BOSTON — The wealthy founder of a drug company plotted to bribe doctors across the country to prescribe a highly addictive fentanyl spray in order to outshine competitors and line his own pockets, a federal prosecutor told jurors Monday.
Assistant U.S. Attorney David Lazarus said John Kapoor was so determined to make Insys Therapeutics Inc. a success that he turned it into a "criminal enterprise" to get the powerful painkiller in the hands of more patients.
"This is not a complicated case. It's a case about greed — about greed and its consequences — and what happens when you put profits over people," Lazarus said as the closely-watched trial opened in Boston.
Kapoor is the highest-level pharmaceutical figure to face trial amid the opioid epidemic that's claiming thousands of lives every year. His lawyers say Insys is not responsible for the drug crisis, noting that its medication makes up a small fraction of the prescription opioid market.
The 75-year-old and four other former employees of the Chandler, Arizona-based company are accused of paying doctors millions of dollars in bribes and kickbacks in order to boost sales for Subsys, which is meant for cancer patients with severe pain.
The bribes were paid in the form of fees for sham speaking events that were advertised as educational opportunities for other doctors, prosecutors allege.
Kapoor's lawyer told jurors that Insys was open about its speaker program and even reported payments to doctors online. Paying doctors to teach others about a medication is not illegal and is a practice widely used by pharmaceutical companies, Attorney Beth Wilkinson said.
"There was nothing illegal about that and there was certainly nothing secret about that," Wilkinson said.
She said Kapoor was motivated not by greed but by a desire to help people dealing with excruciating pain. Kapoor watched his wife suffer from breast cancer and was driven to provide other patients with a chance at relief, she said.
"He did not want that to happen to anyone else," Wilkinson said.
Wilkinson also sought to discredit the government's key witnesses: two former Insys executives who pleaded guilty and are cooperating with prosecutors.
Former sales executive Alec Burlakoff was the one cutting "side deals" with doctors and is willing to say anything prosecutors want him to in order to help himself, she told jurors.
Kapoor and the other executives are charged with racketeering conspiracy, which carries up to 20 years in prison.
The case is being led by longtime federal prosecutor Fred Wyshak, who has won convictions against Boston crime boss James "Whitey" Bulger and other powerful mobsters.
Jurors heard the testimony on the second day of the closely watched federal trial against Kapoor and four other former executives. They include Sunrise Lee, whom prosecutors have described as a former exotic dancer who was hired to be a regional sales manager even though she had no experience in the pharmaceutical world.
Holly Brown, who worked as an Insys sales representative, told jurors that her superiors encouraged her to focus her attention on a doctor who was known for prescribing lots of opioids in Chicago and northwest Indiana. Brown said she had concerns about Dr. Paul Madison, describing his office as a "shady operation" being run out of a "dingy strip mall in a not-so-nice area of town."
Despite that, Madison became a speaker for Insys and started getting paid, Brown said. She said she struggled to get other doctors to attend Madison's speaking events because of his unsavory reputation, so Madison would invite his friends.
"The idea was that these weren't truly meant to be educational programs but they were meant to be rewards, basically, for the physicians," Brown said.
Brown described after one Chicago dinner going with Lee, Madison and another sales representative to a club called The Underground. At one point, Brown said, she saw Lee sitting on Madison's lap and "bouncing around," with Madison's hands "inappropriately all over" Lee's chest.
Lee's lawyer, Peter Hortsmann, denied the allegation during his opening statement Monday after prosecutors had mentioned it and accused them of "objectifying her in the same way Alec Burlakoff did and Dr. Madison did," The Boston Globe reported .
On Tuesday, Hortsmann tried to show that Brown's memory was faulty, noting that they all had been drinking. He also pressed Brown on whether she had been warned that Madison had a "certain reputation with female sales reps" and whether it seemed that Madison "appeared to be taking advantage" of Lee at the club. Brown said she had been warned and agreed with the latter observation.
Madison was convicted in autumn in an unrelated matter on a variety of charges, including health care fraud. He is scheduled to be sentenced in March. Madison's lawyer said Tuesday his client had no comment.
Testimony will continue Wednesday in the trial, which could last more than three months.
Several Insys employees and doctors have already been convicted in other cases of participating in a kickback scheme. A number of states have sued the company, which also agreed last year to pay $150 million to settle a federal investigation into inappropriate sales.
Patients say in a slew of lawsuits filed against the company that they were given high doses of the potent narcotic even though they didn't have cancer, weren't warned of the risks and became addicted before suffering through withdrawal when they were cut off.
Prosecutors say Insys executives targeted doctors at pain clinics known for operating "pill mills" and pushed physicians to prescribe the drug at ever-increasing doses. Insys employees who managed to get doctors to prescribe higher doses were rewarded with bonuses, prosecutors say.
Kapoor "demanded success at all costs," Lazarus said. And when the drug wasn't doing as well as Kapoor wanted, "he decided to get the success he demanded by breaking the law," he said.