Joseph Castronuovo, 77, of Palm Beach Gardens, a Vietnam War veteran and co-defendant to Cynthia Cadet, MD, has until Oct. 18 to surrender and begin serving his 18-month term because he needs hernia surgery and treatment for a heart condition, according to court records.
Drs. Castronuovo and Cadet were two of 32 people of which 13 were doctors, who were charged in a massive indictment that targeted so-called pain management clinics, in Florida owned by Christopher George. The arrests were the result of a multi-agency investigation called Operation Oxy Alley. This goes to show that many jobs in law enforcement and the Justice Department now depend on these attacks on doctors. George, 35, is serving a 16 year prison term. Patients from Kentucky, West Virginia, Ohio, Tennessee and other states to the north drove down to Florida between 2008 and 2010, and then supposedly turned the drugs over to dealers who sold them. At the time Florida did not have a prescription drug-monitoring program and the home states were becoming difficult to receive pain management.
Because they opted to go to trial, their defense lawyers say federal prosecutors are treating them more harshly. Dr. Castronuovo was charged in the overdose deaths of two patients. None of the other doctors who took a plea were charged with causing deaths.
The prosecution got former patients to testify that Dr. Castronuovo did only the most cursory interviews and examinations before literally using a rubber stamp to prescribe highly addictive medications. But they also testified that they lied, cried and twisted their bodies during MRI tests to fake injuries and persuade her to give them what they wanted. That is all the testimony needed to show that the doctor was prescribing under the description of “legitimate medical practice” and not out on the street. So he should never have been charged, and most certainly should not be headed to prison.
Probable Government Agent Perjury
An agent testified that Dr. Castronuovo made self-incriminating statements during a meeting with a prosecutor and agents in 2011. DEA agent Alfred Cortes testified that Dr. Castronuovo said “This place was illegal. My motivation was financial and I needed the money,” But agents are notorious for committing perjury and are protected by the court. On cross-examination, the defense attacked Cortes’ credibility. For example, Cortes testified that Dr. Castronuovo described some of the patients as obvious addicts and said he prescribed pills to people who tested positive for “illegal drugs.”
When Sclafani told Cortes that Castronuovo actually said he presecribed pain pills to people who had tested positive for marijuana use, the DEA agent retorted: “Marijuana is an illegal drug.” Cortes then insisted there was no distinction to be made between marijuana and cocaine or heroin.
Typical Charges Used Which Aren’t Criminal
The usual charges were the basis for the prosecution:
- The doctors performed minimal physical examinations
- They were paid in cash for each patient they saw.
- They prescribed large quantities of the drugs to people without legitimate medical reasons.
- They failed to prescribe alternative medications or implement treatment plans.
- They relied on preliminary radiology
- They knew that many of their patients came from outside Florida, where stricter controls of the pills were in place.
- They prescribed a standard “cocktail” of controlled substances — specifically, oxycodone and alprazolam — on an assembly-line basis.
- They did not obtain prior medical records.
- They did not refer anyone to specialists.
But none of these charges should be illegal or criminal. The only way they have been made criminal is by the adulteration of the law by the Justice Department for money. As long as there is an evaluation of a patient in an office and the doctor isn’t out on the street selling prescriptions to whomever walks by, it is legitimate per the CSA. The treatment plan is the doctor’s decision. Accepting cash in a medical practice is only smart. I recommend all doctors stop taking insurance. Knowing that patients are having to travel to you from out of state because they can’t find treatment in their home state gives personal satisfaction for providing a service. Why would they have to refer patients—they were the specialists.
Doctor Maintains Innocence
Dr. Castronuovo has maintained his innocence regarding the overdose deaths attributed to him. He claims that 2 expert forensic pathologists reviewed the 2 patient deaths and concluded that neither was caused by the medications he prescribed, according to court records.
Dr. Castronuovo, only worked two days a week. He also suffered from severe pain himself which made him more empathetic and understanding of his patients’ pain, Sclafani told the jury.
Thomas Sclafani, Dr. Castronuovo’s attorney and a former federal prosecutor, described his client as a conscientious physician, especially when it came to patients who feigned illness and exaggerated their pain levels in the quest for opioids. “Dr. Castronuovo was able to use his 35 to 40 years of practice to weed out the people who were not legitimate and he threw them out.”