While "patients" lined up outside Professional Pain Center, dropped their used needles in nearby parking lots and sold their prescription pills across the street, federal agents were watching and quietly building a case against the Longwood pain clinic.
During their two-year investigation, agents said, they learned the clinic's leaders hired 10 doctors who were willing to write illegal prescriptions and employed others who falsified documents and accepted fictitious MRIs.
And they made millions of dollars while perpetuating Florida's prescription-drug-abuse epidemic.
According to a U.S. Drug Enforcement Administration investigative summary, one woman who was supposedly being treated for back pain admitted she was exchanging sexual favors with a doctor in the exam room for painkillers. And two of the clinic's patients died from overdoses in the time frame of the probe.
The investigation culminated last week with raids of the clinic on State Road 434 and several homes in Brevard County associated with the business leaders.
None of the clinic managers or affiliated physicians has been arrested in this case, but documents filed in federal court in Orlando suggest charges could be forthcoming.
An 83-page affidavit authored by a DEA agent details the multi-agency investigation into James Long, the pain clinic's registered agent; former Brevard County paramedic Daniel Bogan, who worked at the clinic; and doctors James Pizza and Michael Zelkowitz, along with several other physicians.
Although Pizza and Zelkowitz are not identified by name in the federal court filings, the Orlando Sentinel identified the physicians through various public records, including their individual DEA registration numbers, which are cited in the federal documents.
The DEA would not comment on the investigation, and attempts to reach the clinic employees named in the federal documents were unsuccessful. Reached by telephone, Zelkowitz said he needed to speak with his attorney but did not call back.
'Excessive and possibly lethal'
According to the affidavit summarizing the case, the investigation into Professional Pain Center, which also involved Longwood police and Seminole County detectives, began in January 2011 while the DEA was investigating a doctor shopper.
The court documents showed:
From July 2011 through May 2013, agents monitored the pain clinic and saw patterns of a typical pill mill: long lines, out-of-state license plates and groups of patients arriving together.
On one occasion, agents watched as two people left the clinic and conducted a hand-to-hand drug deal across the street.
Current and former patients, some of whom are facing drug charges, told agents that employees openly discussed selling pills and fake MRIs. Patients said drug deals unfolded in the back parking lot.
Agents used Florida's prescription-drug-monitoring program to find out what type of pills and how much Pizza, Zelkowitz and another physician at the pain clinic were prescribing.
Florida patients came from as far away as Pensacola and Bonita Springs to patronize the clinic. A criminal background check on a sampling of 274 patients revealed that 88 percent had arrest histories.
And a medical expert who reviewed three physicians' prescribing patterns found there was "no legitimate medical reason for prescribing large doses of controlled substances to these patients."
Pizza alone prescribed more than 3 million units of immediate-release oxycodone in two years, according to the affidavit.
Records show the medical expert found the "type, quantity, and combination of the medications prescribed was excessive and potentially lethal."