Doctors in New York “pill mill” worked under daily threats, court hears

BMJ 2015; 350 doi: (Published 13 May 2015) Cite this as: BMJ 2015;350:h2596
  1. Owen Dyer
  1. 1Montreal

The physician owner of two Bronx clinics described by prosecutors as the biggest “pill mill” chain in the US northeast used gangsters and bouncers to control physician employees who were paid cash to produce thousands of prescriptions for oxycodone.

Kevin Lowe, owner of the Astramed clinics, was convicted in a Manhattan court of conspiracy to distribute and possess oxycodone with intent to distribute, which carries a maximum sentence of 20 years in prison. Twenty four other defendants in the case have already pleaded guilty, including one other doctor.

The Astramed clinics, which typically employed a dozen physicians, produced nearly 35 000 prescriptions for 5.5 million oxycodone pills with a street value of more than $165m (£106m; €150m), US attorneys said. Lowe earned $7m in cash while the scheme operated between 2011 and 2014. He wrote no prescriptions himself and “managed largely to keep his hands clean by hiring other doctors,” US attorney Edward Diskant told the Manhattan Federal Court.

Crowds of up to 100 people gathered daily outside the Astramed office on Bronx’s Southern Boulevard, waiting to see physicians for visits that typically lasted moments and involved no examination. These people were members of “crews” recruited by drug traffickers to pose as patients and collect prescriptions. A single prescription for 180 oxycodone pills can change hands for $6000 in New York City and more in nearby states. “Crew chiefs” paid the clinic $300 per crew member seen and oversaw the collection of drugs from pharmacies. Bouncers would also take cash payments from people seeking to enter. Insurance was not accepted.

The case became a cautionary tale about the dangers of dealing oxycodone. Bouncers hired by Lowe and crew chiefs from Bronx gangs roamed the clinics and bullied the staff, including doctors who failed to produce prescriptions fast enough. One staff member who complained about the treatment was thrown through a wall and sustained severe injuries. One doctor who wrote only 50 prescriptions a day was threatened at gunpoint outside the office.

Soon after the clinics were raided by police, one of the physicians who had been questioned, Tomasito Virey, died from an oxycodone overdose. Authorities later said that they had not been planning to arrest him.

Ultimately, only one physician apart from Lowe was charged. Robert Terdiman, formerly a well respected internist at Mt Sinai Hospital, Manhattan, had come out of retirement to work at the clinic. Terdiman wrote 18 700 oxycodone prescriptions in under three years.

Terdiman also suffered abuse from bouncers. His tires were slashed after he called police to complain about a disruptive patient. On the last day before his arrest a bouncer nicknamed Pork Chop was recorded telling him, “I don’t want to hear no nonsense out of you today.”

Terdiman was then living in a hotel room in Yonkers, where police found a revolver by his bed. “The world of prescription drug trafficking is looking more and more like the world of old school trafficking in narcotics like heroin, cocaine, and crack,” said US attorney Preet Bharara.


Cite this as: BMJ 2015;350:h2596

View Abstract

Sign in

Log in through your institution

Free trial

Register for a free trial to to receive unlimited access to all content on for 14 days.
Sign up for a free trial