Physician Who Ran Pill-Mill 'Zoo' Gets 12 Years in Prison

January 21, 2016

The pain management clinic on Southern Boulevard in the Bronx, New York City, was called "the zoo" — a place where addicts, fake patients, and armed drug traffickers thronged, fought, and walked away with millions of oxycodone pills.

The clinic's owner, Kevin Lowe, MD, did not write the bogus prescriptions himself but watched from afar with surveillance cameras as other physicians did his bidding: "[I]ll-equipped, desperate doctors in dire need of work," federal prosecutors said.

A jury in May 2015 found the 55-year-old Dr Lowe guilty of one count of conspiring to distribute narcotics. Earlier this month, US District Judge Lorna Schofield, in the Southern District of New York, sentenced him to 144 months in prison. Prosecutors had sought an even stiffer sentence, arguing that "the magnitude of the defendant's conduct places him on par with true drug kingpins."

Twenty-four other defendants in the case pleaded guilty to conspiring to distribute oxycodone. One of them, Robert Terdiman, MD, was sentenced last year to time already served for churning out prescriptions for 70 patients a day. Saddled with "significant cognitive impairments," as his attorney informed the court, Dr Terdiman was directed to continue living at a senior center as part of his supervised release.

Tomasito Virey, MD, was another physician who pleaded guilty to writing bogus prescriptions for oxycodone at another clinic in the Bronx that was owned by Dr Lowe. He was found dead from an apparent drug-overdose suicide in a relative's home on February 4, 2014, the same day that federal and state agents busted Dr Lowe's operation, prosecutors said.

Neither Dr Virey nor Dr Terdiman had any experience in pain management prior to joining Dr Lowe's operation.

A Violent Style of Practice Management

Dr Lowe owned and operated a string of clinics in New York City called AstraMed, but only the two clinics where Dr Terdiman and Dr Virey worked were involved in the pill-mill conspiracy, according to prosecutors.

Court records describe a brazen criminal enterprise. Drug traffickers known as crew chiefs commanded fake patients, who paid $300 for an office visit lasting only a minute or two. There were no tests or physical examinations. Crew chiefs footed the bill and gave their fake patients nominal sums for their role. The fake patients obtained oxycodone prescriptions, had them filled, and turned over the pills to their crew chiefs, who sold them on the street for $30 apiece in New York City and for more elsewhere. Independent drug dealers and addicts lined up for prescriptions after paying admission fees as high as $1600 in cash.

Practice management for this kind of clinic sometimes turned violent. Crew chiefs and their bouncers were not above throwing a wayward clinic patron through a window or an uncooperative employee against the wall. Prosecutors alleged that members of the conspiracy murdered at least two individuals who got in their way. Physicians were pressured — and in one instance threatened at gunpoint — to prescribe oxycodone at outrageously high volumes.

The gangster-style persuasion appeared to work. Between January 2011 and February 2014, AstraMed physicians wrote nearly 35,000 unnecessary prescriptions for oxycodone, totaling some 5.5 million tablets. Their street value topped $165 million. During this period, Dr Lowe collected more than $7 million in cash for bogus office visits, prosecutors said.

In the trial last year, Dr Lowe's attorney argued unsuccessfully that criminals had infiltrated the two AstraMed clinics in the Bronx and had tried to keep him in the dark about their oxycodone racket. His attorney suggested the ignorance defence again in a memorandum to the court recommending a more lenient sentence than prosecutors were seeking.

"To varying degrees, doctors must hope that the information they receive is correct," wrote attorney Florian Miedel. "Perhaps, unfortunately, Dr Lowe did too much hoping and not enough investigating, and the line was crossed."

In their sentencing memorandum to the court, prosecutors countered that Dr Lowe indeed knew about the criminal activities at the Bronx clinics. "Through those [surveillance] cameras, the defendant witnessed the chaos that was the clinic on a daily basis," they said, noting that law enforcement agents recovered surveillance video from Dr Lowe's computer.

Employees also warned Dr Lowe about drug trafficking, prosecutors said. The clinic "is run by drug dealers," one employee texted Dr Lowe. "Whoever goes there to work will eventually have to be part of the game. It's either that or get assaulted and forced out.... These drug dealers are the ones bringing in the patients."

Far from being in the dark, Dr Lowe had set up the clinics from the beginning to operate illegally, according to prosecutors.

"The defendant's clear greed — and his willingness to use his medical training to turn his clinics into drug dens and his doctors into drug dealers — weighs very strongly in favor of a substantial sentence," they wrote.

Dr Lowe has appealed both his conviction and sentencing. Miedel, his attorney, did not respond to a request for an interview.

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