INDIALANTIC, FL - In early August, a woman walked into Dr. John Gayden Jr.'s pain clinic and walked out 60 seconds later with prescriptions for painkillers and anxiety medication.
In three visits, she received prescriptions for 450 oxycodone pills and 360 tablets of Xanax.
Gayden never asked the patient, identified only as "M.J.," about her medical condition, according to a document filed this week with the Florida Department of Health.
"Dr. Gayden treated Patient M.J. with potentially lethal ... dosages," the document states. "Dr. Gayden merely said hello to the patient, inquired as to whether the patient enjoyed her weekend and then provided the patient with multiple prescriptions."
M.J. turned out to be an agent with the Florida Department of Law Enforcement. The undercover operation was part of an investigation prompted by a revelation that Gayden was one of the most liberal prescribers of painkillers in Florida.
But when the 58-year-old doctor was arrested Tuesday, the charges against him had little to do with such "pill mill" activity. Agents said they learned Gayden had been having sex with a 17-year-old girl and that he had given her narcotics sometime last year - months before the investigation even started. They simply considered it an "opportunity" to arrest Gayden and temporarily suspend his license.
Officials haven't ruled out drug-trafficking charges against Gayden - something residents say contributed to loitering and addiction. But a multitude of issues, most surrounding the subjective nature of whether a patient actually needs the medication, has made it difficult for police investigators to permanently stifle such activity.
"You're talking about investigating a physician who has a license to write prescriptions. You have to show that ... he's actually overprescribing," said Special Agent Supervisor Tom Foy of the FDLE. "It's not just a case of someone calling and giving us a tip. Even seeing a large amount of activity isn't enough."
About two years ago, Gayden set up Indialantic Internal Medicine. Before the doors opened each day, a line formed outside the office. He saw more than 60 patients daily.
Naomi Porter, owner of the nearby Green Bean Thrift Store, recalled one time when a man spryly hopped from his pickup, then strapped a brace onto his back.
"It was just packed with every kind of person you can imagine," she said. "It was so ridiculous and so obvious."
Officials couldn't quantify the complaints lodged against Gayden's practice but said they were "numerous." And during the past five years, Gayden's name popped up in police reports regarding prescription drug activity countywide.
In August 2007, a Melbourne police investigation into a prescription drug overdose revealed that "the deceased, the deceased's boyfriend and the deceased's mother were all patients" of Gayden.
Patients of Gayden said the activity picked up in 2006, when Gayden got divorced. Less than two months later, his 20-year-old son was found dead in a Palm Bay home. An autopsy determined that he overdosed on cocaine and oxycodone.
In 2010, prescription pills were responsible for the deaths of more Floridians than illicit drugs, and on Thursday evening, dozens gathered at a park in Indian Harbour Beach to remember those victims.
The candlelight vigil was coincidental to Gayden's arrest earlier in the week. But his name was not new to attendees.
Life Over Addition, a Melbourne nonprofit, organized the Thursday vigil. Co-founder Julie Judge said it was good Gayden was "off the market.''
'Knowing and proving'
In the years since 2005, the heyday of pill mills in Florida, few local doctors have been imprisoned on drug-trafficking charges.
Dr. David Wang of Orlando was arrested in 2005 after an undercover sting in which he and a co-defendant prescribed painkillers countywide.
He pleaded no contest to lesser counts. His co-defendant, Nima Heshmati, was cleared after experts determined that he legally prescribed the medication.
"The bottom line is that physicians are making decisions every day based solely on the complaints of patients," Assistant State Attorney Wayne Holmes said.
The basis for prosecuting such cases, Holmes said, often rests on expert opinion.
"People say, 'We see this stuff going on, so why don't you just do something about it?' " Holmes said. "But knowing and proving are two different things."
Health officials said the case for a permanent revocation of Gayden's license is solid. The doctor has 30 days to apply for a hearing to get it back.
Gayden prescribed 250,000 oxycodone pills in the first eight months of this year. That rate rivals all doctors in the entire state of California.
Laws that went into effect this year are designed to smother such activity. One prevents doctors from directly dispensing medication. Another requires pharmacies to track patients' prescriptions in a database.
"The only way is to cut off the flow of drugs," Holmes said, "because once it's out of the bag, it's very different to get it back in."