Doctors get rich from kickbacks from drug maker

Posted at 11:12 AM, Feb 20, 2018
and last updated 2018-02-20 11:12:57-05

MOBILE, AL (RNN) - Tamisan Witherspoon lost her marriage, her home and her health while two Alabama pain doctors amassed a fortune at her expense.

The suburban soccer mom turned couch-potato addict - who overdosed weekly from opioids - blames Drs. John P. Couch and his partner Xiulu Ruan for her prescription pill hell.

Public records show the doctors bought luxury cars and lived the good life on the backs of Witherspoon and other patients by prescribing the powerful painkiller Subsys in return for kickbacks from the company that makes the drug.

Tamisan Witherspoon, 40, reflects on the year she lost when she was addicted to opioids prescribed to her by a doctor. “I became addicted to Subsys within the first week. Just like that,” she said, snapping her fingers for emphasis. (Source: Jon Turnipseed/Raycom Media)

Witherspoon is one of the lucky patients. She survived her addiction to?Subsys, a spray form of the opioid fentanyl that’s 100 times stronger than morphine and intended for cancer patients. 

As many as 240 other Couch and Ruan patients died, according to the Drug Enforcement Agency. Both doctors are currently serving federal prison terms for illegal drug prescribing conduct.

Witherspoon says she has never had cancer and should not have been treated with Subsys. “The only reason I was - so somebody could get paid and get rich,” Witherspoon told Raycom Media in an interview earlier this month. “That’s it. It was not because I needed it. I did what they told me. And became an addict.”

Her somber story of addiction illustrates the consequences of pharmaceutical companies courting doctors willing to prescribe opioids in exchange for dollars for consulting fees, meals and travel.

In the opioid crisis gripping the nation, Subsys is small fish. Fewer than 0.02 percent of the 52 million opioid patients were prescribed the drug in 2015, according to the drug’s maker Insys Therapeutics. The company did not return a request for comment. 

The Arizona-based company has attracted scrutiny for its marketing tactics and payments to medical providers who prescribe Subsys.

John Kapoor, the founder and then chairman of Insys, was arrested last year on federal charges, including racketeering and conspiracy to violate the anti-kickback law - which is designed to protect patients and health care programs from the corrupting influence of money.

John Kapoor walks outside a courthouse where he is facing criminal charges for racketeering. He is the founder of Insys Therapeutics, which aggressively marketed the cancer painkiller, Susbys, to doctors. (Source: Associated Press)

But some prescribers of Subsys who accepted Insys payments have not faced similar fates and still practice medicine. 

Of the top 20 recipients of Insys payments from 2013 to 2016, all but one have active medical licenses in their state as of Feb.14, according to a Raycom Media investigation.

Pharmaceutical companies seeking to market their drugs spend billions of dollars in payments to doctors for consulting, promotional speaking, meals and research. The companies are required to report the payments to the federal government.

The federal data shows Insys, a specialty drug company, isn’t even among the top 50 companies that paid doctors. But an expert familiar with bad behavior by pharmaceutical companies says Insys took doctor payments to a new level.

“Insys really sort of set a new bar for sliminess - flat-out bribing doctors to prescribe the most dangerous class of opioid on the market,” said Andrew Kolodny, co-director of the Opioid Policy Research Collaborative at Brandeis University (left).

Over a four-year period, Insys paid $18.7 million to more than 13,000 doctors for food, consulting fees and travel, federal records show.

When the Food and Drug Administration approved Subsys in 2012, it stated that Insys could only market the drug for cancer patients already on painkillers. Providers have a choice to prescribe the drug to non-cancer patients, but must complete educational requirements before issuing Subsys.   

Half of the Insys payments went to physicians specializing in cancer or pain treatment. The rest of the payments - worth $7.6 million - went to doctors such as psychologists, sports medicine physicians and a marriage therapist.

Dr. Todd Schlifstein of New York is one of the paid medical practitioners who specializes in sports medicine. But while Insys was buying him more than a $100,000 in meals, travel and consulting fees, Schlifstein was tweeting about Botox and lip fillers to promote his medical spa business.

His partner, Dr. Jeffrey L. Goldstein, was one of Insys’ top recipients in 2014, receiving $122,000 that year. Government filings listed Goldstein as a doctor in emergency medicine. His bio promoted his “holistic” approach to care and “love for athletics and anti-aging medicine.”

Together, Goldstein and Schlifstein were paid more than $360,000 by Insys from 2013 to 2015. During that time, the two doctors also prescribed $5.5 million worth of the opioid Subsys to Medicare patients. Both still have active licenses. Schlifstein was placed on a three-year probation by the NY Medical Board for misprescribing controlled substances. 

Goldstein and Schlifstein did not return our request for comment.

The more money doctors receive from drug companies, the more brand-name drugs they tend to prescribe, a 2016 ProPublica investigation found.

Dr. Ed Lubin, of Florida, who specializes in pain treatment, received $160,000 from Insys during a four-year period. According to Medicare Part D data, Lubin wrote the third highest number of Subsys prescriptions in the country from 2013 to 2015. His license is still active.

In 2016, Lubin changed clinics and said in an email that his compensation was in exchange for lectures he gave to fellow medical professionals.

“At no time did I advocate, either in my lectures or in discussion with colleagues for the use of Subsys for any condition other than cancer pain," he said. 

Lubin didn’t answer when he was asked if he prescribed Subsys to non-cancer patients.

Subsys is a fentanyl spray applied under the tongue. It was approved for cancer patients. (Photo courtesy of the U.S. Drug Enforcement Agency)

Katie Koziara, spokesperson for the trade group Pharmaceutical Research and Manufacturers of America, said physicians’ prescriptions are based on a wide variety of factors, including patients’ needs. 

She said collaboration between drug companies and doctors “not only helps advance patient care, but is essential in the development of new treatments and diagnostics.”

To help guide that collaboration, PhRMA publishes a 30-page code on proper interactions for industry members.

Arkansas pain doctor Mahmood Ahmad signed onto Insys’ speaker program and quickly became one of the top Subsys prescribers in the country, according to a federal lawsuit filed against him and the drug maker by one of his former patients.

Between 2014 and 2015, Ahmad wrote 1,450 Subsys prescriptions and collected more than $150,000 in payments. The year before, Ahmad prescribed Subsys only 50 times, court records say.

Cheryl Hartsfield began seeing Ahmad in 2011 after a referral from another doctor. Years of lifting and hauling crates of soda as a sales representative for a beverage company had taken its toll on her joints. She was in constant pain.

Ahmad successfully treated her pain with hydrocodone and Tylenol, said her attorney Tab Turner. But in 2014, he added Subsys to her prescriptions in increasing doses even though her condition had not changed.

By the end of 2015, Hartsfield, then severely addicted, ended up in the hospital suffering from extreme withdrawal symptoms because her Subsys had run out. She entered rehab, but by then, her life was forever damaged.

“It basically fried her brain,” said Turner, who filed the lawsuit in Arkansas’ Pulaski County circuit court last year. “Her mother cares for her now.”

Hartsfield wasn’t told about the addictive nature of the drug, that it was meant only for cancer patients or that doctors were being paid by the drug maker to prescribe it, he said. She did not have cancer.

“These patients were not informed about anything, including the profits,” Turner said. “These guys were drug dealers disguised as doctors.”

Ahmad is believed to be living overseas and could not be reached for comment.

Tamisan Witherspoon was a devoted mother to her daughters, pictured here in 2013 before she became an addict. From left to right: Christina Blanks, 16; Cedria Blanks, 10; and Naja Blanks, 17. (Source: Witherspoon family photo)

Tamisan Witherspoon, the Alabama soccer mom, didn’t know Subsys’ back story.

In 2013, during a hernia operation, a surgeon accidentally clamped a nerve to her stomach, leaving her in extreme pain. Rather than operate on the 40-year-old mother again to fix the clamp, the surgeon referred her to Dr. Couch at the Physicians Pain Specialists of Alabama.

On her first day at the clinic, she saw a nurse practitioner and left with prescriptions for a muscle relaxer, Oxycodone and Subsys.

She never met with Couch that day - or any other day during her year of treatment. In fact, she couldn’t even pick him out in court when she testified at his criminal trial for running a pill mill.

Within a week of that first appointment, Witherspoon knew she had become addicted to?Subsys. 

“It takes you so far down,” she said. “It’s a horrific drug to be addicted to.”

Tamisan Witherspoon is deep into her addiction, unable to function or barely leave the couch in 2014. “My kids were always thinking I was dead,” she said. (Source: Witherspon family photo)

Each Monday, she went to the clinic to get her weekly supply of Subsys – and four other prescriptions. All were filled at a pharmacy owned by Couch and Ruan.

Witherspoon didn’t pay for the Subsys. But her insurance company was billed $3,000 every week for a year.

Court records said Insys concocted a scheme to deceive insurance companies, including Medicare, about patient conditions, setting up a call center that pretended to be the doctors’ offices to confirm to insurers that patients receiving Subsys had cancer.

Insurance companies tend not cover Subsys, which is expensive, unless it is prescribed for cancer treatment, meaning patients like Witherspoon, who did not have cancer, should have been excluded. According to the DEA, Couch's office submitted forms noting Witherspoon had cancer.

Witherspoon said she spent nearly every day of 2014 on a couch, unable to function and at times unable to wake up. She estimates her family called 911 weekly to have medics revive her.

“My kids were always thinking I was dead,” she said.

Her two youngest daughters were just 11 and 16 at the time. Her oldest daughter was married but lived nearby in Mobile.

“I never used drugs until then,” Witherspoon said. “I was a church woman, this woman of God. I was a booster mom, a PTA mom.”

The addiction strained her marriage. When her husband hid her drugs, she would ransack the house, tossing clothes from every closet and drawer, until she found them.

Cedric Blanks tried to be a devoted husband to Tamisan Witherspoon. But their marriage of 20 years fell apart when she became addicted to prescription opioids. (Source: Witherspoon family photo)

When he took her drugs to work with him, she’d storm in and cause a scene.

“He gave me a lot of opportunities and a lot of chances,” Witherspoon said. “I would just be irate, screaming and hollering.”

They eventually divorced. 

The week of Thanksgiving that year, Witherspoon arrived at her appointment to find her nurse going in and out of consciousness. Her speech was slurred. Witherspoon recognized the behavior and realized her nurse was also an addict.

She left the appointment with 12 prescriptions for an array of opioids and a new-found determination to get clean. Within 36 hours, she boarded a plane to a rehabilitation center in Wilmington, NC.

Upon her return to Alabama six weeks later, she began to build her new life. When she broke an ankle that required surgically inserted screws, she refused the painkillers the doctors offered.

“I don’t want to take any pain medicines ever again,” she told them.

Tamisan Witherspoon, left, and Lavitria Solis pose for a selfie photo. Solis is the sponsor who helps Tamisan stay clean. (Source: Witherspoon family photo)

Her doctor, Couch, and his partner Ruan, were sentenced last year to 20 years and 21 years in federal prison, respectively, for illegally prescribing opioids. The government also seized their homes, exotic cars, investment accounts and even their children’s college funds to recoup $32 million in court-ordered restitution.

Stephen Azzam, who oversaw the DEA’s investigation, called the doctors “two pieces of garbage. They’ve harmed a lot of people. They abused their privilege and their power.”

Exotic cars owned by Dr. Xiulu Ruan fill a warehouse. The government seized the vehicles to help recover the $32 million Ruan and his partner, Dr. John P. Couch, owe the government for bilking in their pill mill operation. (Photo courtesy of the U.S. Drug Enforcement Agency)

Witherspoon agreed.

“I went in trusting a doctor, trusting in medicine and the goodness of what it’s supposed to do,” she told Raycom Media. “You (Couch) got paid for ruining my life. You got paid for destroying my life. You got paid for the hell I had to go through. That hurts.”

Yet she’s found a way to forgive. She knows she is lucky to have survived and tells her story to honor those who didn’t.

Tamisan Witherspoon smiles as she talks about her new life and new love. She’s been clean for three years. “I had to forgive myself,” she said. “There is life without opioids. It’s beautiful.” (Source: Jon Turnipseed/Raycom Media)

“I met those patients’ wives and families,” Witherspoon said. “I made it, so I’ll be their voice.”

Resolved to stay clean, she kept a photo of her when she arrived at the rehab center taped to her mirror for a year.

“It reminded me of where I was,” she said. “I don’t ever want to be her again, but I don’t ever want to forget her.”

Copyright 2018 Raycom News Network. All rights reserved. Investigative producer Tom Wright and News Content Specialist Erin Snodgrass contributed to this report.