A California doctor now serving a 25-year term for operating a “pill mill” says pain management specialists like himself are scapegoats for the government’s failure to address the opioid epidemic. Many experts and pain advocates contacted by The Crime Report suggest he has raised a valid point.
Dr. Masoud Bamdad and his wife, Shabnam Datalchian, emigrated from Iran to California in 1987, in pursuit of a better life for themselves and their two then-young children.
Four decades later, Dr. Bamdad is serving a 25-year sentence on a federal charge of distributing and dispensing Oxycodone, an opiate pain reliever, in Federal Medical Center (FMC) Fort Worth, a Texas prison.
Dr. Bamdad, believing he was innocent, had refused to take the plea deal he was offered, or to admit guilt, which is why the judge gave him such a high sentence.
The journey he took from clinic to jail is one of hundreds of similar, but little-known, footnotes to America’s struggle with the opioid epidemic.
Dr. Masoud’ Bamdad’s clinic in San Fernando, Ca., was raided by DEA agents in 2008.
Dr. Bamdad is a certified pain management specialist and a physician licensed to practice family medicine. After completing a four-year pathology residency at Rutgers University Medical School, a two-year fellowship at the University of California-Los Angeles Medical Center, and qualifying for a certificate in pain management at USC Holy Cross, he and his wife, a dentist, opened the “Americare Medical and Dental Clinic” in San Fernando, Ca., in 1999.
They did well, following the classic path of immigrants starting from nothing in a new land. Their clinic provided pain reliever medication, including Oxcycodone, and advice to patients suffering acute or chronic pain. The government argues that the clinic was in fact a “pill mill,” dispensing massive amounts of opiates to patients without bothering to check whether they needed them.
But as far as Dr. Bamdad was concerned, he never broke the law.
He believes, in fact, that he is a “scapegoat”–along with other convicted pain doctors like himself–for the nation’s failure to address the opioid crisis.
In an interview via email from prison, he told The Crime Report:
At the time that I was practicing medicine, there was no concern and information about the opioid epidemic, and we were all in [the] dark. The government had not prosecuted all doctors who were prescribing opioids, they just selected some doctors and used them as scapegoats to teach a lesson to others.
Patient advocates and medical experts interviewed by The Crime Report suggest he has a point.
Although they didn’t comment on the specifics of the Bamdad case, they argued that federal efforts to combat the opioid epidemic by cracking down on pain medication prescriptions are an example of government overreach that has unfairly targeted some of the most vulnerable providers.
Worse, they add, the practice has caused grievous harm to many Americans who depend on pain relievers for their chronic illnesses.
”Without access to legal prescriptions, they are forced to go to street dealers for their pills,” said Dr. Nancy Nielsen, the Senior Associate Dean for Health Policy at The University of Buffalo Jacobs School of Medicine and Biomedical Sciences.
“As we reduced the number of opioids out there, chronic pain patients become medical refugees,” she added. “People are dying.”
In the most tragic cases, according to an investigation published earlier this week by FoxNews, it has driven some desperate pain sufferers to suicide.
Leo Beletsky, an associate professor of law and health at Northeastern University, called the government crackdown on prescribers an example of picking on “the lowest hanging fruit.”
Noting that most measurements of DEA success are based on the numbers of arrests and prosecutions, he argued that federal actions have largely ended up “ensnaring a lot of vulnerable people” who, if anything, represented minor players in a crisis that was fueled in part by the activities of major pharmaceutical firms.
The number of doctors and pain specialists imprisoned for violations of the Controlled Substances Act is still relatively small.
A Crime Report investigation identified 263 registered physicians, convicted and imprisoned on charges brought by the DEA Diversion Unit—the unit that handles controlled substances—between 2003 and 2017.
In nearly all the cases, the charges related to opioid prescriptions..
The total number of doctors affected, however, is probably much larger. While only a few hundred doctors have been incarcerated under the crackdown on over-prescribers, over 3,000 doctors have been forced by the DEA to surrender their licenses between 2011 to 2015 alone, according to figures obtained by the Pittsburgh Post-Gazette under a Freedom of Information Act request.
The “Pill Mill” Argument
Like many of the other physicians hit by the crackdown, Dr. Bamdad might have avoided a jail term by simply admitting his guilt, and giving up his license.
But when agents of the Drug Enforcement Administration (DEA) raided his clinic, he was confident that the government would discover its error. The amount of Oxycodone he prescribed to his patients, he claims, was based on guidelines set by the Medical Board of California.
The government charges, however, that he was running a “pill mill,” dispensing large amounts of opioids to his patients without thoroughly examining them.
After declining the plea deal, Dr. Bamdad was convicted on ten counts of illegally prescribing Oxycodone and three counts of illegally prescribing Oxycodone to persons under 21.
His lengthy sentence, according to U.S. District Court Judge George Wu, was justified by the scope of Masoud Bamdad’s “pill mill,” the seriousness of his illicit prescribing, and his apparent lack of remorse.
According to media reports at the time, Wu cited the prosecution’s report that for three years running — including 2008, the year of his arrest —Bamdad ranked among the state’s highest prescribers of Oxycodone, a powerful narcotic popularly known as “synthetic heroin.” The volume of his prescriptions exceeded that of many hospitals and pain management clinics, Wu said.
Dr. Bamdad counters that he never prescribed more than he was permitted under his license, and he also denies prescribing to anyone under the age of 18. He also maintains that he operated a relatively small office with three medical assistants, and rebuts government charges that he was among California’s “highest prescribers of Oxycodone.”
He said in his email:
All my prescriptions were for a legitimate quantity of painkillers for a legitimate time span, as even my defective indictment reveals. 2-3 pills per day as my indictment illuminates, only for controlling pain based on the guidelines of Medical Board of California for treating pain with narcotics at the time of my practice.
The key weapon used by the government to prosecute Dr. Bamdad and other alleged “pill mills” is the Controlled Substances Act. Advocates say the Act, which was most typically used to combat activities of drug kingpins by prosecuting them for the “manufacture, importation, possession, use, and distribution of certain substances,” is being wrongly used against many legitimate medical professionals.
Dr. Linda Cheek, a pain specialist who was incarcerated herself for over-prescribing painkillers and now leads a nonprofit, Doctors of Courage, which champions “innocent doctors” caught up in the opioid crackdown, charges the DEA has based its actions against doctors on a misinterpretation of a key section of the Controlled Substances Act.
Section 802 (56) of the Act allows the individual practitioner to determine what is “legitimate medical purpose for the issuance of [a] prescriptions;” but, Dr. Cheek argues, U.S. Attorneys and DEA agents with little or no medical training have taken it upon themselves to determine what is a “legitimate” medical purpose.
The DEA disputes such arguments, maintaining that there is nothing ambiguous about a “pill mill,” even if it calls itself a pain management clinic.
“In a typical pill mill case, you’d see hundreds of patients in a small amount of time frequenting that facility,” said Melvin Patterson, a special agent who is an official spokesperson for the DEA. “Just like you would see pills in a pill mill— they go in and out. That’s how we came up with the term.”
The charges and countercharges in Dr. Bamdad’s case reflect a much larger and more troubling issue, according to critics of the government’s anti-opioid policies.
While there have been well-publicized examples of profiteering doctors who have operated clinics as a kind of assembly-line where pain medications are dispensed freely with few questions asked, experts say the government is using the blunt weapon of prosecution to hold pain-management physicians responsible for an epidemic that had little to do with their activities.
That begs the question: Are the wrong people taking the fall for the opioid epidemic?
Who’s to Blame for the Opioid Epidemic?
The opioid crisis continues to shake America.
According to figures released by the National Institutes of Health, as of March 2018, more than 115 Americans die every day from overdosing on opiates, including prescription pain relievers, heroin, and synthetic opioids such as fentanyl.
Many critics have singled out the activities of pharmaceutical firms for blame.
So-called Big Pharma is now the target of multiple lawsuits brought by state attorneys general around the country, as well as by native Americans who contend that tribal populations were especially victimized by the opiates that flooded Indian Country.
The lawsuits contend that the production and distribution of massive amounts of pain medications over the past decades were fueled, in the words of one filing, by “a massive deceptive marketing campaign [aimed at] convincing doctors and the public that their drugs are effective for treating chronic pain and have a low risk of addiction, contrary to overwhelming evidence.”
“It’s the…pharmaceutical executives who should be in jail,” said Dr. Nielsen. “They cost lives and terrible, terrible misery.”
Joe Rannazzisi, former head of the Office of Diversion Control for the Drug Enforcement Administration, agrees.
“Should some of these companies have been more heavily fined or criminally prosecuted?” he told The Crime Report. “Yes.”
Rannazzisi, who leaked details of what he said were the federal government’s efforts to deflect prosecutions against pharmaceutical companies to The Washington Post and CBS 60 Minutes in a celebrated “whistleblowing” expose, has charged that the opioid crisis was allowed to spread by “Congress, lobbyists, and the drug distribution industry that shipped almost unchecked, hundreds of millions of pills to rogue pharmacies and pain clinics—providing the rocket fuel for the opioid crisis.”
Advocates say government crackdowns on prescription providers don’t address the real roots of the epidemic, including the question of how opiates like Oxycodone came to be seen as a solution for many symptoms aside from chronic pain.
“We were told that the drugs prescribed for pain were safe, and that it was extremely rare that people became addicted,” said Dr. Nielsen. “And [we now know] that is simply not true.”
But senior management at the companies has received little more than slaps on the wrist. In 2007, three executives at Purdue Pharma pleaded guilty to misdemeanor charges that they misled regulators, doctors and patients about the drug’s risk of addiction and its potential to be abused.
Opiates and Bias
One other aspect of the DEA crackdown on physicians raises additional concerns.
Dr. Cheek, who spent 24 months in prison for prescribing painkillers, believes that racial bias is a factor in many of the cases that resulted in doctors’ imprisonment. She noted that many of her fellow medical incarcerees were minorities, and were therefore considered vulnerable by authorities.
“Once the government sees these people won’t have much support…they think ‘we’ll get a plea out of them, take their money, and on to the next target,’ ” she said.
While such claims are difficult to prove, The Crime Report investigation found that of the 263 doctors incarcerated from 2003 to 2017, 26 percent were persons of color. A majority of them were immigrants to the U.S. from the Middle East or Iran. The research included checking each doctor on the DEA’s list and looking at their home countries and medical schools.
According to statistics, more than one-quarter (247,000) of the doctors licensed to practice in the U.S. have foreign medical degrees.
But while the proportion of convicted foreign-born medics matches the general proportion of foreign-born doctors in the U.S., some argue that the pain management field attracts large numbers of immigrant physicians because there are fewer barriers to entry, and is often considered to have less status by U.S. doctors.
That makes them especially vulnerable, said Leo Beletsky.
“They’ve stepped into those opportunities—some of them probably because they were discriminated against in other areas of medicine,” he said. “Not unlike men of color who don’t have other job opportunities.”
Which is why Beletsky believes that economics as well as racial bias plays a part in the prosecutions.
“Minorities are probably less likely to have the right lawyers, institutional support or someone who can address the charges brought against them,” he said.
“So they bear the brunt of these criminal investigations (while) other doctors who have the resources might be able to get out.”
Shabnam Datalchian believes her husband faces the prospect of spending the rest of his life behind bars because of their naivety about the U.S. justice system.
“It’s much easier for [the government] to go after [immigrants] because they think we don’t have the proper knowledge of the legal system… Which we honestly don’t.” she said.
DEA agents contacted by The Crime Report strongly dispute charges of bias.
“[These are] people who have violated the Controlled Substances Act,” said Melvin Patterson, a special agent and an official spokesperson for the DEA. “We go where the evidence leads us. We could care less what the person looks like or where they are from.”
Patterson said undercover DEA agents make their cases when they go into a suspected clinic and receive opioids without a medical examination.
Dr. Bamdad described the same scenario, but in a different light.
DEA agents came to his office in 2008, posing as patients, and complaining of pain.
Since pain is subjective and there is no real way to prove just how much pain a patient is experiencing, doctors are left with limited options.
They usually chose to believe their patients and prescribe them medication, Dr. Bamdad said.
The Pain Dilemma
Richard A Lawhern, director of research at the Alliance for the Treatment of Intractable Pain, who leads a nationwide effort to end the targeting of prescription opioids, argues that the prosecution of individual doctors has no medical justification.
Lawhern has contended, in a series of columns for The Crime Report, that most opioid overdose deaths are not the results of opioids prescribed for chronic pain users.
Richard A. Lawhern
The U.S. is now chasing the “wrong epidemic” in its efforts to reduce the death toll from narcotic drugs, he wrote.
According to Lawhern, the demographic analysis that supposedly connects chronic pain to addiction doesn’t bear up under careful scrutiny.
“The typical new addict is an adolescent or early-20s male with a history of family trauma, mental-health issues and prolonged unemployment,” he said. “Young men from economically depressed areas are rarely treated long-term for pain severe enough to justify use of opioids.”
In contrast, a majority of chronic pain patients (by a ratio of 60/40 or higher) are women in their 40s or older with a history of accident trauma, failed back surgery, fibromyalgia, or facial neuropathy, he said.
“And women of this age whose lives are stable enough to allow them to see a doctor don’t often become addicts.”
Other research supports Lawhern’s claim.
A recent study published in Addiction, the official journal of the Society for Addiction Studies, found that reducing opioid prescriptions has had little effect on reducing overall opioid deaths,
The study, entitled A Crisis of Opioids and the Limits of Prescription Control: United States, argues that the amount of opioids prescribed is not the sole factor leading to the rise in opioid deaths, nor even necessarily the most prominent one.
“No data supports forced opioid reductions as safe or effective,” wrote the study’s authors, Stefan Kertesz of the Birmingham School of Medicine at the University of Alabama; and Adam Gordon, of the University of Utah School of Medicine and Informatics.
The amount of overdose deaths involving prescribed opioids has remained constant since 2010, despite a reduction in the amount of opioids being prescribed. This “lack of return” is grounds for developing a new approach to the crisis, according to the study.
But so far there is little evidence that such an approach is on the drawing boards in Washington.
As the public continues to clamor for action against the opioid epidemic, the government appears to continue using the playbook from the much-criticized “War on Drugs” of the 1980s.
One hardball tactic frequently used in cases against physicians resembles the “flip” tactics used to get suspected co-conspirators to testify against their former comrades in order to receive lighter sentences or get away with no jail time at all. Similar tactics are being used this month in the prosecution of the notorious reputed Mexican narco-boss El Chapo in his trial in Brooklyn, N.Y.
In an opioid prescription case, prosecutors may warn a doctor’s personal assistants or nurses that they will be co-defendants unless they testify against him or her.
That’s what happened to Dr. Bamdad.
He came to the DEA’s attention when a patient overdosed and died from drugs he prescribed. Members of his staff, including secretaries and nurses, were pressured into giving misleading testimony about his activities to avoid prosecution themselves, he claimed.
Dr. Bamdad believes that if the prosecutors had not introduced the evidence of his patient’s death (his patient committed suicide), no rational jury would have convicted him for prescribing what was a legal quantity of Oxycodone for controlling pain.
Shabnam Datalchian, his wife, told The Crime Report that during the trial, one woman admitted the government threatened her with prosecution unless she testified. After Dr. Bamdad’s attorney told the prosecutor, she was released and never testified.
“It’s insane [that he was given a long sentence for helping patients, for prescribing patients with chronic pain,” Shabnam said.
“The doctors don’t know what to do. If they don’t prescribe pills they get in trouble for not treating a patient’s pain problem. But if they do…they might end up like my husband.”
Advocates suggest that a key problem is DEA investigators’ lack of training which would enable them to distinguish a doctor who is overprescribing or diverting drugs from one who has just taken on a lot of patients who take opioids.
“The DEA assumes any patient who is prescribed more than 90 milligrams of morphine daily has been over-prescribed,” Lawhern said. “[But] if you ever have the chance to talk to pain management doctors in practice, you might learn the normal range of a daily dose for pain patients is between 50 and 1,000 milligrams.”
The DEA counters that the law is clear in distinguishing legitimate doctors from those who operate the so-called “pill mills.”
“You can prescribe large amounts of opioids, but the question is, are (you) doing it within the law?” said former DEA agent Jeffrey Higgins.
“There are certain requirements when you’re licensed by DEA to prescribe drugs and part of that is seeing the patient and evaluating the needs of the patient.”
“If you are prescribing without examining patients, that is a violation of the license.”
The legal requirements, he noted, include being seen by a doctor, and being evaluated on their need for pain medication.
What is ‘Legitimate Medical Purpose’?
The difficulty lies in defining the phrase legitimate medical purpose, used under the Controlled Substance Act according to Dr. Cheek.
She gave the example of the trial of Dr. John Patrick Couch in Mobile, Ala., a doctor who was sentenced to 240 months in prison for running a “massive pill mill.”
When the DEA agent was asked during the trial to define “legitimate medical purpose” in pain management, he said he couldn’t answer that question because “he wasn’t a doctor,” Dr Cheek said in an interview.
That captures the principal problem connected with prosecution of pain doctors, she explained, arguing the government is trying to define “legitimate medical purpose” without any expertise.
Similarly, under questioning during Dr. Bamdad’s trial, the lead DEA investigator admitted she only had one hour of training on painkillers and medications.
“That was all her and her associates’ knowledge of medicine! Isn’t it interesting?!” Dr. Bamdad wrote in his email.
In fact, for most pain management doctors, prescribing large amounts of opioids to chronic pain patients is a legitimate medical practice Dr. Nielsen said. Sometimes, the dosages are high, depending upon the amount of patients each doctor sees, she added.
Today, at 64, Dr. Bamdad remains confused and angry, hoping his case will eventually come before the Supreme Court. His lawyer has petitioned for a review on the grounds that his constitutional rights were violated by the DEA sting.
He argued in his petition that a physician who “was practicing legitimate pain management based on his licensing agency guidelines” could not be held liable for a violation of the Controlled Substances Act that involved the distribution of controlled substances.
Appeals of his case in California have so far been unsuccessful.
Dr. Bamdad’s lawyers hold out slim hope that his petition will get anywhere. Nevertheless, he believes that the country he came to as an ambitious young man will live up to the ideals that drew him here.
“You were damned if you did and damned if you didn’t,” Dr. Bamdad wrote in his email.
“I wish I knew about the Department of Justice and DEA criminalizing treating patients with pain; if so, I never would have done it.”
Megan Hadley is senior staff writer and associate editor of The Crime Report. She welcomes comments from readers.