Pharmacy in suit files for bankruptcy
County’s litigation targets Trinity along with major retailers for amount of opioids dispensed
About a year and half ago, a small San Antonio pharmacy found itself in Bexar County’s crosshairs, targeted because of the huge amount of pain pills it dispensed.
A lawyer for the county dubbed it a “pill mill.”
So Trinity Pharmacies LLC was added to a 2018 lawsuit targeting drug manufacturers, a distributor and various retailers that officials said were fueling the opioid addiction crisis sweeping the San Antonio area.
The litigation — in which Trinity is charged alongside retail giants such as CVS, Walgreens and Walmart — became too costly for Trinity. So, on Feb. 4, it sought Chapter 11 bankruptcy protection.
“It can’t, your honor, sustain the litigation costs,” Trinity lawyer H. Anthony Hervol told Chief U.S. Bankruptcy Court Craig Gargotta during a hearing Wednesday. The pharmacy has racked up more than $40,000 in legal fees defending itself in the massive multi-district litigation that’s unfolding in Harris County District Court.
The bankruptcy puts the county’s lawsuit against Trinity on hold. But the filing under a subchapter of the bankruptcy code designed for small-business debtors is part of a larger legal strategy its owners hope will eventually do away with the causes of action against it. The county’s claims against Trinity and other retailers include: negligent and/or intentional creation of a public nuisance; common law fraud; and civil conspiracy.
The county seeks to recover from defendants its costs associated with the opioid epidemic and punitive damages.
Based on findings from a Drug Enforcement Administration database, Trinity ranked second among more than 328 pharmacies in Bexar County by the amount of opioids it dispensed.
The data shows it received
8,077,200 prescription pain pills from distributors from 2006 to 2019. Only the H-E-B Pharmacy at 3323 SE Military Drive received more in that time period — 8,134,260 pills. The Washington Post published the numbers after it and another newspaper waged a yearlong legal fight for access to the database, which the government and the drug industry fought to keep secret.
The Post reported that, in total, more than 623 million pills were distributed to Bexar County pharmacies in that time period — or about 26 pills for every county resident each year. That was on par with state and national averages, the newspaper found.
In its suit, Bexar County alleges that the huge number of pills received by Trinity shows it “engaged in diversion of opioids.” In other words, the county is alleging the pharmacy at 1162 E. Sonterra Blvd. dispensed powerful narcotics inappropriately or for nonmedical reasons.
Trinity, which also uses the name Sonterra Rx Pharmacy, says there’s a simple explanation for its high volume. It says in a bankruptcy court filing that 99% of the prescriptions it fills are for patients in hospice care. According to information on its website, it services more than 20 hospices in the San Antonio area but also delivers to patients at home. The aim of hospice providers is to make patients comfortable in their final days.
“As such, the prescriptions being filled are for an abnormally high percentage of pain management medications,” Trinity says.
It says it was added to the lawsuit “despite its single location, limited resources and the nature of patients which are the Debtor’s customers. The Debtor is a small independent pharmacy which cannot sustain protracted and expensive litigation despite having meritorious defenses to the claims asserted in the litigation.”
The pharmacy, which has 15 employees, says it filed bankruptcy “to prevent it from having to cease operations due to the inability to continue to finance the defense of the claims.”
A tax return filed in the case shows Trinity generated almost $2.8 million in sales in 2022. But after paying salaries, rent, taxes and other expenses it ended the year nearly $71,000 in the red. It listed assets and liabilities each in the range of $100,000 to $500,000.
The litigation
In the lawsuit originally filed in state District Court in San Antonio, Bexar County accused more than two dozen opioid manufacturers — including industry giants Purdue Pharma and Johnson & Johnson — of deceptive marketing practices, fraud, false representations and efforts to target vulnerable people. The county later added a drug distributor and various retailers as defendants.
The suit was combined with other complaints from around the state in multi-district litigation in Harris County to deal with numerous pretrial issues. The case will be returned to Bexar County for trial.
Some defendants have opted to settle rather than go to trial.
The county’s first amended complaint, which added Trinity as a defendant, is 132 pages. The pharmacy’s lawyers note that Trinity is only mentioned in three of the suit’s 441 paragraphs.
“We’re lumped into the litigation,” Hervol, the bankruptcy lawyer, said in court. “Can’t get out of it, absent some settlement that seems to be something the debtor couldn’t do.”
A lawyer for Bexar County pushed backed on the narrative that it’s wrongly pursuing Trinity.
“We wouldn’t sue Trinity if we didn’t feel like they were substantially responsible for causing harm in Bexar County,” said Tommy Fibich, a Houston trial lawyer representing the county. “I get their argument, ‘poor little me’ (in comparison) to Walgreens, CVS and others.” They don’t have the size of the others.
“But I think on a proportionate level, they’re just as responsible, they’re just as guilty,” he said.
Experts hired by Bexar County determined Trinity to be a pill mill, Fibich said.
Viagra, hydrocodone
Ronald Shaw, a San Antonio lawyer defending Trinity, said the numbers of pills dispensed by the pharmacy over the years “is not an indication that the drugs were abused.”
He added, “I know of no hospice patient undergoing end-of-life care that abuses the medication they’re receiving or somehow misuses, sells it on the street or does anything else that would ever result in any damage to Bexar County.”
Trinity’s owner and pharmacist was flagged by the state 20 years ago. Bexar County cited in its complaint a 2004 action by the Texas State Board of Pharmacy to suspend Trinity pharmacist and co-owner Larry Oliver for 30 days for “selling dangerous drugs pursuant to 1,364 prescriptions, internet connections and prescriptions not issued for legitimate purposes.”
Oliver’s suspension related to dispensing Viagra to people who got a prescription for the erectile dysfunction drug without having seen a doctor, Shaw said. He called it a “technical offense” that wouldn’t raise red flags today.
The DEA database shows that Trinity — particularly in 2013 and 2014 — dispensed a “tremendous amount” of the pain-medication hydrocodone, Fibich said.
Hydrocodone “is not a drug typically prescribed for palliative care” because it’s a “big pill and super sick people cannot swallow big ole pills,” he wrote in a follow-up email. “They need more liquid opioids that are injectable, patches, or other methods of delivery. Hydrocodone only goes up to 10 MME (morphine milligram equivalents). And usually palliative care patients need much stronger opioids like morphine.”
Legal strategy
Because Trinity’s bankruptcy puts its lawsuit on hold, Bexar County will have to decide if it wants to submit a “proof of claim” in the bankruptcy — a form that states how much a creditor is seeking to collect from a debtor.
Filing such a claim would give Bexar County a vote on Trinity’s plan of reorganization and a possible share in any distribution of the pharmacy’s bankruptcy estate. However, Trinity could object to it.
“So rather than take your chances in state court, you file bankruptcy to deal with this,” Gargotta, the bankruptcy judge, said in laying out Trinity’s legal strategy to its lawyer at Wednesday’s hearing. “You listed them as a creditor in the disputed amount, and then your hope is bankruptcy concludes, you’ll get a discharge of that debt, right? Hervol agreed. In bankruptcy, the court can grant a “discharge” that eliminates a debtor’s legal obligation to repay a debt. Creditors can object to a debtor seeking to discharge a debt, however.
Fibich said the county didn’t think much of Trinity’s strategy.
“The way we look at it is that Trinity wants to file bankruptcy instead of taking accountability for all the money they’ve made and all the harm they caused,” he said.