Patients feel the pressure
Interviews with 17 former patients revealed common observations at Lags medical clinics, such as crowded waiting rooms and an assembly line environment. Many said they felt pressure to consent to injections and other procedures or risk having their opioid supply cut off.
Audrey Audelo Ramirez said she had been concerned for years that the care she received at a Lags medical clinic in Fresno was poor. Over the past two years, she said, sometimes there were so many patients waiting that the line wrapped around the building.
Ramirez, 52, suffers from trigeminal neuralgia, a rare nerve condition that sends shocks of pain to the face so severe it’s known as “suicide disease.” Over the years, Lags Medical had taken over prescribing almost all of his medications. This included not only the opioids and gabapentin she relies on to endure excruciating pain, but also drugs to treat depression, anxiety and sleep issues.
Ramirez said she often felt pressured into getting procedures she didn’t want. “They were just pushing injections, injections, injections,” she said. She said staff members performed painful punch biopsies on her, which led to an additional diagnosis of small fiber neuropathy, a nerve disorder that can cause shooting pain.
She was among many patients who said they needed to have the recommended procedures if they wanted to continue receiving prescriptions for their painkillers. “If you refuse any treatment that they say they’re going to give you, you’re considered non-compliant and they stop your meds,” Ramirez said.
She said she eventually agreed to a facial injection, which she said was given without adequate sedation. “It was awful, awful,” she said. Yet, she says, she kept going to the office because there weren’t many other options in her town.
Lagattuta, through his attorney, declined a request from KHN to answer questions about the care provided at his clinics, citing the state’s investigation. “Since there is an active investigation, Dr. Lagattuta cannot comment on it until it is complete,” attorney Matthew Brinegar wrote in an email. Lagattuta’s license remains in good standing, and he testified in his deposition in the Fresno lawsuit that he still sees patients in California.
Experts interviewed by KHN noted that medical procedures such as injections can play a legitimate role in overall pain management. But they also spoke in general terms about the emergence of a troubling pattern in pain clinics across the United States involving the overuse of procedures. In the 1990s and early 2000s, problematic pain clinics hooked patients on opioids and then demanded money to continue the prescriptions, said Dr. Theodore Parran, who is a professor of medicine at the Case Western Reserve University and has served as an expert witness in federal pain clinic investigations.
“What has replaced them are struggling pain clinics that hook patients on drugs and accept insurance, but abuse procedures that pay very well,” he said. For patients, he added, the consequences are not benign.
“I mean they are painful,” he said. “You put needles in people.”
Stick it to customers
Before moving to California in 1998, Dr. Francis Lagattuta lived in Illinois and worked as a team doctor for the Chicago Bulls during their 1995-96 championship season. In the west, he opened a clinic in Santa Maria, a predominantly Latino town along California’s central coast known for its strawberry fields, vineyards and barbecue. From 2015 to 2020, the chain grew from a few clinics in Santa Barbara County to dozens across California, mostly in rural areas, as well as remote locations in Washington, Delaware and La Florida.