One look, and Ken Fusco knew his son was gone. Lying on his childhood bed in dark-washed jeans and a Western-style belt, the garrulous 24-year-old almost looked asleep. But Jason's skin was ashen, and he wasn't breathing.
Ken's older son, Michael, carefully moved Jason to the floor and began CPR as Ken gave directions in his thick Long Island accent. In shock, Ken calmly called 911 and quietly told the operator that rescuers didn't need to hurry — he was pretty sure it was too late. Within minutes that night, June 12, 2008, paramedics arrived at the Royal Palm Beach house and confirmed Ken's fears: His always chatty "Florida cracker" of a son, who made friends in line at Checkers as readily as he caught bass in the backyard canal, was dead.
Like any grieving parent, Ken Fusco looked for someone to blame. Unlike many, he quickly found a target. His name was printed on the amber-colored bottle that had held some of the prescription drugs that killed Jason: Dr. John Christensen. In the weeks to come, Fusco would learn that the West Palm Beach physician with a degree from a Caribbean diploma mill had prescribed his son more than 500 pills a month of oxycodone, Xanax, and methadone. Later Fusco would learn that at least 35 of Christensen's patients had died after OD'ing on the drugs the doctor had prescribed.
At the height of Florida's pill mill boom, Christensen emerged as one of the state's worst system-abusing doctors. And after his arrest, the Palm Beach County State Attorney's Office pledged to make an example of him. As dozens of other bad docs were charged with pumping millions of painkillers into the streets with deadly consequences, prosecutors hit Christensen with murder charges in 2013 and threatened him with the death penalty. Fusco hoped his family might see justice.
But four years later, Christensen has only a few years left to serve of a short stint behind bars — and he's just one of the pill-happy docs who have walked free or been given minimum sentences even as pain clinic owners and employees have faced severe consequences amid crackdowns and tough new laws.
In fact, a New Times review of 31 South Florida criminal cases filed between 2000 and 2015 against doctors who had at least one patient die from overprescribing found the majority got off easy despite the three-to-25-year mandatory minimums the state requires in drug trafficking offenses. Ten doctors received no time behind bars, and 12 got between six months and six and a half years. In all, those 31 doctors distributed millions of pills that killed at least 208 patients, according to records from criminal and civil court cases, the Florida Department of Health, and published reports.
Now that a long-simmering opioid crisis is exploding again across the nation, critics say the legal system's impotence at punishing pill mill doctors has helped fuel the latest deadly public health emergency.
"I think the damage these doctors have caused is exactly what you're seeing right now: the opioid epidemic," Miami-based Drug Enforcement Administration agent Susan Langston says.
Fusco's life has never been the same since the night his son died — and the way Christensen's case played out in court has only made his pain worse.
"It's like we all know what's going on," Fusco says, "but we're not going to do anything about it."
Ken never expected to have Jason in the first place. Three years before his son was born in 1984, Ken and his then-wife, Mimi, lost their youngest boy, Bobby, to SIDS. He was 10 months old; his baby pictures had only just been taken. The grieving parents decided they couldn't bear to have another baby — their two older sons were enough. But then came Jason, a blue-eyed boy with a shock of blond hair. "Surprise!" Ken jokes.
Practically from birth, the youngest Fusco boy was a chatterbox, the type of kid who made friends for his older siblings and easily struck up conversations with adults. By the times Jason was in his early 20s, his perpetual chattiness became a kind of running joke. A video his girlfriend filmed showed Jason sidled up at a bar, chatting with a couple of strangers. "There's Jason," she narrated. "Of course he'd find somebody to talk to... He'll be yakking over there for an hour."
Ken and Mimi had met in high school in their native Long Island and started their family in New York. They moved to the Sunshine State in the early '80s after Ken, a supervisor for Delta Air Lines, was transferred to work at Palm Beach International Airport. So Jason was born a Florida boy — and it showed. He loved fishing in the canal behind the family's Palm Beach County house and even swimming in it, never mind the gators. Once, Ken came home from work to find a baby alligator in the backyard. Jason told him he'd planned to put it in the hot tub as a surprise.
"He just wanted me to see it because it was cute," Ken says. "I laughed my ass off."
In 1989, the Fuscos divorced, and Delta transferred Ken back to New York. Ken, who was awarded full custody of the kids, describes their home life this way: "You ever seen Home Improvement?"
He continues wryly, "Usually, if someone knocked at the door and said, 'Do you know what your son did?' the very first thing I would ask is, 'OK, which one and what did he do?' I was never one to say, 'Oh, no, not my son.'"
Ken regularly received free plane tickets through work and used them to take his boys on day trips to Reds games in Cincinnati, to the Hoover Dam, and to the Vegas Strip to see the lights. They chartered a fishing boat in Maui and went diving in St. Thomas. One summer, Ken saved up all of his time off so they could spend three long weeks driving around the Sunshine State, hitting everything from the Panhandle to the Everglades.
The family moved back to Florida in 1995. This time, they stayed put. At Royal Palm Beach High School, Jason's outgoing personality and quick wit won him friends.
"He could make a joke out of anything," says Stuart Karp, a close friend who lived with the Fuscos when he was a teenager. "You could be screaming mad, and he'd just start singing something or saying something and he'd just make you laugh."
After graduating from high school around 2001, Jason moved in with his longtime girlfriend and got a job in construction. He met Ken for lunch three or four times a week, often at Frannie's, a homestyle restaurant on Southern Boulevard. On weekends, they went fishing or watched football and NASCAR on TV while Ken opened the garage, fired up the grill, and invited neighbors over.
"As weird as it is to a lot of people," Ken says, "my son and I were actually good friends."
But in 2007, South Florida's construction market slowed dramatically as the recession loomed. Jason lost his job. He and his girlfriend broke up, and he moved back in with his dad while looking for work. Ken didn't know it then, but Jason also began seeing a new doctor.
His father still doesn't know what led the then-23-year-old to the A1A Health & Wellness Clinic, which operated out of a two-story building on West Palm Beach's Broadway Avenue. Christensen advertised as a specialist in pain management, and after years of working in construction, Jason complained of aching knees and a hurt back. He'd also been injured in a car accident years earlier.
But Ken wonders if his son, who was often out all night with friends, might have simply wanted the pills to get high. At the time, it didn't really matter. Florida had become the nation's distribution point for powerful opioids such as oxycodone — and whether the patient was truly in pain was often beside the point.
Developed by German scientists in 1916, oxycodone is an opioid and chemical cousin of heroin. By blocking electrical and chemical signals, opioids act as powerful pain relievers, but their high potential for addiction meant that for decades, doctors were hesitant to prescribe them. That attitude changed in the '90s as a new brand of oxycodone launched: OxyContin. Developed by the Stamford, Connecticut-based Purdue Pharma, the drug was designed with a time-release formula the company claimed enabled one pill to relieve pain for 12 hours — twice as long as generic versions.
Purdue aggressively marketed the drug, pumping millions of dollars into "patient advocacy groups," flying skeptical doctors out for "training sessions" at lavish resorts, and downplaying the risks for abuse and addiction. Soon enough, opioid use soared.
The Sunshine State's gaping regulatory loopholes made Florida a fertile ground for opportunists to take advantage of rampant demand. The state had no database to track the number of pills that doctors were handing out, required no special licensing for pain clinics, and allowed doctors to sell drugs directly rather than through a pharmacy.
"All you need is complicit doctors," Palm Beach County State Attorney Dave Aronberg later told New Times in 2011 after being appointed special prosecutor for pill mills. "And Florida has a large supply of retired doctors. Some of them decided to make some quick money. It was a perfect storm."
When Jason became a patient at A1A Health & Wellness the day after Thanksgiving in 2007, he paid $300 cash and wrote in his clinic paperwork that he was taking no medications. Christensen, who had whitening hair and a friendly face, looked over an MRI that showed a small disc bulge and a mild bone bruise. The test results were supposed to be corroborated by x-rays, but none were ever taken. The doctor prescribed 30 two-milligram Xanax tablets, 60 eighty-milligram OxyContin tablets, and 120 thirty-milligram Roxicodone tablets. He told Jason to come back in December for another month's supply.
Over the next few months, Jason complained to Christensen that his pain had intensified, even waking him up in the middle of the night. He was running out of medication, he said, and without it, he was in agony. Christensen didn't suggest any alternate forms of treatment, try to determine why the pain was worsening, or refer Jason to a specialist.
Instead, he continued writing prescriptions, taking Jason off OxyContin and putting him on methadone. By May, Jason was taking 540 pills a month.
The last time he walked into A1A Health & Wellness, in June 2008, Jason Fusco told Christensen he was in agony. He was taking more and more pills to get relief. He just wanted to stop. He had confided the same in his friend Karp and told him he didn't like how the medication made him feel.
But after listening to his patient's alarming concerns June 6, 2008, Christensen simply wrote the same prescription as before: hundreds of powerful pills.
Less than a week later, Jason was dead. The medical examiner later determined that a combined drug toxicity had killed him; his blood had tested positive for the presence of cocaine, methadone, and Xanax. When Ken learned how many pills his son had been getting from the clinic, he was astounded.
"Anybody who's a doctor," Ken says, "is not going to prescribe 400 to 500 pills. You don't prescribe 400 to 500 pills to a 24-year-old kid."
Even among Florida pill mill doctors, Christensen stood out. Five of his patients died of overdoses within the first two years he began practicing pain management, a specialty in which he had little formal training. His medical degree came from a Caribbean school run by a con artist who'd previously been busted for practicing medicine without a license. And some of the credentials he touted don't exist.
Raised in Orlando, Christensen served in the Coast Guard Reserve and got an associate's degree at a Daytona Beach community college before heading to the University of Florida. He left without finishing to attend chiropractic school at the Illinois-based National University of Health Sciences, graduating in 1975 with a bachelor's degree in human biology and doctor in chiropractic medicine. He bought the building at 3001 Broadway Ave. and set up a chiropractic practice.
But his "life goal," he would later say, was to become an MD. In 1991, he found a shortcut: a little-known medical school on the outskirts of Santo Domingo in the Dominican Republic. The Universidad Federico Henríquez y Carvajal made promises of fast-track medical degrees to lure American chiropractors. The school had opened its doors that very year, an investigation by the U.S. Government Accounting Office would later reveal, taking over for a predecessor, the British West Indies Medical College. BWIMC's dean, Gregory Caplinger, had been arrested by Broward County authorities in 1988 for treating two Alzheimer's patients despite not having a medical license.
The new medical school was just another scam, students complained to U.S. regulators. BWIMC handed out medical degrees after six weeks of basics and nine months of clinical rotations. Some of the professors didn't speak English. The quality of the education, one frustrated student reported, was "less than inferior." The Universidad Federico Henríquez y Carvajal was supposed to be a fresh start, but it shared the same students, catalogues, and several key administrators — Caplinger included — as its shuttered predecessor.
Christensen graduated alongside about 20 other American chiropractors in 1996. On his resumé, he boasted he was valedictorian. Although Dominican officials shut the university down two years after his graduation and Caplinger was later sent to prison, Christensen boasted the program was equal to U.S. med schools.
"We took the same examinations... and I did better than the people graduating Harvard Medical School," he crowed years later in a deposition for a civil case.
After his Dominican education, he went on to an internship at the University of Nevada but was kicked out after a year by administrators who worried he wouldn't be able to pass the licensing exam. But Christensen passed on the third try and received his Florida medical license in 2005 after completing a three-year residency with the Palm Beach County Health Department.
Early the next year, he began offering pain management services at his clinic, writing on his website that he would treat pain "in a natural way." Instead, he wrote scores of prescriptions for oxycodone and methadone. By 2007, his practice specialized almost exclusively in pain management. So much cash flowed into the clinic that his wife went to the bank twice a day to make deposits.
Christensen was far from the only shady character in an industry erupting across the Sunshine State. Because Florida didn't restrict who could own a pain management clinic, even felons convicted of drug offenses easily got into the game.
One was Chris George, who had served time for felony drug possession. With his twin brother Jeff and friend Derik Nolan — none of whom had a college degree or any medical training — the 27-year-old happened into the business in 2008. By 2010, the trio operated the largest pain clinic in the nation, with doctors at six offices writing prescriptions for at least 14 million oxycodone pills. Between 2008 and 2010, the group raked in $40 million.
"They'd stumbled into a Bizarro-world, a window of opportunity in which hard drugs were, for the moment, legal," John Temple wrote in American Pain, his 2015 book about the scheme.
The clinics were surreal: Parking lots were packed with out-of-state cars, people regularly suffered seizures in waiting rooms, and hundreds of thousands of dollars in cash piled up in waste baskets below receptionists' desks. Doctors hired off Craigslist each saw up to 70 patients a day, handed out prescriptions for hundreds of painkillers dispensed onsite after spending a few minutes with each supposed pain sufferer, and glanced at MRIs taken in a tractor-trailer parked behind a strip club. To avoid hand-cramping, the docs used rubber stamps to fill out prescriptions. Two doctors at clinics in the George brothers' empire — Michael Aruta and Beau Boshers — carried guns under their white lab coats.
"They were drug dealers with an 'MD' after their names," says Florida Board of Medicine member Steven Rosenberg, a dermatologist in West Palm Beach.
Ty Anderson, a physician in Largo, signed blank prescriptions and left boxes of them at his office for assistants to fill out and hand to patients. Unlicensed clinic staff prescribed large quantities of opioids such as Roxicodone, methadone, and Xanax to patients. Three of those patients fatally overdosed, according to a Tampa Bay Times investigation. A Lake Worth pediatrician named Sergio Rodriguez wrote scripts for Xanax, oxycodone, and methadone, sometimes without examining patients. Three of them died.
Then there's Joseph M. Hernandez, dubbed the "Car Doctor" by some patients because he wrote prescriptions from his white Lincoln Town Car. Of 761 patients the Lake City physician saw between January and April 2011, 34 died, according to Florida Department of Health records.
"They were turning a blind eye, and it was purely for money," says the DEA's Langston, who transferred from the agency's D.C. headquarters to Florida to investigate pill mills. "There's no gray area involved at all. This is not a doctor having a bad day. This is not somebody coming in and fooling the doctor."
Ken Fusco had never noticed the questionable clinics popping up near his neighborhood. In the grief-stricken weeks after Jason's death, though, he was flabbergasted to learn that a doctor could prescribe so many opioids to someone so young and healthy.
"I even called the police and said, 'What the hell is going on?'" he recalls. When he got on his computer to research the trend, he was astounded.
The numbers were staggering: Within a few years, Broward had gone from four pain management clinics to 150 — more than the number of McDonald's restaurants in the county. Florida docs distributed 523 million oxycodone pills in 2009 — twice as many as the next biggest distributor, Pennsylvania, and 25 percent more than the previous year. Deaths from prescription drug overdoses spiked to 2,488 that year.
All of those drugs added up to big profits. In 2011, $8.5 billion worth of painkillers were sold in the States, according to IMS Health. OxyContin alone reeled in $3.1 billion for Purdue Pharma. Doctors at the George brothers' clinics made as much as $1.2 million in 16 months. Christensen, who lived in a $820,000 house in the Palm Beach Gardens country club and golf course community PGA National, raked in $170,000 a month from his pain practice, according to figures in a civil suit.
It wouldn't last. Local and federal authorities finally began cracking down in earnest around 2010, stepping up arrests of doctors and going after the clinic owners who employed them. By 2013, Christensen, Hernandez, and doctors from the George practices had all been arrested and charged with drug-trafficking-related felonies. By the time Christensen was nabbed in July 2013, he'd already settled three lawsuits over patient deaths — including one filed by Ken Fusco.
After charging Christensen with first-degree murder in the deaths of two patients, Aronberg demanded that doctors be held accountable as seven people a day died of prescription drug overdoses in Florida.
"You can't overlook that, you can't ignore it, you can't turn your head away from it," Aronberg told the Sun Sentinel. "This has been, in recent years, the greatest public safety threat to our state."
The day of Christensen's sentencing, Ken Fusco sat anxiously in a courtroom gallery beside another father who had lost a son to pain pills prescribed by the disgraced doctor. Christensen's first-degree murder charges had already been dropped, and he ended up pleading guilty to one count of conspiracy to traffic in oxycodone and two counts of manslaughter. By state law, the trafficking charge carried a mandatory minimum of 25 years imprisonment. But in a total reversal, the same prosecutors who had once threatened the death penalty now waived that requirement and agreed to seek a maximum of five years.
When Palm Beach Circuit Judge Dina Keever announced the sentence this past January 25 — only four years in prison for a doctor with 35 patient deaths — Fusco could only sigh. He had long ago given up on the idea that the man who prescribed the drugs that killed his son would get a just punishment.
"It's done," he told a Palm Beach Post reporter as he left the courtroom January 25. "There's nothing we can do."
Why did prosecutors cut Christensen such a good deal?
"For a 72-year-old man, there's no way to actually have a plea discussion where the starting point is going to be 25 years," says Assistant State Attorney John Parnofiello. "Sometimes you have to have that conversation with family members where you have to explain that this guy is not going to get any punishment if you go through trial as opposed to a guaranteed prison sentence that punishes him."
The DEA's Langston called the four-year sentence "ridiculous."
"If he were a cocaine dealer, he would be in there 25 years," she says.
But Christensen — whose attorney didn't respond to messages from New Times to comment on this story — was far from the only alleged drug-dealing doctor who ended up getting off easy.
Thanks to tricky investigations, lax juries, and generous plea agreements, most doctors ensnared in Florida's pill mill crackdown received relatively light sentences. Excluding two doctors who received life terms, the physicians charged in the 31 cases New Times reviewed received an average of ten years in prison. And among those who got away with the shortest sentences were some of the worst offenders:
Hernandez, the "Car Doctor," was charged with just one count of oxycodone trafficking in 2010. In March 2012, a judge sentenced him to five years of probation. Though he wasn't imprisoned, he did agree to surrender his medical license voluntarily.
Eight doctors who worked in clinics run by the George brothers pleaded guilty and cooperated with the feds in exchange for sentences of six and a half years or fewer. Some were released early, including former plastic surgeon Patrick Graham, who was freed after he was sent to the wrong prison and caught in the middle of a jailhouse riot in which he was grazed by a bullet. The clinic owners weren't so lucky: After accepting plea deals of their own, Chris George was sentenced to 17 and a half years (later reduced to 14), and Jeff got 20.
Three former George clinic doctors who took their chances at trial were cleared in the deaths of their patients. Jurors acquitted Gerald Klein of first-degree murder and convicted him of the felony charge of selling alprazolam. He was sentenced to four years of probation. Cynthia Cadet and Joseph Castronuovo were found not guilty of causing patient deaths but were convicted of money laundering. Cadet, charged in seven deaths, received six and a half years, while Castronuovo, charged in one death, got one and a half years.
Anderson, the Largo doctor who left pre-signed prescriptions at his office, was not charged despite the arrests of another doctor at the clinic, the clinic's owner, and two physicians' assistants. He was allowed to continue practicing for years after the bust despite arrests unrelated to his medical work, including one for cocaine charges. Finally, in 2014, the Board of Medicine declined to renew his license.
It is, legal experts say, significantly harder to go after pill mill doctors than ordinary criminals who break drug laws. For starters, cops and federal agents must prove that doctors intended for the medication to be used illegally. That's a burden unique to drugs prescribed by physicians.
"As an agent, it's much easier to get somebody for trafficking cocaine than it is to get somebody, a doctor, for trafficking pills," says Victor Gobbi of the DEA, who helped build the case against Klein. "These are some of the hardest cases and investigations we do."
If a case does make it to trial, prosecutors then must contend with the fact that doctors don't look like crooks — they're polished, highly educated, and usually have otherwise unblemished records. Jurors tend to have a positive bias toward anyone in a white coat. So prosecutors often find it easier to go after the clinic owners than the people prescribing the pills. In the George brothers' empire, for instance, the twins' mother, who hid $4.3 million of their ill-gotten gains in her attic, was sentenced to more prison time than three of the physicians.
"We're taught as a society to kind of defer medical needs to doctors," says John Niedermann, a Los Angeles prosecutor who in 2015 became the first in the nation to win a murder conviction against a doctor for overprescribing. "They're to be respected; you're supposed to do what your doctor tells you. You have to convince a jury that this person isn't really acting like a doctor; they're just wearing a lab coat."
The benefit of the doubt that society gives to doctors often doesn't apply to addicts. Jurors have been reluctant to hold physicians responsible for deaths caused by taking medication in a way other than how it's prescribed. The defense is able to capitalize on that fact and, in many cases, win.
"We believe Michael was ultimately responsible for his own death," juror David DeMaio told the Sun Sentinel after acquitting former doctor Denis Deonarine of first-degree murder in the 2001 death of a college student whom he had prescribed OxyContin and Xanax. "It pains me, but legally, it had no merit."
Niedermann, however, argues that too much blame is shifted to patients. Doctors have a legal responsibility to recognize the signs of addiction and monitor their patients closely, he says.
"It's kind of like the bartender who sees the person incredibly drunk and gives them one more drink for the road," he says. "How do we not hold that bartender somewhat responsible for the fact they chose to serve the person even one more?"
Sometimes Ken Fusco just gets in his truck and drives. He used to jog, but after two open-heart surgeries, that's not really an option anymore. Now, going for long, aimless drives clears his head. Once he went as far as Key West and back in a single day. He keeps a worn notebook beside him in the white Ram pickup. While pumping gas or waiting at a stoplight, he'll jot down his thoughts.
"I guess the sadness will always come and go," he scrawled in block letters on one page.
He never thought the first-degree murder charges against Christensen would stick — in fact, he figured the doctor wouldn't end up spending a day in prison. After discovering that pill mills had operated uninhibited for years before authorities finally closed them down, he had precious little confidence in the system.
State lawmakers ultimately passed sweeping legislation designed to make it easier to go after doctors who act like dealers. By 2014, some authorities were ready to declare victory. "We closed down the pill mills," Florida Attorney General Pam Bondi said in a campaign ad that year. Yet many of the physicians who staffed those criminal clinics walk free today.
Authorities vary in their opinions on how to better hold bad docs accountable. Some, like Gobbi, say educating jurors is the key. Just as in cases against crooked cops or politicians, he argues that juries need to understand that a person in a white coat can still be a dangerous dealer. "We have to find a way to overcome that hurdle," he says.
Laws passed in recent years have at least helped authorities track clinics and flag potential overprescribers. Florida's prescription-drug-monitoring system finally debuted in 2011, and pain clinics finally began being regulated. They're now required to register with the state, which mandates they be operated by physicians, report their prescriptions, and document adverse incidents involving patients. Perhaps most important, a clinic's registration can be revoked or suspended.
But the state has had a harder time reining in the worst doctors. Since 2015, authorities have arrested at least five physicians whose patients have overdosed on narcotics; those doctors face charges including manslaughter, racketeering, and trafficking oxycodone.
"There's a few things I've learned in this job being in Florida, and one is that money is indeed the root of all evil," says Langston, the DEA agent. "This is all done for profit, and as long as the money is in this, it's going to continue."
Prosecutions of doctors will likely continue as well — especially after Niedermann was able to convince Los Angeles County Superior Court jurors in October 2015 that Dr. Hsiu-Ying "Lisa" Tseng was guilty of second-degree murder in the deaths of three patients. The case, which ended with a 30-year sentence for Tseng, could have ramifications across the nation by encouraging steeper consequences for doctors who put profits ahead of patients.
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Of course, those developments are all too late for the Fusco family.
On a sunny fall afternoon, Ken spreads scores of glossy photographs across his kitchen countertop: Jason as a towheaded toddler, a teenager leaning over a lizard, a young man dressed up for a dinner date with his girlfriend.
After Jason died, Ken didn't go into his son's room for months. He began writing for the first time since high school, filling notebooks with his pain. Almost ten years later, he's still angry that pill mills were allowed to proliferate across Florida, that no one stopped a cadre of crooked doctors from pumping out enough pills to incapacitate entire communities, that he didn't know to intervene sooner.
"There's a lot of what-ifs," he says. "You don't think I beat myself up to this day? What if, what if, what if?"