Federal prosecutors continue to bring the pain against two doctors accused of operating a lucrative “pill mill” pain management practice in Mobile from 2011 until it was shut down by authorities last May.
John Patrick Couch and Xiulu Ruan, who owned Physician’s Pain Specialists of Alabama P.C. (PPSA) on Springhill Avenue and Airport Boulevard, were hit with a second superseding indictment yesterday, adding 11 fresh charges of conspiracy, distribution of controlled substances resulting in the death of patients and violations of anti-kickback statutes to existing charges of racketeering, health care fraud and mail fraud. Individually, Ruan is facing separate charges of money laundering.Most shockingly, the latest indictment accuses both doctors of prescribing medications “outside the usual course of professional practice,” causing “death and serious bodily injury” to a number of patients who later died. The decedents were identified only by their initials, but the indictment detailed the prescriptions written for each.
Allegedly, prescriptions written by Ruan resulted in the death of individuals known as D.W. and J.B., while prescriptions written by Couch resulted in the death of individuals known as K.D. and P.C.
The latest charges also pile on the doctors’ distribution of rapid release fentanyl, hyrdocodone, and brand-name drugs Subsys and Abstral as well as the prescriptions to patients who later died as a result of their use.
• D.W. died after Ruan wrote a prescription in Nov. 25, 2014 for Opana, a mixture and substance containing a detectable amount of oxymorphine.
• J.B. died after Ruan wrote a prescription on Oct. 10, 2012 for MS-Contin, a mixture and substance containing a detectable amount of morphine sulphate.
• K.D. died after Couch wrote prescriptions in March 2015 for Roxicodone and OxyContin, both of which contain oxycodone.
• P.C. died after Couch wrote prescriptions in March 2014 for oxymorphine and Morphine Sulphate Instant Release.
Dennis Knizley, a defense attorney representing Ruan in the case, called the new charges “more of the same,” saying evidence will show Ruan followed medical criteria in evaluating patients and prescribing medications. Knizley characterized the new anti-kickback charge as “a rebate” a manufacturer gave to the pharmacy jointly owned by the defendants, and said the allegations of patient deaths are confusing because the dates and initials don’t match records maintained by the defense.
Federal agents raided the practice last year, alleging the pair wrote approximately 285,000 prescriptions for highly addictive and widely abused pain medications in four years, becoming “not only one of the most prolific purchasers of controlled substances in the state of Alabama, but also in the entire United States.”
Ruan, the latest indictment emphasizes, led the state in purchases of oxycodone and morphine from 2011 until 2015, and fentanyl from 2012 until 2014. “Despite some aspects of legitimate medical practice at PPSA, Ruan and Couch ran what was, in essence, a pill mill,” it explains.
“Their primary method of pain management was writing multiple prescriptions for high doses of [controlled substances] … Some of these prescriptions were diverted and/or abused by drug traffickers and addicts.”
According to the original charges and first superseding indictment, the doctors used PPSA and their related pharmacy in an upcharge and kickback scheme to become personally enriched, compiling several properties, bank accounts, and a stable of exotic cars including Ferraris, Lamborghinis, Bentleys, Porsches, a Saleen and a Maserati.
Several co-defendants in the case have reached plea agreements with prosecutors, including former employees Thomas Justin Palmer and Bridgette Williams Parker, and Christofer Manfuso, the owner of Comprehensive RX Management, who acknowledged paying $864,770 to Couch and $1.7 million to Ruan over a three-year period.
The defendants are scheduled to be arraigned on the new charges May 3. In addition to a forfeiture of their assets and the revocation of their medical licenses, prosecutors indicated the charges carry penalties of 60 to 105 years in prison if the defendants are convicted as indicted. The trial was originally scheduled to begin in June, but in light of the new charges, there is currently a joint motion before the court to push it back to October.
Updated to include the comments of Dennis Knizley and clarify the trial date.
SECOND SUPERSEDING INDICTMENT
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