A federal jury on Friday acquitted a doctor and a physician assistant who briefly worked at a now-closed "pill mill" in west Little Rock, but convicted their co-worker, nurse practitioner Kristen Raines.
All were charged with conspiring to distribute hydrocodone, a pain medication classified as a Schedule II controlled substance, and alprazolam, an anti-anxiety medication commonly known as Xanax and classified as a Schedule III controlled substance, while working in 2014 at the Artex Medical Clinic in a suite of offices at 11215 Hermitage Road.
Raines also worked at the clinic's successor, the KJ Medical Clinic in the same location, until it was shut down in May 2015 as a result of a Drug Enforcement Administration raid.
Neither Dr. Felicie Wyatt, physician assistant Aaron Borengasser nor Raines disputed that the clinics were "pill mills" -- which appear to be legitimate pain clinics from the outside but are actually set up to make money by feeding the illicit drug market, where the prescription drugs are highly sought after. But all the defendants said they didn't know at the time that they were working in a pill mill.
During a two-week jury trial in the Little Rock courtroom of U.S. District Judge James Moody, officer Mike Welborn, who led a DEA task force investigation of the clinics, testified that there is generally "a very large profit margin" for those who sell the prescription drugs on the street.
He said a single 10 mg hydrocodone tablet sells for $5 to $8 on the street, while someone would ordinarily pay about $40 for a prescription of 120 of the tablets. A prescription for 60 Xanax pills would cost about the same, he said, but on the street, the pills, known as "bars" because of their shape, go for $1 to $7 apiece.
Assistant U.S. Attorney Anne Gardner told jurors that under the direction of the clinic owners, who are being prosecuted in federal court in Texas, the health care professionals routinely prescribed a "trinity" of drugs -- a narcotic, a benzodiazepine/depressant and a noncontrolled substance such as an antibiotic or muscle relaxer -- to patients who sometimes camped out overnight at the clinic and then fought to be the first in line when it opened, and paid $150 or $200 cash to be examined.
The patients at Artex were seen by Borengasser, and later by Raines when she replaced him. Both were authorized to prescribe drugs under the authority of a supervising physician, which included Wyatt and other doctors -- two of whom pleaded guilty before the trial began and another who died and was never charged.
Some of the patients were homeless or poor people who were rounded up and driven to the clinic in groups by drug distributors who paid them to fake ailments to obtain the prescriptions, said Gardner and Assistant U.S. Attorney Allison Bragg.
Wyatt, 42, lives in Jackson, Miss., where she was working part time at a Veterans Affairs hospital when she answered an online ad to be a supervising physician at the Artex clinic. She said she had no idea the newly forming clinic was anything but a legitimate clinic. She said the position was attractive because, while the clinic was in Little Rock, her supervisory job required her to be present only about once a week to review patient charts and prescriptions issued by midlevel providers, such as Borengasser and Raines.
Wyatt said she quit after about two months after having a discussion with Borengasser about his troubling habit of routinely prescribing maximum doses and quantities of the pills for nearly every patient he saw. She said he told her he was only following the protocol that she had established. Wyatt said that's when she learned that while the clinic owner told Borengasser that she created the protocol, he had told her that another physician created it.
Concerned about the conflicting information, she said, she did some research and discovered that the owner was a convicted felon. It was time to quit anyway, she said, because she had just learned that her part-time job in Mississippi had become available on a full-time basis, and treating veterans was her specialty.
One of Wyatt's attorneys, Richard Mays of Little Rock, said after the verdict that the Mississippi hospital had placed Wyatt on indefinite suspension when she was indicted in the federal case, but he feels confident that now "she will get her job back."
In Arkansas, where Wyatt is also licensed to practice medicine, "she'll have to address some issues, but she wants to do that, and I think her license will be reinstated," he said.
As a result of the innocent verdict, Borengasser, 36, of Little Rock "will get his DEA license back," his attorney, Darren O'Quinn, said Friday. O'Quinn, who is also a pharmacist, said Borengasser lost his job at a medical clinic in Cabot after federal agents arrested him there in May 2015 and "perp-walked him out" through the waiting room in front of patients.
The license allows Borengasser to prescribe medication under the guidance of a physician, but O'Quinn said that even after the license is restored, Borengasser will have a "taint" on him that might make it hard to find another job.
"He's smart, but naive in street smarts," O'Quinn said of his client. He said Borengasser "really loved" his job in Cabot, where he was able to practice the kind of family medicine that is his specialty.
Borengasser testified that he took the job at Artex because he desperately needed a job but quit after only 13 days because he didn't feel comfortable prescribing so much pain medication. Though he acknowledged that the Artex job didn't "feel right," he said he believed the patients to whom he gave out prescriptions actually needed them.
He said they had all indicated a high level of pain or anxiety on a chart they had to fill out in the waiting room before getting back to see him. Also, employees in the clinic's front office were responsible for checking the Prescription Monitoring Program before sending patients back to him. The program keeps tracks of prescriptions filled statewide for controlled substances so that doctors can make sure a patient isn't "doctor shopping" or hasn't had a similar prescription filled in the past 30 days.
In closing arguments Thursday, O'Quinn told jurors that while Borengasser was accused of being "willfully blind" to the fact that he was working in a pill mill after just two weeks, the DEA investigator's office was in a nearby building, and, "It took him nine months to figure it out."
O'Quinn suggested that the government's expert witness, Dr. J. Carlos Roman of Little Rock, who testified that records from nine patients showed that the three defendants practiced medicine "outside the bounds of acceptable medical practices," merely testified to make money.
"He was a jukebox expert," O'Quinn said. "You drop $20,000 into him and he will play any tune the government wants him to play."
Only nine of 233 patients' charts were found when officers raided the clinic; the others had all been shredded.
Raines, 39, of Little Rock was absent from the courtroom during much of the trial because she was recovering from surgery, according to her attorneys. While Raines testified that she had no idea she was working at a pill mill at the time, prosecutors noted that she worked there longer than the others, first at Artex and then at KJ, and would have had plenty of clues during that time to know she was violating the law.
Attorneys Charles Hicks and Deborah Linton Ferguson, who represented Raines, said she was uncomfortable about practices at the clinic and was going to resign from Artex shortly before Wyatt did, but Wyatt "beat her to the punch," and then her job wasn't needed without a supervising physician in place. When the clinic reopened as the KJ Clinic, Raines didn't know that the owner of Artex still had some ownership in the business, Ferguson said.
"We can all look back and say yes, Artex and KJ were pill mills," Ferguson told jurors. "But we're here today to determine what Kristen Raines knew at the time."
Despite finding Raines guilty on the conspiracy charge, jurors acquitted her on two individual counts of distributing the drugs without an effective prescription.
Several other people who were indicted last year in Operation Pilluted, a DEA prescription-drug investigation spanning several states, are still awaiting trial in separate cases.
A Section on 08/13/2016