Tennessee “Pill mill” doctor sentenced to nearly six years in prison

It was a blow to family members who sat in Knoxville’s U.S. District Court Thursday afternoon when a judge sentenced a former Maryville “pill mill” doctor to nearly six years in prison.

U.S. District Judge Pamela Reeves had heard from a number of medical professionals that 47-year-old James Brian Joyner was one of the finest, hardest-working doctors they had ever known. Medical doctors from at least three states penned letters on his behalf earlier this year.

It wasn’t enough to keep the former emergency room doctor from spending the next few years behind bars, however. After hearing testimony the past two-and-a-half days from former workers and patients of Breakthrough Pain Therapy Center, Reeves went on to sentence Joyner to five years and 10 months in prison for his involvement writing prescriptions and supervising other medical professionals at the Maryville pain clinic.

It was the minimum sentence prosecutors were seeking.

Joyner was one of two doctors indicted in the case two years ago after the clinic’s owners were convicted on drug and money laundering charges. Two physician assistants and five nurse practitioners employed at Breakthrough were also indicted.

One of them, former physician assistant David Erick Brickhouse, died in a car crash in April. Over the course of the next three months, Joyner and the others appeared before Reeves and pleaded guilty to a charge each of conspiracy to distribute Schedule II and IV drugs.

Plea agreements state the group handed out illegal prescriptions for oxycodone, morphine, oxymorphone and alprazolam while Breakthrough was in operation from July 2009 until December 2010, when authorities raided and shut down the facility.

‘Red Flags’ Overlooked

Three of Joyner’s co-defendants testified at Thursday’s hearing in the hopes of receiving a reduced sentence themselves. All three said they began working at Breakthrough in an attempt to help people. They didn’t realize — at least not at the time — they were doing anything illegal, they said.

The trio admitted to ignoring several “red flags,” including missing or minimal patient records and the fact patients were uniformly being prescribed incredibly high doses of narcotics.

Former nurse practitioner Jamie Cordes said much of what when on at the clinic was not “the best medical practice.”

Cordes and the two others to testify Thursday, former nurse practitioner Don Lewis Jr. and former physician assistant Walter Blankenship, said one of the owners, Sandra Kincaid, kept them in the dark regarding much of what was really going on.

“You fell into a practice that, in the light of day, turned out to be a criminal act, correct?” asked Joyner’s attorney, John Eldridge.

“Correct,” Cordes said.

Assistant U.S. Attorney Jennifer Kolman asked Blankenship point-blank if Breakthrough was a “pill mill.”

“Yes, it was,” Blankenship said. “Looking back, yes, it was.”

Lewis admitted the type and amount of narcotics prescribed at the clinic could have killed someone, particularly since he and other medical providers were often working with such minimal patient records. A majority of the time, all they had to go on was a patient’s word, he said. He described the care provided at the clinic as “substandard, for sure.”

Lewis said Dr. Deborah Thomas, the lead supervising physician at Breakthrough, and Kincaid, who had no medical training or background, were the only ones who instructed him on how to treat patients.

Criminal Intent?

In asking for leniency for his client, Eldridge told Reeves that Joyner was just like his former co-workers. Not only were they were naive about pain management, they were “hired by a crooked operation,” Eldridge said. It was a perfect storm, with Kincaid keeping Joyner and the others “in the dark” about many of the clinic’s seedier practices. And like his co-defendants, it wasn’t until much later Joyner realized the truth, Eldridge said.

“(He) did not set out to commit a crime, he just fell into it like everyone else,” Eldridge said. “His failure was that he did not study how to do pain management.”

Eldridge also argued that, while some of the blame does lie with those holding the prescription pads, there’s plenty of blame to go around. That includes the drug companies who manufacture and push these drugs, the pharmacies who fill the prescriptions and the users who seek them. “The failure of the academic community to properly teach” and the government’s “lapse of regulation” were also to blame, Eldridge said.

“I submit we know so much more today in 2016 than we did in 2010,” Eldridge said.

Assistant U.S. Attorney Frank Dale Jr. said Joyner and others like him violated the trust placed in them. He argued that, “people trust physicians perhaps more than any profession.”

“We trust them, and it’s that trust that has been abused in this case,” Dale said. “They put on a white coat, they hid under the mantle of medical practice and they did what they knew was wrong.”

While Joyner may have fallen into the business when it came to Breakthrough, Dale said, he later went to work supervising Cordes at a pain clinic she opened herself.

Apology Issued

Joyner, an emergency room physician for over a decade before he began working at Breakthrough, addressed the judge directly.

“I apologize and take responsibility for my part in this criminal enterprise,” Joyner said, adding that he “exercised poor judgment” and “looked the other way when I should have taken a stand for what is right.”

Joyner also apologized to his family, as well as the prosecutors and investigators working the case.

Before sentencing him to nearly six years, Reeves noted that every patient Joyner saw at Breakthrough was prescribed a scheduled narcotic.

“There is no question this is a serious offense,” Reeves said.

A number of Joyner’s family members were present at the hearing. They were hoping for leniency, but what they got wasn’t wholly unexpected.

“It’s just hard, it’s just hard,” said Joyner’s stepmother, Phyllis Joyner. “I think what they were mostly trying to do here is send a message.”

She said there was also another important fact left out of the court proceedings.

“The reason he pled guilty in the first place (is) they were throwing 39 years at him,” Phyllis Joyner said. “That’s what they were threatening him with. That’s what they were threatening all of them with.”

It left him in a bind, she said. “The way, in this day and time, everybody perceives pain clinics and everything.”

She was accompanied to court Thursday by her husband, Jim Joyner, James Joyner’s father.

“He was a good son, a good doctor,” Jim Joyner said, before adding that his son’s short stint at Breakthrough shouldn’t overshadow all the good he’s done throughout his career practicing medicine.

“He’s been an ER doctor for 17 years,” Jim Joyner said.

Phyllis said it was those fateful 34 days six years ago “that ruined his life.” She further described her stepson as “a good Christian” and “caring doctor” with a great deal of love for his family, which includes a wife and two sons.

“And he’d do anything for anybody,” Phyllis said. “I mean he would. People that have been his patients in the ER have raved about him.”

Reeves also ordered that Joyner spend three years on supervised release upon completion of his sentence. While Joyner and the other medical professionals in the case were also indicted on a charge of conspiracy to commit money laundering, plea agreements state those charges will be dismissed at sentencing. The count against Joyner was dismissed Thursday.

The remaining defendants all have sentencing hearings scheduled in January. Thomas and Cordes are both set for Jan. 13 hearings. Blankenship is to appear at a Jan. 19 hearing.

Former nurse practitioners Sherry Ann Fetzer and Buffy Renee Kirkland are to appear at Jan. 20 hearings. Lewis is scheduled for a Jan. 30 sentencing, and former nurse practitioner Donna Jeanne Smith for Jan. 27.