CINCINNATI — Dr. Saad Sakkal's failures as a doctor were all-encompassing and deadly, prosecutors said in Tuesday's closing arguments in U.S. District Court. The former Hamilton physician stands accused of causing two patients' overdose deaths through reckless prescription practices and distributing dangerous drug cocktails to many more, some of whom showed overt signs of addiction — including arriving to appointments high — when he met them.
Sakkal's defense didn't deny he had acted irresponsibly but insisted his failure was one of perception and procedure. He trusted his patients too easily, was too vulnerable to their demands and struggled too much with technology, attorney Richard Goldberg said. He had never intended to hurt anyone.
Jurors will decide which story they believe.
Goldberg called a single witness for the defense before the end of the trial: Mohammed Sakkal, who testified briefly about his time inputting patient data for his father's practice at Lindenwald Medical Associates.
Then jurors listened to attorneys' rival closing arguments for three hours.
“He is, in fact, a drug dealer with a script pad,” Assistant U.S. Attorney Tim Oakley said of Sakkal, suggesting that street drug dealers selling to clients who know the risks have a more honest relationship with their customers than Sakkal did with his patients.
“He lived on their addictions," Oakley added. "That was his job."
Sakkal was indicted as part of the largest national healthcare fraud and opioid takedown in American history — a sting that caught 76 doctors, 23 pharmacists, 19 nurses and other medical personnel across the nation in June 2018. Some worked at the same clinic, though not at the same time.
The doctor faces 30 counts of illegal distribution of controlled substances and seven counts of using a nurse practitioner’s prescription pad to write prescriptions for his patients.
He also stands charged with causing the overdose deaths of two women. If convicted, he could face life in prison.
“Deliberate ignorance of the obvious is not an excuse for a crime,” Assistant U.S. Attorney Tim Mangan told jurors.
Sakkal repeatedly ignored red flags — failed urine screens, patient overdoses, warning calls from pharmacists — and kept prescribing dangerous drug combinations such as “Holy Trinity,” which produces heroin-like euphoria, prosecutors said.
“They’re not patients at this point; they’re customers," Oakley said. "It was a pill practice. It was a pill business."
Oakley described Lindenwald as the “golden goose” Sakkal used to extend his failing medical career, allowing him to earn at least $180,000 a year “doing nothing but giving pills to junkies.”
Goldberg admitted to the jury that his client was foolish, careless, negligent, committed malpractice and practiced “very bad medicine.”
“I’m not going to stand here and tell you any different,” Goldberg said.
However, Goldberg insisted his client never abandoned his role as a doctor to become a drug dealer and never had a motive to operate a pill mill.
“If he wanted to create a pill mill, he would have said, ‘cash only,’” Goldberg said.
Many former employees testified that the bulk of Lindenwald’s patients were very poor and used Medicaid, which offers the lowest insurance reimbursement to doctors.
“This was the free high,” Mangan said, about the Medicaid patients. “Going to Lindenwald meant you could get your drugs for free. You could get high for free.”
Goldberg insisted his client had good intentions and “reasonably thought he could help these people.” According to him, Sakkal was gullible, believed his patients when they lied about their pain and felt bullied into prescribing them whatever drugs they asked for.
He added: “Each patient has to accept some responsibility for their actions.”
Sakkal practiced endocrinology in a small Pennsylvania town for 17 years without any problems before returning to his native Syria in 2000 to open a free medical clinic. On the witness stand, Mohammed Sakkal described how his family left Aleppo when violence escalated in 2012 to come to Cincinnati. His father left everything behind.
“Everything he owned his whole life. His retirement. Everything he worked for ... it could be in the hands of rebels or the regime or ISIS, we have no idea,” Mohammed Sakkal testified.
After a period of unemployment, Dr. Saad Sakkal got a job at Lindenwald in early 2015.
Mohammed Sakkal described his father as sometimes careless, not technologically savvy and naïve about his patients. He took on increasing numbers of them, too, adding 1,000 during the two years he practiced at Lindenwald. His total caseload comprised some 4,000 active patients, his son testified.
“He cared too much," he testified. "He believed his patients.”
Several former employees testified about an overflowing waiting room filled with people who passed out and vomited while waiting to see Sakkal. Patients lined up before the practice opened, they said.
When many large pharmacies such as Walgreens and Kroger refused to fill Sakkal’s prescriptions in 2016, his office posted a list in the waiting room of the remaining smaller pharmacies that had not yet blacklisted him, former employees testified.
“That doesn’t happen in a normal practice,” Mangan told jurors. “That doesn’t happen at a normal doctor’s office.”
The jury will resume deliberations at 8 a.m. on Wednesday.