Prescribed Controlled Substances in High Dosages and Dangerous Combinations
Bridget G. Brennan, New York City’s Special Narcotics Prosecutor, James J. Hunt, Special Agent in Charge of the U.S. Drug Enforcement Administration’s (DEA) New York Division, New York City Police Commissioner James P. O’Neill, New York City Human Resource Administration (HRA) Commissioner Steven Banks, George P. Beach II, the Superintendent of the New York State Police (NYSP), Angel M. Melendez, the Special Agent-in-Charge of the New York Field Office of the U.S. Immigration and Customs Enforcement’s Homeland Security Investigations (“HSI”), and Queens District Attorney Richard A. Brown announced today the indictment and arrest of Dr. LAWRENCE CHOY on homicide charges and criminal sale of prescriptions for controlled substances, including narcotics. CHOY, 65, allegedly prescribed addictive painkillers and other controlled substances in potentially lethal dosages and combinations for no legitimate medical purpose to patients of his medical practice in Flushing, Queens.
The indictment contains a total of 231 counts, including two counts of Manslaughter in the Second Degree, nine counts of Reckless Endangerment in the Second Degree and 220 counts of Criminal Sale of a Prescription for a Controlled Substance. It follows a long-term investigation by the Office of the Special Narcotics Prosecutor’s (SNP) Prescription Drug Investigation Unit, the New York Organized Crime Drug Enforcement Strike Force Group Z-23 and HRA, with assistance from the Nassau County Police Department and the Suffolk County Police Department. Strike Force Group Z-23 is comprised of agents and officers with the DEA and the New York City Police Department (NYPD).
Agents from the DEA’s Milwaukee District Office arrested CHOY on March 29, 2018 at his residence in Sheboygan, Wis., where he moved in 2017 after he was visited by investigators at his Flushing, New York office. CHOY was released on bail set by a judge in Sheboygan pending extradition proceedings and returned to New York earlier this week to face charges contained in the indictment. An arraignment is scheduled for today before Manhattan Supreme Court Justice Neil Ross, Part 23, 100 Centre St., 13th floor.
Charges relate to 14 patients, to whom CHOY allegedly issued prescriptions other than in good faith in the course of his professional practice. Three of these patients ultimately died of prescription drug overdoses between 2013 and 2016. CHOY is charged with Manslaughter in the Second Degree for allegedly recklessly causing the overdose deaths of two patients: Eliot Castillo, 35, and Michael Ries, 30. Castillo and Ries each fatally overdosed within three days of receiving prescriptions from CHOY. At their final visits with the doctor, both victims received high-dosage prescriptions for oxycodone (an addictive opioid painkiller) and the anti-anxiety medication alprazolam (a benzodiazepine commonly known by the trade name Xanax). Both drugs have the effect of suppressing respiration and when taken together are known to heighten the risk of overdose. CHOY also faces nine counts of Reckless Endangerment in the Second Degree for creating a substantial risk of serious physical injury to patients, including Daniel Barry, 43, who fatally overdosed.
Court Authorized Searches and Regulatory Actions
A licensed physician since 1981, CHOY specialized in internal medicine and nephrology (the treatment of diseased kidneys) and operated a full-time medical office at 142-20 Franklin Avenue in Flushing. Beginning in 2012, his prescribing practices changed dramatically and he began issuing a high number of prescriptions for oxycodone and multiple prescriptions for controlled substances simultaneously to individual patients. This shift coincided with the filing of tax warrants against CHOY for more than a million dollars in taxes owed.
In addition to prescribing to primarily New York City residents, CHOY began to draw patients from a wider geographic area, including Long Island, Upstate New York, New Jersey and Pennsylvania. The criminal investigation was triggered when the Pennsylvania Attorney General’s Office became aware that suspicious prescriptions issued in CHOY’s name were being filled at pharmacies in that state, and then contacted law enforcement partners in New York.
After an investigation, in March of 2016, members of DEA’s Strike Force Group Z-23 and SNP investigators obtained court authorization to search CHOY’s medical office at 142-20 Franklin Avenue, Flushing, NY, and seized records and computer equipment.
CHOY left his practice suddenly in June of 2017, leaving the Flushing office in a state of disarray. Agents and investigators subsequently learned that CHOY had moved from his Manhattan apartment to Sheboygan, Wis. In August of 2017, members of Strike Force Group Z-23 and SNP investigators obtained a second court authorized search warrant for the office and seized additional records. Since 2017, CHOY has not been authorized to prescribe controlled substances.
Dangerous Prescribing Practices
The indictment charges prescribing that allegedly rose to the level of criminality when CHOY prescribed drugs carrying substantial risks of addiction, physical harm or death, based upon inadequate examinations and unverified patient complaints. In addition, CHOY allegedly prescribed addictive medications in inappropriately high dosages and pill counts, and in potentially lethal combinations.
For example, the investigation revealed that CHOY simultaneously prescribed individual patients a trio of drugs including one or more opioids, a benzodiazepine (such as alprazolam or clonazepam) and a muscle relaxant (such as carisoprodol, commonly known by the trade name Soma). Medical literature explains that this combination is known to be favored by individuals suffering from substance abuse and by those seeking to resell pills on the black market. Because all three drug types have the effect of suppressing respiration, the risk of overdose is heightened when they are taken together. Both patients who are the subject of Manslaughter charges allegedly received this combination of prescriptions from CHOY.
Opioid prescribing guidelines by the Centers for Disease Control and Prevention (CDC) released in March of 2016 recommend that clinicians prescribe the lowest effective dosage as measured by Morphine Milligram Equivalent (MME), a value assigned to opioids to represent their relative potencies. The CDC recommends clinicians “carefully reassess evidence of individual benefits and risks” when prescribing over 50 MME per day and to “avoid” or “carefully justify” increasing the dosage to more than 90 MME per day.
Dosages prescribed by CHOY allegedly exceeded the dosages recommended in the CDC’s opioid prescribing guidelines. The investigation revealed that during the final office visits for the three patients who fatally overdosed, CHOY issued prescriptions for between 135 and 450 MME per day (more than quadruple the recommended maximum amount).
The CDC also advises clinicians against prescribing certain combinations of drugs, such as opioids and benzodiazepines. Two of the deceased patients received simultaneous prescriptions for opioids and a benzodiazepine while being treated by CHOY and had both drug types in their systems at the time of death.
The investigation further revealed that CHOY received reports about patients’ involvement in accidents, including motor vehicle accidents, participation in substance abuse treatment programs, and receipt of prescriptions from other prescribers and yet CHOY allegedly continued to prescribe addictive medications to these patients.
Manslaughter Charges for Two Patients’ Deaths
CHOY faces two counts of Manslaughter in the Second Degree for his allegedly reckless prescribing of controlled substances to patients Eliot Castillo and Michael Ries, both of whom fatally overdosed within three days of receiving prescriptions from CHOY. The Manslaughter charges stem from Choy allegedly prescribing dangerous levels of narcotic drugs in high-risk combinations with other controlled substances. He allegedly did so while failing to perform adequate examinations, prescribe appropriate types or dosages of medication or follow up on signs of substance abuse.
Castillo suffered a fatal overdose on February 23, 2013 at age 35. He was found on a couch at his mother’s home in Jamaica, Queens. Following an autopsy, the OCME determined the cause of death was acute intoxication by the combined effects of oxycodone and alprazolam. A bottle of alprazolam found on the scene had been prescribed to Castillo by CHOY three days earlier on February 20, 2013, according to a report by OCME. CHOY had also prescribed Castillo oxycodone-acetaminophen (commonly known by the trade name Percocet). A corresponding pill bottle was later found at the residence.
A clothing store operator and father of two, Castillo first saw CHOY in March of 2012. CHOY allegedly failed to perform a medical work up and immediately began prescribing a combination of oxycodone, the anti-anxiety drug clonazepam and carisoprodol. The amounts prescribed increased and came to include oxycodone-acetaminophen and alprazolam. The investigation revealed that Castillo’s general health declined during the 11 months he was being treated by CHOY and he frequently received early prescription refills. In June of 2012 alone, Castillo received prescriptions for 680 oxycodone pills. According to family members, Castillo entered a treatment program during the time he was seeing CHOY, but relapsed. In addition to the Manslaughter charge, CHOY faces 23 counts of Criminal Sale of a Prescription for a Controlled Substance in connection with his treatment of Castillo.
Michael Ries, a 30-year-old who worked in car dealerships, died on March 23, 2014 at his family’s home in Hauppauge, L.I. The cause of death was determined to be acute intoxication by the combined effects of oxycodone, alprazolam and carisoprodol. A medical examiner’s report noted several empty pill bottles at the scene that were associated with prescriptions CHOY issued to Ries between October of 2013 and February of 2014.
Three days before his death, on March 20, 2014, Ries received and filled four prescriptions from CHOY for oxycodone, oxycodone-acetaminophen, alprazolam and carisoprodol, for a total of 720 pills (or 24 pills per day if taken as prescribed). In the two months prior, CHOY issued Ries prescriptions for more than 2,100 pills of controlled substances during three office visits.
The investigation revealed CHOY began treating Ries in November 2011 for anxiety with high-dose alprazolam. In May of 2012, CHOY began prescribing Ries opioids as well, which Ries had never before been prescribed. Choy prescribed high-dosage opioid and benzodiazepine prescriptions to Ries, who died less than two years later. Despite awareness of indications of abuse by Ries, including multiple accidents, Choy’s only adjustment to medications was an increase in dosage. CHOY faces one count of Manslaughter and thirty-seven counts of Criminal Sale of a Prescription for a Controlled Substance in connection with Ries.
Reckless Endangerment in the Second Degree
CHOY faces nine counts of Reckless Endangerment in the Second Degree in connection with eight surviving patients and deceased patient Daniel Barry. CHOY is charged with recklessly prescribing controlled substances to these patients that created a substantial risk of serious physical injury.
Barry, who worked as a chef, fatally overdosed on oxycodone and alprazolam on January 15, 2016 at his residence in Suffolk County. On January 7, 2016, CHOY allegedly prescribed Barry oxycodone, morphine sulphate and fentanyl patches (all opioid painkillers). Throughout Barry’s treatment by CHOY, he regularly received prescriptions for these three opioids. The investigation revealed that on November 11, 2015, CHOY received notice that Barry was receiving treatment for substance abuse. Nevertheless, CHOY continued to prescribe the same medications. Barry continued to seek treatment for substance abuse up until the date of his death, January 15, 2016. CHOY is charged with Reckless Endangerment in the Second Degree and 10 counts of Criminal Sale of a Prescription for a Controlled Substance in connection with Barry.
Special Narcotics Prosecutor Bridget G. Brennan thanked her office’s Prescription Drug Investigation Unit, Queens District Attorney Richard A. Brown, the U.S. Drug Enforcement Administration (DEA) Strike Force and DEA Milwaukee District Office and the New York City Human Resource Administration (HRA). She also thanked the Nassau County Police Department, the Suffolk County Police Department, the Pennsylvania Attorney General’s Office, the New York City Office of Chief Medical Examiner (OCME), the Suffolk County Medical Examiner’s Office, the Nassau County Medical Examiner’s Office and the Sheboygan County Police Department for assisting with the investigation.
The New York Organized Crime Drug Enforcement “Strike Force” is comprised of agents and officers of the DEA, the New York City Police Department, Immigration and Customs Enforcement – Homeland Security Investigations (HSI), the New York State Police, the U. S. Internal Revenue Service Criminal Investigation Division, the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF), U.S. Customs and Border Protection, U.S. Secret Service, the U.S. Marshals Service, New York National Guard, the Clarkstown Police Department, U.S. Coast Guard, Port Washington Police Department and New York State Department of Corrections and Community Supervision. The Strike Force is partially funded by the New York/New Jersey High Intensity Drug Trafficking Area (HIDTA), which is a federally funded crime fighting initiative and part of the Organized Crime Drug Enforcement Task Force program.
Special Narcotics Prosecutor Bridget G. Brennan said, “It is critically important that law enforcement agencies diligently and tenaciously investigate medical professionals who use their privileged status to enhance their own incomes by recklessly prescribing dangerous drugs. Dangerous and unnecessary prescribing not only causes grievous harms to patients, but also tragic consequences for patients’ families and communities. I thank all of our partners who, through their work on this investigation, demonstrated their commitment to protecting the public and fairly prosecuting the law.”
DEA Special Agent in Charge James J. Hunt stated, “Dr. Choy’s blatant disregard to the practice of medicine became a parent’s worst nightmare and an opioid addict’s dream. Similar investigations into the diversion of prescription medication have put doctors at the same level as drug kingpins; both types of traffickers push millions of doses of opioids into our communities leaving grieving families in their wakes.” SAC Hunt commends the investigators and prosecutors who worked tirelessly on this investigation.
“Mr. Choy violated his privilege and authority to prescribe controlled drugs by unlawfully putting his own personal gain ahead of his patients’ health,” New York City Police Commissioner James P. O’Neill said. “Licensed medical practitioners who provide these powerful opioid-based drugs without a legitimate medical purpose only compound the epidemic we are facing across our country. The NYPD and our partner agencies, as members of the far-reaching Strike Force, are committed to fighting this national crisis through aggressive investigation and prosecution of doctors who abuse their positions of power and compromise the trust placed in them by the public.”
“As we face an opioid epidemic in our city, more than ever doctors have an added responsibility to be vigilant and put their patients’ care above all else. What makes this case particularly egregious is that Dr. Choy allegedly ignored his patients’ declining health and their substance use history in order to enrich himself,” said Department of Social Services Commissioner Steven Banks. “The Human Resources Administration will continue working with the Special Narcotics Prosecutor to ensure that those who are breaking the law like this face the consequences of their actions.”
NYSP Superintendent George P. Beach II said, “While the primary work of a medical practitioner is to help patients, this doctor did nothing but hurt his victims and had no regard for their health. By illegally selling prescriptions, Dr. Choy put his patients and the community he served at risk, with the drugs ultimately causing the death of some of those patients. I thank our law enforcement partners involved in this investigation, and for their efforts to keep drugs off streets and work to prevent prescription drug abuse. Together, we will continue this fight.”
HSI Special Agent-in-Charge Angel M. Melendez said, “Choy was trusted to care for the well-being of his patients. Instead, it is alleged that three patients in his care died from an overdose of what he prescribed. We are committed to partnering with the DEA and our other law enforcement partners to ensure that those who overprescribe these addictive medications are held responsible for the results of their negligence.”
Queens District Attorney Richard A. Brown said, “This indictment is another example of law enforcement working together to combat the deadly and growing pain killer addiction that is ravaging our communities. It is particularly troublesome having to confront a professional as in this case, willing to sell his license to line his pockets with silver. The defendant in this case took an oath to do no harm, yet three of his patients are dead. Dr. Choy is alleged to have recklessly prescribed the dangerous drug oxycodone and deadly combinations of this drug with others that resulted in fatal overdoses. My office will continue to work with our law enforcement colleagues to aggressively pursue those who flood our streets with pills that kill.”
The charges and allegations are merely accusations and the defendant is presumed innocent until proven guilty.Download Press Release
Special Narcotics Prosecutor’s Office
DEA New York Division