A Casper doctor accused of running a pill mill testified for several hours Friday, casting himself not as the center of a lucrative prescription drug scheme but as a well-meaning doctor who placed too much trust in his patients.
“I’ve learned a great deal now about deception (and) lies,” Shakeel Kahn told his attorney, Michael Thompson, Friday afternoon.
Kahn is facing 21 charges related to his alleged criminal activity, including a single count of conspiracy to distribute drugs resulting in death. During his years of practice in Arizona — where one of his patients overdosed and died — and Wyoming, Kahn wrote nearly 15,000 prescriptions for controlled substances, totaling roughly 2.2 million pills, nearly half of which were oxycodone.
But Kahn, dressed in a gray suit and white shirt, told the jury for hours that “at all times” he followed the law in his efforts to help his patients treat their chronic pain. Asked throughout the day if he thought any of his prescriptions — many of which were for high quantities and high dosages of potent narcotics — were inappropriate, Kahn repeatedly testified that he believed his treatment methods were medically appropriate.
He testified that he tried “every route we could” to ensure his patients — who regularly paid hundreds of dollars for each office visit — were not abusing their medications. He said he would “ask straight up” if patients were abusing pills. But he acknowledged that the patients would often deny the accusation, and without any proof, he would continue writing them hefty prescriptions.
Kahn denied ever being suspicious of many of his patients, even when they would call and ask for certain quantities of specific medications. He said he continued writing scripts for one patient even after he heard she had been arrested for selling her pills. He testified that he asked the patient if she was selling them, and when she denied she was, he continued treating her because he had no proof otherwise. He told Thompson and the courtroom that he was concerned that if he “fired” one of his patients from his pain clinic in Casper, then he might face a lawsuit from that person.
If he was guilty of anything, Kahn said, it was poor record keeping. A staple of the government’s case against him is that the doctor allegedly altered medical records to evade scrutiny and punishment from medical boards. He acknowledged doing so Friday, though he said it wasn’t to “deceive” medical authorities; it was for the purpose of “completeness” in his records.
He admitted to changing a patient’s pain score — the rating from 1 to 10 of how much pain a patient was in — in that patient’s records. In that case, it wasn’t a desire to have complete records that made him change the patient’s chart. It was “stupidity,” he said.
“I couldn’t give you a logical answer at this time,” he said, though he added that he didn’t mean to mislead the Arizona Medical Board, which investigated Kahn repeatedly over a period of years for complaints made against him by former patients and pharmacists who were concerned about his prescribing habits.
Kahn maintained that the poor record keeping didn’t translate into poor patient care. Though he acknowledged he was careless and sloppy with his records, he called record keeping a “bureaucratic nightmare” and that he sometimes changed records — like scribbling in an approximate time of a visit from years prior — to avoid nitpicking by investigators from the medical board.
He acknowledged that he had added a patient’s signature to a form, though he testified that he had the patient’s permission to do so and that he didn’t consider it “improper.”
At one point, Kahn argued that not surreptitiously updating medical records would’ve been a lie. He said he went back and added results of a urinary test, reasoning that he had performed the test and that to leave the chart without that information would’ve been more dishonest than quietly altering the record itself.
Kahn spoke for hours, his voice often picking up speed to the point where his attorney or the court reporter had to ask him to slow down. He walked Thompson through the forms that his patients had to fill out, which included promises to not abuse or misuse opioid prescriptions.
But they also included a document that featured a list of statements the patient must acknowledge, which Kahn said was included to protect him from legal action. The first item on that list was a statement that Kahn was not a drug dealer, and suggesting that he was is “actionable as slander.”
Thompson asked whether Kahn was a drug dealer.
“No, absolutely not,” he replied.
The second item in the list was a statement that acknowledged Kahn “did not now or in the past addict me to any controlled substance,” and another line in the list forbid the patient from suing Kahn for any liability — like an overdose — that may arise from use of the medications Kahn would prescribe. The final item on the list stated that any patient who brought legal action against Kahn would have to pay the doctor $100,000.
He said that provision was to guard against “false allegations.” Kahn explained to the court that he created the document after his troubles in Arizona, where patients had accused him of getting them addicted to pills and pharmacists accused him of overprescribing.
$500 office visits
Perhaps most eyebrow-raising was Kahn’s testimony about how he charged his patients. While he continually painted himself as a physician concerned for his patients’ pain levels, Kahn showed no leniency when it came to his fees. At the time of his arrest in late November 2016, he was charging a flat rate of $500 for each office visit. Patients were expected to see him for each refill, each month.
He no longer accepted insurance, which he said was because of issues with the companies, and accepted only cash or cards. He testified that he charged more for patients who were “higher risk” — which seemed to translate to those patients who were on higher doses of narcotics.
Some patients where charged as much as $1,000 a visit. A friend of another patient offered Kahn $1,800 to write him three narcotic prescriptions. Kahn said in court that he would normally charge $500 but that he wouldn’t turn down the higher amount. He stressed that he wouldn’t write the script without seeing the new patient in person first.
That conversation — between Kahn and the patient who was asking for $1,800 worth of pills — was captured on tape. Kahn replies that “I guess I can do that,” referring to writing the script. He testified that he didn’t find the request suspicious, that he wasn’t really paying attention on the call and that he later said he had to see the patient.
Later on that same call, the patient — Deni Antelope, who took a plea deal — asked Kahn if she could get a discount on her office fees. According to the recording, Kahn laughed and said no. He told her that if she wanted to pay less, he could give her fewer pills.
“I don’t think you want to do that,” he said.
When asked by Thompson what he meant by that, Kahn testified that he was telling Antelope that if she wanted to save money, he would write her a smaller script to save money at the pharmacy.
In another call, Paul Beland — who also took a plea deal — asked Kahn to write his friend a script for 120 Xanax. Kahn had not seen this person and told Beland that he was trying to stop writing Xanax scripts. But he told Beland he would do it this one time.
Kahn then testified that he never wrote the prescription and was trying to get Beland off the phone.
Kahn denied that the exact strength of a pill had a corresponding dollar figure, though he said patients on higher doses required more time and thus were charged more. But it’s unclear what Kahn meant by “more time” — he said he would have to spend more time talking with and checking those patients, though he also testified that he checked on all of his patients’ medications and that, in order to get a script, he had to speak with them.
He said the higher-dose patients were often able to get in touch with him easier.
“You’re paying for greater access,” he told the court.
But in many cases, Kahn said he would write patients’ prescriptions even if they didn’t come to see him for every refill — only as long as they called him and that they paid him. They would be charged for calling in a script just as if they had come in and seen him.
He would regularly split up patients’ prescriptions if they couldn’t pay up front. If a patient could only pay half at the time of the visit, for instance, Kahn would give the patient half of his or her pills. He would write the other half of the prescription after he was paid.
“In a business sense, if you give it all up front, you likely won’t see them again,” he said.
Trades for pills
Kahn acknowledged that he would accept goods in return for his services. He said he traded his doctor visits — and, by extension, the prescription refills — for guns, motorcycles, car batteries — even dentist visits.
He scoffed when his attorney asked him if there was anything improper or illegal about trading his services for his patients’ things, calling the practice the oldest form of purchasing.
He denied ever selling a patient’s medications or providing one patient’s medication to another person. But he later admitted giving a prescription meant for an Arizona patient to his brother, Nabeel — who is also facing two charges. Nabeel, he said, was in legitimate medical need. Kahn had planned on mailing the pills to the Arizona patients, and instead gave them to his brother.
Asked by his attorney if that was improper, Kahn said no. He likened it to when a family member has Vicodin left over after a dental procedure and gives it to a relative in pain.
“We all do it,” he said.
The doctor repeatedly said he had no reason to doubt his patients, even when they appeared to give him strong warning signs otherwise. An undercover officer once came to his clinic, complaining of “intermittent wrist pain” and describing the pills he wanted by their color. Kahn said he figured the man had purchased drugs off of the street previously; he gave the officer a low dose of Percocet.
In another case, Kahn said he wasn’t suspicious of one patient paying another’s office fee. Another patient was discovered to be doctor shopping — meaning she was getting prescriptions for controlled substances from multiple physicians. Kahn initially kicked her out of his practice. She begged to come back, he testified, and he relented. But he lowered the amount and strength of pills he would give her and required that she see him in person twice a month. He charged her $600 for each visit.
Kahn had maintained that he was writing the prescriptions for his patients based on their legitimate medical need. Why, then, did he seemingly arbitrarily lower this patient’s dosage?
He said it was for doctor shopping, and that he had to charge her more because she was a “high-risk” patient who would require more time and observation.
In the case of Jessica Burch and Anthony Vargas, a couple in Arizona, Kahn saw nothing amiss when Burch began picking up Vargas’ pills from Kahn. Kahn had also photoshopped Vargas’ signature onto forms, believing he had the patient’s permission. Vargas had been jailed in Las Vegas, but Kahn kept writing him scripts and Burch kept picking them up. Kahn also acknowledged writing down vital signs for Vargas while the man was in jail, essentially manufacturing the information, which he said was done for record “inclusiveness.”
Vargas testified earlier in the trial, saying he had become addicted to prescription pills after two or three visits with Kahn. He and Burch sold some of their pills and used others. After he was released in Las Vegas, Burch was changed, he said. One night, he found her passed out near their house. She was unresponsive but breathing.
The next morning, she was dead. Kahn is charged in her death.
Asked about Burch’s death, Kahn said he “had regrets,” should’ve paid more attention to her when she came to his office for refills and that he shouldn’t have “gone on blind trust alone.”
But, he said, “hindsight is 20/20.”
The case will continue Monday morning, when the prosecution is expected to cross-examine Kahn. Nabeel Kahn’s attorneys have still yet to make an opening statement and likely will early next week. The two sides will likely make closing statements Tuesday, after which time jury deliberations will begin.