Written with Karl Baker for Delaware Online.

In late September, law enforcement raided a small Wilmington pain clinic, seizing bundles of cash just weeks after the death of its owner, Dr. George Dutkewych.

Neighbors who watched from a distance described an hours-long operation with what looked like federal agents hauling boxes from the Delaware Chronic Pain Management and Detox Center, tucked between a laundromat and a massage parlor in the Trolley Square shopping center.

Three months later, the true story of the late Dr. Dutkewych – a Ukrainian immigrant who had practiced medicine from Bolivia to Wilmington – is shrouded in mystery, even as a federal investigation looms over his still-operating clinic.

Patients said he was a doctor who did good work in the face of overzealous federal agents fighting a nationwide opioid scourge.

Certain neighboring businesses contend that his clinic has been a nuisance for years, serving patients who take up too many parking spots and some who appear intoxicated while loitering for hours.

Dutkewych's obituary, which called his September death sudden, told the story of a man born in the former Soviet Union who later became a U.S. Army Green Beret and then a private surgeon. Former patients flooded the comment section in the online obituary to share warm memories of the doctor.

One said he had saved her life.

The U.S. Drug Enforcement Administration is saying very little, but recently cited laws prohibiting the illicit sale of controlled substances as the reason for the September raid and subsequent seizure of assets.

The agency last month revealed that it seized nearly $52,000 in cash from Dutkewych's Trolley Square clinic, as well as more than $212,000 from bank accounts in Delaware and North Carolina associated with the doctor, his widow, and the company

Expanding the multi-state operation, agents also seized two cars – an Acura and a Lexus – from New York and Florida that belonged to the doctor's estate.

Before forming the Delaware Chronic Pain Management and Detox Center in 2007, Dutkewych practiced medicine in Florida and New York. Prior to his death, he had been living in West Chester, and also owned a townhome within a beach development, 90 miles north of Miami.

Public records show numerous Florida addresses associated with Dutkewych over the past two decades, but their exact relationship to him is unclear as Dutkewych's family declined to comment for this story. Employees at his Trolley Square pain clinic also declined to comment.

Past scrutiny

The September raid was not the first time Dutkewych's operations attracted scrutiny from authorities.

Among the top half-percent of opioid prescribers in the country in past years, a Delaware drug regulator told The News Journal in 2011 that Dutkewych's medical practice was suspicious because it charged patients $200 in cash for visits and, at the time, wrote 500 to 750 prescriptions a week for narcotics and anti-anxiety medications.

As the national opioid crisis has grown since, similar cash-only pain clinics have been blamed for fueling addictions that have ravaged communities.

In total, more than 300,000 people have died from opioid overdoses during the last two decades, according to the Centers for Disease Control and Prevention.

In October, the DEA's independent watchdog painted a damning picture of its oversight of opioids during the past two decades, claiming the agency was slow to respond to an exploding epidemic, allowed bad actors to keep manufacturing and distributing opioids, and failed to prevent controlled substances from entering the illegal drug trade.

The DEA said in response that it has improved how it detects and deters bad actors, and has imposed millions of dollars in civil penalties against drug companies.

Dutkewych in 2011 told The News Journal he was prescribing pain medicine responsibly. To ensure patients were not abusing their medications, he regularly would count patients' pills after prescribing them and conduct urine tests, he said then.

He also scoffed at the notion that he was breaking any law. His patients had bad backs, rheumatoid arthritis and pelvic injuries, he said then.

"Thirty-seven years of being a physician, all of a sudden I'm turning into some felon," Dutkewych said in 2011.

Those public statements apparently didn't quell regulators' suspicions. In 2014, Delaware's Board of Medical Licensure and Discipline placed Dutkewych's medical license on probation for 18 months.

The state claimed he had mistreated patients for pain in previous years by inappropriately prescribing controlled substances such as Roxicodone, Soma, Valium and methadone.

Later that year, Dutkewych entered into a consent agreement to settle the case.

Particularly at issue was an incident in 2009 when Dutkewych prescribed a pregnant woman opioids for pain. He told regulators that he had confirmed the treatment with the woman's OB/GYN, but the confirmation was not documented in the patient's records, according to the consent agreement.

Dutkewych also failed to document whether he had discussed with the pregnant woman the "inherent risks for the fetus of opioid use," the consent agreement stated.

Her baby was born premature at 36 weeks – and opioid dependent, according to the public documents.

Other patients were also mistreated by Dutkewych's failure to document and coordinate with doctors about their care, the consent agreement stated.

In addition to probation, the state ordered Dutkewych to pay $7,500, take a continuing education class about safe prescribing practices and enroll in Delaware's Prescription Drug Monitoring Program. He also was required to submit his patient records for a state audit.

The Delaware Department of State declined to provide a copy of the audit, citing an exemption under the public records law for "investigatory files." But a department spokesman said in an email that the audit found "sufficient compliance with the issues cited in the consent, i.e. appropriate patient screening, risk assessments and treatment planning."

Still, as a result of Delaware's disciplinary action, New York state regulators in 2016 ordered Dutkewych to "immediately cease and desist from engaging in the practice of medicine in New York State."

Dutkewych also voluntarily relinquished his medical license in Florida in 2017 after that state brought charges related to the Delaware action. They included a failure to notify Florida about the Delaware sanctions within 30 days of the order.

The morning ritual

On most weekday mornings, a cluster of patients arrive early and park in the Trolley Square lot outside the Delaware Chronic Pain Management and Detox Center. 

There, they wait for the clinic's 8 a.m. opening. 

Early one Tuesday morning, there were pickup trucks, a sports car and two sedans bearing Maryland and Delaware license plates.

Some patients waited outside the cars, chatting with those they knew from previous visits.  When asked by The News Journal, most were quick to defend Dutkewych, though none of them wanted to give their names.