Trial starting for 'pill mill' doctors accused of roles in patients' deaths

Federal prosecutors say they can prove that two South Florida doctors prescribed powerful, addictive pain pills in such an irresponsible way that they should be held criminally accountable for the deaths of nine patients.

If convicted of the most serious charges — possession with intent to distribute controlled substances resulting in death — the two doctors could face up to life in prison and fines of $2 million.

Cynthia Cadet, 43, of Parkland, and Joseph Castronuovo, 74, of Key Largo, are scheduled to go on trial this week on charges their prescription writing of oxycodone at so-called "pill mill" clinics in Palm Beach and Broward counties contributed to the deaths of seven patients who were treated by Cadet and two who saw Castronuovo.

Defense lawyers say the doctors did nothing wrong and have been unfairly targeted and charged with more serious crimes than their former peers because they refused to plead guilty to lesser charges and insisted on going to trial.


Photos: Coolio show in South Beach

Michael Weinstein, who represents Cadet, and Thomas Sclafani, who represents Castronuovo, said they will argue to the jury that their clients are the victims of "vindictive prosecution." Weinstein said his client was arrested in a "dragnet" operation that falsely presumed any doctor working at the clinics was guilty and part of the conspiracy.

The two are the last defendants fighting — out of a total of 32 originally charged — in connection with Operation Oxy Alley, a long and complex investigation of pain clinics in Boca Raton, Lake Worth, Wilton Manors, Fort Lauderdale and West Palm Beach.

Prosecutors charged 13 doctors and 19 other individuals with a range of offenses including racketeering conspiracy, money laundering conspiracy and drug-related charges linked to clinics operated by Wellington twin brothers Christopher and Jeffrey George, now 32 years old.

The George brothers' clinics distributed more than 20 million oxycodone pills and made about $40 million between 2008 and 2010, according to prosecutors. Christopher George is serving more than 17 years in prison and Jeffrey George is serving more than 15 years in prison.

Several of the co-defendants who have pleaded guilty are expected to testify against the doctors, but the defense predicted their clients will be cleared.

"There's no doubt that the George brothers set up these clinics to make them look legitimate," Weinstein said.

Among the more surprising potential witnesses listed to testify — for the defense — is Florida's Attorney General Pam Bondi, who has joined federal authorities in their battle to close down the state's pill mills and make it harder for them to operate. It's not yet clear if she will actually testify or what she would say.

The defense lawyers said their clients never violated the accepted standards of care for treating patients — that they examined their patients, who all complained of pain, and should not be blamed for the deaths of people who hid or lied about drug addictions and died days or weeks after the doctors prescribed painkillers.

The trial at the federal courthouse in West Palm Beach is expected to take about two months, with jury selection starting Monday and expected to take a couple of days.

Prosecutors say the doctors were part of a criminal conspiracy with the disreputable clinic operators, their peers and other staff members.

The prosecution described chaotic scenes at some of the Georges' clinics, with 87 percent of patients traveling to some of those offices from out of state seeking easier access to pain pills that some South Florida practices offered. Some drove a thousand miles or more, prosecutors said.

"Patients were shooting up in the parking lot … people were crushing and snorting their pills in the parking lot," prosecutor Lawrence LaVecchio told U.S. District Judge Kenneth Marra in court.

The doctors rushed or did no meaningful examinations, over-prescribed the addictive pain pills and anti-anxiety medicines, and literally used rubber stamps with numbers and strengths of pills to help speed up the prescription lines, prosecutors and investigators said. Many of the patients were brought in by "recruiters" who took their prescribed pills, which were dispensed at the clinics, and sold them to dealers or other drug users, investigators said.

The clinic staff kept cash payments in garbage bags that were deposited in the bank at the end of the business day, the investigators said.

Among the evidence prosecutors plan to use in the trial are statements Castronuovo made during an interview with them and federal agents in January 2011, prior to him being formally charged.

Castronuovo told them that he took the job when he saw an ad on Craigslist and needed a job because he had been laid off from his prior employment at a hospital. He said he knew the place was operating illegally and "that his motive for working there was that he needed the money."

He also said it was obvious that most of the patients were what he called "hillbillies" or drug-seekers who came from out of state and had needle track marks on their arms.

The alleged victims are: Stacy Edward Mason, Alice Marie Moore, Patricia Marcus, Stephen Andrew Wooten, Bobby Shane Romine, David Keith Coffmann, Shawn Michael Harper, Tommy Wayne Harris and Michael Grant. While authorities did not provide their ages, hometowns or where they died, public records show that some of them appear to have been from Kentucky, Tennessee, West Virginia and northern Florida.

pmcmahon@tribune.com, 954-356-4533 or Twitter @SentinelPaula