Profiting from Pain: Roland Clinic Draws Scrutiny

The clinic accepted cash or debit-card payments only, up to $195 for the first visit, $95 for follow-ups.

It accepted no insurance, and asked some patients to sign a form promising they wouldn’t file for Medicare reimbursements.

It required patients to submit one prior X-ray, CT scan or MRI. It didn’t matter how old they were.

The clinic’s central figure is Bernard M. Tougas Jr., a physician assistant who migrated from Arkansas after his supervising doctor there died in 2009. Tougas owns and manages the Wellness Clinic and recruited the doctors who work there, according to the state Narcotics Bureau and medical licensure board.

Until several months ago, the clinic’s medical director was Dr. Ronald V. Myers Sr., who describes himself as a 58-year-old family practice doctor, Baptist minister, civil rights activist and pain patient advocate. In his spare time, Myers plays trumpet and flugelhorn in jazz bands.

Myers is a salaried employee of Tougas, according to investigative documents. He is also Tougas’ supervising physician. State authorities said it is illegal for a P.A. to employ his supervising doctor.

The Wellness Clinic is still operating. Tougas and Myers are still practicing. The narcotics bureau filed an overprescribing case against Myers in June. A hearing has been scheduled for January 2015. The medical licensure board filed its own case against Myers in August and has scheduled a disciplinary hearing for March 2015.

No enforcement actions have been filed against Tougas.

According to case documents, at least two of Myers’ patients at the Wellness Clinic were killed by overdoses of the narcotics he prescribed them. A third patient who also received narcotic prescriptions from him died for unknownreasons. A fourth patient, who was seen by other clinic personnel, also died of an overdose.

“The business model of the Wellness Clinic was designed to provide massive amounts of high-dose CDS (controlled dangerous substances) to patients under the veil of a legitimate pain management clinic,” the medical licensure board stated in one document.

“The Wellness Clinic did so through the careful screening of new patients and firing of current patients coming under the scrutiny of law enforcement. In time, the Wellness Clinic became so well known as a pill mill that people were traveling to it from as far away as Colorado. Patients came from at least 10 different states, some traveling as far as 1,800 miles” per round trip, the document said.

Tougas did not respond to requests for an interview.

In a document filed with the medical licensure board, Myers denied many of the allegations made by state authorities and demanded “clear and convincing proof” of their accuracy.

Myers stated that he “at all times used sound clinical judgment in the treatment and diagnoses of patients.” He denied that he “failed to adequately examine or care for any patient” or that he “failed to discharge his professional duties and standard of care with respect to any patient.”

In the document, Myers acknowledged that he was Tougas’ supervising physician. But he denied that Tougas was his employer.

In a brief telephone interview with Oklahoma Watch and The Oklahoman, Myers declined to comment on the specific allegations lodged against him. He noted that the cases are civil enforcement actions, not criminal charges.

In a follow-up email, Myers portrayed himself as a nationally recognized advocate of compassionate pain treatment who is being persecuted by overzealous state enforcers.

“I have already experienced too much discrimination and racism by some law enforcement agencies in Oklahoma because I have the God-given moral conviction to treat poor chronic pain patients,” Myers wrote.

“Please portray me truthfully as the historic poor and chronic pain patient advocate that I am,” he said.

One of Myers’ defenders is Robert Wiley of Mountain View, Ark. Wiley, 47, is national facilitator for the National Pain Patients Coalition, which Myers helped establish. He also is a patient of Myers at the Wellness Clinic.

“A lot of chronic pain patients, we’re kind of kicked to the side and treated like drug addicts, and we’re not,” said Wiley, who has had multiple back surgeries and a knee replacement. “I’ve been on this treatment for a long time, and it’s worked. It’s actually given me mobility, and a little bit higher quality of life than I would have without it.”

Wiley characterized Myers as a compassionate family practitioner who provides patients like himself with effective and affordable treatment they could not receive in Arkansas. Wiley said he has reviewed the allegations contained in the Oklahoma actions and regarded them as bogus.

“I know what the state has accused him of, and a lot of it is garbage,” Wiley said.

Other than prescribing, treatment at the Wellness Clinic was minimal, according to case documents filed by state investigators.

At least two patients interviewed by a medical licensure board investigator said they were never seen by a physician. One patient said she was seen by Myers in his office, but he “never looked up from his computer” and never made eye contact.

Another patient, identified only as “TB,” said she was seen by Tougas on Dec. 10, 2013. The session lasted about 40 seconds.

“No exam was performed,” the medical licensure board said. “P.A. Tougas merely took some prescriptions from a file and handed them to TB. Yet, it was the defendant (Myers) that signed the prescriptions.”

The patient walked out with a prescription for 84 60-milligram oxycodone pills, 224 30-milligram oxycodones, 30 20-milligram oxycodones and 112 10-milligram diazepam (Valium) pills.

Regardless of whom they saw, the patients received narcotics prescriptions signed by Myers or one of the other two doctors practicing at the clinic, Dr. George B. Howell, or Dr. John C. Friedl, according to case documents. Patients said the prescriptions appeared to have been prewritten.

One patient told agents the clinic waiting room “was always full, sometimes with standing room only,” one case document stated.

That patient “did not feel comfortable among the type of people in the waiting room,” the document said. “He described them as addicts ‘just wanting their pills.’ He had heard patients speaking of where they could sell their medications.”

On April 24, 2013, a narcotics bureau agent posing as a patient went to the clinic seeking medication, according to another case document. She was seen by Tougas. He prescribed her oxycodone and tramadol, another painkiller.

“It is like shoe shopping. You have to try them on to see what fits,” she said Tougas told her.

According to the narcotics bureau and medical licensure board, Tougas ran the show, and Myers provided the cover.

“P.A. Tougas, under the defendant’s (Myers’) supervision, sought to continually increase the number of patients seeking addictive pain-killing drugs at the clinic and paid bonuses based on a quota of patients seen,” the licensure board stated. “P.A. Tougas effectively ran the clinic and attended to patients. The clinic sees approximately 120 patients a day and ‘fires’ approximately 30 patients a month. The clinic had a goal of adding 10 patients per week.”

Myers is not the only physician who has worked at Tougas’ clinic and gotten in trouble for alleged overprescribing. In February 2014, Howell was “terminated” by the clinic, according to case documents. Three days later, he surrendered his narcotic prescribing licenses issued by the state Narcotics Bureau and U.S. Drug Enforcement Administration. The medical licensure board has initiated an overprescribing case against Howell.

In July, the Wellness Clinic announced that a new doctor, John M. Wellman, was joining its staff. Myers told Oklahoma Watch and The Oklahoman that Wellman has replaced him as medical director of the clinic, although Myers still practices there.

Drug law enforcers said one of the reasons they want the Oklahoma Legislature to grant them authority over clinics is that some owners consider their salaried doctors to be expendable and simply recruit new ones when current ones get in trouble.

“They’re out there looking for doctors,” said Lyle Kelsey, executive director of the medical licensure board. Kelsey was not commenting on the Wellness Clinic in particular but on the phenomenon of non-physician ownership in general.

“What they want is somebody that doesn’t ask questions and signs the legal document that has to be signed by physicians,” Kelsey said. “Absolutely, they recruit them.”