A 93-year-old physician in Las Vegas, Nevada, was sentenced to 10 years in prison earlier this month for illegally prescribing oxycodone and, in the words of federal prosecutors, having "contributed to the opioid epidemic that plagues this community and nation."
The punishment for the Netherlands-born Henri Wetselaar, MD, who was convicted by a federal court jury in March, illustrates how tough the government is getting in response to what President Trump has now called a national emergency.
Dr Wetselaar's attorney, Jeffrey Setness, asked US District Judge Kent Dawson to sentence his client to home confinement for 5 years. The physician's age was the first justification cited. "At 93 years old, Dr Wetselaar is most likely one of the oldest if oldest defendant to ever be sentenced in the federal criminal judicial system," Setness wrote in a sentencing memorandum filed in the case.
Setness, who did not respond to a request for an interview, offered other reasons for home confinement. He quoted physicians who described Dr Wetselaar's mental state before his trial as so impaired as to prevent him from fully participating in his own defense. One neurologist diagnosed him with Alzheimer's disease. Then there was his overall physical health, beset by chronic renal failure, prostate cancer, heart valve disorders, hypothyroidism, and 12 other conditions.
Prosecutors, in turn, asked the judge to sentence Dr Wetselaar to 20 years in prison, calculated on the basis of federal sentencing guidelines. The willingness of prosecutors to go by the book and not take into account the defendant's age or health seems to reflect the push by Attorney General Jeff Sessions to crack down on criminal offenders, especially drug traffickers.
In May, Sessions instructed Department of Justice prosecutors to both charge the most serious provable offense in criminal cases and seek reasonable sentences, but stay within the sentencing guidelines, as opposed to cutting convicted felons too much slack.
"So we are returning to the enforcement of the law as passed by Congress — plain and simple," Sessions said in a speech that month. "If you are a drug trafficker, we will not look the other way. We will not be willfully blind to your conduct…. And you're going to prison."
Attorney Michael Elliott, a former federal prosecutor now in private practice in Dallas, Texas, said that the recommendation to incarcerate Dr Wetselaar for 20 years "was in line with the Attorney General's directive to ask for the maximum sentence."
The directive doesn't apply to federal judges, who are free to deviate from the sentencing guidelines. Still, federal judge Kent Dawson sent Dr Wetselaar to prison for 10 years, which for a 93-year-old person is the same as a 20-year sentence, Elliott told Medscape Medical News. Either way, the physician is likely to die behind bars.
Dawson also ordered Dr Wetselaar to pay a $2.5 million fine.
Cash-Paying Patients, Bank Deposits Under $10,000
Three quarters of a century ago, Dr Wetselaar did something that also merited leniency, his attorney argued. The physician fought the Nazis during World War II as a member of the Dutch Underground and the British Army. While serving in the Dutch Underground, he risked execution if he had been captured, according to Jeffrey Setness.
In 1952, Dr Wetselaar earned a medical degree at the University of Amsterdam. He continued his medical training in Canada and eventually moved to the United States.
Sometime around 2008, according to prosecutors, Dr Wetselaar switched from family medicine to pain management, without any training or certification in that field. He was charged with illegal distribution of oxycodone and related crimes in 2011 when he was 87 years of age.
Prosecutors noted that the physician repeatedly sought to postpone his trial date, undermining the argument that a 93-year-old shouldn't be sent to prison. In other words, he could have taken his chances in court at a younger age.
As with the matter of sentencing, Dr Wetselaar's defense at trial hinged partly on his age. According to various news accounts, Sensett told the jury that his client's prescribing practices, though well intentioned, reflected outmoded medical training. And Sensett suggested that Dr Wetselaar's advanced age might have made him more trusting of drug-seeking addicts and their stories.
However, the jury believed the prosecutors' portrayal of Dr Wetselaar as a drug pusher driven by greed. They presented evidence consistent with a classic pill-mill operation:
Dr Wetselaar's visits with patients who complained of pain lasted a "matter of minutes," with little to no physical examination.
A review of his charts indicated that Dr Wetselaar hardly made any effort to identify someone's source of pain, never ordered nondrug therapy, and rarely referred patients to specialists.
Patients came to Dr Wetselaar from out of state, as far away as Kentucky and Ohio. And they paid in cash.
Prosecutors said Dr Wetselaar endangered patients by prescribing contraindicated combinations of oxycodone, alprazolam, and the muscle-relaxant carisoprodol. Despite receiving reports that some of his patients had died, he "persisted in his drug dealing," according to prosecutors.
The pill-mill operation generated a lot of cash. In July 2010, for example, Dr Wetselaar made bank deposits that totalled roughly $90,000. How the physician banked that money showed that he was trying to hide his criminal activity, prosecutors said.
In late 2009, Dr Wetselaar began making dozens of bank deposits in amounts just below $10,000, the threshold that triggers a bank report to the Financial Crimes Enforcement Network of the Department of Treasury. A pattern of such "structured" deposits to evade detection is a federal offense. Prosecutors said he also laundered his pill-mill revenue by using $105,000 of it to buy a home in 2009.
The physician's eventual conviction points to the overwhelming resources that the federal government can bring to bear on a criminal defendant. The investigation was conducted by the FBI, the Drug Enforcement Agency, the IRS, the US Department of Labor, the US Department of Health and Human Services, the Nevada Department of Public Safety, and the Las Vegas Metropolitan Police Department.
Dr Wetselaar is appealing "all aspects of his conviction and sentence" to the United States Court of Appeals for the Ninth Circuit in California, according to court records.
Follow Robert Lowes on Twitter @LowesRobert
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Cite this: 93-Year-Old 'Pill Mill' Physician Gets 10 Years in Prison - Medscape - Aug 14, 2017.