All language subtitles for American Greed s12e02 Deadly Opioids Dirty Doctors

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.