BAD MEDICINE

Dr. Feelgood Got Busted, Got Free, and Gave Woman 300 Pills Before She Died

Authorities stopped Dr. Robert Ritchea after he admitted to 4,000 acts of fraud, but then they reinstated him. Now the DEA has him in its sights.

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Despite admitting to prescribing unjustified pain medicine and committing more than 4,000 acts of Medicare fraud, Dr. Robert Ritchea was found fit to practice medicine.

After imposing fines and a slap on the wrist in 2010, both the Georgia Composite State Board of Medical Examiners and the Alabama State Board of Medical Examiners allowed Ritchea to continue seeing patients with little to no restrictions, according to state medical board records.

Six years later, he’s awaiting trial for unlawful distribution of prescription drugs and money laundering and stands accused of killing a patient to whom he had prescribed more than 300 pills.

So when the DEA raided Ritchea’s Phenix City, Alabama, office last March, many of his patients arriving for an appointment would not have been surprised when federal agents poured out of the bland, one-story office building, carrying boxes of medical records, computers, and hard drives filled with evidence that he was operating a “pill mill,” according to a search warrant application.

One long-time patient, who wished to remain anonymous, was first treated by Ritchea for chronic back pain. Eight years after she first started seeing him, she was walking out the door with 630 pills per visit: 210 methadone, 180 hydrocodone, 90 Valium, 90 Klonopin, 60 Adderall, 60 Soma, and 30 pills to treat high blood pressure, she told The Daily Beast.

“It would have killed me in 3 days if I took the dosage recommended,” she said. “You go in, you get weighed, make small talk. No matter where I told him I was in pain, he never followed up on it. He just started writing prescriptions before I finished. He never checked my heart beat or anything like that. Whether it was 9 a.m. or 2 p.m., that office was packed every time I visited. And I would meet people waiting in the office as far away as Panama City, Florida. And, only four pharmacies in the area would fill prescriptions from him before he got shut down so the parking lots of those pharmacies would basically be a drug dealing market,” she said.

Ritchea’s subsequent arrest left hundreds of opiate-addicted patients without their drugs, legitimate or not. State medical board records revealed his office was ranked in the top 1 percent of more than 10,000 medical doctors in Alabama with the highest number of prescriptions for controlled substances. Since then many chronic-pain suffering patients have found themselves headed to the streets or methadone clinics.

By this point, Ritchea had his medical licenses back only for a few years. With an office in Phenix City, Alabama, which is just west of Columbus, Georgia, and separated only by the Chattahoochee River, and with medical licenses in both states, investigators and patients on either side of the border were very familiar with Ritchea.

In January 2008, after a lengthy investigation by Alabama State Board of Medical Examiners, Ritchea admitted that from 2001 to at least 2006 he prescribed unnecessary pain treatments and fraudulently received $2.2 million in Medicare funds, court documents show. For this, Ritchea was assessed “administrative fines and costs, requiring continuing medical education and providing for monthly record reviews with quarterly reports to the Commission,” according to Alabama board records.

But less than a year later, he was facing a similar investigation by the Georgia Composite State Board of Medical Examiners who concluded that Ritchea was, once again, guilty of prescribing pain treatment without medical justification, and illegally billing Medicare for the costs. He was eventually sued in a civil case by the U.S. Attorney’s Office in Georgia, again admitting to thousands of malpractice acts, court documents revealed.

In July 2011, the Alabama medical licensure commission decided to “removed all conditions and restoring to full, unrestricted status the license to practice medicine in Alabama,” commission documents show. About three months later, the Georgia Composite State Board of Medical Examiners made a similar ruling, restoring all medical privileges to Ritchea, despite himself admitting to “over prescribed, and over utilized, without medical justification,” medical board records show.

The Georgia Composite State Board of Medical Examiners and the Alabama State Board of Medical Examiners could not be reached for comment.

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Most of the patients from Ritchea’s office tended to be young, white men with no insurance and seemingly no obvious signs of pain or medical concerns, despite having multiple prescriptions for the most dire of terminal cancer diagnoses, multiple pharmacists reported to the DEA. They would often travel in packs, driving sometimes more than two hours from their hometowns for a visit to Ritchea’s office. By 2013, the DEA began to receive complaints from pharmacists who denied many of their prescriptions issued by Ritchea, relaying their encounters with what they believe to be opioid-abusing, drug-seeking, sometimes irate customers, according to court documents.

Eric Long, a pharmacist at a Phenix City Walgreens located about a mile from Ritchea’s office, told the DEA that a typical Walgreens fills about 600 pills of Roxicodone, a highly addictive narcotic pain reliever, for all its customers in a given week. But, with a surge of customers wielding prescriptions from Ritchea, the pharmacy would dole out approximately 4,000 pills a week, according to court documents. The increase in pill orders, which are automatically placed by a computer system when supplies are low, was so great that the corporate loss prevention department suspected the drugs were being stolen, that is until the pharmacist told them about Ritchea.

In late 2014, pharmacists in the Phenix City area began reporting an uptick in opioid-seeking patients from Ritchea’s office and it was no coincidence, they believed, that it was around this time that hydrocodone was moved from Schedule III drug classification to the more restrictive Schedule II classification by the federal government. Ritchea was one of the few remaining doctors in the area willing to prescribe these drugs liberally.

Meredith Street, a pharmacist at CVS in Opelika, Alabama, told the DEA it was around this time that her store refused all prescriptions written by Ritchea. But up until that policy was implemented, Street said she would see “as many as 10 to 20 patients per week from Ritchea’s office,” despite being more than a half-hour drive away, according to court documents.

Citing repeated refusals by pharmacists to fill prescriptions written by Ritchea as a “strong indicator that he was issuing illegitimate prescriptions,” DEA Birmingham District Office Tactical Diversion Group 48 decided to ratchet up the investigation into the suspected “pill mill.” Beginning in March of 2014, law enforcement began conducting surveillance of Ritchea’s office. In a single day, one task force office witnessed two separate incidents where individuals exited Ritchea’s clinic to do what they believed to be hand-to-hand drug deals before returning inside the clinic, according to an application for a search warrant.

An undercover DEA operation that would span more than three years ensued. Surveillance agents began visiting Ritchea’s office to try to obtain prescription narcotics. Feigning lower back pain, one agent was reportedly able to obtain more than 1,200 hydrocodone pills (including refills), among other prescriptions, over the course of three visits which included only one initial brief medical examination, the agent testified.

But, the most alarming allegation against Ritchea is his involvement in the overdose death of a 40-year-old woman just six days after he prescribed her 60 methadone tablets, 120 oxycodone tablets, and 150 Xanax tablets. The autopsy concluded the cause of death as “mixed drug toxicity” with a “toxic methadone blood level,” according to court documents. Law enforcement agents who interviewed her husband say he encouraged his wife to visit Ritchea to obtain a prescription for methadone. Her husband said he heard it was standard treatment for opioid addiction. Ritchea prescribed her much more.

Even though this incident was cited as evidence of illegitimate prescribing habits, Ritchea wasn’t charged in her death, which was ruled an accident.

The raid by the DEA eventually led to Ritchea being indicted by a grand jury on four counts of dispensing hydrocodone, oxycodone, hydromorphone, and other powerful opioids with “no legitimate medical purpose,” along with four counts of money laundering. Investigators found Ritchea purchased nearly $20,000 of alleged illegal proceeds worth of Schedule II drugs directly from a pharmaceutical company, which he would then prescribe to his patients, according to court documents.

Page Pate, a lawyer representing Ritchea, categorically denied the DEA’s allegations in the indictment brought against his client, saying that all the prescriptions issued by Ritchea were legitimate.

“We’ve had medical experts review them and found them to be medically justifiable,” Pate said. “When asked whether he believed Ritchea was providing too many opioids, the volume of opioids he was prescribing is relatively low compared to other physicians in Alabama.”

In response to Ritchea ranking 27 out of more than 10,000 medical doctors in Alabama with the highest number of prescriptions for Schedule II, III, IV, and V controlled substances, Pate said that being a pain management specialist, Ritchea would expect to be high on that list. But, the DEA in its indictment contends that Ritchea is not in fact a pain management specialist, but a general practitioner. Pate said that with 99 percent of his patients citing chronic pain as the reason for their visit, Ritchea was, in fact, a pain management specialist.

Indeed, during the DEA undercover operations, an independent pain specialist was consulted to examine the evidence and concluded that “there are significant, severe, and repeated lapses in the standard of care regarding scheduled medications—but I cannot state categorically that there is absolutely no medical legitimacy in the treatment provided by Ritchea.”

Ritchea’s arrest forced many of his patients to go cold turkey. For the long-time patient cited above, that resulted in four emergency room trips over the course of 12 days. She says it took her six months to feel normal again and now treats her pain with non-narcotic medication.

Ritchea notified court on Tuesday that he intends to change his previously entered plea of not guilty to guilty.