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In Illegal Online Drug Sales Scheme, Does Pharmacist’s Punishment Fit the Crime?

It’s a basic principle of criminal justice theory: the punishment for criminal activity should equate to or exceed the benefit the criminal received from the criminal activity. A key reason for this is to deter other would-be criminals and make them think twice. That’s especially true for pharmacists and physicians involved in supporting rogue Internet pharmacy operations, given the heightened duty people in these professions have to the public and to patients.

It’s troubling, therefore, when participants in rogue Internet pharmacy networks walk away with a slap on the wrist.

In 2012 we wrote about the indictment of two pharmacists, three physicians and five website operators relating to the online sale of prescription medications, including controlled substances. One of those pharmacists, Peter James Riccio, owned Towne Pharmacy in Dunellen, New Jersey, as well as two pharmacies in Pennsylvania. The physicians would issue prescriptions for addictive medicines without seeing patients in person, and the pharmacies would turn a blind eye to the invalid prescriptions and send the drugs to customers. In all, the participants were paid at least $13 million between 2010 and 2012, according to the indictment.

So what punishment did Riccio receive for illegally doling out prescription pain pills and other medications? Two years probation, forfeiture of $400,000, and, more recently, the loss of his pharmacy license for five years. Riccio, who pleaded guilty to all charges, admitted that he knew doctors had written these prescriptions without seeing the patients.

Quotes from an article related to Riccio’s loss of license seem to paint this as a win for public safety. Acting New Jersey Attorney General John J. Hoffman said, “This pharmacist chose to put profits ahead of public safety and professional integrity. He provided an addictive, dangerous, and often-abused drug to patients who had not actually been seen and evaluated by the unscrupulous doctors who allegedly wrote their prescriptions. I applaud the Board of Pharmacy for suspending his license.”

But was it a win for public safety — or for Riccio? How much money did Riccio actually make? That’s not clear, but if we assume that he took about 20% of the cut as one of five participants, that’s $2.6 million. (Would you walk away from your pharmacist’s license for $2.6 million?) We don’t have all of the facts at our disposal, but the repercussions for Riccio in this case — forfeiture of a small chunk of what he likely brought in, probation, and no prison time — are difficult to see as adequate deterrents to other pharmacists and physicians. Indeed, it may cause some who wouldn’t mind walking away with seven figures to roll the dice. Although Riccio didn’t exactly win, it’s not clear that he really lost, either.

Consider the facts. Throughout their investigation, law enforcement conducted five undercover purchases of butalbital, a Schedule III controlled pain medication, from the Internet pharmacies involved. In all five instances, pharmacies controlled by Riccio filled the order and sent it to the customer via the United States Postal Service. Other prescription medications mentioned in the indictment were Soma (carisoprodol), Fioricet, and Ultram, all of which are various types of pain medications that require actual medical supervision by a licensed physician who has physically examined a patient. Riccio was further charged with multiple counts of mail and wire fraud, as well as being involved in a money laundering conspiracy.

These are the types of criminal charges often brought against drug dealers and organized crime syndicates (a description that we think applies to Riccio’s behavior). But does Riccio’s probation, forfeiture, and five-year loss of license really serve as any deterrent for others who are currently involved in these criminal activities? After all, Riccio wasn’t just an Internet pharmacy website operator without any professional training. Rather, he served in a public trust: as a member of a licensed profession, pharmacy, that is supposed to put patients before profits. In our view, Riccio’s punishment is a weak deterrent, at best, to other pharmacists and physicians who are considering operating online pill mills.

So what’s the status of the other defendants? According to available information, seven of the other nine defendants also pleaded guilty to the charges, but it’s not clear if all of them have been sentenced. One of the website operators, Christopher Riley, was sentenced to 18 months probation, according to court documents. One of the physicians, Robert Imbernino, of South Carolina, agreed to pay a $404,000 judgment to the government. It is unclear if his license was also revoked. According to the indictment, the $404,000 payment was only $4,000 more than he received for writing the illegal prescriptions. Another website operator, Gergana Chervenkova, of Bulgaria, is abroad and outside of US jurisdiction. Lena Lasher, whom Riccio hired to manage the two pharmacies in Pennsylvania, was the only defendant to plead not guilty. According to an article, her trial is scheduled to begin sometime in 2015.

LegitScript understands that prosecutions can go south or necessitate a weak plea bargain for any number of reasons outside of law enforcement’s control. But the punishment needs to fit the crime. Just as a too-strong penalty for a minor infraction is unjust, so too is a minor punishment for serious behavior. Law enforcement and the judicial bench had an opportunity to send a message with Riccio’s conviction. Next time, we hope those involved will consider making that message stronger.