James Maccarone, DO, an internist and certified pain management specialist in Clarksville, Tenn., pleaded guilty January 26, 2022 to conspiring to illegally distribute drugs. Dr. Maccarone owned and operated Gateway Medical Associates in Clarksville, Tenn., a pain management clinic. He was charged in federal court in Kentucky, however, for “helping fuel the drug problem in Kentucky”. Dr. Maccarone was charged along with John Stanton, MD, orthopedic surgeon, pain management specialist and medical director of the pain clinic, for illegally prescribing 46,060 pills that contained controlled substances from July 2016 to about March 2021.

How did Dr. Maccarone “conspire” to illegally distribute drugs?  Well, here’s the story according to the media.

Another Kentucky resident charged in the conspiracy, 53 y/o Terry L. Prince of Barbourville, KY admitted that he sponsored people to go from the Knox County area to Dr. Maccarone, about four hours away, to get opioid prescriptions which he then got some or all back from them to then sell illegally. Now that does make Prince and his associates guilty of a crime, but not the doctor if the people actually complained to the doctor of a pain problem.  As described in the post Advice to Family Members of Opioid Addicts Seeing Doctors, a doctor-patient relationship must be built on trust that the patient’s history is legitimate.

To charge Dr. Maccarone with conspiracy, the government used the ilegitimate “red flags” of

1. People traveling long distances from the eastern end of Kentucky, sometimes in groups.
2. People waiting long hours to see the doctor, even into the evening or early morning hours.
3. People paid more than $400 for each clinic visit.

In the plea agreement, the government also wrote that the people coming to the clinic often tested positive for illegal drugs, or tested negative for the pills they were being prescribed at the clinic, an indication they were selling them instead of using them as prescribed or they failed to appear for pill counts. However, without actual medical records, these charges could have been fabricated and the doctor had to sign compliance in order to get the plea ageement.  Usually with plea agreements, you are forced to agree to things that aren’t true, simply because they put these egregious conduct statements in the agreement in order to get a heavier prison sentence.

For example, Dr. Maccarone also acknowledged in his plea that he “repeatedly failed” to adhere to accepted professional standards for treating pain:

1. Not trying other treatments before prescribing opioid painkillers,
2. Failure to draw up a valid treatment plan.
3. Did only cursory office visits with no real physical examination.

None of these statements are justification for criminalization of a doctor’s treatment. Obviously, using opioids for pain would be his valid treatment plan. Usually patients have already tried other treatments before visiting a pain management physician. It is cruel and unusual punishment to require a patient to repeat using these non-opioid treatments again simply because they are new to your office. Again, you believe the patient’s history and proceed from there. Also, Dr. Stanton who was also charged, has stated that his job was to treat those requiring higher doses and do to alternative treatments to opioids. So obviously Dr. Maccarone WAS covering the bases of using alternatives when appropriate.

As part of his plea agreement, Dr. Maccarone agreed to surrender his Tennessee medical license; forfeit the clinic property to the government; give up $204,186 from bank accounts; and pay the government $1.3 million. So, by attacking this doctor, the government and all of the agencies involved in the investigation gleaned about 2 million dollars.  Not bad for a fraudulent attack by an untouchable government agency.

James Maccarone, DO is still awaiting sentencing.