COLUMBUS, Ohio — One patient was prescribed painkillers even after she was caught faking a urine test, while others paid a doctor to increase their prescriptions, according to documents related to the shutdown this week of a notorious clinic in a region of southern Ohio so identified with painkiller addiction that the office's standard dosage was known as "Portsmouth cocktail" after the nearby county seat.
The Greater Medical Advance clinic in Wheelersburg, an Ohio River city of about 6,000 residents, was a perpetually busy drug house where the owner carried a handgun and tens of thousands of painkillers were dispensed at inflated prices, according to charging documents and search warrants The Associated Press obtained through a public records request.
Authorities allege the clinic, the last remaining "pill mill" in painkiller-plagued Scioto County, was a destination well-known among addicts and dealers and had just one purpose: "to make as much money off illegal drug trafficking and the funding of illegal drug trafficking as possible."
The documents reveal the length to which addicts and dealers will go to get pills and illustrate the mechanics of supply and demand at a time when painkiller overdoses are now the leading cause of accidental death in more than a dozen states — more than car crashes.
Clinics that critics call pill mills often operate as pain management centers and are known for doing cash-only business with scant patient examinations.
Dr. Victor Georgescu, now facing corruption and drug trafficking charges, told investigators he was scared by goings-on at Greater Medical but needed the work because he had been fired from four previous jobs after suffering a stroke, according to a 2010 request for a search warrant during an investigation of more than two years.
"You don't like what you were doing here," Kevin Kineer, an investigator with the Ohio Board of Pharmacy, asked the doctor.
"Right," Georgescu responded.
"You know it's wrong," the agent said.
"Yes," the doctor said.
Columbus defense attorney Mike Miller, who is temporarily representing the 50-year-old Georgescu but doesn't expect to take his case, said he hasn't reviewed the charges yet. Three other people were also charged, including clinic owner George Marshall Adkins, who faces similar charges, as well as a count of carrying a gun while involved in drug trafficking. Adkins often wore a handgun while working, according to documents.
A lawyer who has represented Adkins in the past said the clinic had safeguards against such alleged abuse.
"To my knowledge they ran the place in accordance with the way they were supposed to," said attorney Mike Mearan, of Portsmouth, the seat of Scioto County.
A judge ordered the clinic temporarily closed as a public nuisance, with a hearing next week in which authorities will argue it should be permanently shuttered. The owners of the property operated by Adkins, Billy and Katherine Inmon, deny any involvement with the clinic or knowledge of what was happening there.
"We're conservative people, people of faith, and people that don't stand for anything close to what these people are accused of doing," Billy Inmon, who owns several shopping centers around Ohio, told the AP.
Documents paint a picture of an operation where pills were readily dispensed to just about anybody who could pay.
So many patients brought in non-patients seeking drugs that the clinic had to post a sign limiting the number of visitors, according to a charging document. Husbands and wives often received the same prescriptions, as did people living at the same address, raising suspicions that drugs were prescribed with little or no diagnosis.
Clients could pay extra to have their prescriptions increased, and the "Portsmouth cocktail" was often dispensed to convicted drug dealers and addicts, according to the documents.
Clinic employee Tammy Newman would take a "pill tax" from patients, usually two to five tablets, during the pill counts, the indictment against Adkins said.
Many patients traveled long distances, sometimes from other states, bypassing other clinics and pharmacies, documents said. Many patients appeared stoned while at the clinic, and unsigned prescriptions or prescriptions with stamped signatures were found, in violation of Ohio law.
Georgescu frequently wrote prescriptions that lasted longer and with higher and stronger dosages than other doctors, according to the search warrant request. During one nine-month stretch more than 14,000 prescriptions were written.
"A review of patient records found massive failure to comply with health care standards and Ohio law," according to Adkins' indictment.
The pill mills in Scioto County — there were once more than a dozen — created regional collateral damage, feeding addiction and crime in surrounding counties and states that lacked the clinics but not the people they served, said Aaron Haslam, the painkiller drug czar for Ohio Attorney General Mike DeWine.
Wiping them out in a single county was significant, but the painkiller addiction crisis is still responsible for huge problems that will take years to resolve.
The number of children born addicted to drugs, an increase linked to painkiller abuse, is skyrocketing in Ohio and elsewhere. Last year, nearly 1,200 Ohio newborns were diagnosed with drug withdrawal syndrome, up from just 310 in 2005.
Florida, also struggling with rampant prescription painkiller abuse, saw 1,374 babies with the syndrome discharged from hospitals last year, a nearly 300 percent increase from 2006. Kentucky, Maine and Pennsylvania have also documented the increase, among other states.
Drug overdose deaths have surpassed traffic accidents as the top cause of accidental death in Ohio, Colorado, Massachusetts, New York, Oregon and 11 other states. Substance abuse counseling centers are getting more and more referrals.
More than 1,300 people died from accidental drug overdoses in 2009 in Ohio, according to the most recent data from the Ohio Department of Health. The number of fatal overdoses has more than quadrupled from 1999, when the state recorded 327 accidental deaths, according to the department.
"A drug addict is sick; there's something that is not right, and they need help," said Angela Hamilton, 40, whose sister died in 2009 the day after getting a prescription from Georgescu, according to U.S. Drug Enforcement Administration records.
"They don't need people to be greedy and look at them as a dollar sign," said Hamilton, of Greenup County, Ky., across the Ohio River from Scioto County.
Ohio Gov. John Kasich signed a bill in May cracking down on pill mills, blamed by health officials for contributing to hundreds of overdose deaths in the state each year.
Around the country, heroin use is on the rise as addicts switch to the cheaper drug after starting with painkillers, which can be expensive, according to the DEA and doctors and counselors who treat addictions.
Haslam likened the fight against pill mills to squeezing a balloon.
"They're going to find ways to make money," he said. "If it's not in Scioto County, they're going to go to another county in Ohio or they're going to go to Kentucky, to Indiana, to Pennsylvania, to Florida, to whatever state will allow them to do this until they're policed and forced out."