By WENDY HOLDREN
BECKLEY, W.Va. — During the second day of his criminal trial, after hearing testimony from the prosecution’s third witness, Dr. Michael Kostenko asked the court to accept a guilty plea to one of the 22 felony counts against him.
The third witness, Michael Kevin Meadows, a former patient, employee and friend of Kostenko’s, testified Tuesday that the doctor not only played a role in his oxycodone addiction, but also his cocaine addiction.
Kostenko, former owner and operator of Coal Country Clinic in Daniels, was charged with maintaining a drug-involved premises, 19 counts of distributing oxycodone not for legitimate medical purposes, and two counts of distribution resulting in the deaths of two patients.
Meadows discussed his personal drug use, as well as witnessing the doctor’s use of marijuana, oxycodone and cocaine.
At the conclusion of Meadows’ testimony, Kostenko indicated he wanted to plead guilty to Count 7 — distributing oxycodone not for legitimate medical purposes — a felony carrying up to 20 years imprisonment and up to a $1 million fine.
“Have you had a change of heart?” U.S. District Court Judge Irene C. Berger asked the 61-year-old doctor.
“Yes,” he responded. “I don’t think I’m popular enough to win. I don’t believe I’m going to prevail in this case.”
U.S. Assistant Attorney Miller Bushong asked for specific clarification, as Kostenko had initiated a plea deal previously, but backed out at the last minute.
Berger asked Kostenko if he wanted to plead guilty; he said, “Yes. I don’t believe I can communicate to this jury.”
The judge hesitated in her acceptance of Kostenko’s guilty plea, as he initially said he was dissatisfied with his legal representation. Kostenko called into question Meadows’ mental health and his attorneys’ failure to further cross examine him.
After his attorneys, Ward Morgan and Derrick Lefler, explained their defense strategy, Kostenko said he understood and was satisfied with their counsel.
When asked, ultimately, if he pleaded guilty, Kostenko stood, dressed all in black, with metal shackles around his waist and ankles, and took a deep breath.
“It is in my best interest to take the plea,” he said. As part of the plea deal, the remaining 21 charges were dismissed. Had Kostenko been convicted of distribution resulting in the death, he could have faced life in prison.
He turned to the back of the courtroom to look at his daughter, who was struggling to hold back tears. She smiled at her father and blew him a kiss.
Kostenko then told the judge the medical principles he practiced were “inappropriate” and were not approved by West Virginia guidelines.
Berger accepted his plea and scheduled sentencing on Aug. 23 at 10 a.m. in Beckley federal court.
• • •
During Meadows’ testimony, he said the first time he met Kostenko, through a mutual friend, they all smoked a joint together.
Their friendship continued and he became a patient of the doctor’s in 2005. He was seeking relief from painful kidney stones.
At first, Kostenko prescribed 5 milligram oxycodone, but Meadows’ pain did not subside. Two weeks later, the doctor increased the dosage to 15 milligrams.
“It helped the pain, but it also sped me up… it gave me energy.”
Although he took the medication as prescribed, he developed an addiction after three or four years. He began crushing and snorting the pills, as well as smoking the drug.
Shortly after becoming a patient, Meadows was also contracted by Kostenko to build a staircase. Meadows was hired for a variety of other odd jobs, too, such as lawn mowing and maintenance, and eventually procuring cocaine for the doctor.
“He asked me if I could get him some cocaine,” Meadows said, noting that the doctor’s money was used to purchase the drugs.
“I saw him use it. He told me it was low quality, and he told me to start checking it before buying.”
Meadows’ “quality checks” quickly escalated into addiction. He said Kostenko knew he was using, but the doctor continued to smoke marijuana with him and continued writing his oxycodone prescriptions.
Meadows said his prescription was increased to 30 milligrams on a few occasions, when the doctor would take some of Meadows’ 15 milligram pills for personal use.
“I would run out because he would ask me for pills because he had pain… He cut coke with oxy. He told me it was to keep him balanced out.”
Jurors also watched one of Kostenko’s 50-minute lectures, Class 8, which focused on sex and the brain’s pleasure centers. He referenced other classes focused on the seven deadly sins, as well as the importance of diet and exercise.
He told the group how all the elements work together in conjunction with their oxycodone prescription.
“If you’re just here for the drug, it’s not going to work,” Kostenko said. He also told his patients that sugar is the gateway drug to addiction in American culture.
Meadows, who once believed in the doctor’s medicine, told the jury, “In hindsight, it was bull****.”
• • •
During opening statements Monday morning, the prosecution portrayed Kostenko as part of southern West Virginia’s prescription drug epidemic.
Assistant Prosecutor Bushong pointed out on a single day in December 2013, Kostenko wrote 375 prescriptions — all without actually seeing the 271 patients — a total of more than 22,000 oxycodone pills and more than $20,000 collected in cash.
He highlighted one of the prosecution’s witnesses, Jennifer Justice, who did not get to testify because of the doctor’s unexpected plea agreement. Justice, her husband, her mother and her father, all traveled each month from Wyoming County to Coal Country Clinic to see Kostenko.
Bushong said the family got up around 4:30 a.m. that morning, traveled two hours on the winding mountain roads to Kostenko’s home, which also served as his clinic, where they filled out some paperwork, paid $120 each and listened to a 40- or 50-minute lecture with 20 to 30 other patients.
They all left with prescriptions for oxycodone. By noon, Bushong said their prescriptions would have been filled and the husband would have already crushed and snorted some of the pills. Other pills would be sold for $25 each to Hanover residents.
The prosecution said at Coal Country Clinic, there was no patient/doctor confidentiality, no individual treatment plans, no non-narcotic treatment plans, no discussion of physical therapy or alternatives to painkillers, nor did the doctor consult with the patients’ other medical caregivers.
The defense refuted the claims Kostenko’s practice was a “pill mill.” Lefler said although the doctor’s practice was different, it was not unlawful.
He described the doctor’s medical practice as self-management based and holistic, focusing on the entire body. He said many of Kostenko’s patients had already tried alternative treatments and therapies — these folks were just trying to manage their pain-filled lives.
Bushong did not offer a comment about the outcome Tuesday, but U.S. Attorney Carol Casto issued the following statement in a release: “West Virginia is at the epicenter of a drug crisis that is ravaging our state and has left us with the highest overdose rate in the nation. Doctors are entrusted with prescribing authority in order to heal and protect patients, not betray that trust by contributing to prescription drug addiction.”
Defense attorney Morgan told a group of reporters after the hearing, “We knew from the outset it was going to be a difficult case given the popular conceptions. We knew it would be an uphill battle. After the first days of the trial, that has been apparent.”
Lefler said their client’s decision was a prudent one.
“His heart was in the right place,” Lefler said of Kostenko’s medical practice. “I think he genuinely tried to help people.”
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