Dr. John Patrick Couch and Dr. Xiulu Ruan not only facilitated pain pill addiction in Alabama but in several surrounding states. In fact, they were just two among 20 other doctors and over 200 pharmacists who were charged as a result of Operation Pillution throughout Alabama, Arkansas, Louisiana, and Mississippi. But the damage they caused didn’t end there: Evidence points to people traveling from such distant points as Tennessee and Kentucky because of their opiate pain pill addiction. These two doctors alone, in the period from January 2011 through May 2015, are accused of allegedly writing 277,982 controlled-substance prescriptions.
The Death of a Patient
What’s worse is that Dr. Couch and Dr. Ruan didn’t start out that way. Bryan Bechtol told Casey Tomer of Al.Com the story of his wife’s injury, treatment, and ultimate death. It’s easy to track the descent of these two doctors from wise and compassionate physicians to uncaring criminals when they became preoccupied with seeking out the profits associated with pain pill addiction in Alabama.
Bechtol’s wife, Teresa Odom, became paralyzed from the neck down in 1999 and was a patient at the clinic operated by Couch and Ruan for 15 years, until just before her death in July 2015. Bechtol describes the time when he noticed a tangible change in the culture of the office and in the appearance of the other patients treated by Couch and Ruan.
After Odom’s accident, her primary care physician referred her to Dr. Couch, who implanted a pain pump into Odom’s abdomen. Through the pump she could manage doses of medications including Marcaine, morphine, and baclofen. Marcaine is a medication utilized to block nerves; baclofen treats muscle spasms; and morphine—well, we all know what morphine does. At intervals no greater than 45 days, Odom would present in Couch’s office to have the pump drained and refilled.
Bechtol pinpoints 2004 or 2005 as the year when he noticed changes in the doctors’ practice. The nurses they liked and trusted were leaving and new ones came on board, and the turnover was high. Because the doctors took on so many new patients, the usual time in the waiting room skyrocketed from 30 minutes to two hours.
Other noticeable changes occured as well. Long-term familiar patients like Odom were far outnumbered by a new group of patients , and the doctors’ prescribing habits became more random: Couch began writing Odom prescriptions for hydrocodone, oxycodone, Lortab, and Percocet, seemingly without giving it a second thought. Actually, Odom rarely saw Couch himself—her case was relegated to a nurse practitioner who saw her and rushed her through her appointments.
In early spring of 2015, Odom’s skin became infected around the site of the pain pump—but Couch’s nurse ignored signs of infection and simply injected her through the red, inflamed skin. Odom returned to her primary care physician who ordered antibiotics. Odom last visited Couch and Ruan’s office in April, and federal agents raided and closed their practice—Physician’s Pain Specialists of Alabama—in May.
Odom’s primary care physician referred her to another pain management clinic, a new place that seemed like breath of fresh air to Odom and Bechtol. However, Odom’s infection never completely healed, leaving a small hole open in her skin that was contaminated when her colostomy bag broke. In June, Bechtol came home and could smell the infection in the air. He rushed his wife to an emergency department where her pain pump finally was removed. She received antibiotic and pain management treatment over the next two weeks, but in June she passed away.
Pain Pill Addiction in Alabama: Benefits and Fallout
Odom and Bechtol’s story gives perspective on how a team of doctors morphs from two practitioners who prescribe with care and integrity into greedy pill mill operators who are only in it for the money. Just how did these menaces to society benefit from their promotion of pain pill addiction in Alabama? When they were arrested, federal agents cataloged a fleet of luxury cars, 27 different bank accounts, and high-end Gulf Coast real estate investments.
Their employees were also affected. A couple of them were in drug rehab programs for pain pill addiction. Couch kept opiate medications in a safe and a refrigerator at his home. In fact, Ruan warned Couch, in an email the year before their arrest, to go easy on writing OxyContin and Roxicodone in order to avoid investigation.
Their practice included an integrated pharmacy, and the doctors not only promoted pain pill addiction in Alabama but also asked two pharmaceutical firms to pay them kickbacks for ordering medications from their firms. They also billed patients’ insurance for urine tests that were never ordered—just one more way to abuse the system. Also, their nurses provided services for patients and then billed the insurance as if the doctors had provided services, so that the insurance would pay at a higher rate. A third doctor who practiced with Couch and Ruan was not charged. He surrendered his DEA license, but he has since applied to get it back.
A federal agent posing as a patient as part of Operation Pillution states that he was seen by one of Dr. Couch’s nurses with an exam lasting 43 seconds and left with pain pill prescriptions. Ruan, through their pharmacy, was the third top purchaser of morphine in the United States. If he worked 40 hours per week, federal agents estimated that he would write 685 prescriptions, or one every 3.5 minutes. We can only hope that the trial set for July will result in the justice they deserve.
Pain pill addiction in Alabama ranks among the highest in the nation, possibly tied with Tennessee for the top two spots. The Centers for Disease Control cite 143 pain pill prescriptions written for every 100 adults in the State of Alabama. That’s a lot of lives stolen or affected by opiate addiction.
If you find yourself in search of recovery from pain pill addiction in Alabama, call your local opiate treatment program to learn more about methadone as a therapeutic option. Methadone along with individual counseling can help a person recover, and get back the life that’s been lost.
