Dr. Opioid – HuffPost Highline Opioids, Opioid Crisis, Pill Mill, Dr. William O'Brien, Philadelphia, Pagan's Motorcycle Club

Story by Chris Pomorski Illustrations by Chris Visions

William O’Brien was a well-heeled doctor with a thriving Philadelphia medical practice. He was also at the center of a massive painkiller supply chain run by an outlaw biker gang.

His ambition was nurtured, above all, by his grandfather, who started as a bricklayer during the Depression and died a millionaire at 78. O’Brien was the eldest of three children born to working-class parents, and it was money from Pop Pop, as O’Brien called his grandfather, that paid for his medical education. His cousins John and David Capponi, with whom O’Brien grew up, marveled at his intelligence. He read voraciously and seemed to have a photographic memory. “He was scary smart,” John said. The best student of the three, he received a scholarship at their private Catholic high school. But by the measures of masculinity esteemed by teenage boys, he lagged behind. “He was the fat guy that everybody teased,” David remembered. O’Brien envied John, a strapping football letterman known to pummel the occasional loudmouth. Fairly or not, John’s reputation was bolstered by his last name, which, in an era of colorful Philadelphia mob figures, could evoke gangland associations. When friends joked about this, the Capponis, whose family had no Mafia connections, would laugh it off. But the correlation appealed to O’Brien. “Bill liked the idea of being able to intimidate people,” David recalled. “I wouldn’t be surprised, when we were younger, if he’d introduced himself as Bill Capponi.” O’Brien attended medical school outside Miami. In May 1992, as he was nearing graduation, he went on a date with Kathy Hardiman, a fitness trainer. At the time, O’Brien weighed 280 pounds and was sure she was out of his league. But to his surprise, Hardiman found him attractive: smart, funny and ambitious. Within months, he asked her for her ring size. John asked O’Brien why he was rushing things. “I’m never going to get another woman that looks like that,” he explained. When Hardiman suggested that she might need more time to consider the proposal, O’Brien replied with a line that might have been cribbed from Pacino or Pesci: You will be asked once. In retrospect, Kathy says, she should have heard it as a warning. The couple married in 1993 and settled in Pennsylvania. Two years later, O’Brien opened a medical practice, which he would later call WJO Inc., in Newtown, about 30 miles outside Philadelphia. It was a moment of flux in the way the American medical establishment thought about pain and its treatment. For decades, doctors had considered opioids, a class of drugs that includes morphine and oxycodone, a prescription of last resort, suitable only for excruciating cancer pain, severe injuries and postoperative convalescence. That view started to change in the late 1960s, with the advent of the hospice movement. In the mid-1980s, doctors at Memorial Sloan Kettering Cancer Center in New York started using opioids to treat patients with afflictions as diverse as back pain and sickle cell anemia. By the end of the decade, states were adopting laws and guidelines that endorsed the value of opioids to treat chronic pain. In 2001, following lobbying by the pharmaceutical industry, hospitals took up pain as the “fifth vital sign.” As Barry Meier writes in “Pain Killer,” his account of the origins of the opioid crisis, physicians were encouraged to “ask patients about their level of pain and to treat it, often with opioids.” The same year O’Brien founded his practice, Purdue Pharma introduced the now-infamous oxycodone drug OxyContin with a marketing blitz that would prove to be flagrantly dishonest. O’Brien, an osteopath who specialized in treating injuries, was acutely aware of the new view of pain. “When I went into practice, you could be sued for not treating pain,” he recalled. But he was conservative with opioids, preferring treatments such as trigger point therapy and electrical nerve stimulation. He had reason to be cautious. Soon after OxyContin hit the market, a wave of oxycodone abuse swamped the nation, and before long, doctors were being indicted for overprescribing it. Once, when O’Brien met with another physician about the possibility of buying his practice, the man opened the discussion by asking whether he was wearing a wire. The implication was clear: The other doctor had been writing illicit prescriptions and suspected that he was being watched. On another occasion, while O’Brien and an employee were readying office space for a WJO satellite, they found a photograph of the former tenant, a doctor who’d been imprisoned for the rampant overprescription of opioids. “Bill went on a long rant about how stupid it was,” the employee said. “He said, ‘Why would you ever risk it?’” In any case, O’Brien had no motivation to gamble: His practice was thriving. Within 12 years, WJO had seven medical offices and was generating an estimated $12 to $14 million annually. Over dinners, drinks and outings to sports events, O’Brien cultivated relationships with hundreds of personal injury attorneys who could refer car accident victims. The model furnished a steady stream of new and potentially long-term clients. When accident patients’ car insurance coverage was exhausted, the practice encouraged them to continue treatment as chronic pain patients, subbing in their medical insurance to cover the payments. The O’Briens’ three children attended private Catholic school; the family lived in a gracious home in an exclusive suburban enclave and rode in luxury cars. O’Brien was generous with friends and employees, distributing envelopes of cash and paying for air travel. For his 40th birthday, in 2005, he threw a lavish party at a private clubhouse. Its theme evoked the gangster extravagance of Roaring ’20s bootleggers, with tables decorated with golden bricks. As a party favor, he distributed a soundtrack for the event that opened with the theme music from “The Sopranos.” Friends remember that in the cover photo, he appeared in a three-piece suit and held a Tommy gun.

According to family lore, O’Brien began his path to medicine when he was 7 years old. Swinging a golf club one day in his grandparents’ backyard, he inadvertently hit his sister, cutting her below the eye. In the emergency room, he watched two young physicians stitch the wound. From then on, he wanted to be a doctor.

In 2008, O’Brien and Hibbs, whom he promoted to chief operating officer, moved into a historic penthouse overlooking Rittenhouse Square, a colonial-era park in one of Philadelphia’s toniest neighborhoods. The condo cost nearly $2 million, and the couple set about restoring it to high early-20th-century glamour, drawing up plans to add crystal chandeliers and sconces. O’Brien was besotted with Hibbs, who was voluptuous and dark-haired. “Bill would often describe her as the most beautiful woman he had ever met in his life,” Madison West, a close friend, said. Yet many people in O’Brien’s circle felt uneasy about the relationship. “She was so demeaning to him,” West said. “She said that he was stupid. She would curse at him.” O’Brien told West that once, in the midst of an argument, Hibbs threw a safe off the balcony. (Hibbs denies this.) Another time, in an apparent effort to humiliate him, she appeared nude in front of two of his friends. As their relationship intensified, O’Brien saw his friends and family less. “She cut him off from everybody,” O’Brien’s mother said. When the couple wed in 2010, in a sumptuous Las Vegas affair, Hibbs tried to stop O’Brien’s daughter from attending the reception. Another friend recalled that Hibbs would tell O’Brien, Your daughter is spoiled. She doesn’t love you. She only cares about your money. His resources, Hibbs suggested, would be better spent on her and her two college-age daughters. “Bill unfortunately adopted that idea for a period of time,” West said.

As O’Brien’s business boomed, Kathy says, things at home grew tense. Family life interested him less, and he found reasons to be away even when he wasn’t working: nights out with pharma reps, trips to Las Vegas. He became cocky, flirtatious with other women. He was fond of strip clubs. “He started thinking he was this king,” Kathy said. “And [in his mind], there would be the wife, and then there would be mistresses.” O’Brien felt Kathy bullied him about his weight. In turn, he could be verbally abusive. With help from a private eye, Kathy learned that O’Brien was having an affair with one of his physician assistants, Elizabeth Hibbs. Kathy filed for divorce, initiating a lacerating child support and alimony dispute.

He was also convinced that the federal government was persecuting him. The previous September, following various purported regulatory violations, the FBI had confiscated a hyperbaric oxygen chamber O’Brien had designed and was using to treat patients. He considered the seizure illegitimate. To compensate him for damages, he calculated, the feds owed him some $635 million. It did not hurt, either, that Nocille projected outlaw authority of a kind O’Brien had long admired—he even badgered him for a Pagans T-shirt. To assist in his new venture, Nocille approached a childhood friend, a tow-truck operator named Michael Thompson. Nocille suggested that to make some extra cash, Thompson go see O’Brien, tapping a Pagans associate named Joseph Mehl to facilitate the introduction. In February 2012, Thompson and Mehl met at the South Philadelphia office of WJO. In the waiting room, Mehl helped Thompson fill out his paperwork. It was important to alert the doctor that Thompson could be trusted, so Mehl listed Thompson’s source of referral as “Cousin, Sammy Nocille.” In the examination room, Thompson complained vaguely of back and neck pain. But O’Brien showed more interest in his affiliations than his health. “Oh, Sammy is your cousin?” Thompson recalled him asking. “What do you need?” Following Mehl’s instructions, Thompson asked for oxycodone. “Let me see what I can do,” O’Brien told him.

In early 2012, a tattooed and powerfully built man began to appear with unusual frequency in one of WJO’s offices. Sammy Nocille was the vice president of the local chapter of the Pagan’s Motorcycle Club. Among his friends, he was known as shrewd and predatory. How exactly he met O’Brien is unclear. But in the doctor, Nocille perceived a lucrative revenue stream: routing prescription drugs to the black market. Frantic for cash, O’Brien had become less averse to the idea than he’d been earlier in his career.

“They have an old-fashioned ideal of masculinity,” said Donald Charles Davis, a former club member and Vietnam veteran whose website, The Aging Rebel, chronicles outlaw motorcycle exploits. “It’s a cliche to describe motorcycle outlaws as cowboys on iron horses. But they often think of themselves that way, as living on their own, not hemmed in by the rules and regulations that [others] are defined by.” (Davis died in June, as a result of injuries suffered in a fall.) In the 1970s and 1980s, the Pagans, like other outlaw clubs, evolved from a primarily social affair into a structured criminal enterprise. They established chapters throughout the mid-Atlantic. A governing board known as the Mother Club oversees the organization under the leadership of a president who dictates policy. Each Mother Club member takes responsibility for a geographic region ranging in size from a few counties to several states. Beneath them are chapter presidents, vice presidents, secretary-treasurers, sergeants-at-arms and the rank and file. In 1983, testifying before a permanent subcommittee of the Senate Committee on Governmental Affairs, a Pennsylvania State Police investigator named George Ellis estimated that the Pagans controlled 60 to 70 percent of the manufacture and distribution of PCP in the greater Philadelphia area, and 30 to 50 percent of the region’s meth trade. Raids of Pagan property in Pennsylvania had lately turned up “automatic weapons, plastic explosives, dynamite, hand grenades, blast simulators for the cruise missile system, and every size and type of firearm normally available to the general public.” A recent case, Ellis said, “involved the recovery of homemade bombs from a Pagan member who was wanted for the attempted murder of a law enforcement officer.”

Founded in the late 1950s in Maryland, the Pagans are the smallest of the major outlaw motorcycle clubs in the U.S., which also include the Bandidos, the Hells Angels and the Outlaws. Often called one-percenter clubs — as distinct from those with American Motorcycle Association charters — the outlaw clubs trace their origins to the post-World War II era, when they drew from returning GIs seeking hard-drinking male camaraderie. The clubs proved attractive to subsequent generations of veterans, particularly those who’d served in Vietnam, providing a culture of brotherhood to a membership that skews blue collar and white.

Nonetheless, researchers consistently identify street dealers as a primary source for off-label prescription opioid users. In 2012, researchers in Florida published a paper in Drugs: Education, Prevention and Policy that sought to provide clarity on the question of how street dealers acquire their inventory. The savviest dealers employed a practice that would soon be familiar to Michael Thompson. “The most voluminous sellers of pills reported developing large networks of individuals that would visit pain clinics on their behalf,” the authors wrote. “I’d rent a van,” one dealer told them. “We’d pile up and they go in there, fill out the paper, and … Boom!” The authors called this practice “sponsorship.” The HHS agent who worked on O’Brien’s case confirmed, “It’s been there in every big pill case I’ve been involved in.” A notable flashpoint for the prescription epidemic was Florida. By 2010, pain clinics there accounted for 85 percent of all the oxycodone prescribed in the country, often operating out of shabby strip mall storefronts perpetually mobbed by drug users and out-of-state dealers. Within two years, Florida shut down several hundred of them, and opioid prescriptions nationwide declined from a high of more than 255 million, in 2012, to roughly 168.2 million in 2018. Conscious of being monitored, pill mill operators of the present day tend to be more sophisticated. Indictments in April of last year charged doctors in Appalachia with performing unnecessary procedures to justify prescriptions, while last February, following a DEA initiative known as Operation Hypocritical Oath, a California doctor pleaded guilty to writing oxycodone prescriptions for fictitious patients in coordination with a dealer who sold the drugs to users. In September 2019, authorities indicted Texas doctors and pharmacists for their role in a multimillion-dollar pill mill that involved using falsified prescription pads from physicians whose identities had been stolen.

The murkiness that surrounds pharmaceutical diversion arises in part from the fact that there is a great deal of culpability to go around and little agreement on how to distribute it. Officials charged with regulating the medical industry have tended to pin responsibility on doctors, pharmacists and other health care workers. Doctors and pharmacists blame doctor-shopping patients and prescription forgers. How users describe their procurement methods varies by location and demographics: insurance fraud, friends and family, pill mills, the elderly. (DEA officials estimate that less than 1 percent of the 1.8 million licensed prescribers in the U.S. are deliberately engaged in drug diversion.) An influential 2009 paper published in the Journal of Addictive Diseases calls diversion “a black box.”

One day at the South Broad Street office, Thompson witnessed a conversation about a man named Anthony Rongione, who had become a patient after a car accident. According to O’Brien’s calculations, Rongione had run up a debt of $11,000. O’Brien had tried to collect without success. I do favors for you, Thompson recalled O’Brien telling Mehl in an exam room. You have to do a favor for me. According to Thompson, Mehl replied, “I will call [Patrick] now.” Patrick Treacy, who went by Redneck, had been a Pagan for many years. By his mid-40s, he had spent much of his life imprisoned for crimes including aggravated assault and making terroristic threats. Once, at a bar, he’d shot another patron point-blank through the lung. Thompson was familiar with Treacy’s reputation. “He didn’t care about too much,” he said. “And that’s what they done. … They called Redneck.” O’Brien leaned against an examination bed, writing down Rongione’s address. It was not long thereafter that Anna Marie Rongione observed Treacy (the bearded, burly man) and Mehl (the balding, wiry one) through the second-floor window of her South Philadelphia home. O’Brien continued to nurse a grudge against his ex-wife, Kathy, too. “She has to go, Mikey,” Thompson recalled him saying. “Who could we get?” Thompson considered this beyond the pale. “I told him he is crazy,” he said. “It’s your wife.”

The system beneath Michael Thompson developed into a sophisticated, Amway-style operation. A number of his recruits developed subgroups, too, and paid kickbacks in kind. At the peak of his partnership with O’Brien, Thompson made about $500,000, while the doctor, in the perhaps somewhat inflated estimate of the U.S. Attorney’s Office, profited some $2 million over the course of his collaboration with the Pagans.

At some point, Murphy, a waitress, started giving him cash to pay for drugs; she hoped it would discourage him from stealing. But in 2011, Hart and an accomplice pleaded guilty to third-degree murder. Desperate for drug money, they had assaulted a 90-year-old woman and taken her purse, which contained $185. The woman later died from her injuries. Hart, who was 22 at the time, received a 20- to 40-year prison sentence. Murphy mourned the loss of her son, and could not help but feel for the family of his victim. To her, the epidemic seemed ubiquitous. “If you have 100 properties on a street,” she liked to say, “[in] 85 of those homes at least … it has somebody or someone that is addicted to heroin.” This perception was reinforced by the time she’d spent working at a diner near O’Brien’s South Philadelphia office. Three co-workers had been patients of his. At least one sold the opioid pills O’Brien prescribed. Another, an older woman, became addicted to heroin, which was cheaper, when she couldn’t afford to pay O’Brien’s $200 office fees. Murphy relished the chance to help prosecute the doctor. “My son is in jail … because he was a heroin addict because … a doctor in South Philly gave [a] prescription to a student who sold to other students,” she said. On another occasion, Murphy remarked, “O’Brien is a scumbag.” Not long after meeting Huffman, she visited O’Brien’s office and asked for an appointment. Crucially, she mentioned the name of one of her former co-workers from the diner. The receptionist told her to wait; many people were already on a waitlist to become patients, she said, and she had to ask the doctor. After a time, O’Brien emerged, gave Murphy a once-over, and went back inside. Some weeks later, Murphy returned for the first of 15 appointments. On each occasion, Huffman outfitted her with a black handbag concealing video and audio recording equipment. O’Brien’s practice did not operate like the medical offices Murphy was used to. Loud music blared in the waiting room, where she often spent an hour or more in a standing-room-only crowd. Once, the person who led her to an exam room was a man who looked “right off the street,” in a denim jacket and headband. “It was really, really, very chaotic,” she said. O’Brien’s examination struck Murphy as cursory. Neither he nor anyone else ever took her blood pressure. Beyond asking what had brought her into the office, O’Brien did not take a medical history. Following a plan that she had discussed with Huffman, Murphy complained of headaches. She mentioned that she occasionally took Percocet, and that the medication helped. After indicating that he did not prescribe narcotics on a first visit, O’Brien told Murphy that in her case, he would make an exception. He suggested no over-the-counter alternatives.

For perhaps a year, the FBI tried without success to infiltrate O’Brien’s office. Then, in late 2013, Diana Huffman, the lead agent on the case, met Marian Murphy. Murphy had spent time in state prison on charges of theft and forgery, and experienced post-traumatic stress from an abusive marriage. She also had strong personal motivations for participating in the investigation. Her son, Daniel Hart, had started abusing prescription opioids in high school. He later became addicted to heroin.

The government ultimately charged O’Brien with, among other things, distribution of controlled substances, health care fraud and conspiracy to engage in money laundering. O’Brien chose to act as his own lawyer. “That was a huge mistake,” said Troyer, the prosecutor. “Any drug dealer could tell you, you set aside money, and if you get caught — because someday, you probably will — then you spend that money on a good attorney.” But O’Brien still thought of himself as a doctor, not a drug dealer. He had front-row Flyers tickets, after all — in the same row as a Delaware senator — and he’d once lived in a penthouse on Rittenhouse Square. He seemed to believe that if he could just make the jury understand these things, they would find him blameless. Rather than take a plea, he chose to go to trial.

“People might say, ‘A white-collar guy—a doctor—and an outlaw biker? That don’t make sense,’’’ said a former Pagan. “To me, it does.”

Despite their difficulties, O’Brien and Hibbs lived well. Over the years, they vacationed regularly in Florida and Aruba. They traveled to Napa Valley, stayed at the Four Seasons, and booked tables at Tavern on the Green and Del Frisco’s. O’Brien showered Hibbs with diamond jewelry, designer shoes and handbags. To decorate her house at the Jersey Shore, he commissioned a portrait of Hibbs by Pino Daeni, an artist known for his illustrations of bodice-ripper paperbacks. On their bed, he once spelled out “I Love You” in hundred-dollar bills. But Hibbs was not easily satisfied. A friend and former WJO executive said that Hibbs once responded to a lunch invitation by saying, “I only eat if I can have Dom Perignon.” “She wasn’t kidding,” the former executive said. (Hibbs largely denies the details of her relationship with O’Brien reported in this story. When contacted for comment, she said, “I was a hardworking woman that fell in love with a bad guy. It was innocent. You’re making it ugly.”) Though business at WJO was brisk, O’Brien was spending so much money that he ultimately had to reduce staff. Remaining employees took pay cuts. Several people close to O’Brien told me that at some point, Hibbs forbade him from making any further payments to his ex-wife, and in 2010, to duck alimony obligations, he declared both personal and corporate bankruptcy. He was forced to put the penthouse on the market, a development that enraged Hibbs. “I want that place,” the executive recalled her shouting at O’Brien in the office. “A real man would find a way to keep it.”

O’Brien was forced to put the penthouse on the market. “I want that place,” an enraged Hibbs shouted. “A real man would find a way to keep it.”

“It was important to go after the doctors,” said prosecutor Mary Beth Leahy. “Without them, the pills aren’t going to get onto the street.”

O’Brien kept an envelope at the front desk to store the cash. He collected it twice daily, often stuffed to the point of overflowing.

In the coming months, Thompson returned to the office roughly every four weeks for oxycodone prescriptions. O’Brien prescribed the drug in 30-milligram doses, each of which fetched at least $15 on the street. Thompson was also prescribed Xanax and methadone, which had a street value of $3 or more per pill. He didn’t initially concern himself with these details. For each 120-count oxycodone prescription, Nocille paid him a flat fee of $500. Once Thompson’s prescriptions were filled, Mehl wholesaled the pills to a street dealer. (Among the organization’s retail dealers was an employee at a South Philly deli called How U Doin’.) Nocille got prescriptions of his own, and other Pagans and associates were recruited to pose as patients. His financial agreements with his recruits varied, but the vast majority of revenue flowed up to him. His overhead was limited. Beyond paying each “patient,” he had only to cover O’Brien’s visit fee, which at the time was $100 cash, plus the cost of the prescriptions. It was a lucrative model, yielding for Nocille at least $1,000 profit per patient, per month for oxycodone and methadone prescriptions alone. For O’Brien, the advantages came down to speed, volume and cash payments, which could be concealed from creditors, courts and his ex-wife. His visit fee eventually doubled. On a given day, it would not have been unusual for him to see 60 patients. At the front desk, he kept an envelope to store the cash. He collected it twice daily—at lunch and before he went home—often stuffed to the point of overflowing. A portion of O’Brien’s practice remained legitimate, but a striking number of his patients now received prescription opioids. It is difficult to say precisely when this shift began. But records show that in 2011, O’Brien had written 492 prescriptions for Schedule II controlled substances, a class of drugs including oxycodone and methadone, which the Drug Enforcement Administration considers to have a high potential for abuse and dependence. In 2012, the year he began working with Nocille, he wrote some 3,800, nearly eight times as many. Around the country that year, Americans received 259 million prescriptions for opioid painkillers, or enough to provide every adult with a bottle of pills: the zenith of the prescription epidemic. O’Brien’s volume of prescriptions was notable enough that local pharmacies, calling to verify prescriptions, began to raise concerns with his office manager. Rite Aid would eventually cut him off. His practice faced other perils, as well; bank records suggested that he was routing deposits to personal accounts unsanctioned by the bankruptcy court, and in July 2012, the bankruptcy trustee monitoring WJO Inc. fired O’Brien from the company he’d founded, leaving his business homeless. O’Brien opened a new practice, Dr. Bill O’Brien LLC, with a pair of offices: a suburban location in Levittown and a modest place on South Broad Street, in Philadelphia. At the Philadelphia office, Thompson functioned as the doorman. “I always had to be there to let the Pagans in, the Pagans’ girlfriends,” he said. “Every day, every week … it got bigger and bigger.” By then, Nocille had expanded Thompson’s privileges, allowing him to keep the profits from his prescriptions and to enlist “patients” of his own. He became an organizational catalyst, recruiting friends, family and neighbors from the working-class South Philadelphia community where he’d spent his whole life. Some were drug users. These Thompson paid in methadone. But in the wake of the recession, most were simply strapped, pleased to have the $500 that Thompson offered for each visit to O’Brien. The same economic conditions that fed the epidemic proved fertile for enlisting “patients.” “Sometimes people didn’t have money, you know what I mean?” Thompson said. “So Christmas comes … and that’s what they did.”

Racketeering prosecutions, internecine bickering and vendettas with other outlaw outfits have sapped energy from the club. But the Pagans remain alive to new opportunities. A recent FBI memo, for example, expressed concern that they were potentially collaborating with the Latin Kings to import liquid methamphetamine into the U.S. from Mexican drug cartels. Anthony Menginie, the author of a raw memoir about his roughly 15 years with the club, “Prodigal Father, Pagan Son,” works as an auto mechanic in a rural area an hour’s drive west of Philadelphia, where he and his girlfriend raise chickens. When I told Menginie about O’Brien’s collaboration with the Pagans, the doctor’s attraction to the club didn’t surprise him. “Citizens”—non-outlaws—had often approached Menginie at ballgames and bars to ask how to become a Pagan, buy him a round, and tell stories of their own minor legal run-ins. To Menginie, they seemed envious of his apparent freedom from the strictures of mainstream life. Wayne Bradshaw, who rode with the Pagans in the ’70s, told me that “a lot of people might say, ‘A white-collar guy—a doctor—and an outlaw biker? That don’t make sense.’ To me, it does. It makes a lot of sense.” For the Pagans, O’Brien’s world held its own appeal. One of the main troubles with a front is that its true source of profit lies in goods or services that, if discovered, tend to expose the ruse. A gambling parlor in the basement of a pizzeria strongly suggests that the mozzarella and tomatoes upstairs are secondary. A doctor’s office dispensing illicit prescriptions avoids this problem: The illegitimate practice of medicine involves the same materials and facilities as the legitimate practice of medicine. Evidence of crime might be convincingly explained away as everyday doctoring. The dynamic can make prosecuting corrupt physicians challenging. At WJO, to the casual observer, nothing about the practice had looked amiss. Not long after O’Brien opened his new office on South Broad Street, however, the FBI began hearing complaints from neighbors. “There were these Pagan guys, with their motorcycle jackets and so forth, hanging out on the street, dropping their cigarettes,” Mary Beth Leahy, an assistant U.S. attorney who worked on the case, told me. “People who are obviously drug addicts showing up. Fights breaking out. It was more like a bar than a doctor’s office.” The accounts echoed a tip the FBI had recently received from a former WJO employee, and in the fall of 2012, the bureau installed a camera across the street, monitoring comings and goings outside for eight to 10 hours a day. By then, most states had instituted fairly robust prescription drug monitoring systems. Investigators watched as O’Brien’s volume of Schedule II prescriptions climbed. In 2014, he would write nearly 8,000, about twice as many as he had during his first year in business with Nocille. Agents also used Pennsylvania’s drug monitoring system to identify and interview his patients. “They would detail what kind of a person he was,” a U.S. Department of Health and Human Services agent who worked on the case said. “That he was giving out prescriptions like candy.” But what investigators really needed was an informant, armed with a hidden camera, to record events inside an exam room. “We have to demonstrate that drugs were prescribed outside the course of normal medical practice,” said Troyer, of the U.S. Attorney’s Office. Unfortunately for Troyer and his team, Thompson and Nocille had taken precautions, installing a lieutenant in the waiting room and instructing the office manager to grant appointments only to people referred by trustworthy sources. Despite a number of attempts over several months, investigators were unable to book an appointment at Dr. Bill O’Brien LLC. “You have to be able to really show that this isn’t medicine,” Troyer continued. “This is drug dealing.”

According to DEA officials, traditional organized crime groups have been more active in the latter stages of the opioid crisis—in practices such as importing Chinese fentanyl, manufacturing counterfeit oxycodone pills, moving huge quantities of cheap heroin—than they have in prescription diversion. But newspaper accounts suggest that they took an interest as early as 2004. That year, authorities concluded Operation Dr. Feelgood, arresting some 20 people in New Jersey, Massachusetts and Arizona—an OxyContin syndicate involving associates of the Lucchese family and the Bloods. In 2016, a Los Angeles Times investigation traced 1.1 million pills from a California clinic to Mexican American mobsters and members of the Crips. This operation, too, used “sponsorship,” recruiting Skid Row residents to pose as patients. The Pagans seem to have been early adopters. At the same time investigators were looking into O’Brien in Philadelphia, another branch of the club was in the diversion business with a doctor on the Jersey Shore. “[O’Brien’s] was one of the earlier cases our office did,” said Leahy, of the U.S. Attorney’s Office. “The epidemic was just starting to be something that people were really talking about. We felt it was important to go after the doctors, because without them, the pills aren’t going to get onto the street.”

The Pagans gave O’Brien proximity to a kind of power he’d long been fascinated with. “The doctor liked strippers,” said an associate.

As the operation grew, so did the need for caution. O’Brien, Thompson and their associates favored recruits who had X-rays or MRIs, some of them faked, showing past injuries—anything that could make high doses of opioids seem justified. (A DEA official told me that pill mill operators have since become more cautious still; a recent California case involved a doctor who would accept patients only after they’d seen a particular MRI provider.) O’Brien also instituted a pain management contract—an agreement between doctor and patient common in chronic pain treatment, which outlines the conditions under which opioids will be prescribed or suspended. In addition to giving O’Brien plausible deniability, a pain contract could specify which pharmacies patients should and shouldn’t patronize, reducing the risk of suspicious traffic at a nearby locale. After pharmacists looked askance at his opioid-centric prescription sheets, O’Brien began prescribing common complementary medications: laxatives, anti-inflammatories.

He also moved the practice again, after Thompson and Nocille learned about the surveillance of the South Broad Street office. In early 2014, he settled in a suburban neighborhood of Northeast Philadelphia. Thompson and his organization followed. In the Levittown office, where O’Brien also spent two days a week, a similar business had sprung up. The Pagans gave O’Brien proximity to a kind of power he’d long been fascinated with, but never had access to. “The doctor liked strippers,” Thompson recalled. Drawing on his connections at a club called the Oasis, Mehl, the Pagans associate who’d taken Thompson to his first appointment, brought dancers into the office for prescriptions, encouraging at least one of them to have sex with O’Brien. The doctor also traded prescriptions for oral sex. In some cases, he threatened to cut off patients he knew to be addicted unless they met his sexual demands. He adopted a similar strategy to extract favors from Pagans and their associates, calculating that his power to write prescriptions trumped their recourse to violence. What seemed to Thompson like a hundred times, O’Brien told him, “The pen is mightier than the sword!”

Murphy estimates that O’Brien never spent more than seven minutes on any one of her appointments. But he seemed to grow comfortable with her quickly. When she indicated that she drank alcohol with the opioids he prescribed her, O’Brien did not discourage the practice. When, in accordance with Huffman’s direction, she said she’d increased her dosage of her own accord, he wrote her a stronger prescription. “You can’t fix crazy,” he told her on one occassion. “You can drug it.” When Murphy told O’Brien she’d given opioids to a friend, he told her, “Be careful prescribing medication. It’s not as much fun as you think.” In August 2014, Murphy brought a young woman with her to O’Brien’s office, introducing her as her niece, Heather O’Connell. Over the course of several visits, her experience reflected what Murphy had already seen. But O’Brien was attracted to the young woman. “No birth control,” he said, reading from her paperwork with a sideways smile. “[I’ll] have to keep that in mind.” Once, he told her, “When you come back next time, we will see how much you appreciate me.” During her next appointment, using the street term for a potent dosage of Xanax, he told her, “I’ll give you the blue, you give me the blow.” The young woman later recalled, “He was saying, ‘I will give you the blue Xanax if you give me a blow job.’” Murphy’s “niece,” Heather O’Connell, was, in truth, an FBI special agent named Heather Whelan, and on the morning of January 29, 2015, when O’Brien was preparing to fly to Florida for a long weekend with Hibbs, he was arrested and taken to bureau headquarters in Philadelphia. During a two-hour interview, he allowed that he was “a heavy prescriber” and that he’d occasionally had sex with patients, but otherwise denied wrongdoing. He gave no hint of understanding that his medical career was over.

“When you come back next time, we will see how much you appreciate me,” O’Brien once told a female patient.

O’Brien thought of himself as a doctor, not a drug dealer. He seemed to believe he could make the jury understand that and be found blameless.

In 2016, O’Brien was convicted of 124 criminal counts and sentenced to a 30-year term in federal prison. His punishment reflected a slew of aggravating factors, including making “credible threats or [using] violence” and “abuse of trust or use of [a] special skill.” (Thompson, who gave extensive trial testimony, received a six-and-a-half-year sentence; Mehl and Treacy, who gave none, got 15 and 20 years, respectively, for drug offenses. Sammy Nocille, jailed on unrelated charges, reportedly died of a heart attack in 2014.) In court, O’Brien based much of his defense on his expertise, and on the trust he enjoyed as a physician. At one point, he told the judge, “When I hear [a prosecutor] stand up there and pontificate … about how I practice medicine, somebody that does not know an aspirin from a Tylenol, it’s not fair and it’s not right." O’Brien is incarcerated at FCI Hazelton, a medium-security prison in West Virginia. Citing unspecified safety concerns, Hazelton’s warden denied my requests to visit, but over the course of the past 18 months or so, O’Brien and I communicated via mail and email. He continued to insist on his innocence, sent updates on his campaign to overturn his conviction, and espoused a brutal view of laissez-faire economics. “Medicine is just like any other business,” he wrote. “Our society rewards CAPITALISM.” Elsewhere, he said, “Any day the DEA can stop all narcotics—but they don’t...And why the hell is the doctor responsible when the patient does the wrong thing? NO PHYSICIAN SHOULD EVER PRESCRIBE ANY medication then.” In effect, O’Brien argued, he’d been entrapped. During the mid-1990s, as pharmaceutical companies and their allies were urging physicians to prescribe more opioids, they also succeeded, for a time, in defeating congressional efforts to create a state and national prescription drug monitoring program. Given what followed—a spectacular windfall arising from the overprescription of opioids—it is tempting to view this victory as groundwork for a premeditated crime: the legislative equivalent of disabling the alarm before a home invasion. In 2016, when the opioid epidemic had already resulted in more than 350,000 deaths, industry lobbyists shepherded into law a bill that made it virtually impossible for the DEA to halt suspicious drug shipments to likely points of illicit distribution. According to a Washington Post investigation, “the law was the crowning achievement of a multifaceted,” yearslong drug industry campaign that included at least $1.5 million in contributions to the 23 lawmakers who sponsored or co-sponsored the bill. (Overdose deaths in 2020 are projected to exceed what was likely a single-year record of almost 72,000 in 2019.) The pharmaceutical industry defended the law as a check on onerous federal oversight and a way to ensure that patients received relief. But the zeal with which drug companies pursued its passage was a clear acknowledgement of their reliance on the black market to stoke demand. With few exceptions, the pharma companies complicit in the opioid crisis and the executives that led them have fared much better than doctors like O’Brien, who routinely receive long prison sentences. Last week, the U.S. Department of Justice announced that Purdue Pharma, the maker of OxyContin, had agreed to plead guilty to charges of defrauding health agencies, paying illegal kickbacks to doctors, and engaging in misleading marketing tactics. The settlement includes fines of roughly $8.3 billion. But even that figure is a pittance compared to the total cost of the opioid epidemic, estimated to be more than $2 trillion. Owing to legal niceties, Purdue is unlikely to pay more than a small fraction of the fines. I began to think of O’Brien as the protagonist in a noir parable for the opioid era. His sense of persecution had intensified. His letters were flecked with aggrieved self-regard and unprintable references to his first wife. Mostly, he reserved kind words for Hibbs, who received a short sentence for financial malfeasance related to his crimes. (The couple divorced in 2012, but, according to investigators, continued to live as husband and wife.) “My 2nd wife, Elizabeth, is an ANGEL,” he wrote. “I pray for her every day.” The story of how a violent motorcycle club became concealed in the sedate camouflage of a once-prosperous medical practice was also a story about a society so consumed with profit that venal criminality could be confused with a kind of patriotism. Against all evidence, O'Brien seemed to preserve his sense of himself among those who could expect legal immunity. Soon, he said, he would be vindicated. He would resurrect his hyperbaric oxygen business and buy a place in Napa Valley. “When I’m released,” he wrote, “I’ll build and change our healthcare for the BETTER. It’ll really impress you what I’ve done, and what’s on the horizon.”

date: october 28, 2020

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Credits: [STORY by CHRIS POMORSKI] Chris is a writer based in Philadelphia. His work has appeared in Vanity Fair, The New York Times Magazine, Bloomberg Businessweek, and elsewhere. [Illustrations by CHRIS VISIONS] Chris is a Storyteller, Illustrator, and Muralist living in Virginia. [ART Direction & design by YENWEI LIU] Yenwei is a graphic designer from Taiwan. HE IS A SENIOR ART DIRECTOR AT HUFFPOST & VISITING assistant PROFESSOR AT PRATT INSTITUTE. [Research by MATT GILES] Matt is a freelance writer and the head of research and fact-checking at Longreads.

The Philadelphia police ruled the scene a murder-suicide. But to Anna Marie, that didn’t make sense. Anthony and Spering, who was 52, were friendly. Moreover, she didn’t think her son had any reason to contemplate suicide. An easygoing man, he had a loving relationship with his teenage daughter, and he was good at his job, which involved working with computers. Anna Marie thought the police should have paid more attention to a strange incident that occurred the day before. She had been upstairs cleaning when she heard yelling across the street. Through her window, she could see two men outside Anthony’s house. One was long-necked and wiry, with a hairline in deep retreat and small, coal-like eyes. He held a metal pipe. The other was bald, bearded and burly. She yelled down, threatening to call the police. The wiry man walked into the street and looked up at her. “Do you know who I am?” he said. Anna Marie had never laid eyes on him. Before the exchange went much further, the men got into a car and drove away. Anthony told his mother that they had come to collect a debt, but Anna Marie couldn’t imagine how he had come into contact with such people. And months later, when the FBI began looking into things, investigators tended to agree with her hunch that their visit was connected to the deaths of her son and his tenant. They also had an explanation for how the intruders had entered Anthony’s orbit. Not long before his death, Anthony had become a patient of a physician named William O’Brien III. O’Brien had run a successful Philadelphia-area practice for roughly two decades. Among friends and family, he was known to enjoy lounging in front of the TV in SpongeBob SquarePants pajamas, eating pizza and drinking red wine. But investigators believed that in recent years, he had broadened his interests to include fraud and drug trafficking, conspiring with the Pagan’s Motorcycle Club—something of a small but fearsome cousin to the Hells Angels—to siphon prescription painkillers to the black market on a massive scale. The men Anna Marie had seen on the day before her son’s death were affiliates of the club. In examining the killings, federal investigators devoted special attention to an audio file recovered from Anthony’s cellphone. It contained a conversation between several people. One of the speakers seemed to believe that Anthony owed him $11,000. He sounded enraged, threatening to “hunt [Anthony] down like a dog.” David Troyer, the chief of the Government and Healthcare Fraud Section at the U.S. Attorney’s Office for the Eastern District of Pennsylvania, said the recording reminded him of a loan shark’s shakedown. During the 1980s, at the tail end of the cocaine wars, Troyer had been a state prosecutor in Miami. “The language he used,” he said, “it sounded like someone doing an extortion routine.” With the help of some of his former employees, the FBI ascertained that the voice in question belonged to William O’Brien. Diversion—the mechanisms by which legal pharmaceuticals are funneled into unsanctioned markets—remains among the least well-understood aspects of the opioid crisis. This is attributable to, among other causes, the flat-footedness of regulatory agencies as the epidemic gathered steam; the reluctance of lawmakers to institute prescription monitoring programs; the willingness of major American corporations to enlist black marketeers in distributing their wares; and the ingenuity of criminal enterprises in meeting demand for a seductive new product. It is also a testament to the magnetism that easy money and power can have for the thousands of U.S. doctors who have acted as middlemen, linking pharmaceutical C-suites to street dealers. The case of William O’Brien provides a rare, revealing glimpse into an especially shadowy portion of the pharmaceutical supply chain.

On a chilly Friday evening in January 2013, Anna Marie Rongione left her home in a quiet working-class neighborhood of South Philadelphia and walked across the street to the brick row house that belonged to her 44-year-old son, Anthony. She planned to borrow some dog food. Anna Marie let herself in and called her son’s name. When she got no response, she ventured up the stairs to look for him. Halfway up, she saw Anthony’s body lying in the second-floor hallway. When the police arrived, they found the body of Anthony’s tenant, Michael Spering. Both men had been shot to death.

In preparing their case, federal agents and lawyers uncovered crimes that would have been unlikely to surface had O’Brien not insisted on his innocence. They scrutinized his patients’ medical records, hiring an expert to verify that he had routinely prescribed drugs outside the course of professional practice. They reviewed many hours of jailhouse phone calls between Pagans and their associates, who had a way of finding themselves imprisoned. They confirmed the direct role of opioids he prescribed in the fatal overdose of at least one patient. In all likelihood, it was during this period that federal agents reexamined the deaths of Anthony Rongione and Michael Spering, reasoning—though they couldn’t prove it—that the men had been murdered as a result of Rongione’s debt to O’Brien.

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