This episode is sponsored by StationWise, the
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.com. Welcome to the Behind the Shield podcast.
As always, my name is James Geering and this
week I have one of the most important conversations
I would argue I've had on the show. Rick Mountcastle
is a former U .S. attorney and was also the man
who led the team to prosecute Purdue Pharma after
their predatory actions with OxyContin that led
to today's opioid crisis. So in this conversation,
we discuss a host of topics. from his own journey
into the world of law, prosecuting mobsters,
the deliberate falsification of documents and
information by Purdue that created the OxyContin
crisis, government corruption through the FDA,
the dark side of nursing homes, his documentary
No Country for Old People, and so much more.
Now, before we get to this incredible conversation,
as I say every week, please just take a moment.
Go to whichever app you listen to this on, subscribe
to the show, leave feedback and leave a rating.
Every single five -star rating truly does elevate
this podcast, therefore making it easier for
others to find. And this is a free library of
almost 1 ,200 episodes now. So all I ask in return
is that you help share. these incredible men
and women's stories, so I can get them to every
single person on planet Earth who needs to hear
them. So that being said, I introduce to you
Rick Mountcastle. Enjoy. Well, Rick, I want to
start by saying two things. Firstly, thank you
to our mutual friend, Dr. Todd Otten, for making
this connection. And secondly, I want to welcome
you onto the Behind the Shield podcast today.
Yeah, thank you, James. It's a pleasure to be
here. And yes, kudos to Todd for hooking us up.
So where on planet Earth are we finding you this
morning? I'm in Mount Pleasant, South Carolina,
right outside of Charleston. I've been we've
been here a little over three years, kind of
the place that we retired to. So and yeah, it's
kind of retired, but then I unretired in April.
So congratulations. Thanks. Well, I would love
to start the very beginning of your timeline.
Obviously, you're known for two very specific
areas at the moment when it comes to what's being
portrayed on the screen. I'd love to just kind
of learn the backstory as well. So tell me where
you were born and tell me a little bit about
your family dynamic, what your parents did, how
many siblings. Wow. Okay. So I was born in Tokyo,
Japan. My father was in the Air Force. My mother
was a Japanese national. And so that's sort of
the beginning. And then, of course. As an Air
Force brat, we moved all over the place. I got
two younger sisters, and we lived all over the
United States and in Europe. After my father
left the Air Force, he went to work for the Army
as a civilian, and we continued to move every
two or three or four years, sometimes even more
often. My teenage years were spent in Italy and
Germany at Army Department of Defense schools.
And then upon graduation, I came back to the
States, went to Marquette University undergrad
in George Washington University Law. Had an ROTC
scholarship for my undergrad. So I ended up going
in the Army for four years after law school as
a JAG. And, you know, then I guess after that,
after the four years, I did a couple of years
at a. An agency, Department of Transportation,
sub -agency, and then went to the Department
of Justice in 1986. So that's kind of a quick
start to the first 30 years or so. I lived in
Osaka, Japan for 15 months as a stuntman. So
totally different path than you took. One of
the things, I forget, I think it's Hemingway.
talks about the enemy of prejudice is traveling,
or I'm paraphrasing. But it's when you have traveled
around the world and lived in different places,
you start to see some of the differences in cultures
and some of the solutions to some of the problems
that different areas have. When you reflect back
now to your early years all over the globe, what
were some of the things that were maybe done
better than other areas? And then maybe some
of the ones that were more challenging as you
were kind of... Jumping around from country to
country. Yeah, done better. That's a hard one
because a lot of my time was spent in like enclaves
of, you know, on bases and stuff. So there was
that kind of insulation. But I think maybe one
of the most memorable experiences is that we
were in Guatemala for four months and seeing
and this would have been in the late 60s. I don't
know that. Things have changed a great deal since
then. But seeing the extreme poverty, that's
kind of left an impression on me. Just, you know,
at the time, maybe it's changed now. We were
in Guatemala City, the capital. There was a couple
of paved streets, but almost all of the streets
were unpaved. And just people just... you know,
in extreme poverty, just trying to get by kind
of left an imprint in terms of what we have in
the United States and how little we appreciate
what we have. So and, you know, and then kind
of put a perspective on, well, why do we need
to have as much as we do? And, you know, the
chasing after. uh things of of money and things
of um you know uh tangible possessions that kind
of thing that that kind of left an imprint we
were only there for four months and i was in
like seventh or eighth grade so that's one experience
um you know uh other again i haven't i haven't
been out of the country really to speak of uh
for a long time now but uh Just traveling around
and meeting people, it's all these differences
that are portrayed in the media don't really
exist in real life. I mean, you go out and you
talk to people and they're people, no matter,
you know, and then the media, you know, you go
to the media and social media, especially, and
you see people trying to create divisions and
exploiting divisions. So, you know, people are
people. I've said that, I mean, internationally
and then just domestically as well. You know,
we were told that there are all these groups
that don't like each other and, you know, they're
dangerous to each other. And then you walk out
your front door and you don't see race wars or,
you know, extremism, you know, related violence
or whatever it is. And, of course, they occur.
I mean, there's horrible things that occur all
over the planet. But I would argue, especially
in this country, they're the absolute extremes.
They're the minority groups that are doing these
kind of things and even having these conversations.
If you were king for a day, I would normally
ask this later in the conversation, but seeing
as we're going to talk about chasing money at
the expense of human lives and suffering, if
you were king for a day, what do we do to...
get back to that community that you know we as
human beings have relied on for millennia before
yeah it's wow that's a yeah if i were king for
a day hadn't thought about that one because the
i uh the the possibility never never really seemed
within grasp but you know i i think a lot of
it is um it's just like having conversations
educating people Talking to people, getting points
of view, talking about different ways to do things.
It seems like we are less communicative now,
even though we have more tools of communication
than we were, you know, 20 or 30 years ago. And
so I think we need to get back to actually. face
to face, one on one communication and keeping
an open mind and having understanding and understanding
that in the long run, if we prioritize people
and not profit and things in the long run, it's
going to be better. You know, we're all about
short term. What can I get today, tomorrow, the
next couple of hours? And we don't take the long
view. And I think it's important. People should
try to think about, hey, take the long, look
at the long run. What's going to be best, you
know, a year, two years, five years from now?
But we, you know, human beings don't do that.
So I don't, how to, I would, I would try to encourage
people to take the long, the long view and not
look at what, you know, what, what the next few
hours are going to bring so much. Absolutely.
We'll just kind of revisit in earlier life for
a moment. What were you playing as far as sports
and exercise? You know, I tried, I wanted, I
was a wannabe athlete, but I didn't have the
skills. So I, in school, I, you know, played
football, tried my hand at basketball. You know,
eventually when I was getting ready to go into
the military, I knew I knew I needed to do certain
things to prepare myself physically. So I started
running. And so I've kind of kept that up over
the years, although now running would be what
would be an exaggeration of what I actually do.
It's it's probably more of a fast walk, maybe
not even a fast walk. But I try to get out and
and run three or four times. a week and being
near charleston near the beach i like running
on the beach that's kind of my my vibe now now
what about career aspirations you mentioned about
obviously following the law journey once you
got into kind of the rotc route were you always
dreaming of that when you were younger or was
there something else you had in your mind you
know uh i'm not Not really. And I wanted to do
things. I had, you know, one of the things that
I, you know, being a professional football player,
that kind of stuff that were not really realistic.
But when I was in college and I was looking at,
OK, I've got I owe the army four years. What
am I going to do? And then I just thought about,
you know, I decided I wanted to go to law school
because I had an interest in justice. And seeing
injustice in the world kind of got, you know,
kind of got my juices flowing and saying that
that's something I need to try to fix. And so
I so I decided to go to law school for that reason.
Number one, number two, to put off going in the
army for for three years. And then, you know.
And when I finished law school, there were two
things I decided I would never do. I would never
do criminal law and I would never do tax law.
And so in 1986, when I went to the Department
of Justice, I was hired to go to the criminal
tax division, of course. That was a lesson in
never say never. was pretty good at it, I guess.
What was it that made you retain that passion
for justice? And again, I'm sweeping, I'm brushing
with a very broad stroke at the moment, but we
have a large subsection of the legal community
in the kind of lawsuit side that in some areas
are very predatory. And again, in our profession,
we saw that, you know, the ambulance chasers.
Um, and then we've got people that have had,
you know, multiple people on the show that have
fought tooth and nail and, you know, put everything
on the line to, to do what's right. And obviously
that was something that's burning still to this
day in your heart. What, where did that come
from? And how did you hang on to that? When maybe
there was the law that's going on, on some of
these more financially lucrative paths instead.
Yeah, you know, I don't I'm not exactly sure
where that came from. It just is is there and
it continues to be there for my first. Well,
I my entire career up to this point was in government
service. You know, I went from the Army to Federal
Railroad Administration for a couple of years
to the Department of Justice for 33 years. And
once I retired from the Department of Justice,
I went to the Virginia Attorney General's office.
And so my experience with private practice has
just been the last six months. And so I was always
I always felt I guess I like being, you know,
I like detective stories. I like stories about
good versus evil and good triumphing, triumphing.
And I always wanted to be. One of the on the
good side, one of the good guys, one of the white
hats. So I guess that just was somehow there.
And so I kind of prided myself. Hey, I've never
been in private practice. I've done government
service my entire, you know, almost four year
career. And the feeling like I was doing something
to benefit the public, this is benefit society
just kind of gave me motivation. You know, in
criminal prosecutions, to me, it was about the
victims and about the safety of the community
and about maintaining a system of justice that
is not perfect, but it's probably the best we
can do given the human flaws that we bring to
systems. Giving people confidence that there
is at least some place where there's a little
bit more equality and that people that have means
and financial resources and power don't necessarily
rule the day all the time. Although that's kind
of changed now. But that was sort of being part
of it. That's kind of a system that tried to
level the playing field. I took a lot of pride
in. You say that's changed now. What has changed?
You know, to me, I was always proud of being
working for the Department of Justice, the United
States Department of Justice, both at the main
office, the main justice in Washington and then
later in the U .S. Attorney's Office. And always
feeling that I was there to do justice, not necessarily
to win cases. And I was there to do justice in
an even handed manner. And I see that the Department
of Justice is now being used to settle personal
scores for personal gain. You know, I think it's
being actually abused and it's like in less than
a year, it's it's become very sad to me what
the Department of Justice has become. And a lot
of people. Very good lawyers, career lawyers
who looked at making that a career because of
the ideals that the department used to promote
have left. And so what you have now is a skeleton
that is run by people who have no honor and who
have no morals and who have no ethics, who are
there just for personal gain and to and political
gain. And then, yeah, you know. I'll say it.
That's what it is now. It's a travesty. I mean,
this is what we need to be talking about. I've
been very open about the last few presidents
that we've had. I've always said same person,
different color tie. And obviously there are
extremes on both sides. But the hijacking of
the American people is so blatantly obvious.
When you get people to be so entrenched in, well,
this is my party or this is my president and
they forget that the people come first. And again,
you know, I think I would argue we both come
from professions that understand that, you know,
that we leave our families to go and, you know,
better the country as a whole. It just it makes
me so sad. It really, really does. And, you know,
when you're so hoodwinked and I think, you know,
divided because you're so overworked, stressed,
you know. fearful of these bad guys that we're
told are out there it's so much easier to divide
a country and we saw that sadly in covid and
if i wish there would be some kind of national
awakening where everyone just realized okay is
this a kind or be unkind it's it's that simple
are these people doing what's best for the country
or best for themselves and i think you'd be able
to filter out the chaff immediately and get good
people back in these positions again right no
i agree yes We're in a sad state of affairs right
now. And so all we can do is try to individually
work to, you know, get back to where we should
be. Now, just I want to move on, but just quickly,
how everyone listening in the ability in their
own hands, how do we start going back? Regardless
of whichever political system is in power at
that moment, how do we start regaining this country
again and putting the right people in these positions?
Yeah, I honestly don't know. From my point of
view, it's partially why I went back into the
game in April. A door -open opportunity. So I'm
now with a whistleblower. a small whistleblower
firm based in D .C. And so, you know, it was
one it's one of those you do what you what you
can do in terms of trying to change things for
the better. And so that that kind of door opened
and kind of fit my talent, I think, to to represent
whistleblowers. And so. you know, and, and to
continue to fight against injustice. So, so we
can only do it. Well, we can, we have the ability
and the talent to do, but we should do something.
Okay. Yeah. Whatever it is you you're able to
do, whether it's, you know, broadcast having
a podcast or, you know, going out and volunteering.
at a shelter or Meals on Wheels, helping people,
doing good or bringing light against darkness,
however that looks. I mean, we're not going to
go out there and all of a sudden you're going
to snap your fingers and things are going to
change. What you can do, each of us has the talent
and the ability to do something. It may seem
small, but even a small thing has a ripple effect
that can... can affect in a positive way a larger
number of people. So I would say just even volunteering
to get out into the community and help people
in need because there are a lot of people in
need. And I can see in the next couple of years
even more people being in need the way the economy
is going, the way the cost of living is going,
the way health insurance is being taken away
from people. I think that being light in darkness,
you know, and I know that's a kind of a nebulous
concept, but being light in darkness by doing
things to help people, I think, individually
is one way of fighting back. I couldn't agree
more. They say you want to change the world,
start at home. And even like you said, what you're
doing, I mean, you're having a much bigger impact
than I am. But what we are collectively doing,
each of us is a drop of water. But if all of
you stand side by side, now you're a waterfall.
You're a force of nature. So I agree 100%. Well,
before we get to when Purdue Pharma came on your
radar. Prior to that, I know in Dopesick, they
made reference that you were taking down mobsters.
So what were some of the kind of career cases
that you had prior to OxyContin? Yeah, so that
case. So in the tax division, doing criminal
work from the tax division at DOJ, one of the
initiatives that we had in the early 90s. was
to go after excise tax fraud, which was a thing
that organized crime was using to make a lot
of money with relatively low risk. And so there
was an initiative. We focused on the Long Island,
New York, so Eastern District of New York. And
so there was a group of us that went up there
to work on excise tax cases that involved organized
crime in the background. So one of those cases
I had was a case that involved the head of the
Russian mob at the time, a gentleman named Murat
Balagula. And so we, myself and another attorney,
a co -counsel, prosecuted that case. in a two
-week trial, and we got a conviction of him and
a couple of his associates. So that was the case
that was alluded to as the mob, you know, prosecuting
mobsters and dope sick. You know, and there were
other, you know, the cases I did were tax fraud
cases, so they were different from, they involved
people of means. Kind of just cheating on their
taxes. I think there was another case involving
an attorney that I did right at the time I was
moving from Maine Justice to the U .S. Attorney's
Office in Virginia. An attorney in southwestern
Virginia who was setting up companies for a coal
mine operation. A lot of business corruption.
That's where I learned about business corruption.
It kind of crosses all different. occupations,
including health care at the end of the day.
It's corruption that involves most of the time
stealing money from the government, right? And
so tax monies or health care monies. So the case,
you know, we prosecuted. Evolving a lawyer who
is setting up shell corporations for a coal mine
operator who would, again, you know, steal the
tax money and employment taxes, especially in
an employment tax case where an employer is stealing
the employment taxes. They're really also hurting
their employees because a portion of that money
is supposed to go to the the employees in terms
of their. Social Security taxes and Medicare
taxes, those kinds of things. So those employees
end up with a zero where the employer collects
the money from them but does not submit it to
the government in essence. And their records
then get screwed up with the government in terms
of their Social Security contributions and the
like. So that was, you know, there was another
case that we again had a probably I think it
was a two week trial and convicted the attorney
and and then the judge didn't want to sentence
him. So we had an appeal. And so that case, you
know, dragged on for a few years. So a couple
of cases like that. And I did, you know, domestic
violence, kidnapping cases and and felt illegal
gun cases and some drug cases. And then getting
into, oh, now we've got doctors who are overprescribing
opioids. And that was kind of the entree into
the world of pharma. So walk me through that
kind of on -ramp to that then, through your perspective.
Yeah, so I moved from Washington, D .C. down
to a place called Abingdon, Virginia, which is...
in the Appalachian Mountain region of Virginia,
where the corner of Virginia, it's like a triangle,
and that corner touches on FAP, where five states
come together, Tennessee, North Carolina, West
Virginia, and Kentucky. And so it's a very rural
and economically depressed area. Coal mining
is big down there, farming. But a lot of people,
especially those who work in the coal mine industry
and get injured, there's a lot of injuries, physical
injuries, end up being on disability and being
on Medicaid and needing pain relief. And so there's,
unlike the cities where there was a problem with
street drugs, down there the problem was prescription
drugs because people could get. Pills, doctors
were prescribing opioids. A lot of people had
legitimate reasons for them, but a lot of people
didn't. And so going down into that environment
and seeing that that was an issue, a problem
with the community, our office, our little office,
three -person office in Abingdon started looking
at You know, we're part of the community there.
It's being in a small office. You're part of
it. You're part of the people. You're you're
not like in some ivory tower as a prosecutor
waiting for people to bring stuff to you. You're
out there in the community. And we saw that,
hey, there's a problem with with pills on the
street. That's a problem. And we as as a federal
prosecutor, we wanted to look at going to the
root of the problem. not just taking you know
going and prosecuting people on the street who
are largely addicted to opioids and just trying
to feed their addiction but go up to where the
source is so we started looking at doctors and
we had a big project in the late 90s where we
we targeted a half a dozen or more doctors who
were who based on the data were over prescribing
opioids And we began prosecuting them into the
late 90s to the early 2000s. And then we started
hearing some things coming from the community.
Number one, the local law enforcement said there's
a huge spike in overdoses of this new drug called
OxyContin. And that in addition to that, their
communities were being ravaged by crime. Most
of it related to people trying to get money to
buy Oxycontin on the street, which was selling
at a dollar per milligram. The pills were in
20, 40, 80 and 160 milligram quantities. And
then we also heard from some local pharmacists
that. They were getting aggressively pursued
by Purdue Pharma sales reps whenever they were
hesitant to fill a prescription because in a
small town, the pharmacist knows everybody. And
they know who maybe doesn't really need the pills,
who's abusing them, who's selling them. And so
when they hesitated to fill some prescriptions
they thought were questionable, a Purdue Pharma
rep would come in and be very aggressive with
them. And we got complaints about that. So one
day, my co -counsel Randy Ransire and I were
just sitting around the office talking about
those things at the end of the day. And we decided
maybe we need to open up an investigation on
Purdue Pharma because of this information we
were getting. and just see what's going on. Why
are we being ravaged by OxyContin? And why are
they pursuing pharmacists so aggressively? So
that was around 2000, you know, late 2000, early
2001, we decided we would open an investigation.
Which was unusual because most investigations
get opened up in the prosecutor's office because
law enforcement has come in and said, hey, we
have a case here. This was one that we generated
from our side. Probably almost never happens
from the prosecutor's side because of the information
that we got from the community and the feeling
that we needed to look into this just. because
it's our home and our community, and things did
not appear to be right. When I moved to America,
I went to Fire Academy in Orlando, and then I
moved down to the Miami area and was testing.
And my now ex, my wife at the time, got a job
in a doctor's office. At the same time, I remember
one time I was sick and I don't normally go ever
see a doctor, but it was one of those ones where
I need antibiotics. This thing isn't going to
go anywhere. And I remember sitting in a doctor's
office for hours and watching these model like,
you know, women usually with a little kind of
roll on suitcase going into the doctor's office.
And it never even occurred to me at the time.
I'm just like, OK, well, this is annoying. These
drug reps are getting ahead of us. But then my
my son's mother. I said, this is so weird. We've
got people flying from all over the country down
to this doctor and he gives them a prescription
and then and then they fly away. And this is
Broward County, Florida. So I had a very, you
know, a naive at the time, you know, view of
exactly what we're about to talk about. So you
mentioned the drug reps. Talk to me about the
army and the kind of predatory practice that
Purdue was deliberately creating to. prey upon
these medical practitioners and skew their understanding
of the drug? Yeah. So, you know, you've seen
Dope Sick. So the thing about Dope Sick is that
the underlying, of course, it's jazzed up for
TV, right? The dialogue and kind of the sequence
of events all kind of jazzed up for TV. But the
underlying The storyline about how Purdue marketed
the drug is very accurate in Dope Sick. When
I was talking to the creator of Dope Sick, Danny
Strong, he came and interviewed me. And I told
him, the only reason I'm talking to you is because
I want to make sure you get the facts right in
terms of what our investigation found. So that
storyline is very accurate in terms of what actually
happened and what Purdue did. And what Purdue
did was they used data, right? They looked and
saw where most of the opioids were, the regular
opioids, the smaller dose opioids, like the Percocets
and those kinds of things. They saw where most
of those were being prescribed. And of course,
it was in locations that were generally like
Appalachia in southwestern Virginia, eastern
Kentucky and southern West Virginia, where you
had people who worked in occupations that were
physical in nature and there were injuries. And
then they would go and once they were injured,
they'd get pain pills. So they targeted places
like that, and they targeted Maine, where the
timber industry was. They targeted where the
coal mining industry was. You know, Florida,
I'm not sure exactly why they targeted Florida,
but probably because of the older population
and then, you know, the physical ailments that
come with aging. But they took that data and
they said, we're going to go in. Essentially,
I mean, I'm paraphrasing, but they said, we're
going to go into these places where there is
a large opioid market and we're going to take
our drug and we're going to say our drug is better
than the other drugs that you are prescribing.
Their market research found that one of the things
that doctors were hesitant about was the potential
for addiction. that would come from these larger
quantities of the opioid, of oxycodone that were
in their pills. And so they created this marketing
program to some extent in collusion with the
FDA, which we can talk about in a minute, where
they went in and told the doctors. who had people,
you know, the doctors are having to make decisions
based on just looking at someone who says I'm
in pain, which is very subjective and deciding,
well, do I write a prescription or not? Are they
going to get, am I going to get them addicted
or not? Are they abusing it or selling it or
not? There's a lot of unknowns for the doctors.
So when Purdue comes in and tells the doctors,
hey, we've got this new drug. It's in a delayed
release delivery system. And therefore, that
makes it less addictive than these other drugs
that you're prescribing. And oh, by the way,
because it's in this delivery system, it's also
less prone to abuse. All of those things were
blatant lies. The doctor is going to... be put
in a position where, hey, I either prescribe
the same old stuff that has addiction and abuse
potential, or I prescribe OxyContin, which, hey,
I'm being told, in a credible fashion, is less
addictive and less prone to abuse. In fact, some
of them were told it can't be abused because
of this delivery system. The doctor's put in
a position where they almost have to prescribe
OxyContin. And that's kind of what happened.
What, you know, I can get into the FDA's role
in this if you want me to. Let's do it. At the
risk of, I don't want to be droning on, but so
what happened, you know, and this is what, again,
this is also part and parcel to what's portrayed
in Dope Sick. Purdue, of course, had to get OxyContin
approved by the FDA. And this is around 1994
to 1995. It got approved at the end of 94. So
this is 94. There was an FDA reviewer, a doctor
named Dr. Curtis Wright, who was assigned to
review and approve OxyContin for the FDA. Now,
Dr. Wright, it was a trained and had practiced
as an addictionologist. OK, he had treated addiction
of various kinds, including opioids. So, you
know, he was the person I think at FDA who they
said, OK, he's got expertise in this area. He
should review it. Now, what Dr. Wright did apparently
was, you know, and it's a little murky, but he
had meetings outside of the FDA's office with
Purdue Pharma's. executives or the team that
they put together to get OxyContin through the
FDA. And one of the things that comes with a
new drug that's approved by the FDA is what's
called a package insert. Okay. And, you know,
when you go and pick up a prescription from the
pharmacy, you get like a stack of papers, right,
that you don't read. You kind of just throw away,
well, that's the package. That's the patient
version of the package insert. So there's also
a more official physician's version of the package
insert, which talks about the dosing, the frequency,
potential side effects, has a lot of information
in it. One of the things that the Purdue folks.
got put into that package insert courtesy of
Curtis Wright was the statement that delayed
release as provided by OxyContin tablets is believed
to reduce the abuse liability of a drug. OK,
so if you think about that statement, what does
it really mean? Nothing. It doesn't mean nothing,
but it's got. language in there that kind of
says this is the FDA's approved language for
this drug. So when a sales rep would walk into
a doctor's office to promote OxyContin and they
would tell the doctor, hey, we got pills that
have 10, 20, 40, 80, 160 milligrams of Oxycodone
in them and they are less addictive. And the
doctor who is. has any kind of street smarts
even, and has any kind of training says, you're
crazy. That amount of oxycodone in one pill,
there's no way it's less addictive than a 10
milligram Percocet pill. And so the sales rep
pulls out the package insert and says, look,
read this language here. According to the FDA,
this is the FDA's official position, our pills
are believed to reduce its abuse liability. That's
kind of the hook that they had to convince doctors
that what they were telling them, the blatant
lie of less addiction and less abusability, was,
you know, there was some truth there because
it was endorsed by the FDA with that ridiculous
language. That was approved by Dr. Wright, who
should have known better because he was trained
in treating addiction. You know, I spent a lot
of time investigating him because I said there's
something there, but I could never, never prove
any kind of corruption or any kind of, you know,
payoff or anything like that. And then the rules
for. One of the problems with our government
is that the rules for conflicts of interest are
so lax that there's nothing that he did that
was a violation of any kind of regulation or
rule or conflict of interest. But that, to me,
is really the thing. The FDA was fully complicit.
in the opioid crisis because that language was
allowed to be in that package insert for the
first seven years that the drug was on the market.
Quick question. After the FDA, who did Curtis
Wright work for? He went to work, yes. He went
to work for, so he left the FDA and he went into
some obscure pharmacy company, pharmaceutical
company for about 12 to 18 months. my view to
make it look good. And then he went to work for
Purdue Pharma at $400 ,000 a year, I think about
quadruple his FDA salary. And yeah, that was
all very suspicious. I mean, we see it over and
over again. There are people that were in the
government that then worked for weapons manufacturers.
I mean, all these people that are obviously greasing.
the pathways for their companies to benefit off
the american people then lo and behold a year
two years later they're working for the very
you know organizations that they were supposed
to be regulating and you know and again it is
us that is paying the price i mean i saw it as
a paramedic the number of opioid deaths that
i went to the number i'd say one of the biggest
you know the largest amount of people that i
saved was simply through narcan And Narcan not
being invented, you know, I'd have a lot more
deaths on my career. So this is what blows my
mind is that this happens over and over and over
again. And yet, you know, those people aren't
held accountable. And it is directly at the cost
of American men, women and children. Yes, that's.
And that's existed for a long time. It's called
the revolving door is one of the phrases that's
used. When I worked in D .C. back in the 80s,
we talked about that all the time. So the revolving
door has been there for decades, maybe longer.
It is a flaw in our system that people can capitalize
on their government service and go out and...
in a conflict of interest scenario. And they
also come back and part of what happened in Purdue
was the phone call from the well -financed, well
-connected defense lawyers to the Department
of Justice. The connections there also exist.
Those are two things that... should be fixed.
I don't know that there's a will to do that.
But the conflict of interest of coming into government
and greasing the skids and then going out and
capitalizing on, you know, your work for the
government that you maybe didn't do the way you
should do. And then also the concept of Certain
people being able to call, make phone calls to
people who are in decision -making positions
with that kind of influence. Those are two things
that are a real problem. And like you say, it
costs lives. Yeah. Well, I mean, again, it's
portrayed in Dope Sick, but the Giuliani connection
was already related to Purdue Pharma as well.
Yeah. So as as our case progressed and we got
to the point of, OK, we've got this, we're ready
to pull the trigger. You know, what normally
happens is we'll reach out to the company attorneys
and say, hey, we're going to provide you. We're
going to sit down with you and sort of give you
a preview of what we found in our investigation
to see if you want to come to a resolution before
we go formally to court. They brought in. Giuliani
as kind of their their fixer. Right. And the
reason they brought in Giuliani was this was
2006. So there's you know, there's the election
cycle for 2008 was getting ready to gear up.
Giuliani at that time was viewed as one of the
leading candidates for the Republican nomination
for president. Okay, this was 2006. He was coming
off of the 9 -11 and he was, you know, America's
mayor, all that kind of stuff. And so he was
brought in because of that power that he had
as a potential Republican presidential candidate,
which meant that he had a direct line. He could
pick up the phone and call. the decision makers
in the Department of Justice who were part of
the Bush administration, Republicans, which he
did, and get an exert influence that way. So
that, you know, again, my view, that absolutely
happened. That's why we had proposed the prosecution,
felony prosecutions of... not only the company,
but the three top executives at the time. Our
case was criminal. It was almost exclusively
criminal until we reached the settlement phase.
And in a criminal case, as you probably know
or many people know, is you start at the bottom
and you work your way up to get to the top, right?
our view was that we wanted to to prosecute the
highest level of uh corporate officer that the
evidence allowed us to do in applying the beyond
a reasonable doubt standard and we had gotten
to the ceo the general counsel and the medical
director and but above them were the board of
directors okay the sackler family and what we
needed we we had some information about the Sackler
family, certain of the Sacklers, two or three
of the Sacklers, in particular one, Richard Sackler,
who was calling the shots. We had some information
about him, but we needed one more witness, right?
One of these top three guys to roll up on the
person that was directing them to do things.
And so the thinking was that If they were faced
with felony prosecutions or even felony convictions,
those got one or more of them might very well
decide they wanted to cooperate to get out from
under prison time. So that was sort of where
we had put posture the case when we went up to
the Department of Justice because it had to be
approved at that level. And that's kind of where.
Rudy Giuliani exercised his influence because
we had meetings up there and we were told that
we were not going to be allowed to prosecute
any of the individuals. Just to clarify, as we
sit here in 2025, I've looked for many, many
posts and things that I've talked about in the
last few years. We lose basically 100 ,000 people
annually. to the opioid crisis so all these people
that we've talked about the fda giuliani all
these other people that are benefiting financially
from this are doing so as we lose a hundred thousand
americans every single year can i add to that
yes a hundred thousand we're well over a million
um opioid overdose deaths but also think about
the countless millions more of people who have
become addicted to opioids and the impact on
their families, okay? You're not talking about
your... Yeah, it's horrible that you have overdose
deaths and those families impacted. On top of
that, you have the addiction of millions and
what that does to their families, right? It is,
you know, it's not just limited to 100 ,000 deaths
per year. You're talking, if you add in the families,
I believe the families are victims as well. And
so you're talking about literally, I don't know,
10 million, 20 million, 50 million people who
are impacted in one way or another. And yes,
you know, it just kind of. boggles the mind that
there really is no justice for those families
and those people. I mean, once I retired, I decided
I would do whatever I could for victims. And
so I've got a few contacts in the opioid victim
community. In fact, a fellow... that I've been
a friend that I've met through this process named
Ed Bish lost his son in 2001, 18 year old son
in 2001, when nobody really knew what was going
on, it took one pill, one Oxycontin pill ended
up dead just like that, you know? And so he's
been fighting for justice now for almost 25 years.
I mean, the families want to see, and I believe
the only way you, deter that kind of conduct
is to criminally prosecute those who are responsible.
And I'm talking about responsible corporate officers,
not street dealers, you know, not middle managers,
but the people at the top who are making the
decisions that result in the illegal marketing
or the false marketing of drugs that doctors
then prescribe and that end up killing people
and ruining families and lives. The government,
this is another problem. Let's say the third
flaw in the government is that the enforcement
program for pharmaceutical companies in general
and opioid manufacturers in particular is to
go after companies and make companies pay fines.
That's the enforcement program. Well, the fines
are never going to be high enough to match the
profits that were made. Therefore, the fines
that the government collects from these companies
is the cost of doing business. And they have
profited so much that their conduct is not going
to change. Companies are not driverless cars,
okay? Companies do illegal conduct because responsible
corporate officials made decisions that they
should do, that they will do illegal conduct.
And those responsible corporate officials need
to be held accountable. And until you start holding
them accountable, that conduct is not going to
change. That's the only way you're going to change
corporate conduct is to hold the responsible
corporate officers or officials or executives
who made the decisions to have the company do
illegal things. You have to hold them accountable.
Otherwise, nothing changes. And that's borne
out. I mean, you can go and look at how many,
the number of companies that the Department of
Justice has. prosecuted either criminally or
civilly over the past 25 years it's in the thousands
okay and they've collected lots of money the
press releases of the billions of dollars that
have been collected nothing changes then if you're
doing it for 25 years and you're still collecting
that money something's wake up somebody ought
to wake up and say wait a minute nothing's changing
behavior is not changing we're just collecting
money For those companies, it's like a speeding
ticket. Write a check, keep doing what you're
doing because you're making so much money. And
this is something that we were wanting to do
from the beginning of the Purdue case. We knew
that the conduct would not change unless you
held the responsible corporate officers accountable.
And we were not allowed to do that for political
reasons. Well, let's talk then about that, you
know, talk about the initial settlement. I know
it's in the news again at the moment. You know,
how much was the settlement? And then let's contrast
that exactly what you're talking about with how
much was made off, you know, the blood of the
American people that took this and died. Yeah.
So I'm going to I'm going to go into the lead
into the settlement we met at the Department
of Justice. and made presentations to the high
officials, to the assistant attorney general
for criminal who was delegated by the deputy
attorney general to handle all the meetings and
all the stuff involved. And so the Purdue attorneys
were allowed to meet. They didn't have a time
limit. When we went up there, we were given an
hour. When we were done with the meeting, I was
waiting outside. The U .S. attorney, my immediate
boss, came out from meeting with the assistant
attorney general and some other aides and said
he was all upset. They're not going to let us
prosecute the individuals and they want us to
resolve this case. So we met with the Purdue
attorneys that evening. And we basically. managed
to salvage having those three executives plead
guilty to misdemeanors. So there was some, and
if you look again at the records of the department,
that in and of itself is very rare. Okay. You
could probably count on one hand, the number
of executives that they have actually had to
plead guilty to something. Of all the thousands
of cases that have been done. So we at the time
we were feeling at least we salvaged that those
guys are going to get a conviction, although
it's a misdemeanor and there's no now no incentive
for them to cooperate because there's not going
to be any jail time. We at least thought we had
salvaged that. And then we the amount of money
that. we required Purdue to pay was, I think,
around $650 million, if I recall correctly. So
it was a $650 million, three misdemeanor pleas
by the top three executives. And we thought,
given that the department had basically cut our
legs out from under us, we thought that that
was like, that's the best we're going to do.
It's not satisfactory, but it's something. And
maybe we can shine the light on Purdue Pharma
as being this criminal lying, you know, lie telling
company. And maybe the public will see that and
conduct will change accordingly. Unfortunately,
no. And by that time, I think, as I recall, Purdue
had made probably in the neighborhood of three
or four billion dollars. So a 650 million dollar,
you know, payment, you know, cost of doing business.
Right. Well, so I went on, you know, I went on
to do other things, other cases, but. What happened
in the meantime, and I've gone back and looked
and read a lot of the documentation. In 2007,
that's when our case was resolved. It went to
court. The guilty pleas were entered. The judgments
were entered. At that point, apparently not too
long after, the Purdue Board of Directors, the
Sackler family, decided to hire this. public
relations firm called McKinsey to see how they
could, quote, turbocharge OxyContin sales. Okay.
So, again, perhaps naively, I thought, oh, well,
they dodged a bullet, right? We were threatening
a whole lot more, but they got off. you know,
relatively easily, maybe they're going to change
their behavior. No, they decided to double down
and hire the public relations firm so they could
turbocharge OxyContin sales. And so that's what
they did. They targeted, and this is in the 2020
guilty plea. Okay. So now you have a two -time
drug dealing offender. If it was any of us. The
second time they lock us up and throw away the
key. Right. So 2020, the 2020 case, they turbocharged
Oxycontin sales. They targeted the doctors who
were the highest prescribers and who were the
most likely to be diverting over prescribing
and knowingly prescribing to abusers. And they
they sold. I think around 11 billion dollars.
in OxyContin between 2008 and 2016. At the same
time in 2007, 2008, the family, the Sackler family
had conversations apparently among themselves
and said, hey, somebody else is going to come
after us. We need to make sure we move our money
to places where it cannot be reached. And this
is in the Supreme Court's opinion on the bankruptcy.
They began in 2008 moving, taking money out of
Purdue, basically leaving Purdue just bare bones
operating fund and moving it offshore to offshore
accounts and to family businesses to prevent
anyone from coming after their money after they.
did this next set of crimes from 2008 to 2016.
And the crimes that they had Purdue do under
the McKinsey guidance were much more serious
even. I mean, the crimes that I prosecuted were
lying about the drug to doctors. The crimes that
they committed involved, you know, that the company
pled guilty to in 2020 were... crimes related
to straight up narcotics trafficking, healthcare
fraud, and paying kickbacks. Okay. Now, 2020's
case, not a single executive, not a single individual
has been prosecuted for those more egregious
crimes for that second, you know, the recidivism.
crimes. And that is, to me, that is outrageous.
That is completely outrageous. There are documents
that are filed, and the Sacklers actually had
a civil settlement themselves, that involved
themselves, a civil settlement. The language
in that civil settlement, there's always something
called covered conduct. The covered conduct in
that civil settlement to which the Sacklers don't
agree, but the government does not put covered
conduct into a document that's filed in the courts
unless it has a basis to do that. It shows that
the Sacklers were making the decisions regarding
the criminal conduct that occurred from 2008
to 2016. So, that's, you know, it becomes almost,
it becomes really outrageous. at this point.
And you have them on top of that to add to the
outrage because all of their money is overseas.
And now they've got this flood of lawsuits coming
in from government agencies and private individuals.
They put the company in bankruptcy. Okay. They
choose a bankruptcy court. in White Plains, New
York, where the judge has a very favorable disposition
towards allowing non -parties to get releases.
So, of course, part of the settlement that's
advanced by Purdue for the bankruptcy is that
the Sackler family members and a whole list of
others, including corporate officers in Purdue,
are going to get releases from all civil liability
out of a bankruptcy that just involves the company.
And so you have essentially the Sackler family
who the Supreme Court has documented laundered
money out of Purdue, which pled guilty, which
makes that money the proceeds of criminal conduct.
Getting the benefit. of a bankruptcy that they're
not a party to. Okay? So, outrage upon outrage
and complete breakdown of the whole justice system
is what I see in the government, the Department
of Justice under, you know, two different Well,
three different administrations that you have.
The Trump administration originally, the Biden
administration, and the Trump administration
second have done nothing. Okay. Which underlines
our point. It's not about the Republicans or
the Democrats. It's the wrong kind of people
in these positions. And, you know, when you look
at the, you know, the way that the Sacklers are
portrayed, it mirrors something that I've kind
of had an awakening myself about only a year
ago. I've spent nine years talking about mental
health as one of the topics when it comes to
first responders and military members and doctors
and nurses and everyone else. And when you talk
about that in our profession, you talk about
us, the guys on the streets, the ones trying
to save the lives of the very people that we've
been talking about for the last hour. But we
don't talk about the people that are at the helm,
whether it's a fire chief, whether it's a president,
whether it's a CEO. And if there is unaddressed
mental ill health and a sociopath is allowed
to be at the helm of this kind of company where
people are dying, whether you're burying your
own soldiers or firefighters or whether your
product is killing people and you sleep soundly
at night, you are not. you know fit for that
position and we do not have that discussion i
mean the current i would say like as you just
alluded to the last what would that be nine plus
years the people that we've had leading this
country are unfit mentally unfit and yet we just
turn our heads yeah and i think uh a lot of it
has to do with money right uh the the companies
that do these things are making campaign contributions,
paying lobbyists big money to go knock on doors
up on Capitol Hill and in Washington in general.
And that, unfortunately, is what is kind of ruling
the day, kind of what we see. in the nursing
home industry as well. I mean, I think it covers
most of the healthcare industry where lobbying
and campaign contributions sway public policy
and legislation. And people, ordinary people,
you know, there's a lot of advocates to say,
let's write our congressman and let's send emails
to the congressman and to the senators, et cetera.
I'm kind of a cynic now. I don't know that I
should. Well, people should take this with a
grain of salt. OK, my view is this. The companies
that are making money, that making huge profits
off of a system that is broken, they go to the
congressmen, the senators and the legislatures,
even at the state level with bags of cash. OK,
and they and they get. they get a seat at the
table, they get heard. If you're just writing
letters because you don't have bags of cash or
you're sending emails, they don't care, okay?
They don't, real honest, my view is they do not
care because the cash is more important to them.
And so people need to understand what's going
on, that this is the system that we have. And
I think the only way that we can change that
is that people learn about it, they understand
it, and they get outraged about it, and they
vote those people out. There's too many people
that are just sitting in their positions. making
plenty of money to finance advertising for their
campaigns, but they're really not doing anything.
They're actually hurting people, right? And I
know that sometimes we feel powerless to do that,
but I think that if we were to educate ourselves
and come together again, the need to come together
because... And there's an advantage to dividing
the people, right? They don't come together.
We can come together and try to make a change.
But it's not going to happen as long as we keep,
you know, lining up and thinking that we're all
divided. I couldn't agree more. I mean, it's
funny when you were talking about the lack of
accountability. I was just thinking tongue in
cheek how the National Guard needs to put it
in D .C., not the streets of these cities. You
know, if you're talking about criminals that
are. causing hundreds of thousands of deaths
you know annually whether it's through obesity
whether it's through addiction whether it's through
these chemical companies poisoning or tobacco
or whatever it is i mean that's where we should
be deploying people with that being said i had
a sam quinones on the show who wrote dreamland
and his perspective was he did a good job of
kind of detailing the pharmaceutical side, but
then also the closing of the pill mills about
the time that we're talking about now. And again,
I remember, you know, the one in Orlando having
the line of people around it, and then one day
it was shut down. So now you've got all these
addicts that were, you know, spoon fed through
the legal route. Now that's taken away. And now
you've got the cartels coming from Mexico. Again,
the same exact business model that's target where
these addicts are. Again, these same kind of
industrial towns where there aren't already big
gang, you know, gang presences. And now that's
what led to the, you know, the heroin spike.
And then we had fentanyl. And obviously now we're
losing more people than ever because of the potency
of that. One thing that if we're talking about
healing and we're talking about coming together
and we're talking about being proactive. I've
said this story many times on here. My mom moved
to Portugal about 25 years ago. And when I started
the podcast, she said, you know what we did here
in Portugal for addiction? And what had happened,
they had had a massive opioid crisis after a
war in one of their colonies. And they did the
traditional war on drugs. And it just didn't
work. And so they truly democratically, not demistocracy
like we have here, you've got to be rich and
no ethics, but actually put it to the people.
And they voted to put addiction in the hands
of the medical community. So they decriminalized
addiction. Doesn't mean you can go into the grocery
store and buy meth. You just, if you get caught
with the user's amount, you get educated on the
resources that are available to you. The addicts,
I mean, excuse me, the smugglers still go to
jail. The dealers still go to jail. But what
they found is less than 10 years by destigmatizing
being an addict and not giving them a criminal
record for simply chasing their fix. They gave
them addiction counseling. They gave them mental
health counseling. There was job creation. There
was housing. And less than 10 years, they went
to the lowest addiction rate in the world, I
believe. Incredible. What is your stance on decriminalization
or legalization when it comes to the addict?
Again, not the dealer, not the smuggler, but
taking addiction and truly putting it into the
world and funding it into the hands of the medical
community. So back in around 2017 to 2018, when
I was the U .S. attorney in the Western District
of Virginia, I was working with DEA supervisors
and other law enforcement. One of the things
that we were saying back then in the law enforcement
community is we're not going to be able to arrest
our way out of this problem. OK, it's a three
prong approach that needed to be taken. And as
we were discussing back then, yeah, we go and
arrest the dealers and the smugglers and those
people. But you've got to have treatment. The
treatment is inadequate, right? If you live in
a rural area, you've got to travel miles to get
treatment. You've got to have a strong treatment
base. And you've got to try to get people who
are addicted into those treatment centers. And
you've got to have prevention, right? You've
got to go start talking to... You know, maybe
back then it was middle schoolers, but now you
got to go start talking to elementary schoolers
and educating them about what it is to, you know,
the dangers, right? The death, the addiction,
what that looks like. So we were having those
conversations in 2017, 2018. It sounds like they've
stopped. OK, we're now going to we're shutting
the borders. We're going to like arrest everybody
and we're going to like, you know, bomb bomb
boats that are bringing drugs in. OK, well, that's
that's all well and good. But you got. You know,
millions of people who are addicted as a result
of of corporate malfeasance. OK. And you shut
off the supply. And so now they're having to
go get more dangerous drugs. I mean, there's
stuff that, you know, fentanyl and worse, believe
it or not, worse than fentanyl, carfentanil and
xylazine and all kinds of other substances that
are out there. Where's the treatment? OK, I don't
see much improvement in 10 years since we've
we've known about this problem. We grapple with
this problem with treatment. One of the takeaways
from Dope Sick, not the story of my case, but
one of the takeaways that I thought was good
from Dope Sick was the destigmatizing of addiction,
okay? That, you know, there are many different
ways to provide treatment. I used to be kind
of a skeptic of medication -assisted treatment,
but on the other hand, you know the kind of the
cold turkey gutted out didn't seem to be working
real well so it you you got to just deploy all
of of the treatment options and make those available
i don't see that being done very well right now
and i see almost no prevention quite frankly
nobody's going out and trying to warn and educate
young people about you know, the dangers of opioids
and becoming addicted. If you count Purdue's
piece, another $7 billion, $57 billion or more
have been collected from different pharmaceutical
companies over the past several years into these
funds that are supposed to be going to opioid,
quote, opioid abatement. I am very skeptical
about how those are going to be used. A lot of
them are going to just go to cover government
programs and deficits and tax reduction and all
that. We're not doing a good job with treatment
and prevention. And yeah, I agree. I still view
we're not going to arrest our way out of it.
You can't throw everybody in prison and that's
not going to help. You're still going to have
people addicted. So we need to have it needs
to be a three pronged approach. You're going
to have to fight the battle on three fronts.
Right now, we just seem to be all as a society
focused on let's just arrest people and throw.
lock them up and throw away the key, that's not
going to solve the problem. If only we had a
book by a really kind, compassionate person that
would create a religion of empathy. We could
call it Christianity or something. We could work
on that. Yeah, well, the problem is that I think
the word Christianity does not really... for
the most part, convey in the meaning that it
really should. There's a lot of Christians in
name only, okay? Yeah, 100%. I agree. I think
I've said this. I actually kind of made a picture
the other day because there's that magnet that
people put on their cars around this time of
year, and it says, keep Christ in Christmas.
And I changed it to say, keep Christ in Christianity,
because I think that's far more important right
now. True. That's a good... Well, we've been
talking about the opioid crisis, and we could
talk for hours more on this, but I want to transition
to what you're working on now. The same predatory
practice, and ironically, I just had a conversation
with a filmmaker yesterday, a friend of mine,
who is kind of, again, in a way, whistleblowing
the fact that our public pensions, you know,
city and county and states are being used by
private equity companies and being pilfered.
And these are funding a lot of these things.
So you've got drug companies. You've also got,
as we talked, the other areas of healthcare.
How did the world of nursing homes come on your
radar? And let's kind of unpack that. Yeah. So
I know just like a lot of things by happenstance,
coming out of the Purdue case in 2007, a whistleblower
attorney came to Roanoke, Virginia. to meet and
said they had a case against Abbott Laboratories,
another pharmaceutical giant. And the case involved
Abbott Laboratories marketing its anti -epileptic
drug Depakote to nursing homes for the treatment
of agitation and aggression in dementia patients
in nursing homes. Well, it was completely not
approved for that. And one of its depakote side
effects is somnolence. And so, of course, if
you give an elderly patient in a nursing home
who has dementia something that's going to put
them to sleep, they will be less aggressive and
less agitated. And so that's what they were marketing
the drug for at that point. So that was my kind
of my first foray into the nursing home world.
And it was like one of those, oh, OK, I see what
they're doing. Pharmaceutical companies in the
opioid business preyed on people who were prone
to addiction. And nobody's going to listen to
an addict because they can be they're vilified.
Right. OK, so now they're coming into nursing
homes and preying on these elderly people with
dementia. And who's going to listen to a dementia
person? They're not in their right mind. And
so they go after these people who are marginalized,
who have basically no voice and prey upon them
to make money. And so, you know, we did that.
We investigated that case for a couple of years
and got it to the point where we had criminal
and civil. It was a $1 .5 billion total settlement,
which at the time was, I think we believe was
the largest single drug settlement in history.
And we also recommend prosecution of the top
executive. And I got shot down at the highest,
predictably at the highest levels of the department.
And so that was my first entree into the nursing
home world and seeing, you know, kind of what.
What those large companies were doing to vulnerable
people kind of got, you know, sparked the outrage
in me. And then in the midst of that investigation,
I got a colleague at the Health and Human Services
Office of General Counsel sent me a survey report
on a nursing home in far southwestern Virginia.
That was over 200 pages long. And basically she
said, you need to take a look at this. And I
read it and I was like appalled at the treatment
of the residents in that facility. And I said,
you know, I don't know how to do these cases,
but we got to do something. So I opened up a
criminal investigation of that, that nursing
home, which was owned by someone who lived in
Miami, an investor, kind of like a similar to
private equity, but on a smaller level, individual
level. I think what happens is that they put
together a package of nursing homes. They make
them investment opportunities for individual
investors. And so you can buy into four or five
or six nursing homes at different locations.
So this was a guy in Miami who was like a private
investor. And he had one of the operations officers
who lived in Ohio. Columbus, Ohio. And so it
was like this. And the management office was
in Miami where they paid the bills and collected
the money and all that. And so here we have this
nursing home in a very rural area, small town
in southwestern Virginia. And the residents are
getting these horrific pressure sores. They're
not being bathed. Their hair is not being cut.
Their nails aren't being, I mean, it's just like,
like they're living, it's unreal. And so I got
to look at, I got to read patient records and
reports and look at photos and, you know, all
those horrors that, you know, sparked outrage
in me. And so we investigated that case and it
took a long time because those cases are very
difficult. We ended up using the racketeering
statute as a means of grabbing the guy in Miami
and the operations officer in Ohio because they
have plausible deniability. I'm not there. I'm
not there every day. I come in once every quarter
and check things out. I rely on the staff at
the facility. But at the same time, wait a minute.
No, you're calling the shots in terms of budget.
And when the facility calls and says, oh, we
need to buy washcloths. And you tell them no,
because that's out of the budget. Or they call
and say, we need to hire a couple more people
because we have nobody to work on weekends. And
you say, no, you've got to be held responsible
some way for that. So we use the racketeering
statute in that case. But that kind of, again,
was. You know, looking at those records, I mean,
I tend when I do a case, I tend to get into the
weeds. I tend to look, you know, at the evidence.
I tend to read the statements, the witness statements
and read the patient records and all that. So
that gave me a kind of an education in how nursing
homes work and the finances involved and how
how the finances can be controlled by an outside
party that's interested only in making money.
The facility itself and the residents are left
basically to rot. So after doing that case, fast
forward to, hey, I retired in 2022. All of a
sudden, Dope Sick was out and I was getting all
these requests to be on, you know, podcasts and
interviews. And so this filmmaker out of Los
Angeles named Susie Singer Carter had. had an
experience with her mother who was a dementia
patient that she was the main caregiver for,
contacted me to be on her podcast, but not to
talk about Purdue specifically, but to talk about
the Abbott case. So I did that. I went on her
podcast talking mostly about the Abbott case.
And then she, after that, she reached out to
me again and said, hey, I'm having issues with
the nursing home. My mom, you know. Can you give
me any guidance? So I started, I tried to help
her find an attorney to represent her and her
mom out in Los Angeles. And I also started just
kind of walking her through what I knew of the
process and what her mom was going through and
the root of the problems, basically a neglect
and abuse issue. pressure sore, stage four pressure
sore that went unreported and, you know, hospitalizations
and all that. And, you know, we got to the point
where she was having a difficulty getting an
attorney to agree to take the case. And we can
talk about the whys of that in a little bit.
And I just said, hey, wait a minute, you know,
here's the problem. Elderly people with dementia
in nursing homes, it's difficult for attorneys
to see the value of a case that involves neglect
and abuse of those people because there's no
lost wages and there's no medical bills. The
bills are being paid for by government programs.
And those are usually the two main things for
valuing a case by a lawyer. But the damages here
are the pain and suffering because it's horrific.
pain and suffering, not only to your mom, but
to the family, having to witness what's going
on. And I said, you're a filmmaker, start taking
videos, show a day in the life, show what's happening
to your mom. So she did that. And that ultimately
convinced an attorney to take the case, helped
convince an attorney to take the case. And then
When her mom finally passed, we were just having
a conversation after kind of an aftermath conversation.
And it was this discussion about how the system,
this is really a system problem. Her mom was
the victim of a system that rewards understaffing,
rewards neglect, has very little accountability
for things that are, again, you know, flashback
to Purdue. There's very little individual accountability
for. Those kinds of things on the part of owners
and people making money off of it. How do we
change that system? So the thought I had was
I worked all these cases. I spent hours and hours
working these individual cases and nothing seems
to change in terms of the system. It just keeps
getting worse. Maybe we need to go to the public
and educate them. Maybe we need to do it where
there's a public get their information these
days. It's film, YouTube, podcasts. They don't
read for the most part. They don't watch traditional
television. Nobody watches CNN anymore, those
kind of shows. You got a whole new generation
that gets their information a different way.
So we decided, let's try to reach that next generation
with a documentary. And so that's how we just...
came onto the production of No Country for Old
People, which is currently a three -part docuseries
streaming on Amazon, with the thought of we need
to let the public know, especially the next generation
who are going to inherit the problems, especially
of aging, because there are so many of us who
are aging right now. The next generation are
the ones that get to figure out how to take care
of us and who need to know what's going on and
what the problems are and what the root of the
problems are. So that's the thought of let's
do this documentary and whatever follows on to
that, we're trying to figure out what to do next.
in that area but how do you convince people and
and just not it's not only uh with nursing homes
but it's probably with a lot of other issues
that our generation is handing a whole bunch
of problems on to the next generation we need
to somehow prepare them for those problems well
i think what you decided to do was i i agree
100 the right way and i'm actually working on
a tv uh adaptation of my last book to do the
same thing i think the way that you really get
to the hearts and minds is you got to do it through
the screen that is where we all are transfixed
these days and get people to understand that's
what dope sick did so so well was it wasn't just
portraying the corruption and the the dogmatic
nature of the way Your team was pursuing the
case, but also the human stories, you know, the
doctor that got addicted, the girl that almost
made it out and didn't in the end. I mean, just
these, you know, the connection. Johan Hari says
the opposite of addiction isn't sobriety. The
opposite of addiction is connection. And you
see that when these families come together, people
start healing, all these communities come together.
And then the converse is also true. The more
you divide, the more you prey upon people for
your own personal gain, the more we start falling
apart. And I think that the documentary world
especially is doing such a great job of that
at the moment. So we talked about, again, this
horrendous predatory element when it came to
Purdue. Talk to me about the nursing. nursing
facility world because i mean i think you did
a good job in the documentary of saying look
it's not the nurses there are some bad nurses
i've seen them as a paramedic i've been to awful
awful nursing homes my grandmother was in one
in england that we paid or she paid you know
her um my granddad left the money but a lot of
money but she was treated so well but they were
just very very lucky to have the the money for
that and then my brother -in -law's mother She
had the exact sores that you're talking about,
and she ended up passing away. So you're very
deliberate in saying, look, it's not the nurses
specifically, not the staff. It's the understaffing,
which we're seeing in the first responder professions
and the mismanagement of cities and counties
and fire chiefs and police chiefs at the moment.
So parallel that with the nursing world that
you were seeing in these homes. Yeah. It's all
about cutting costs. Okay, so in nursing homes,
most of the money, 70 % or more, comes from the
government. It's mostly Medicaid for long -term
care and Medicare for the rehabilitation for
the short -term care. So the companies that run
nursing homes, that's where their money's coming
from. And it's a fixed amount, right? It's not...
We'll do more service and we'll get paid. It's
a per diem amount that's fixed. So how do you
maximize profit? Well, the only way you maximize
profit in that kind of a financial environment
is to reduce costs. What's your biggest cost
in a nursing home? Your biggest cost in a nursing
home is labor. So if you're going to make maximize,
you know, if you're going to do optimize and
maximize your profit is you cut labor. Okay.
And so labor means staffing. And so the more
you cut staffing, the less hands -on care you
have for nursing home residents. And let's face
it, the reason they're in the nursing home in
the first place is because they need 24 -7 hands
-on care. You cut back that hands -on care, you
have delays in answering call bells. You have
delays in providing sort of basic hygiene. You
have delays in a lot of the residents cannot
move about themselves. So they have to be helped
up, helped out of bed, helped and put into a
wheelchair maybe or help to the bathroom. You
cut out the staffing to do all that. Then you
have people who are basically end up just laying
in one place for most of the time. with no kind
of mental or emotional stimulation. And they
develop illnesses. They become dehydrated. They
become malnourished. If you don't have enough
staff to help them eat, they develop pressure
sores. They develop infections. uh because you
don't have enough staff to provide hygiene and
sanitation and help them move around and you
know you get from there you go into sepsis and
from sepsis you go to death and you know i i
know it's very easy to say well they're you know
they're old people and they're at the end of
their life anyway and they've already lived their
lives but One of the people that spoke in the
docuseries says, you know, it's not necessarily
dying, it's how you die. And to be neglected
and have pressure sores and be malnourished,
not fed and dehydrated, those are all forms of
torture. And none of us. I don't care how old
we are, how long we've lived our lives, how well
we lived our lives. None of us deserve to die
while being tortured. And so that business model
of understaffing is what leads to that kind of
treatment. You know, it is what is really happening
is in the large corporations and the private
equity groups that are that are starting to take
over nursing homes. And I'm not and it's just
not private equity as sort of the formal business
model. It's a private equity model that is being
adopted by corporations and individuals. It's
not necessarily they're not necessarily. private
equity per se, but they've got that model. But
the model is to take out as much money as fast
as you can. And the way you do that and keep
the flow of money coming from the government
at the same level is to create what are called
related entities. So a good many of the nursing
homes that are in the private equity model, building,
the real estate is held by another company. They
have other aspects of the business, like a management
company that runs the accounts receivable, takes
in the payments from the government, pays the
bills. That's another separate entity, but all
of these other entities are all owned by the
same either corporate or individual person. And
all they're doing is moving the money from the
nursing home into these other entities. The rent
that the real estate company charges is often
inflated. The management company is charging
a pretty hefty fee just to run the bills and
to pay, you know, issue checks to pay bills.
Sometimes they own the physical therapy company.
Sometimes they own the staffing company to bring
in visiting nurses. But they're taking money
out. I think there are some studies that have
been done, two studies that have been done that
show that 63 % of the profits that nursing homes
make are being funneled out. They call it tunneled
out to related party entities. I mean, that's
63 % of the profit. So what they show to the
government is We're not making any money or we're
losing money, and therefore you need to increase
how much you pay us. But what's hidden underneath
is the fact that they're pulling money out secretly
into these related entities. In order to, you
know, if they're private equity, they will need
to do a return on investment to their private
equity shareholders. Or if they're just greedy
corporations or businessmen, they're just taking
out the money for themselves. That business model
is being allowed to go forward by CMS, the Centers
for Medicare and Medicaid Services, an agency
of the Health and Human Services Department,
because of the lax oversight, the very weak reporting
that they require, and the lack of enforcement.
And again, so the same pattern, our government
agency that's supposed to be the Watchdog over
that is kind of is complicit, is allowing it
to happen. And it's all about making as much
money as you can. And you will see the depersonalization
of nursing home residents in corporate books
and records, financial records. They're not called
residents or they're not called people. They're
called beds. OK, so completely depersonalized
and just as. uh people addicted to opioids are
stigmatized and you know just written off as
addicts well these are just beds in a facility
they're not really people that's again the corporate
part of the corporate model i mean you just see
the same blueprint no matter what industry we're
talking about and i think you know where it really
kills me is when areas need funding people say
oh we don't have the money there's not enough
oh you want to raise taxes and it's not even
about that If you look at the nation as we sit
here now, we are 70 % overweight, of which 40
plus percent is obese. So if you just simply
actually valued the citizens and you put in programs
like real food in schools and put PE programs
back in and bolstered local farmers to grow clean
food, you know, you would. turn that around and
then you'd have all of this money to start putting
in and then you know prisons and nursing homes
and all these other places would not be as you
know as uh overcrowded as they are and your first
responders wouldn't be worked into the ground
but it's if you have this model where that doesn't
matter we're just we're just servants to the
machine and you're just focused purely on profit
This is just going to get worse and worse and
worse. And my profession, if we don't change,
if we don't stop working our men and women into
the ground while our chiefs go home at five every
night and don't care, then there will be no one
when you call 911 anymore. There will be no doctors
and nurses left to staff these facilities if
we keep treating them this way. So I don't know
how we can get to the point of enough is enough.
And I think storytelling is a big part of that.
But I mean, I don't think it's too dramatic to
say that we're getting close to that point now.
Yeah, I mean, you know, the other thing we document
in No Country for Old People is what's called
moral injury. And I'm sure you know in your profession
that that's a real thing, right? You're told
you can't do everything you feel like you need
to do. because you're not given enough resources
and you're not given enough support to do it
and that's what's happening with our our health
care workers not i think not just in nursing
homes but across the board is that they're you
know they're people go into those professions
you know first responder um health care worker
they go into that out of a sense of wanting to
help people right and when you're not able to
do that the way it should be done you have an
injury. It's an, it's a moral injury. There's,
there's, it affects you, right? You don't, you
don't just walk away and say, Oh, I did what
I could do. And, you know, so, you know, it has
an impact on you emotionally and psychologically.
And that's a real thing. And people, they, they,
people are not going to, they're not, they're
going to leave because they cannot take. the
moral injury day in and day out. And that's kind
of what's happening in nursing homes, in healthcare
in general, with nurses in all kinds of different
facilities and other caregivers. And it's what's
happening with first responders. If you're not
given the ability to do the job, you're there
because you have a sense of duty and a sense
of purpose. But if you cannot, if you're prevented
from doing it the way it should be done, you're
going to have some sort of an injury. I think
the question that we need to ask ourselves is
if we feel so deeply when we lose someone, the
inability to save, whether it's lack of training,
lack of resources, whatever the thing is, and
that does affect us so deeply, why do these people
that make these decisions that hundreds of thousands
of people die not have moral injury? And it goes
back to my question, are they fit to even be
in that position in the first place? Because
as a servant, we feel it so, so deeply. I can't
even comprehend being at the head of a tobacco
company, knowing that 8 million people or 6 million,
excuse me, 6 or 8 million people around the world
die annually from my product. And, you know,
it doesn't bother me. That's hard to imagine,
hard to fathom, right? It's hard to... There
are people like that out there, but there are.
And yeah, they shouldn't be. You know, one of
the things about the case, the two cases that
I did, both the Purdue case and the Abbott case,
was that at least Health and Human Services Office
of Counsel to the Inspector General has the ability
to exclude people from basically Medicare and
Medicaid. In essence, that excludes them from
health care. So we had exclusions of the three
top executives. They were no longer able to work
in health care for a period of 12 years. And
then we had an exclusion of the nursing home
owner from Miami and the official from Ohio.
I forgot how much she got excluded for, but he
got excluded for like 50 years. So he was never
going to be in the business, nursing home business
again. And so, yeah, you know. Definitely had
that sense. These guys don't, they shouldn't
be doing this stuff. They shouldn't be in this
business. And there's a, there is a mechanism,
an administrative mechanism, at least in healthcare
to, to do that. Again, it's getting the government,
the agency to want to actually act on with that
authority, actually utilize that authority, but
it's there. So again, you know, it's like, you
know, there's things you can do, but. even though
you get knocked back and you're not able to do
as much as you can, it's like, well, let's keep
fighting. You got to keep fighting. Absolutely.
A hundred percent. Well, I could talk to you
for another two hours easily, but I know you've
actually got to call Todd in a few minutes. So
for people listening, where are the best places
to find the documentary? And then if they want
to reach out to you personally. Yeah. The documentary
is on Amazon. It's called No Country for Old
People, a nursing home expose. It's a three -part
docuseries. I think it's also on Tubi. So if
you don't have Amazon, you can go to Tubi and
look up No Country for Old People. I'm on LinkedIn.
I guess if you could, Rick Mountcastle on LinkedIn.
I haven't checked it lately. Also on Facebook.
So there are two places you can track me down
at. So, yeah, happy to connect with anyone that
wants to help move things forward. Well, I want
to thank you so much. I mean, firstly, obviously,
for what you have actually done for so many people,
I mean, especially nationally with the Purdue
case. I don't think people... would ever really
comprehend the the ripple effect of the lives
saved you know with with what you and your team
did and obviously all the voices of that community
too that stood up and then now with the the nursing
home side as well so not only that though i just
want to thank you for being you know one of the
beacons of light because i completely believe
that if we just have hope and we believe that
every single one of us can be part of this fight
and as you said whatever your skill set is I
never thought that talking into a microphone
would be something that I would do or write in
books, but here we are. But yeah, just being
part of that movement, saying, you know, just
rolling up your sleeves and saying enough is
enough. So I want to thank you so much for being
so generous with your time today and coming on
the Behind the Shield podcast. Hey, James, thank
you for having me. And it was, I enjoyed it.
And, you know, greetings to all your listeners.