How Comprehensive Pain Specialists, Owned By A Nashville Legislator, Helped Shape Tennessee Laws | Nashville Public Radio

How Comprehensive Pain Specialists, Owned By A Nashville Legislator, Helped Shape Tennessee Laws

Sep 6, 2018

A troubled chain of pain clinics — reportedly treating tens of thousands of Tennesseans a month — has blamed its sudden closure on tighter regulations.

But Comprehensive Pain Specialists had a hand in shaping the state's pain clinic laws. And the company, which is under federal investigation, has been quietly co-owned by a current state lawmaker from Nashville. 

Records show that state Sen. Steve Dickerson was a founder and and owner of CPS, a role that has not been widely known even as lawmakers have tried to crack down on pain clinics.

It's unclear how much of a direct role Dickerson has played in shaping state policy. But it's certain the company itself has been a player as the legislature revisited pain clinic regulations in response to the opioid epidemic.

Until December, CPS employed at least two lobbyists at the Tennessee State Capitol, playing defense as regulations tightened nearly every year in response to the opioid epidemic. Despite their efforts, a big leap came in 2015 when a measure passed requiring pain clinics to be owned by physicians and limiting how many facilities they could oversee.  

"We've driven another nail tonight in the coffin of prescription drug abuse," state Sen. Ken Yager, R-Kingston, who was the sponsor, crowed at the time. He went on to thank the organizations that provided input.

"We've worked with the Tennessee Medical Association, the Department of Health and Comprehensive Pain Specialists representatives."

Buried in the text were provisions that delayed some parts of the law's implementation, amendments that may have served to keep CPS going.

Still, in July, the Brentwood-based company abruptly started closing up shop. The company's former CEO had been indicted earlier this year in an alleged Medicare kickback scheme, but even before then, The Tennessean revealed that the company was already under investigation by federal authorities.

In 2017, Kaiser Health News reported that the company was making much of its money on in-house drug testing rather than pain services, raising red flags for federal regulators.

Dickerson's Pain Clinic Ownership

Quiet during the legislative debates about pain clinics was Dickerson, even though he frequently cites his clinical experience as an anesthesiologist on medical issues, especially as he promotes his medical marijuana proposal in Tennessee.

The two-term Republican specializes in epidural injections for pain, and he is listed on the CPS website — but as a physician. There's no mention that he also founded the company.

Even fellow lawmakers like Rep. Bob Ramsey, R-Maryville, who helped write several updates to pain clinic laws, were unaware of Dickerson's stake in CPS until WPLN informed them.

Dickerson did not agree to an interview with WPLN to discuss his role with the company, but business filings and a court deposition confirm that he started CPS in 2005. His partner and the current CEO, Peter Kroll, has said they hatched the business plan over coffee at a Nashville Starbucks.

CPS is technically a subsidiary of another firm, Anesthesia Services Associates, that Dickerson incorporated in 2000. But as Dickerson explained in a 2015 deposition, "it's one corporate entity."

In fact, by then CPS had outgrown its anesthesia business. Not long before Dickerson gave his testimony, the anesthesia practice was sold to Anesthesia Medical Group.

Yet throughout his time in office, Dickerson has listed Anesthesia Services Associates as his primary source of income on ethics disclosure forms. That same company, not CPS, is also listed as the employer of the lobbyists who worked on the company's behalf in the state capitol.

Dickerson wasn't the only founder. And as recently as 2015, there were seven other physician-owners, including Kroll.

Three of those physicians — Dickerson, Kroll and Melissa Rose — remain as the owners listed on the most recent CPS corporate filing. Rose declined to be interviewed when reached by WPLN. Attempts to contact Kroll were unsuccessful.

CPS itself also did not answer questions on the record for this story. General counsel Alex Munderloh instead released a written statement.

"Comprehensive Pain Specialists was founded in 2005 by a group of physicians committed to helping patients find the pain management care they needed," it says in part. "Since that time, pain management medical practices — and the healthcare industry as a whole — have experienced significant regulatory and operational uncertainty. Because of these challenges, CPS recently notified patients, physicians, and other public health officials that it planned to initiate a responsible winddown of operations."

Fighting Opioid Abuse

Dickerson sat out several votes for bills that cracked down on pain clinics, including the one from 2015. Tape of the state Senate shows that he was present as senators took final action, and that Senate Speaker Ron Ramsey even asked him by name whether he planned to vote on the measure.

Ultimately, it didn't matter. The bills were largely uncontested and passed the Senate unanimously without him.

And while he's stayed relatively silent on pain clinics, Dickerson has been vocal about the related issue of opioid abuse — even sponsoring new regulations protecting people who transport an overdose victim and exploring use of abuse-deterrent opioids.

"The state has done, I think, a very good job of making physicians — frankly — look over our shoulders," he said at a panel discussion on opioids in August. "They send you a very nice letter — I said that sarcastically — and get your attention. They've done a great job at getting primary care doctors and some folks who frankly should not be writing long-term opiate prescriptions for patients, to think long and hard before they do."

Dickerson's company has some experience with being called out for overprescribing. Some of those flagged prescribers were staff at CPS clinics.