A prominent Florida oncologist was arrested last month and some in the medical community are puzzled.

Michael Dattoli, MD, radiation oncologist and chief medical officer at Dattoli Cancer Center in Sarasota, Fla., Has been charged with prescription and insurance fraud, according to the Sarasota County Sheriff’s Office.

The charges include three counts of fraudulent possession of a controlled substance, three counts of criminal use of personal identification information and three counts of insurance fraud.

Dattoli was arrested on December 16.

According to investigators, a former Dattoli Cancer Center employee alleged that Dattoli filled prescriptions for diazepam (Valium) three times on behalf of his wife using information from another health care provider.

Some experts find it strange that a doctor of his stature would eventually indulge in such a transgression – a relatively minor fraud with serious consequences.

“He’s a well-respected doctor who’s done a lot of good in the community, and it just doesn’t make sense,” said Jay Wolfson, PhD, JD, professor emeritus of public health medicine and pharmacy and vice president associate. for Health, Policy, and Safety Law at the University of South Florida, Tampa. “It’s low level fraud, and not like he’s laundering money or being involved in pill mills, which has been problematic in Florida.”

According to recent reports from local news agencies, in August 2021, Sarasota Police contacted investigators from the Sarasota County Sheriff’s Office Pharmaceutical Diversion Unit regarding a prescription fraud dating back to 2019 and 2020 involving Dattoli and a “victim”.

The victim, a former employee of the Dattoli Cancer Center, had quit his job at the end of 2020 after 5 years. His name and position at the cancer center were redacted in the arrest warrant, but the warrant mentions that he treated patients while he worked at the center.

The former employee told police that when checking the Florida prescription drug database for controlled substances in September 2021, he noticed that several fraudulent prescriptions for diazepam – a controlled substance – had been seized. from 2020. The recipient was Dattoli’s wife Rita Beatrice Dattoli, but the former employee said he never authorized these prescriptions and Dattoli’s wife had never been his patient.

In September 2021, police obtained copies of several prescriptions from local pharmacies that were called up throughout 2020 by the Dattoli Cancer Center. The prescriptions were filled and collected the same day by Dattoli himself, whose identity had been verified by his driver’s license.

Dattoli’s wife, who was questioned by police in October 2021, said she had never been a patient at the center, the order was not hers, and she never had used the prescribed medication.

A month later, Sarasota Police subpoenaed bank statements that matched accounts owned by Dattoli, which showed the same dates, the same total purchase price, and the same stores where fraudulent orders had been filled, collected and purchased.

None of this really makes sense, Wolfson said Medscape Medical News. “Any doctor who needs Valium doesn’t have to fake a prescription, they can get it from any of their colleagues,” he noted. “And why did you put it in his wife’s name? He also submitted it to his insurance, which leaves more paper trails. And he didn’t need to have insurance for that – Valium is a very cheap drug. “

Further, Wolfson added: “I know people who have been treated by Dr Dattoli and they have nothing but good things to say about him – he is a great doctor with a great bedside manner. is a virgin, he’s never been reprimanded, he’s built a successful practice, and then this thing drops from the sky by parachute. “

The investigation is ongoing and detectives from the Sarasota Police Department have said they “believe there may be other victims.”

Dattoli was released the day after his arrest on $ 1,500 bail. His arraignment is scheduled for January 22. If found guilty, he could face a jail term, fines or even lose his license to practice medicine.

Wolfson added that the arraignment is the first step in the process. “But even if it can be determined that he forged a signature, I don’t think that will reach a level where his license will be revoked,” he said.

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Bill Mather, a pharmacist in the small town of Greenfield, Iowa, wanted to make sure his neighbors could fill their prescriptions without traveling long distances or incurring long wait times.

So when drugstore chains and big-box stores began to expand into rural markets, he sold his drugstore in 2007 to Pamida, a grocery chain owned by department store company Shopko, hoping that it would keep his practice alive. Then, in 2019, when Shopko declared bankruptcy, closing more than 360 stores, he and another Shopko pharmacist helped open a new pharmacy for the town of about 2,000 people.

Across the country, pharmacists like Mather are filling the voids left by the withdrawal of large drugstore chains and big-box stores with pharmacies from small communities. In some areas, pharmacists who were laid off when large chains closed are now opening new pharmacies, often in the same locations. In other regions, owners of pharmacies in neighboring towns are opening new branches. Without them, many communities would have been left without a pharmacy.

It wasn’t like this before. Big-box stores like Shopko began aggressively pushing into the drugstore market 30 years ago, hoping customers would fill their carts while the store filled their prescriptions. Large chains have established footholds in small towns by acquiring independent pharmacies or driving them out of business.

According to the Bureau of Labor Statistics, the number of pharmacists employed in big box stores peaked at more than 31,800 in 2012. But as online sales and mail delivery of consumer goods and drugs on orders were increasing, the big box stores had no reason to stay. By 2019, the number of big-box pharmacists had fallen to less than 18,000. (The bureau no longer reports the number.)

“Big box stores have entered smaller and smaller communities, and in essence they’ve outperformed every other pharmacy in the area,” said David Zgarrick, professor of pharmacy at Northeastern University in Boston. “Now they are completely gone and with them the pharmacy services and everything they used to provide. They left a void in many of these places.

With CVS Health’s recent announcement that it will be closing 300 stores per year for the next three years, more cities could lose another tier of pharmacies: large drugstore chains. CVS has not yet specified which stores will close.

“We consider a number of factors when making these decisions, including local market dynamics, population shifts, store density and the needs of underserved communities,” said Mike DeAngelis, gatekeeper. word of CVS Health. “In fact, reaching underserved populations has been a priority for us throughout the pandemic, like access to the tests and vaccines we have provided.”

Kathleen Bashur, spokesperson for the National Association of Chain Drug Stores, said pharmacy chains of all types and sizes play an important role in meeting the health and wellness needs of communities across the country. country. “The decision to close a store is difficult,” she said.

Zgarrick attributes much of the decline in big-box pharmacies to Amazon and other online merchants that have undermined the profitability of their non-pharmaceutical sales. In the past, big box stores could treat drugstores as loss leaders and offset that revenue with the sale of other products. Now, Zgarrick said, big box stores have to ask themselves tough questions about how to allocate their space: “’At the end of the day, how are we going to make the most money per square foot? Is it by having a pharmacy or by selling tires? »

Nelson Lichtenstein, a history professor at the University of California, Santa Barbara who has chronicled the rise of Walmart, said big box stores are constantly reassessing their store locations, closing less profitable and opening new ones in places where they think they can make money.

“They just keep kind of a slow churn,” he said.

The cost to build a big-box store is about $10 million, Lichtenstein said, and those stores can generate $200 million in annual revenue. Pulling out of a site is therefore not a huge loss for a large company if revenue declines.

“So they’re going to close the stores and leave a town devastated because Walmart put the other guys out of business,” he said.

Walmart did not respond to questions about its closures.

The growth of online options for all kinds of items, spurred by home shopping during the covid-19 pandemic, has put additional pressure on big-box stores.

“Now they’re less likely to make those purchases on the go than they were five years ago,” said Adam Hartung, business strategy consultant at Spark Partners. “They’re not going to say, ‘Oh, let’s get a prescription and, while we’re at it, walk around the store and look at the vacuum cleaners. It doesn’t happen anymore.

Hartung said the US retail market has an excess of stores, up to 40% compared to other countries, and more big box stores are expected to close in the coming years.

But the closures offer opportunities for regional chains or pharmacists willing to strike out on their own.

In Orofino, Idaho, the mayor, the chamber of commerce and many residents called on pharmacist Rod Arnzen after Shopko pulled out. So Arnzen began delivering to Orofino from his store 23 miles away in Kamiah. He then opened a branch in Orofino in the building left by the pharmacy that had previously sold its business to Shopko.

Andy Pottenger, who owns a pharmacy 45 miles away in Lewiston, Idaho, added a second pharmacy in Orofino, which has a population of about 3,000, after receiving hundreds of responses to an ad he placed in the local newspaper for assess interest.

“It was overwhelming,” he said. “It kind of cemented the idea that we should do it.”

In Montana, Mike Matovich, a third-generation pharmacist, opened stores in Roundup and Hardin after Shopko closed.

“It’s a pretty big community and there’s a hospital and a clinic in town,” Matovich said of Roundup, “and all of a sudden people are driving 50 miles one way to fill an antibiotic for a kid sick.”

Matovich has seen what can happen when a rural community loses its only pharmacy.

“If there’s a hospital clinic and a pharmacy there, they’ll do pretty well,” Matovich said. “Once you lose one or the other, communities start to struggle because people start leaving to be closer to health care.”

For the residents of Greenfield, Iowa, Shopko’s decision meant they had to scramble. Shopko had sold the pharmacy records to a Walgreens 50 miles away. Some people have turned to Hy-Vee grocery stores in neighboring Iowa towns Atlantic or Winterset, or Walmart in Creston, each at least a half-hour away. Others have gone to mail order.

“It was pure chaos,” said former Shopko pharmacist Rachel Hall. “People were trying to figure out what to do, where to send their prescriptions.”

Mather, Hall and the rest of the Greenfield staff were only given a week’s notice after being told they had nothing to worry about. Their pharmacy was among the fastest growing locations in the chain.

“We literally had Shopko trophies that we threw away when we left,” Hall said.

Former Shopko executives contacted by KHN declined interview requests. Shopko Optical, which operates in 11 states, said it is no longer affiliated in any way with Shopko Stores and declined to comment.

Mather and Hall did not want to abandon Greenfield. They contacted NuCara, a chain of 30 retail pharmacies in five states, and he agreed to help them open a pharmacy in their city.

NuCara opened pharmacies in two other communities that Shopko left. In the towns of Cokato and North Branch of Minnesota, NuCara partnered with pharmacists who had previously sold their pharmacies to Shopko, said Brett Barker, vice president of pharmacies for NuCara.

In Greenfield, Hall and Mather weren’t allowed to speak to customers at the new NuCara pharmacy until Shopko officially closed. Hall said Shopko management wanted to retain the value of the customer files it sold to Walgreens. So Hall and Mather asked the local chamber of commerce to spread the word.

They found temporary space at the local hospital, which moved its billing office to accommodate them. A year later, they moved back to their old location in the old Shopko building, leasing the space to new owners, who operated a housewares store there.

After serving three generations of Greenfield customers, Mather was relieved the town still had a pharmacy. But he couldn’t forget how Shopko ended things.

“The way they slammed the door, I was really unhappy with that,” Mather said. “It wasn’t fair to all the people at Greenfield Pharmacy and the people of Greenfield. Shopko couldn’t care less.

Still, the move has come full circle for Mather. Greenfield still has a pharmacy, like when he started at Murdy Drug in 1968. It’s just a different storefront, with a new name on the sign.

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