The unethical downfall of Dr. Jerrold Rosenberg is about to hit rock bottom in just a few days. He already knows he could be facing up to 15 years in prison, that he must pay nearly $755,000 in fines and that he is no longer permitted to practice medicine in the State of Rhode Island. For a physician and for a 63-year-old man, it is akin to committing professional (and personal) suicide. An 
unethical downfall is painful.
Rosenberg had two offices, the main office being in North Providence. His specialty was pain management. He admitted guilt to committing health-care fraud and to receiving kickbacks. He did not act in his fraud alone. An unethical downfall – especailly a medical ethics failure – rarely happens in a vaccum.
In the world of powerful, addictive opioids, a spray version of fentanyl (manufactured by Insys Therapeutics), is one of the most addictive drugs available. The payoffs were dressed up to look like speaking engagements. The speaking engagements never really happened in a legitimate sense, they were simply “cash-filled envelopes,” handed out under the table in exchange for Rosenberg’s continuing efforts to hook patients on a powerful and expensive drug they did not need.
As part of the scam, Rosenberg lied to the following organizations: Medicare, Blue Cross Blue Shield of Rhode Island, Neighborhood Health Plan of Rhode Island, UnitedHealthcare and several others.
You would think his shame would be enough, but as they say, “Wait, it’s going to get worse.” The first step on the slippery slope of an unethical downfall is slick, but the trip down the unethical downfall slope can be disasterous.
Unethical downfall – Meeting “A.R.”
As part of his plea deal, admitting to his guilt, he told his lawyer that he would not implicate the Insys sales representative. At first blush, it sounds “noble,” that he would try and protect a pharmaceutical company, but it goes much deeper; “A.R.” is his son.
The scam was a “family scam,” and I am sure that “A.R.” was the recipient of many Insys bonuses, for as tiny as Rhode Island may be, Rosenberg was the biggest prescriber of fentanyl spray in the state, and amazingly of the country.
The payoffs for the speaking engagements (and there were 91 of them from July 2012 through July 2015) were at often at high-end restaurants that were attended by Rosenberg’s family members, Insys sales representatives, or colleagues and friends. At each fancy dinner, the same people were typically present. As part of the indictment it came out that Dr. Rosenberg forged the names of doctors who were never present.
The pharmaceutical company and Rosenberg forged an unholy alliance. The Insys drug reps funneled patients to the doctor and the doctor wrote prescriptions. Subsys (the trade name for the Insys fentanyl spray) is used to treat cancer patients. He prescribed the drug whether patients had cancer – or not. Therefore, the scam required intentional misdiagnoses. To date, “A.R.” has not been convicted of any crimes though Insys has been named in other lawsuits in other states.
The Spiral of an Unethical Downfall
Greed has a very powerful pull. It tears apart organizations and it tears apart people. The greed is rationalized as a need, and it is cloaked in opportunity. What drove Rosenberg, a man who must have at one time been an idealistic person, to wide up in this unethical downfall? It is not enough to say he was “weak.” He built a practice that had two offices. He was at one time respected. Why did he sacrifice his reputation, and his practice to get $188,000 in kickbacks? It seems almost absurd, but then in hindsight most unethical downfalls do.
We must look at his scam through the eyes of rationalization. To his mind, organizations such as Medicare were faceless, nameless, banks that were too steeped in bureaucracy and ineptitude to challenge his “intelligence.” He undoubtedly viewed the patients, those who were cancer-free and for the most part “simply” opioid addicted, as a lower-class, an underclass of addicts that he ironically enabled.
He knew precisely what the pharmaceutical company was doing. He went along with it. Did he enjoy the temporary power of being needed to perform an unethical series of acts? When he held his fancy “lectures” he was the man, the center of attention, the go-to person for the powerful pharmaceutical company, who could have cared less about his unethical downfall.
What then of his son, the Insys sales representative? Did he rationalize that his acts of greed were all done for the sake of his son? Did he feel that his own life had gone so far past redemption that his only hope was to make his son successful?
Perhaps all of it is true. His choices, one by one, led to a spiral – an unethical downfall. In the end, his greed helped no one. If this were a Greek tragedy as in the time of Hippocrates, he would certainly be the main character.
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