A federal jury began deliberating late Thursday afternoon on charges against a doctor, a nurse practitioner and a physician assistant who worked at a Little Rock clinic in 2014 that was shut down last year after being declared an illegal "pill mill."
U.S. District Judge James Moody Jr. sent jurors home for the evening about two hours later, with instructions to resume deliberations at 9 a.m. today on charges against Dr. Felicie Wyatt of Jackson, Miss., and central Arkansas residents Kristen Raines, a nurse practitioner, and Aaron Borengasser, a physician assistant.
All are charged with conspiracy to distribute hydrocodone and Xanax, both controlled substances, without an effective prescription. Raines is also charged with two separate counts of illegally distributing the drugs on two specific dates.
All three contend that they didn't know at the time that the Artex clinic, for which they worked briefly during 2014, was a front for the illegal distribution of the popular prescription drugs that sell for high prices on the streets.
Wyatt said she quit working for the clinic after about two months, after she learned that one of the clinic owners told Borengasser that the prescribing protocol he had to follow, with which she disagreed, was created by her. She said she then looked further, discovering that the man who had hired her had a criminal record.
Borengasser testified that he had been led to believe that Wyatt wanted the protocol followed. He later told Drug Enforcement Administration officers that he had felt uncomfortable prescribing high quantities of maximum-dose narcotics but stayed on at the clinic for three weeks out of financial necessity until he found another job in Cabot.
Raines took over for Borengasser, and also worked briefly at the KJ Medical Clinic that opened in the same location, under one of the same owners, after the Artex clinic closed its doors in response to a reclassification of hydrocodone. The reclassification required stricter physician oversight for prescribers.
Assistant U.S. Attorney Anne Gardner said the three were among others who joined the "train of conspiracy" by continuing to work at the clinic despite knowing, shortly after starting work, that something wasn't right.
"They either knew it, or chose not to know it to such a degree that their knowledge can be implied," Gardner told jurors in her closing arguments Thursday. "Everyone testified that they thought it was a legitimate practice ... but at some point, they knew -- and that's the reality we're working with here."
Gardner said Borengasser was given the name "The Bullet" because, during training at clinics run by the same owners in Texas, "he could see more patients than anyone else."
She said that's why the owners hired him to get the Artex clinic in Little Rock started. She noted that according to records, the first 15 patients seen at the clinic on its first day of operation all received 120 20mg hydrocodone tablets and 60 2mg Xanax tablets -- the maximum dosage and quantity allowed -- and that all of them came from El Dorado.
She told jurors that according to a woman who testified she was hired to recruit patients, "They took at least 1,000 pills a day to El Dorado for distribution."
And that was just from one recruiter, Gardner said, reminding jurors of testimony over the last two weeks that "there were five regulars."
The same dosage and quantity was echoed in other prescriptions that followed, even though in some of them a noncontrolled substance was added, she said. So, "you're seeing 20 to 30 new patients every day, and every patient coming out of there gets the exact same prescription."
"Those are the drugs that sell, and those are the drugs that patients came in to get," she said, explaining why that protocol was in place.
Attorneys for the defendants didn't dispute that the clinic was a "pill mill," but they insisted that the professional appearance and charm of the owner who hired them, Stanley James, convinced each of them that the clinic was a legitimate primary care operation.
Attorney Darren O'Quinn told jurors that Borengasser, who worked at Artex for just 13 days, issued the prescriptions only for patients who described pain and anxiety, which are "legitimate medical purposes," having no reason to believe that the patients were recruited from the streets and lied about their conditions.
He noted that James, who has pleaded guilty in Texas, testified that he didn't tell the people he hired about his "criminal plans" for the clinic, because he "needed a legitimate medical practitioner to make it work."
Attorney Richard Mays, representing Wyatt, told jurors, "There is nothing wrong with people coming in and complaining about pain, and treating that patient for pain. Doctors treat patients. They are not DEA agents."
Mays asserted that "the system was designed to fool the doctor, the physician's assistant and the nurse."
He noted that even the general manager of the clinic, Christopher Manson, testified that he didn't realize the clinic was a "pill mill" until after he left.
Manson also pleaded guilty in the case.
Deborah Ferguson, an attorney representing Raines, told jurors that in this case, the government was simply "wrong" in assuming that just because someone worked for the clinic, they knew it was engaged in illegal activities.
"Kristen Raines was not willfully burying her head in the sand," Ferguson said. "She was going to work and getting a normal nurse's salary."
Manson testified that staff members, including Raines, were routinely paid in cash, but Ferguson said the only evidence of money Raines received from the clinic was in the form of checks that indicate she wasn't overpaid.
"Doctors are duty-bound to take patients at their word," she said. "There can be a lot of doctors prosecuted if they [law enforcement officers] send in patients to lie to them."
Metro on 08/12/2016