Original subtitles

In this episode of American Greed, 9 -1 -1, what is your emergency?

Americans are dying by overdose in record numbers.

Victims of the worst opioid addiction epidemic in history.

And in Mobile, Alabama, two doctors, Patrick Couch and Shulu Ran, are serving

heavy doses of the dangerous drugs.

One drug they prescribe is brand new.

Made by a multi -billion dollar drug company that is paying the doctors to

its product.

Fifty times more potent than heroin.

That's more like a lethal weapon than a medicine.

And some of their patients who want relief from chronic pain descend into a

living hell.

It said on the pack you may become addicted.

It should say you will become addicted.

But the drug maker and these doctors are unrelenting, turning patients' pain

into enormous profits.

This case was a pill mill that was also a money mill.

And some of the families of patients who die hold the doctors responsible.

He lost his life because he was seeing a doctor that prescribed him that

medication, and he winds up dying under his care.

In Mobile, Alabama, in the spring of 2014,

Patrick Chaussé heads to class at the University of South Alabama.

Chaussé is an Army veteran, home from two tours of duty in Iraq, where he

made time to check in with his girlfriend, Amanda.

He called me every single day, every single day while he was over there.

He made it a point.

But today, something is wrong.

Patrick is not returning Amanda's calls.

Worried, she races to campus and finds his truck.

Inside, Patrick is passed out, apparently not breathing.

I screamed and screamed and screamed and screamed for help.

Somebody came, called 911.

Just 27 years old, Patrick Chaussé is dead.

News of his death sweeps across campus.

Students are asking, what killed Patrick Chaussé?

I don't wish that on anybody.

I don't want anybody to ever feel, ever feel what I had to go through.

The private story of Patrick Chaussé's last days is found in a dark chapter

in Mobile.

This is a place that prides itself on its old world southern charm with a busy

commercial port and peaceful waterfront.

And in 1997, a young doctor from Georgia moves here and opens a pain clinic.

He is Patrick Couch, an anesthesiologist.

He calls his clinic Physicians Pain Specialists of Alabama, eventually known

PPSA.

Early on, Couch and his clinic earned a good reputation.

I would say that Patrick Couch was an influential member of the community.

a well -respected doctor at some point in his career.

He was a very competent doctor.

Everybody thought highly of him.

In 1999, Brian Bechtel takes his wife, Teresa Odom, to Couch's Clinic.

Teresa is paralyzed following a car accident and suffers from spasms in her

legs. She would be in her wheelchair, and her legs would just kick, and it

hurt her. When you don't feel most of your body, the pain you do feel is

extreme.

Couch has the answer, a pump that delivers an anesthetic to her spine.

It's exactly what we were looking for. She was comfortable.

Everything seemed to work fine.

Couch operates on his own for seven years and then brings in a partner,

Ran.

Born in China, Ran is educated in the U .S. He is the author of multiple

articles in medical journals and claims to be a world record holder for board

certifications.

Under Ron, PPSA expands and a new marketing campaign is launched.

At Physicians Pain Specialists of Alabama, we don't treat pain. We treat

patients who are suffering from pain. And it is clear to many that Ron is

running the show.

Dr. Ron could persuade Dr. Kautz to do anything.

Lori Carver -Linder is the PPSA clinic manager.

Dr. Ron had the run of the practice, especially when it comes to the money

to the billing. It was always up to Dr. Ron.

And by all appearances, Ron is exceedingly concerned with money.

The overarching goal for Dr. Ron, regardless of what drug he was

was how do I maximize profit? What is going to be the most amount of money we

can squeeze out of every single patient?

And to keep profits high, it is best to insist that patients have insurance.

Many of the medications they prescribed were extremely expensive.

And by ensuring that your patients have insurance, you know that you are going

to get paid.

But really big money is made when a clinic has its own pharmacy.

And so Couch and Ron opened CNR Pharmacy, immediately adjacent to PPSA.

CNR was really critical to Ron and Couch's ability to churn out money the

they did.

Without CNR Pharmacy, They could prescribe drugs, but they would be

Walgreens or CVS or a local drugstore. And that local drugstore is then the one

that gets the reimbursement from insurance companies. So it's the

makes the money.

Several years after Ron arrives, PPSA is a big operation, eventually serving as

many as 8 ,000 patients.

But some of Couch's long -term patients are not impressed.

After Dr. Ron came, things started to change.

Every time we went there, the office was full, and there would be people coming

in of questionable character, coming in hollering, wanting their refills, and it

was terrible.

And for Bechtel, Dr. Couch is conspicuously absent.

Eventually, we never seen Dr.

Couch. The nurse would fill her pump.

And go out of the office and come back with the prescriptions. At some point,

became almost disassociated with what he was doing. He just kind of checked out

of being a doctor and wanted to do other things like play in a band.

Couch actually does have a band, appropriately called Midlife Crisis.

And he makes it clear to many that this is where he wants to be.

Because his main goal was he wanted to be a rock star.

But that did not.

You know, support his lifestyle.

The doctor indeed.

And that lifestyle includes a million -dollar house on Mobile Bay.

This is what a doctor's income buys.

But according to Carver Linder, Couch's disdain for a doctor's work is no

secret.

He'd have his patients laying on the table waiting for their procedure.

All passed out, sedated and everything, sometimes for two and three hours to

where we'd have to re -sedate them before we could ever do the procedure.

And so Couch comes up with a way for others to do his work.

Nurse anesthetist Stacey Madison and nurse practitioners Bridget Parker and

Justin Palmer.

I would probably see on average about 32 patients a day.

Some days I would see more.

There were a few days I saw 50 or 60.

Many patients assume Palmer is a doctor.

After all, he is signing their prescriptions.

I was given blank, pre -signed prescription pads, or if I needed to, I

forge his name.

It works for the nurses and the doctors, but for the patients, it's dangerous.

Because the supervision over what they were prescribing and what they were

was almost nonexistent.

And under that limited supervision, they prescribed very powerful, dangerous

narcotics. Opioids to patients like Teresa Odom.

She had all this pain medication beside her in the drawer. And I said, Teresa,

look at this pain medication you got. This is one month prescription.

If anybody took this as prescribed, they would not function.

They wouldn't be alive.

Hydrocodone, hydromorphone, oxycodone, oxymorphone, and fentanyl. Dr. Ron, Dr.

Couch were in the top ten in the state of Alabama for each of those drugs. For

most of those drugs, for most of the years in question, they were the number

and number two by a long shot.

And how is that serving their patients?

Opioids are not good medicines for long -term pain.

Dr. Andrew Kolodny is the Director of Physicians for Responsible Opioid

Prescribing. Because of tolerance to the effects, the only way to continue

getting pain relief is if your dose keeps going up.

And as the dose gets higher, you'll often see that the patient's level of

functioning begins to decline.

And of course, as the dose gets higher, it becomes much more...

And while several of Couch's and Ron's nurse practitioners provide easy access

to opioids, what is most alarming is that they are also helping themselves.

Bridget Parker becomes addicted as a pain patient herself.

She admitted that she would rifle through patients' purses when they were

getting their blood pressure taken, and that when patients brought back

medication, it should have been returned or destroyed, but Bridget would keep it

for herself for her own personal use.

And she is not the only one. When I interviewed initially, I was very

with Dr. Couch that I'd previously been to treatment for opioid addiction.

And I did continue to do the right thing, maybe about a year.

And then I started using narcotics again.

Palmer's choice of opioid is Dilaudid. And he would shoot it up.

And he gave testimony at trial that he injected over 600 milligrams of Dilaudid

a day.

And he told the jury that it was enough to kill everyone in this courtroom.

That's how bad of an addict he was.

And what few people at the clinic know is that the problem extends to one of

men in charge.

You know, Couch had a substance abuse problem himself.

He had been to Narcotics Anonymous.

and Alcoholics Anonymous.

And on some occasions, he did meet some of these nurse practitioners in

Narcotics Anonymous.

And he actually recruited some of these nurse practitioners to come work with

him inside of the pain clinic, mind you.

By 2012, the money is pouring in.

But Patrick Couch's pain clinic has become a recipe for disaster.

Up next, a spray 50 times more potent than heroin.

A pharmaceutical company's answer to pain.

And we believe this platform is very important for the future of drug

In 2012, the epidemic of opioid addiction is building across the

Deaths from prescription opioids are skyrocketing.

And against that backdrop, insists therapeutics.

A pharmaceutical company in Arizona announces a new product made from one of

most addictive and dangerous substances in medicine, fentanyl.

Fentanyl is about 50 times more potent than heroin. A tiny dose can cause

someone to stop breathing and die.

John Kapoor, a billionaire drug entrepreneur and the founder of Insys

Therapeutics, is betting on fentanyl with a new product called Subsys.

Instant release fentanyl that comes in a spray.

The drug is FDA approved for cancer patients who need extra pain prevention.

It is marketed as easy to use.

Squeeze your fingers and thumb together to spray subsist under your tongue. The

company has high hopes.

Tell us what it is about Insys that has investors so excited.

The device that I brought with me today allows the patient to simply, with no

priming, spray the drug underneath their tongue.

in a plume geometry, and we believe this platform is very important for the

future of drug delivery.

But Subsys, as FDA approved, has a limited market.

There isn't very much money to be made with a medicine that's only going to be

prescribed to patients at the end of life with pain from cancer.

Sure, no, we're in it for the long term. And so executives at Insys Therapeutics

reach out to pain doctors like Couch and Ron.

We know that before that substance even came on the market, that Insys had flown

Dr. Ron and Dr. Couch out to where their headquarters was, and they were on the

advisory board for substances prior to this drug even hitting the market.

Imagine what you could do if you were pain -free.

With an inside track at the drug company, Ron and Couch start writing

prescriptions for off -label use for substances.

Treating common chronic pain conditions with... Any opioid is probably not

appropriate, but to prescribe fentanyl for those problems is totally

unacceptable. The immediate -release fentanyl products, like the fentanyl

substance spray, that's more like a lethal weapon than a medicine.

Camison Witherspoon has a close encounter with substance after abdominal

leaves her with severe pain.

Before surgery, I was a woman of God in church, married, mother of four,

daughters all good students, husband, great job.

But then she makes an appointment at PPSA.

She sees nurse practitioner Bridget Parker, and she says she is immediately

given a prescription for substance.

She didn't, you know, feel to see how the pain was, where the pain was, or

anything like that. She just gave me these prescriptions and told me to take

them. I didn't know. I thought maybe that's how pain clinics work because I

never been to a pain clinic before.

What should have occurred was the doctor sitting down and saying, I understand

that this is a cancer drug for end -of -life cancer pain.

You don't have that. However, nothing else is responding well to your pain.

I truly believe that this is something that may provide you the relief that you

seek. But those conversations weren't happening.

Witherspoon is simply told to follow directions on the box.

The first day I took it, I felt the jump up.

It said on the pack you may become addicted.

It should say you will become addicted because right away I think I was

to it. And while patients are becoming addicts, Ron maintains the use of

substance for chronic pain of all kinds is just good medicine.

He was a cutting -edge doctor that thought he knew the best way to treat a

patient. And providing substance, this fentanyl product, in his mind he thought

it would be faster and better pain relief for the folks.

And so the boxes of substance are flying off the shelves at CNR Pharmacy.

For several months after the drug comes on the market, Ron and Couch are among

the top prescribers of the drug in the entire United States.

And according to federal prosecutors, that makes them very important to

executives at Insys Therapeutics.

Dr. Ron was powerful enough that what Dr. Ron wants, Dr.

Ron gets.

When Insys asked Ron who he would like Insys to hire as his sales rep, Ron

suggests a woman he wants to date.

Natalie Perhax, a medical equipment salesperson. And immediately, Perhax is

hired.

She later testifies in trial that she has no experience in drug sales, has no

idea what fentanyl is, but sure enough, because she gets a recommendation from

Ron, she gets the job.

And that job is making sure Ron and Couch keep writing prescriptions for

substance.

Natalie Perhax was in PPSA's clinic roughly five days a week. She was there

almost every single day.

So she was very on top of what was being prescribed.

And at what quantity?

And to help perhaps motivate the two doctors to prescribe substance, Insys

Therapeutics has a proven incentive, cold cash.

Insys calls the money paid to the doctors a fee for giving speeches to

doctors about substance.

Having speaker programs is not illegal. That is something that most drug

companies do.

But there has to be a legitimate benefit to it. And according to PPSA employees,

in the case of Couch and Ron, the speeches amount to lunch out with the

It was a free meal. That's what it was about. Nobody cared about.

The drug?

And the speaker engagements were the biggest boondoggle there ever was.

They would have these meetings at restaurants in the local area, and only

staff would come to these meetings. And these doctors would be paid $2 ,000 for

that small amount of time, and it would be money sent to their personal

accounts. Over the course of three years, big prescribers Couch and Ron

collect more than $250 ,000 in speaker fees from Insys Therapeutics.

The overriding purpose of why Insys Therapeutics was paying our doctors this

amount of money was in exchange for them to continue prescribing the substance.

And that may explain, in part, why Tammison Witherspoon can get as much

substance as she says she wants.

I told them, I said, I'm running out of my medicine. And they was like, what are

you doing? Are you using it? I said, yes, I'm using it more than I'm supposed

because I feel like I need it.

So their remedy was to bump me up from 200 micrograms to 400 micrograms.

And not surprisingly, her life on substance has become miserable.

My kids, they would find me passed out from taking so much medicine.

I turned into a monster because it makes you, when you don't have it, you are a

monster. She remembers one incident that was particularly terrifying.

One night, I had taken all my meds. And I fell asleep on a heating pad.

And when my girls came in, they were like, Mom, you bleeding.

And I was like, what do you mean? And I looked down and on both my breasts, I

burned a hole in them. And I ended up having to go to the emergency room

I was on so much pain meds, I didn't feel it at all.

And for a woman who was once a model of success, the shame of her addiction is

excruciating. I never used drugs. I never even drank alcohol. I've never had

alcohol in my life.

And here I am, total drug addict from something that I could go get

legally.

One of our biggest commitments is to remain profitable and cash flow

And she has no idea that behind her addiction is a pharmaceutical company

is raking in millions.

In May 2013, Insys Therapeutics goes public.

With what will be the most successful IPO of the year.

Insys Therapeutics up 400%. Up next, for doctors Ron and Couch, when profits

are big, so are the toys.

Bentleys, Mercedes,

Porsches, cars I can't even pronounce.

In Mobile in October 2013, PPSA has an astounding month.

Couch and Ron write 110 prescriptions for substance.

The prescriptions are filled at CNR Pharmacy, and insurance companies pay a

whopping $572 ,000.

One month, one drug. The doctors are taking the term pill mill to a whole new

level. Over the years, Pill mills are evolving and continue to evolve.

They're not the walk -in, pay cash, get handed a script that they were some

years ago.

This case was a pill mill that was also a money mill.

That is something Tim Burns understands well.

His wife, Kathleen, becomes Ron's patient after a car accident leaves her

serious back pain.

Dr. Ron puts her on subsys.

I didn't find out what kind of drug it was until I talked to my sister -in

She told us, both of us, that it was a cancer medicine for cancer patients that

are dying to get relief from the pain they're in.

In fact, sepsis is so dangerous that most insurance companies will only pay

the drug for its FDA -approved use for cancer patients who are tolerant to

opioids.

Kathleen Burns does not have cancer, but her insurance company thinks she does.

Why? The answer may be found in the discovery by federal investigators that

employees at Insys Therapeutics have misled insurance companies about

diagnoses. Criminal indictments and public reporting show that Insys has

manipulated the insurer approval process. In September 2017...

A U .S.-centered investigation details its findings on how insurance companies

have been deceived.

Incest techniques have included the falsification of medical histories for

substance patients and the concealment of the company's role in intervening

the insurers and pharmacy benefit managers.

Incest puts responsibility on mistakes by its employees.

But at PPSA, it is understood that in order to get insurance company approval

for a cancer -free patient like... Kathleen Burns, the staff can simply go

the INSA sales rep, Natalie Perhax.

I would call the rep and say, I'd like to give this patient

sepsis, but it's not being approved. Can you help me?

And they would. I've seen some really slimy behavior by pharmaceutical

companies, but that sets a new bar.

And the price that is paid by cancer -free patients is tremendous.

What had happened, she was getting into that drug, and she would just use it

every time she got a chance.

And I'd find her laying in the floor on the couch.

I tried hiding it. I locked it in a cabinet with a chain around it, a file

cabinet. But that just pushes Kathleen out, looking for whatever she can find.

Well, she'd be out in the streets buying more drugs.

And it was horrible to sit there and watch a beautiful, fine woman go down to

nothing.

Like many patients at a pain clinic, Kathleen Burns is given a urine test to

make sure that the prescribed drugs, and only the prescribed drugs, are in her

system. And month after month, Kathleen Burns fails the test.

It's clear she needs help, not more opioids.

She should be turned away by the clinic. She should be fired.

But Ron's attitude about firing addicts is explained in an email obtained by

federal investigators.

He says, we fire patients rather infrequently.

In private practice, the more you fire, the more revenue you lose.

So he's basically equating patients to revenue.

And so Kathleen Burns continues to receive substance.

Her insurance company pays $150 ,000 for her prescription.

But then the company, HealthSprings, discovered the truth.

HealthSprings contacted the Burns' and asked about her cancer treatment, to

which the response was, I don't have cancer.

And a letter was then sent to Dr. Ron saying, we're no longer going to approve

her receiving substance prescriptions as she doesn't have cancer.

And that is when Dr. Ron finally asks Kathleen Burns to get out.

Kathleen Burns...

was profitable to him, and while she was profitable, he was going to keep her on

as a patient. But as soon as he could no longer prescribe her this $10 ,000, $15

,000 a month drug, then she's not worth it to him to keep on anymore.

And profits do matter to Couch and Ron.

Theirs is a very successful clinic.

It was extremely profitable.

They saw a massive number of patients. They did a number of procedures.

Received monies from the CNR pharmacy connected to their building, massive

amounts of monies there. And they received kickbacks, so they were

money on top of money.

And a very good measure of the money they are bringing in is found in their

collection of sports cars.

Bentleys, Mercedes,

Porsches, cars I can't even pronounce, Lamborghinis, high -end cars, well

-maintained. One Porsche that had a Payne MD tag on it.

Not far from where the doctors showcase their luxury cars, Tim Burns is watching

his wife's drug addiction take its toll.

She went from this vibrant woman down to nothing.

And then in the winter of 2015, Kathleen Burns dies.

The morning I woke up, she had passed away sitting up.

That was pretty rough there.

Yeah, I figured I'd be the one to go first.

Up next, Couch and Ron suddenly have a new favorite drug.

It shows a massive spike in prescribing, where it goes from virtually no

micrograms per month to Dr. Ron spiking at over 2 .5 million micrograms per

month.

In Iraq in 2007, Sergeant Patrick Chaussé is on patrol.

A time when roadside bombs like this one were the number one killer of American

soldiers in Iraq.

And one of those IEDs blows up a truck in Chaussé's convoy. He suffers injuries

to his knee and back.

After two tours in Iraq where Chaussé is awarded numerous medals, including the

Global War on Terrorism Service Medal, He makes it home to Mobile, enrolls at

the University of South Alabama, and marries his girlfriend, Amanda.

He proposed to me on a dock out in Daphne on the other side of the bay, and

still in his uniform, so it was great.

But the pain from his injuries continues, and he makes an appointment

specialist, Patrick Couch.

Of course, we didn't see him.

We saw Stacy,

and she was nice.

understanding of you know his pain and immediately nurse anesthetist stacy

madison starts patrick on the usual load of medications in no time the pain is

gone but so is the patrick amanda married it was horrible because he would

be doped out of his mind and and it was just a a cycle of him not being there

anymore this is what it came down to he wasn't there anymore

But that does not stop Patrick from getting more and more narcotics

by a nurse who Amanda believes does not listen.

I let Stacy have it. I was like, you have to take him off this medication.

It was crazy.

I have heard of the situation before where despite family members

plea telling a prescriber, you're going to kill my loved one, please stop, the

prescriber just...

And it's very hard to understand what would motivate that behavior, why

not trying to help that patient get into addiction treatment. And it does make

you wonder if what's behind this is greed.

And that question is amplified in the fall of 2013, when Couch and Ron start

looking at investment opportunities.

So Dr. Ron and Dr. Couch discussed, what company can they buy stock in?

where they can essentially move the needle. This is a big pain practice, and

they own their own pharmacy.

What company could they have an impact on the stock price through their

prescribing? The answer they come up with is Galena Biopharma, the maker of a

drug called Abstral, another instant -release fentanyl.

It is a direct competitor to substance.

Ron writes Couch, this is the product. We can play a big role.

Couch agrees.

And beginning in December 2013, they eventually purchased close to $800 ,000

worth of Galena Biopharma stock each.

And then they start cranking out prescriptions for, you guessed it,

So one of the things that we did was we graphed out certain of the drugs the

doctors prescribed. DEA investigators chart the micrograms of Abstro

by Couch and Ron following the stock purchase.

What's particularly stark about this Abstro chart, is it shows a massive

in prescribing, where it goes from virtually no micrograms per month to Dr.

Ron spiking at over 2 .5 million micrograms per month. That spike

directly with the time period that Dr. Ron and Dr. Couch were talking about and

ultimately buying large amounts of stock in Galena Biopharma.

At the high point, Couch and Ron are writing one -third of all the abstral

prescriptions in the U .S. And that raises the question, are patients

what is good for them or good for the doctors?

You're getting what is going to be profitable for the doctor. The manner in

which the doctors prescribed abstral was not based on patient need, but based on

the financial motivation of the doctor, the stockholder.

And according to trial testimony, executives at Insys Therapeutics, makers

Sepsis, are concerned that because its top prescribers are prescribing Abstro,

they may lose out to the competition.

And so John Kapoor, the founder of Insys and other top brass, pay a visit to

Mobile in February. They need to keep their big customers happy.

This is extraordinary.

This is a billionaire.

founder of a massive pharmaceutical company who's flying to Mobile, Alabama

meet with Dr. Ron and Dr. Couch.

That's how much power Dr.

Ron and Dr. Couch had over Insys Therapeutics.

And following the meeting, the doctors are given a better deal on the delivery

of subsists.

So the deal was that Insys would do direct supply to CNR Pharmacy, cutting

the wholesaler, saving Couch and Ron 5 % to 8 % on profits.

If only the patients taking the drugs mattered as much as the profits that are

made from them.

That's what Amanda Chausset says she is wishing every day, and especially on

April 2nd, the day she learns from doctors at the local emergency room that

Patrick has died.

He recently had pneumonia, which weakened his lungs, and then he was

on a high level of oxymorphone.

Likely what happened is that you...

decreased his lung level to such a degree that he just was unable to

In Amanda's mind, there is no question that if he had not been taking the

Patrick would be alive.

He lost his life because he was seeing a doctor that prescribed him that

medication, and he winds up dying under his care.

So, yeah, there's no doubt in my mind that those drugs that he was prescribing

killed him.

The loss of Patrick Chaussé draws attention from strangers who send

for someone they say they consider a hero, a 27 -year -old man who was ready

die for his country.

He did two tours, and then to come back to that?

To trust somebody in your own country?

For greed?

For money?

It's something horrible.

Up next, what an undercover agent discovers about Patrick Couch.

For

almost

a year, Tammison Witherspoon lives in the hell of her addiction to fentanyl.

By this time, I needed, I was taking it so I wouldn't get sick. I was taking it

so I wouldn't.

I felt like I was dying because my heart rate would drop so low, and I would

sweat so bad, you know, nausea, and it was awful.

And so Witherspoon worked hard to never miss an appointment with nurse

practitioner Bridget Parker, who, according to Witherspoon, is still

with her own addiction.

My last visit with her, she was passing out.

She was sitting in a chair writing prescriptions, and her head just slumped

over, and she went to sleep for 10 minutes. And I was sitting there going

through in my mind saying, if my nurse is addicted to drugs, it's no hope for

me. And when I left that day, I just cried and I cried and I cried. I didn't

know that this was going to be the turning point, but I kept thinking about

I saw Bridget.

And I called my husband, and I said, I'm going to rehab.

Like Bridget Parker, Justin Palmer continues to abuse the clinic's drugs.

At one point, a medical assistant finds him passed out in an exam room with a

needle in his arm. And now everyone knows he is using.

And when Dr.

Couch found out, he told me to take a couple weeks off and get my head

So I did. I took a couple weeks off, and nothing changed. I kept doing what I

was doing.

And while the problems at PPSA are swept under the rug, an undercover agent from

the DEA is posing as a patient.

Now, without hurting yourself, I want you to bend over like this as far as you

can. He is seen by nurse anesthetist Stacy Madison.

Watch this.

This is the undercover doing the range of motion test.

He's going to stand up, he's going to bend over, bend backwards, and bend side

to side.

His range of motion is what a normal person would have.

And then

the undercover agent admits he has been getting pills off the street.

Definitely a sign of a drug -seeking addict.

Does that help you with your pain? Of course it helps you with your pain.

what I want you to prescribe me, and that's what I want to get.

Finally,

Couch walks into the room and almost immediately signs a prescription for 15

milligrams of Roxycodone and leaves.

So in 43 seconds, his doctor meets with the patient.

and gets a prescription for a controlled substance and leaves.

Tonight, the Fed have made hundreds of arrests in a major crackdown on the

illegal distribution of powerful prescription painkillers. Surprise raids

doctors and pharmacies. In the morning of May 20, 2015, 1 ,000 law enforcement

officers spread out across four southern states in a major DEA offensive

designed to combat the epidemic of opioid addiction sweeping the country.

The four -state arrest sweep in Arkansas, Alabama, Louisiana, and

the biggest pharmaceutical case in DEA history. In all, 280 doctors,

pharmacists, and drug traffickers are arrested, including Shuluran and Patrick

Couch.

Next, a young widow has her say in court.

It felt good so that I can try to be Patrick's voice.

2015, the FBI raided Physicians' Pain Specialists of Alabama.

For almost two years in Mobile, the criminal prosecution of Patrick Couch

Shulu Ran is covered in the nightly newscasts.

Investigators say the doctors orchestrated a lucrative prescription

game. Finally, the trial opens in January 2017.

Opening statements began today in the federal trial involving two pain

Couch and Rod have pleaded not guilty to a long list of felony charges,

including RICO, conspiracy to illegally prescribe controlled substances, health

care, wire and mail fraud, and violations of the anti -kickback

From day one, the prosecutors know they are faced with convincing a jury of what

seems improbable.

It's a difficult case.

Two men who are highly educated would trade their ability to continue to

practice medicine for a fistful of dollars.

Both Ron and Couch did not respond to requests for comments from American

but they do testify in their trial.

Ron points out that he has impeccable credentials.

His argument was, look, I am an expert doctor.

I know exactly what goes on with my patients.

I am the greatest doctor in the area. And in fact, I'm a world record holder

number of board certifications. And therefore, the government should not be

telling me how to treat a patient, particularly since the drugs I'm giving

are alleviating pain.

In his defense, Couch says he was unaware that the nurse practitioners

using opioids.

They trusted the nurse practitioners.

How could they know that nurse practitioners were?

High at work, falling asleep at work, injecting Dilaudid into the arm at work,

stealing drugs from other patients. How would they know that? Well, you should

have known it. You're the doctor. You're operating this clinic.

It's your job to know. And one by one, people who work beside them plead guilty

and testify against the doctors.

Incis sales representative Natalie Perhax pleads guilty to charges of

the anti -kickback statute.

Nurse practitioners Bridget Parker and Justin Palmer plead guilty to charges of

conspiring to illegally prescribe controlled substances.

Palmer is sentenced to 30 months in prison.

This has basically destroyed my life as well as, you know, my family.

I think the shame and embarrassment of it all is the worst.

But PPSA doctors and staff are not the only ones facing criminal charges

surrounding subsists.

Executives at Insys Therapeutics, including founder John Kapoor, are also

indicted. In a case that is still ongoing, they have pleaded not guilty to

charges that include bribing doctors to sell their product and misleading

insurance companies, all as part of a conspiracy to illegally profit from a

controlled substance.

It is truly a conspiracy between the doctors, nurse practitioners, and the

pharmaceutical companies to get as much opioid products to the patient and onto

the streets. I mean, one can't work without the other. It was truly like a

on a wheel. You had to stay together in order for it to roll.

Couch and Ron's trial lasts seven weeks.

Eighty -one witnesses testify, and among those who take the stand is Amanda

Chausset.

It felt good so that I can try to be Patrick's voice.

And finally, she gets to lay eyes on the doctor who was responsible for

Patrick's care.

I just felt angry.

It was disgust, sadness.

It was, how could you do that to somebody?

All out of greed, out of money.

After a few days of deliberation, the jury finds both doctors guilty of

conspiracy to illegally prescribe controlled substances, to commit wire,

and health care fraud, and to receive illegal kickbacks.

Couch receives a sentence of 20 years, and Ron is sentenced to 21.

The judge noted in her sentencing that the reason that she gave Ron more is he

agreed with the United States in our position that...

Couch, left to his own devices, probably could not have pulled off what happened

here. And that Dr. Ron was the manager and the driving force of the massive

amount of greed that occurred at PBSI.

Crime absolutely pays, and it pays a lot.

An arrogant auction house with a collectible fraud that scams millions.

He had to tell people, I pulled one on the world.

American Greed, coming up next.

CNBC. Get yours.

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