Dr. Gosy trial takes surprise turn with plea deal

BUFFALO, N.Y. (WKBW) — Dr. Eugene Gosy, the prominent local pain management doctor at the center of a high profile case, has agreed to a plea deal with the U.S. Attorney's office.

Jury selection was scheduled to begin on Tuesday but instead took a surprise turn with the announcement of this deal. Under the plea agreement, the doctor pleaded guilty to one count of Conspiracy to Unlawfully Distribute Controlled Substances and to another count of Health Care Fraud.

During the court proceeding in front of Chief U.S. District Court Judge Frank Geraci, Jr., Dr. Gosy admitted to prescribing powerful painkillers despite the fact some of his patients showed signs of addiction and without doing examinations. He also admitted that some of the prescriptions were written while he was out of the country and then falsely billed to the NYS Insurance Fund to collect reimbursement for examinations that did not take place.

Dr. Gosy is set to be sentenced on May 21. He faces a recommendation of 78 months in prison and a $250k - $1million fine. Under the original charges, Dr. Gosy faced the possibility of more than 20 years in prison.

"This office has spearheaded the enforcement effort targeting those who pedal this poison in our communities," said U.S. Attorney James Kennedy, Jr for the Western District of New York.

Reaction from a Gosy patient

“I wish they would just leave him alone,” Penni Hollis, a long-time patient of Dr. Gosy.

Hollis suffers from fibromyalgia, osteoporosis and severe bone degeneration. Following the first Gosy indictment, she struggled to find a new doctor who would treat her pain. She said she was labeled an addict simply because she was one of his patients.

"When you go now to order your medication, you hear 'I know why you're ordering your [medications] because I remember you. You were a Gosy patient weren't you?' What the hell difference does that make," Hollis said.

Hollis said Dr. Gosy was the best doctor to ever treat her.

"I don't think he should be punished for this. I don't think he did anything wrong that anybody else hasn't done," Hollis said, "If he was there today I'd go back to him right now. I loved Dr. Gosy. I found nothting wrong with him what-so-ever."

In December, more than half of the 166 felony counts against the Amherst doctor were dropped. All of those charges related to illegal distribution of drugs. However, charges related to conspiracy and the doctor's role in the death of six patients remained.

"If there was a conviction on any one of those death instances, that could result in a very, very long sentence. Perhaps even a life sentence," said Defense Attorney Joel Daniels in explaining why the plea deal was accepted for a shorter possible sentence.

Prosecutors said they were open to the plea deal to avoid a lengthy, expensive trial and realizing that Dr. Gosy did provide care to a large number of patients who had very difficult chronic pain situations that were not treated by other local doctors.

However, said U.S. Attorney Kennedy, the size of Gosy's practice became so large that greed took precedence over patient care: "Because he liked the money and the lifestyle it provided to cut corners in his practice," added Kennedy.

According to the U.S. Attorney's Office, in entering guilty pleas to Conspiracy to Distribute Controlled Substances and Health Care Fraud, the doctor admitted to the following:

· prescribing controlled substances without conducting a physical examination and/or after conducting only a limited and inadequate physical examination;

· prescribing controlled substances in ways that were likely to cause, and did cause, dependence and addiction, and that contributed to existing addictions;

· issuing prescriptions for controlled substances in dosages and/or in combinations dangerous to the health and safety of the patient;

· issuing prescriptions for controlled substances despite indications that patients were abusing and misusing the prescribed controlled substances;

· prescribing controlled substances without monitoring or using objective treatment information;
· recommending a course of treatment, including the prescription of controlled substances, which caused patients to become so addicted to opioid drugs that some eventually utilized heroin and other street drugs, in order to satisfy their addiction;

· issuing prescriptions for controlled substances to patients despite knowing that such patients had overdosed, or had otherwise been hospitalized for conditions relating to misuse of controlled substances;

· continuing to prescribe controlled substances in the same manner, and failing to adapt practices to prevent additional deaths and overdoses, despite having notice that treatment they were following had resulted in obvious drug-seeking behavior and addiction; numerous patient overdoses; and patient deaths;

· signing death certificates, in the absence of an autopsy or medical examination, for deceased patients to whom Gosy and/or his employees had prescribed controlled substances despite aberrant behaviors;

· recommending a course of treatment, including the prescribing of controlled substances, which caused the death of at least six individuals, and contributed to the deaths of others;

· utilizing a telephonic patient prescription renewal process, whereby patients could obtain prescriptions for Schedule II, III and IV controlled substances that were prepared by persons who were not medically trained and issued by mid-level providers who had inadequate knowledge about the prescription and the patient, and without adequate review of the prescription and the patient’s chart;

· Dr. Gosy pre-signing blank prescriptions and permitting other persons to fill out the remaining information for the prescription, when he would leave the Buffalo area for extended periods;

· Dr. Gosy failing properly to review and sign his own patient file notes, and arranging for other, non-medical, personnel to sign said patient file notes, to make it appear as if he had reviewed them;

· Dr. Gosy failing properly to review patient file notes/reports prepared by mid-level providers working under his supervision and working in collaboration with him, and arranging for other, non-medical, personnel to sign said patient file notes, to make it appear as if he had reviewed them;

· failing adequately to review records provided to the office from other providers, and failing to obtain a complete patient history and information about present illness and conditions;

· prescribing controlled substances to individuals while failing to refer the patient to and/or ensure compliance with drug addiction treatment despite aberrant behaviors, and requests from patients and/or their family members for help with addiction;

· prescribing methadone to individuals exhibiting aberrant behaviors, outside of a methadone clinic setting, and without employing additional safety precautions or referring the patient to addiction treatment;

· Dr. Gosy, beginning in 2008, circumventing state and federal regulations by prescribing buprenorphine for the treatment of narcotics addiction, improperly using his regular DEA number, and sometimes labeling the prescriptions as for “pain management,” even when the drug was being prescribed primarily for the purpose of treating narcotics addiction;

· Dr. Gosy issuing prescriptions to patients for buprenorphine, a Schedule III controlled substance, for the treatment of narcotics addiction, without having completed the required medical training course in order to be a “qualifying physician” to treat narcotics addiction;

· Dr. Gosy failing to complete training requirements, including Continuing Medical Education courses, Worker’s Compensation training, and Infectious Disease Control training, and instead requiring members of his office staff to take the online courses purporting to be the defendant; and

· Dr. Gosy engaging in prescribing patterns whereby high-risk patients that had run out of their prescribed opioids were given buprenorphine until Dr. Gosy could again prescribe other opioids.

Other practices adopted and used in defendant Gosy’s office included the following:

· Mid-level providers (Physician Assistants and Nurse Practitioners) were encouraged to maximize volume of patients seen. Providers who saw certain volumes of patients received monetary bonuses, and/or gifts. Providers who saw less patients were threatened with pay cuts. Providers also earned credit towards bonuses for performing certain, more lucrative procedures on patients.

· Beginning in 2012, a “script line” was established which allowed patients seeking prescriptions, who were not scheduled for an office visit, to call and request a prescription. The “script line” was attended to by individuals with no medical training or certification. They were responsible for drafting the requested prescriptions with the proper drug and dosage, checking the patient’s file for “alerts,” and the New York State iStop program, a Prescription Monitoring Program. Each week a mid-level provider was designated to sign all, or almost all, prescriptions requested through the “script line.” This typically amounted to hundreds of prescriptions per day, many of which were for patients whom the practitioner had never seen and/or with whom the practitioner had little or no familiarity.

· A system was in place for ordering urine drug tests whereby, once the test was ordered, an employee other than the treating practitioner would typically fill out the request form for the laboratory. As a result, the drug screens often tested for the presence or absence of drugs other than those actually prescribed to the patient. However, as part of the usual course of medical practice, urine drug tests should have been ordered and reviewed in consultation with the patient’s medical file, including history and list of current prescribed medications. This is because urine drug testing provided valuable objective information to assist in diagnostic and therapeutic decision making, provided confirmation of compliance with the treatment plan, and provided indication of overutilization of prescribed drugs, diversion/non-use of prescribed drugs, the use of prescription drugs not prescribed to a particular patient, and/or the use of alcohol or illicit street drugs.

· As with the “script line,” toxicology results, including urine drug screens, were reviewed by a mid-level provider, many of whom had never seen the patient and/or with whom the practitioner had little or no familiarity. As a result, tests were often labeled as “consistent,” and not given appropriate attention, even when the tests showed the presence of a non-prescribed drug, or the lack of a prescribed drug.

· Patient records often contained incorrect or insufficient information to justify a diagnosis and warrant treatment. Mid-level providers frequently dictated their office notes, failed to review their notes after transcription, and “batch signed” large quantities of notes without review. In addition, Dr. Gosy rarely, if ever, signed his own notes, and arranged for others to affix his signature to office notes and patient files, in order to facilitate more expeditious billing.