KNOXVILLE, Tenn. — Eight workers at what federal authorities call a pill mill are on the road to prison after pleading guilty to federal drug conspiracy charges.
One of them, Dr. James Brian Joyner, was sentenced last week to 70 months in federal prison. The others — another supervisory doctor, two physician's assistants and four nurse practitioners — are awaiting sentencing in a case that federal prosecutors in East Tennessee say is a first for them: asking a grand jury to indict a pain clinic's medical staff, not for overprescribing or fraud, but for dealing drugs just like hustlers on the street peddling crack cocaine.
"It was good money, an easy job," one of the physician's assistants, Don Robert Lewis Jr., testified last week in U.S. District Court here. "I had always worked an extra job. I didn't think about it much either way. I was just pretty much going through the motions. It was a kind of willful blindness, I guess."
They asked a question or two and wrote a prescription. None knew a thing about pain management and only slightly more about the deadly drugs they were doling out, they said.
They had plenty of warning signs that the clinic where they worked, Breakthrough Pain Therapy Center in Maryville, Tenn., was no clinic at all:
- Cash only payments
- Gun-toting workers
- Entire families as patients with identical pain complaints
- No medical referrals
- No prior testing
- No medical equipment
- No appointments
- A boss with zero medical experience
But the clinics were perfectly legal and completely unregulated, so they said it was easy to convince themselves they were doing nothing wrong.
Federal authorities raided the clinic about 15 miles south of Knoxville in December 2010 and had Sandra Kincaid; her husband, Randy Kincaid; and two family members indicted as drug dealers. That did nothing to stop pill mills or even to stop some of the providers who worked at Breakthrough from going to work at another pill mill or setting up clinics of their own.
Joyner went to live in Martinsville, Va. He had been granted a Virginia medical license in July 2010 and began practicing there.
So in 2014, the U.S. Attorney's Office in Knoxville made a bold move. Prosecutors made a case to a federal grand jury to indict Breakthrough's medical staff, too.
Only then did other doors begin to close. Joyner was allowed to retire his Tennessee license in July 2015; his license in Virginia wasn't suspended August 2016, according to online records from the medical boards in both states.
Lewis and Joyner; physician's assistant Walter David Blankenship; nurse practitioners Jamie Chiles Cordes, Sherry Ann Fetzer, Buffy Renee Kirkland and Donna Jeanne Smith; and Dr. Deborah Gayle Thomas each worked part time at the clinic from 2009 to 2010, earning anywhere from $500 a day to, for the doctors, $1,000 a day. Their boss, Sandra Kincaid, was an opiate addict who opened the clinic with her husband as a way to make money and feed her addiction.
She not only ran the clinic but paid patients to give her a percentage of the pills they received. In just 17 months, the clinic pulled in $12.5 million — all in cash.
The defendants fought mightily, arguing that their indictment was a federal encroachment on the doctor-patient relationship, an abuse of the government's power and in no way akin to garden-variety drug dealing. They lost.
Now, five medical professionals also are charged in a separate 2015 case, and two of them face life in prison if convicted of allegations that they directly caused overdose deaths.
But things really haven't changed much, an IRS Criminal Investigation Division investigator, Meredith Louden, testified last week. The opiate epidemic, which has now led to a companion heroin epidemic, is showing no signs of slowing.
"It's gotten even worse," she said.