The arrest warrant affidavit for Operation Pill Street Blues offers many glimpses into the two-year investigation. It ended Wednesday with seven doctors and seven nonmedical suspects who allegedly owned and/or managed the network of clinics being charged with a total of 144 crimes.
The 147-page document details why law officers contend the clinics were set up to make money by prescribing narcotic pain medication to people with little or no medical need for them.
In one instance, an undercover Indian River County sheriff's detective posing as a patient at Southern Back and Spine in Daytona Beach reported a doctor told him he was addicted to oxycodone. He stated Dr. Susan Helen Yandle did not refer him to drug treatment, but instead prescribed him 90 more oxycodone pills that same day, along with other drugs and a referral to physical therapy.
There were occasions when requests by officers for stronger drug dosages were refused, but doctors gave them the same drug in smaller doses. One such instance involved Oct. 3 and 31 trips to Jacksonville Back and Spine by an undercover Vero Beach Police detective claiming that he had a stiff back and shoulder.
The detective told Dr. Sanjay Trivedi a doctor not affiliated with Jacksonville Back and Spine had given him 30 milligram oxycodone pills in the past. Trivedi told him his condition did not justify that strength.
When the undercover detective questioned the doctor's decision, Trivedi replied that "this is not a restaurant" and he could go elsewhere if he wished.
The detective left with 98 oxycodone pills that were half the strength he requested, plus 28 Valium.
Intercepted phone conversations covered topics that included cheap street drugs cutting into the quota of clinic patients, most of whom are believed to have paid between $200 and $250 cash per office visit.
Another undercover officer visiting the Jacksonville clinic reported that, while handing $250 to the receptionist, he "noticed that the top left desk drawer of the desk was open and it contained a white envelope full of U.S. currency."
Another phone conversation transcribed in the report was between Stuart Pain Management Center owner Bruce Karlin and Dr. Bruce Kammerman of Palm City, who worked at that Vero Beach clinic. In the April 20 conversation, Kammerman seems to be advising Karlin that the clinic needs to scale back its number of patients.
"You know, 'cause, you got to remember, you send all these people then out into the community and, uh, it just overwhelms the pharmacy's (sic) and then they start thinking bad things about us, and things like that."
Karlin replied, "Where are these people going to go to, if there's no other pain clinics, where they going to go to?"
According to the affidavit, Kammerman replied, laughing, "They don't have to go anywhere, half of them don't even need to be on medicines."
Karlin replied, "Yeah, OK, that's true, and that's why in certain areas business is down, 'cause the ones who are selling it, I guess Dilaudids are real cheap, they're not worth anything on the street, right?"
Dilaudid, a narcotic pain medicine, is not listed among the drugs authorities charge the clinic doctors and owners as needlessly dispensing. But hydrocodone, Valium and Xanax are cited.
Indian River County Sheriff's Detective Eric Flowers, who compiled the affidavit, wrote the April 20 phone conversation is evidence that Karlin and Kammerman were "keenly aware that the 'patients' seen at their clinics do not have a medical need for the controlled substances that the clinics prescribe."
The affidavit describes more undercover visits to the clinics across Florida by detectives from Vero Beach and Port St. Lucie police departments, the Indian River County Sheriff's Office, the Florida Department of Law Enforcement and agents of the federal Drug Enforcement Administration.
Detectives wore audio and sometimes video wires, which apparently went undetected in medical exams.
During return visits to the clinics, they had to provide urine samples to screen for presence of their prescribed pain medications. When these came back negative, the undercover officers invariably replied they had run out of drugs early because they had taken more than the prescribed dosages.
An expert witness for the DEA reviewed Kammerman's interactions with three different undercover officers who posed as patients visiting the Vero Beach clinic during the summer and fall of 2011.
"The prescribing continued, despite every patient admitting to running out early and having urine drug screens negative for all prescribed drugs every time they presented to the clinic," Dr. Harold Cordner stated. "These patients