42,680 --> 00:30:47,080 At the high point, Couch and Ron are writing one -third of all the abstral 445 00:30:47,080 --> 00:30:51,340 prescriptions in the U .S. And that raises the question, are patients 446 00:30:51,340 --> 00:30:54,140 what is good for them or good for the doctors? 447 00:30:54,880 --> 00:30:58,940 You're getting what is going to be profitable for the doctor. The manner in 448 00:30:58,940 --> 00:31:04,100 which the doctors prescribed abstral was not based on patient need, but based on 449 00:31:04,100 --> 00:31:06,380 the financial motivation of the doctor, the stockholder. 450 00:31:07,360 --> 00:31:12,720 And according to trial testimony, executives at Insys Therapeutics, makers 451 00:31:12,720 --> 00:31:17,520 Sepsis, are concerned that because its top prescribers are prescribing Abstro, 452 00:31:17,640 --> 00:31:19,680 they may lose out to the competition. 453 00:31:20,500 --> 00:31:26,340 And so John Kapoor, the founder of Insys and other top brass, pay a visit to 454 00:31:26,340 --> 00:31:30,160 Mobile in February. They need to keep their big customers happy. 455 00:31:30,700 --> 00:31:31,940 This is extraordinary. 456 00:31:32,300 --> 00:31:33,520 This is a billionaire. 457 00:31:34,280 --> 00:31:40,140 founder of a massive pharmaceutical company who's flying to Mobile, Alabama 458 00:31:40,140 --> 00:31:41,900 meet with Dr. Ron and Dr. Couch. 459 00:31:42,140 --> 00:31:43,700 That's how much power Dr. 460 00:31:43,900 --> 00:31:46,640 Ron and Dr. Couch had over Insys Therapeutics. 461 00:31:46,920 --> 00:31:51,220 And following the meeting, the doctors are given a better deal on the delivery 462 00:31:51,220 --> 00:31:52,240 of subsists. 463 00:31:52,700 --> 00:31:58,540 So the deal was that Insys would do direct supply to CNR Pharmacy, cutting 464 00:31:58,540 --> 00:32:02,620 the wholesaler, saving Couch and Ron 5 % to 8 % on profits. 465 00:32:03,240 --> 00:32:07,600 If only the patients taking the drugs mattered as much as the profits that are 466 00:32:07,600 --> 00:32:08,600 made from them. 467 00:32:09,160 --> 00:32:13,940 That's what Amanda Chausset says she is wishing every day, and especially on 468 00:32:13,940 --> 00:32:18,460 April 2nd, the day she learns from doctors at the local emergency room that 469 00:32:18,460 --> 00:32:19,580 Patrick has died. 470 00:32:20,320 --> 00:32:25,140 He recently had pneumonia, which weakened his lungs, and then he was 471 00:32:25,140 --> 00:32:27,260 on a high level of oxymorphone. 472 00:32:27,960 --> 00:32:29,460 Likely what happened is that you... 473 00:32:29,740 --> 00:32:33,660 decreased his lung level to such a degree that he just was unable to 474 00:32:37,340 --> 00:32:41,760 In Amanda's mind, there is no question that if he had not been taking the 475 00:32:41,880 --> 00:32:43,380 Patrick would be alive. 476 00:32:44,320 --> 00:32:48,700 He lost his life because he was seeing a doctor that prescribed him that 477 00:32:48,700 --> 00:32:51,700 medication, and he winds up dying under his care. 478 00:32:52,520 --> 00:32:56,500 So, yeah, there's no doubt in my mind that those drugs that he was prescribing 479 00:32:56,500 --> 00:32:57,780 killed him. 480 00:32:59,210 --> 00:33:04,350 The loss of Patrick Chaussé draws attention from strangers who send 481 00:33:04,350 --> 00:33:09,110 for someone they say they consider a hero, a 27 -year -old man who was ready 482 00:33:09,110 --> 00:33:10,170 die for his country. 483 00:33:11,010 --> 00:33:14,010 He did two tours, and then to come back to that? 484 00:33:14,590 --> 00:33:16,370 To trust somebody in your own country? 485 00:33:17,450 --> 00:33:18,450 For greed? 486 00:33:19,250 --> 00:33:20,250 For money? 487 00:33:20,730 --> 00:33:21,850 It's something horrible. 488 00:33:26,700 --> 00:33:31,340 Up next, what an undercover agent discovers about Patrick Couch. 489 00:33:33,840 --> 00:33:34,400 For 490 00:33:34,400 --> 00:33:42,800 almost 491 00:33:42,800 --> 00:33:47,460 a year, Tammison Witherspoon lives in the hell of her addiction to fentanyl. 492 00:33:47,740 --> 00:33:52,280 By this time, I needed, I was taking it so I wouldn't get sick. I was taking it 493 00:33:52,280 --> 00:33:53,280 so I wouldn't. 494 00:33:53,340 --> 00:33:57,180 I felt like I was dying because my heart rate would drop so low, and I would 495 00:33:57,180 --> 00:34:01,100 sweat so bad, you know, nausea, and it was awful. 496 00:34:01,840 --> 00:34:05,980 And so Witherspoon worked hard to never miss an appointment with nurse 497 00:34:05,980 --> 00:34:10,780 practitioner Bridget Parker, who, according to Witherspoon, is still 498 00:34:10,780 --> 00:34:11,880 with her own addiction. 499 00:34:12,920 --> 00:34:16,360 My last visit with her, she was passing out. 500 00:34:16,760 --> 00:34:20,120 She was sitting in a chair writing prescriptions, and her head just slumped 501 00:34:20,120 --> 00:34:23,560 over, and she went to sleep for 10 minutes. And I was sitting there going 502 00:34:23,560 --> 00:34:29,580 through in my mind saying, if my nurse is addicted to drugs, it's no hope for 503 00:34:29,580 --> 00:34:34,840 me. And when I left that day, I just cried and I cried and I cried. I didn't 504 00:34:34,840 --> 00:34:37,920 know that this was going to be the turning point, but I kept thinking about 505 00:34:37,920 --> 00:34:38,920 I saw Bridget. 506 00:34:38,960 --> 00:34:41,739 And I called my husband, and I said, I'm going to rehab. 507 00:34:42,760 --> 00:34:47,420 Like Bridget Parker, Justin Palmer continues to abuse the clinic's drugs. 508 00:34:47,780 --> 00:34:52,440 At one point, a medical assistant finds him passed out in an exam room with a 509 00:34:52,440 --> 00:34:56,199 needle in his arm. And now everyone knows he is using. 510 00:34:56,699 --> 00:34:58,460 And when Dr. 511 00:34:58,680 --> 00:35:02,220 Couch found out, he told me to take a couple weeks off and get my head 512 00:35:04,170 --> 00:35:08,890 So I did. I took a couple weeks off, and nothing changed. I kept doing what I 513 00:35:08,890 --> 00:35:09,509 was doing. 514 00:35:09,510 --> 00:35:14,270 And while the problems at PPSA are swept under the rug, an undercover agent from 515 00:35:14,270 --> 00:35:16,910 the DEA is posing as a patient. 516 00:35:17,230 --> 00:35:20,790 Now, without hurting yourself, I want you to bend over like this as far as you 517 00:35:20,790 --> 00:35:24,230 can. He is seen by nurse anesthetist Stacy Madison. 518 00:35:24,790 --> 00:35:25,689 Watch this. 519 00:35:25,690 --> 00:35:27,750 This is the undercover doing the range of motion test. 520 00:35:27,970 --> 00:35:31,590 He's going to stand up, he's going to bend over, bend backwards, and bend side 521 00:35:31,590 --> 00:35:32,428 to side. 522 00:35:32,430 --> 00:35:35,070 His range of motion is what a normal person would have. 523 00:35:36,410 --> 00:35:42,290 And then 524 00:35:42,290 --> 00:35:49,150 the undercover agent admits he has been getting pills off the street. 525 00:35:55,650 --> 00:36:01,070 Definitely a sign of a drug -seeking addict. 526 00:36:01,370 --> 00:36:03,670 Does that help you with your pain? Of course it helps you with your pain. 527 00:36:03,670 --> 00:36:05,810 what I want you to prescribe me, and that's what I want to get. 528 00:36:07,070 --> 00:36:08,070 Finally, 529 00:36:09,770 --> 00:36:14,130 Couch walks into the room and almost immediately signs a prescription for 15 530 00:36:14,130 --> 00:36:16,610 milligrams of Roxycodone and leaves. 531 00:36:19,510 --> 00:36:24,210 So in 43 seconds, his doctor meets with the patient. 532 00:36:24,560 --> 00:36:27,020 and gets a prescription for a controlled substance and leaves. 533 00:36:27,280 --> 00:36:31,080 Tonight, the Fed have made hundreds of arrests in a major crackdown on the 534 00:36:31,080 --> 00:36:35,780 illegal distribution of powerful prescription painkillers. Surprise raids 535 00:36:35,780 --> 00:36:41,080 doctors and pharmacies. In the morning of May 20, 2015, 1 ,000 law enforcement 536 00:36:41,080 --> 00:36:46,040 officers spread out across four southern states in a major DEA offensive 537 00:36:46,040 --> 00:36:50,260 designed to combat the epidemic of opioid addiction sweeping the country. 538 00:36:51,020 --> 00:36:56,320 The four -state arrest sweep in Arkansas, Alabama, Louisiana, and 539 00:36:56,320 --> 00:37:01,600 the biggest pharmaceutical case in DEA history. In all, 280 doctors, 540 00:37:02,040 --> 00:37:07,120 pharmacists, and drug traffickers are arrested, including Shuluran and Patrick 541 00:37:07,120 --> 00:37:08,120 Couch. 542 00:37:08,480 --> 00:37:12,080 Next, a young widow has her say in court. 543 00:37:12,440 --> 00:37:16,340 It felt good so that I can try to be Patrick's voice. 544 00:37:27,240 --> 00:37:31,340 2015, the FBI raided Physicians' Pain Specialists of Alabama. 545 00:37:31,760 --> 00:37:36,200 For almost two years in Mobile, the criminal prosecution of Patrick Couch 546 00:37:36,200 --> 00:37:39,160 Shulu Ran is covered in the nightly newscasts. 547 00:37:39,440 --> 00:37:44,020 Investigators say the doctors orchestrated a lucrative prescription 548 00:37:44,020 --> 00:37:47,480 game. Finally, the trial opens in January 2017. 549 00:37:48,600 --> 00:37:52,420 Opening statements began today in the federal trial involving two pain 550 00:37:52,740 --> 00:37:56,660 Couch and Rod have pleaded not guilty to a long list of felony charges, 551 00:37:56,780 --> 00:38:01,920 including RICO, conspiracy to illegally prescribe controlled substances, health 552 00:38:01,920 --> 00:38:06,440 care, wire and mail fraud, and violations of the anti -kickback 553 00:38:07,120 --> 00:38:11,680 From day one, the prosecutors know they are faced with convincing a jury of what 554 00:38:11,680 --> 00:38:13,400 seems improbable. 555 00:38:13,660 --> 00:38:15,140 It's a difficult case. 556 00:38:17,800 --> 00:38:23,080 Two men who are highly educated would trade their ability to continue to 557 00:38:23,080 --> 00:38:26,580 practice medicine for a fistful of dollars. 558 00:38:27,880 --> 00:38:32,860 Both Ron and Couch did not respond to requests for comments from American 559 00:38:33,000 --> 00:38:35,100 but they do testify in their trial. 560 00:38:35,320 --> 00:38:38,800 Ron points out that he has impeccable credentials. 561 00:38:39,440 --> 00:38:43,060 His argument was, look, I am an expert doctor. 562 00:38:43,260 --> 00:38:46,600 I know exactly what goes on with my patients. 563 00:38:47,100 --> 00:38:52,940 I am the greatest doctor in the area. And in fact, I'm a world record holder 564 00:38:52,940 --> 00:38:56,260 number of board certifications. And therefore, the government should not be 565 00:38:56,260 --> 00:39:00,300 telling me how to treat a patient, particularly since the drugs I'm giving 566 00:39:00,300 --> 00:39:02,480 are alleviating pain. 567 00:39:02,840 --> 00:39:07,900 In his defense, Couch says he was unaware that the nurse practitioners 568 00:39:07,900 --> 00:39:08,900 using opioids. 569 00:39:09,200 --> 00:39:11,040 They trusted the nurse practitioners. 570 00:39:11,300 --> 00:39:14,140 How could they know that nurse practitioners were? 571 00:39:14,620 --> 00:39:18,580 High at work, falling asleep at work, injecting Dilaudid into the arm at work, 572 00:39:18,780 --> 00:39:22,440 stealing drugs from other patients. How would they know that? Well, you should 573 00:39:22,440 --> 00:39:25,020 have known it. You're the doctor. You're operating this clinic. 574 00:39:25,300 --> 00:39:30,560 It's your job to know. And one by one, people who work beside them plead guilty 575 00:39:30,560 --> 00:39:32,660 and testify against the doctors. 576 00:39:33,240 --> 00:39:38,220 Incis sales representative Natalie Perhax pleads guilty to charges of 577 00:39:38,220 --> 00:39:39,560 the anti -kickback statute. 578 00:39:40,250 --> 00:39:45,130 Nurse practitioners Bridget Parker and Justin Palmer plead guilty to charges of 579 00:39:45,130 --> 00:39:48,070 conspiring to illegally prescribe controlled substances. 580 00:39:48,710 --> 00:39:51,630 Palmer is sentenced to 30 months in prison. 581 00:39:52,790 --> 00:39:57,690 This has basically destroyed my life as well as, you know, my family. 582 00:39:58,130 --> 00:40:03,410 I think the shame and embarrassment of it all is the worst. 583 00:40:04,700 --> 00:40:09,260 But PPSA doctors and staff are not the only ones facing criminal charges 584 00:40:09,260 --> 00:40:10,600 surrounding subsists. 585 00:40:11,800 --> 00:40:16,900 Executives at Insys Therapeutics, including founder John Kapoor, are also 586 00:40:16,900 --> 00:40:21,900 indicted. In a case that is still ongoing, they have pleaded not guilty to 587 00:40:21,900 --> 00:40:25,620 charges that include bribing doctors to sell their product and misleading 588 00:40:25,620 --> 00:40:31,140 insurance companies, all as part of a conspiracy to illegally profit from a 589 00:40:31,140 --> 00:40:32,140 controlled substance. 590 00:40:32,960 --> 00:40:38,120 It is truly a conspiracy between the doctors, nurse practitioners, and the 591 00:40:38,120 --> 00:40:43,840 pharmaceutical companies to get as much opioid products to the patient and onto 592 00:40:43,840 --> 00:40:48,620 the streets. I mean, one can't work without the other. It was truly like a 593 00:40:48,620 --> 00:40:51,480 on a wheel. You had to stay together in order for it to roll. 594 00:40:52,420 --> 00:40:55,300 Couch and Ron's trial lasts seven weeks. 595 00:40:55,640 --> 00:41:00,580 Eighty -one witnesses testify, and among those who take the stand is Amanda 596 00:41:00,580 --> 00:41:01,580 Chausset. 597 00:41:02,000 --> 00:41:06,460 It felt good so that I can try to be Patrick's voice. 598 00:41:06,760 --> 00:41:11,140 And finally, she gets to lay eyes on the doctor who was responsible for 599 00:41:11,140 --> 00:41:12,140 Patrick's care. 600 00:41:12,420 --> 00:41:14,160 I just felt angry. 601 00:41:14,680 --> 00:41:16,560 It was disgust, sadness. 602 00:41:17,100 --> 00:41:21,780 It was, how could you do that to somebody? 603 00:41:23,760 --> 00:41:26,320 All out of greed, out of money. 604 00:41:28,000 --> 00:41:32,660 After a few days of deliberation, the jury finds both doctors guilty of 605 00:41:32,660 --> 00:41:37,220 conspiracy to illegally prescribe controlled substances, to commit wire, 606 00:41:37,440 --> 00:41:40,540 and health care fraud, and to receive illegal kickbacks. 607 00:41:41,520 --> 00:41:46,400 Couch receives a sentence of 20 years, and Ron is sentenced to 21. 608 00:41:47,120 --> 00:41:52,740 The judge noted in her sentencing that the reason that she gave Ron more is he 609 00:41:52,740 --> 00:41:55,560 agreed with the United States in our position that... 610 00:41:55,960 --> 00:41:59,800 Couch, left to his own devices, probably could not have pulled off what happened 611 00:41:59,800 --> 00:42:05,040 here. And that Dr. Ron was the manager and the driving force of the massive 612 00:42:05,040 --> 00:42:07,320 amount of greed that occurred at PBSI. 613 00:42:12,820 --> 00:42:15,740 Crime absolutely pays, and it pays a lot. 614 00:42:16,020 --> 00:42:19,560 An arrogant auction house with a collectible fraud that scams millions. 615 00:42:20,000 --> 00:42:22,420 He had to tell people, I pulled one on the world. 616 00:42:22,720 --> 00:42:24,320 American Greed, coming up next. 617 00:42:24,860 --> 00:42:26,640 CNBC. Get yours.