(CN) - A husband and wife behind two Ohio "pill mills" that pumped out pain killers with virtually no medical examination were properly convicted of conspiracy to distribute, the 6th Circuit ruled.
As the operators of "pill mills" in Waverly and Columbus, Ohio, Lester and Nancy Sadler were convicted last year of conspiracy to illegally distribute addictive pain medications
The Sadler establishments were "not conventional pain clinics," according to a decision affirming most of their convictions Thursday by the 6th Circuit in Cincinnati.
"At the Waverly clinic, patients would arrive well before it opened, filling the clinic's parking lot and the lots of nearby businesses," Judge Jeffrey Sutton wrote for a three-judge panel. "While waiting for the clinic to open, the patients used drugs and traded prescription forms for cash in the parking lots. The patients often traveled long distances (and in large groups) to come to the Sadlers' shops, sometimes as much as 316 miles in a roundtrip, even though most of the patients lived much closer to other clinics." (Parentheses in original.)
Patients paid a $150 cash-only appointment fee to see a doctor for no more than five minutes, then walked out with a prescription for pain medication, which was often prepared weeks before the patient's appointment.
The clinic processed nearly 100 patients a day this way. One of the Waverly clinic's doctors was the state's No. 1 prescriber of hydrocodone in 2006 and 2007, outstripping the second-most prolific prescriber by 107,000 dosage units in 2006.
The Sadlers also added phantom patients, usually family members, to the clinic's rolls, to fill the prescriptions. They then gave the medications to a relative who sold the pills on the street.
In addition, they did not have a license when directly ordering from pharmaceutical companies hydrocodone and other opioids, which either the clinic employees used themselves or sold outside in the parking lot.
A federal judge sentenced Lester to 12 years in prison, and Nancy to 17 years in prison on charges of conspiracy to distribute controlled substances illegally.
The 6th Circuit affirmed all but Nancy's conviction for wire fraud on Wednesday.
While Nancy lied to pharmaceutical distributors, using a fake name on her orders, and claiming the drugs were for legitimate purposes, "the evidence shows that Nancy paid full price for all the drugs she purchased and did so on time," Sutton wrote. "How, then, did Nancy deprive the distributors of property?"
The right to accurate information about the intended use of the pills is not a property right that the wire fraud statute covers, according to the ruling.
"Nancy may have had many unflattering motives in mind in buying the pills, but unfairly depriving the distributors of their property was not one of them," Sutton said. "As to the wire-fraud count, she ordered pills and paid the distributors' asking price, nothing more."
Lester meanwhile failed to show that his actions were "innocent."
"The government had no obligation to produce 'direct evidence' against Lester, as 'guilty knowledge and voluntary participation may be inferred from surrounding circumstances,'" the 12-page opinion states. "Those circumstances all pointed in one direction - that this pain-treatment operation was a charade, and Lester played a critical part in facilitating the charade."
It was also reasonable to find that Nancy distributed more than 1,900 grams of hydrocodone, and 85 grams of oxycodone, according to the ruling.
"A 'dope sick' drug addict could walk into Nancy's clinic, hand over some cash, get no 'real pain assessment,' tell an obvious lie, and walk (or skip) out of the clinic minutes later with a drug prescription in her pocket," Sutton wrote (parentheses in original). "That Dr. [Brenda] Banks and other conspirators wrote these prescriptions does not absolve Nancy of responsibility."