Archive

Monthly Archives: October 2014

Case II: Chapter 11: We Need a Strategy

It didn’t take much effort for Dudley to convince Isabella that he wanted to talk with her. To say that she was expecting an explanation after seeing him with Frank Garcia would be an understatement.

The next morning the three of them met in Isabella’s office. Dudley began by explaining what he observed in the physical therapy room and his suspicions regarding Ekaterina Bubolsky’s special drink concoctions. He briefly summarized the results of the lab tests that he requested through Lt. Garcia. He concluded by saying that it was important to not accuse someone of a serious crime when, in reality, it may be nothing more than a very clever approach to physical therapy.

“But if there is something going on with these prescription medications, we need to know about it as quickly as possible, said Isabella quite forcefully. I will not jeopardize the reputation and integrity of La Vida Aureo under any circumstances.”

“Then we need to figure out how to run this to ground as quickly as possible with the maximum amount of discretion”, offered Garcia. Doc, you may have probably already aroused some suspicion with Ekaterina and you need to back away from any direct involvement in future actions. Is also important to that we determine whether this is the activity of the single individual, namely Ms. Bubolsky, or whether or she is simply part of a larger operation. Although she appears to be very clever, my gut tells me that she is not acting alone. Do either of you know what her connection is to the orthopedic surgeon who recommended her?”

“I do know that she came highly recommended by Doctor Malinikov’s office, said Isabella, and he has also sent a number of his patients here for rehabilitation after knee or hip replacement surgery. All of those patients checked out through our initial screening process so they are legitimate patients. Suppose I contact a number of the other facilities in the Albuquerque area? I know a number of other Executive Directors personally and can speak to them on a confidential basis to inquire if they have seen anything similar to do what Doc has observed.”

“I think that makes sense, said Garcia, but I trust you will be very circumspect in your initial questioning. We don’t want to alarm people or alert to anyone that we are suspicious. I would also like to consider setting up some kind of undercover sting operation to gain a better understanding of exactly what’s going on and the extent of these activities.”

“I think I forgot to mention the interchange between Bubolsky and one of the patients in our facility, namely Horace Johnson, added Dudley. Last week they seemed to be having an argument and he accused her of trying to recruit someone, a new patient. I think there may be some significance to his use of the word recruit and I think it is important to understand what she was potentially recruiting him to do.”

“That makes sense, Doc. The patients are the ones who have legal access to these drugs and need to have some role in the overall process.”

“It’s also important to mention that Ekaterina had offered to pick up Mrs. Arthur’s pain medication prescription for her. And, as I mentioned, Mrs. Arthur complained that her pain medications weren’t working once she began working with Ekaterina. In that case, I don’t think she recruited Mrs. Arthur but she may be using her to gain access to her legitimate prescriptions.”

“The instances that you described would give Ekaterina access to the prescription medication drugs and if she is substituting over-the-counter analgesics, she would then have the prescription drugs to do with as she pleases.”

“Let me summarize, said Isabella. It sounds like we’ve identified a potential source of the drugs as well as a very clever way to obtain them from patients without their knowledge.   I suspect Mrs. Arthur is an unwilling participants but it is still not clear to me what role Mr. Johnson’s playing.”

“It is obvious, at least to me, that he is involved and is somehow being manipulated by Ekaterina’s wiles.”

“I think we have a good place to start, said Garcia. If it is 0K with everyone, let’s meet back here next Monday morning and review the situation and decide on how to proceed. I appreciate your raising the red flag, Doc, and I appreciate your full cooperation, Isabella.”

“As I said, I will not tolerate any kind of suspicious, much less illegal, activity in this facility.”

As they all got up to leave, Isabella asked Dudley to remain. “I am still a little upset that you didn’t tell me about this situation sooner. I assume you have your reasons. I understand you were hesitant to say anything and accuse people of a potentially very serious crime. Remember, you were the one who said we don’t need any more Millicent Branches at this facility!”

“I appreciate your understanding, Isabella. You are correct. I had to observe several instances before I decided to act and even then it was difficult for me.”

“Even though Garcia suggested that you stay in the background as this investigation proceeds, I still want you involved in all future discussions with him or any other authorities involved. I know you share my commitment to this facility and its residents and would do everything to protect its integrity.”

The following Monday morning, Lt. Garcia, Isabella Duncan and Matthew Dudley met in her office to review what they had learned. Isabella began by summarizing the conversations that she had with two other executive directors.   “Each of them has one physical therapist that came highly recommended through Dr. Malinikov’s office, one young man and one young woman. Both seem competent and well liked by the residents and neither of them is using this idea of a special shake drink to facilitate taking the pain medication. There was, however, some concern expressed by some residents that their rehabilitation wasn’t progressing very rapidly and that the level pain they were experiencing seemed to be intermittent. There was no evidence that they were not receiving pain medication, or at least what they were told was prescription painkillers.”

“I’ve been able to do some background checking on this Dr. Malinikov, said Garcia. He joined the Sierra Vista Orthopedics Group within the past year. There are no complaints filed with the State Medical Board and he seems to have steadily increased his practice. He also has begun delivering guest lectures at the local junior college to physical therapy and healthcare aide students.”

“I’ve also talked to my colleagues on the drug enforcement side and there seems to be an increasing amount of drug overdoses related to prescription pain medication in some of the more well-to-do parts of Albuquerque. I don’t know if these events or are connected but I thought it was worth mentioning this bit of information.”

“Have you given any more thought to some sort of undercover or sting operation?” asked Dudley.

“We have. We’ve arranged for two people to be placed in two separate rehabilitation facilities. One is an officer who had recently had major knee surgery and the other is an administrative person who suffers from chronic back pain. I decided that it would not be appropriate to have either of these people at this facility.”

“I had a meeting with my counterpart in drug enforcement to talk about possible ways that this entire operation might be set up and alternative ways for the prescription meds to flow from a legitimate source to the street market. He told me that it is typically necessary to provide some mechanism so that the legitimate owner of the prescription can be deceived. He described some cases where older people have simply not been given their medication and it was stolen by a friend or relative using the excuse of picking up the prescription for the older persons to have. He also described situations where some sort of sugar pill or substitute was provided in lieu of the prescription painkiller. His final comment was that the people who are participating in this area illegally had become increasingly creative as these opioids have become the “drug of choice” in certain parts of the city.”

“This entire area is new to me, said Doc. But I can certainly see how those techniques could be employed just based on what I’ve seen with the two instances of Horace Johnson and Martha Arthur.”

“I think we can learn from what we’ve seen in the past few days, said Garcia and I will be responsible for the next series of actions. While I realize this is primarily a police matter, I will report back to you as soon as we have further information and before we take any action that involves this facility.”

“Thank you very much, Lt. Garcia. Please let me know if there is anything that Doc or I can do to expedite this process. I know you must move cautiously but I remain concerned about the health and well being of our residents and other elderly citizens and facilities throughout the city.”

 

Case II: Chapter 12: The Trap is Set and Sprung

Several weeks later, Dudley was on the third floor of the main building repairing a faulty light fixture. He glanced out the window and saw Lt. Garcia drive into the parking lot followed by three more Albuquerque police vehicles. Isabella had not mentioned anything about a meeting with Garcia and he was confident that she would have alerted him. Dudley finished his repair job, left the apartment unit and hurried to a window at the end of the hallway where he could observe the parking lot. A few moments later, Garcia came back into view and he was leading Horace Johnson to a waiting police van in handcuffs.

Dudley quickly went downstairs to locate Isabella Duncan. He approached her in the hallway and was about to speak when she put her finger to her lips and motioned for him to follow her into her office. Once inside, she closed the door behind them.

“Garcia called less than twenty minutes ago and I could not locate you to alert you. His team has made considerable progress in the last few weeks and they think they have figured most everything out. Their strategy is to pressure Horace Johnson into providing some key information that would confirm their major conclusions. They assume that Johnson’s very public arrest will cause their primary suspects to take precipitous action and they’re waiting to spring several traps. That’s all he told me this morning. He promised to give us both a full report once they’ve completed the remainder of their arrests.”

“So, my suspicions about Johnson proved to be correct?”

“I presume so, but Garcia did say that he was a minor player. They are just using his arrest to shake the major players into action.”

“I guess I can wait to hear the full story. I will go back to my ToDo List and try to keep my mind occupied until we hear from him. I do plan to continue my exercises and will try to avoid any contact with Ekaterina Bubolsky.”

“That would be wise. I’ll call you as soon as I hear from Garcia.”

Things were relatively quiet for Matthew Dudley for the next several weeks. He fell into a routine of daily exercise followed by various repair jobs throughout the La Vida Aureo complex. The only change he noticed was that Ekaterina Bubolsky was absent from the physical therapy facilities.   He asked Hans if he knew anything and he had replied, “She called in sick one morning about a month ago and hasn’t been here since.”

Isabella stopped Dudley in the hallway one afternoon and told him that Lt. Garcia would be in her office at 4:00 o’clock that afternoon to give them both a “full report” of the results of the police investigation.

Garcia opened the meeting by saying, “Well, Doc, we want to thank you once again for alerting the police to a rather nasty situation developing right under our noses. As it turns out, there were several prescription pain medication scams operating throughout the City, essentially all connected with legitimate healthcare programs at retirement facilities and particularly at nursing homes. Let me try to summarize what we learned through our investigation and undercover operations.”

“There were a variety of schemes designed to basically “intercept” prescription pain medications as they made their way from the pharmacy to the consumer patient. These opioid-type drugs were then sold through other channels to the street market, primarily to young adults in some of Albuquerque’s better neighborhoods.”

“The overall operation was initially conceived and directed by Dr. Egon Malinikov at the Sierra Vista Orthopedic Surgery Center. He recruited a number of physical therapists whose job it was to basically steal the drugs from unsuspecting patients. Many of those were Dr. Malinikov’s hip and knee replacement surgery patients, such as your own Horace Johnson. There were also many people like your Mrs. Arthur who were simply tricked into handing over their prescriptions to one of Malinikov’s operatives. This was particularly happening at nursing homes and some senior centers.”

“There were numerous drug substitution schemes involved. Typically, the patient’s real prescription drugs were replaced with a simple sugar pill or, in some cases, an actual pain medication from some off-brand foreign source. The protein shake or smoothie substitution scheme used by your Ms. Bubosky was particularly ingenious. She replaced the prescription medication with over the counter analgesics like aspirin and/or acetaminophen and disguised everything in a tasty drink. Her technique was more effective than many others because she included analgesics which provided some measure of pain relief. Several other physical therapists in this criminal network had adopted her technique.”

“We also discovered several instances of direct theft or fraud. A few of the more enterprising individuals set up “pyramid schemes” on their own. They used nurses’ aides and other lower-paid individuals to directly steal prescription medications from unsuspecting people, typically older citizens. It was a variation of the tactic used on Mrs. Arthur. The aide would offer to pick up a prescription and then pocket a portion of the pills. If the person questioned the aide, they were provided a tragic story about why the pills were stolen. The most common story we heard was that the aide’s brother was a veteran and could not get his medication through the VA. Another version was that the aide’s mother had cancer and could not afford pain medication. By playing on the elder person’s sympathy, the aide was able to steal a portion of the prescription, sometimes repeatedly.”

“What about Horace Johnson, asked Dudley. How did he fit into the scheme of things? He didn’t strike me as the criminal type, just an easy mark for Ekaterina.”

“Poor Horace, laughed Garcia. He had been recruited by Ekaterina to “churn” his prescriptions. His role was to have Dr. Malinikov write an excessive number of prescriptions for him and then turn the drugs over to Ekaterina when he came here for physical therapy. As you related to me, she used her rather provocative Betty Boop personality to “encourage” him to do her bidding. It did not take much persuading by the police for him to tell us what was going on, at least the part he was aware of. He’ll probably avoid jail and just get off with some probation for helping us break the case.”

“By telling me about Johnson’s comments to you, Doc, you alerted us to another potential criminal activity. Johnson implied that Ekaterina was using sex to encourage him to have his other knee replaced so that he could continue to visit her for what he called “her special massage therapy”. Apparently, Ekaterina was paid a “bounty” for recruiting patients for Dr. Malinikov. If we can substantiate this, there will be additional charges against him”

“The turning point in our investigation was the decision to “follow the money”. Dr. Malinikov only took a portion of the final drug sales. His primary motivation was the money he was paid by the insurance companies for the actual operations. By focusing on people like Horace Johnson with so-called Cadillac insurance plans, he was able to supplement an already lucrative practice. His justification was that the reimbursements were being reduced so he decided to perform more surgeries to compensate. His attitude concerning the excessive amount of drug prescriptions was that he was doing the patients a favor and simply fulfilling their request. Unfortunately, none of those actions are illegal, just unethical. But, receiving a “kick-back” from the drug sales provided sufficient evidence to arrest him. He may get off, but we’ve also contacted the State Medical Board and he will probably lose his license to practice.”

“Essentially everyone else involved faces criminal charges for drug distribution and/or drug sales. We’re encouraging the District Attorney to seek significant fines and jail sentences to send a signal to others who might consider this activity.”

“Anyway, it appears that we’ve completely shut down this specific operation and arrested the major players. One of the more disturbing things we learned, however, is that too many doctors are far too willing to recommend surgery as well as write prescriptions for these very powerful and highly addictive opioid-based pain medications. ”

“This investigation has opened our eyes to the growing problem with these “legal drugs” and we are currently revising our approach. In the past, we have had our hands full with drugs like cocaine and methamphetamines, etc. because these were always connected with the gangs and criminal elements in the metro area. But these prescription medications are obviously a much more serious problem than we suspected and potentially as damaging to the City and its citizens. Personally, I suspect that what we’ve uncovered with this one doctor and his operation is only the “tip of the iceberg” so to speak. I will push to dig deeper into this as quickly as possible.”

“Hopefully, our actions were able to essentially stop a potential problem here at La Vida Aureo before it got out of hand, offered Isabella.   But, we must remain alert going forward as long as we continue to operate a physical therapy section. We certainly appreciate your prompt action, Lieutenant. Is there anything we can do to support you and the police?”

“Yes. The information you provided from your colleagues at other facilities was very helpful. I would ask you to continue your dialog with them and expand this network to as many other facilities and organizations as possible. This experience has shown us that the elderly population is particularly vulnerable to these scams and we need to support them as much as possible. I am convinced that information and education are key elements to being successful and I am convinced this problem will continue to grow.”

Lieutenant Garcia stood and thanked Isabella and Dudley once again as he left. “I will try to stop by periodically. Maybe we can have any future meetings in your dining room. That would give me an opportunity to pay my respects to Señora Angostura.”

“You are welcome any time, Lieutenant.”

 

Case II: Chapter 13: Wrap Up

Isabella Duncan and Matthew Dudley sat in her office for what seemed like a very long time after Lieutenant Garcia left, neither saying a word. Finally, Isabella spoke. “Thank you for spotting this situation before it got much worse. You know, Doc, I would have never expected something like this to happen here at La Vida Aureo. Maybe I’ve been too naïve. Growing up here, I was aware of the gangs and drugs in Albuquerque, but thought this place was immune to those kinds of things. I refuse to be afraid or paranoid, but we must remain alert, like Garcia said.”

“Isabella, I too am shocked. I believe that in my role as Handyman, I can move freely around the entire complex and will be more observant in the future.” Then, trying to lighten the mood, Dudley said, “I promise I’ll try to not become another Millicent Branch and see crime and mayhem in everything! I just hope we can put this kind of thing behind us and get back to providing the level of service and care our residents deserve.”

“Lt. Garcia mentioned one thing that I think deserves a suggestion, if I might. I know that these aide positions are not very well paying and that turnover can be a problem. If that makes these young people particularly vulnerable to a “get-rich-quick” scheme like he described, we should try to deal with it to decrease that risk. I obviously don’t know the details, but it might be worthwhile to review the pay scale and overall approach for this group. If we paid them a bit more up front and provided more training and supervision and more frequent reviews, we might be able to develop a higher level of competence as well as loyalty. That would benefit La Vida Aureo and our residents and guests.”

“That makes a lot of sense, Doc. Anything we can do to enhance our reputation would benefit everyone. I’ll look into the situation as soon as possible. Thank you.”

As they parted to resume their respective duties and responsibilities, they were both hopeful that things would run smoothly and that there would not be any major incidents, at least for a while.

Lt. Garcia, on the other hand, had begun to realize that La Vida Aureo was like a small town in many ways. It was comprised of individuals and there would always be competitions, petty jealousies and other typical personal emotions and these invariably led to conflict and trouble.