In the nondescript shopping plazas dotting Florida, the unchecked prescription drug marketplace was thriving. Called pill mills, the storefront cash-fueled businesses operated with the rush and thrill of candy stores, with long lines of pill-popping addicts chasing their next high.
Parents with unshakeable habits were dying.
So were babies. Hardly anyone noticed.
We saw the explosion, said Bob Dillinger, for 17 years the elected public defender of Pinellas County. Nobody was making a connection to the deaths of children. We were all focusing on the deaths of adults.
Among those failing to make the connection was the Department of Children & Families.
I never was fully aware of the depth of it, George Shelton, DCFs secretary at the time, said recently.
A prolific prescription drug trade, a state government caught flat-footed and a troubled child protection system set the stage for what was to come.
Collectively, it was an incubator for child deaths.
Since 2008, 123 children have died after DCF had been told that one or both parents were abusing prescription drugs, a Miami Herald investigation found. More than 85 percent of the children were 2 or younger.
Oxycodone, Xanax, methadone and other prescription meds were found in the stomachs of deceased infants and toddlers or in the urine of their parents. Parents accidentally smothered their babies in bed while under the influence. They left pills where their kids could get to them, swallow them and overdose. Some children drowned while their parents slept off their highs.
They were as young as Jaiden Washpun, whose mother was arrested for doctor-shopping dashing from doctor to doctor in search of multiple prescriptions the day before he was born. He suffocated in bed 104 days later. His mother pleaded no contest to the doctor-shopping charge.
They were as old as Seth Mixon, who became a user just like his mother, DCF reports say. He overdosed at 13. His 9-year-old sister said she saw Seth grab seven to nine of his mothers Xanax pills the day he died.
The prescription drug epidemic took hold of Florida in ways big and small. Pain doctors asked few questions as they dispensed thousands of prescriptions for narcotics each day to drug tourists from as far away as Canada, as well as to locals, often under the guise of treating suspect injuries.
As the drug trade prospered, Florida became known as the pill mill capital of the United States. Police in other states called highways to Florida the Oxycontin Express.
A prosecutor based in Fort Lauderdale issued a dire warning to health regulators: Without swift action, the epidemic would destroy families.
Assistant statewide prosecutor Oscar Gelpi called Floridas burgeoning prescription drug trade a public safety issue, and characterized the states halfhearted reaction to it as dangerous and irresponsible.
That was in December 2004. Seven years later, Florida finally began to systematically shut the the pill mills, but only after the state was humiliated by officials in other states most memorably Kentuckys lieutenant governor, who publicly begged Florida to do something to choke off the supply of drugs coursing into his state.
O.D. on methadone
Before Kristin Love Adams died, her mother had been busted more than a dozen times, including an arrest on felony charges of doctor-shopping.
During Kristins infancy, DCF received at least three reports on the Nassau County family, including allegations in March 2007 that Kristins mom, Brandy Love Edwards, would become sleepy and veer off the road while Kristin was unrestrained in the car. Edwards denied the allegations. Two months later, DCF was told Edwards nodded out in a methadone haze while caring for Kristin.
There are burn holes in the sheets, and no food in the home, a May 2007 report said. Edwards, the file said, had been arrested while trying to obtain prescription drugs from two different doctors on the same day. But after Kristins mother appeared to be coherent, DCF did not move to shelter the child. Instead, the parents agreed to voluntary supervision, though it is unclear from the record whether that ever happened.
Kristin died of a lethal dose of methadone in the bed she shared with her parents on Jan. 25, 2008. Edwards was convicted of child neglect.
Meanwhile, Gelpis push for the state to crack down on the pill mill industry was encountering pushback. The Agency for Health Care Administration, which regulates the healthcare industry, said these clinics were operating essentially as cash businesses and not accepting reimbursement from insurance companies. Therefore, AHCA said, the agency had no jurisdiction; they were not subject to licensing or monitoring as long as patients paid with cash.
Gelpi disagreed strongly. AHCA has created a loophole by interpreting the statute to mean that only clinics that tender charges to third parties [Medicare, Medicaid or private insurers] are required to be licensed, Gelpi wrote in an email to his boss at the Florida attorney generals office.
AHCAs then-deputy secretary, Elizabeth Dudek, wrote in a letter to Gelpi that AHCA could not even enter and review records at the clinics. Remaining unlicensed, Dudek wrote, was in the clinics sole discretion.
In a 2006 email, Jim Schneider, another prosecutor at the attorney generals office, suggested that AHCAs reluctance to license the clinics might stem from a desire to avoid the cost of taking on a new regulatory burden.
Gelpi kept trying. In 2007, he wrote that the clinics with the loophole still open were operating without any sort of supervision or oversight by the state. In various emails and memos, he wrote that AHCA was misinterpreting state law.
Dudek, now secretary of AHCA, told the Herald on Thursday that she stands by her opinion that the agency had no authority to act.
In 2009, the Florida Legislature approved a prescription drug monitoring database that launched in 2011. It was intended as a tool to stem doctor shopping and weed out rogue physicians. Florida was the largest state without such a database.
Gov. Rick Scott, elected in 2010, wanted to repeal the measure, saying it was a violation of patient privacy. After Scott shut down the office charged with raising money to run the database, the funds were raised through a private foundation.
Among those who supported the database was Floridas newly elected attorney general, Pam Bondi.
We had become one of the top oxycodone dispensers in the country. We had this horrible, horrible problem, Bondi said. Children were dying because their parents were addicts.
The new database, stronger anti-pill mill laws, a statewide strike force and a $3 million budget finally slowed the flow of narcotics, with more than 3,700 arrests and the closing of hundreds of pain clinics.
The pill mills created an environmental crisis. You had addicts in the home, and it had taken over their whole lives, said Jim Hall, an epidemiologist and co-director of Nova Southeastern Universitys Center for Applied Research on Substance Abuse and Health Disparities. Everything is focused on obtaining the next fix, not their family life.
Child protection administrators were more concerned with keeping families together than taking a hard look at why children were succumbing to their parents addictions, said Dillinger, the public defender.
They never talked about children dying, said Dillinger, a member of Pinellas Countys Juvenile Welfare Board. It just never came up.
There was another problem, a prickly one: Many of the parents who were reported to the states abuse hotline had prescriptions, however dubious, for the drugs that could kill their children.
When a parent is prescribed a legal drug for any purpose, it is very difficult for a government agency to restrict that parents contact with their child, and the burden is on the family to provide the necessary protection and supervision if they perceive a problem, DCF wrote in September 2009 after the death of an 8-day-old baby whose methadone-addicted mother passed out on top of him.
In 2012, 1,630 babies were born in Florida with Neonatal Abstinence Syndrome, a condition in which the infants must be medically withdrawn from their mothers drugs. That number had increased more than threefold since 2007, state records show.
Newborns addicted to oxycodone and other drugs suffered terribly from withdrawal symptoms, including tremors, abdominal pain, incessant crying and rapid breathing.
Jaiden David Washpun was one of the children who came out of the womb with drugs in his system. Born on June 26, 2009, at about 26 weeks and weighing two pounds and four ounces, Jaiden carried his mothers opiates, benzodiazepines and marijuana. Carrie Leah West had been arrested for doctor-shopping the day before he was born, and had lost custody of two other children due to her intractable addiction.
DCF was told West had no interest in her baby: She declined to see him when he was born, and asked for a cigarette instead, one report alleged. An investigator was told West had tried to give the baby away to another couple as a wedding present. That could not be confirmed.
DCF lawyers decided that as long as West was in drug treatment, they had no cause to remove Jaiden.
He died before he reached 4 months, found unresponsive on a bed in a Panama City motel room where, DCF noted. West and her ex-boyfriend had set up shop as drug dealers. The mother was seen scooping up pills off the nightstand into a backpack when officers arrived to investigate Jaidens death, the DCF file noted.
The infant had been smothered in a co-sleeping incident. His mother had not brought with her a medically required apnea monitor. West tested positive for opiates, marijuana and benzodiazepine, but could not provide prescriptions for them. She served time.
It is extremely difficult to understand why an infant would be considered safe in the care of the mother, with only voluntary services, while older siblings remained in out-of-home care, a review of Jaidens death concluded.
Matthew Condatores mother wasnt picky about the substances she abused, though they largely came in the shape of a pill, DCF files said. There were two DCF investigations in December 2012 and February 2013. In March, Amanda Condatore acknowledged using alcohol, methamphetamine, marijuana, synthetic marijuana, Lortab, Soma, Vicodin, Percoset, Darvocet, Xanax, Roxies and benzodiazepine.
Matthews parents already had long histories with DCF in Lake County when the agency was told just after Christmas 2012 that his mother disappeared days at a time while she went to her drug dealer to buy and smoke methamphetamine. She had been arrested for DUI three months earlier.
With that investigation still open, DCF received a report on Feb. 5, 2013, alleging Matthews mother continued to abuse narcotics and alcohol, and was beating one of her children. She told another child, the report said, she was going to burn him alive.
During the 2012 investigation, Amanda Condatore denied prescription drug abuse, admitting only to drinking alcohol.
Matthew died two weeks shy of his first birthday. He was found by his 8-year-old sister, face-down in an overflowing bathtub. According to the death review, his mother was unconscious by the tub. She said she had blacked out.
At the time of Matthews death, his 28-year-old mother tested positive for amphetamines, methamphetamine, opiates and benzodiazepine some with prescriptions. She later told investigators she had taken one of her husbands pain pills, and had smoked methamphetamine.
A family affair
Some of the pain pill epidemics child victims lived long enough to become addicts themselves, including Seth Mixon, son of Michelle Windham.
Seth, who first came to DCFs attention in Hillsborough County when he was 2 and had more DCF reports than birthdays overdosed in his bed on Feb. 12, 2010, at age 13.
A DCF death review says the teen took his mothers Xanax bars long, skinny pills from which pieces can be broken off and are intended to treat anxiety as well as methadone. Windham had been getting her drugs, a DCF report said, from Dr. John Mubang, who was arrested two years earlier for trafficking at two Hillsborough County clinics. Mubang wore an ankle monitor to work each day as he dispensed pills.
Seths history with child protection investigators began on April 13, 1998, when he was found wandering around his parents trailer park barefoot, wearing only a T-shirt, while his mother was home asleep.
Among the 15 other hotline calls about Seth:
• September 1998: Seth was again wandering the neighborhood unsupervised digging in the trash looking for food while his mother was allegedly using crank and marijuana. Windham refused services.
• January 1999: Seth was found outside unsupervised, and Windham was allegedly using and dealing crack. She fled as the investigation got underway.
• February and March 2001: Seth, then 5, was observed outside for hours by himself, and playing behind dumpsters. He was also his 6-month-old siblings baby-sitter. DCF offered Windham free daycare and other services, and warned that the agency would yank her children if she continued to abuse drugs and neglect them.
• February 2004: Windham and her boyfriend were allegedly using and selling drugs out of their home, and her children were not being properly supervised. DCF investigators were told by DCF lawyers that they did not have legal cause to pursue court action. Instead, she agreed to accept more voluntary services.
• November 2005: While Seth and his sister were living with their maternal grandmother, Windham was arrested and later convicted on robbery charges after she held up a drugstore.
• January 2007: Seth was now living with his paternal grandparents after his maternal grandmother died of an overdose. Windham was in jail, and Seths father was homeless and selling pain pills.
• September 2009: Seth, now 13, was suspended for bringing Xanax to school. Windham tested positive for several drugs, but an investigator was stymied by the refusal of her clinic doctor, Mubang, to return phone calls.
Six months after Seths fatal overdose, a lengthy DCF analysis of the case acknowledged missed opportunities to intervene on his behalf. It concluded that those missteps had no direct impact on his death.