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Thursday, June 07, 2007
More Died as 3-Year Probe Unfolded (Sun. June 3, 2007 Columbus Dispatch)
Important dates in the case of a southern Ohio pain-management clinic that led to a 22-count federal indictment against a physician and two clinic managers:
April 1: Tri State Health Care & Pain Management opens in Portsmouth with Dr. Paul H. Volkman as physician.
June 27: Aaron Gillespie, 33, of Portsmouth, becomes the first of the clinic's patients to die.
Oct. 21: Charles Jordan, 40, of Wittensville, Ky., dies.
Nov. 17: Daniel Coffee, 47, of Greenup, Ky., dies.
Nov. 20: Jeffery Reed, 37, of South Shore, Ky., dies.
Jan. 10: Mary Catherine Carver, 32, of Portsmouth, dies.
Feb. 11: James Estep, 32, of Ashland, Ky., dies.
Feb. 13: A person identified by the U.S. Drug Enforcement Administration only as "Patient E" dies.
March 9: Kristi Ross, 39, of Portsmouth, dies.
Aug. 12: "Patient G" dies.
April 20: Steve Hieneman, 33, of Greenup, Ky., dies.
Aug. 12: Dwight Parsons, 47, of Greenup, Ky., dies.
Aug. 18: "Patient I" dies.
Sept. 11: Volkman leaves the clinic and works out of his home in Portsmouth.
Sept. 29: Scottie Lynn James, age and address unavailable, dies.
Oct. 2: Bryan Brigner, 39, of West Portsmouth, dies.
Oct. 10: Volkman moves to office near Chillicothe.
Oct. 23: "Patient K" dies.
Oct. 29: Ernest Ratcliff, 38, of Webbville, Ky., dies.
Nov. 19: Mark Reeder, 34, of Portsmouth, dies.
Dec. 28: William Wicker, 44, of Vanceburg, Ky., dies.
Sources: Federal indictment, U.S. Drug Enforcement Administration documents, Dispatch research
Ernest Ratcliff was one of the last to die.
He was found in bed in Webbville, Ky., killed at age 38 by the pain pills he had obtained the day before from a doctor near Chillicothe.
By the time the disabled boilermaker died on Oct. 29, 2005, the twice-raided Dr. Paul H. Volkman was working from his third cash-only office.
And, as it had since mid-2003, the U.S. Drug Enforcement Administration was watching, still waiting to bust the resilient Volkman.
Federal officials portray him as a supplier to addicts and dealers, a physician who handed out millions of doses of heavy-duty narcotics to people who didn't need them.
The doctor responded in court papers that he just tried to serve chronic-pain patients in an underserved area.
Volkman finally went down on Feb. 10, 2006. The DEA raided his office and suspended his drug license, putting him out of business.
By then, at least 18 of his patients had died, a dozen within two days of visiting the doctor. He later would suggest many likely had committed suicide.
Federal prosecutors contend the Ohio and Kentucky residents died of overdoses and lethal mixtures of pain pills and sedatives.
An indictment unsealed on May 22 accuses Volkman and the mother-daughter team that ran a clinic in Portsmouth of pocketing $3.1 million while patients died from their conspiracy to sell narcotics.
Some relatives of the dead wonder why it took the DEA nearly three years to take down the operation, particularly when the agency was aware of what it later described as "an alarmingly high rate of deaths."
"A lot of people lost their lives by him not being shut down," said Ed Ratcliff, 67, father of Ernest. "If somebody is killing people, go after him. Do something about it."
Daniel Coffee, 47, a school custodian from Greenup, Ky., was one of the first drug-related deaths, on Nov. 17, 2003. His mother, Lena Coffee, 79, can't understand why so many others followed.
"I told him, 'Danny, they gave you too many pills.' On the third day, he was dead." she said. "I certainly believe they should have shut (Volkman) down more quickly."
The DEA is unwilling to discuss the case. Spokesman Richard Issacson says only: "Every investigation is going to be different. … There are a lot of different factors."
Portsmouth Police Capt. David Thoroughman called the wait to end Volkman's practice frustrating, but he said it takes time to build a case against a physician accused of peddling pills.
One of Volkman's attorneys, Kevin Byers of Columbus, presents a different view of the physician with a doctorate in pharmacology.
"This is not a story about drug-dealing thugs or smugglers," Byers wrote in a court filing. "Rather, it is a story of an accomplished, experienced, competent physician working in a rural, underserved area trying to help manage the pain of his patients."
The indictment and DEA records document the allegations that federal authorities have made against a trio they call major suppliers of illicit drugs in Ohio and Kentucky.
Denise Huffman, a former fast-food and factory worker with no formal medical education, opened Tri State Health Care & Pain Management in South Shore, Ky., on Oct. 1, 2001.
Huffman, who had worked in the office of a South Shore physician later sent to prison for writing bogus narcotics prescriptions, used fill-in doctors to staff her clinic.
On April 1, 2003, she moved the clinic across the river to Portsmouth. She hired Volkman, a once-bankrupt Chicago pediatrician, who was paid $5,500 a week as a pain-control specialist.
Area pharmacists soon became suspicious. They called the DEA to report that Volkman was writing huge numbers of multiple prescriptions for patients. Worried about patients' health and safety, many pharmacists refused to fill the pill orders.
Around July 30, Tri State opened its own dispensary to fill Volkman's drug orders for his patients, with Huffman's daughter, Alice Huffman Ball, as manager.
Distributors soon reported to the DEA that Volkman was buying alarming amounts of narcotics for the dispensary, where a 9 mm semi-automatic was kept on hand to keep the peace.
Volkman would end 2003 as the nation's second-largest individual buyer of oxycodone, a painkiller better known under the brand name OxyContin. On the streets, where it sold for up to $100 per pill, it was called "Killer" and "Coffin."
DEA agents began to interview some of Volkman's patients. Four had died of overdoses by the time a DEA informant made the first undercover visit to obtain pills on Jan. 6, 2004.
Tri State was a popular place. Patients in search of pain medication would travel more than 400 miles and pay up to $200 in cash for an office visit.
Volkman required first-time patients to state that they were not undercover cops before a three- to five-minute visit, with no examination, produced prescriptions for upward of 1,000 pills.
At least one patient was required to sign a "death waiver," acknowledging the risks of taking medications prescribed by Volkman.
The clinic went unmolested through 2004 as Volkman's practice became the nation's No. 1 purchaser of oxycodone and five more patients died.
Undercover DEA drug buys picked up in early 2005, leading to a June 7 raid in which patient records, drugs and other items were seized.
A drug audit found that more than 850,000 pills from the dispensary could not be accounted for, even as the deputy Scioto County coroner warned of a rash of overdoses and drug-related deaths.
Despite the raid, it was business as usual at the clinic. Three more patients died before Huffman and Volkman parted ways in September.
Volkman set up shop in his Portsmouth house on Sept. 11. Patients waited hours, sitting in chairs in the backyard, as an armed guard kept order in the residential neighborhood.
Portsmouth police wouldn't stand for it. They served a search warrant Oct. 4. They found neither latex examination gloves nor an examination table.
They did find photocopies of a map directing patients to a pharmacy on the Near East Side of Columbus. Patients were instructed not to go alone and to be careful when visiting the pharmacy.
The Dispatch is not identifying the pharmacy because its employees have not been charged with wrongdoing.
After two more patients died while he operated alone in Portsmouth, Volkman again went hunting for an office.
In six days, he was in business near Chillicothe, where patients bribed employees to move up in the waiting line and a guard used a metal detector to check for weapons.
On Dec. 14, DEA agents watched about 25 patients, who paid $125 to $200 each, enter Volkman's office in 5 1/2 hours for a total take of up to $5,000.
Four more patients died as a result of prescriptions received at Chillicothe before the DEA busted Volkman in early 2006 and Tri State moved to South Point in Lawrence County.
The 22-count grand jury indictment against Volkman, 60; Huffman, 54; and Ball, 32, was unsealed after their arrests on charges of conspiracy to illegally distribute and sell controlled substances.
They have pleaded not guilty to the charges, which carry up to 20 years in prison. They could receive life imprisonment if prosecutors prove their actions led to patient deaths.
Volkman is being held in jail without bond. Mother and daughter were released on unsecured $100,000 bonds and placed on electronic monitoring.
James Rion, a Dayton lawyer representing Huffman, said: "As far as she knows, she was running a legal operation for pain control. It wasn't a drug house, as the government is trying to make it out to be."
Attorneys for Volkman and Ball did not return telephone calls.
In court appeals to get back his DEA license and seized bank accounts, Volkman argued that his prescriptions were medically justified and that he is not responsible for patient deaths.
Volkman wrote that about 10 patients died of apparent overdoses that likely were deliberate because "chronic pain patients are well known to have a high risk of suicide."
"In no instance did a patient expire or experience an adverse drug reaction provided he or she took the medicines according to my specific directions," Volkman wrote.