The Needham doctor’s drug-dealing scheme was simple, the prosecutor said in his closing argument Wednesday: put vulnerable patients on powerful opioids, keep them high, and collect every month.
But defense attorneys said Dr. Joseph P. Zolot, 64, was a compassionate practitioner who navigated the complex field of pain management to find the best options for his patients.
Any negligence, they argued, was unintentional, the result of drug-addicted clients who may have duped him to keep their prescriptions coming. And therefore it was not deserving of a guilty verdict.
Zolot is on trial in federal court in Boston, where Assistant US Attorney Michael Crowley argued that he irresponsibly prescribed powerful painkillers between 2003 and 2007. Prosecutors say the prescriptions led to six overdose deaths, though Zolot is no longer charged with the deaths.
“Do no harm: the basis of medicine. The defendants chose not to follow that rule,” Crowley said in court Wednesday.
Zolot and nurse Lisa M. Pliner, 54, are charged with conspiracy to violate drug laws and seven counts of illegal drug distribution.
“They were doing nothing more than addicting [patients] and giving them drugs to either sell or give away,” Crowley said. “They knew what they were doing. They just didn’t care.”
Zolot’s attorney, Howard M. Cooper, cited testimony that Zolot’s patients continually falsified their pain to get prescriptions. If Zolot were “willfully acting as a drug pusher,” Cooper said, his patients wouldn’t have had to lie to him.
“They knew Dr. Zolot was a doctor acting in good faith and making medical judgments and not a drug dealer,” Cooper said.
Doctors clash in the field of pain management, a difference highlighted by expert witnesses called by both sides.
The prosecution’s witness, Dr. Christopher J. Gilligan, codirector of the Spine Center at Beth Israel Deaconess Medical Center, said Zolot should have seen warning signs and sent his patients to treatment for addiction or weaned them off medication.
But Dr. Carol A. Warfield, a full professor at Harvard Medical School, found Zolot’s medical judgment sound and said she probably would have written the same prescriptions, Cooper recounted to the jury.
Crowley said that Zolot and Pliner covered up their scheme by cloaking medical files in stock language, such as “chronic mechanical back pain.” He said they ignored drug tests that showed that patients were using street drugs or not taking the medication they had been prescribed.
“This was straight drug dealing that they covered up with their files, with their template language,” Crowley said. Zolot and Pliner gave up their roles as medical providers, he argued, when they peddled prescriptions for “cash, cash, cash.”
Crowley cited Zolot’s tendency to give clients multiple kinds of opioids at once.
But Cooper said such choices make sense within the common practice of rotating painkillers, a widely accepted model of treatment at the time of Zolot’s operation.
Zolot moved to the United States from the former Soviet Union as a political refugee in the 1980s. After working in pediatric surgery and adult trauma, he opened the Nonsurgical Orthopedic Center in Needham in 2003. Eventually, it was drawing between 50 and 60 patients per day, the prosecution said. Zolot worked with Pliner, another refugee from the Soviet Union who studied medicine in the United States.
As Cooper spoke Wednesday, Zolot watched intently, with Russian-speaking supporters sitting in courtroom benches behind him.
One of Zolot’s patients who died, Crowley said, was so addicted that he cut open fentanyl packages to suck out the liquid inside. Another had clear symptoms of heroin use, and others openly admitted their addictions to Zolot, Crowley said, yet Zolot prescribed painkillers.
Zolot’s patients included Dennis Dillon, who was 36 when he died in 2004. Jeffrey Campbell, 26; Thomas Dunphy, 49; and James Curley, 44, died in 2005. Christopher Bartoloni, 35, and Scot Poulack, 39, both died in 2006.
Zolot and Pliner were initially charged with causing the deaths of their patients. Prosecutors withdrew those charges after a Supreme Court ruling this year narrowed the scope of evidence allowed to prove those charges.
Jurors are scheduled to begin deliberation Thursday morning.