News 5 is learning more about the elaborate year-and-a-half long investigation of two pain specialists arrested for excessively prescribing pain medications in Mobile.
In May, authorities executed a raid of Physicians’ Pain Specialists of Alabama‘s (PPSA) two clinics in Mobile and C&R Pharmacy, all operated by Dr. John Patrick Couch and Dr. Xiulu Ruan. It was part of “Operation Pillution,” a massively-coordinated DEA raid of prescription painkiller clinics across four southern states. Dr. Couch and Dr. Ruan were both arrested for distributing controlled substances outside of legitimate medical purposes and healthcare fraud.
On Monday, News 5 obtained the court documents used to obtain the search warrants that culminated in those raids. The affidavit, totaling 153 pages, extensively details the evidence investigators had gathered to justify moving forward against Dr. Couch and Dr. Ruan.
Here are the highlights of the affidavit:EXCESSIVE, IRRESPONSIBLE AMOUNT OF PRESCRIPTIONS WRITTEN
Investigators say Dr. Couch and Dr. Ruan wrote 66,892 prescriptions combined in 2014, deliberately “over-prescribing controlled substances to increase revenue.”
Based on the evidence gathered, a significant portion of the clinic’s patients had no legitimate need for pain medication. They are described as “pill seekers” who obtained the drugs to use for themselves or give to others.
For Dr. Ruan (34,883 prescriptions in 2014), the excessive writing of prescriptions given to patients amounts to writing a prescription once every three and a half minutes. For Dr. Couch (32,009 prescriptions), it amounts to a prescription written every four minutes.
One informant who previously worked for Couch and Ruan said the two doctors would regularly compete to see who could hand out the most prescriptions to patients.
Additionally, patients from at least 18 different states were said to have received prescription painkillers from Dr. Couch or Dr. Ruan.
FORMER EMPLOYEES EXPOSE COUCH AND RUAN’S ILLEGAL ACTIVITIES
Investigators interviewed two unidentified former employees of PPSA, who saw patients for both Dr. Couch and Dr. Ruan.
The informants told investigators they were given pads of prescriptions pre-signed by Dr. Couch in order to give out medications to more patients. One informant said he was paid by the clinic based on the number of patients he saw in a given day, and hence, was encouraged to see patients rapidly.
Dr. Couch would see only a handful of patients daily, according to one informant, as he and other assistants were entrusted to see a bulk of the clinic’s patients and give out pre-signed prescriptions.
The informant said he would regularly forge Dr. Couch’s signature on prescriptions and other medical documents. The routine would later become standard practice around the clinic, as other employees would regularly approach the informant and ask for Dr. Couch’s signature.
The informant also told investigators about two thirds of the clinic’s patients were not legitimate pain patients, but instead, “pill seekers.” The informant also said he knew some of the patients were selling the drugs prescribed to them by Dr. Couch.PHYSICIAN’S ASSISTANTS USING PAINKILLERS THEMSELVES
According to the affidavit, several of Dr. Couch’s assistants were abusing painkillers during work hours.
The controlled substances weren’t prescribed by Dr. Couch. However, Dr. Couch is said to have been aware that the physician’s assistants were taking pills that were “not properly accounted for” by the clinic.
By early 2015, two of Dr. Couch’s assistants had been admitted into drug rehab programs.UNDERCOVER AGENTS EXPOSE CASUAL PRESCRIBING OF PAINKILLERS
During the course of the investigation, undercover officers posed as patients at both PPSA locations, exposing the casual methods used to prescribe powerful painkillers.
At least one undercover agent obtained a prescription for a painkiller without admitting any pain at all during a routine test by one of the clinic’s assistants.
During a September appointment, an undercover agent posing as a patient engaged in a conversation with another assistant. According to the undercover agent, the assistant admitted that “no one cares about the patients’ pain, and that they just cared about the money.”
Routinely during follow-up appointments by the undercover agents, higher dosages of the painkillers were prescribed without issue.
The undercover agents also paid close attention to the prescriptions they were given, noting that they had appeared to be pre-signed prior to their respective appointment.
EVIDENCE OF ILLEGAL PAINKILLER USE FOUND IN DR. COUCH’S TRASH
According to the affidavit, the Baldwin County Sheriff’s Office Drug Task Force found evidence of illegal painkiller use in Dr. Couch’s trash.
The task force sorted through the trash left outside Dr. Couch’s home in Daphne and found an abundance of packaging of controlled substances not prescribed to Couch.
One of Couch’s former employees, now an informant, revealed to investigators suspicions that Couch was a painkiller user himself. The informant said Couch was abusing Fentanyl, a schedule-II controlled substance, after an amount of the drug went missing from Couch’s inventory.
The informant also found a pile of used needles inside Couch’s office bathroom.EMAILS SHOW ATTEMPT AT STAYING OFF THE DEA’S RADAR
Emails obtained by investigators show Dr. Ruan’s concern with keeping their medical practice off the radar of state and federal authorities.
One such email written by Dr. Ruan to Dr. Couch on July 8, 2014 reads as follows:
“Pat, have you been watching the news? AL is the leading state with the most opioid Rx written! … Now, everyone in the nation knows that AL state prescribes the most painkillers in the nation, we will need to adjust our routine regimen a bit. One of the things I have done is to wean off on Benzo, or ask their PCP to write their Benzo, as Benzo prescription is also one of the things they look at and. We would rather be careful than sorry.”
Another email from several months later from Dr. Ruan references Dr. Couch’s suspicions that a raid was in the works. This email was written to Dr. Couch on October 14, 2014:
“Just two weeks ago, you mentioned to me that we were supposed to be raided by FBI, which got you concerned, but thanks god, it did not happen… Let’s make a paper agreement between you and me, if you were out, or if I were out, the other party takes over the leaving party’s business until the leaving party comes back, for whatever reason.”
ALABAMA’S LEADING PAINKILLER PRESCRIBER
Investigators revealed statistics that show Dr. Couch and Dr. Ruan’s prescription totals were growing higher each year, culminating in staggering levels in 2014, among the highest in the country.
- In 2013 Dr. Ruan is the #1 purchaser of oxycodone in Alabama, by 62% over the #2 purchaser.
- In 2013 Dr. Ruan is the #1 purchaser of morphine in Alabama, by 61% over the #2 purchaser.
- In 2013 C&R Pharmacy was the #1 pharmacy purchaser in Alabama of oxymorphone, by 68% over the #2 purchaser.
- In 2013 C&R Pharmacy was the #1 pharmacy purchaser in Alabama of fentanyl, by 41% over the #2 purchaser.
- In 2013 C&R pharmacy was the #2 pharmacy purchaser in Alabama of hydromorphone and morpine.
- In 2013 C&R pharmacy was the #3 pharmacy purchaser in Alabama of oxycodone.
- In 2014 Dr. Ruan was the #1 purchaser in Alabama of oxycodone, morphine and fentanyl.
- In 2014 C&R Pharmacy was the #1 purchaser of oxymorphone and fentanyl, #2 purchaser.
- In 2014 Dr. Ruan was the #3 purchaser of morphine, #5 purchaser of fentanyl and the #6 purchaser of oxycodone and hydromorphone in the nation.
SECONDARY URINE TESTS DONE SOLELY FOR PROFIT
As previously reported, the affidavit states Dr. Couch and Dr. Ruan contracted with outside labs to conduct secondary urine samples solely to generate additional revenue.
At PPSA, urine tests are conducted to ensure the patient is not taking non-prescribed drugs and to ensure the patient isn’t distributing drugs previously prescribed.
To supplement the primary urine testing, secondary tests were sent out, averaging $755 in reimbursement profit per sample. Investigators noted that it takes 48 hours for the secondary test results to come back, but by that time, patients had already received their prescriptions.
DR. RUAN’S HIDDEN WAREHOUSE OF EXOTIC CARS
Interestingly, the affidavit also includes a lengthy section about Dr. Ruan’s collection of exotic cars, which he stored in a warehouse in Mobile.
According to investigators, Ruan is said to have hidden his vast collection of exotic automobiles in the warehouse because he was in the midst of a divorce. The cars, along with their titles, registrations, keys, purchase documents, and bank records, were stored in the warehouse for fear that they would be included in Ruan’s divorce agreement had they been discovered.
Ruan’s exotic car collection is said to include a Saleen, a Bentley, a high-end Mercedes-Benz, among many others.
Investigators requested a search warrant of Ruan’s warehouse as part of their application.