A physician on trial

Did internist Sudipt Deshmukh recklessly prescribe opioids to obvious addicts, illegally trapping one patient into a spiral of addiction and “with depraved indifference” causing the death of another?

Or is Deshmukh a caring general practitioner who prescribed opioids to vulnerable patients with no thought other than alleviating their terrible chronic pain?

Indicted in February, Deshmukh, 58, faces a charge of second-degree manslaughter in the 2015 overdose death of a male patient. He also was charged with first-degree reckless endangerment, criminal sale of a prescription for a controlled substance or of a controlled substance by a practitioner or pharmacist, and fourth-degree health care fraud.

The top charge Deshmukh faces is a class C felony, with a maximum sentence of five to 15 years in prison.

An approximately one-week bench trial on the above charges before state Supreme Court justice Vincent Dinolfo wrapped up Monday. Deshmukh did not take the stand. Dinolfo has not yet ruled.  

Deshmukh is only the second New York physician to be accused of murder for allegedly too freely prescribing dangerous controlled substances.

The first doctor so charged in the state is George Blatti. A Long Island general practitioner, Blatti, 78, was indicted by Nassau County’s district attorney in 2021 on five counts of murder. His trial is ongoing.

Blatti’s murder charges came two years after he was indicted for allegedly “selling” opioid prescriptions to numerous addicts. Prosecutors say Blatti met “customers” in a former Radio Shack store that was still lined with merchandise racks, a hotel parking lot and in a Dunkin Donuts.

Blatti allegedly never examined such “customers,” writing scrips for whatever drugs they asked for in amounts they specified. In the 2021 murder indictment, prosecutors allege that after his 2019 arraignment, Blatti ignored the pleas of addicts’ family members to stop, continuing to write opioid scrips despite the deaths of at least five “customers.”

A judge last year reduced Blatti’s murder charges to manslaughter and granted bail. Blatti has yet to be convicted of any charge, court records show.

The Rochester case

A native of India, Deshmukh earned a bachelor of medicine degree from Bangalore University’s Bangalore Medical College in 1987 before completing an internship and residency at Northshore University Hospital on Long Island. From 2007 to 2020, he was employed by Rochester Regional Health as a primary-care physician.  

On Monday, Deshmukh, a round-faced man of medium height, sat impassively and expressionless on a hallway bench on the second floor of the Monroe County Hall of Justice waiting for the last day of his trial to begin. A woman who might have been his wife sat close by his side. She handed him a water bottle and he took a drink. When Deshmukh was distracted by a cellphone call, the woman gently took the bottle, which he seemed to have forgotten he was holding, from his hand.  

Charges leveled by state Attorney General Letitia James against Deshmukh center on two patients he treated while employed by RRH’s Long Pond Internal Medicine Group.

Prosecutors allege that both patients, Joseph Manuel, a middle-aged man who died of an overdose in 2015 and Casey Bennem, a woman in her 20s who eventually kicked opioids and testified for the prosecution, were clearly addicts and should never have had opioids prescribed.

Summing up the state’s case, Margaret Jones, an assistant attorney general in the AG’s Medicaid Fraud Control Unit, highlighted medical records including copious charts and graphs showing that levels of addictive drugs Deshmukh prescribed for both patients were an order of magnitude higher than recommended maximums. That both patients were addicts should have been patently obvious to Deshmukh, she asserted. The law is unambiguous, Jones said. Prescribing opioids to known addicts is a criminal offense.

Jones also highlighted medical records showing that colleagues who had treated the same patients had expressed concern, recommending that Deshmukh should taper off their use of opioids, but that Deshmukh had ignored the advice, in one case increasing rather than reducing the patients’ opioid prescriptions.

Seeking to counter Jones, Deshmukh’s lawyer, Joseph Damelio, a well-known Rochester criminal defense attorney, leaned heavily on what he characterized as Deshmukh’s benign reasons for prescribing opiates to the patients in question. In ignoring the care Deshmukh showed for his patients, Damelio asserted, the state had failed to show his client’s guilt on the standard required for a criminal conviction, proof beyond a reasonable doubt.

Bennem had three back surgeries that left her in nearly unbearable pain and had bariatric surgery that at one point resulted in her having to be fed through a tube to get adequate nutrition. She also suffered from chronic diarrhea and as result of her surgeries was left with a painful condition called a fistula. Both patients had long-term, ongoing mental health issues, Damelio told the judge. He cited testimony of a nurse who described Deshmukh as frequently spending more time than allotted with patients.

Deshmukh spent much time treating and examining the woman, Damelio argued. The drugs he prescribed to her were meant to alleviate pain. In consultation, Deshmukh discussed the perils of addiction with Manuel, who told the doctor what medications worked so that Deshmukh might prescribe accordingly.

“That is called the practice of medicine,” Damelio said. “It’s not being a drug dealer.”

Jones countered, citing testimony in which Bennem stated that because she had used prescribed drugs rather than drugs bought on the street, she had not considered herself an addict while under Deshmukh’s care. Once she had gotten off opioids, she realized that she had been addicted.

A finding of professional misconduct

In 2019, Deshmukh faced a state Department of Health inquiry into his prescribing practices. Examiners looked at his treatment of four patients identified only as patients A-D. The examining panel’s ruling notes a number of instances spanning several years in which Deshmukh overprescribed opioids and failed to taper patients off them despite numerous red flags, his own acknowledgement that patients were addicted, and warnings from colleagues.

Finding Deshmukh guilty of professional misconduct on several counts, state examiners suspended his license to practice for 36 months in May 2019. The department said it would enforce only three months of the suspension, putting Deshmukh effectively on probation for the remaining 30 months.

In March 2020, RRH, which had taken Deshmukh out of service while the state investigation was pending, fired Deshmukh. The exact reasons for his dismissal are unclear.

“RRH has cooperated fully with the investigations of Dr. Deshmukh. RRH cannot comment further on matters of criminal investigations and litigation,” the health system said this week in a statement.

In online medical forums, patients’ evaluations of Deshmukh are mixed.

One patient sings Deshmukh’s praises as “wonderful a great listener (who) involved me in decision making.”

But another complains that “he ignores what I say, doesn’t treat my ailments doesn’t even keep my health problems on file/computer! He just stares at you with a blank look on his face acting anxious like he just can’t wait for you to stop talking to him.. I say things that ail me or things I may need him to look at, he just acts like I never mentioned them at all…acts like (you’re) speaking a foreign language that he doesn’t understand!”

At several points in his closing argument, Damelio raised the issue of the medical community’s changing standards regarding opioid prescription. Standards applied now to judge his client differ starkly from standards in place “10 or 15 years ago when Deshmukh was treating the patients in question,” Damelio argued. He particularly cited Purdue Pharma’s role over a decade beginning in the mid-1990s in successfully convincing legions of doctors to freely prescribe OxyContin.

The Sackler saga

Founded, closely-held and run until a few years ago by members of the Sackler family, Connecticut-based Purdue Pharma is seen by some as having almost single-handedly ignited an ongoing opioid crisis that through the 2000s has ensnared millions of Americans in a cycle of addiction and sparked a wave of overdose deaths that cut a tragic swath across America’s social classes and economic strata.

Three brothers—Arthur, Mortimer and Raymond Sackler, the sons of eastern European immigrants who grew up in Depression-era Brooklyn—founded Purdue. All three were doctors.  But they made their most significant mark as pioneers of pharmaceutical advertising, developing techniques and strategies to market drugs that changed the face of the industry.

The family’s advertising and marketing prowess reached an apogee with OxyContin in a decade-long campaign engineered by the founding brothers’ descendants. A key feature involved having company-financed doctors urge colleagues to freely prescribe OxyContin. Many doctors listened, hailing the powerful opioid as a godsend.

Despite the drug’s status as a highly addictive opioid, Purdue promoted OxyContin as safe because when used as directed, it is time-released. Sales surged, making the Sacklers one of America’s richest families, collectively worth more than $30 billion.

Sackler family members’ status as leading lights in the rarified world of one-percenter socialite philanthropy unraveled after plaintiffs including 50 states attorney generals sued Purdue, seeking recompense and punitive damages for the company’s role in sparking the opioid crisis. Institutions like the Museum of Modern Art to which the family had contributed scrubbed the Sackler name.

Facing a likely massive payout in the lawsuit, Purdue filed a Chapter 11 bankruptcy petition in 2019. In 2020, Sackler family members faced congressional scrutiny over their role in creating the opioid crisis. The family said the crisis was regrettable but took no personal responsibility.

After extensive negotiations, a Bankruptcy Court judge in Westchester County approved a plan in the Purdue bankruptcy in 2021 in which the company would contribute $4 billion to a fund to help states deal with the opioid crisis. The deal called for individual Sackler family members to be given immunity from prosecution or civil action. In a separate agreement, the family agreed to donate $250 million to a federal fund marked for alleviating the crisis.

Some states’ attorneys general and the U.S. Trustee objected to the bankruptcy deal on grounds that the Sackler family’s get-out-jail-free card violated the Bankruptcy Code. The objectors won an appeal in U.S. District Court. The Sacklers, who have now withdrawn from Purdue, agreed to up the company’s contribution to the states to $6 billion. Proponents of the Bankruptcy Court deal appealed to the Second Circuit Court of Appeals.

Urging the appeals panel to reinstate Purdue’s Chapter 11 plan, attorneys involved in the bankruptcy told a Second Circuit panel in oral arguments last year that the Sackler family had withdrawn $10.4 billion from the company before agreeing to a deal and tied up those funds in a welter of trusts that would be virtually impossible to penetrate. Killing the $6 billion settlement would only deprive states of much-needed funds to fight the opioid epidemic. The appeals court has yet to say whether it would reinstate the Chapter 11 plan.

Awaiting a verdict

Whether Dinolfo would see the lax opioid-prescribing climate the Sacklers allegedly engineered as having any bearing on Deshmukh’s case is not clear.

As Deshmukh’s trial concluded this week, Dinolfo vowed to instruct himself on how to ponder the case’s legal merits as he would have instructed a jury. Setting an April 21 date for delivering a verdict, he said he would spend the next month poring over the reams of evidence submitted and would consult the 42 pages of notes he took during the trial as well.  

In closing arguments, Jones and Damelio each urged the judge to fully grant their preferred outcome. Jones asked the judge to convict on all counts.  Damelio asked him to dismiss all charges.

In a possible hint of where he might be headed, Dinolfo asked both attorneys if they would agree to let him to consider lesser charges. Both said yes.  

Will Astor is Rochester Beacon senior writer. The Beacon welcomes comments and letters from readers who adhere to our comment policy including use of their full, real name. Submissions to the Letters page should be sent to [email protected].