To prosecutors, he was no different than a street-level drug dealer. Dr. Joseph P. Zolot, a prominent Needham doctor, stands accused of irresponsibly prescribing powerful painkillers, leading to at least six overdose deaths.
But a lawyer for Zolot argued in federal court in Boston Tuesday that his client was a caring doctor who sought the best treatments for his patients in the complicated field of pain management, but may have been duped by some who abused their prescriptions to feed their addiction.
Prosecutors say that Zolot caused the deaths of several patients, though he is not charged in their overdoses. Zolot and nurse Lisa M. Pliner, 54, are charged with conspiracy to violate drug laws and seven counts of illegal drug distribution.
“It’s not just a violation of physicians’ ethical [standards] to give drugs to people who shouldn’t be getting them; it’s a crime, and that’s why we’re here,” Assistant US Attorney Eric P. Christofferson told jurors in his opening statement Tuesday.
But Howard Cooper, Zolot’s lawyer, argued that when Zolot, 64, learned clients were abusing their prescriptions, he terminated his relationship with those patients. “A doctor has to make a good faith medical judgment, and we should defer to that judgment, because he was there,” Cooper told the jury.
Zolot’s case has been closely watched by those in the medical community and the health insurance industry. The trial is expected to touch on proper pain management and patient care, as well as professional and licensed drug dealing. The trial comes as the region faces a growing opioid abuse epidemic, based in large part on the abuse of prescription painkillers. The trial could last two months.
Zolot moved to the United States from the former Soviet Union as a political refugee in the 1980s. In his opening statement, Cooper sought to draw a picture of Zolot’s efforts to learn proper English, obtain a medical license, and raise a family. Though he was initially trained in pediatric surgery, Zolot obtained jobs in adult trauma and moved into the pain management field.
In 2003, he opened his own practice, the Nonsurgical Orthopedic Center in Needham, working with Pliner. Cooper said Zolot established a full-service practice with a variety of services that directed patients to neurologists and psychologists and offered holistic approaches to care, including acupuncture, yoga, tai chi, and an exercise room.
“It was his goal to treat patients and improve their functions . . . and that’s what Dr. Zolot did to treat all of his patients, and he did it for years,” Cooper said.
But Christofferson argued that few of those patients were there for yoga or acupuncture. He said 90 percent of Zolot’s patients were prescribed pain medications, including methadone, OxyContin, and fentanyl.
One of Zolot’s patients who died, Christofferson said, was so addicted that “he was cutting open these [fentanyl] packages to suck out the liquid that was inside.”
Zolot’s patients included Dennis Dillon, who was 36 when he died in February 2004. His brother approached Zolot and was allegedly told, “Your brother had problems anyway,” according to Christofferson.
Jeffrey Campbell, 26; Thomas Dunphy, 49; and James Curley, 44, were former patients of Zolot who died in 2005. Christopher Bartoloni, 35, and Scot Poulack, 39, both died in 2006.
According to Christofferson, Bartoloni had visible track marks, a sign of heroin abuse, and tested positive for cocaine and methadone. He was given methadone by Zolot anyway, Christofferson said, and died days later. Doctors are required to check for signs of drug abuse, Christofferson argued.
Zolot and Pliner were initially charged with causing the deaths of their patients, which carried a minimum mandatory sentence of 20 years if convicted. Prosecutors withdrew the more serious charges after a Supreme Court ruling this year narrowed the scope of evidence allowed to prove those charges.
Cooper told jurors that Zolot was simply doing his job. He said the patients, including those who died, came in for a variety of pain problems, including herniated disks. And, Cooper said, there are no clear guidelines in the medical community on how to treat pain, noting that a patient could legitimately be taking many medications at one time.
“None of us, including a doctor, can feel another’s pain,” Cooper said.