COLUMBUS, Ohio - Employees at a southern Ohio pain clinic had strict marching orders, authorities say: Set up enough appointments to fill 30 to 40 prescriptions of powerful painkillers a day at $125 a visit.
Workers who met the quota would receive a week's pay for three or four days' work, according to the government. Those who slipped up got less.
Gov. John Kasich planned to sign a bill Friday cracking down on such operations, dubbed pill mills by their critics and blamed by health officials for contributing to hundreds of overdose deaths in Ohio each year.
The new law for the first time would require the State Board of Pharmacy to license pain clinics as distributors of dangerous drugs.
The legislation would also put limits on how many pills a doctor could dispense directly at a clinic, and tries to reduce the illegal distribution of prescription painkillers by creating a statewide system for collecting unused supplies of the narcotics.
The law provides "an opportunity to close some of the loopholes that have caused many of our neighbors, friends or family members to fall victim to prescription drug abuse and related death," said Rep. Terry Johnson, a Republican from Scioto County and a doctor and former county coroner.
Other states have pushed similar pill-mill legislation, most notably Florida, where lawmakers this spring approved stiffer penalties for doctors who overprescribe painkillers and enacted tighter regulation of pharmacies.
The allegations against Ohio Medical and Pain Management in Waverly are similar to charges brought against other pain clinics and doctors in recent months, many of them operating in southern Ohio, considered by the Drug Enforcement Administration to be one of the worst places in the country for prescription painkiller abuse.
"In some cases, customers traveled in excess of 200 miles round trip or in excess of four hours travel time round-trip to be `treated' at the clinic," according to a 2010 indictment against the clinic's operators and a physician who worked there.
Each customer, required to pay cash, "would receive at most a cursory examination at the Clinic by someone other than the physician," the indictment said.
The indictment also alleges clinic operators and employees used the federal prescription-writing certificate issued to the clinic's physician, Dr. Brenda Banks, to order more than 200,000 painkillers, mainly hydrocodone.
The clinic operators would then keep the pills for themselves or resale to local drug dealers, the indictment said.
"Banks would often allow Clinic employees to make their own arbitrary medical determinations on the customers ailments based on a brief interview of the customer and no other type of evaluation," according to the indictment against Banks and clinic operators Nancy and Lester Sadler.
The state medical board revoked Banks' license in 2008. Messages left Thursday and Friday for her attorney were not immediately returned.
An attorney for Lester Sadler defended the clinic's operations.
"They did everything they could to ensure that proper medical care was given to the patients and pills were not given out to people who shouldn't be receiving them," said Cincinnati attorney Richard Goldberg.
Nancy Sadler's attorney did not return phone calls, and attorneys for the other three defendants declined to comment.
Kasich has made prescription painkiller abuse a top priority, visiting Portsmouth in southern Ohio, considered an epicenter of the problem, even before he was officially sworn in in January.
Community activists say the region's painkiller abuse, which took off in the 1990s following the introduction of Oxycontin, has created problems that will take generations to fix.
"It affects the schools, it affects the health care down here, it affects employers," said Bob Walton, a member of the Scioto County prescription drug abuse task force.
"If you were trying to hire 50 people, it would take you a while to get through enough people that would be able to pass a test without that in their system, and maybe would not have a prescription to prove why they're on it," he said.