by Christopher Dale

Nurse, we need a prescription pad and a lawyer, STAT. Oh, and refer the patient to the county morgue.

According to medical professionals directory VITALS.com, “Lisa C Hofschulz is doctor primarily located in Naples, FL, with another office in Milwaukee, WI. Her specialties include: Pain Medicine, Nurse Practitioner. She speaks English.”

According to a jury of her peers, however, Lisa Hofschulz, along with ex-husband Robert Hofschulz, are now convicted federal felons. She speaks only through an attorney.

On August 17, a U.S. District Court in Wisconsin found the pair guilty of unlawful distribution of controlled substances – primarily opioid painkillers – through a cash-only clinic called Clinical Pain Consultants. In addition, Lisa Hofschulz was convicted of the 21^st Century equivalent of medical manslaughter, as one of her “patients” died as a result of her unlawful controlled substances distribution.

Despite the seeming mom and pop nature of the case, this was no small-scale operation. In 2015 and 2016, the Hofschulz’s distributed millions of opioids and other controlled substances to patients throughout Wisconsin; during this timeframe, Lisa was the Badger State’s number one prescriber of oxycodone and methadone, as compared to all other Medicaid providers.

In fact, Lisa Hofschulz prescribed opioids and other dangerous controlled substances to 99% of patients, each of whom paid $200 per month for their prescriptions. Many never even saw a medical professional in person, and simply had their pills mailed to them. All totaled, Clinical Pain Consultants collected nearly $2,000,000 from patients over two years.

The Hofschulz case is a microcosm of a large, lethal landscape. Per the Centers for Disease Control, more than 81,000 drug overdose deaths occurred in the United States in the 12 months ending in May 2020, to that point the highest number of overdose deaths ever recorded in a yearlong period. Synthetic opioids were the primary driver for the uptick, spiking 38.4 percent.

During this timeframe, all but one of the 38 U.S. jurisdictions with available data reported increases in synthetic opioid-involved overdose deaths; of those, 18 saw increases over 50 percent. Astoundingly, 10 western states reported at least a 98 percent increase in synthetic opioid-involved deaths.

It gets worse. In mid-August, preliminary numbers for the full 2020 calendar year (Jan-Dec) reveal more than 93,000 drug overdose deaths – the largest single-year percentage increase in over two decades. Unsurprisingly, opioids continue to be key driver in a crisis claiming more American lives annually than car accidents and gun deaths combined.

The opioid epidemic has been, and continues to be, driven by one overarching challenge: the veil of medical deference and legal viability. Lisa and Robert Hofschulz didn’t get caught because they were doing something illegal (though of course they were). They got caught because they were doing something illegal so egregiously that they couldn’t help but get caught sooner or later.

They got caught because when you’re at the very top of the list of opioid prescribers with a 99% patient-to-prescription rate, there’s a target on your back so big and red that it’s completely unmissable. Most people – especially those with advanced medical degrees – aren’t that stupid. And therein lies the problem.

Take, for instance, the other state in which Lisa Hofschulz was licensed, Florida. There, according to Brandeis University researcher Andrew Kolodny, “the distributors and pill mills were really pouring gas on the fire” initially lit by Big Pharma. And the main driver for their proliferation was its legal murkiness.

Florida’s pill mills “opened fast and furious because there was very little regulation … and the majority of law enforcement was not trained to handle the movement of legal drugs for illegal purposes,” said Lisa McElhaney, a former sheriff’s narcotics investigator in Broward County. “Our laws were geared toward your traditional street-level drugs — cocaine, heroin, marijuana, methamphetamine — and not so much on prescription drugs.”

Slowly, the laws have begun to catch up. In 2015, while Lisa and Robert Hofschulz were becoming the painkiller kingpins of Wisconsin, some 250 pill mills were shut down in Florida alone.

But criminals, being criminals, have ways of staying one step ahead of the law. And with pill mills, that tendency is exacerbated by the legality of the substance and the understandable leeway shown to doctors and advanced nurse practitioners. With the opioid crisis, the result is a protracted game of Whack-a-Mole where pill mills are shut down and, as we’ll see, often renamed and reborn by those staff that went unprosecuted in the initial bust.

Kill One Weed and Another Sprouts Up

The Hofschulz case is, in fact, just the visible, ground-level tip of a rabbit hole, one whose twists and tunnels exemplify the simultaneously interconnected and disjointed paths law enforcement officials must navigate in their continued pursuit of doctorate-level drug dealers. Kill one weed and, inevitably and in short order, another sprouts up.

Less than three months before charges were brought against the Hofschulz’s, news broke of potential pill mill operations at Wisconsin clinic called Universal Pain Center. The enterprise was an offshoot of Wauwatosa Pain Management Clinic, which was co-founded by Justin Hanson, a roofer (a roofer!) with no medical background, and – you guessed it – our very own Lisa Hofschulz.

Former employees told DEA agents that Hanson pressured them to prescribe high-dose opioids, even to patients whose urine screens showed they weren’t taking them (which suggested they were instead selling the pills illicitly) or had run out of their last allotment before they should have (which suggested they were abusing them). They told investigators that patients would usually pay about $300 for an initial visit and then $200 for follow-ups, when they would get refills. Sound familiar?

The practice was a cash cow from the very start. According to court records, in its first two months of business Wauwatosa Pain Management deposited over $175,000 into one of its accounts. Less than five months later, more than $502,000 in cash was placed into a separate account.

Rachel McCauley, one of several young prescribers working for Hanson, told investigators that she wrote prescriptions for people she suspected were not taking the pills, but rather selling them.

She was right.

The year prior, 2017, a drug ring raid in nearby Washington County confiscated a trove of opioid pills originally prescribed by Universal Pain Center. The drug ring’s leader, Lori Merget, received some 270 pills per month from the clinic. Merget plead guilty to delivering narcotics and possession of heroin with intent to distribute. She was sentenced to eight years in prison.

The practitioner who prescribed the pills to Merget, Julie Driscoll, ranked near the top of Wisconsin’s average number of Medicaid-covered oxycodone prescriptions for the first seven months of 2017. During that time, she meted out an eye-and-pill-popping 3,561 prescriptions comprising more than half a million pills.

The place was a flashing red light for years. Another former nurse told investigators that patients often got upset when she didn’t prescribe more oxycodone, sometimes telling her they had “an understanding” with Hanson, and that they were paying the $200 per-visit fee to continue obtaining high doses of the drug. Many traveled significant distances to visit the clinic – classic drug seeking behavior.

One physician, who worked only briefly at the clinic, claimed the office manager would appear at appointments and attempt to negotiate prescription for patients. If the physician refused, the manager would refund the patient’s money. When the physician recommended that 98% of the clinic’s patients be discharged for lack of pain relief necessity, he was quickly fired. 

Universal Pain Center has since been shut down. But where, pray tell, did all these (allegedly) nefarious actors end up?

For starters, no records of any charges against Justin Hanson exist. Perhaps he rediscovered his first passion and is currently shingling something in suburban Milwaukee. Meanwhile, Julie Driscoll now seems to be employed by questionably reputable “tele-health” practice called Horizon Health Care. She did not respond to a voice message left with the company’s service.

What about our felonious friend Lisa Hofschulz? Was she caught up in the demise of Universal Pain Center?

So while Lisa and her ex-hubby rot in the Big House, her former cohorts are free to scheme and plot and, in Hanson’s case, patch leaks and clean rain gutters.

The Hofschulz indictments which occurred in 2018, were part of a larger National Healthcare Fraud and Opioid Takedown coordinated by the Department of Justice and the Department of Health and Human Services. To that point, it comprised the largest-ever crackdown of healthcare fraud enforcement action – a sweeping effort targeting 601 charged defendants across 58 federal districts, including 165 doctors, nurses and other licensed medical professionals. Their alleged schemes involved more than $2 BILLION in false billings. Of the 600 charged, 162 were accused of prescribing and distributing opioids and other dangerous narcotics.

But as the case of Clinical Pain Consultants shows, they are but the tip of the semi-legal drug-dealing iceberg. On and on goes the deadly cat and mouse game. Pill mills are still operating. People are still dying.

Lisa and Robert Hofschulz are scheduled to be sentenced on November 2, by Chief United States District Court Judge Pamela Pepper. Lisa Hofschulz faces a mandatory minimum of 20 years behind bars, and a maximum sentence of life in prison.

Good riddance. Two down, far too many more to go as we continue to wrestle with an unprecedented opioid epidemic – one assisted by miscreants with medical degrees peddling legal heroin under the guise of chronic pain relief.