The Pill Mill That Ravaged Portsmouth

The apartment was on the first floor of a house on Center Street, a sleepy, brick-paved block in Portsmouth, Ohio—the once-booming industrial town on the southern edge of the state Along the banks of Ohio River. There was no prominent sign to indicate that it was a doctor’s office, and there were no other businesses on the street. It was a plain, two-story building with a gray shingle roof and the numbers 1310 stenciled on the steps leading up to the front door. This was where Paul Volkman, M.D., operated.

Like the other pain clinics in Portsmouth where Volkman had worked, the clinic only accepted cash—no insurance, no Medicaid. In exchange for $150, patients could expect to receive high doses of pain medications, anti-anxiety agents, and muscle relaxers. In September 2005, according to a search warrant, one Portsmouth Police informant stopped in to see Volkman and received prescriptions for 180 oxycodone pills, 180 Lorcet (a hydrocodone-based painkiller) pills, 120 Soma (a muscle relaxer) pills, and 90 Xanax. Two days later, another informant received a prescription for 270 oxycodone pills, 270 Percocet, 120 Somas, and 60 Xanax. Volkman’s clinics brought in thousands of dollars in cash and pumped out thousands of pills in a region that was already being described in the Portsmouth Daily Times as “The OxyContin Capital of the World.”

All told, Volkman spent nearly three years working in southern Ohio, and his four offices—three in Portsmouth, one in Chillicothe—stood out, despite their plain exteriors. The buildings were patrolled by armed guards and some were monitored by video cameras; numerous local pharmacies refused to fill the prescriptions Volkman wrote from inside them; and local and federal law enforcement received a steady stream of complaints. A prosecutor described the scene at one clinic as “like a Led Zeppelin concert: six to ten cars waiting at 6 a.m.” On Center Street, traffic jumped noticeably during Volkman’s office hours, with some cars bearing license plates from Kentucky and West Virginia. A neighbor I spoke to remembered seeing a minivan filled with people waiting to see the doctor; one of them was knitting. Other days, she said, visitors with slurred speech mistakenly rang her doorbell in the early hours of the morning looking for the doctor, or left fast-food wrappers on her lawn. She remembers seeing an armed man patrolling the premises next door.

Inside the house, Volkman saw patients in one of the bedrooms. The living room and backyard served as waiting areas while patient files were kept in filing cabinets in the kitchen. According to law enforcement documents, two patients died within days of receiving prescriptions written at the house. One, a 30-year-old who had seen Volkman at least five times before, succumbed to what a coroner described as “multiple drug intoxication.” Another, a 39-year-old man, died from “acute multiple drug intoxication (oxycodone and others),” according to his death certificate.

The apparent danger of the house on Center Street did not go unnoticed. During Volkman’s 2011 criminal trial in federal court in Cincinnati, Diana Colley testified about the day she drove to the house to plead with the doctor to stop prescribing pills to her son, a recovering addict who had recently relapsed. She described how she interrupted a visit with a different patient to tell Volkman that her son was an addict. When Volkman told her that he would take it under consideration, she told him “that if he wrote another prescription in…my son’s name, I had a .38 that would convince him not to.”

Tales of corrupt doctors are, unfortunately, nothing new in Ohio or the nation. But even on a long list of such illicit operations, the Volkman case stands out. Between 2003 and 2005, while playing the role of both doctor and pharmacist, he led the nation in purchasing and dispensing the opioid painkiller oxycodone, and a jury would later find him responsible for the overdose deaths of four of his patients. In 2012, he received one of the longest sentences for prescription drug-dealing in American history: four consecutive life terms.

Photograph source: Boone County Jail

Volkman, meanwhile, believes unequivocally in his innocence. One of his lawyers once described him as an “accomplished, experienced, competent physician working in a rural, under-served area trying to help manage the pain of his patients.” And at his 2012 sentencing hearing in Cincinnati, he told the courtroom that he had no regrets about his actions and no apologies to make. Wearing a prison jumpsuit, he directly addressed U.S. District Court Judge Sandra Beckwith when he said, “In sentencing an innocent man to death in jail, you are revealed as the heinous criminal in this courtroom.”

Today, more than a decade after Volkman’s last clinic closed, Ohio’s opiate crisis rages on, with heroin and other opioid derivatives taking center stage. (The state continues to lead the nation in overdose deaths, with at least 4,149 fatalities—including one out of every nine heroin overdose deaths in the country—in 2016, according to a survey conducted by the Columbus Dispatch.) Though the reasons for the epidemic are varied and complicated, there’s little doubt that high-volume “pill mill” prescribers played a major role in spreading the problem. Shawn Ryan, M.D., president of the Ohio Society of Addiction Medicine, says that one of the key triggers of addiction is exposure to the addictive substance, and these clinics “fulfill[ed] that critical component of addiction…en masse.” Prosecutors, meanwhile, have said that in southern Ohio the Volkman operation was “one of the clinics that showed the other clinics how to start.”

According to one DEA official, Volkman was “as bad as any doctor in the country.” His story, and those of other pain clinics, stand as the prologue to a public health disaster.

Paul Volkman grew up in a working-class Jewish household in Washington, D.C., the son of a pharmacist and a clerk at the U.S. Treasury Department. After being named valedictorian of his high school class, he attended the University of Rochester on a partial scholarship. There, Volkman was a model student who sang in a choir and participated in the chess club. After graduating with honors in 1968, he enrolled in a new, federally-funded M.D./Ph.D. program at the University of Chicago called the Medical Scientist Training Program.

“I honestly thought that one day I would pick up the newspaper and see that Paul had been given the Nobel Prize in Medicine.”

Friends and acquaintances from this time describe Volkman as a chubby, slightly disheveled guy who liked to play bridge and listen to classical music. While painfully shy around women, he had a wry sense of humor, a fierce intelligence, and a strong work ethic. “I honestly thought that one day I would pick up the newspaper and see that Paul had been given the Nobel Prize in Medicine,” a former roommate says.

For his doctorate, Volkman’s chosen area of focus was pharmacology—the study of medications and their effect on the body. Yet after receiving his M.D. in 1974, he pivoted from pharmacology to pediatrics, a move that befuddled some classmates. He wasn’t exactly a warm and fuzzy personality, for one thing, and pediatrics didn’t match his previous area of focus. One classmate told me it was like “being a world-class downhill skier and decid[ing] that you’re going to do figure skating.”

He made the shift, nonetheless—“I like kids,” Volkman once told me—and after he completed an internship at Duke University, he and his wife, Nancy, returned to Chicago, where he opened a pediatrics and family medicine office on the city’s South Side. That work was never as lucrative as he had hoped, though, so he had to moonlight in local emergency rooms for extra income. Eventually, he found that he could earn a better wage in small-town hospital emergency rooms, where doctors were in higher demand. In the medical profession, these kinds of jobs are called locum tenens work. So he started traveling around the region, taking temporary gigs in towns like Ft. Wayne, Milwaukee, and Decatur.

Life as a traveling temporary ER physician would be the closest thing Volkman found to a professional niche. He never landed a secure academic position or joined a larger medical practice, where he would have worked in tandem with other doctors. The portion of his C.V. titled “Hospital Experience as Attending Emergency Physician” lists jobs at 10 hospitals between 1975 and 2002, and an unspecified number of locum tenens positions from 1992 to 1995 and 1998 to 2000. Over time, Volkman obtained medical licenses in at least six different states, including Ohio.

Volkman might have kept going with that kind of work until retirement age, but during his years shuttling from job to job between the 1980s and early 2000s, he was the subject of four malpractice lawsuits. In one case, a young man who had been in a bar fight wound up having a serious internal injury that led to lasting brain damage after receiving treatment from Volkman. His family blamed Volkman for the fact that the injury hadn’t been more quickly diagnosed. (Volkman insisted the man was uncooperative and refused the necessary testing and examination that would have diagnosed the injury.) In another case, Volkman was named in a lawsuit when a baby stopped breathing in his office waiting room in Chicago and a key piece of equipment used by emergency personnel ran out batteries. In a third case, an elderly woman was injured after pulling out a feeding tube attached to her stomach; Volkman had been the one to previously insert the feeding tube. Two of these cases resulted in judgments against Volkman, and two others resulted in settlements by his insurance companies.

It is difficult to track down the records from these lawsuits—and the parties involved—to get a clear sense of what happened and the extent of Volkman’s culpability. However, Volkman insists they were either the result of unscrupulous lawyers, wrong-place-wrong-time bad luck, or the skewed number of frivolous lawsuits targeting ER doctors. “The risk of such settlements often induces insurance companies to settle claims without trial, regardless of a lack of evidence or wrongdoing on the part of the insured doctor, usually without his consent,” he wrote to me from prison.

Whatever the particulars, one thing is certain: By the early 2000s, Volkman, then in his mid-50s, was unable to obtain malpractice insurance. And with a $4,000-per-month apartment on Chicago’s Lakeshore Drive and a wife who worked as a public school librarian, he needed to make another career shift.

Volkman typed up a lengthy narrative about his life and career in 2014 via a series of e-mails that he sent me. Of this fateful career juncture in the early 2000s, he wrote (in the third person) that he found himself “quite unable to get any employment in Chicago in any kind of doctor job, since even ghetto Medicaid storefront clinics required malpractice coverage for night hospital coverage. After a maximum six months of unemployment compensation, and brief stints chopping vegetables in restaurant kitchens, Dr. V responded to an internet ad for a pain management clinic in Portsmouth, Ohio.”

The clinic was called Tri-State Healthcare and the starting salary was $5,000 per week. No malpractice insurance was required. Volkman got the job.

The advent of pill mills is credited to a man named David Procter. A flamboyant, diamond-and-fur-wearing Canadian ex-pat, Procter practiced across the river from Portsmouth in South Shore, Kentucky, and his cash-only, heavy-prescription model would become infamous. “Procter’s business model spread like a virus, unleashing unstable doctors on a vulnerable region,” writes Sam Quinones, author of the award-winning book Dreamland: The True Tale of America’s Opiate Epidemic.

Many of the clinics that followed Procter’s example displayed the kinds of operating procedures described in a 2012 article on pill mills in Kentucky Law Enforcement magazine: “No physical exams are given; only cash is accepted as payment; excessive traffic to and from the doctor’s office; complaints from pharmacists about doctor’s practices; large cash deposits at the bank; [and] patients are in and out of the doctor’s office in minutes.” Volkman’s gig in Portsmouth checked a number of those boxes.

Tri-State Healthcare, which hired Volkman in 2003, was run by Denise Huffman, who had started the clinic two years earlier in South Shore, Kentucky. Huffman had no formal medical education and an employment history that included working in shoelace factories and fast food restaurants. Her experience with chronic pain treatment came primarily as a patient. In a 2006 deposition, Huffman said she “felt it was a good business that’s needed for the area.” Her daughter, Alice, who also lacked medical training, helped with the clinic’s day-to-day operations.

Prior to Paul Volkman’s arrival, the Huffmans had hired a string of temporary doctors through locum tenens staffing companies; none had lasted. But something clicked between the Huffmans and Volkman, and in April 2003 he began a weekly routine of flying from Chicago to Columbus on Mondays and driving two hours south to Portsmouth. On Fridays, after his work-week in Appalachia, he would go back to his life 400 miles away.

The Huffmans’ medical inexperience and Volkman’s commute were not the only unusual aspects of Tri-State Healthcare. It was a cash-only establishment, with the cost for one appointment reportedly ranging from $125 to $200. (Third party payments were an “endless hassle,” Volkman told me in a 2010 interview.) It was not affiliated with any of the local hospitals and maintained security measures you might expect more from a bank than a medical office. “As far as security, we have three to four large armed men in the clinic, and video and infrared cameras all about the building,” Volkman wrote in an e-mail at the time to a fellow pain doctor.

In a separate e-mail that was later introduced as evidence in his trial, he described the clinic’s clientele: “We have about 700 patients most of whom are mine workers, pipe fitters, construction workers, truck drivers, carpet layers, who have been ruined by years of hard work and various wrecks, but who eagerly return to working 60 to 80 hours a week when given enough pain medicine so they can walk.”

Volkman claims that he followed appropriate medical procedures while working at Tri-State, including conducting physical exams, evaluating patient complaints, and reviewing medical records. He would later describe himself as a “law abiding, responsible physician and family man with no previous history of violations of law and no history of any actions against him by any state medical board.” In fact, complaints were made against him almost immediately after he started working in Portsmouth.

In June 2003, a DEA diversion investigator in Columbus received a tip from a pharmacist in Kenova, West Virginia, about the amounts of Lorcet, Soma, Xanax, Lortab, and OxyContin Volkman was prescribing. Over the next 21 months, DEA offices in Louisville, Columbus, and Cincinnati received 10 similar complaints from other pharmacies. “Everybody got the same excessive quantities,” recalled one Kentucky pharmacist at the trial, while explaining why he quickly refused to fill Volkman’s prescriptions.

Rebuffed by pharmacies, Volkman and the Huffmans began distributing the pills themselves, becoming equal parts clinic and pharmacy. (On-site dispensaries were legal at the time in Ohio, provided that an on-site doctor kept a close eye on operations.) This new business model proved profitable; the DEA estimates that between April 2003 and September 2005, Tri-State raked in over $3 million from cash payments for office visits and dispensary sales. But it also attracted unwanted attention.

In August 2003, a medical supply company notified the DEA in Ft. Worth, Texas, that Volkman had recently placed the largest order for the opiate hydrocodone the company had ever seen. That same month, another medical supplier in Connecticut notified the DEA that it had received an order for hydrocodone that exceeded the company’s limits for ordering. According to the DEA, in 2004, Volkman, acting as a practitioner purchaser, ordered 457,100 dosage units of oxycodone, 106,100 more than the next closest doctor in the United States. His orders accounted for 96 percent of all the oxycodone sold directly to practitioners in Ohio that year and were 97 times greater than the national average. Some of his prescriptions called for patients to take 30 pills each day. The DEA further found that between June 2003 and October 2005, there were 11 overdose deaths in Kentucky and Ohio that appeared to be linked to Volkman prescriptions. Ten of those overdose victims were under 40 years old.

Despite the complaints, unprecedented pill orders, a DEA raid, and patient deaths, Volkman continued to see patients at Tri-State Healthcare for nearly two and a half years. After a falling out with the Huffmans in September 2005, he began writing prescriptions in his Center Street apartment for three weeks until a police raid shut him down. Undeterred, he opened another office 40 miles north of Portsmouth in a double-wide trailer beside Route 23 on the outskirts of Chillicothe. A sign advertised to passing drivers: “Paul H. Volkman, M.D. PAIN MANAGEMENT.” One former employee told the DEA that he believed Volkman took in $9,000 in cash on the Chillicothe clinic’s first day of operation. In December 2005, a DEA agent surveilled the trailer office for four and a half hours in the middle of the day and saw approximately 25 patients walk in. He noted cars parked from eastern Kentucky and one from 100 miles away, in Nitro, West Virginia. According to the employee, some days Volkman would see patients as early as 7 a.m.; others, as late as 2 a.m.

Stoney Carver watched his wife die from an overdose of pills she had been prescribed by Volkman, yet he still continued to go to the doctor. His reason was simple: “I was hooked on drugs.”

The way Volkman tells it, his practice was a win-win for all parties. He says he felt he was “serving a desperately poor…underserved part of the population, giving them very good service, and making a very good living at the same time.” In a document submitted before his sentencing, he scoffed at any notion of himself as a drug dealer.

“A drug dealer obviously sells drugs to anyone with money for his drugs,” he wrote. “He has no regard for the health and safety and well-being of his customers. He does not have an office listed in the phone book with a secretary and nurses. He does not make appointments. He does not give receipts to his customers for cash received. He does not do physical exams to determine the need of his customers for drugs. He does not obtain records of prior medical treatment of his customers. The drug dealer would not think of performing pill counts or give drug screens to ensure that his customers are consuming their drugs in a safe manner and not reselling them. The drug dealer will not dismiss paying customers from his business. The drug dealer does not refer his customers to medical consultants. The drug dealer does not instruct office staff to fill out insurance and disability forms for customers.”

When patients died, Volkman told me in 2009, it was due to illnesses that brought them to the clinic in the first place, like heart disease or complications from obesity. Another explanation, he claims, is that they died as a result of using the medications in ways other than they were prescribed, or because they didn’t tell him about other drugs they were using. Volkman has said that suicide risk among pain patients is “way, way higher than the general population” and “there were three [patients] who I know of who committed suicide.”

Many of his patients and their families, meanwhile, saw Volkman as a drug dealer. Diana Coffee McCabe’s brother Danny was one of those patients. McCabe remembers him as a brown-eyed boy who played baseball with her as a child. He grew up to be a handsome, dark-eyed man who loved his mother’s chili and listening to the Eagles. He tried desperately to kick his pill addiction, but he never could, she says. He cashed in his retirement savings and sold his car to pay to see Volkman. She was at work at the Greenup County School Board in November 2003 when she got the call from her father that Danny had died. The superintendent drove her to her parents’ house, where Danny, a retired public school janitor, had been living. When she got out of the car, she could hear her mother wailing.

Steven Heineman was 33 years old when he died on April 20, 2005, from what his death certificate described as “Acute combined effects of Oxycodone, Diazepam, and Alprazolam.” At Volkman’s trial, Steven’s mother Paula Eastley testified that he struggled with “serious drug problems,” and that he had previously attempted suicide. Eastley said she had personally spoken with Volkman and asked him to stop prescribing to her son, but Volkman and his staff had brushed her off. “Dr. Volkman flew back and forth from Chicago each week for the sole purpose of writing mind-boggling amounts of [prescriptions for] narcotics and Xanax to drug addicts in exchange for cash,” she said at his sentencing. “He ruined and crushed many mothers’ hopes and dreams. He extinguished aspirations of fathers for their sons and their daughters. He ruined happy families.”

Stoney Carver, a former Volkman patient (and widower of another former patient, Mary Catherine Carver), testified at Volkman’s trial that even after he watched his wife die from an overdose of pills she had been prescribed by Volkman, he still continued to go to the doctor. His reason was simple: “I was hooked on drugs,” he told the courtroom.

In February 2006—nearly three years after Volkman began working in southern Ohio—authorities raided Volkman’s trailer in Chillicothe. A few days later, the DEA revoked the registration that allowed him to prescribe controlled substances. Over the ensuing months, he fought the DEA in court for the reinstatement of that registration, but was denied. Instead, on May 21, 2007, around 7:30 a.m, Volkman heard a loud knock on the door of his Chicago apartment. Waiting for him on the other side of the door was what he would later describe in a 2009 interview as “a SWAT team of about 16 DEA agents wearing flak jackets and masks, [with] guns drawn.”

Volkman was arrested and arraigned on 22 federal counts and temporarily imprisoned in downtown Chicago. (He was eventually released and spent most of the next four years awaiting trial as a free man.) After a 10-week trial in Cincinnati in 2011, a jury convicted him on 18 counts, including one count of firearm possession in furtherance of a drug-trafficking crime, four counts of maintaining a drug involved premises, eight counts of unlawful distribution of controlled substances, and four counts of causing the death of another by unlawful distribution.

Nine years passed between Volkman’s first prescription in Ohio and his sentencing in 2012. In that time, the regional prescription drug problem transitioned into a full-blown national crisis, with Portsmouth as its symbolic epicenter.

In 2010, an Associated Press article reported that nearly one in 10 babies were born addicted to drugs in Scioto County. In 2011, the town was featured on The Dr. Oz Show with the heading “A Town Addicted to Pain Killers.” By the time the Volkman trial began on March 1, 2011, the Scioto County Board of Health had declared a public health emergency. Around that time, Portsmouth Health Department public health nurse Lisa Roberts told a crowd of police officers and detectives, “I think it’s the first time, probably ever, in the history of the world that a public health emergency has been declared by a doctor as a result of something that other doctors are doing.”

Few people know the history and extent of Scioto County’s drug problems as well as Roberts. She describes the area as being hit by a “pharmaceutical atomic bomb” over the last 20 years, with “several hundred” overdose deaths and at least 10 doctors or clinic owners convicted of illegal prescription drug diversion. According to Roberts, Volkman helped “set the stage for this epidemic that we found ourselves in.” She sees him as a link in a chain of corrupt physicians who together represent an era when Scioto County became “a dumping ground for every crazy, disgraced doctor that couldn’t make an honorable living being a doctor anymore and came here and just wrote prescriptions for narcotics.”

Portsmouth’s acute devastation is a result of a mix of factors, Roberts says. When pills hit the scene, many in this impoverished region were ready to embrace an underground economy—obtaining pills at pain clinics, then selling them at a premium on the street—that provided a much-needed source of income. Due to the town’s location near the convergence of three states, it was easy for prescriptions to slip through cracks in prescription monitoring programs and difficult for law enforcement to investigate and prosecute doctors across state lines and in other jurisdictions. Add highly-addictive, heavily marketed opiates like OxyContin to the mix, and sophisticated distributors like Procter and his criminal progeny, and you’ve got what Sam Quinones refers to in Dreamland as “the town that led the country into the opiate epidemic, ground zero in the pill mill explosion.” At one point, there were more than a half-dozen pain clinics in operation for a county with a little over 75,000 people. With the help of Ohio House Bill 93, the anti-pill mill legislation signed by Governor John Kasich, the last clinic was closed in December 2011.

Today, the area remains in a public health crisis due to heroin, fentanyl, and carfentanil—opiates that offer a more powerful and cheaper fix for addicts who can no longer afford pills. Still, closing the pill mills has brought some signs of hope. Teen use of prescription pills in Scioto County is now lower than the national average. Hepatitis C rates (which correlate strongly with intravenous drug use) have dropped 40 percent. According to Roberts, the county saw an immediate drop in overdose deaths when the last local pain clinics closed. This, she adds, is not a coincidence: “Fatal overdoses and pain-pill distribution rates follow the same trajectory.”

The recovery process is still ongoing, but Roberts says that after years of infamy Portsmouth is becoming known for something other than pills, overdoses, and addiction. “I think we’re also famous for being the town that just said, ‘Hell, no! You people can’t just come down here and poison us like this!’”

Since the pill mills have closed in Portsmouth, the town’s public health focus has largely shifted from pills to heroin, a by-product of the rampant opioid distribution in the area. On March 25, hundreds of residents walked through the city streets, past houses and factory buildings, as part of a March Against Heroin. Some wore shirts that read “High on Hope” or “Recovery Mafia.” Others carried photos of loved ones lost to drugs, or signs like the one that read “In Memory of Kellie Watters.” The procession featured a fire truck, as well as a modified hearse with a red spinning police light on top and the words “HEROIN KILLS. IS THIS YOUR LAST RIDE?” painted on its rear door.

Volkman seemed to relish Judge Beckwith describing him as “dangerous.” “She called me ‘dangerous’ the way Martin Luther was ‘dangerous’ to the Pope.”

Paul Volkman is Federal Inmate Number 19319-424 at the Coleman United States Penitentiary, 50 miles northwest of Orlando. He is 70 now, and is almost certain to remain there for the rest of his life. The Sixth Circuit Court of Appeals has now rejected his appeals twice and it would take some kind of legal miracle to overturn his four life sentences. That hasn’t stopped him from espousing his purported innocence. “My case makes it starkly clear that this government is perfectly willing to jail innocent pain doctors who have little hope of relief from a corrupt Department of ‘Justice’ and politically motivated federal judges, while huge numbers of citizens suffer needlessly,” he wrote in a letter to friends last September.

Volkman is now part of a legacy of corrupt doctors that swooped in to southern Ohio, profited through pill mills, and ended up in prison. That includes physicians like David Procter, who pioneered the business model; John Lilly, a Princeton- and University of Cincinnati–educated former surgeon who pled guilty to corrupt activity; and dozens more both in the region and across the country. Some have served their time in relative silence, others have vocally opposed court rulings. Few have been as bombastic as Volkman in their own self-defense.

In a letter he sent to friends after his sentencing, he seemed to relish Judge Beckwith describing him as “dangerous.” “Whether she realized it or not,” Volkman wrote, “she called me ‘dangerous’ the way Martin Luther was ‘dangerous’ to the Pope, the way Thomas More was ‘dangerous’ to Henry VIII, the way Thomas Jefferson was ‘dangerous’ to George V, the way good, principled, honest, courageous, outspoken men are always ‘dangerous’ to cruel, evil, corrupt, petty tyrants.”

It wasn’t just the doctor who wound up facing punishment, either. Denise Huffman, the owner, operator, and founder of Tri-State Healthcare remains in federal prison with a scheduled release in September 2020. Her daughter Alice pled guilty to operating and maintaining a drug involved premises in 2011 and testified at Volkman’s trial; she was sentenced to five years in prison and released in 2016. Harold Eugene Fletcher, a Columbus pharmacist who filled a number of Volkman’s prescriptions, received a two-year sentence for distributing oxycodone and filing false tax returns, and a lifetime ban from working as a pharmacist.

Meanwhile, the Volkman case has become a study in illegal prescription drug diversion. One of the lead DEA agents on the case delivered a slideshow titled “Pill Mills & Pain Clinics: United States v. Volkman” at the National Conference on Pharmaceutical and Chemical Diversion in Cincinnati in 2012. Slides from the presentation include a photograph of a safe filled with hastily-piled cash and copies of a signed patient waiver that Volkman used in an attempt to shield himself from law enforcement. It read, in part, “I am not appearing to seek care from Paul H. Volkman, M.D., Ph.D. as part of an ongoing investigation of Paul H. Volkman, M.D., Ph.D.”

For the families of Volkman’s patients, the fallout from his pain clinics continues. Thirteen years later, Diana Coffee McCabe vividly remembers the day her brother died; she couldn’t stand up straight. “I mean, my stomach physically hurt like I had been literally knifed,” she says.

She’d hate for anybody to have to go through this, she told me. “It was probably the most pain I’ve ever went through in my life.”