MECHANICSBURG, PA. 17050 | Telephone: (717)691-2201 eee OF POLICE CRIMINAL COMPLAINT COUNTY oF ath en oF PENNSYLVANIA, Magisterial District Number: 09-3-04 MDs: Hon. KATHERYN H. SICOX DEFENDANT: (NAME and ADDRESS}: Address: 5275 E. TR@INDLE ROAD JOSEPH _THOMAS. ACRI First. ‘Mido Name Last Nae Gen NCIC Extradition Code Type 1B t-Felony Fut Dit Fetony No Et. TB -Misdemeanor Limited T Entiscemeanor Pending i 2Fetony Le C5 Feony Pond TloMisdemeancr Suroundng Stee] Distance | Die-elony Surounding Slats] AdMsdomoanor Ful Cb -Nislemeanor No Extraction Dosjeh A iveSea rer | Compuinlncaan Namba | SD equa La Sovicos? eBou cP PRE Lerma eee | SEND os B//e/ias 7 rod [nae Dos [so-Defendantis) Gf Bl Male Fist Name Middle Name LastName cen | Gremie | aa RACE wi a teak Ti Aaron nae “ETHNIGHTY — Pye — 2 Bhatia —- HAIR COLOR Biervisey CORED (Roan) Choy ena) E)aLU (Bow) Cir Pune) LBRO (own | Cleuxeescy Cone orange) Chwniewnie) Cec uniioaly Elan (cre) nk inky Datn one seavbery) : EYE COLOR Catk eiack) iat fate) BaR0 (orem) Ti caw (Greeny Dicer an nz aren ar roan) _LPaK (ek) Tmut anstesresy —C00« (Usnoun) Driver License | stato PA License Nu be Expires: 05/19/2017 WEIGHT (Ibs) DNA. Dyes TINO [oa tocation FBLNumbor . TaN Rambo Fo HEIGHT Defendant Fingerprinea | LIVES LINO 5 10 Fingerprint Classification: : DEFENDANT VEHICLE INFORMATION. ] Off NCIC Voh: Code | Reg. Stato | Hazmat |” Registration ‘Comm Veh School Pte LEG" | secteremny —_/ ina} eget sare [va - ] Yoar Hake oder ‘She ] eater oe l | o | Office of the attorney for the Commonwealth (Approved Cl Disapproved because: Th aorney Tor he Common woah may Toque Tat He COM, ATOR WaRaRT AMT, oF BIN BS BOPTOWET Dy tofing. See PaR Grim. 507). Te Gray Tors CoRTTORTD BGP DAG ROBERT SMULITIS a i aye Canoe SST TAT HS CTT = "| AGT WILLIAM DELGADO __ _BADGE #159 : {Name of the Afar) {PSPIPOETC -Assignod Afiat 1D Nanibor& Badge F | of PA OAG - BNI&DC __PA0224000 _ {Idenify Depariment or Agency Reprosartod and Poltca’ Subdivision) ~~ (Police Agency ORI Number) do hereby state: (check appropriate box) Bi | accuse the above named defendant who lives at the address set forth above I acouse the defendant whose name is unknown to me but who is described as 1 therefore desianated as John Doe or Jane Doe with violating the penal laws of the Commonwealth of Pennsylvania al HILL, PA 17011 AND Orwe- lecwhens in Por in CUMBLERAND County [1 (County Code) yp ECunberlend Coun | accuse the defendant whose name and popular designation or nickname are unknown to me and whom have on or about FEBRUARY 9, 2011 THRU MARCH 12, 2014 3649 MARKET ST, CAMP} reat AOPC 412A — Rev. 07/10ths POLICE CRIMINAL COMPLAINT Docket Number: Date Flea | OTNiLiveScan Namiber Compiainvincident Namber BN30036-14 sang non ahaa First: ‘Middle: Last: | pomeeienees | JOSEPH [owas ACRI | The acts committed by the accused are described below with each Act of Assembly or statute violated, if appropriate. When there is more than one offense, each offense should be numbered chronologically. (Set forth a brief summary ofthe facts suficent to advise the defendant ofthe nature of the offense) charged. A citation tothe statut(s) violated, without ‘mare, isnot sufficient in a summary case, you must cits the specfc section(s) and subsoction(s) of the stafut(s) of ordinanco(s) allege vislaled, The {age ofthe vitim at the tine ofthe offense may bs Included i known. In aditon, social security numbers and financial information (eg PINa) shoul hot be liste. the identy ofan account must be established ist ony the last four digit, 206 PA Gade $6 213.1 218.7) Tnchoate | C] Attempt 1 Solicitation Ci Conspiracy Offense | — 129074 7 ieoonn” _ ra908, @ [i 780-113 [(A\(14)_[orme | 35 4 F a — St PRS | — cain Gade — “ee Ofenas Cas UORNERTCE snnDOT Data | Accor ‘dtapancabiey =| cmon 1 saety Zone 1 wor Zon0 Statute Description (include the name of statute or ordinance): THE ADMINISTRATION, DISPENSING, DELIVERY, GIFT OR PRESCRIPTION OF ANY CONTROLLED SUBSTANCE IN ACCORDANCE WITH TREATMENTPRINCIPLES ACCEPTED BY A RESPONSIBLE SEGMENT OF THE MEDICAL PROFESSION ‘Acts of the accused associated with this Offense: in that betwean the dates of February 9, 2011 thru March 12, 2014, Dr Joseph Thomas AGT | an Osteopathic Physician and Surgeon, dd knowingly administer, dspense, OxyContin and Oxyeadane tables, Doth a Schedule II controled substance to | patients: T.C, CE, ME, and S.E. Dr. Ac! provided 8 prescriptions of 240 tablet Oxycodone 30 mg to C.E. and S.E. and 10 prescriptions of 240 tablets Oxycodone 30 mg tablets to ME. while they working at a Pizzeria proving na examination tothe patents, In adction Dr. ai provided T.-C. ‘approximately 36,100 Oxycodone tablets, at times prescriptions for 2,000 Oxycodone tables provided t T.C. as a 90 day supply but providing addtional resorption for large amounts wel pir tothe 90 days. Dr. Acti acted notin good faith in the course of Rs professional practice, not thin the scope of {he natien relationshin, nor within the trealmentcrinciies accented bv a resnonsibe seament af the madical profession we treating Inchoate | 1) Attempt Di Solicitation CO Conspiracy Offense | 100014 129028 e503, O [2 | 780-113 (A)(12)_fetthe | 35, 1 F Lead? Ofanssl sa Stor Bx Sas Tie] Com ade We ofens 65ae USNS ae PennDOT Dat Accident eran | eee Satay Zona i Wark Zon0 ‘Statute Description (include the name of statute or ordinance) ACQUISTION OR OBTAINING POSSESSION OF A CONTROLLED SUBSTANCE BY MISREPRESENTATION, FRAUD, FORGERY, DECEPTION, OR SUBTERFUGE: 35 .S. § 780-113(a) (12) = (F) ‘Acis of the accused associated with this Offense: In that on or about Septoriber 5, 2013 and March 12, 2014 , De. Joseph T. Aci, dd knowingly, intentionally and recklessly, acquire or obtain possession ofa controled substance by misrepresentation, frau, forgery, Geception, or subterfuge to wit: Dr. Acti conspired with and agreed to assist T.C. n obtaining a quant of OxyContin tablets, a Schedule It controled substance, by veriving two presciptions that Dr. Ar acknowledged were forged andjor altered, T.. vas able to fil these prescriptions are obtain the tablets by presenting the altered | brescrptions to the pharmacy. These prescriptions were then verted by Dr. Act which then authorized the pharmacy til sid prescriptions when they | othenvise would not have done so without said verification, “inchoate” | LD Attempt a BH Conspiracy a |omrense | ‘e901 18908 ofB 903(A)(1) 1 F Loser “ORS ——soaton ‘Susecia PASE TH] — Caan nae Nie os 6506 USERS PennDOT Data | Accident stay done oe ] | (applicable) || Number D satay 2 I Work 2 ] Statute Description (include the name of statue or ordinance): CRIMINAL CONSPIRACY/ACQUISTION OR OBTAINING POSSESSION OF A CONTROLLED SUBSTANCE BY MISREPRESENTATION, FRAUD, FORGERY, DECEPTION, OR SUBTERFUGE: 35 PS. § 7BD13(a) (22) -(P) ‘Adis ofthe accused assocated with his Offense: tn hat on or abot SestemberS 203 and Wah 2, 201¢, br. esp, A wth be intent of poming of facta te commision of tec of aequsiono obang posession fe controled sac (xyebnn)by Iisrepresrtatn, rau ogy, cece, subtruge, agree wth anther person fat they er ne move of them wou engane ocd hich Cones the afin, Yo wi: "br Act conpred wih and agreed to asset. Inotanng @auaty of OryContn abs, Sete cooled Stbstance, by vein wo prescplons tat br. At adrowetges were forged and/or ated. .c wes able fol hese pesaplons and cbt the | le cg lire espn pray. Ten petgtierthen eed yA when aah tang © | sneer hers Wo AOPC 412A — Rev. 07/10 Page _ of _288 POLICE CRIMINAL COMPLAINT 1 Docket Number: Date Fi ‘OTWiLiveScan Number ‘Complainuincident Number _ BN30036-14 al Fret Tie Last: percents 7 JOSEPH THOMAS I ACRI The acts committed by the accused are described below with each Act of Assembly or statute allegedly violated, if appropriate. When there is more than one offense, each offense should be numbered chronologically. {Set forth a brief summary ofthe fects sufficient to advise the defendant ofthe nature of the offenso(s) charged. citation to te statutes) allegedly Violated, without more, is not suficent na summary case, you must cite th specific section(s) and subseetion() ofthe stlutes) or ordinansefah allegedly violated. The age ofthe victim atthe time ofthe ofanse may be incluted it known. In audilon, social security mumblrs sd fnanclal information (6.3. PINS) should not be liste. I the identity of an account must be established, list only the lat four digits, 204 PA.Gode §§ 2181-2137) Tnchoate | C] Attempt iE Solicitation T Conspiracy Offense | 190014 189024 18603 — = - O [4 [780-113 (ayai_ [fetthe [35 al ™ Loser “ORE —— sas Sse 7X Sis Tis] — aun Gage — Wee OFanesGas —— USHERS To Femoor bas | aa Ciitonte | Ceawyzom | Ll Won zane Statute Description (include the name of statute or ordinance): FAILURE TO KEEP RECORDS of DISTRIBUTION of CONTROLLED ‘SUBSTANCES: 35 P.S, §780-113 (13)(a)(21) ~ (M) | Acts of the accused associated with this Offense: In that between the dates of February 9, 2011 tru March 12,2014, Dr Joseph Thomas Aana Practtoner licensed by law to administer, dspense or dlstribute contrlled substances shall keep a recor of al such substances administered, dispensed or stributed by him, showing the amount administered, dispensed ordstrbuted, the date, the name and address of the patient, to whom such substances are dlspensed or dstrbuted. Such record shall be kept fortwo years from the date of administering, cspensing or distributing such substance and shal be ‘open for inspection by the proper authorities pursuant to Tite 35 PS. Section 780-112(b). To wt Dr. Act admitted to vrtng several presenpions for TC ror to adhising TC. that Dr. Acro longer wished to treat him as a patient any longer. Dr, Ac admitted that he kept na records ofthese prescriptions. Teheate_ | Atompt Ci Scitation TDi Gonssiracy Offense | — 189074 ies024 : 18908 a I ohibe| Z tendo “Dienst ser ——"— sa SS Sate na ee aoe PennDOT Data | Accident Inter fey Zone ork Zoe (Wapplicabie) | _Nonbor Binet | Csartyz Bwerkzore | Statute Description (include the name of statute or ordinance) | Acts of the accused associated with this Offense: Tichoate” | Attempt i Solicitation Di Conspiracy Offense =| 1600" A 189024 18903 _ aq —— Lento Osa = Sa) Ga — nas — We Oss Cae —— DSBS ES PennDOT Data) Accent care ‘Slely Zone ae (applicable) — | Number | Ot OD sate a Statute Description (include the name of statute or ordinance): ‘Adis of the accused associated with this Offense: OPC 412A — Rev. 09/12 Page _ ofeas POLICE CRIMINAL COMPLAINT Docket Number’ | Date Filed: | OTNLiveScan Number ‘Complainincident Number ] LL BN30036-14 _ | S Fist Tid ast 1 [pefeodantneme: | S0SEPH | THOMAS | ACRI _ | 2. ask that a warrant of arrest or a summons be issued and that the defendant be required to answer the charges | have made. 3. | verify that the facts set forth in this complaint are true and correct to the best of my knowledge or information and belief This verification is made subject to the penalties of Section 4904 of the Crimes Code (18 Pa.C.S. § 4904) relating to unsworn falsification to authorities. 4. This complaint consists of the preceding page(s) numbered 1 through 4. The acts committed by the accused, as listed and hereafter, were against the peace and dignity of the Commonweetth of Pennsylvania and were contrary tothe Act(s) ofthe Assembly, or in violation of the statutes cited (Bofore a warrant of arrest can be issued, an affidavit of probable cause must be completed, sworn to before the issuing authority, and attached.) | j a2 )™ Teng Bizete LLL Col > cay ‘Signature oF Aianty AND NOW, on this dato 2elt% ‘An affidavit of probable cause must be completed before 3 L been properly completed and verified. (Magisterial District Court Number) \OPC 412A ~ Rev. 07/10APPENDAGE "A" COMMONWEALTH OF PENNSYLVANIA V. DR. JOSEPH ACRI CRIMINAL COMPLAINT NO, AFFIDAVIT OF PROBABLE CAUSE IN SUPPORT OF CRIMINAL COMPLAINT Narcotics Agent William J. Delgado, being duly sworn according to law, deposes and says: Your Affiant is employed by the Office of Attorney General and is presently assigned to the Bureau of Narcotics Investigation and Drug Control, Lemoyne, Pennsylvania Your Affiant has been conducting a criminal investigation into violations of the Controlled Substance, Drug, Device and Cosmetic Act and Criminal Conspiracy in and around Cumberland County. Your Affiant alleges that the evidentiary results of this investigation and the investigative efforts of the Thirty-Ninth Statewide Investigating Grand Jury demonstrate that the aforementioned crimes were committed by Dr. Joseph Acri. Your Affiant has reviewed the Thirty-Ninth Statewide Investigating Grand Jury, Presentment No. 1 (a copy of which is attached hereto and incorporated herein by reference) and | find that the factual findings described therein correspond with the results of your Affiant’s own investigative findings. I have reviewed the sworn testimony given by the witnesses referred to in Presentment No. 1, subject to the penalties of perjury and false swearing. Your Affiant avers that testimony of these and other persons who appeared before the Thirty-Ninth Statewide Investigating Grand Jury is consistent with the information contained within the Presentment No. 1 and is also reflected in the instant criminal charges.Furthermore, Presentment No. 1 shows on its face that it is based upon evidence which the Thirty-Ninth Statewide Investigating Grand Jury reviewed and evaluated which includes sworn testimony of witnesses appearing. Your Affiant has reviewed the evidence presented before the Thirty-Ninth Statewide Investigating Grand Jury and finds that it comports with the results of these investigative efforts and findings as to allegations contained in this instant criminal complaint. Additionally, the aforementioned Presentment was reviewed and approved by the Honorable J. Wesley Oler, Jr., Supervising Judge of the Thirty-Ninth Statewide Investigating Grand Jury, who, by Order dated January 21, 2016, (a copy of which is attached hereto and incorporated herein by reference) directed that appropriate criminal charges be prosecuted by the Office of Attorney General, Commonwealth of Pennsylvania. hk LL A ‘ Narcotics Agent Will Office of Attorney General SWORN TO AND SUBSCRIBED BEFORE ME nash , 2016 NOTARIAL SEAL SHEILA M. DIMON, NOTARY PUBLIC BORO. OF LEMOYNE, CUMBERLAND COUNTY, PA MY COMMISSION EXPIRES OCTOBER 26, 2017INTRODUCTION We, the members of the Thirty-ninth Statewide Investigating Grand Jury, having received and reviewed evidence pertaining to violations of the Controlled Substance, Drug, Device, and Cosmetic Act and the Crimes Code, occurring in and around Cumberland County, pursuant to Notice of Submission of Investigation Number], do hereby make the following findings of fact and recommendation of charges: SUMMARY OF INVESTIGATION The Thirty-ninth Statewide Investigating Grand Jury heard testimony and reviewed evidence related to the unlawful prescription practices of Dr. Joseph Acri. More specifically, the Grand Jurors heard testimony from: Agent William Delgado, Case Agent from the Pennsylvania Office of Attorney General, Bureau of Narcotics Investigation and Drug Control Unit (BNI); Thomas Tomcanin, Pharmacist at the Medicine Shoppe Pharmacy in Newport, PA; Jedidiah Landis, Pharmacist who was formerly employed by the Medicine Shoppe Pharmacy; Michell Rarick, Pharmacy Director for Carlisle Regional Medical Center; David Galano, Director of Health Information for Carlisle Regional Medical Center; and three individuals who obtained prescriptions for Schedule II narcotics from Dr. Acri, identified in this presentment as C.E., S.E. and M.E, The Grand Jurors also reviewed evidence which included: Dr. Acri’s employment records from Central Penn Management Group and EmCare; prescriptions for Schedule Il narcotics written by Dr. Acri to an individualidentified in this presentment as 1.C.; medical records for T.C.; patient profiles for C.E., S.E. and M.E.; Carlisle Regional Medical Center's Master-Patient Index; and DEA regulations regarding the dispensing of Schedule II narcotics. Agent Delgado testified that the investigation into Dr. Acri developed out of another investigation into a Cumberland County doctor who was unlawfully prescribing Schedule II narcotics and the individuals who were fraudulently obtaining prescriptions from this doctor. Agent Delgado was able to determine that one of those individuals, T.C., obtained Schedule II narcotics from the Cumberland County doctor and Dr. Acri. Agent Delgado testified that he then obtained prescriptions written by Dr. Acri between 2011 and 2014 for T.C. Review of these prescriptions demonstrated that Dr. Acri prescribed extremely high doses of Oxycontin and Oxycodone to T.C., oftentimes earlier than was permissible based on the length of the prescriptions. Additionally, Dr. Acri verified at least two prescriptions for T.C, that appeared to have been improperly altered. Furthermore, these prescriptions were written on Carlisle Regional Medical Center prescription pads despite the fact that Dr. Acri was not affiliated with the Medical Center at the time and the fact that the Medical Center had no records of Dr. Acri seeing T.C. as a patient of the Medical Center during this time period. Agent Delgado spoke with Dr. Acri about the prescriptions written to T.C. Dr. Acri admitted that he chose to stop treating T.C. as a patient. At that time, Dr. Acri provided T.C, with several prescriptions for Schedule I narcotics and discharged him from his carewithout providing any further medical guidance or treatment. Dr. Acri admitted that he kept no records of these prescriptions. Additional witnesses and evidence confirmed Agent Delgado’s account of Dr. Acri’s activities. Thomas Tomcanin testified that he spoke with Dr. Acri regarding at least two of the improperly altered prescriptions and Dr. Acri verified both prescriptions. Employment records confirmed that Dr. Acri was not affiliated with Carlisle Regional Medical Center at the time the: prescriptions were written, David Galano confirmed that the hospital had no record of Dr. Acri treating T.C. as a pat nt of the Medical Center during the time the prescriptions were written. Michelle Rarick confirmed that Dr. Acri should not have written prescriptions on Carlisle Regional Medical Center prescription pads at a time when he was not affiliated with the hospital. Jedidiah Landis reviewed several of the prescriptions written by Dr. Acri for T.C, and confirmed that the prescriptions were for extremely high doses of Schedule II narcotic pain-relievers. Finally, three separate individuals testified that they obtained prescriptions from Dr. Acri for Schedule II narcotic pain-relievers despite never receiving a medical examination from him, never appearing in his office for an examination or treatment and, in at least one instance, never even meeting with Dr. Acri in person prior to obtaining the prescriptions. C.E. testified before the Grand Jury that he obtained these prescriptions from Dr. Acri when Dr. Acri would come to eat at his restaurant. C.E. obtained prescriptions for himself inside his restaurant without any form of medical examination or testsbeing performed or any requirement that he visit with the doctor in the Medical Center, CE. testified that he also obtained prescriptions for his wife, S.E., simply by telling the doctor of her pain as well. S.E. testified that she was never examined by the doctor and received most of these prescriptions without even meeting with Dr. Acri in person. M.E., C.E.'s sister, also testified that she was also able to obtain prescriptions from Dr. Acri inside the restaurant without undergoing any examination or treatment. This evidence demonstrates that Dr. Joseph Acri prescribed Schedule I narcotic pain-relievers outside the scope of the doctor-patient relationship, outside the treatment practices accepted by a responsible segment of the medical profession and not in good faith during the course of his professional practice. Furthermore, Dr. Acri authorized the dispensing of Schedule II narcotics for two prescriptions that Dr. Acri admitted were altered and forged. Finally, Dr. Acri failed to keep records of the four prescriptions he provided T.C. prior to sending T.C. to another physician. FINDINGS OF FACT In October 2014, Agent Delgado was conducting an investigation into the unlawful prescription practices of a Cumberland County doctor and the unlawful acquisition of these prescriptions by several individuals. During the course of that investigation Agent Delgado was able to determine that one of the people, T.C., who was obtaining controlled substances from the Cumberland County doctor, was also obtaining Schedule II narcotics from Dr.Joseph Acri. In an effort to further the investigation into T.C., Agent Delgado obtained the prescriptions written by Dr. Acri to T.C. These prescriptions were filled at two locations: the Medicine Shoppe Pharmacy in Newport, PA, and SmartMed Pharmacy in Carlisle, PA. Between February 2011 and August 2012 T.C. presented a total of twenty-one prescriptions for Schedule II narcotics at the SmartMed Pharmacy. Nine of these prescriptions were for Oxycodone 30 milligrams of varying tablet amounts. Six prescriptions were for Oxycontin 40 milligrams with tablet amounts varying between 400 and 1200. Five prescriptions were for Oxycontin 80 milligrams of varying tablet amounts. One prescription was for Opana, which is also a Schedule II narcotic. All of the prescriptions contained Dr. Acri’s signature and were written on prescription pads with the letterhead of Carlisle Regional Medical Center Hospitalists. T.C. began presenting Dr. Acri's prescriptions at the SmartMed Pharmacy in February 2011 and stopped bringing in Dr. Acri’s prescriptions at the pharmacy in August 2012. These prescriptions were filled by the pharmacy and the drugs dispensed, During the first year that T.C. was filling prescriptions at SmartMed he was consistently obtaining his medication early and was able to do so because Dr. Acri was consistently writing prescriptions for these medications early. For example, on February 9, 2011 Dr. Acri wrote T.C. a prescription for a 78 day supply of Oxycodone 30 milligrams, which was filled by T.C. on February 10, 2011. On March 15, 2011, Dr. Acri wrote T.C. an additional prescription for a 90 day supply of Oxycodone 30 milligrams, which was filledby T.C. on March 16, 2011. This was 45 days prior to the expiration of the first prescription. On May 3, 2011, Dr. Acri wrote the next prescription for T.C. for an additional 90 day supply of Oxycodone 30 milligrams, which was filled by T.C. on May 5, 2011. This was 40 days earlier than the expiration of the previous prescription. On June 16, 2011, Dr. Acri wrote T.C. a prescription for an additional 90 day supply of Oxycodone 30 milligrams, which was filled by T.C, on June 16, 2011, This was 58 days earlier than the expiration of the previous prescription. On July 25, 2011, Dr. Acri wrote T.C. a prescription for a 78 day supply of Oxycodone 30 milligrams, which was filled by T.C. the same day, This was 51 days earlier than the expiration of the previous prescription. ‘The Grand Jurors were provided with a copy of 21 C.F.R. § 1806.12, the Federal Regulation governing the issuance of multiple prescriptions for Schedule II controlled substances. The pertinent section of that regulation reads as follows: An individual practitioner may issue multiple prescriptions authorizing the patient to receive a total of up to a 90-day supply of a Schedule II controlled substance provided the following conditions are met: (i) each separate prescription is issued for a legitimate medical purpose by an individual practitioner acting in the usual course of professional practice; (i) the individual practitioner provides written instructions on each prescriptions (other than the first prescriptions, if the prescribing practitioner intends for that prescription to be filled immediately) indicating the earliest date on which a pharmacy may fill each prescription; (ii) the individual practitioner concludes that providing the patient with multiple prescriptions in this manner does not create an undue risk of diversion or abuse.... Nothing in this paragraph shall be construed as mandating or encouraging individual practitioners to 9issue multiple prescriptions or to see their patients only once every 90 days when prescribing Schedule II controlled substances, Rather, individual practitioners must determine on their own, based on sound medical judgment, and in accordance with established medical standards, whether it is appropriate to issue multiple prescriptions and how often to see their patients when doing so. ‘The prescriptions written by Dr. Acri to T.C. did not contain any instructions limiting when subsequent prescriptions should be filled. Additionally, according to the testimony of Pharmacist Jedidiah Landis, the duration of a prescription is based on the dosage amount listed in the prescription, The May 3, 2011 prescription was for 1440 tablets, with four tablets to be taken every six hours as needed for pain. This is then calculated by the pharmacy to be a 90 day supply. Landis testified that Oxycodone is an immediate release medication that is used for “breakthrough pain.” If someone had a bout of pain they would take that to get immediate relief as the extended release tablet wore off. The manufacturer of Oxycodone recommends taking Oxycodone one to two of the 30 milligram tablets every four to six hours. Thus, Dr. Acri's prescriptions were written for twice the manufacturer's recommended dosage even if they were written, filled, and taken properly. However, the evidence demonstrates that Dr. Acri consistently and improperly provided these prescriptions early. Providing additional prescriptions early increased the dosage amount exponentially and, obviously, increased the risk of abuse for these highly addictive narcotics. ‘The possibility for abuse was compounded by the Oxycontin prescriptions that Dr. Acri also gave to T.C, during this time period, On 10February 20, 2011, Dr. Acri wrote T.C. a prescription for a 60 day supply (1200 tablets) of Oxycontin 80 milligrams, which was filled by T.C. on February 25, 2011. Dr. Acri recommended that T.C. take four to five tablets every six hours as needed for pain. According to Landis, Oxycontin is an extended release pain medication that is typically taken twice a day, every twelve hours. Oxycontin comes in a range of doses that varies per individual from 10 milligrams to 120 milligrams. However, regardless of the dosage amount, the manufacturer's recommendation and the recommendation of the FDA is to take one tablet twice a day. Dr. Acri's prescription for T.C. called for him to take twelve to fifteen times that amount. On May 3, 2011, Dr. Acri wrote T.C. a prescription for a 20 day supply (400 tablets) of Oxycontin 80 milligrams. That amounts to approximately 20 pills a day, ten times the manufacturer's recommendation, On May 13, 2011, ten days after the previous prescription, Dr. Acri wrote T.C. a prescription for a 60 day supply (1200 tablets) of Oxycontin 80 milligrams, which was filled by T.C. on June 10, 2011. Again, this prescription called for ten times the recommended dose. Review of the twenty-one prescriptions filled at SmartMed demonstrated that this practice of providing huge amounts of Oxycodone and Oxycontin to T.C. continued through August 2012, but did not end there. Instead, T.C. began filling prescriptions at the Medicine Shoppe Pharmacy in Newport in April 2012 and continued to do so through March 2014, T.C. filled a total of ten prescriptions for Schedule I narcotics, Oxycodone and Oxycontin, at the Medicine Shoppe Pharmacy. Agent Delgado uwas able to obtain nine of these. Four of these prescriptions were for 1440 tablets of Oxycodone 30 milligrams, one prescription was for 2000 tablets of Oxycodone 30 milligrams, and four prescriptions were for 1200 tablets of Oxycontin 80 milligrams, ‘The four prescriptions for 1440 tablets of Oxycodone constituted 80 day supplies of the medication. The 2000 tablet prescription constituted an 83 day supply. The Oxycontin prescriptions constituted 60 day supplies of that medication, All of the prescriptions contained Dr. Acri's signature and were written on prescription pads containing the letterhead of Carlisle Regional Medical Center Hospitalists. T.C, initially appeared at the Medicine Shoppe pharmacy approximately every 90 days to obtain his Oxycodone medication. The first three prescriptions were filled within days of being written by Dr. Acri, However, the fourth prescription did not continue this pattern. The fourth prescription T.C. filled for Oxycodone 30 milligrams at the Medicine Shoppe was written by Dr. Acti on November 17, 2012 and called for an 80 day supply of Oxycodone, This was only 34 days after the previous prescription was written on October 14, 2012. That prescription was filled on October 16, 2012 and also called for an 80 day supply of Oxycodone. Additionally, the November 17, 2012 prescription was noteworthy because it contained notes from the pharmacist who filled it. Pharmacist ‘Thomas Tomcanin ‘confirmed during Grand Jury testimony that the notes contained on that prescription were his notes, The notes stated, first, that the patient, T.C., was going away for a job and would be gone for up to three months. The patient was concerned about getting his medication while away. 12The notes further stated that Dr. Acri called in and verified the prescription. Dr. Acri verified his identity by providing bis DEA number, his national identification (NPI) number and license. During this call Dr. Acri confirmed T.C.'s statements and verified the prescription. Despite verifying that T.C. would be gone for three months in November 2012, Dr. Acri wrote T.C. a prescription for 2000 tablets of Oxycodone 30 milligrams on December 28, 2012, That was only 41 days after he wrote the previous prescription and was written during a time when T.C. was supposed to be away for work. T.C. didn't fill this prescription until February 15, 2013. Once again, T.C. filled Oxycontin prescriptions written by Dr. Acri at the Medicine Shoppe in addition to the Oxycodone prescriptions. On September 27, 2012, T.C. filled a prescription for 600 Oxycontin 80 milligram tablets, calculated as a 30 day supply based on the recommended dose and written by Dr. Acri on August 16, 2012. On November 19, 2012, T.C. filled a prescription for 1200 Oxycontin 80 milligram tablets, a 60 day supply, written by Dr, Acri on November 6, 2012. On February 20, 2013, T.C. filled a prescription for 1200 Oxycontin 80 milligram tablets, this time calculated as a 90 day supply and written by Dr. Acri on December 6, 2012. T.C. would not fill another Oxycontin prescription from Dr. Acri until seven months later on September 5, 2013. It would be another six months before he filled the final Dr. Acri prescription on March 12, 2014. Both of these prescriptions contained alterations that placed the date they were actually written by Dr. Acri into question, 13These prescriptions, hereinafter identified for purposes of this presentment via their serial numbers (6267 for the prescription filled on February 20 and 5790 for the prescription filled on March 12}, were shown to the Grand Jurors and Agent Delgado outlined the apparent alterations. Prescription 6267 appeared to have been written in 2012, but the “2” at the end of 2012 was changed to a “3” in order to make it appear as though the prescription was written in 2013. Prescription 5790 appeared to originally have been written on December 6, 2012. The actual date originally written on the prescription was written numerically as "12/6/12." However, when the prescription was presented to the Medicine Shoppe Pharmacy on March 12, 2014, the “1” in the first twelve, representing December, was crossed out. The “2” in the second twelve, representing 2012, was changed to the number 4 in order to give the appearance that the prescription was written in 2014, Both prescriptions contained notes from Thomas Tomcanin indicating that he spoke to Dr. Acri regarding these prescriptions and that Dr. Acri verified both prescriptions, Tomcanin testified that he called to verify the prescriptions because he felt they were for very high doses, 1200 tablets of Oxycontin 80 milligrams, and because he suspected the prescriptions may have been altered. Tomcanin felt that the dates seemed odd and possibly altered on both prescriptions because of different pen marks that were apparent on prescription 6267 and because of the numbers crossed out on prescription 5790. 14Agent Delgado met with Dr. Acri twice to discuss the prescriptions that Dr. Acri provided to T.C. During the course of the first meeting, Dr. Acri acknowledged that he had been treating T.C, for severe back pain, but he was not treating T.C. any longer. Dr, Acri did not provide a specific date for when he stopped treating 7.C., but did tell Agent Delgado that he was not treating T.C. as a patient in 2014. During their second meeting, Dr. Acri was given the opportunity to review prescriptions 5790 and 6267. Dr. Acri acknowledged that they were his prescriptions. However, Dr. Acri agreed that the prescriptions were altered and stated that the dates on the prescriptions were not the dates on which he originally wrote these prescriptions, Dr. Acri then wrote on both prescriptions, in Agent Delgado’s presence, that, “these dates are altered and forged.” Agent Delgado then confronted Dr. Acti about the fact that the prescriptions indicated that he verified prescriptions which he now admitted were forged. Dr. Acri denied verifying any prescriptions for T.C. in 2014, but said nothing regarding verifying prescriptions for him at any other time. Dr Acri then admitted that, at some point in his treatment of T.C., he no longer wished to continue to treat ‘T.C. At that point, Dr. Acri provided T.C. with four prescriptions similar to prescriptions 5790 and 6267. Dr. Acri stated that he then directed T.C. to see another doctor, Dr. David Wait. Dr. Acri further admitted that he kept no records or documentation of these prescriptions. Agent Delgado also spoke to Michelle Rarick, Carlisle Regional Medical Center's Director of Pharmacy, regarding prescriptions 5790 and 6267. 15Ms, Rarick was familiar with Dr. Acri from the time he worked at the Medical Center, most recently as a hospitalist, According to Rarick, Carlisle Regional Medical Center hospitalists are employed by an outside agency which contracts with Carlisle Regional to provide care for hospital in-patients, Hospitalists do not typically maintain a medical practice outside the hospital. Rarick further explained that in February 2012 Carlisle Regional ended their contract with the outside company that Dr. Acri was working for and Dr, Acri never returned to work at Carlisle Regional Medical Center. Review of Dr. Acti's employment records, which were provided to the Grand Jurors, confirmed that Dr. Acri was employed by Central Penn Management Group from 2006 to 2010 as a hospitalist working with Carlisle Regional Medical Center and by EmCare from 2010 to 2012 in the same capacity. Dr. Act's affiliation with Carlisle Regional Medical Center ended in February 2012 when he took a leave of absence for one year and never returned to practicing medicine at the Medical Center. As was previously noted, all of the prescriptions written by Dr, Acri for T.C. were written on Carlisle Regional Medical Center prescription pads, including all ten of the Medicine Shoppe prescriptions, which were all written and filled after Dr. Acri began his leave of absence from Carlisle Regional Medical Center. Rarick testified that once Dr. Acri began his leave of absence he should not have been writing prescriptions on Carlisle Regional Medical Center prescription pads. Doing so would cause pharmacies to believe that Dr. ‘Acri was still treating patients at the Medical Center and attempt to contact them with any questions or concerns regarding the prescriptions. Rarick 16indicated that it was bad medical practice for Dr. Acti to have kept the Carlisle Regional Medical Center prescription pads and to have continued to write prescriptions for T.C. at a time when Dr. Acri was not affiliated with the Medical Center. More troubling, though, was the fact that Carlisle Regional Medical Center had rio documentation of T.C. being a patient of Carlisle Regional Medical Center between February 2011 and March 2014, the entire duration of which T.C. received and filled Dr. Act!’s prescriptions, David Galano testified that he reviewed the Medical Center's Master-Patient Index, which contained a list of when a patient was in the Medical Center, and compared it to the time Dr. Acti was affiliated with the Medical Center. ‘The Master-Patient Index, which was presented to the Grand Jurors, demonstrated that '.C, was not a patient of Dr. Acri’s at Carlisle Regional Medical Center during this time period, In fact, the last time T.C. was a patient in the Medical Center was 2003, Thus, Dr. Acri was providing T.C. with prescriptions for Schedule II narcotics on Carlisle Regional Medical Center prescription pads, which indicated that Dr. Acri was treating T.C. as a patient of Carlisle Regional Medical Center, despite the fact that the hospital had no record of T.C. actually being a patient of the Medical Center. Additionally, Dr. Acri provided at least ten of these prescriptions at a time when he was not affiliated with Carlisle Regional Medical Center. Finally, these prescriptions called for doses of highly addictive narcotics that were exponentially larger than the recommended 7dosage for such substances. Unfortunately, T.C. was not the only person that Dr, Acri did this for. C.B. testified that Dr. Acri was a customer of his restaurant in Camp Hill. C.E. stated that his brother was a patient of Dr. Acri’s, but he was not. In 2011, C.E. spoke to Dr. Acri at the restaurant and told him that he was having pain in his back, legs and hands from standing all day at work. C.E. asked Dr. Acri if there was anything he could do. At that point, Dr. Acri started giving him prescriptions for Oxycodone. Between April 2011 and August 2011, Dr. Acri provided eight prescriptions to C.E. Bach prescription was for 240 tablets of Oxycodone 80 milligrams. The duration of the prescriptions varied between 20 and 30 days. C.E. testified that Dr. Acri informed him that he was working at the Medical Center, but never told C.E. that he needed to come to the hospital for an exam or check-up. Dr, Acri provided C.E. with the prescriptions while he was inside the restaurant. Dr. Acri provided no examination on C.E. prior to writing the first prescription or at any time afterwards. According to C.E., the only thing Dr. Acri did was ask him where he hurt. C.E. further explained that whenever Dr. Acri would come into the restaurant C.E. would ask when Dr. Acri planned to return so that he could be sure to get a new prescription. C.E. admitted that he had become addicted to the pills, Dr. Acri always provided C.E. with prescriptions when C.E. asked for them and stated that he was doing it just in case he wasn't back in the restaurant in time. At no point did Dr. Acri inform C.E. that he needed to come 18into the hospital to get checked or run tests, Dr. Acti never performed or requested any X-Rays or MRIs on C.E. When asked about this, C.E. stated, “This stuff I did by myself, but he never told me." When questioned further, C.E. stated that approximately one and a half years ago he went to his family doctor because of the pain he was experiencing. C.E. stated that as soon as he told his family doctor about his afflictions his doctor sent him to get X-rays and an MRI. C.E.’s addiction to the pills had gotten to the point where he couldn't get up in the morning without taking pills, However, in August of 2011 Dr. Acri stopped coming into his restaurant. C.E. never saw Dr. Acri again. C.E. went from receiving approximately 500 Oxycodone pills per month to receiving none. E. admitted that he had to see another doctor because of this and was given Suboxone to help him get off his addiction to Oxycodone, Dr. Acri also wrote prescriptions for C.E.’s sister, M.E., and C.E.’s wife, SE. MLE. testified that she knew Dr. Acri from when he came into the restaurant. M.E. worked in the restaurant with her brother. M.E. admitted that she knew her brother received pills from Dr. Acri and she believed they helped him, so she spoke to Dr. Acri about pain she had in her legs. Once again, this conversation took place in the restaurant and M.E. never saw Dr. Acri as a patient in the Medical Center. M.E. stated that she told Dr. Acri about her pain and he began writing her prescriptions as well. M.E. also received a total of eight prescriptions for 240 tablets of Oxycodone 30 milligrams. MLE. stated that Dr. Acri did perform one cursory examination of 19her in the kitchen area of the restaurant. She stated that he touched her legs and back, the location where she complained that she had pain, and then simply wrote her a prescription for Oxycodone. Once again, Dr. Acri never told M.E. that she needed to come into the hospital for a check-up, X-rays, or an MRI. Instead, he performed a brief exam in the kitchen area where M.E. worked and then proceeded to write her eight prescriptions for the highest dose of Oxycodone. When Dr. Acri stopped coming into the restaurant in August 2011, M.E. was forced to come off the Oxycodone cold-turkey. She was sick for two weeks after that, but never went back to taking the medication after that. S.E, testified that she also knew Dr. Acti as a customer at her husband's restaurant. S.E. also received a total of eight prescriptions for 240 tablets of Oxycodone 30 milligrams from Dr. Acri over essentially the same time period as her husband and sister-in-law. In fact, many of the prescriptions were written the same day. S.E, testified that she did not even speak to Dr. Acri about receiving the first prescription. She stated that she spoke to her husband about the problems she was having and C.E. stated that he would talk to Dr. Acri about getting a prescription for her as well. S.E. never met with Dr. Acri when she received the first prescription, She received only one or two of the prescriptions directly from Dr, Acri, with the remainder being given to her husband, At no point did Dr. Acri perform any sort of tests or exams on her. In fact, he never even specifically spoke to her about the issues she was having with pain. However, at one point, 8.E. spoke to Dr. Acri about the way the pills 20were making her feel. She stated that the pills were making her light-headed and giving her stomach cramps. Dr. Acri informed her that she was given a lighter dose, which was not true, and then told her that she could take less of the pills. Dr, Acri never asked her to come into the Medical Center for a more thorough examination. Finally, S.E. stated that all of the prescriptions she received from Dr. Acri were written on Carlisle Regional Medical Center prescription pads. Review of the Master-Patient Index from February 2011 through March 2014 confirmed that S.E., M.E., and C.E. were never patients of Carlisle Regional Medical Center during this time period. 2RECOMMENDATION OF CHARGES Based on the evidence that we have obtained and considered, which establishes a prima facie case, we, the members of the Thirty-ninth Statewide Investigating Grand Jury, recommend that the Attorney General or her designee, institute criminal proceedings against the following individuals and charge them with the listed offenses: DR. JOSEPH ACRI Violations of the Controlled Substance, Drug, Device and Cosmetic Act, 35 P.S. § 780-113(a)(12)(14); Violations of the Controlled Substance, Drug, Device and Cosmetic Act, 35 P.S. | § 780-112(b); 78 -"'3a.Cat) Criminal Conspiracy to Commit Violations of the Controlled Substance, Drug, Device and Cosmetic Act, 18 Pa.C.S.A. §903, 35 P.S, § 780-113(a)(12). 22