Physician Given Second Chance Gets 10 Years on Opioid Charges

May 18, 2017

An Alabama internist who had received a second chance after running afoul of his state's licensing agency was sentenced last week in a federal district court to 10 years in prison for operating an opioid pill mill and laundering the illegal proceeds.

Robert Ritchea, MD, of Phenix City, Alabama, was such a prolific prescriber of oxycodone, methadone, and other opioids that he ranked in the top 1% of Alabama prescribers for the volume of Schedule II, III, IV, and V controlled substances, according to a Drug Enforcement Administration (DEA) agent who investigated him. In the process, the 54-year-old Dr Ritchea helped make Alabama the number-one state in the country for opioid prescriptions per capita, as ranked by the Center for Public Integrity and the Associated Press in a joint investigation 2 years ago.

His excessive opioid prescribing was arousing suspicions as far back as 2011, the same year he received a clean bill of professional health from the Medical Licensure Commission of Alabama. The commission had reprimanded him in 2008 for letting an unlicensed medical assistant inject patients with unnecessary pain medications. Besides levying a $50,000 fine, the commission required him to take seminars on pain management as well as ethics and have another physician review selected patient charts of his, all terms of a consent order agreed to by Dr Ritchea.

In July 2011, the commission declared that because Dr Ritchea had apparently complied with the conditions of the consent order, "he shall henceforth have a full unrestricted license to practice medicine in
Alabama."

Although it seemed like he was off to a fresh start, Dr Ritchea had to live with a settlement he reached in 2012 with the Department of Justice in a False Claims lawsuit over the missteps that led to Alabama's disciplinary action. Under the settlement, he was banned from participating in Medicare, Medicaid, or any other federal healthcare program for 7 years and was required to sell a second home, with the proceeds going to the government.

During this time of financial upheaval, federal prosecutors said, Dr Ritchea perfected another business model for his pain-management practice that didn't require any third-party payers — writing medically unnecessary opioid prescriptions for addicts on a monthly basis for $150 or more in cash.

"In exchange for monthly cash payments, Dr Ritchea poured poison into his community," said Acting US Attorney Clark Morris for the Middle District of Alabama in a news release.

Directed to a Prison With a Drug Rehab Program

The DEA and other law enforcement agencies launched their investigation of Dr Ritchea in July 2013. Interviews with area pharmacists raised numerous red flags.

A Walgreens pharmacist in Phenix City told the DEA that a typical pharmacy in his company's chain filled roughly 600 pills of oxycodone for its customers each week. In contrast, his own pharmacy went through 4000 oxycodone pills a week because so many of Dr Ritchea's patients came there, according to a DEA affidavit. The pharmacist began noticing the physician's unusual prescribing habits in 2011.

Pharmacists described other hallmarks of a pill mill:

  • Dr Ritchea prescribed excessive quantities of pills in a single prescription — as many as 360 methadone pills, in one instance.

  • His patients matched the profile for opioid addicts. They were not in apparent pain, they paid in cash, and they were prone to lose their temper if they were turned down at the pharmacy counter for some reason.

  • Groups of Dr Ritchea's patients would arrive at a pharmacy by "truckloads," all with identical prescriptions.

Sensing a criminal operation, many area pharmacies eventually refused to fill Dr Ritchea's opioid prescriptions. However, he found a way to service addicts by essentially becoming his own pharmacy, according to prosecutors. He used the proceeds from his illegal prescribing — deemed money laundering — to purchase hydromorphone and hydrocodone directly from a drug manufacturer and then dispense the painkillers directly to his patients.

Dr Ritchea's pill-mill operation came to a halt when he was arrested in May 2016 shortly after a federal grand jury indicted him. He pleaded guilty to one count of conspiring to illegally distribute controlled substances and one count of money laundering in January 2017.

Each criminal offense carried with it a maximum prison sentence of 20 years. Prosecutors said Dr Ritchea's guilty plea warranted a somewhat lighter sentence. However, on May 9, the day of Dr Ritchea's sentencing, they reminded US District Judge W. Keith Watkins that at least one of the physician's patients had fatally overdosed — on methadone — within days of receiving the prescription.

The 10-year sentence handed down by Watkins contained instructions that flesh out the personal tragedy of a physician who broke bad. Watkins recommended that Dr Ritchea be incarcerated in a prison with a residential drug treatment program. And during 3 years of supervised release after he left prison, Dr Ritchea was to participate in a substance abuse program and submit to testing "to determine whether he has reverted to the use of drugs."

Dr Ritchea's criminal attorney did not respond to a request for an interview.

Follow Robert Lowes on Twitter @LowesRobert

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