By the summer of 2012, many sales representatives at Insys Therapeutics were struggling to sell the company’s new product, Subsys, a powerful fentanyl spray meant to ease the severe pain of cancer patients.
In the midst of an opioid epidemic that was bringing increased scrutiny, doctors were hesitant to prescribe a new painkiller that was not likely to benefit a large number of patients, said Holly Brown, a former sales representative for Arizona-based Insys who was the first witness called Tuesday by the Massachusetts US attorney’s office in a federal trial in Boston of five former drug company executives.
“I was struggling,” said Brown, who in September 2012 had been working only a few months in Insys’s Chicago branch and was far from meeting her target sales. “At this time, a lot of us were pretty beaten down. The pressure was high.”
Enter Alec Burlakoff, the new vice president of sales, and Sunrise Lee, a former stripper who was now regional sales director for the Midwest, and Brown’s new boss.
Their message was “we’re going to toss the old book out the window,” said Brown, who testified in US District Court in Boston before a courtroom filled with lawyers and reporters.
A lucrative speaker program for doctors who prescribed Subsys heavily was launched, and Insys employees began working side by side with doctors to provide patient information to urge insurance companies to cover the costs of the fentanyl spray.
Brown said Lee seemed to have no prior pharmaceutical sales experience and used “sexually suggestive” techniques with doctors, wearing low-cut tops and meeting with them for drinks outside of the office. On one occasion, Brown said, Lee even gave one doctor a lap dance.
“It was a disappointment,” Brown, 36, said. “Certainly something that I as an employee was not willing to engage in.”
Lee, 39, is among five executives and former sales directors of Insys on trial for a landmark racketeering case that alleges they orchestrated a scheme to pay bribes and kickbacks to doctors and other health professionals in exchange for prescribing fentanyl to patients who did not need it.
She is being tried alongside the founder of the company, John Kapoor; Joseph Rowan, another former regional sales director; Michael Gurry, the former vice president of managed markets; and Richard Simon, former national director of sales. Burlakoff has pleaded guilty to racketeering conspiracy and is likely to testify for the government.
Defense attorneys say Burlakoff is not credible and that prosecutors are using the racketeering charge to unfairly punish the defendants for the opioid epidemic.
Kapoor is being depicted by his lawyers as a heartbroken widower whose horror over his wife’s painful death from cancer compelled him to develop a powerful painkiller for other cancer patients.
Lawyers for Lee said she is being objectified by prosecutors to secure a conviction.
The testimony on Tuesday certainly leaned toward the prurient.
Brown was asked to describe what she witnessed one night in October 2012 at a club in Chicago called the Underground. She had gone there with Lee, another sales representative, and a doctor named Paul Madison, who had become one of Insys most valuable physicians, prescribing Subsys regularly to his patients, none of whom had cancer.
The group had been drinking heavily, and Brown testified that she turned around at one point to see Lee straddling Madison.
“She was sitting on his lap and kind of bouncing around,” Brown said. His hands were on her chest, she testified.
“Do you feel like you were getting a message about what tactics to use to market this product?” Assistant US Attorney Fred Wyshak asked.
The defense objected before she could answer.
Brown testified that she was assigned to work alongside Madison and keep pushing him to write prescriptions, a task she disliked because Madison had a dubious reputation among other doctors and worked out of an office “in a dingy strip mall” in suburban Illinois.
“The first time I went there was a guy behind the desk counting a big wad of cash,” Brown said.
Madison’s prescription volume became so high that the company signed him on to its speaker program. Brown said she did not believe other doctors would come to hear him speak, but she quickly learned that attracting a large audience to an informational event was not the company’s aim.
“The idea was that these weren’t truly meant to be educational programs but they were meant to be rewards for the physicians who were prescribing” large amounts of Subsys, Brown said.
During cross examination, Kapoor’s lawyer, Beth Wilkinson, pointed to e-mails that showed Brown had no problem putting pressure on doctors or cajoling them into switching to Subsys.
“Been practicing my most charming smile,” Brown wrote in one e-mail to a supervisor, months before she started working under Lee.
Lee’s lawyer, Peter Horstmann, forced Brown to admit she sent “false” e-mails to a supervisor claiming she met with Madison more frequently than she had.
Brown acknowledged she made up the reports because she was uncomfortable meeting with Madison.
“Isn’t it true that you have described [Madison] as a large black man in a leisure suit?” Horstmann asked.
“Yes,” Brown replied.
“You’ve also called him a giant black man in a leisure suit, correct?”
“He’s very tall, yes,” Brown said.
Horstmann suggested that at the Underground, Madison, who is 6 feet, 5 inches tall, was “taking advantage” of Lee, who is petite and 100 pounds “soaking wet.”
During re-direct examination, Wyshak asked whether if at any point Madison forced himself on Lee.
No, Brown said.
Did Lee appear to be participating in the “activity?” Wyshak asked.
Yes, Brown replied.
Madison, who is in his 60s, was convicted last December of defrauding insurers.