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Washingtonian
February 2014
The Spectacular Unraveling of Washington's Favorite Shrink Starring
Alen Salerian
By Ariel Sabar
About five years ago, C. Ray Foster, the sheriff of Buchanan County,
Virginia, noticed the name of an unfamiliar doctor on the pill bottles
turning up at drug busts, overdoses, and DUIs. OxyContin and other
narcotic painkillers feed an epidemic of crime and addiction as
insidious in this Appalachian outpost as the kudzu astride the Levisa
Fork River. But this prescriber's name-Alen Salerian-was an enigma.
The man wasn't a pain specialist but a psychiatrist, a doctor trained
to treat mental illness. And his office was 400 miles north, in one of
Washington's wealthiest neighborhoods.
"I came out of there with 450 roxy 30s, 450 methadone 10s, Adderall
and Xanax," someone calling himself "Crazy" wrote online about his
first visit to Salerian, the popular subject of nearly 500 posts in a
Buchanan County web forum. "My sister went the same day and got the
same thing. . . . At one time 5 of us rode together and he made our
appointments back to back . . . . I don't know how in the world we
made it home we would be so messed up."
The question Foster kept asking himself was why people in his
impoverished county were driving up to eight hours each way-sometimes
in caravans and carpools-to see a psychiatrist, one who didn't even
take insurance.
Salerian's colleagues back in Washington would have been just as
bewildered. Salerian, now 66, was once chief psychiatrist to the FBI's
employee-assistance program, traveling the world to minister to
troubled agents. He taught at George Washington University, published
in medical journals, wrote op-eds for theWashington Post.
His private practice, steps from the Neiman Marcus in DC's Friendship
Heights, was a world away from the troubles of Buchanan (pronounced
"buck-cannon") County, a once-booming coalfield at Virginia's border
with Kentucky and West Virginia that's now one of the poorest and most
isolated places in the state.
To get there from Washington this past September, I drove for hours
down interstates 66 and 81, up through tunnels bored into mountains,
and over the Trail of the Lonesome Pine. Finally, the road tucked into
valleys so vertiginous that for much of the day the hills were
shrouded in shadow.
Sheriff Foster-a wry lawman with a silver mustache and a reputation
for candor-was at his desk, picking at a breakfast of biscuits and
gravy in a Styrofoam clamshell, when I entered. "I'm an old fat man,"
he quipped when asked his age.
But when I mentioned Salerian, Foster grew serious, turning off the
air conditioner and dialing up his hearing aid. Buchanan County
residents die of prescription-painkiller overdoses at more than five
times the statewide rate, and Foster held the psychiatrist at least
partly responsible. His pills had shown up at drug scenes across the
county and in the homes of families so lost to addiction that the
state had to take custody of children.
"I've never met him, but I've met a lot of his work," Foster said.
"His clientele has become my clientele"-by which he meant denizens of
the county lockup.
The giant doses Salerian was prescribing to young, seemingly healthy
people in the county where Foster had grown up didn't make sense. "Why
would a 20-year-old feller take five Oxys a day?" he asked. "Why would
you prescribe that to a 20-year-old that has not got cancer, has not
got no fatal disease, has got no chronic pain?"
A visitor to Alen Salerian's office in the 1980s and '90s would have
encountered one of the most glittering waiting rooms in Washington.
Middle Eastern royals, Hollywood actors, and heiresses were all under
his care, as were a general and a senator turned presidential
candidate. Many patients felt he was the first doctor to really
understand their suffering: "the one person I trusted," local author
Gail Griffith said in a memoir.
Though just five-foot-seven, Salerian had a way of filling a room. He
was garrulous, with an exotic accent and boisterous charm, and he
loved the limelight. He had wrangled a gig as an on-air commentator
for Channel 9, Washington's CBS affiliate, and was sought out for his
expertise by TV programs such as 48 Hours.
It was a remarkable ascent for a man who'd landed in the US from
Istanbul in 1971 with no connections beyond a letter admitting him to
a medical internship. Salerian's father, a successful engineer, and
mother, a noted painter, had sent him and his identical-twin brother
to America because they saw no future for Christian Armenians like
them in Turkey. Alen's brother, Nansen Saleri, now a Houston oil
executive, calls himself the ace student and "conformist one." Alen
was more like his mother, a social butterfly with artistic impulses
who sometimes skipped school to be with friends.
No one was surprised when he declared an interest in psychiatry. "He
wanted to be around people," Nansen says; among all the medical
specialties, "it would allow him more of an emotional relationship
with patients."
Salerian's supervisors at George Washington University, where he
completed his psychiatry training, named Salerian chief resident and
hired him as an assistant clinical professor right after his training
ended in 1976. He was no less a hit at Metropolitan Psychiatric Group,
one of the nation's largest group mental-health practices. Salerian
drew so much business to its DC and Rockville offices that the group
made him partner after just two years.
Soon after a Pennsylvania company acquired the group in 1994, Salerian
took a $1.5-million payout and started his own practice on the ground
floor of the Psychiatric Institute of Washington, a Wisconsin Avenue
hospital that eventually named him associate medical director.
It was a heady time. Pharmaceutical companies were so taken by the
doctor's social dexterity that they paid him tens of thousands of
dollars a year to host dinners introducing colleagues to new drugs.
He'd also landed a glamorous five-year contract with the FBI's
employee-assistance program, which wanted him to find help for agents
wrestling with alcoholism, family strife, and other personal issues.
Salerian, a married father of four, had always liked difficult cases:
patients whose depression responded to none of the usual treatments,
manic-depressives who'd sooner live on the streets than take their
meds. At the FBI, he cracked his toughest case yet: getting hardened
agents to confide in a shrink.
Chuck McCormick, a former FBI agent who led the assistance program in
the 1990s, says he could call day or night and Salerian would get on
the next plane to anywhere in the world-domestic FBI offices, overseas
embassies. "We saved lives, salvaged careers," McCormick says. "We
kept families together. We prevented divorces. He was a godsend."
A few years into the contract, however, Salerian had a falling-out
with the agency over what he construed as a supervisor's racist remark
about his olive-toned skin. "I used every F-word," Salerian recalls of
his response. McCormick says he remembers no such incident. All the
same, the bureau decided to shift its program in-house after
Salerian's contract was up in 1997-a parting that would come to haunt
the FBI and the doctor both.
In February 2001, a veteran FBI spy catcher, Robert Hanssen, was
arrested in the gravest security breach in the bureau's history: The
mild-seeming Virginia man, it turned out, was a double agent who had
been selling US secrets to the Russians for more than two decades.
In his former employer's humiliation, Salerian glimpsed opportunity.
He had been trying for years to write opinion pieces for major
newspapers, with scant success (despite the help of publicists). Three
weeks after Hanssen's arrest, Salerian got his big break: ThePost
published his long op-ed flogging the FBI for not subjecting agents to
routine mental-health checks.
The piece read like a John Grisham thriller, with Salerian as its
dashing lead, a troubleshooter who'd saved the agency from untold
numbers of overstressed G-men who might well have become other
Hanssens.
He made no mention of his falling-out with the FBI. Nor did he
disclose that he was just then auditioning for a starring role with
Hanssen's defense team.
Salerian had recently offered his services to Plato Cacheris,
Hanssen's court-appointed lawyer. Cacheris was the go-to attorney for
defendants in the inner circles of Washington power: Aldrich Ames,
Monica Lewinsky, and John Mitchell, of Watergate notoriety, had all
been clients.
Cacheris hadn't envisioned a psychiatric defense. "On the other hand,"
he says, "if a psychiatrist could say something helpful, if not
exonerating, we might need it.
"I figured if the FBI used him, he must be okay."
Over the course of seven jailhouse meetings, Salerian got Hanssen, a
shy and socially awkward man, to confide his most humiliating personal
secrets: his father's physical abuse, his sexual obsessions, the
hidden camera Hanssen had installed in the bedroom he shared with his
wife so a friend could watch their lovemaking.
Privacy laws and professional ethics hold both lawyers and doctors to
strict client/patient confidentiality. Federal rules for high-risk
detainees like Hanssen set an even higher bar: Disclosures to possible
witnesses or codefendants, such as a suspect's wife, are verboten. Yet
despite Cacheris's explicit orders, Salerian went to Hanssen's wife,
Bonnie, with details of her husband's betrayals, then lobbied her for
permission to speak to the press.
When she refused, Salerian did it anyway, telling BBC reporters about
his jailhouse conversations with Hanssen. He even offered to take a
photo of Hanssen to sell to the media.
Shocked, Cacheris summoned Salerian to his office in May 2001 and
fired him. He warned the doctor to say no more to anyone about the
case. His client, after all, was facing the death penalty.
But Salerian had other priorities.
Over the next few months, he gave on-the-record interviews to CBS
News, the Post, the Sunday Timesof London, and many others. He
portrayed himself as a prophetic doctor who could have seen the
warning signs the FBI and the Catholic Church had missed (Hanssen had
confessed to a priest) and who owed America the truth.
"His espionage was an escape from his sexual demons," Salerian told
Lesley Stahl on 60 Minutes. "When he found himself in exciting and
dangerous positions, such as espionage and spying, he found that his
demons slowed down, they calmed down."
Salerian sold the option rights to his story to author Norman Mailer
and film producer Lawrence Schiller, who took him to a boozy dinner at
Old Angler's Inn in Potomac. Though they never portrayed him in their
book and TV movie about Hanssen, the voluble doctor appears to have
held nothing back: Mailer's interview transcripts with Salerian span
some 500 pages.
When the rare reporter questioned whether Salerian's dismissal from
the defense affected his credibility, the doctor suggested he answered
to a higher code: He knew better than the lawyers or the guardians of
medical ethics what was good for Hanssen and society. "I have
100-percent moral and psychological authority," Salerian said.
Others saw another motive. Cacheris had decided to seek a plea deal
sparing Hanssen's life, and for Salerian that meant one thing: no
chance to be the star expert in a trial with headlines the world over.
"He told people he was hoping I wouldn't settle the case and deprive
him of the opportunity" to testify, Cacheris says.
Weeks after a plea deal was reached, Salerian argued that the
opprobrium heaped on him by fellow psychiatrists proved that it was
they-not he-who had failed the mentally ill. "The biases against
psychiatric disorders and mental illnesses will only go away if we
confront them," he wrote in USA Today. "So far, no one is brave enough
to go up against them-not the church, not the FBI, not even the mental
health profession itself."
No one, that is, but him.
Many colleagues struggled to square the brazenness of Salerian's
conduct with the thoughtful physician they thought they knew. But
clues to another side of the doctor-explosive, attention-craving,
defiant-were hidden in plain sight.
In his first year as a resident at GW, Salerian openly mocked a
renowned expert on narcissism, who later bristled to the program
director, "Where do you get your residents?"
At the Metropolitan Psychiatric Group, Salerian needled what he called
his "lily-white colleagues" by treating psychotics, schizophrenics,
blacks, and the poor-people who deviated from the stock clientele of
affluent women suffering what he dismissively dubbed "Bethesda Wife
Syndrome."
The board exams in psychiatry are a mark of professional distinction.
But Salerian failed them and never tried again: "I began disagreeing
with psychiatry," at least as currently practiced, he says. "It slowly
began occurring to me how different my thinking was."
Salerian saw his reputation for controversy as the calling card of an
original mind. He sought patients whom other colleagues couldn't
handle or wouldn't touch, then gave them treatments other doctors
wouldn't. In the 1980s and early '90s, when most psychiatrists were
still analyzing patients on couches, he began prescribing newly
approved drugs in unorthodox combinations, in search of experimental,
"off label" treatments, sometimes for conditions outside his field.
His willingness, even eagerness, to prescribe exotic drug cocktails
endeared him to many patients, particularly those in the grips of
despair. A Chevy Chase woman whose brother is bipolar says they'd
visited specialists in DC and New York before a doctor referred them
to Salerian in 2000. For years, her brother refused pills that doctors
said he needed to get better. Salerian was the first to break through.
He patiently explained how the brain worked, never charging for the
extra time, and drew sketches showing how pills helped. "From our
family's perspective," she says, "Dr. Salerian saved a life."
But his pharmaceutical cocktails made even his admirers nervous. "They
were very unusual combinations of medications," says Carl Gray, a
Rockville psychiatrist who sent Salerian some of his toughest
patients.
Laurence Greenwood, a psychiatrist in Prince George's County,
remembers seeking out Salerian for advice about a relative with
intractable schizophrenia. Salerian suggested the stimulant Ritalin,
an ADHD drug traditionally thought to aggravate psychosis. The
relative's doctor balked: He wasn't comfortable turning his patient
into a test subject. "Nor would I have been as a doctor, because as a
doctor I'm being cautious," Greenwood says. "But as a patient, a
family member, where the quality of life of a whole family is being
severely disturbed by the patient's suffering, it would be a very
reasonable thing to try. In a sense, I wish I had Alen's courage."
Bernard Vittone, who directs a prominent mental-health clinic in DC's
Foggy Bottom and has known Salerian for decades, puts it another way:
"He has some traits you could view as being admirable or very
reckless."
After the Hanssen affair, George Washington University cut Salerian
loose and the Psychiatric Institute declined to renew his hospital
privileges. He and the drug companies whose pills he promoted parted
ways.
The Maryland medical board issued an excoriating ruling that accused
Salerian of "gross" ethics violations in the Hanssen case. The doctor,
the board wrote, seemed to have "a perception of self so grandiose as
to raise concerns about his judgment." Remarkably, the Maryland and DC
medical boards let Salerian off with a reprimand and fines of just
$8,500.
The ruling barely broke his stride. Salerian remained a regular on
Channel 9 and kept up a busy practice, where patients who remembered
his TV appearances now felt they were in the hands of a highly
sought-after psychiatrist.
But things were getting strange. In 2003, Salerian self-published a
glossy book of cartoons called Honest Moments With Dr. Shrink. Though
pitched as a satire of psychiatry, the cartoons-pastel-crayon doodles
that call to mind a grade-school art fair-were at best cryptic, at
worst racially charged and sexually vulgar. "Doc, please help me find
my G spot," a woman shaped like an eel says on the first page. "Who
saw it last?" says Dr. Shrink, who's drawn in the shape of a
refrigerator.
Honest Moments was followed by a Salerian line of vitamins. Then came
a deepening preoccupation with John F. Kennedy's assassination,
research trips to Dealey Plaza, and a torrent of more than 200
JFK-inspired paintings that he exhibited in Dallas and DC.
Salerian found another canvas for his creative impulses on the lawn
outside his office. Pronouncing the landlord's landscaping "bland," he
turned the empty sod into a statue garden, complete with a rooster
figurine, a fountain ringed by 24 lion heads, and a giraffe he named
after his son Justin. He told the Washington City Paper at the time
that the installation was a whimsical welcome mat meant to "make
neuropsychiatry accessible."
Inside Salerian's office, however, some longtime patients felt
unsettled. A Maryland woman recalled her unease when a large oil
painting depicting a nude couple in the throes of coitus went up in
the waiting room. Once-brisk appointments turned into drawn-out bull
sessions about the doctor's art and his latest JFK findings. "When you
went to see Dr. Salerian, you took the whole day off," one patient
says.
The most extraordinary shifts were inside the exam room. A growing
number of patients were traveling great distances for another new
sideline: addictive narcotic painkillers such as OxyContin, methadone,
and Fentanyl.
The doctor appears to have embraced the drugs soon after Cacheris
fired him from the Hanssen case and just as the first major news
stories about OxyContin's dark side broke. The pill, approved by the
Food and Drug Administration in 1995, was the first made of pure
oxycodone, a powerful derivative of the opium poppy. It was formulated
to dissolve in the body over 12 hours, but people found they could
ingest the oxycodone all at once by crushing the pill and then
snorting or injecting it. The euphoria gave the drug street value and
the nickname "hillbilly heroin."
Narcotic painkillers, typically prescribed to cancer patients and
others in severe physical pain, have no FDA-approved psychiatric uses.
But Salerian wanted to blaze a new frontier. "I have prescribed
OxyContin to more than 200 of my patients, and none of them has become
addicted," he boasted in a 2002 op-ed in theIndianapolis Star. He said
he'd used the drugs to treat not just physical pain but also
depression.
It had been at least a half century since doctors had tried anything
of the kind. Though physicians in the 1800s had given opium
derivatives such as morphine to people with "melancholia" and other
ailments, by the 1950s scientists had produced the first class of
modern antidepressants. They were more effective and had fewer side
effects than opiates and were not addictive. To tout opiates for
depression now would be somewhat like prescribing arsenic and mercury
for syphilis, decades after the invention of penicillin.
Salerian's faith in the power of painkillers springs from something he
calls the Salerian Theory of Brain. This "new paradigm," he wrote in a
non-peer-reviewed medical journal, would do to the foundations of
modern psychiatry what Galileo did to "Ptolemaic assumptions about the
celestial movements."
The theory's narcotics bit goes something like this: Endorphins, our
bodies' natural opiates, are necessary for healthy brain chemistry and
good mood. People with too few endorphins-a group that in Salerian's
view includes drug addicts-can get right, he believes, by taking
super-sized doses of manmade opiates like OxyContin.
As his colleague Bernard Vittone put it, Salerian was "operating in
universes I've never even seen."
Yet the doctor had nearly absolute faith in his patients. Though he
often prescribed OxyContin at three times the recommended doses, he
refused to subject patients to common safeguards against abuse and
dealing. "Any doctor who creates these monkey, Mickey Mouse forms and
forces you to give drug urines," he told an internet radio show, "is
actually raping Hippocrates."
The test subject for his opiate cure, Salerian says, was a severely
depressed, drug-addicted railroad worker named Paul. Over a series of
hospitalizations in the mid-1980s, Salerian used conventional methods
to wean Paul off an addiction to Fiorinal, a non-opioid painkiller and
muscle relaxant.
But in the 1990s, after traditional depression treatments failed,
Salerian says he ceded to Paul's request for Percocet, a narcotic
painkiller. Salerian rhapsodized about the results. Though forced into
a disability retirement, Paul discovered true pleasure in a new car
and in vacations with his wife, Salerian insists. (Paul's wife
disputes Salerian's account.) All the same, in the spring of 2001,
Salerian added another pill to Paul's drug cocktail: OxyContin. The
next year, another: Fiorinal, the very drug Salerian had detoxed Paul
from a decade and a half earlier. Paul grew addicted again, this time
to the active ingredient in OxyContin. In 2004, his wife filed a
complaint with the DC medical board about Salerian's narcotics
experiments, but it didn't do her any good. She became a widow in
2005, when Paul bled to death from an undiagnosed intestinal ulcer.
Four years later, in January 2009, the DC medical board said there
wasn't sufficient evidence of misconduct and dismissed the case.
Salerian, who spent $750,000 on an elaborate defense, says he took the
ruling as both exoneration and endorsement. He changed the name of his
practice to the Salerian Center for Neuroscience and Pain and felt
that his scientific revolution was finally under way. "It was a
dream," he said later. "My march began."
By February 2010, another patient was dead.
Patrick Kennedy-or Paddy, as his family called him-was a quiet but
playful kid who began taking illegal drugs his sophomore year at
Bethesda-Chevy Chase High School. In college he grew depressed and
worried he might be succumbing, as had his mother, to schizophrenia.
His elder brother took Paddy, then 20, to see Salerian, with whom
their family had had good experiences in the past. Salerian gave Paddy
an on-the-spot diagnosis of obsessive-compulsive disorder,
attention-deficit disorder, and phobia-and a prescription for
methadone, a narcotic approved only for chronic physical pain and for
heroin maintenance and detox therapy.
Because it can slow breathing, the medical rule of thumb for methadone
is start low, go slow. Salerian wrote Paddy a dose above the
manufacturer's guidelines, believing it would boost his dopamine, a
neurotransmitter that helps regulate motivation and pleasure-seeking.
The day he took his first pill, Paddy sent his family an effusive
e-mail. "Dr. Salerian has given me new hope," he wrote.
Two days later, his father, Steven Kennedy, an editorial consultant,
cooked a dinner of beef-and-barley soup and settled onto the couch
with his son for an episode of House, the TV drama about a drug-addled
doctor with a genius for diagnosis. Before the show was over, Paddy
complained about his vision. "My eyes feel out of focus, Dad," he said
and went to bed.
When Paddy was still in bed at 11 the next morning, his father went in
and found his son's body pale and rigid. Blood had pooled in purple
blotches under his skin, a sign he'd probably been dead for hours.
Detectives counted the remaining methadone pills: There was no
indication he'd taken more than prescribed. The Virginia medical
examiner ruled the death an accidental overdose.
On the morning of March 3, 2011, teams of gun-toting DEA agents in
black jumpsuits raided Salerian's home. They handcuffed Salerian's
wife and the two adult children at home. (His wife told me she was so
traumatized that she soiled herself.) Salerian arrived at his practice
to find it commandeered by agents, who spent the day searching his
computers, files, and financial records. Under civil-forfeiture laws,
which don't require criminal charges, the agents also seized three
cars and the cash in three bank accounts.
Salerian responded by appointing himself leader of a global movement
to end discrimination against pain sufferers. The curtain raiser was
to be a giant civil-rights-style demonstration-Festival Pain Brain-in
the fall of 2011 at the Lincoln Memorial. Salerian hired an
advertising firm to mount a publicity campaign and to e-mail
invitations to 40,000 medical students. He promised a guest appearance
by country star Blake Shelton, an onslaught of 20,000 protesters, and
the freeing of thousands of butterflies. Actual turnout: perhaps two
to three dozen. There was no Shelton (who'd never agreed to come).
There weren't even butterflies.
Convinced of sabotage, Salerian made a defiant trip three months later
to southwestern Virginia, where he'd heard that his long-distance
patients were being harassed by police. He had persuaded a Buchanan
County newspaper, theVoice, to host a public forum to take on critics.
The paper's publisher, Earl Cole, told me the issue was personal: His
painkiller-addicted son had committed suicide in 2007, and his
21-year-old grandson was high on pills a year later when he lost
control of his car and died in a head-on crash with a tractor-trailer.
"I said, 'You have a lot to do to convince me that you're not a drug
dealer,' " Cole recalls. "But he did convince me. When he showed me a
picture of the brain and how it all worked, I began getting an open
mind about it."
Cole remembers Salerian telling him, "I'm going to win a Nobel Prize for this."
As the months passed, Salerian's waiting room saw fewer patients in
Rolexes and designer suits and more who looked like extras in some
modern Grapes of Wrath: coal dust under fingernails, hats bearing
Confederate flags. According to court papers, other tenants were soon
complaining to the landlord about "the traffic of dirty unkempt
people."
Veteran staff bolted, and his office became a kind of hall of mirrors.
Salerian hired one of his sons as a clinical director and another as a
medical technician. He rated patients on a Salerian Pain Score,
Salerian Mood Score, and Salerian Attention Measure. Though people
came to him for physical pain as well as emotional distress, "there
wasn't a blood-pressure cuff or a stethoscope in the entire office," a
former employee says.
Salerian hired a bodyguard and, according to court records, ordered a
strip search of a patient he thought was a police informant. By 2012,
his fee for an initial "pain management" consultation had risen to
$1,200, from $350 in 2010.
The front-desk staff soon asked patients to sign a new form. "I am not
an undercover agent," it began, before warning that anyone who tattled
to authorities risked "serious consequences to [their] health."
Seven hours to the south and west, Sheriff C. Ray Foster and Buchanan
County's chief prosecutor, Tamara Neo-along with state and federal
law-enforcement officials-were building what they hoped would be a
bulletproof criminal case.
A police informant showed up at Salerian's office with a healthy MRI
and records from a previous doctor who thought he needed nothing more
than over-the-counter painkillers and exercise; the informant walked
out with a prescription for 210 tablets of oxycodone, 90 of methadone,
and 90 of Adderall, a stimulant, according to court records. The next
month, when he wanted refills, the informant didn't even have to come
in. A request was phoned in to the office, and two days later UPS
delivered the prescriptions to the informant's doorstep in
southwestern Virginia, in an envelope bearing the slogan "The Art and
Science of Healing."
The DEA, meanwhile, heard from a Rockville pharmacist who'd stopped
filling Salerian's prescriptions. The final straw for the pharmacist
was the parade of patients with Tennessee ID cards who visited five
minutes apart, each bearing a Salerian script written the same day.
Investigators discovered that Salerian had been prescribing more than
800 pills a month to four members of a major western Virginia
drug-trafficking ring, according to court records. There was also a
Buchanan County man, Brian Justice, who "was working with his mother,
apparently, and his sister," a prosecutor said at a hearing. "Other
people were engaged to go as girlfriends down to see the doctor, and
they were actively recruiting-this was a thriving business, sort of
like Mary Kay."
Last April, a federal grand jury in southwestern Virginia indicted
Salerian on 36 felony drug counts. Two months later, it added over 100
more. The doctor now faces one count of conspiring to unlawfully
distribute controlled substances and 143 for unlawful distribution-in
many instances, to people in and around Buchanan County. If convicted
at a trial set to begin February 10, Salerian could spend the rest of
his life in prison.
The end can't come soon enough for police in southwestern Virginia. In
Sheriff Foster's office last summer, I asked two of his plainclothes
drug investigators where Salerian had ranked among doctors writing
scripts to county residents. "Number one," came the reply. "The
majority of the medication coming into this county was written by
him."
Salerian denies any wrongdoing. His lawyers paint him as a pioneering
pharmacologist whose clinic bore no signs of a profiteering pill mill.
"Unlike other doctors actually convicted of similar charges," they
wrote in a statement, "Dr. Salerian established a doctor-patient
relationship with each of his patients. He did not receive kickbacks
in exchange for prescribing medication. He never led an extravagant
lifestyle. He never treated phantom patients."
For Salerian, though, the ultimate indignity came in June of last
year, when the DC medical board finally acted. The board, composed
mostly of fellow doctors, voted unanimously to revoke Salerian's
medical license. Salerian, trailed by his family, stormed out of the
hearing room. One of his sons wiped away tears.
I walked out with Paddy's father, Steven Kennedy. On the plaza outside
the health department, Salerian, shaking with rage, pointed at
Kennedy. "Child molester!" he bellowed. "Child molester!"
As bystanders looked on stunned, Salerian's family tried to move him
away. But he wouldn't back down. "Child molester is here!" Salerian
sputtered. Finally, one of his sons managed to lead him up the steps
to North Capitol Street.
I caught up and asked Salerian for a response to his professional
defrocking. "The Vatican was unanimous when they said the world was
flat," Salerian said. "Remember Galileo."
Alen Salerian lives with his wife on a wooded lot in Bethesda. I
visited a week before he lost his license, and he answered the door
unsmilingly, with the darting eyes of a hunted man.
He's free on $100,000 bond until his trial. But a judge confiscated
his passport and restricted his travel to Maryland and DC. Salerian
has filed for personal bankruptcy and owes his twin brother at least
$1.9 million, much of it for legal fees. In addition to preparing his
defense, his lawyers are fighting to reinstate his medical license.
Experts they've hired will argue that something other than methadone
killed Paddy Kennedy.
In the first minutes of our four-hour interview, I felt as if I were
listening to the raw neural firings of a persecuted man, the ravings
that jangle in our brains but that we dare not give voice for fear of
being seen as unhinged. There were disjointed references to "the laws
of the universe and the jungle," "computers and nuclear bombs," and
"devastation with trickery." The shelves of a sunroom that had become
his makeshift office were lined with conspiracy books: Plausible
Denial, Rush to Judgment, Lessons in Disaster.
Salerian told me that a former employee whose depression he'd treated
with narcotics had family in Buchanan County, and that's how people
there discovered his practice. Prosecutors, he said, were reading too
much into the distance patients had traveled and the spike in his
fees. He charged many people on a sliding scale. There was no mystery
to his popularity: Southwestern Virginia is home to many "poor,
uneducated" people in injury-prone jobs like mining and trucking.
Overzealous DEA crackdowns, Salerian said, had deterred all but the
noblest doctors from prescribing the painkillers patients desperately
needed.
Some of Salerian's friends and longtime patients told me they worried
Salerian had himself succumbed to dangerously "narcissistic" and
"grandiose" delusions. The doctor needed professional help, they said,
not prison.
When he and I spoke again last fall, I asked if it was possible he was ill.
Salerian told me he'd been diagnosed in the 1980s with anxiety and
ADHD, for which his psychiatrist still prescribes Prozac and Adderall.
But he rejects the idea, proposed to him by colleagues over the years,
that he also suffers from bipolar disorder, a more serious condition
in which people sometimes feel possessed of a kind of superhuman
invincibility. He said his colleagues, forgivably, had mistaken his
prodigious work habits, theatrical personality, and wide-ranging
artistic pursuits for a disorder.
"Show me another psychiatrist who has had the record I have," he said.
February 2014
The Spectacular Unraveling of Washington's Favorite Shrink Starring
Alen Salerian
By Ariel Sabar
About five years ago, C. Ray Foster, the sheriff of Buchanan County,
Virginia, noticed the name of an unfamiliar doctor on the pill bottles
turning up at drug busts, overdoses, and DUIs. OxyContin and other
narcotic painkillers feed an epidemic of crime and addiction as
insidious in this Appalachian outpost as the kudzu astride the Levisa
Fork River. But this prescriber's name-Alen Salerian-was an enigma.
The man wasn't a pain specialist but a psychiatrist, a doctor trained
to treat mental illness. And his office was 400 miles north, in one of
Washington's wealthiest neighborhoods.
"I came out of there with 450 roxy 30s, 450 methadone 10s, Adderall
and Xanax," someone calling himself "Crazy" wrote online about his
first visit to Salerian, the popular subject of nearly 500 posts in a
Buchanan County web forum. "My sister went the same day and got the
same thing. . . . At one time 5 of us rode together and he made our
appointments back to back . . . . I don't know how in the world we
made it home we would be so messed up."
The question Foster kept asking himself was why people in his
impoverished county were driving up to eight hours each way-sometimes
in caravans and carpools-to see a psychiatrist, one who didn't even
take insurance.
Salerian's colleagues back in Washington would have been just as
bewildered. Salerian, now 66, was once chief psychiatrist to the FBI's
employee-assistance program, traveling the world to minister to
troubled agents. He taught at George Washington University, published
in medical journals, wrote op-eds for theWashington Post.
His private practice, steps from the Neiman Marcus in DC's Friendship
Heights, was a world away from the troubles of Buchanan (pronounced
"buck-cannon") County, a once-booming coalfield at Virginia's border
with Kentucky and West Virginia that's now one of the poorest and most
isolated places in the state.
To get there from Washington this past September, I drove for hours
down interstates 66 and 81, up through tunnels bored into mountains,
and over the Trail of the Lonesome Pine. Finally, the road tucked into
valleys so vertiginous that for much of the day the hills were
shrouded in shadow.
Sheriff Foster-a wry lawman with a silver mustache and a reputation
for candor-was at his desk, picking at a breakfast of biscuits and
gravy in a Styrofoam clamshell, when I entered. "I'm an old fat man,"
he quipped when asked his age.
But when I mentioned Salerian, Foster grew serious, turning off the
air conditioner and dialing up his hearing aid. Buchanan County
residents die of prescription-painkiller overdoses at more than five
times the statewide rate, and Foster held the psychiatrist at least
partly responsible. His pills had shown up at drug scenes across the
county and in the homes of families so lost to addiction that the
state had to take custody of children.
"I've never met him, but I've met a lot of his work," Foster said.
"His clientele has become my clientele"-by which he meant denizens of
the county lockup.
The giant doses Salerian was prescribing to young, seemingly healthy
people in the county where Foster had grown up didn't make sense. "Why
would a 20-year-old feller take five Oxys a day?" he asked. "Why would
you prescribe that to a 20-year-old that has not got cancer, has not
got no fatal disease, has got no chronic pain?"
A visitor to Alen Salerian's office in the 1980s and '90s would have
encountered one of the most glittering waiting rooms in Washington.
Middle Eastern royals, Hollywood actors, and heiresses were all under
his care, as were a general and a senator turned presidential
candidate. Many patients felt he was the first doctor to really
understand their suffering: "the one person I trusted," local author
Gail Griffith said in a memoir.
Though just five-foot-seven, Salerian had a way of filling a room. He
was garrulous, with an exotic accent and boisterous charm, and he
loved the limelight. He had wrangled a gig as an on-air commentator
for Channel 9, Washington's CBS affiliate, and was sought out for his
expertise by TV programs such as 48 Hours.
It was a remarkable ascent for a man who'd landed in the US from
Istanbul in 1971 with no connections beyond a letter admitting him to
a medical internship. Salerian's father, a successful engineer, and
mother, a noted painter, had sent him and his identical-twin brother
to America because they saw no future for Christian Armenians like
them in Turkey. Alen's brother, Nansen Saleri, now a Houston oil
executive, calls himself the ace student and "conformist one." Alen
was more like his mother, a social butterfly with artistic impulses
who sometimes skipped school to be with friends.
No one was surprised when he declared an interest in psychiatry. "He
wanted to be around people," Nansen says; among all the medical
specialties, "it would allow him more of an emotional relationship
with patients."
Salerian's supervisors at George Washington University, where he
completed his psychiatry training, named Salerian chief resident and
hired him as an assistant clinical professor right after his training
ended in 1976. He was no less a hit at Metropolitan Psychiatric Group,
one of the nation's largest group mental-health practices. Salerian
drew so much business to its DC and Rockville offices that the group
made him partner after just two years.
Soon after a Pennsylvania company acquired the group in 1994, Salerian
took a $1.5-million payout and started his own practice on the ground
floor of the Psychiatric Institute of Washington, a Wisconsin Avenue
hospital that eventually named him associate medical director.
It was a heady time. Pharmaceutical companies were so taken by the
doctor's social dexterity that they paid him tens of thousands of
dollars a year to host dinners introducing colleagues to new drugs.
He'd also landed a glamorous five-year contract with the FBI's
employee-assistance program, which wanted him to find help for agents
wrestling with alcoholism, family strife, and other personal issues.
Salerian, a married father of four, had always liked difficult cases:
patients whose depression responded to none of the usual treatments,
manic-depressives who'd sooner live on the streets than take their
meds. At the FBI, he cracked his toughest case yet: getting hardened
agents to confide in a shrink.
Chuck McCormick, a former FBI agent who led the assistance program in
the 1990s, says he could call day or night and Salerian would get on
the next plane to anywhere in the world-domestic FBI offices, overseas
embassies. "We saved lives, salvaged careers," McCormick says. "We
kept families together. We prevented divorces. He was a godsend."
A few years into the contract, however, Salerian had a falling-out
with the agency over what he construed as a supervisor's racist remark
about his olive-toned skin. "I used every F-word," Salerian recalls of
his response. McCormick says he remembers no such incident. All the
same, the bureau decided to shift its program in-house after
Salerian's contract was up in 1997-a parting that would come to haunt
the FBI and the doctor both.
In February 2001, a veteran FBI spy catcher, Robert Hanssen, was
arrested in the gravest security breach in the bureau's history: The
mild-seeming Virginia man, it turned out, was a double agent who had
been selling US secrets to the Russians for more than two decades.
In his former employer's humiliation, Salerian glimpsed opportunity.
He had been trying for years to write opinion pieces for major
newspapers, with scant success (despite the help of publicists). Three
weeks after Hanssen's arrest, Salerian got his big break: ThePost
published his long op-ed flogging the FBI for not subjecting agents to
routine mental-health checks.
The piece read like a John Grisham thriller, with Salerian as its
dashing lead, a troubleshooter who'd saved the agency from untold
numbers of overstressed G-men who might well have become other
Hanssens.
He made no mention of his falling-out with the FBI. Nor did he
disclose that he was just then auditioning for a starring role with
Hanssen's defense team.
Salerian had recently offered his services to Plato Cacheris,
Hanssen's court-appointed lawyer. Cacheris was the go-to attorney for
defendants in the inner circles of Washington power: Aldrich Ames,
Monica Lewinsky, and John Mitchell, of Watergate notoriety, had all
been clients.
Cacheris hadn't envisioned a psychiatric defense. "On the other hand,"
he says, "if a psychiatrist could say something helpful, if not
exonerating, we might need it.
"I figured if the FBI used him, he must be okay."
Over the course of seven jailhouse meetings, Salerian got Hanssen, a
shy and socially awkward man, to confide his most humiliating personal
secrets: his father's physical abuse, his sexual obsessions, the
hidden camera Hanssen had installed in the bedroom he shared with his
wife so a friend could watch their lovemaking.
Privacy laws and professional ethics hold both lawyers and doctors to
strict client/patient confidentiality. Federal rules for high-risk
detainees like Hanssen set an even higher bar: Disclosures to possible
witnesses or codefendants, such as a suspect's wife, are verboten. Yet
despite Cacheris's explicit orders, Salerian went to Hanssen's wife,
Bonnie, with details of her husband's betrayals, then lobbied her for
permission to speak to the press.
When she refused, Salerian did it anyway, telling BBC reporters about
his jailhouse conversations with Hanssen. He even offered to take a
photo of Hanssen to sell to the media.
Shocked, Cacheris summoned Salerian to his office in May 2001 and
fired him. He warned the doctor to say no more to anyone about the
case. His client, after all, was facing the death penalty.
But Salerian had other priorities.
Over the next few months, he gave on-the-record interviews to CBS
News, the Post, the Sunday Timesof London, and many others. He
portrayed himself as a prophetic doctor who could have seen the
warning signs the FBI and the Catholic Church had missed (Hanssen had
confessed to a priest) and who owed America the truth.
"His espionage was an escape from his sexual demons," Salerian told
Lesley Stahl on 60 Minutes. "When he found himself in exciting and
dangerous positions, such as espionage and spying, he found that his
demons slowed down, they calmed down."
Salerian sold the option rights to his story to author Norman Mailer
and film producer Lawrence Schiller, who took him to a boozy dinner at
Old Angler's Inn in Potomac. Though they never portrayed him in their
book and TV movie about Hanssen, the voluble doctor appears to have
held nothing back: Mailer's interview transcripts with Salerian span
some 500 pages.
When the rare reporter questioned whether Salerian's dismissal from
the defense affected his credibility, the doctor suggested he answered
to a higher code: He knew better than the lawyers or the guardians of
medical ethics what was good for Hanssen and society. "I have
100-percent moral and psychological authority," Salerian said.
Others saw another motive. Cacheris had decided to seek a plea deal
sparing Hanssen's life, and for Salerian that meant one thing: no
chance to be the star expert in a trial with headlines the world over.
"He told people he was hoping I wouldn't settle the case and deprive
him of the opportunity" to testify, Cacheris says.
Weeks after a plea deal was reached, Salerian argued that the
opprobrium heaped on him by fellow psychiatrists proved that it was
they-not he-who had failed the mentally ill. "The biases against
psychiatric disorders and mental illnesses will only go away if we
confront them," he wrote in USA Today. "So far, no one is brave enough
to go up against them-not the church, not the FBI, not even the mental
health profession itself."
No one, that is, but him.
Many colleagues struggled to square the brazenness of Salerian's
conduct with the thoughtful physician they thought they knew. But
clues to another side of the doctor-explosive, attention-craving,
defiant-were hidden in plain sight.
In his first year as a resident at GW, Salerian openly mocked a
renowned expert on narcissism, who later bristled to the program
director, "Where do you get your residents?"
At the Metropolitan Psychiatric Group, Salerian needled what he called
his "lily-white colleagues" by treating psychotics, schizophrenics,
blacks, and the poor-people who deviated from the stock clientele of
affluent women suffering what he dismissively dubbed "Bethesda Wife
Syndrome."
The board exams in psychiatry are a mark of professional distinction.
But Salerian failed them and never tried again: "I began disagreeing
with psychiatry," at least as currently practiced, he says. "It slowly
began occurring to me how different my thinking was."
Salerian saw his reputation for controversy as the calling card of an
original mind. He sought patients whom other colleagues couldn't
handle or wouldn't touch, then gave them treatments other doctors
wouldn't. In the 1980s and early '90s, when most psychiatrists were
still analyzing patients on couches, he began prescribing newly
approved drugs in unorthodox combinations, in search of experimental,
"off label" treatments, sometimes for conditions outside his field.
His willingness, even eagerness, to prescribe exotic drug cocktails
endeared him to many patients, particularly those in the grips of
despair. A Chevy Chase woman whose brother is bipolar says they'd
visited specialists in DC and New York before a doctor referred them
to Salerian in 2000. For years, her brother refused pills that doctors
said he needed to get better. Salerian was the first to break through.
He patiently explained how the brain worked, never charging for the
extra time, and drew sketches showing how pills helped. "From our
family's perspective," she says, "Dr. Salerian saved a life."
But his pharmaceutical cocktails made even his admirers nervous. "They
were very unusual combinations of medications," says Carl Gray, a
Rockville psychiatrist who sent Salerian some of his toughest
patients.
Laurence Greenwood, a psychiatrist in Prince George's County,
remembers seeking out Salerian for advice about a relative with
intractable schizophrenia. Salerian suggested the stimulant Ritalin,
an ADHD drug traditionally thought to aggravate psychosis. The
relative's doctor balked: He wasn't comfortable turning his patient
into a test subject. "Nor would I have been as a doctor, because as a
doctor I'm being cautious," Greenwood says. "But as a patient, a
family member, where the quality of life of a whole family is being
severely disturbed by the patient's suffering, it would be a very
reasonable thing to try. In a sense, I wish I had Alen's courage."
Bernard Vittone, who directs a prominent mental-health clinic in DC's
Foggy Bottom and has known Salerian for decades, puts it another way:
"He has some traits you could view as being admirable or very
reckless."
After the Hanssen affair, George Washington University cut Salerian
loose and the Psychiatric Institute declined to renew his hospital
privileges. He and the drug companies whose pills he promoted parted
ways.
The Maryland medical board issued an excoriating ruling that accused
Salerian of "gross" ethics violations in the Hanssen case. The doctor,
the board wrote, seemed to have "a perception of self so grandiose as
to raise concerns about his judgment." Remarkably, the Maryland and DC
medical boards let Salerian off with a reprimand and fines of just
$8,500.
The ruling barely broke his stride. Salerian remained a regular on
Channel 9 and kept up a busy practice, where patients who remembered
his TV appearances now felt they were in the hands of a highly
sought-after psychiatrist.
But things were getting strange. In 2003, Salerian self-published a
glossy book of cartoons called Honest Moments With Dr. Shrink. Though
pitched as a satire of psychiatry, the cartoons-pastel-crayon doodles
that call to mind a grade-school art fair-were at best cryptic, at
worst racially charged and sexually vulgar. "Doc, please help me find
my G spot," a woman shaped like an eel says on the first page. "Who
saw it last?" says Dr. Shrink, who's drawn in the shape of a
refrigerator.
Honest Moments was followed by a Salerian line of vitamins. Then came
a deepening preoccupation with John F. Kennedy's assassination,
research trips to Dealey Plaza, and a torrent of more than 200
JFK-inspired paintings that he exhibited in Dallas and DC.
Salerian found another canvas for his creative impulses on the lawn
outside his office. Pronouncing the landlord's landscaping "bland," he
turned the empty sod into a statue garden, complete with a rooster
figurine, a fountain ringed by 24 lion heads, and a giraffe he named
after his son Justin. He told the Washington City Paper at the time
that the installation was a whimsical welcome mat meant to "make
neuropsychiatry accessible."
Inside Salerian's office, however, some longtime patients felt
unsettled. A Maryland woman recalled her unease when a large oil
painting depicting a nude couple in the throes of coitus went up in
the waiting room. Once-brisk appointments turned into drawn-out bull
sessions about the doctor's art and his latest JFK findings. "When you
went to see Dr. Salerian, you took the whole day off," one patient
says.
The most extraordinary shifts were inside the exam room. A growing
number of patients were traveling great distances for another new
sideline: addictive narcotic painkillers such as OxyContin, methadone,
and Fentanyl.
The doctor appears to have embraced the drugs soon after Cacheris
fired him from the Hanssen case and just as the first major news
stories about OxyContin's dark side broke. The pill, approved by the
Food and Drug Administration in 1995, was the first made of pure
oxycodone, a powerful derivative of the opium poppy. It was formulated
to dissolve in the body over 12 hours, but people found they could
ingest the oxycodone all at once by crushing the pill and then
snorting or injecting it. The euphoria gave the drug street value and
the nickname "hillbilly heroin."
Narcotic painkillers, typically prescribed to cancer patients and
others in severe physical pain, have no FDA-approved psychiatric uses.
But Salerian wanted to blaze a new frontier. "I have prescribed
OxyContin to more than 200 of my patients, and none of them has become
addicted," he boasted in a 2002 op-ed in theIndianapolis Star. He said
he'd used the drugs to treat not just physical pain but also
depression.
It had been at least a half century since doctors had tried anything
of the kind. Though physicians in the 1800s had given opium
derivatives such as morphine to people with "melancholia" and other
ailments, by the 1950s scientists had produced the first class of
modern antidepressants. They were more effective and had fewer side
effects than opiates and were not addictive. To tout opiates for
depression now would be somewhat like prescribing arsenic and mercury
for syphilis, decades after the invention of penicillin.
Salerian's faith in the power of painkillers springs from something he
calls the Salerian Theory of Brain. This "new paradigm," he wrote in a
non-peer-reviewed medical journal, would do to the foundations of
modern psychiatry what Galileo did to "Ptolemaic assumptions about the
celestial movements."
The theory's narcotics bit goes something like this: Endorphins, our
bodies' natural opiates, are necessary for healthy brain chemistry and
good mood. People with too few endorphins-a group that in Salerian's
view includes drug addicts-can get right, he believes, by taking
super-sized doses of manmade opiates like OxyContin.
As his colleague Bernard Vittone put it, Salerian was "operating in
universes I've never even seen."
Yet the doctor had nearly absolute faith in his patients. Though he
often prescribed OxyContin at three times the recommended doses, he
refused to subject patients to common safeguards against abuse and
dealing. "Any doctor who creates these monkey, Mickey Mouse forms and
forces you to give drug urines," he told an internet radio show, "is
actually raping Hippocrates."
The test subject for his opiate cure, Salerian says, was a severely
depressed, drug-addicted railroad worker named Paul. Over a series of
hospitalizations in the mid-1980s, Salerian used conventional methods
to wean Paul off an addiction to Fiorinal, a non-opioid painkiller and
muscle relaxant.
But in the 1990s, after traditional depression treatments failed,
Salerian says he ceded to Paul's request for Percocet, a narcotic
painkiller. Salerian rhapsodized about the results. Though forced into
a disability retirement, Paul discovered true pleasure in a new car
and in vacations with his wife, Salerian insists. (Paul's wife
disputes Salerian's account.) All the same, in the spring of 2001,
Salerian added another pill to Paul's drug cocktail: OxyContin. The
next year, another: Fiorinal, the very drug Salerian had detoxed Paul
from a decade and a half earlier. Paul grew addicted again, this time
to the active ingredient in OxyContin. In 2004, his wife filed a
complaint with the DC medical board about Salerian's narcotics
experiments, but it didn't do her any good. She became a widow in
2005, when Paul bled to death from an undiagnosed intestinal ulcer.
Four years later, in January 2009, the DC medical board said there
wasn't sufficient evidence of misconduct and dismissed the case.
Salerian, who spent $750,000 on an elaborate defense, says he took the
ruling as both exoneration and endorsement. He changed the name of his
practice to the Salerian Center for Neuroscience and Pain and felt
that his scientific revolution was finally under way. "It was a
dream," he said later. "My march began."
By February 2010, another patient was dead.
Patrick Kennedy-or Paddy, as his family called him-was a quiet but
playful kid who began taking illegal drugs his sophomore year at
Bethesda-Chevy Chase High School. In college he grew depressed and
worried he might be succumbing, as had his mother, to schizophrenia.
His elder brother took Paddy, then 20, to see Salerian, with whom
their family had had good experiences in the past. Salerian gave Paddy
an on-the-spot diagnosis of obsessive-compulsive disorder,
attention-deficit disorder, and phobia-and a prescription for
methadone, a narcotic approved only for chronic physical pain and for
heroin maintenance and detox therapy.
Because it can slow breathing, the medical rule of thumb for methadone
is start low, go slow. Salerian wrote Paddy a dose above the
manufacturer's guidelines, believing it would boost his dopamine, a
neurotransmitter that helps regulate motivation and pleasure-seeking.
The day he took his first pill, Paddy sent his family an effusive
e-mail. "Dr. Salerian has given me new hope," he wrote.
Two days later, his father, Steven Kennedy, an editorial consultant,
cooked a dinner of beef-and-barley soup and settled onto the couch
with his son for an episode of House, the TV drama about a drug-addled
doctor with a genius for diagnosis. Before the show was over, Paddy
complained about his vision. "My eyes feel out of focus, Dad," he said
and went to bed.
When Paddy was still in bed at 11 the next morning, his father went in
and found his son's body pale and rigid. Blood had pooled in purple
blotches under his skin, a sign he'd probably been dead for hours.
Detectives counted the remaining methadone pills: There was no
indication he'd taken more than prescribed. The Virginia medical
examiner ruled the death an accidental overdose.
On the morning of March 3, 2011, teams of gun-toting DEA agents in
black jumpsuits raided Salerian's home. They handcuffed Salerian's
wife and the two adult children at home. (His wife told me she was so
traumatized that she soiled herself.) Salerian arrived at his practice
to find it commandeered by agents, who spent the day searching his
computers, files, and financial records. Under civil-forfeiture laws,
which don't require criminal charges, the agents also seized three
cars and the cash in three bank accounts.
Salerian responded by appointing himself leader of a global movement
to end discrimination against pain sufferers. The curtain raiser was
to be a giant civil-rights-style demonstration-Festival Pain Brain-in
the fall of 2011 at the Lincoln Memorial. Salerian hired an
advertising firm to mount a publicity campaign and to e-mail
invitations to 40,000 medical students. He promised a guest appearance
by country star Blake Shelton, an onslaught of 20,000 protesters, and
the freeing of thousands of butterflies. Actual turnout: perhaps two
to three dozen. There was no Shelton (who'd never agreed to come).
There weren't even butterflies.
Convinced of sabotage, Salerian made a defiant trip three months later
to southwestern Virginia, where he'd heard that his long-distance
patients were being harassed by police. He had persuaded a Buchanan
County newspaper, theVoice, to host a public forum to take on critics.
The paper's publisher, Earl Cole, told me the issue was personal: His
painkiller-addicted son had committed suicide in 2007, and his
21-year-old grandson was high on pills a year later when he lost
control of his car and died in a head-on crash with a tractor-trailer.
"I said, 'You have a lot to do to convince me that you're not a drug
dealer,' " Cole recalls. "But he did convince me. When he showed me a
picture of the brain and how it all worked, I began getting an open
mind about it."
Cole remembers Salerian telling him, "I'm going to win a Nobel Prize for this."
As the months passed, Salerian's waiting room saw fewer patients in
Rolexes and designer suits and more who looked like extras in some
modern Grapes of Wrath: coal dust under fingernails, hats bearing
Confederate flags. According to court papers, other tenants were soon
complaining to the landlord about "the traffic of dirty unkempt
people."
Veteran staff bolted, and his office became a kind of hall of mirrors.
Salerian hired one of his sons as a clinical director and another as a
medical technician. He rated patients on a Salerian Pain Score,
Salerian Mood Score, and Salerian Attention Measure. Though people
came to him for physical pain as well as emotional distress, "there
wasn't a blood-pressure cuff or a stethoscope in the entire office," a
former employee says.
Salerian hired a bodyguard and, according to court records, ordered a
strip search of a patient he thought was a police informant. By 2012,
his fee for an initial "pain management" consultation had risen to
$1,200, from $350 in 2010.
The front-desk staff soon asked patients to sign a new form. "I am not
an undercover agent," it began, before warning that anyone who tattled
to authorities risked "serious consequences to [their] health."
Seven hours to the south and west, Sheriff C. Ray Foster and Buchanan
County's chief prosecutor, Tamara Neo-along with state and federal
law-enforcement officials-were building what they hoped would be a
bulletproof criminal case.
A police informant showed up at Salerian's office with a healthy MRI
and records from a previous doctor who thought he needed nothing more
than over-the-counter painkillers and exercise; the informant walked
out with a prescription for 210 tablets of oxycodone, 90 of methadone,
and 90 of Adderall, a stimulant, according to court records. The next
month, when he wanted refills, the informant didn't even have to come
in. A request was phoned in to the office, and two days later UPS
delivered the prescriptions to the informant's doorstep in
southwestern Virginia, in an envelope bearing the slogan "The Art and
Science of Healing."
The DEA, meanwhile, heard from a Rockville pharmacist who'd stopped
filling Salerian's prescriptions. The final straw for the pharmacist
was the parade of patients with Tennessee ID cards who visited five
minutes apart, each bearing a Salerian script written the same day.
Investigators discovered that Salerian had been prescribing more than
800 pills a month to four members of a major western Virginia
drug-trafficking ring, according to court records. There was also a
Buchanan County man, Brian Justice, who "was working with his mother,
apparently, and his sister," a prosecutor said at a hearing. "Other
people were engaged to go as girlfriends down to see the doctor, and
they were actively recruiting-this was a thriving business, sort of
like Mary Kay."
Last April, a federal grand jury in southwestern Virginia indicted
Salerian on 36 felony drug counts. Two months later, it added over 100
more. The doctor now faces one count of conspiring to unlawfully
distribute controlled substances and 143 for unlawful distribution-in
many instances, to people in and around Buchanan County. If convicted
at a trial set to begin February 10, Salerian could spend the rest of
his life in prison.
The end can't come soon enough for police in southwestern Virginia. In
Sheriff Foster's office last summer, I asked two of his plainclothes
drug investigators where Salerian had ranked among doctors writing
scripts to county residents. "Number one," came the reply. "The
majority of the medication coming into this county was written by
him."
Salerian denies any wrongdoing. His lawyers paint him as a pioneering
pharmacologist whose clinic bore no signs of a profiteering pill mill.
"Unlike other doctors actually convicted of similar charges," they
wrote in a statement, "Dr. Salerian established a doctor-patient
relationship with each of his patients. He did not receive kickbacks
in exchange for prescribing medication. He never led an extravagant
lifestyle. He never treated phantom patients."
For Salerian, though, the ultimate indignity came in June of last
year, when the DC medical board finally acted. The board, composed
mostly of fellow doctors, voted unanimously to revoke Salerian's
medical license. Salerian, trailed by his family, stormed out of the
hearing room. One of his sons wiped away tears.
I walked out with Paddy's father, Steven Kennedy. On the plaza outside
the health department, Salerian, shaking with rage, pointed at
Kennedy. "Child molester!" he bellowed. "Child molester!"
As bystanders looked on stunned, Salerian's family tried to move him
away. But he wouldn't back down. "Child molester is here!" Salerian
sputtered. Finally, one of his sons managed to lead him up the steps
to North Capitol Street.
I caught up and asked Salerian for a response to his professional
defrocking. "The Vatican was unanimous when they said the world was
flat," Salerian said. "Remember Galileo."
Alen Salerian lives with his wife on a wooded lot in Bethesda. I
visited a week before he lost his license, and he answered the door
unsmilingly, with the darting eyes of a hunted man.
He's free on $100,000 bond until his trial. But a judge confiscated
his passport and restricted his travel to Maryland and DC. Salerian
has filed for personal bankruptcy and owes his twin brother at least
$1.9 million, much of it for legal fees. In addition to preparing his
defense, his lawyers are fighting to reinstate his medical license.
Experts they've hired will argue that something other than methadone
killed Paddy Kennedy.
In the first minutes of our four-hour interview, I felt as if I were
listening to the raw neural firings of a persecuted man, the ravings
that jangle in our brains but that we dare not give voice for fear of
being seen as unhinged. There were disjointed references to "the laws
of the universe and the jungle," "computers and nuclear bombs," and
"devastation with trickery." The shelves of a sunroom that had become
his makeshift office were lined with conspiracy books: Plausible
Denial, Rush to Judgment, Lessons in Disaster.
Salerian told me that a former employee whose depression he'd treated
with narcotics had family in Buchanan County, and that's how people
there discovered his practice. Prosecutors, he said, were reading too
much into the distance patients had traveled and the spike in his
fees. He charged many people on a sliding scale. There was no mystery
to his popularity: Southwestern Virginia is home to many "poor,
uneducated" people in injury-prone jobs like mining and trucking.
Overzealous DEA crackdowns, Salerian said, had deterred all but the
noblest doctors from prescribing the painkillers patients desperately
needed.
Some of Salerian's friends and longtime patients told me they worried
Salerian had himself succumbed to dangerously "narcissistic" and
"grandiose" delusions. The doctor needed professional help, they said,
not prison.
When he and I spoke again last fall, I asked if it was possible he was ill.
Salerian told me he'd been diagnosed in the 1980s with anxiety and
ADHD, for which his psychiatrist still prescribes Prozac and Adderall.
But he rejects the idea, proposed to him by colleagues over the years,
that he also suffers from bipolar disorder, a more serious condition
in which people sometimes feel possessed of a kind of superhuman
invincibility. He said his colleagues, forgivably, had mistaken his
prodigious work habits, theatrical personality, and wide-ranging
artistic pursuits for a disorder.
"Show me another psychiatrist who has had the record I have," he said.