Special interviews with recovering addicts
We were blessed to capture the powerful and heart-wrenching testimonies of several recovering addicts, including four former patients at one of Dr. Kishore’s clinics in Waymouth, MA, and four who were treated by Percy Menzies at ARCA in St. Louis, MO. The raw honesty with which they shared their struggles with addiction, as well as their invaluable insights into the different treatment methods currently available to heroin addicts, are juxtaposed with Kishore’s and Menzies’ more humane, common-sense, low-tech, and comprehensive methods. These interviews add value to the film like no other expert witness could.
Punyamurtula S. Kishore, MD
In the Winter of 1977, a young man travelled from New Delhi, India, to Boston, Massachusetts, with little more than a medical degree and a desire to help his fellow man. Young Dr. Punyamurtula Kishore was inspired to carry on his family’s legacy in the medical profession. He had also been deeply impacted by a classic of Hindi cinema he watched as a boy about a jail warden who rehabilitates six outcasts into productive men of virtue, a theme that would eventually mimic Kishore’s own life story and calling.
Through a series of extraordinary events, including a random act of kindness by a stranger the day he arrived at Logan International, Dr. Kishore was employed at—and later became the Medical Director of—the Washingtonian Center for Addictions, the first organization in the U.S. to recognize addiction as a disease. This experience changed his entire medical career plan and drew him into the field of addiction medicine.
Over the next decade, Dr. Kishore worked in most of the major addiction programs in Massachusetts. He had experience in every phase of treatment—whether inpatient, outpatient, or residential and a variety of philosophies from sobriety based to maintenance or twelve step to therapeutic community based. Then in 1990, while the Associate Medical Director for the Department of Corrections at Bridgewater State Hospital, Dr. Kishore founded "Home Free," an innovative award-winning pilot home detoxification program.
In 1996, he opened the first office of Preventive Medicine Associates, Inc. (PMAI), a private medical practice focused on addiction medicine. It was a quaint one-room office in Brighton, Massachusetts, built around a model of primary care. As the practice grew it became apparent that additional sites were necessary to provide easier access for patients traveling long distances to reach the office. Request came from community members, physicians, or the political structure of various communities requesting additional sites be developed in their community.
The practice became a statewide network of sites offering a full spectrum of services, available to all patients at all sites. In addition, by providing access to sober housing in all areas of the Commonwealth, the network enhanced the continuity of care. Each practice location consists of a multidisciplinary team, which typically includes a mix of physicians, psychiatrists, nurse practitioners, physician assistants, counselors, office managers and medical assistants. From this experience he developed a model of care which he called the Massachusetts Model of Addiction Recovery. Dr. Kishore’s model depends on a multidisciplinary team of professionals, including, nurse practitioners, physicians, physician assistants, psychologists, nurses, and peer group counselors, who plan and assist in the treatment process. The physician or nurse practitioner would meet individually with the patient to conduct an interview, review the client's test results, and plan medical goals and objectives, and operated on the assumption that abstinence is the ideal means and sobriety the optimal result. The treatment provided tools and a context for the client to learn new ways of living without alcohol and other drugs, and could be employed on an outpatient basis.
At its peak in 2011, PMAI had a nearly $10 million per year payroll, and served thousands of new patients each month. But billions of dollars are at stake for the government and corporate drug war establishment, so the state devoured a non-combatant like Dr. Kishore who threatened their entrenched system.
The war on drugs has been a cash cow since it was started by President Richard Nixon in 1971. Since then, governments at every level have thrown ever larger sums of money at the problem, with dismal results. Additionally, a vast network of private companies feed off of the government bureaucracy, providing counseling, substitute drugs, sober houses, medical treatment, detox, and more. Failure in the drug war, as measured by increased drug dependency, has become a roaring success for government, keeping a lot of people employed.
The attorney general of Massachusetts, Martha Coakley, started a highly visible crusade against Medicaid fraud in 2007, which continued for years. She found that some commercial drug testing labs had bribed the owners of so-called “sober-houses”—where recovering addicts stay to learn to live a sober life—in order to get the houses' drug testing business, most of which was then illegally billed to Medicaid. Once caught, several of these labs paid huge fines to the state, and were driven into hands of well-connected acquisition companies.
In Dr. Kishore's medical practice, by contrast, he or his associates examined his patients, diagnosed them, and made therapeutic drug testing part of the treatment plan. That is a legally reimbursable expense under medicaid, whereas non-prescribed stand-alone tests are not. Despite the fact that he did intakes with every patient, the government lumped him in with the obvious scammers who just did forensic drug testing as a requirement for housing, and brought the aforementioned criminal indictments against him.
Starting in 2007, Attorney General Martha Coakley and drug czar Botticelli waged a war on Dr. Kishore's medical practice, culminating in two sets of indictments brought in 2011 and 2013. Despite a five year-long colonoscopy of Dr. Kishore and PMAI, the attorney general could not turn up one smoking gun that proved a criminal act. It wasn't for lack of trying. So, the indictments had to be based on an implication that he must be engaging in some kind of secret “scheme,” even though the attorney general admitted that all of his records showed that he did everything by the book.
First up was the attorney general's crack medicaid fraud division, which she sent in to audit PMAI in January of 2007. They worked the books over for thirteen months, but could not find anything to provoke a reprimand letter.
In May of 2009, Paul Cirel, the type of lawyer that some would call a “fixer,” delivered AG Coakley's first ultimatum to the doctor. Her message: Give up your drug testing labs to a competitor, Willow Labs, or you'll be in trouble. And, while you are at it, you have to give up your medical license, too. Dr. Kishore politely declined the AG's offer, and canned the lawyer.
Next up was an Attorney General-run “sting” in December of 2009, that resembled a movie plot. It arose out of Dr. Kishore's expansion of his practice into “sober houses,” where recovering addicts live, so he could bring medical services to the people who needed his help the most. Dr. Kishore negotiated lease agreements with over twenty of these sober houses around Massachusetts to place PMAI medical practices in them.
There was one sober house owner whom Dr. Kishore had never called on, however: David Perry. He owned a place called Recovery Education Services (RES) in Boston, which was sketchy at best. Perry, a former addict, cocaine dealer, and a disbarred lawyer, had a dreadful reputation from his days as co-owner,with his friend David Fromm, of a now defunct sober house operation called Safe Haven. It was anything but safe, or sober. It had been the site of several overdose deaths and was ultimately shut down by the city of Boston for numerous code violations. Constant drug use by the residents, disturbing the peace, trading of sexual favors, and overcrowding brought an end to it in 2008.
After Safe Haven was shut down, Mr. Perry immediately started RES, his new sober house business, while his buddy Fromm put together a commercial drug testing lab called Precision Laboratories. Perry had Fromm/Precision Labs drug test each of his sober house residents three times a week, and primarily billed Medicaid for the test costs. This was illegal under medicaid rules, but he was a friend of the attorney general, and so he got a pass.
In December of 2009, Perry went to attorney General Coakley to discuss taking down Dr. Kishore. He had already helped expose another commercial drug lab for taking bribes, using a staged entrapment ploy, at the behest of AG Coakley. His zeal to be part of this operation may have been to help his friend and partner Fromm to eliminate competition for his Precision Labs. However, Dr. Kishore did not run his business in an illegal manner, but did all of the testing of his patients as part of a medical treatment plan, as the law requires.
The attorney general's office point man for the Kishore sting operation was her right arm and senior investigator named Brian Robinson. The plan started with David Perry contacting Dr. Kishore and asking the doctor to come to Perry's sober house in Boston and talk about setting up a PMAI clinic there, and to make arrangements to drug test his residents. It was all a setup; He had no intention of actually coming to an agreement. He hoped that during the meeting, Dr. Kishore would offer a bribe or a quid pro quo in order to be allowed to get the drug testing business, and thus subject himself to criminal charges.
Right before they were to meet, investigator Robinson put some of his people into Perry's sober house office as dummy employees, who could listen to their conversation during the meeting, and he set up a listening post for himself as well. At the appointed time, Dr. Kishore arrived with several of his top executives, not suspecting that he was walking into a potential trap. The principals met and spoke, but the attorney general did not get what she wanted, because Dr. Kishore did not offer any gratuity. Dr. Kishore did not even find out that he had been played this way until nearly two years later.
The scrutiny intensified in 2010. An inspector from the U.S. Office of the Inspector General came in September of 2010, and spent two weeks going over PMAI with a magnifying glass, but initiated no actions. When that didn't work, the U.S. Drug Enforcement Administration followed with an investigation two months later, hoping to catch the doctor in some improper prescription of controlled substances. But, since he did not prescribe DEA regulated narcotics to his patients, that investigation turned up nothing. Following two months after that was the Massachusetts Dept. of Revenue, and you can imagine what they were looking for, but they, too, found essentially nothing.
At this point, Dr. Kishore realized that he was a target, and hired another very connected lawyer, one Frank Libby, in hopes that he could reduce the government pressure. However, the Attorney General had tea with Attorney Libby in January of 2011, after which he met Dr. Kishore and delivered another AG offer: Take a pre-indictment “guilty” plea (before he was charged with anything) and appoint Libby's law firm as a $1.2 million a year compliance monitor to oversee his PMAI medical practice for five years. Generous terms, those, but the doctor demurred, and fired him also.
A third, even more connected lawyer, a former United States District Attorney, Donald Stern, was the Attorney General's chosen vessel for another ultimatum just two months later, on March 17, 2011. After having lunch with Madame Coakley, Mr. Stern told Dr. Kishore that she would let him off easy if he gave up his drug testing laboratory business to one of her cronies, David Fromm's Precision Labs, and then serve as its “prescription mill” so it could go legit on its medicaid submissions. Plus, he would have to agree to be monitored by Stern's firm, just like in the other “offer.” Dr. Kishore again decided not to pay to play; but there is almost always a price to pay when you refuse an “offer you can't refuse.”
Two weeks later, on March 29, 2011, the owner of that drug testing company, Precision Labs, with complicity of the Attorney General, sued Dr. Kishore civilly for unfair competition, and got an attachment on all of his business bank accounts and property. That was the beginning of the end.
All the while the lawyers were delivering ultimatums, the agencies were investigating, and the AG was running the sting with Mr. Perry, a grand jury was also meeting, starting in June of 2009. It meandered for over two years, before delivering thirty-two indictments against Kishore and his company PMAI on September 21, 2011. Due to a strange quirk in Massachusetts criminal procedure, a criminal complaint was issued against Dr. Kishore a week before that date, and he was arrested one day earlier, the night of September 20, 2011.
The arrest was an over-the-top spectacle orchestrated by AG Coakley for maximum TV and media coverage. If it bleeds, it leads, as the old TV saying goes. To arrest one unarmed middle aged doctor, they sent fifteen police cars, thirty three state police vehicles, attack dogs, and even a helicopter on the night of September 20, 2011. Good thing an actual crime was not happening anywhere, because all the police firepower was at Dr. Kishore's house.
The next morning, the attorney general had Dr. Kishore do the “perp walk” in front of the cameras on the way into court for every TV network, displaying her “trophy.” The show continued at the courthouse for Dr. Kishore's arraignment, and the story appeared on every news outlet that evening.
Depending on where you sit, the case against Doctor Kishore and his company PMA looks like a trumped-up political witch hunt... Or, a heroic operation by the government which uncovered illegal Medicaid reimbursements made to the doctor which were obtained by bribing sober-house owners to give him exclusive drug testing business. It gets all bogged down in arguments over the meaning of words in a poorly written law, and in whether federal or state law applies.
Dr. Kishore tried to run a clean house. He had systems in place to ensure that every patient was seen, diagnosed and given a treatment plan. He used standard lease arrangements to rent the spaces in the sober houses, and checks showing monthly rent paid for space in each place. The Attorney General acknowledged these facts, but called these rentals at sober houses a “scheme” on paper. But this was a “scheme” in which the Doctor did it all legally and openly. It is a common business practice to do “co-location,” renting space in another premises, to save the cost of a full facility. Subway sandwich shops does that in convenience stores, as do all concessions in airports.
When the attorney general tested her hypothesis that Dr. Kishore was crooked and taking bribes in 2009, using David Perry in the sober house sting describe above, it turned up no hint of a bribe. In another instance, a sober home operator was hinting at getting some financial reward beyond rental of his facility for the placement of a PMAI practice, and one of Dr. Kishore's managers sharply retorted that, “PMA did not buy contracts,” according to a statement by the attorney general to the court.
Two years later, the grand jury issued another forty-four indictments against Dr. Kishore and the now-defunct PMAI on November 21, 2013. This second set were issued because, if Dr. Kishore had bribed sober houses to get business years ago, then any medicaid reimbursements obtained from them were illegal per se, regardless of whether they were medically necessary. The attorney general admitted that there was no “fake” medically unnecessary testing at issue.
Some things don't add up: Although Dr. Kishore was accused of bribing sober house owners, the director of the largest one, Laurence Schneider, of North Cottage Program, Inc., was not indicted for taking those same alleged bribes. The Attorney General took all of Dr. Kishore's personal emails without permission or a warrant, including hundreds of emails to his defense lawyers. The Supreme Judicial Court issued a slap on the wrist after much wrangling about this serious breach of constitutional rights and legal ethics.
Meanwhile, with Dr. Kishore's business out of the marketplace, drug addiction in the state soared, provoking alarm in all quarters, including, ironically, at the attorney general's office. It organized all kinds of programs, task forces, and other expensive but meaningless responses to the crisis, which will not help the addicts one bit since Kishore's sobriety-maintenance program was forcibly shut down in September of 2011. Opioid-related deaths in Massachusetts totaled 1379 in 2012, and they spiked to over two thousand deaths in 2013, an increase of about 45%.
Dr. Kishore was at first determined to fight to prove his innocence, but the prosecution piled on 80 charges. Losing on a single one would have meant 5 years in prison and deportation. After spending nearly $2 million on lawyers, he was destitute and relying on friends to pay for gasoline. The court was forcing his lawyers to work without compensation, but he had good reason to think their representation was inadequate. They called no expert witnesses and failed to subpoena prosecution witnesses for cross-examination. The government turned up the pressure on his family, as by auditing his wife’s very simple medical practice. Ultimately, he pled guilty to a single charge of larceny of more than $250. Such plea bargains require the defendant to “agree” to the government’s statement of the “facts,” and to give up the right to appeal. He spent 8 months in prison and faces 10 years probation.
The prosecution portrayed him in the press as a demon. The $4.9 million his practice collected annually from Medicaid was allegedly victimizing the state’s “most vulnerable” patients, even though his success rate was at least 750% higher than the state’s big-name programs. The state has deprived Dr. Kishore of the right to defend himself, but the last chapter is not yet written.
This film will attempt to tell the whole story.
SOURCES: "The War on Drugs Devours a Non-Combatant," by Greg Hession, and "Drugged America," by Jane Orient.
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