Drug agents have called them the worst pill mills in Central Florida and among the worst in the state.
From a small pain clinic near downtown Orlando and an affiliated office east of there, a single doctor prescribed more oxycodone during a three-month period in 2010 than all doctors in the state of California combined, agents said.
Ex-employees told law-enforcement officers that one of the clinics' managers crushed and snorted painkillers in the office. A former office assistant said a shipment of 3,200 oxycodone pills had disappeared one day. And a security guard told investigators he was fired because he called 911 to report a drug deal in the parking lot.
Those are just a few of the details in a nearly 200-page affidavit filed in Orange County Circuit Court in the racketeering case against doctors Riyaz Jummani and Aron Rotman, and Lewis Shapiro and his sons Jarrett Shapiro and Darin Shapiro, who owned or managed the clinics the doctors worked in.
The documents offer a rare glimpse inside the lengthy investigation, which took down the two so-called pill mills, resulting in the arrests earlier this month.
"These things are being managed by criminals who hire doctors to facilitate their criminal enterprise," said Danny Banks, assistant agent in charge of the Florida Department of Law Enforcement's Orlando office. "If we stop just at the doctors, we're never getting to those people who truly may be behind this entire criminal activity."
About seven people die each day in Florida because of prescription-drug abuse. In 2010, the most recent year for which data are available, 147 people died in Orange and Osceola counties because of accidental prescription-drug overdoses.
As part of the investigation into the Pro Relief Center (also known as Pain Relief Orlando) and Pain Relief Center of Orlando, FDLE and Metropolitan Bureau of Investigation agents gathered prescribing data from the U.S. Drug Enforcement Administration, pulled state corporation filings and viewed Department of Health records.
Agents obtained the prescribing histories for 75 of Jummani's patients who got their drugs at Walgreens and found that 64 had criminal records. Of those, 42 have been arrested for drug-related crimes.
In addition to exploring the various paper trails, agents and investigators employed more-traditional law-enforcement tactics.
Undercover MBI agents posed as patients and were prescribed painkillers with little or no medical assessment. While waiting for their turns to see the doctors in the clinics, they overheard patients in the lobby talk about selling drugs.
Banks said the original target of this investigation was Jummani, but as agents gathered intelligence, it became clear they needed to get to the top of the operation: the Shapiros.
Cash - no insurance
State records show Lewis Shapiro, 65, founded Pain Relief Center of Orlando in 2008.
His son Darin, 38, who retired from water-ski competition in 2004 as the winningest competitor in the history of the sport, founded Pain Relief Orlando in 2009. The next year, he was inducted into the Water Ski Hall of Fame.
FDLE agents say all three Shapiros worked in a management capacity at the clinics. Each would not be interviewed by the Sentinel.
They recruited doctors to work at the clinics, but court documents show they had a problem retaining them. A man who used to work at a nearby business told agents Lewis Shapiro complained to him that doctors were quitting and suggested he would hire the man to don a lab coat and pretend to be a doctor at the clinic.
When legislators enacted a law last year requiring pain clinics be owned by a physician, ownership of the Shapiro clinics was transferred to Jummani. When agents questioned Jummani during a raid last year, he admitted the transfer was for compliance purposes only and that the Shapiros paid him $150 an hour, the affidavit shows.
The pain clinics were a cash business. Insurance was not accepted, and employees told agents the price per visit ranged from $160 to $350.
Undercover agents said there were indications the Pro Relief Center was a pill mill. There were long lines outside; armed security guards; and signs that warned patients they needed to bring empty pill bottles and posted what medications were available and a price list for the pills.
In May 2010, Jummani gave 120 painkillers, without a thorough medical exam, to an undercover agent posing as a patient with a stiff back, court records show. On the same visit, he gave another agent 90 painkillers after she complained about a knee problem.
During the investigation, agents tracked down former employees of the pain clinics. One said she was paid cash for her job as an office assistant at the Pain Relief Center of Orlando off Curry Ford Road and that Lewis Shapiro kept no business records.
She said one doctor quit after a receptionist stole his prescription pad and forged his name. Another doctor quit because she wasn't comfortable with the pressure Shapiro put on her to see a higher volume of patients. The office assistant ultimately quit, fearing it was an illegal business, she told agents.
Agents say the majority of prescriptions written by Jummani and Rotman were for oxycodone, a powerful, addictive painkiller. From October to December 2010, Jummani wrote more than 8,400 prescriptions filled at 446 pharmacies. Combined, those prescriptions tallied 506,126 oxycodone pills.
Raids, search find $1M
In June, agents raided the two clinics and searched Lewis Shapiro's home on Marsh Pine Circle near Lake Nona, where they found almost $1 million in cash. When questioned by agents, he blamed 65-year-old Jummani for what occurred at his businesses.
"Dr. Jummani created his own monster," Shapiro told agents. "There were plenty of people that shouldn't have been seen, and if they were seen, they shouldn't have gotten OxyContin . their MRI didn't warrant it."
Neither the doctors nor the Shapiros were arrested at the time of the search warrants. The medical offices closed, and the Shapiros moved to Hawaii, where they opened another pain clinic, FDLE's Banks said.
Earlier this month, state prosecutors filed charges of racketeering and conspiracy to commit racketeering against Jummani, 55-year-old Rotman and the Shapiros. The father and sons were arrested in Hawaii and also charged with money laundering. They were brought to Florida last week and remain in the Orange County Jail.
Rotman's attorney would not comment. Rotman remains in the Orange County Jail. Jummani bonded out.
Defense attorney Rajan Joshi, who is representing Jummani with lawyer Mark NeJame, would not discuss specific allegations against his client but said, "We've determined there is much more to this case than there initially appeared, and we are very optimistic for a very positive outcome for Dr. Jummani."
FDLE's Banks said these type of investigations require significant resources. In addition to combing bank records, agents also reviewed Crimeline tips and records from the Medical Examiner's Office tying Jummani to possible prescription-drug overdoses.
"There's so many different prongs of this problem; we've got to attack all of them," he said.
The veteran investigator said he thinks agents have saved lives by building the case against Jummani, Rotman and the Shapiros and putting them out of business.
"The battle is nowhere near over. People still die every single day in Central Florida from this plague," Banks said. "As long as people still die every day ... we've got to keep fighting it."