Opinion ID: 3153469
Heading Depth: 2
Heading Rank: 3

Heading: East Health Center’s Operation

Text: East Health Center opened its doors on February 21, 2011. LeFrancois testified that patients paid $250 to $300 to see a doctor and receive a prescription. Patients had to present a recent MRI in order to see a doctor, so that there could be documentation of a chronic-pain injury warranting medication. In order to obtain an oxycodone prescription, patients also had to provide a urine sample to establish that they already had oxycodone in their systems. They could not be seen by a doctor unless they passed the urine test. Barbuscia and Afthinos testified that they were “marketers” for East Health Center. In this capacity, they attempted to recruit clients by intercepting people as they were visiting other pain clinics, talking to people at gas stations and low-scale hotels, and looking for “raggedy” out-of-state cars. Barbuscia would hand out fliers advertising “incentives” at the clinic. Barbuscia agreed that clients he was targeting looked like “zombies” or “addicts.” LeFrancois wanted to keep a low profile, so he limited the number of patients that could visit the clinic each day and encouraged patients to park in alternative parking lots so that their out-of-state license plates would not attract 8 Case: 14-13703 Date Filed: 11/10/2015 Page: 9 of 60 attention. LeFrancois stocked East Health Center with limited medical supplies and some health-related posters. There were security cameras to deter patients from stealing from the clinic. The clinic never dispensed medication on site. East Health Center employees audited the cash each day. The clinic used patients’ cash payments to pay the doctors’ salaries, purchase lunch, pay for the employees’ rental house, pay the clinic’s lease, and cover any expenses such as electrical work and cable. The remaining cash was deposited at a bank at the end of each day. An agent from the Chatham-Savannah Counter Narcotics Team visited the clinic during the first two days of its operation. The agent advised LeFrancois that he needed more medical supplies to meet minimum requirements. LeFrancois went shopping and purchased the necessary equipment, which he agreed functioned as “prop[s].”
Dr. Azmat was the only doctor working at the clinic at its inception. He began on February 21, 2011, and was terminated on March 18, 2011. According to Wise, the office manager at East Health Center, Dr. Azmat was aware of the clinic’s marketing techniques because they were openly discussed within the office. Dr. Azmat knew that patients paid in cash and saw them congregating in 9 Case: 14-13703 Date Filed: 11/10/2015 Page: 10 of 60 front of the clinic. Wise paid Dr. Azmat in cash each day “[f]rom the daily take of whatever came in.” Furthermore, according to Wise, while Dr. Azmat may have been unaware of the terminology or the particulars of the financial arrangements, Dr. Azmat knew that “sponsors” would bring groups of patients to the clinic. Wise explained that “sponsors” were pill seekers who would pay for patients’ appointments in exchange for a portion of the pills prescribed during the visit. Wise had entered a guilty plea related to his involvement in the clinic. LeFrancois testified that he fired Dr. Azmat primarily because Dr. Azmat did not give patients what they expected to be prescribed, and pharmacies were refusing to fill his prescriptions. Wise confronted Dr. Azmat about why he was reducing prescriptions, and, according to Wise: Dr. Azmat would get frustrated and explain that it was his license on the line, that he wasn’t going to do what they wanted him to do, and he would increase the patients’ prescription on their next visit. He wanted to show that they weren’t starting off at a high amount. He wanted to show that they were getting less than what they were getting at a previous clinic. Barbuscia similarly testified that patients were angry that Dr. Azmat was not writing heavy enough prescriptions. Aside from issues with the prescriptions, LeFrancois was also upset that Dr. Azmat was refusing to treat patients seeking primary care because he did not have the proper medical malpractice insurance. Afthinos added that the clinic 10 Case: 14-13703 Date Filed: 11/10/2015 Page: 11 of 60 directors were angry that Dr. Azmat was spending 15 to 20 minutes with each patient, which was too long. The negative feelings against Dr. Azmat were compounded by the fact that he was an outsider to the group who had previously worked together in Florida.
After the clinic fired Dr. Azmat, Dr. Ken Gossett took his place. Dr. Gossett testified that he understood that the patients paid in cash for his services and were seeking oxycodone. The only time that he did not prescribe a patient oxycodone was when he could not find a justification for doing so based on the patient’s medical records or complaints. When this happened, the patient would get a refund. Dr. Gossett also testified that he recognized that it would be odd for patients experiencing intense pain to travel hours from home to see a doctor. When asked whether it was apparent that many of his patients were drug abusers, Dr. Gossett responded: “It seemed that they acquired a lot of pain medicine, yes.” Finally, Dr. Gossett clarified that, as a doctor, he had a license to prescribe medicine, not a license to dispense medicine.