Doctor Vs. Doctor At Pill Mill Trial

By George Anastasia
For BigTrial.net

It was a second opinion that Dr. William O'Brien 3d didn't want to hear.

Dr. Stephen M. Thomas, a Stanford Medical School trained pain management clinician called as an expert witness by the prosecution in O'Brien's ongoing pill mill trial, systematically ripped apart O'Brien's prescription practice, repeatedly telling the jury that his analysis indicated the drugs O'Brien prescribed were not "medically legitimate."

At one point during his day-long stint on the witness stand, Thomas referred to what O'Brien did in his office as "drug dealing."  At other times, he read from the charts of O'Brien's "patients" and then commented on the drugs prescribed.

"This combination will scramble your brain," he said of a combined prescription for oxycodone, methadone, Xanax and Adderall. "And at these doses it's dangerous."

Of another, he said, "Not consistent with legitimate medical diagnosis . . . Not medically necessary."

And of a chart that showed continual increases in the dosages, he added, "This is a pattern for addiction or diversion (selling the pills)." Still later, of a similar situation, he said, "Something else, that is non medical, is driving that."

The clash of the two doctors, which included sharp verbal exchanges and lengthy philosophical ruminations, is expected to continue when the trial resumes Wednesday morning.

The prosecution hopes to use Thomas' testimony to undermine O'Brien's now beleaguered defense. Despite a half dozen witnesses who have testified to the contrary, including O'Brien's own office manager, O'Brien has continued to argue that he was practicing legitimate medicine and had no idea some of his patients were selling the pills he prescribed.

O'Brien, who is representing himself, is charged with conspiracy, drug dealing, contributing to the death of a patient, money-laundering and bankruptcy fraud. The prosecution alleges that he pocketed $1.8 million over a three-year period by writing prescriptions for fake patients who were part of a pill mill operation set up by members of the Pagans outlaw motorcycle club.

The government contends that some members of the Pagans were making $10,000-a-week in the scam, selling drugs like oxycodone, methadone, Xanax and Percocet that O'Brien prescribed for clients who were working with the bikers. The government alleges O'Brien was paid $200 per visit to do little more than write a prescription. The fake patients were then paid about $500 after having their prescriptions filled and turning the drugs over to the Pagans or Pagan associates.

Today's testimony focused for the first time on the medical side of the investigation. The jury has already heard from several co-defendants who have pleaded guilty and who have said that O'Brien was a willing part of the pill mill scheme. The witnesses have also included two strippers who said they exchange sex for drugs after O'Brien said he would waive the $200 visit fee if they would give him a blow job.

The dancers said they complied.

Today's testimony was more philosophical than sexual and included a clash of egos.

Thomas, a doctor with 30 years experience in pain management (O'Brien has 20 years), seldom looked at O'Brien as he was being cross-examined. Instead, he looked at the jury and in soft spoken but firm language detailed his findings and opinions.

To date, Thomas said he has been paid $30,000 by the government for his work.

Asked if he was paid in cash, Thomas appeared perplexed.

"Did you know informants are paid in cash?" O'Brien asked. The prosecution objected to the question, but Thomas, shaking his head and smiling, said he was paid by check.

O'Brien, who has argued continually that he was wrongly targeted by federal authorities who did not understand medicine or pain management, took the cross-examination in several different directions and, as has been the case often during the five-week trial, it was not always clear what point he was trying to make.

He and Thomas disagreed on most medical questions and got into a discussion about whether the practice of medicine was an art or a science.

Thomas waxed philosophically in response, telling the jury, "to practice medicine without books is to sail an uncharted sea. But to practice only through books is to never go to sea at all."

When O'Brien referred to an 1896 study involving cocaine and other narcotics, Thomas replied that he preferred to base his practice and opinions on studies done in the current century. The jury also heard O'Brien and Thomas discuss whether George Washington and Thomas Jefferson were drug dealers since both raised hemp on their farms - hemp is a form of cannabis.

And so the cross-examination rambled on.

When Thomas offered another lengthy response to a question, O'Brien asked, "Do you like to hear yourself talk?" A prosecution objection was sustained by Judge Nitza Quinones.

But the question, after nearly five weeks of often disjointed cross-examination, could also be asked of O'Brien.

George Anastasia can be contacted at George@bigtrial.net.