(Editor's note: This article has been updated throughout.) 

Dr. Howard Diamond's prescribing of opioids outpaced every other Texas doctor save one in 2014, according to data from the Centers for Medicare and Medicaid Services. Diamond, who runs the DiamondBack Pain and Wellness Centers in Sherman and Paris, is facing a laundry list of charges including conspiracy to possess with intent to distribute controlled substances, money laundering and abetting, distribution of controlled substances and health care fraud, and aiding and abetting. The charges also link Diamond’s prescriptions to the overdose deaths of seven people.

The Associated Press reported that the overdose deaths occurred in three Texas cities — Abilene, McKinney and Sulphur Springs. Deaths mentioned in the indictment also occurred in four Oklahoma cities — Ardmore, Hugo, Idabel and Yukon.

Diamond pleaded not guilty to the charges in federal court Tuesday.

CMS data shows that Diamond's opioid claim count was 11,035 in 2014. "The claim count is the number of Medicare Part D opioid drug claims, including original prescriptions and refills," CMS says. Diamond ranked 24th in the nation, according to the 2014 CMS data.

Federal court records show that Diamond was appointed public defender Denise Benson to represent him on Tuesday by Federal Magistrate Judge Christine A. Nowak and is scheduled to appear before Nowak Friday. Denise Benson could not be reached for comment on Tuesday or Wednesday.

The indictment that was returned on July 6, says that the seven people, who are not named in the indictment, filled prescriptions obtained from Diamond and then overdosed on those medications in the days and weeks that followed. Some of the patients died within a couple of days of filling the prescriptions and others were within a month of getting the medication. The drugs prescribed by Diamond that are linked in the indictment to overdoses include Fentanyl, Hydromorphone, alprazolam, methadone, morphine, oxycodone, zolpidem and oxymorphone.

In addition, the indictment says Diamond filed or caused to be filed paperwork with Medicare seeking payment for services he said he rendered to patients at times when the government says it has proof he was not in the place where the services were rendered. The indictment lists nine such counts that relate to charges ranging from $100 for an injection to $556 for a new patient visit. The indictment says the government is seeking the forfeiture of Diamond’s medical license if he is convicted of the charges.

Previous law enforcement action

This is not the first time the federal law enforcement has come calling on Diamond. In May, the Drug Enforcement Administration executed a search warrant at the Sherman office and collected records related to doctor’s prescription writing.

At that time, DEA Special Agent Elaine Cesare said the agents were investigating Diamond’s writing of prescriptions for pain medication.

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On April 16, Diamond posted on his practice’s page a statement recognizing that local pharmacies had stopped filling prescriptions for his patients.

“As many of you might know, for reasons that have not been discussed with me, most of the pharmacies in my practice region, Sherman and Paris Texas have stopped filling prescriptions for my patients,” Diamond said in the post. “This is an unexplained circumstance that is out of my control, and inconsistent with the medical welfare of my patients.”

The post goes on to state that Diamond was working to restore treatment to his patients, but did not have an answer for when that would occur.

“I realize that these actions of the pharmacies that have stopped filling my prescriptions for my patients is having serious and negative impact in your lives and I have no power or control to change that today,” Diamond said in the post.

A history of prescriptions problems

A Texoma pharmacist, who asked not to be named because she was not authorized to discuss the matter, said the pharmacy at which she works stopped filling Diamond’s prescriptions more than a year ago.

She said it’s at the pharmacy’s and pharmacist’s discretion whether to fill a prescription or not. Some of the things pharmacists look out for are patients who often seek refills early, who are on high doses or combos, and who are doctor and pharmacy hopping, which became the case with Diamond’s patients as pharmacies began denying his prescriptions. She said pharmacist can track prescriptions filled for patients across pharmacies thanks to a database, but ultimately not filling a prescription is a judgment call.

“You just have to trust your gut. You can tell,” she said.

The pharmacist said before denying Diamond’s prescriptions, pharmacists at the pharmacy tried to discuss the prescriptions with Diamond to understand his rational.

“We tried calling his office several times … and they were not real open to talk to us,” she said.

Latrivia Caldwell, who identified herself as a former receptionist of six months at Diamondback Pain and Wellness Centers, said she was asked by staff during her November 2015 hiring process, if she had heard anything about Diamond’s professional reputation and his practice’s difficulty in getting prescriptions filled. Caldwell said she knew of Diamond, but nothing of his reputation or the prescription issue — the latter of which she said was vaguely explained by the staff.

“They just said that he had a bad reputation for medications and that’s why a lot of pharmacies would not fill,” Caldwell said.

The former receptionist said the office had a high rate of employee turnover and said she was fired without explanation. Caldwell said the process of applying for unemployment benefits through the office was so difficult that she nearly sued the company.

“They wouldn’t even give that information to unemployment,” Caldwell said, referring to the explanation of her firing. “They refused to return their phone calls.”

Caldwell said Diamond was, however, quick to take the calls of his patients, who lived as far away as Austin. Patients would often call Diamond on his personal cellphone, she said. Patients tended to contact Diamond on his cellphone before they contacted office staff and that became both a complication and concern for the employees.

“I know for a fact they (patients) had his number because that was a big issue for everyone,” Caldwell said. “And they would call him at all times of the night.”

Caldwell said she enjoyed her brief employment with the pain center and described Diamond as a nice and generous person. But, she said, she believed some type of legal consequence would result from the way the office operated.

“In other words, do I think he abused the situation of using his license to prescribe medicine?” Caldwell said. “I do.”

Texas Medical Board investigation

In August of 2015, the Texas Medical Board found that Diamond had failed to maintain adequate medical records documenting his care and treatment of chronic pain patients, according to records available online from the Texas Medical Board.

“Although a large number of patient records were reviewed and found lacking in detail, with certain pages missing, the Panel found that (Diamond’s) prescribing was appropriate and his rationale well-considered,” the documents state.

The records show that Diamond didn’t admit to or deny the charges against him but agreed to a remedial plan with the Board. The panel found no standard of care violations, and Diamond was said to have cooperated with the investigation. He was ordered to complete eight hours of continuing education in medical record keeping. The remedial plan ended in September 2016 when Diamond completed the requirements.

Herald Democrat reporter Alex Maxwell contributed to this report.