Eagle physician Michael Minas went from operating a family practice to one focused on pain, federal prosecutors allege in a pre-trial brief.
Minas, who is charged with 146 counts of distributing controlled substances, went on trial Monday in a case that is expected to last two weeks. He is accused of prescribing powerful painkillers, mostly oxycodone, in amounts that exceeded what prosecutors claim would have been proper medical treatment.
“He did so with little to no medical basis or treatment plan, minimal, if any, diagnostic tests and little, if any, consideration of non-opioid treatment,” assistant U.S. attorneys Kevin Maloney and Darci Ward wrote in the brief.
Prosecutors say he did not develop treatment plans for his patients, did not establish goals and failed to come up with ways to evaluate treatment progress. Nor did he initiate trials for starting patients at the lowest possible dosage nor establish plans to reduce the amount of painkillers patients were taken.
As Minas changed the focus of his practice, he relied on unqualified medical staff members — some of whom were volunteers whom themselves received prescriptions from Minas for painkillers, prosecutors said.
Minas, who pleaded not guilty to the charges, said he did his best to relieve chronic pain for his patients.
His patients were “maintained on varying does of pain medication therapy, which allowed these patients to otherwise live functional, if not productive, lives,” defense attorneys C. Tom Arkoosh and James Stoll wrote in their pre-trial brief.
The attorneys say Minas, as one of a few independent physicians in the Treasure Valley not affiliated with the Saint Alphonsus and St. Luke’s health care systems, was targeted by the government to set an example to doctors throughout Idaho who continue to provide pain medication outside a pain clinic setting.
“The government seems to make Dr. Minas the scapegoat for a broader drug problem for which he is not responsible,” Arkoosh and Stoll wrote.
They noted that the alleged actions by Minas did not result in any serious injuries or deaths.
Since 1999, the number of prescriptions written for opioid painkillers in the United States has quadrupled, Dr. Debra Houry, an emergency physician who serves as injury prevention director at the Centers for Disease Control and Prevention, told journalists meeting last week in Baltimore for a weeklong conference on opioid abuse. More than 249 million prescriptions were written in 2013, Houry told the group, which included an Idaho Statesman reporter.
Five percent of doctors write 40 percent of opioid prescriptions, Dr. Caleb Alexander, co-director of the Center for Drug Safety and Effectiveness at the Johns Hopkins Bloomberg School of Public Health, told the same gathering. Addiction, not the non-medical use of opioids, has been the main catalyst for a significant rise in opioid prescription overdose deaths, which occur once every 20 minutes in the United States.
During interviews with federal Drug Enforcement Agency investigators, Minas estimated that 40 to 50 percent of his pain management patients were drug seekers, drug addicts or people who sold their medications on the street, according to the brief.
Several of Minas’ patients were arrested for trafficking in heroin or other opiates, which he knew. Minas also told investigators he had been told six to eight times in the year prior to the interview that his patients were selling their drugs.
Prosecutors say Minas routinely prescribed hundreds and sometimes more than a thousand 30 mg oxycodone pills a month to individual patients. They plan to introduce testimony at trial by other physicians saying those levels were way out of line with accepted medical standards.
Three of the 14 “patients” listed in the indictment were actually undercover police officers. Minas claims they worked to entrap him. Prosecutors say the officers first approached Minas in 2014, at least two years after the other patients had received excessive painkillers.