This story, part of a joint project by Oklahoma Watch and The Oklahoman, is by Andrew Knittle and Phillip O’Connor of The Oklahoman and Warren Vieth of Oklahoma Watch.
In August, when former physician William Valuck pleaded guilty to murder for the prescription drug overdose deaths of eight patients, the owner of an Oklahoma City pain clinic where Valuck plied his illicit trade was never mentioned in the courtroom.
Patrick A. Reynolds, the owner of Vista Medical Center, is not a doctor. His primary business, he has said, is real estate.
Reynolds, 69, of south Oklahoma City, is one of at least several Oklahoma pain clinic owners who hold no medical license.
Public officials and experts in the field say allowing non-physician ownership of clinics makes them more difficult to regulate and helps explain why Oklahoma has among the highest prescription drug abuse and overdose death rates in the country.
“To me, one of the most important things is who gets to own these clinics,” said Sandra LaVenue, deputy general counsel of the Oklahoma Bureau of Narcotics and Dangerous Drugs Control. “The clinics that end up in trouble tend to have ownership that is separated from the primary physician … Essentially, what they’re trying to do is separate the money from the prescribing.”
Valuck wasn’t the first person who worked at Vista to run afoul of authorities. At least four other medical professionals who worked at Reynolds’ clinic have been disciplined for overprescribing in Oklahoma or other states.
Three of those five have been linked to the deaths of at least 20 patients from prescription drug overdoses.
Neither Reynolds nor his lawyer responded to interview requests.
Several states have adopted laws increasing oversight of pain clinic operations, including bans on non-doctor owners. They say the laws have helped reduce the number of people dying from overdoses.
Narcotics bureau officials helped draft such a measure for Oklahoma. But they backed off earlier this year under pressure from medical industry lobbyists and regulation-wary lawmakers, officials said. They plan to test the waters again in 2015.
Fueling an Epidemic
Pain clinics dispense highly addictive narcotic drugs such as morphine, oxycodone, hydrocodone, methadone, fentanyl, diazepam (Valium) and alprazolam (Xanax). Those seven drugs account for the majority of prescription drug overdose deaths that in recent years have driven state officials to pursue tougher monitoring, saying the state faces a crisis. Last year, more than 800 Oklahomans, or on average about two a day, died of overdoses from all drugs — more than in car wrecks.
Several authorities interviewed by The Oklahoman and Oklahoma Watch said they believe most doctors specializing in pain management are conscientious practitioners who try to ensure that their patients are not overusing narcotic medications.
The problem has accelerated in recent decades because of a movement within the medical community to dispense opiate drugs more aggressively to treat chronic pain patients instead of reserving the highly addictive medications for terminal patients experiencing extreme pain.
These authorities said they are convinced most pain management clinics are operating responsibly. But the actions of a few have contributed to the state’s prescription drug abuse crisis.
Drug authorities said their goal is to reduce overprescribing without deterring good doctors from providing compassionate care to tens of thousands of Oklahomans with back injuries and other chronic pain conditions.
Addressing the problem of non-doctor-owned pain clinics is near the top of their priority list.
A Powerful Tool
Prescription drug abuse and overdose deaths began to spiral upward following the introduction of new narcotic painkillers such as OxyContin in the 1990s. In recent years, nine states have enacted comprehensive laws designed to increase oversight of and punish abuses by “pill mills.”
Florida was among the trailblazers. In 2010, 2011 and 2012, the state took several steps to crack down on rampant overprescribing at clinics. One of the key measures was a 2010 law requiring pain clinics to register with the state and restricting ownership by anyone other than a licensed physician, group of licensed physicians or licensed health care clinic.
Before the changes, Florida was the national epicenter of prescription painkiller abuse. Overdose deaths increased 61 percent from 2003 to 2009. By 2010, the state was home to 98 of the 100 U.S. physicians who dispensed the highest quantities of oxycodone directly from their offices, according to the Centers for Disease Control and Prevention.
Following the enactment of its new pain-clinic restrictions and a series of enforcement raids across the state, more than 250 pain clinics were shut down, the CDC reported. Prescription drug overdose deaths fell by 23 percent. Deaths caused by oxycodone plunged by 52 percent.
“They’ve clearly cut down on the number of pill mills,” said Sarah Kelsey, CEO of the National Alliance for Model State Drug Laws in Charlottesville, Va. “There are fewer pills on the market, fewer doctors overprescribing.”
Other states that have enacted broad pain clinic regulation acts are Georgia, Kentucky, Louisiana, Mississippi, Ohio, Tennessee, Texas and West Virginia, according to the alliance.
“Certain components of pain clinic laws are an important part of a comprehensive approach,” Kelsey said. “Ownership is certainly a big one. It should be owned by a physician licensed to prescribe controlled substances.”
Oklahoma Bill Goes Nowhere
Oklahoma got its chance to do something about pain clinics earlier this year.
Oklahoma already was a pioneer in some areas of narcotic prescribing oversight. It created the nation’s first computerized prescription monitoring program in 1991. Three years ago, it became the first state to require pharmacists to log narcotic prescriptions online within five minutes of filling them.
But regulators wanted to do more. During a 2013 national conference of drug enforcers in St. Louis, LaVenue asked about Florida’s efforts to crack down on overprescribing. She wanted to know what they considered to be the most important tools to combat the deadly trend.
“They told me that regulating the pain management clinics was the one thing that’s making a substantial difference,” LaVenue said.
When she returned, LaVenue consulted with state Narcotics Bureau Director Darrell Weaver and other bureau officials. They decided to make passage of a pain clinic bill a priority. They helped draft a bill, and persuaded Sen. Rob Standridge, R-Norman, to introduce it. Standridge is a licensed pharmacist who has sponsored other measures to combat drug abuse.
Standridge’s Senate Bill 1267 would have have required pain management clinics to register with the narcotics bureau. Under existing law, only the doctors who practice in the clinics are required to register. The bill said pain clinics must be owned and operated by physicians who have not had felony convictions or been subject to drug-related enforcement actions.
State narcotics officials say they are powerless against non-physician owners.
“We don’t have any control over that outside party. He doesn’t have a license with us or a registration. We can’t do anything,” LaVenue said.
“We don’t even know where the pain clinics are.”
Standridge’s bill defined a pain management clinic as any facility in which more than 50 percent of patients receive prescriptions for opioid painkillers, benzodiazepine tranquilizers, barbiturate sedatives or carisoprodol, a muscle relaxer. The definition also included any clinic that advertises itself as a pain management business.
SB 1267 was assigned to the Senate Health and Human Services Committee chaired by Sen. Brian Crain, R-Tulsa.
It never came out. No hearings were held. No votes were cast.
Crain did not respond to requests for an interview.
Too Much Fire
State Narcotics Bureau spokesman Mark Woodward, who spends part of his time consulting with lawmakers and lobbyists at the state Capitol during legislative sessions, said the bureau agreed to stop pushing for passage after determining that the bill was drawing too much fire.
“We were told there was opposition to it, that some people thought that it was too much government oversight and overreach into this area,” Woodward said. “They said, ‘We’re just not going to move the bill forward.’”
At the time, Woodward said, he was told that lawmakers would consider the issue in an interim study between legislative sessions. No interim study was done.
Director Weaver said the bureau would raise the issue again during the 2015 session.
“We will definitely talk to Sen. Standridge about it,” Weaver said. “We’ll have a conversation about it.”
Standridge, a pharmacist, said he wasn’t sure whether he would reintroduce the bill.
“I’m kind of torn,” Standridge said. “I’m not saying it’s not a worthy objective to try to eliminate drug abuse and addiction. But to me, it looks like the way we’re going down this road may not help any of them, while at the same time curtailing access to all of these medications.”
Standridge said he concurred with Woodward’s description of this year’s legislative inaction.
“I didn’t really have a personal problem with it … It was others who had problems,” he said. “I’d hate to introduce it again for it to languish a few weeks later.”
Wes Glinsmann, legislative affairs director for the Oklahoma State Medical Association, acknowledged that the physicians group voiced objections to Standridge about the specific provisions of SB 1267.
He said the association was concerned that the bill did not precisely define the term “physician” to mean medical doctors and osteopaths only. Under Oklahoma law, optometrists, chiropractors, podiatrists and dentists also are allowed to call themselves physicians.
In addition, Glinsmann said some of the association’s psychiatrist members were concerned that the bill included the prescribing of benzodiazepine drugs such as diazepam (Valium) and alprazolam (Xanax).
Glinsmann said the medical association was not opposed to revisiting the issue.
“We had some specific concerns,” he said. “But we’ve got a very good relationship with Sen. Standridge, and if it’s something he wants to work on, we’d be more than happy to.”
LaVenue said she remains convinced that passage of a pain clinic bill is critical to the state’s efforts to curb overprescribing.
“I still strongly believe that that will make a huge difference,” LaVenue said.
“Anytime we run into a clinic that is a problem, it is always owned by somebody else.”
A Business Model
State drug enforcers and medical licensing boards say defining the scope of the problem is difficult. Current state law does not authorize them to license, register, regulate or take action against clinic owners. They do not track the number of pain clinics or their management.
“We don’t even know who owns the clinic. Or ask,” said Deborah Bruce, executive director of the Oklahoma State Board of Osteopathic Examiners.
No standard definition exists of what constitutes a pain clinic. In the nine states that have enacted comprehensive pain clinic acts, the definition varies from one state to another.
According to the National Alliance for Model State Drug Laws, indicators of “pill-mill” activity can include:
* High-volume practices.
* Limited appointments, walk-ins accepted.
* Cash payments required.
* Failure to screen for substance abuse disorders.
* Missing or deficient patient histories.
* Missing or deficient prior medical records.
* Inadequate physical examinations.
* Inadequate diagnostics.
* Limited non-narcotic care strategies.
* Controlled substances as primary therapy.
* Physicians or prescribers near the end of their careers.
* Physicians or prescribers with abuse or addiction problems.
* Patients who travel long distances to clinic.
* Patients whose physical appearance suggests abuse or addiction.
“The thing about these doctors, they don’t work hard,” LaVenue said. “… Forty seconds, and then they get $190 cash. There’s huge money to be made.”
Some suspect clinics have smartened up and now cover their tracks with more complete patient records, LaVenue said. But that doesn’t mean the patient records are legitimate. “They can come up with an X-ray, MRI, from 10 years ago,” she said.
The clinic doctors, in turn, “don’t order any testing…no blood work, no additional MRIs, X-rays,” LaVenue said.
‘A Doctor’s Income’
Patrick Reynolds, who owns Vista Medical Center in southwest Oklahoma City where Valuck worked for three years, has been making money from the medical industry for at least three decades.
From 1985 to 1996, Reynolds co-owned Chronic Pain Associates, which operated clinics at 2520 N.W. Expressway and 3200 S. Western Ave., until his partner went to court seeking to force him out of the business.
The former partner, Laurence Altshuler, testified that Reynolds had a bad temper, behaved rudely, harassed employees and had an office worker “spy” on Altshuler, who said he feared for his safety.
“There was just a lot of coldness between us. I didn’t want to see him. I didn’t want him around,” Altshuler said in a court hearing.
In his lawsuit, Altshuler claimed Reynolds’ involvement in the business violated the Oklahoma Professional Entity Act, which says unless a person is a licensed medical professional he or she cannot serve as a shareholder, officer, director or manager of a corporation engaged in the practice of medicine.
Altshuler, an internist, saw patients, offered diagnoses, ordered tests and wrote prescriptions while Reynolds ran the business end: hiring and firing, collecting accounts and soliciting business from workers’ compensation and personal injury attorneys, according to court records.
Reynolds countersued for, among other things, wrongful termination, breach of contract and intentional infliction of emotional distress, as well as assault and false imprisonment, related to Altshuler hiring off-duty Oklahoma City police officers to escort Reynolds from their offices on the day he was let go.
In a court hearing, now-retired Oklahoma County District Judge John M. Amick said it was obvious the two men could no longer work together.
“The corporation, it seems to me, was unethical from the very outset. And the lack of ethics benefited Mr. Reynolds,” Amick said. “He had what some people might call a bird’s nest on the ground in that he was getting a doctor’s income without being a doctor.”
Reynolds testified that he earned almost $2.7 million during the 11 years he co-owned Chronic Pain Associates, according to court records, or an average of about $245,000 a year.
Amick said he thought Reynolds’ role in the corporation was illegal and that the corporation should be dissolved and the assets disbursed.
Soon after, Reynolds and Altshuler reached a settlement and the corporation was dissolved.
Reached at his Tulsa office, Altshuler declined comment for this story.
Back in Business
Within months, Reynolds was back in business, opening Vista Medical Center in a nondescript 4,800-square-foot former bank building at 3700 S. Western Ave.
In the years since, Vista has marketed itself as a weight loss center, an immigration medical clinic and a pain management practice.
Meanwhile, the clinic’s medical providers racked up some of the highest prescribing rates in the state for controlled dangerous substances, and three of the clinic’s medical personnel were linked to at least 20 overdose deaths.
Court and disciplinary records and interviews with former employees paint a portrait of Reynolds as being deeply involved in the clinic’s day-to-day operations, including matters involving patient care and prescribing practices.
Physician assistant Rob M. Phillips, 57, of Oklahoma City, worked at Vista for four months in 2005 before quitting, partly over differences with Reynolds, he said.
Phillips said Reynolds pressured him to overprescribe and do other things Phillips considered unethical.
“That was his M.O.,” Phillips said. “He was pressuring me.”
Phillips said when the clinic received a shipment of flu vaccine, Reynolds “was sitting there drawing them up himself. He’s not a medical professional. So yeah, it was very wrong to do something like that. I can remember he would get mad when the medical assistant would draw up the flu shot because he thought they were wasting 1cc to 2cc of the flu vaccine.”
David Lee Trent
Phillips said David Lee Trent, a general surgeon, was the medical director of Vista when he worked there, but that he only saw Trent once at the clinic during that period and could rarely track him down if he had a question.
Trent had been charged 10 years before in Latimer County with fraudulently writing prescriptions for a controlled dangerous substance, though the felony charge was dismissed.
The Oklahoma Board of Medical Licensure and Supervision disciplined Trent three times between 1978 and 1996 for overprescribing. His license was suspended a final time in 2007 after he was deemed incompetent.
Medical board records show that Trent’s medical license is inactive and that he has “agreed not to practice.”
Trent, whose last known address is in Wilburton, could not be reached for comment.
Cecil Allen Moore
After Trent’s departure, troubles involving an osteopath arose at Vista.
In 2010, the Oklahoma Board of Osteopathic Examiners opened a file on Cecil Allen Moore, who was practicing at Vista, after a woman called to say he was overmedicating her sister.
In late 2011, the board launched an investigation of Moore’s prescribing practices after receiving complaints from pharmacies, other patients and relatives. But it wasn’t until early 2012 that the board began investigating Moore in earnest after learning that the osteopath was still prescribing narcotics after letting his license lapse.
When the board examined Moore’s patient files and investigated further, the board discovered that Moore’s prescribing practices during parts of 2010 and 2011 were linked to the overdose deaths of nine patients.
Medical board and state Narcotics Bureau records show that during one three-month period, Moore was writing an average of 101 narcotic prescriptions every day at Vista, for a total of 633,000 pills.
In February 2012, the board suspended Moore’s license to practice, noting that his prescribing practices “constitute a serious danger to the health, safety and well-being of the public.” The board later revoked his license permanently.
Repeated efforts to contact Moore for comment were unsuccessful.
Jill Smoot said she never knew that her son, Aaron, 43, who suffered from mental illness, was one of Moore’s patients who died of an overdose until recently contacted by a reporter. Smoot died in August 2011 from a fatal combination of oxycodone and other prescription narcotics, according to the medical examiner.
Jill Smoot said she was shocked to learn that medical professionals at Vista continued to overprescribe after her son’s death and that the clinic remains in operation.
“I’ve been outraged for some time,” Smoot said about the care received by her son, who grew up in south Oklahoma City and attended high school at Christian Heritage Academy in Del City. “I was outraged before, but I didn’t have anything to connect it with until now. What do I do?”
Retired physician assistant Joe Beasley said he worked for about two months at Vista under Moore before resigning, in part, over prescribing practices involving narcotics. Beasley, 67, said he rarely saw Moore at the clinic and that he quickly found himself “pretty much at odds professionally,” with Reynolds, who he said “pretty much ran the show.”
“As far as I was concerned, when I was there, I was the medical authority,” Beasley said. “I got some vociferous input from Patrick regarding prescribing. I felt I just needed to leave. I told him I wasn’t putting my medical license or DEA number (a number the federal agency assigns health care providers allowing them to write controlled substance prescriptions) at risk for him or anybody else.”
“I didn’t like having a layman tell me how to practice medicine,” Beasley said. “I wanted to get people off of pain meds and back to work and he thought they should continue to return (for treatment). It’s all about money.”
William Valuck, an osteopathic physician and surgeon, began working part time at Vista in 2010 and went full time the following year. Before long, he was writing narcotic prescriptions at a rate of nearly 30,000 a year.
By February 2012, the U.S. Drug Enforcement Administration already was looking into his prescribing activities after being called by pharmacies and patients’ relatives concerned about the amount of narcotics he was prescribing.
Most of his patients received combined prescriptions for the painkiller hydrocodone, the anti-anxiety drug alprazolam and the muscle relaxer carisoprodol, a DEA agent testified at Valuck’s preliminary hearing in April 2014.
Valuck left Vista in November 2012 and went to work at another clinic, Advanced Care Clinic, about three miles from Vista. During a three-month period he wrote an average of 115 prescriptions for controlled drugs every workday, according to court testimony. Valuck’s patients used 215 pharmacies in 50 cities to fill his prescriptions.
It was about that same time that the DEA received reports of one or two of Valuck’s patients dying, the agent testified.
One pharmacy chain began denying his prescriptions, she said.
By late spring 2013, the DEA and state Bureau of Narcotics and Dangerous Drugs Control had opened a full investigation into Valuck.
In August 2014, Valuck, 72, pleaded guilty in Oklahoma County District Court to eight counts of second-degree murder and was given an eight-year prison sentence. Because of the nature of his crimes, he will have to serve nearly seven years before being eligible for parole.
Michael Hume worked as a physician assistant under both Moore and Valuck at Vista, and later under Valuck at Advanced Care. Like Vista, Advanced Care was not owned by a medical professional. That clinic, instead, was owned by Hume’s wife, Dorothy June Hume, who has no medical license.
In November 2013, Hume voluntarily surrendered his license in lieu of prosecution for overprescribing and his role in the overdose deaths of three patients.
In a sworn admission statement filed with the Oklahoma State Board of Medical Licensure and Supervision, Hume said that Reynolds owned and operated Vista and and paid him “solely on his production.”
During the period reviewed by the board, Hume was treating about 37 patients a day.
Hume said Vista didn’t accept insurance, Medicare or Medicaid, only cash. Patients were charged $250 for the first office visit, $140 for the second and $100 per visit thereafter.
Hume declined comment for this story.
Helen Broadbooks, 63, of Lexington, lost her daughter, Carie Marie Simmons, 27, to an overdose of prescription drugs in May 2013. Broadbooks said her daughter saw Valuck for about two years, both at Vista and Advanced Care.
“You should write prescriptions and see patients based … on that patient’s needs, not based on how many narcotic prescriptions you can write to keep them coming back every month,” Broadbooks said. “When you pay a doctor to work for you and his salary is based on how many narcotic prescriptions he writes on a given day, that’s criminal, Broadbooks said.
Michael E. Salrin
After Valuck left Vista, another doctor with a history of problem prescribing went to work at the clinic. By the end of 2013, that doctor, Michael E. Salrin, was the 10th-highest prescriber of oxycodone to Medicaid patients in Oklahoma, according to the Oklahoma Health Care Authority. Through the first eight months of 2014, Salrin, 69, is the second-highest prescriber.
Salrin was disciplined by the Kansas State Board of Healing Arts in 1989, after a consultant hired by the state medical board found that Salrin was “inappropriately and questionably prescribing and dispensing controlled substances to his patients.”
In December 1992, after moving to Oklahoma, Salrin petitioned the Oklahoma State Board of Osteopathic Examiners to regain the authority to write prescriptions for narcotic drugs after he had moved to Oklahoma. The authority was granted.
Salrin worked at a clinic in Shawnee, Family Medicine Specialists, prior to coming to Vista Medical Center.
“It blows my mind. I think it should be shut down,” Michelle Casson, 53, said when told that another doctor with a history of overprescribing had replaced Valuck at Vista. Her son, SaShawn Saatian, 32, died Aug. 8, 2013, of a drug overdose, a day after Valuck prescribed him 240 pills.
“How far does it have to go, where more people die? I just don’t get it.”
Meanwhile, another former Vista employee who left the clinic in May 2013 was charged in November with two felonies for obtaining diazepam and hydrocodone with a forged or altered prescription. Tammy Hernandez, 42, of south Oklahoma City, who former patients say worked the front office at Vista, was spotted by surveillance cameras in a southwest Oklahoma City Walmart on July 8 picking up the drugs and exiting the pharmacy, according to court records.
In August 2012, Hernandez told police that her son, Kevin M. Lange, had entered Vista, walked behind the counter, pushed her and another woman to the ground, grabbed a cash box containing about $2,200 and run out the door. Lange was charged with felony grand larceny. He pleaded guilty in January, was fined $50 and sentenced to three years on probation.
Since February, the families of four of Valuck’s patients who overdosed and died have filed medical negligence lawsuits against Vista, Valuck, Hume and others.
The lawsuits contend Vista was a known “pill mill” where patients “would show up in van loads from all over the state.”
One of the lawsuits contends, “Patrick Reynolds managed all aspects of Vista Medical Center with an iron fist,” including paying bills, controlling patient scheduling, collecting payments and hiring and firing staff, including doctors.
In his interview, Phillips, the former physician assistant, agreed, saying, “He ran things. He absolutely ran things, period. No ifs, ands or buts about it.”
In seeking to be dismissed from a lawsuit, Reynolds argued that he is only the landlord and bears no responsibility for the patient deaths.
‘Beginning of the Story’
Medical, legal and drug enforcement authorities interviewed by Oklahoma Watch and The Oklahoman were unable to cite any criminal or enforcement actions ever being taken against non-physician clinic owners in Oklahoma.
That’s partly because, in the absence of a Florida-style statute, Oklahoma law does not give drug enforcers or medical licensing boards any jurisdiction over clinic owners.
Oklahoma Attorney General Scott Pruitt told The Oklahoman and Oklahoma Watch that a district attorney, or even his office, could bring charges against a clinic owner for distribution of controlled dangerous substances, if the facts of the case merit it.
“There’s nothing that insulates that individual or any other individual from criminal liability if they are in fact engaged in overprescribing,” Pruitt said.
“They can create all the layers they want,” Pruitt said. “If, factually, there is a connection … to the physicians that are engaged in a practice of overprescribing and pill mills, there’s criminal liability on all fronts … From an investigatory standpoint, we would target those kinds of investigations because of that very relationship.”
Pruitt said he had not reviewed the history of Vista Medical Center and Reynolds and was not commenting specifically on that case.
Scott Rowland, the Oklahoma County assistant district attorney who led the prosecution of Valuck, responded cryptically when asked whether more criminal charges could be filed.
“That’s a very open, active case, and I wouldn’t be willing to discuss it publicly in the press,” Rowland said. “That entire matter — I think I said publicly, at the time, that more charges could come from this.”
“The Valuck prosecution was the beginning of that story, not the end of it.”
Contributing: Jaclyn Cosgrove of The Oklahoman.
Man Profiled in April Report Is Dead of Overdose
Kevin Vandagriff, 51, of Norman used pain medications to treat old injuries.
Kevin Vandagriff depended on pain medications to treat old injuries. In April, the Norman resident shared his story of living with chronic pain in a video interview included in the first installment of the Addicted Oklahoma series. Less than two months later, Vandagriff was dead. The medical examiner ruled his May 25 death in his home an accident and determined the probable cause to be acute combined drug toxicity from oxycodone and antidepressants. He was 51.