Physician Charged in Pill Mill Scheme Found Dead

October 27, 2016

A 78-year-old New York psychiatrist accused of illegally prescribing 10,000 tablets of oxycodone, sometimes from the front seat of his gold Lexus, was found dead in his home earlier this month.

Alfred Ramirez, MD, had pleaded not guilty to federal charges of illegally distributing oxycodone and other controlled substances that prosecutors said had resulted in at least one overdose death. Police did not find signs of foul play when they discovered Dr Ramirez's body at his home in Monroe, New York, on October 16. Results of an autopsy have yet to be released.

Dr Ramirez's attorneys had described him in court filings as having poor health. When he was temporarily in federal custody, he requested medical treatment for hypertension, an enlarged prostate, arthritis, and mild diabetes. Dr Ramirez also revealed that he had suffered a prior stroke.

The federal drug case wasn't his first encounter with the judicial system. In 1986, he pleaded guilty to stealing almost $48,000 from New York's Medicaid program and received a "shock sentence" of 6 months in a state prison, according to court records. Published reports indicate that he was excluded from both the Medicare and Medicaid programs for 5 years but that he kept his medical license.

Dr Ramirez's prescribing practices publicly came into question in 2005 when one of his patients at the time, 16-year-old Raul Laguerre Jr, went on trial for assaulting and sodomizing a woman. Laguerre's attorneys blamed his actions on a cocktail of sertraline (Zoloft, Pfizer), atomoxetine (Strattera, Eli Lilly), and risperidone (Risperdal, Janssen Pharmaceuticals) prescribed by Dr Ramirez. An expert witness testified that the drugs induced bipolar disorder in Laguerre. A jury nevertheless found him guilty.

David Robinson, an investigative journalist for The Journal News in White Plains, New York, has reported that concerns about Dr Ramirez's prescribing date back several decades. Robinson interviewed a pharmacist who said she had notified the state Medicaid program in the 1980s that the psychiatrist was promiscuously prescribing controlled substances to drug abusers. The pharmacist said she had stopped filling Dr Ramirez's prescriptions.

Late-Night Prescriptions in the Parking Lot

The federal charges against Dr Ramirez stemmed from a 5-month investigation in 2015 spearheaded by the US Drug Enforcement Administration (DEA). In a complaint filed September 30, 2015, in the federal district court in New York City, DEA Special Agent Michael Muller said that Dr Ramirez had conspired with co-defendant James Cooney from at least 2012 to illegally distribute oxycodone, alprazolam (Xanax, Pfizer), and other drugs. Muller pieced together the scheme with the help of informants and undercover law enforcement agents.

In some instances, Dr Ramirez allegedly wrote scripts for individuals without conducting a physical exam. He would see customers as late as 10 pm, charging anywhere from $150 to $400 in cash for his signature on prescriptions. During one stretch when he didn't have an office, Dr Ramirez met customers in a parking lot and wrote his prescription inside his Lexus, Muller said.

The psychiatrist also allegedly wrote bogus prescriptions for co-defendant Cooney, who would fill them and then sell many of the pills on the street for a profit. One of Cooney's customers was Daren Gajdusek, a 31-year-old elementary school teacher in Yonkers, New York, who was found dead in his apartment on March 23, having overdosed on oxycodone and alprazolam. Cooney was a contact in Gajdusek's cell phone, Muller said.

An empty bottle of oxycodone recovered at the scene showed Dr Ramirez to be the prescribing physician, according to Muller. The name of the patient on the bottle had been scratched off, but records revealed that Dr Ramirez had written that prescription for Cooney. Prosecutors said that alprazolam taken by Gajdusek was probably from a prescription that the psychiatrist had written for his accomplice as well. Text messages in the teacher's phone show that Gajdusek had chatted with Cooney about oxycodone and alprazolam, referring to them by slang, 3 days before his death.

On October 1, 2015, 1 day after Muller's complaint was filed in federal court, law enforcement agents arrested both Dr Ramirez and Cooney. Roughly $325,000 in cash was discovered in Dr Ramirez's home when agents arrested him there. One of Dr Ramirez's attorneys characterized that money in a court filing as "proceeds of his legal medical practice" and unrelated to pain management treatment.

Cooney has pleaded not guilty to violating narcotics laws. In January, US Magistrate Judge Paul Davison ordered him into an inpatient treatment program. As of September, he was participating in an outpatient program at a private substance-abuse treatment facility called Inter-Care, according to court records. He was receiving injections of naltrexone, which helps prevent relapses in individuals with opioid or alcohol dependency who have stopped using those substances.

Follow Robert Lowes on Twitter @LowesRobert

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