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'Patients are beating down our door': As trial winds down, testimony shows how pain clinic thrived

Sylvia Hofstetter is charged along with several others with helping run a pill mill scheme that thrived in the early 2010s.

KNOXVILLE, Tenn — Months after it started, federal prosecutors are finally at the end of their witness list in the trial of alleged pill mill overseer Sylvia Hofstetter.

Assistant U.S. Attorney Tracy Stone told U.S. District Court Judge Tom Varlan he planned to wrap up the government's proof Monday. Then, attorneys for the four defendants including Hofstetter will call their own witnesses.

The trial appears likely to conclude in the next week or two. Monday was the first day back for jurors after a two-week holiday break.

The panel of East Tennesseans began hearing proof the week of Oct. 21.

As one of its last witnesses, Stone called FBI Special Agent Mickey Nocera, who reviewed cautionary emails a medical director sent Hofstetter soon after authorities say she set up the first pill mill on South Gallaher View Road.

Dr. Gary Blumenthal, now dead, warned her in early 2011, months after the clinic opened, that the patient ranks were swelling with people eager to get opioids.

Blumenthal said he'd recently run into Knox County Criminal Court Judge Mary Beth Leibowitz, a friend, who told him the county was battling a serious drug problem and that pill providers faced great scrutiny.

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The judge, he wrote, had told him to be "exceedingly careful."

"Patients are already beating down our door to be seen," he wrote Hofstetter.

He said the clinic needed to "tighten our prescribing techniques."

Defense attorneys Randy Reagan and Chuck Burks objected to introduction of the emails in part because of the prejudicial effect of including Leibowitz's name. Stone at first said the emails already had been allowed into evidence but on further review retracted that.

Stone said the government viewed Blumenthal as an unindicted conspirator in the pill mill operation, even though his time dated to the early part of the scheme and he eventually was fired after clashing with Hofstetter. 

Varlan, after taking a break, said he would allow jurors to hear Nocera testify about the emails. Stone then proceeded to formally offer them.

Federal authorities raided several area clinics in March 2015 along with Hofstetter's Farragut area home. Hofstetter was tapped to move to East Tennessee in about 2010 after helping with a clinic operation in South Florida, according to the government.

The government says the clinic operators generated more than $21 million in revenue, handing out opioids for cash with little or no medical supervision to East Tennessee addicts.

The government alleges some 700 patients of the Florida and Tennessee clinics are now dead, and "a significant percentage of those deaths, directly or indirectly, were the result of overdosing on narcotics prescribed by the (clinics). As alleged in the indictment, the narcotics prescribed by the (clinics) contributed to the deaths of another significant percentage of those patients".

Defendants standing trial in Knoxville with Hofstetter are Courtney Newman, Holli Womack and Cynthia Clemons. Others associated with the conspiracy have pleaded guilty and testified at trial.