Why Florida's Gov Fought to Save the State's Poison "Pill Mills"

By Dirk Hanson and Walter Armstrong 03/31/11

Florida's toxic "pill mills" serve up more bogus prescriptions than all other states combined. So why did Tea Party governor Rick Scott kill a bill that would have shut hundreds of them down?

Tricky Rick: Florida Governor Rick Scott
Photo via blogs.browardpalmbeach

What makes Ricky run? Is it money (he already has more than God), or monomania (ditto)? Or is he just high—and, if so, on what? That's a question a lot of Floridians are asking these days in the aftermath of the Tea Party governor's surprise torpedoing of the "Pill Mill Bill" last week. After all, what else would drive the leader of the country’s most drug-damaged state to veto an overwhelmingly popular measure aimed at cutting down its out-of-control traffic in illicit oxycodone and other legal narcotics? "When it doesn't make sense, just follow the money," goes the old adage. And when it comes to Florida's  GOP governor, most of the media are heeding that advice. Whether they should be barking up another tree is an open—and increasingly urgent—question.

As The Fix reported on Monday, Rick Scott ignited a major furor after he blocked 2009 state legislation to create a computerized prescription database that would have dramatically stemmed the frantic growth of the state’s notorious “pill mills.” The long-anticipated system would have helped police, pharmacists and health officials pinpoint patients who abuse medicine's array of highly potent, addictive, and therefore dangerous legal opioids and other analgesics by getting multiple prescriptions, an illegal but prevalent practice known as "doctor shopping." It would have also enabled authorities to target the operators of the cash-only pill mills in this under-the-radar industry. Presently, there is no other way for Florida to crack down on this “legal drug dealing,” because only legitimate pain clinics that accept health insurance are regulated—a glaring loophole in a recent state law that was specifically passed to deal with this problem.

Since Florida prescribes more prescription pills than all other states combined, the idea of implementing an effective database already in use by almost 40 states drew near-unanimous support from law enforcement officials, physicians and the vast majority of the state’s residents. In a particularly partisan state, the measure also enjoyed rare backing from legislators on both sides of the aisle, which made Scott's last-minute move to kill the bill particularly shocking. Public anger over his decision was fast and furious. But despite bitter denunciations from state-wide journalists and officials, the governor—never a very communicative guy—remained typically cryptic about the reasons for his decision. "He just doesn't think this kind of thing should be undertaken by the government," his spokesman stuttered at a press conference the following day. Indeed, the veil of secrecy that has become a hallmark of Scott's new administration has made it especially difficult to divine the governor’s true motives in the Oxy affair.

"It makes no logical or rational sense," Paul Sloan, a Venice-based pain clinic owner and president of the Florida Society of Pain Management Providers, told Mother Jones. "It's absolutely absurd. This is the most important weapon in the fight against prescription drug abuse..." In the Miami Herald, writer Carl Hiaasen blasted the continued proliferation of “Florida’s storefront pain clinics, which are still handing out Vicodins like Tic-Tacs, and overdosing customers at the rate of seven fatalities per day—more than heroin, crystal meth and cocaine combined.”

Next to Disneyworld and South Beach, Florida's pain management clinics rank among the state's top tourist attractions, attracting up to a million pill-seeking visitors a year. “The pain management clinics in South Florida range from legitimate medical business targeting specific patients suffering chronic pain to junkie-friendly, low-rent operations,” says the Broward Palm Beach News. “Second, a lot of these clinics open and shut down quickly, only to reopen at a new location. Third, and most important, there is little government regulation of the industry, and no agency responsible for tracking the businesses.” This is the environment in which Rush Limbaugh was charged with “doctor shopping” after getting caught sending his maid on drug runs. (Surely coincidentally, both Bush and Rush were among Governor Scott’s major boosters in the bitterly divisive 2010 Senate campaign.)

So why is the cantankerous Conservative candidate who ran for governor on a strict law-and-order platform dead set against cracking down on criminal drug mills?

Perhaps because he faces a serious conflict of interest in this matter—about $62 million worth, to be exact.  Scott, who has built up a nearly $219 million fortune, made most of his money in 2002, after founding a chain of walk-in clinics in Florida called Solantic. Jim White at Firedoglake discloses that “Scott holds stock in Solantic Corporation valued at $62,034,298, according to the financial disclosure form he filed with the state on June 18, 2010. The Solantic stock is the largest single holding in his overall net worth.” Since he ran for public office, the stock is now technically owned by his wife, which in Republican circles passes for divestiture. No way he could get his hands on those millions—they’re now under the control of the Frances Annette Scott Revocable Trust.

Pressed repeatedly to explain his opposition to the anti-drug measure, the governor finally replied that the database was an "invasion of privacy," since it would require pharmacists to register and report every sale of controlled narcotics to the government. "Regulations grow and spread like weeds—if we aren’t actively working to cut them back, they choke off every productive effort," he told a group of business leaders. He also insisted the program would squander much-needed state funds.  But while Scott claims he didn’t want Florida taxpayers to end up on the hook for such a program, the truth is, federal grants and private fundraising efforts had already generated enough money to run the database for the next two years. And Purdue Pharma, the company that produces OxyContin, has offered to donate an additional $1 million to help fund the program even longer.

How did Florida become the pill-mill capitol of America in the first place? One theory has it that cocaine dealers, always a fixture in the smuggler’s paradise of Florida, found that they could make just as much money, and cut down on their personal risk, by trafficking in prescription drugs. According to Dave Aronberg, who was recently appointed by the new attorney general as the “Pill Mill Czar” and charged with ridding the state of this dangerous blight, Florida’s reputation as an illicit medical mecca has a lot to do with historically weak enforcement. And it was clear that Scott had the prescription database in his cross hairs even before his million-dollar inaugural gala. Scott closed the state’s Office of Drug Control in a hurry, claiming it as a casualty of his waste-in-government axe. But the four-person staff, whose only mandate was to address the epidemic of drug abuse in Florida, cost the state a mere $500,000 a year. (Surely coincidentally, The Office of Drug Control was the agency most responsible for getting the Prescription Database on the legislature’s agenda in the first place.)

Pfizer, which contributed lavishly to celebrate Scott's inagural, was also one of several major pharmaceutical companies to contribute to the candidate's campaign. Not long after Scott took office, the drug giant acquired King Pharmaceuticals, a maker of strong pain medications like Embeda and Flector. King is also working on a supposedly abuse-resistant version of OxyContin called Remoxy. “There is no end to Florida governor Rick Scott’s hypocrisy on the issue of “pill mills,” writes Jim Edwards of BNET, the CBS business channel. During his campaign, Rick Scott grabbed hold of the Tea Party hysteria over “Obamacare” and rode it for all it was worth. He bankrolled Conservatives for Patients' Rights (CPR) to pressure U.S. Democrats to enact health care legislation based on free-market principles. He trumpeted Solantic on the campaign trail as a model of the kind of free-market, for-profit enterprises that would save the government money. (At Solantic, a "basic" visit costs $99, a "moderate" visit $139 and a "complex" visit $239.)  “If he succeeds in killing a pill mill database to track OxyContin doctor-shopping by the Rush Limbaughs of the world,” wrote Joy-Ann read in the Miami Herald, “it could benefit both Solantic and Pharmaca, a pharmacy and herbal remedy chain that’s one of Scott’s lesser-known investments.” The publicity is especially damaging to Scott because of his earlier track-record at Columbia/HCA, which was fined $1.7 billion for Medicare fraud after Scott was forced to resign as CEO of the company in 1997.

After stiff-arming the Feds this week by declining to assist in a statewide raid on selected pill mills, Scott quickly engaged in damage control by announcing the creation of a statewide law enforcement effort to halt criminal distribution and abuse of drugs in Florida. 
Yesterday, Scott said he would appoint a presumably compliant “task force” composed of six state agencies to do the pill mill cleanup job on the ground—thereby continuing to keep the Feds at arm’s length.

Solantic, which has 32 clinics scattered across the state, is a company with a checkered past. Dubbed the “Starbucks of Health Care” by the media, Solantic is currently being investigated by the U.S. Department of Health and Human Services for alleged Medicare fraud. The firm has also been sued by former employees for racial discrimination, and for allowing nurses practitioners to treat patients. The Reid Report obtained an email from Dr. Randy Prokes, the former director of Solantic’s Jacksonville clinic, in which he complained of “inappropriate pressure on physicians to sell drugs that Solantic has on sale in their facilities…” The Scott camp responded that Prokes had been selling painkillers in his spare time while employed at Solantic. During hearings on the matter, Scott declined to answer questions 75 times, and the company quietly settled with the government.

But killing the pill mill database isn’t the governor's only health care “innovation.” Mother Jones reported that the sweeping Medicare reform bill that Florida Republicans are currently attempting to pass “would give HMOs and other private health care companies unprecedented control over the government health care program for the poor. Among the companies that stand to benefit from the bill is Solantic…” writes Jason Linkins in the Huffington Post, noting that the governor “seems to want to make it easier for other serial fraudsters to commit serial fraud.”

There’s also another potential Solantic bonanza on the horizon, in the form of a GOP-proposed plan to drug test all of Florida's welfare recipients and the state's entire public workforce, despite the lack of any evidence to suggest that struggling single moms, teachers, or police officers are any more prone to working high than, say, stockbrokers or CEOs. Conveniently, however, Scott's Solantic happens to sell drug-testing kits for both the home and office.

But wait, there’s more! Solantic doesn't accept traditional Medicaid, but it does accept privately run Medicaid HMOs. Scott’s budget recommends saving money by moving Medicaid recipients into HMOs, potentially adding to Solantic's client base.

Are these blatant conflicts of interest actionable? Quite possibly, says legal and ethics expert Marc Rodwin, a law professor at Suffolk University who is the author of several books on health care and conflicts of interest. "Placing his ownership in the name of his wife is not an effective way to control for conflicts of interest and not generally accepted because they are personally related," Rodwin said. Scott's blindness to Solantic's daily business decisions likewise does not relieve his conflict. "His family still benefits from it," Rodwin said.

But the biggest question remains: Given the obvious political and PR blowback, why did he do it? What did Scott hope to gain by blocking a digital database that the vast majority of states had quietly put in place without political conflict. What was the point of screwing with health insurance or trying to ram mandatory drug testing down the throats of state employees and welfare recipients?

If you ask much of Florida's press corps, it all comes down to money. The influential Reid Report, written by veteran political ceolumnist Joy Reid of the Miami Herald, reveals that “Florida has just under 168,000 state employees, including just over 105,000 in the executive branch. For Rick Scott, the proposed new health laws would send nearly 170,000 new potential customers pouring in to his … sorry, his wife’sSolantic walk-in clinics."

But could there  be a much simpler reason for the freshman governor to defy his state on such a controversial issue? During November's hard-fought gubernatorial campaign, Scott made no seccret of his distaste for government and its "poisonous effect on American life." Viewed in this context, his hardline reaction to the drug bill shouldn't be a surprise. It's quite probable that Scott is what he has always professed to be: a Tea Party true-believer who thnks that government has no business knowing what medicines you take, regardless of the consequences. But if so, his libertarian views often seem at odds with his more traditional conservative positions. His popular promise to have the government impose mandatory drug testing on all welfare recipients helped launch Scott's seemingly quixotic candidacy but seemed at odds with his libertarian mantra. “We’re using taxpayer money, so we shouldn’t be subsidizing people that do the wrong thing regarding drug use,” he lectured theOrlando Sentinel during the campaign. Apparently, a slim majority of Floridians agreed. But after winning by a small margin over popular Democratic candidate Alex Sink, Scott has watched his poll ratings drop like a rock, partly because he's a wooden and uncharismatic leader, and partly because his inherent contradictions seem almost irresolvable:

—He's a conservative governor who opposes a pill mill database, but favors mandatory drug testing for state employees.  
—He's a multi-millionaire businessman who owns a chain of medical clinics by proxy, but sees no conflict in backing Medicaid reform and other changes in state law that would clearly benefit his clinics.
—He's a politician who pointedly turned down more than $2 billion in federal money for high-speed rail projects, while also spurning a $1 million offer from Purdue Pharma, a private corporation, to pay for a program that would help take on one of the state's most persistent problems.

Perhaps Governor Rick Scott is nothing more than a “cartoon villain fraudster,” as the Huffington Post's Jason Linkins suggests. Maybe he's a libertarian zealot, who has allowed his puritan ideology to trump the grim realities that are helping to destroy his home state.  Regardless of his motives, he seems unlikely to be stopped by anything short of prosecution—or the next election. When we last checked, his approval rating among Florida voters was hovering under 32%— lower than those of any Florida governor in history after five months in office.


Please read our comment policy. - The Fix