After a monthlong trial, a jury is expected this week to decide the fate of Michael Belfiore, a Merrick physician accused of writing hundreds of opioid prescriptions for profit and causing the deaths of two South Shore men.
Assistant U.S. Attorney Bradley King delivered a nearly two-hour PowerPoint presentation to jurors on Monday, reviewing the government’s evidence, attacking Belfiore’s credibility — and that of his expert witnesses — and urging the jury to find him guilty on all 28 charges.
Belfiore was acting as a “drug dealer,” King said, when he wrote oxycodone prescriptions for John Ubaghs, of Baldwin, and Edward Martin, of East Rockaway, both of whom died of overdoses.
Ubaghs, a U.S. Marine Corps combat veteran and a martial artist, was “functional and fit” when he started receiving prescriptions for 30-milligram oxycodone pills from Belfiore, King said.
By the time of his death on April 13, 2013, Ubaghs was taking 15 pills a day and suffering from acute withdrawals — sweating, vomiting and anxiety — when he ran out, according to King.
On April 12, Ubaghs picked up a prescription for 150 pills from Belfiore, King said, and went to the movies with his girlfriend, who testified earlier in the trial that throughout the date, he was popping pills. The next day, he fell asleep while cooking a grilled cheese sandwich and stopped breathing.
The Nassau County medical examiner’s office, when preparing Ubaghs’s autopsy report, said that it had “never seen an oxycodone level that high in any living person,” according to King.
“He survived Iraq, but he could not survive this defendant’s illegitimate medical practice,” King said, pointing to Belfiore, who showed little reaction during closing arguments.
Martin was found dead in his bed in March 2013, where, King said, a cut straw with oxycodone residue on it, and a bottle of oxycodone pills with Belfiore’s prescribing information on the label were found “within arm’s reach.”
Martin’s autopsy report indicated an oxycodone level of 0.46 — enough to kill, King said.
Medical records from Martin’s first visit to Belfiore indicate that he showed signs of alcoholism, and on his second visit, Belfiore wrote that Martin was attending Alcoholics Anonymous. Still, according to King, Belfiore wrote Martin a prescription that day for 128 30-milligram oxycodone pills.
“He allowed an alcoholic with a serious addiction problem to leave his office with a month’s supply of high-dose, legal heroin,” King said.
King also reminded jurors of Detective James Marinucci’s testimony on the first day of the trial. Marinucci, of the Nassau County Police Department’s vice squad, saw Belfiore while undercover as “James Burke,” a factory worker with back pain, visiting Belfiore six times in 2013.
During his visits, Marinucci deliberately told Belfiore that he had been given oxycodone pills by his friend — another of Belfiore’s patients — and at one point told him that he was sharing the pills with his girlfriend, and asked Belfiore if he would take her as a patient.
The fact that Belfiore continued to prescribe for Marinucci, despite the obvious “red flags,” and that he kept inaccurate — King called them “fake” — medical charts about Marinucci’s treatment program, should have been enough for the jury to find Belfiore guilty, King said.
King also took aim at Belfiore’s defenses — including that he relied on misinformation from Purdue Pharma, an oxyco-done manufacturer, when prescribing the drug.
Pointing to Purdue promotional videos, which the Herald viewed last year, King expressed disbelief that Belfiore would rely on them, and not the growing body of knowledge about the dangers of opioids during the time he was prescribing them.
“He wants to you believe that these infomercials — which, I submit to you, were not very convincing — somehow corrupted his thinking,” King said.
Belfiore’s defense attorney, Tom Liotti, told jurors that prosecutors were unfairly trying to turn accidental death cases into a double homicide, and said that King’s evidence was selective and his presentation was “smoke and mirrors . . . and a very big lie.”
“I’m very, very angry,” Liotti said. “As a professional, I have to control my anger. I’m going to try to do that.”
Liotti also urged jurors to recognize the difference between addiction and dependence when it comes to pain medication — dependence meaning a patient needs the medication to function. Belfiore focused on keeping patients functional, he said.
“There is a difference,” Liotti said. “And doctors are in a delicate position.”
Later, Liotti added that doctors can differ on a patient’s need, because pain is subjective.
“A doctor has to go on the credibility of his patients, and what they tell him of their pain,” he said. “If he says his pain is a 10 out of 10, does Dr. Belfiore turn him away? No. He gave him four different medications and told him to use the oxycodone sparingly.”
Belfiore was also supported in the courtroom on Monday by a number of family members and patients.
Laura Sherris, a Syosset attorney and a patient of Belfiore’s, said she could not comment on the specifics of the case, but that Belfiore was a “genius” doctor who had “cured or substantially improved” the quality of life for many of his patients.
Belfiore, contrary to the picture painted by prosecutors, works with patients to get them off medication — “to get at the root cause” of their pain, Sherris said.
“He has treated me for cancer, and for autoimmunity,” she said. “It’s Dr. Belfiore who changed my protocol, and got me back into the health you can see today, so I’m able to work 12 hours a day in my law practice.”
Jurors began deliberations on Tuesday afternoon. Look for more as the story develops at www.liherald.com.