Relieving Pain but Causing Misery? Doctors Among Unsung Victims of Opioid Epidemic
An important testimonial of how the American opioid epidemic went horribly wrong for doctors too, including those committed to relieving pain and acting as the neighborhood doctor, like Richard Minicozzi, M.D. (1934-2015). This is a Q&A with his daughter, Alessia Minicozzi, Ph.D., MBE, a talented editor and contributor on health topics to Impakter. She is deeply missed. Impakter Editorial Board.
Richard Minicozzi was born on March 14, 1934, in Philadelphia, PA, to Italian immigrants Angelo and Dora Minicozzi. They owned and operated two bakeries in their South Philadelphia neighborhood while rearing their eight children. Richard worked for several years as a draftsman. Unable to get into an American medical school, he applied to foreign programs, getting accepted by the Guadalajara Medical School in Mexico. He began taking Spanish classes at the University of Pennsylvania to prepare for medical school where he met his future wife, Maria Teresa Calderon. Maria, who hailed from Puerto Rico, was earning a master’s degree in Italian literature. They married on May 12, 1970, in Puerto Rico.
Their daughters Arianna and Alessia were born in Puerto Rico in 1971 and 1975, respectively, and Viola was born in Philadelphia in 1980. Due to Richard’s age, he was not admitted to any American residency programs, so he opted to work as a general practitioner. The only internship program that would accept him was in Puerto Rico. He spent seven years in an internship program and gaining experience and earning money there while his young family lived in North Philadelphia.
When Dr. Minicozzi returned to Philadelphia, he found a physician from Puerto Rico who was looking to hire a partner for his North Philadelphia practice. Dr. Minicozzi spent several years there before the owner died without bequeathing the practice.
In 1989, with an inheritance of $25,000, Dr. Minicozzi bought a practice from a solo physician in his beloved South Philadelphia. He remained at that location until his office was raided on September 13, 2010 – as the opioid epidemic soared. On that day, both the office and his house were invaded by the Federal Bureau of Investigation (FBI), Drug Enforcement Agency (DEA), and local police.
The following is a Q&A with Dr. Minicozzi’s middle daughter, Alessia, about how her father, then a 77-year-old physician, would come to be ensnared by the opioid epidemic in the U.S., and die in prison after a career of serving some of the most desperate patients.
Q: Alessia, how did your father come to be arrested? How did it link into the opioid epidemic?
A: For starters, he was ill-equipped philosophically and temperamentally as well as, perhaps, because of his age to be in practice by himself at that point. What happened to him was a crime, but he was no El Chapo.
His ideal medical practice would have been only to provide natural medicine. He believed that allopathic medicine often did more harm than good and he started to study alternative natural solutions to treating patients. He took countless courses on Traditional Chinese Medicine, macrobiotic diets, juicing, vitamins, certain exercises, reflexology, and what are considered other complementary and alternative therapeutic approaches.
Unfortunately, South Philadelphia was not, over his years of serving the community, the ideal location to introduce that kind of practice. Only a handful of patients were interested in adopting such a course of treatment. In many respects, my father felt pressured to practice medicine in ways with which he didn’t always agree but are considered part of evidence-based medicine.
His client base was largely indigent. In his later years of practice, my elderly father faced a rapidly evolving medical landscape and patients increasingly experiencing chronic pain, coincident with the opioid epidemic raging across the U.S. He felt a deep connection to South Philadelphia and believed he was giving back to his community.
Unfortunately, his secretary of 20 years did not feel the same way.
My family suspected that she was selling his prescriptions when he fell ill. She testified against him in exchange for immunity. Also, she perjured herself twice on the stand, but our inadequate lawyer did nothing.
During the trial, my father was accused of running a pill mill rather than a medical practice. Undermining that characterization were some tapes in which he was treating children and teenagers. My father loved working with kids and their parents to provide a strong foundation for health.
Q: Your father claimed that his signature was forged in most cases of Oxycodone prescriptions – at the heart of the opioid epidemic. Was the veracity of this claim challenged or supported in court? And what can you reveal about his secretary?
A: My father was out of the office for extended periods of time because of multiple surgeries. During this period, his secretary took a script and photocopied them, we believe.
There was another person named in the case that was convicted of 176 counts of identity theft and using their identity to get prescriptions filled, selling the pills on the streets. This individual worked at a printing press and at the Hospital of the University of Pennsylvania. She was also a longtime friend of the secretary, and my father kicked her out as a patient years prior.
None of this was brought up in court. Our lawyer cautioned that expert witnesses were expensive and could backfire. Instead, we felt ambushed during the three-day trial and had no way of fighting back.
My father’s secretary was divorced and had two sons. She was on welfare and lived in the neighborhood all her life. She was conniving and opportunistic, and kept information on everyone and never shied away from using it. People were understandably scared of her. She preyed on my father’s inability to turn anyone away and when she came into his office to ask for a job, he gave it to her.
My father truly believed he could save everyone and he thought by giving her a chance—because no one else would—she would not take advantage of him. He thought she would be grateful that he gave her a chance to better herself, also providing free medical care to her sons and making sure they were fed.
As my father’s health declined and he started to spend more time out of the office due to hospitalizations, I believe she saw an opportunity to make some side money from selling scripts.
We found out through a private investigator (PI) that she had quite a ring going on that was extremely well hidden.
Unfortunately, the PI was not able to obtain tangible evidence, it was all hearsay. Informants were scared to talk against her. The PI was completely perplexed by how this tiny woman could have everyone in a panic. I completely understood her threat. She struck me as having a ruthless, criminal mind. She was also a compulsive liar. This made her even more dangerous. We never knew if what she said needed attention or was just bullshit.
Q: If he was licensed to prescribe potent narcotics, how did the charges against him arise?
A: It was a 19-count indictment all based on controlled substances. He was accused of dispensing/selling drugs without any medical reason and found guilty on 18 of these charges. There were no patient deaths associated with the 19 counts, but my father ultimately received a death sentence.
Every physician has the opportunity to request a license to dispense and prescribe controlled substances. Every four years, the state requires the physician to renew this license. A hefty fee is required to maintain this privilege. Most physicians practicing primary care medicine and various other specialists have this license.
Once the license is acquired, the physician must be aware of the state-regulated guidelines to dispense and prescribe these medications. There are four levels of controlled substances, the higher the level the more severe the drug.
The problem lies in the verbiage of the guidelines, particularly “legitimate medical reason.” Physicians must use their own judgment to identify legitimate medical reasons based on what is presented by the patient. My father’s entire case was based on this argument.
The prosecution believed my father was not dispensing and prescribing controlled substances for legitimate medical purposes even though he had dual licenses (to dispense and prescribe) to do so at his discretion. My father’s defense was supposed to prove that he was following federal guidelines and they had to prove medical need. Unfortunately, this defense is almost impossible to substantiate unless you hire countless medical experts to testify on each patient’s case.
My father did have a clear understanding of the guidelines and memorized them. What he failed to grasp was the vital importance of being shrewd and using a firm approach to patients who presented with a sob story. He loathed turning patients away, but when he did do it, it took a toll on his wellbeing. There were days when he would come home exhausted after pleading with drug-addicted patients to get help or, worse, having to kick them out of his office because he could not risk his license.
We believe that a patient who did not like being asked to leave my father’s office for seeking opioids was at the root of the charges. My father had several patients who were addicted to drugs and he would ask them to leave when it became clear they were not interested in rehab.
Q: Can you further describe your father’s practice and explain how the DEA entered the picture, what was the link there with the opioid epidemic?
A: Prior to 2005, my father was constantly being wined and dined by representatives from pharmaceutical companies. At the same time, DEA agents would stop in to ensure that he was following drug-dispensing guidelines. The majority of his patients were uninsured or underinsured. He decided to turn his office into a cash-based practice charging a modest sum ($35.00) per visit.
Often, he had to refer patients for tests and specialists, but the follow-up or compliance by patients was low. They did not want the hassle and/or expense of managing pain. So the opioid was the easiest and often the only option for most of his patients. That is one of the root causes of the opioid epidemic.
As more free clinics started to open, detox became more available and my father was excited to see some hope for relief. Could this be the end of the opioid epidemic? But this hope was short-lived since the majority of detox clinics were overcrowded and located far from his office.
My family suspects that the agents that frequented my father’s office may also have been working with pharmaceutical companies that hired agents to ensure that doctors were following federal regulations. We do not believe he was called out by the wholesalers (contrary to what was quoted in a Philadelphia Inquirer article about the case) because they were the ones constantly calling me, as the business manager, or my father about orders. They would remind him he was “due” for his next shipment. Every two weeks, like clockwork, a rep would call me. Finally, it was stated during the pretrial that no one, including the pharmacist filling out most of my father’s scripts, complained about him.
Ideally, my father should have had DEA contact him and inform him that his license was being reviewed and relinquishing his license would be best. Labeling my father as a drug dealer was just a way to make an example of him to other physicians that abuse their license to dispense controlled medication illegally.
Also, the extreme rise in opioid overdoses, what was, in fact, an exploding, uncontainable opioid epidemic, was pushing the US Department of Justice (DOJ) to eliminate any easy targets to make it look like they were doing something about the war on drugs.
Q: Given your father’s age when he was sentenced after the hard work and help of Masterson Law LLC, his attorney’s comment that he was pleased your father received a “break” in his sentence due to his military service (7 years in prison instead of 12.5) sounded disingenuous at best. Did you and your family feel that the defense attorney was competent? And did you feel that the judge was trying to make a broader statement with what was, and should have likely been seen as your father’s death sentence? In other words, why was there no trace of justifiable mercy in the sentence?
A: My father’s defense attorney was truly a con man. He apparently knew my uncle Arnold, a high-ranking lawyer in the 1970s and used that fact to make us feel like he cared. The lawyer was an older man (70 years old) that did not realize the magnitude of this case. The volume of research and expert witnesses required to mount a defense against the case the DOJ had compiled against my father was overwhelming for any attorney, much less one that was ending his career.
He did not understand my father’s simplistic way of practicing medicine. Why would anyone hire a lady that was on welfare and a supposedly reformed addict to run his office? He did not view any of the tapes in evidence. He knew nothing about medicine and where to object in court due to his inexperience with the massive issue of opioid addiction.
In essence, my father did not get a defense. He literally was left to the mercy, or lack thereof, of the court.
The judge was an African American man who had mainly worked for years out of Chester County where black men were being sent to prison for drug misdemeanors by the truckload. His stenographer, who had been with him for 20 years, had just lost his beloved son to a heroin overdose.
The judge and stenographer seemed to me to be extremely resentful and disdainful towards my father. My presence in the courtroom made everything more complicated. They thought I was there to gain sympathy, rather than be a supportive presence for my father. One article referred to me as the daughter who brought her wheelchair with her to the courtroom.
The judge could not look into my eyes and never spoke directly to me. It was completely insulting. Essentially, he thought my father was using his disabled daughters, his age, and ailments to gain compassion from the court.
Q: What other factors led to your father’s imprisonment? And why did your father’s conviction amount to a death sentence?
A: My father was investigated for seven years. During that time, he was in and out of the office due to lengthy health issues. This meant that the office was closed for several weeks. His secretary was not able to work and the office was empty.
As I reviewed the copious amount of evidence, I was able to locate prescriptions dated at the exact time my father was actually in the hospital. We believe this is when the secretary started to forge his signature and sold his prescriptions. We brought this to our lawyer’s attention, but he dismissed hiring a writing expert as too expensive.
The lawyer knew we didn’t have the funds to try this kind of case. In order to win such a highly complex case, it had cost one physician $4 million to get acquitted. He still wound up staying in prison for four years, since he was tried on appeal. He is now practicing medicine in a small town in California.
My father had been the sole provider for my family, particularly for my mom. He felt a tremendous obligation to care for me and my younger sister due to our disabilities. He was diagnosed with the blood disorder polycythemia at 56. He was given 10 years to live. He had three children in various stages of education, two with disabilities. He never allowed that diagnosis to affect him. He was hyper-focused on natural and conventional ways to keep himself alive. He was diagnosed with prostate cancer in his 70s.
My father was formally sentenced on January 29, 2013, and went to prison on March 15, 2013. From the time he was indicted to when he was imprisoned, he was treated for an occurrence of bladder cancer. He also had a partial foot amputation due to his blood disorder. His license was taken away and the practice was rendered worthless.
He was incarcerated in a medium-security prison because he had to be in a medical facility. He shared space with pedophiles, robbers, murderers, drug lords, and mafia kings.
His emails expressed desperation about getting appropriate medical treatment. He developed several hernias and we believe colon cancer, but he died before he could get a colonoscopy. We believe he died due to a blood clot caused by the insufficient way he was weaned from his blood thinners in prison. The autopsy was “inconclusive,” but he was a physician and he knew what was not being done.
He died on June 28, 2015, after a visit from my mom and older sister. He is buried at Washington Crossing National Cemetery in Newtown, PA. He served in the Army during the Korean War.
He had told me that he felt betrayed by his own country.
Q: I am deeply sorry for your loss, Alessia. The opioid epidemic and opioids remain in the news on a daily basis, most often these days in relation to state lawsuits against Johnson & Johnson, Purdue Pharma, and others. Do you think this represents a turning point in the opioid epidemic? And what do you think is omitted or obscured as media attention shifts toward the culpability of drug manufacturers?
A: The short answer is yes. Some institutions, such as Tufts University, have rightly removed the Sackler name from any programs and facilities at their institution because of the harm the Sackler’s company Purdue Pharma has perpetrated.
But so much more needs to be done to alleviate this multidimensional epidemic.
As for my father, I do not believe he should have been practicing medicine by the time he was charged. This conclusion is not because he was guilty, but because the environment in which he was practicing was dangerous and did not support his antiquated ways of thinking about medicine.
Q: Alessia, do you have any final thoughts you’d like to share?
A: My father surrounded himself with individuals that knew he was aging and gullible. He wanted to help everyone whose needs taxed or transcended his scope of capabilities. I, too, loved my father’s notion of the neighborhood doctor, but it needed to be updated and carefully reconstructed.
To think of him as a criminal is never to have known him at all. My father was a dreamer that loved medicine but did not understand that change is good and necessary. Solo practices are neither safe nor conducive to the current climate surrounding the opioid epidemic. When physicians are being branded as drug dealers and thrown in prison, then something needs to change.
Alessia Minicozzi, Ph.D., MBE, was a medical expert in sociology and bioethics who dedicated nearly two decades working with medical companies, clinicians, and healthcare executives to address critical healthcare issues such as physician training, risk policy, and quality patient care. She spent 10 years leading and developing startups into successful thriving businesses.
Late in 2015, Alessia recruited me to write for Impakter Magazine. We shared similar intellectual bents as well as world views and quickly became friends. About a year later, we began discussing a book proposal on the opioid epidemic (tentatively titled Relieving Pain but Causing Misery: The Opioid States of America). We intended to cover it from various perspectives, including aspects of her father’s story as one of many cautionary tales. In fact, this Q&A was to be one of the personal narratives in the project.
As summer 2019 concluded, Alessia decided that she no longer wanted to pursue the book, concluding that continuing to focus on her father’s case had become a stumbling block in grieving him. We had been trading ideas on how best to collaborate in the future when she fell ill.
At the age of one and a half, Alessia was diagnosed with spinal muscular atrophy, type II. This genetic disease is characterized by voluntary muscle weakness and atrophy, which causes difficulties in walking, breathing, and swallowing among other important functions. Most patients, including Alessia, require the use of a motorized wheelchair. This condition also leaves patients especially vulnerable to other illnesses. In December 2019, Alessia succumbed to a heart attack after a lengthy bout of pneumonia. She was 44 years old.
The world has lost a bright, giving, incisive, candid soul. I will miss my friend.