For the first time, jurors heard a witness describe the Schneider Medical Clinic as "a pill mill."
The phrase, which had been included in the federal indictment of a Haysville doctor and nurse, came from the testimony Wednesday of a nationally recognized addiction specialist.
Ted Parran, a physician from Cleveland, provided some of the most forceful testimony yet for the prosecution in the trial of Stephen and Linda Schneider.
Stephen Schneider, a doctor, and his wife, a nurse who managed their clinic, are charged in federal court with crimes including illegally prescribing narcotics and health care fraud.
Parran, an associate medical professor at Case Western Reserve University, said that in his studies of drug addictions he had developed about 10 characteristics of a "pill mill" or a "script clinic."
These are clinics, Parran said, that dispense prescription drugs and strong narcotics beyond what is normally considered good medical practice.
"They're offices and doctors, but I wouldn't call it a medical practice," Parran testified.
Among those characteristics he's found common to such clinics are frequently prescribing drugs on the first office visit, little attention to prior medical histories, sloppy record-keeping and lack of diagnostic testing for ailments.
"I rarely find all of them present," Parran said.
"Were they all present at the Schneider clinic?" prosecutor Tanya Treadway asked.
"Yes," Parran answered.
Parran examined more than 100 records of patients at the Schneider clinic that he said showed a routine of prescribing strong narcotics, even as patients' conditions deteriorated under their use.
On cross-examination, Parran sparred with defense lawyer Lawrence Williamson over details in those records — which represent about 1 percent of the clinic's patients.
Parran acknowledged the records showed that Schneider performed osteopathic manipulations and other procedures to treat patients for their pain.
Schneider also treated patients for other ailments including diabetes, high blood pressure and high cholesterol.
But the clinic's records also carried warnings of potential dangers of prescribing narcotics to some patients, Parran testified.
A Wichita drug treatment center had written to the Haysville clinic on behalf of one woman, claiming she was addicted to the drugs being prescribed, Parran said. The woman had been involved in 15 automobile accidents.
Stephen Schneider, who saw the woman on 75 visits, continued to prescribe mixtures of strong narcotics even after reports she'd had a heart attack and respiratory failure, Parran said. She eventually died of a drug overdose, Parran said.
Parran told of an 18-year-old woman who was prescribed Xanax for "performance anxiety" related to her job as an exotic dancer.
Parran said that usually wasn't the kind of anxiety that would require the doses of Xanax the woman received.
A few months later, Parran said, the same woman received an amphetamine as a diet suppressant after being diagnosed as obese. She was 5 feet, 2 inches tall and weighed 142 pounds.
"And it would have made her anxiety worse," Parran said of the drug.
A 16-year-old boy, meanwhile, was treated for migraines by being given Actiq, a lollipop of fentanyl — a drug many times stronger than morphine. Parran said the boy received the lollipops at a dose four times what was typically given to a terminal cancer patient.
"This is simply unbelievable, that a 16-year-old would receive that kind of dosage," Parran said.
"This was not a duped physician's office, or a dated physician's office," Parran testified. "This was a dishonest office... a pill mill."