The Cowboy | Dirty Laundry | S5-E4

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“Kathy Monaco had seen her share of bad backs.”

She had worked in medical administration for nearly 25 years. For the last four, she had worked for Dr. John Schneider, handling patient requests at his clinic. So when her husband Russell heard his back lifting a beer keg, Kathy knew he needed to see a doctor. According to court documents, she later said, "He was in a lot of pain, and I said it's time to go. We need to get checked out because you can't miss work."

Russell was 47 years old. He and Kathy lived with their two daughters, Mallory and Madison, and their Husky, Timba. Russell worked as a machinist, and in his spare time coach Softball for one of his daughter's teams. He'd had trouble with his back before, and Russell wasn't sure about his local surgeon. So Kathy called in a favor. She sent her boss an email.

“It read, "I know you're busy, and I'm sorry to bother you again.”

But could you look at my husband's lumbar MRI that was done yesterday?" Dr. Schneider got back to her the same day. He told her that Russell had three rupture discs, and would need an operation pretty quickly. But if they wanted Schneider to do it, they would have to go all the way to the hospital where he did his surgeries in Cody, Wyoming, and that was out of their healthcare providers network.

She said later, "It's worth it in my book to have somebody you trust do the surgery for you. Versus somebody, you don't know." We knew if he needed surgery, we wanted Dr. Schneider to do it. Kathy was doing what any wife would do. Putting her husband's care in the hands of the doctor she trusted most.

The doctor she worked for.

She had no way to know that they were walking headlong into a tragedy from which her family would never recover.

And this time, the medical board would finally seek justice. From audible originals, I'm Laura Beal, and this is Dr. Death, the Cowboy. This is episode four, dirty laundry. I'm Leon Nefock.

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Only fantasies in depth look at the world's newest profession and how the rules of human intimacy are being rewritten online. Listen wherever you get your podcasts or binge all episodes of only fantasy, add free, only on audible. When Kathy and Russell Monaco arrived at West Park Hospital, they went to the front desk to be admitted as Dr. Schneider had told them to. Within hours, Russell was on the operating table. Dr. Schneider performed a spinal laminectomy, a removal of part of Russell's spine.

Afterwards, Schneider told them the operation had been a success. But two days later, Russell's condition hadn't improved. In fact, he told Kathy that despite taking pain killers, he was hurting more than ever.

He never felt this much agony.

She spent a long night watching over him in the hospital. In later testimony, she said she'd never seen him cry, and now he was, because of the pain. To ease it, Dr. Schneider's physician assistant wrote an order for a fentanyl patch, an extremely powerful opioid many times stronger than morphine. The patch quickly reduced the pain, but it also made his breathing gross lower and shallower. By lunchtime, his oxygen levels had plunged dangerously low.

The nurse was worried about the safety of sitting him home without oxygen, so she made a call to Dr. Schneider's office. He didn't pick up, but his physician assistant, Harley Morrell, did. Later, in a statement, Morrell described what happened. He said, "The nurse stated that they wanted to send Mr. Monica home on oxygen, and I relayed this information to Dr. Schneider who was sitting next to me on his computer. Dr. Schneider told me to let them know to sit him up and take some deep breaths, and that the saturation levels would return to normal."

Morrell says that Schneider ordered Russell to be sent home as planned without oxygen.

In addition to the fentanyl patch, Russell was prescribed a daily dose of four volume tablets, six hydrogen morphone tablets, and 12 tablets of oxycodone.

“Harley Morrell maintained that all the medications were given under, quote, "the direction and supervision of Dr. Schneider."”

That wasn't the only time Dr. Schneider would be accused of prescribing a large dose of narcotics. He was notorious for sending patients home with this cocktail. He would send home volumes of prescription medications. Julie Mossbacker, the self-professed battle-axe of the nursing station, says she saw this kind of thing happen multiple times.

You know, here's your pharmaceutical bag. Take what you think you need. It wasn't just the quantity of drugs that Dr. Schneider was prescribing, but also the combination, which, if taken together, could be dangerous.

But when Schneider was challenged, he would crush you.

You know, he looks at you like he could shoot daggers at you. And we started empowering some of the other nurses to stand up to him once to say, "No, this isn't safe. This is not safe for the patient."

“Julie says that if things went wrong, Dr. Schneider's physician assistant would take the fall.”

If anything went down, he just blamed Harley. Harley did it, not me. Nope, he didn't talk to me, he did it all on his own. Then one day, it was Julie's turn. Dr. Schneider wrote one of her patients a prescription for a combination of sedatives and painkillers. To her, the mix was dangerous.

I said, "No, I am not going to do that. He was angry at me. He expected me to follow his orders blindly." But Julie was convinced it was risky. So, when I discharged that particular patient, I did not give him that cocktail. I refused. He just let my supervisors and immediate know that I did this and this is why I did it. Julie says that she reported her concerns about Dr. Schneider up the chain of command,

that she waited for a response. None ever came nor did the hospital respond to our requests for comment.

“Dr. Schneider meanwhile told us via his lawyer that he doesn't even remember to leave.”

He says that his practice was always aligned with the highest standards of care.

The monocose took Russell's prescriptions and made the long drive home. Waiting for them there was a Russell's mom who had been looking after their two daughters. She later testified that he could barely walk or stay awake. He had trouble even getting from the doorway of their family room into a chair. That evening, Russell lay in his recliner in the living room as the family aide dinner.

Before bed, his eldest daughter asked if she could get him anything. A new back, he told her. At 9.30 pm, Russell's wife Kathy left him his pain killers. She offered to stay with him in the living room, but he told her to get some rest upstairs. Even so, she left a phone next to him and told him to call her if he needed anything at all.

The next morning, Kathy checked on her husband. He was in the same position as the night before. She said, "His glasses were sitting on the desk, his crutches sitting there. He hadn't moved an inch." Then she saw that he was blue.

Russell Monica died less than 24 hours after being discharged from Dr. Schneider's care. A few days later, news reached to the Wyoming Board of Medicine. They already had complaints against Dr. Schneider, the ones from Dr. Narotsky, but this raised the stakes. A patient had died.

That's a big deal. As you would imagine, we take fatalities very, very seriously. Kevin Bonnenblast is the Board's executive director. You've got a case where there's something a grievous happens. Something that, to use the courts to show shocks, the conscience, something needs to happen.

Sooner the better. The autopsy left no doubt. Russell Monica had died of a drug overdose. To the board, it seemed like Dr. Schneider was an imminent threat to the public.

You don't underring that bell easily. All of a sudden, you're having a call patient saying, "Hey, you know, I'd do your surgery next week, but the board of medicines has been to my license."

For the first time, Schneider was barred from seeing patients.

His career was hanging in the balance. Which Schneider's sidelined, they set about investigating just exactly what had gone wrong in Russell Monica's treatment. They looked at the decision to prescribe Russell a fentanyl patch. Fetanyl carries a black box warning.

It's the strongest safety alert the food and drug administration can make. The black box warning on that says, "Do not give it for post operative pain. It's for long-term cancer treatments, things like that. It is not for acute pain. So if you're not paying attention to what the black box warning is,

that's a pretty hard argument that you failed to meet the standard of care."

The deeper they looked, the worse it got.

They found that Schneider repeatedly prescribed fentanyl after surgery, despite the warnings against that use. Then there was the mix of other opioids and sedatives, plus the decision to send Russell home when his oxygen levels had been so low. To the Wyoming Board of Medicine, it seemed like they had overwhelming evidence.

of Dr. Schneider's wrongdoing. We have a silver bullet here. I don't know if it's hurting people in surgery or over-prescribing or just whatever. But if somebody is repeatedly doing that, something needs to happen. Schneider's history was catching up with them and not just through the Board of Medicine.

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Follow British scandal wherever you get your podcasts or listen early and add free on audible. Cody Dr. Jimmy Biles had been on a quest to figure out who was behind the mysterious letter from Rita. The one that had landed in 14,000 mailboxes filled with false allegations against him. We did reach out to Dr. Biles for this series, but he declined to take part. However, we know it happened because Dr. Biles eventually filed a lawsuit that named the supposed perpetrator.

And that person came out of nowhere, a woman named Lisa who lived 1,500 miles away in Indiana. But the suit was also clear in saying that although she had paid for the flyer that they believed she was acting on behalf of someone else. Journalist CJ Baker was tracking the story for the local newspaper. He couldn't understand what a woman in Indiana had to do with a feud in Wyoming. So he gave her a call.

I said, hey, maybe this is completely random, but you were just named in this suit by this physician over here in Cody. And he's saying that you were responsible for this mailer.

“You know what I think about? I got to tell me about that kind of thing.”

And she said, oh, I have any idea what you guys are talking about. Eventually, she admitted it to the court. She had sent the letters, but she insisted she had acted alone.

In an email later revealed in court, Lisa's lawyer laid it out for her.

“He said, no nurse in Indiana decides one day to send out a flyer because she does not like the way a doctor is behaving and Wyoming.”

Unless you are completely crazy, that dog don't hunt. The boat don't float, and that story is not believable. Still, she stuck to this implausible alibi, until the truth arrived in the form of a flash drive, found in the pocket of a pair of unwashed scrubs in the laundry room at the hospital where Dr. Schneider worked. It contained pages and pages of letters addressed to Lisa. Oh, man. You know, I don't know how much further your jar could drop or how many more times you can be surprised in the course of a case, but this was one of it.

Just seemed to get worse and worse. Those letters weren't signed, but there was one person they certainly appeared to have been written by Dr. Schneider.

“One document read, as we have discussed, if you are able to take a bullet, you will be taken care of far in excess of any paycheck.”

And another one said, "They will obviously say many times through various ways that it is better for you to tell the truth about your co-conspirator. Don't believe any of it. They will not befriend you or help you in any way, and as soon as they turn you, you will be treated like a prison bitch." Dr. Biles launched a new lawsuit against Schneider, accusing him of mass-reminding the smear campaign. Dr. Schneider replied that he would fight the case, but the evidence kept mounting. As the case entered Discovery, Dr. Biles got a hold of more damning material.

E-mail, showing that Dr. Schneider told Lisa, she should have a "250k+ payoff for her future" as well as instructions for how she could avoid answering questions under oath. Dr. Schneider even offered to help her destroy evidence by giving her hard drives to the "microwave" treatment.

“And yet, Dr. Schneider continued to insist that he had done nothing wrong.”

To this day, he says he did not "direct, review or send the flyer to the community." But now, Schneider was fighting on two fronts. The Wyoming Medical Board was questioning whether he was putting patients at risk, and the court filings around the Cody mailings portrayed him as a man willing to intimidate and manipulate to get his way. Together, they painted a picture of a doctor who seemed dangerously out of control. Still, Schneider kept moving forward. He flew to Nashville and sat through a short course on prescribing medicines and agreed to restrictions on what he was allowed to prescribe.

That was enough to get his suspension lifted while the Wyoming investigation continued. As soon as he got the news, Schneider began firing off tweets to his one single follower. Back in the operating room stamping out disease, communication failure from the physician assistant caused this death, not Dr. Error. These events are orchestrated by our competitor to undermine our vision. We will prevail and provide expert cost-effective care.

Then, he settled the case with Jimmy Biles at a cost of nearly $3 million without admitting any wrongdoing.

To pay it, he used his malpractice insurance. For years, Dr. Schneider had ensured himself with his own money. He had set up an insurance company backed by his personal millions. The money was supposed to be fenced off for patients, but instead, he used the funds to pay for the defamation settlement and legal bills, meaning there wouldn't be enough left to pay out any malpractice claims. And with his suspension lifted, he was back in the operating room, working on patients who had no clue about the kind of trouble he was in.

63-year-old Alan Kenop wasn't a new patient. He had already been seeing Dr. Schneider for a while. Alan had first become aware of Schneider a few years earlier when he saw a billboard off the highway.

He could hardly have missed it. The advertisement was enormous. A giant picture of a doctor in a white coat, beaming down at him. I mean, we're talking about something that says of my living room. He had this huge smile on his face. The impression that he gave me from the billboard was, "You can trust me."

Schneider operated first on his neck, and that seemed to go well.

Then Dr. Schneider operated on Alan's back, a spinal fusion. Over time, the pain got worse. By 2012, just months after getting his license back, Dr. Schneider was telling Alan that he needed a second operation on his back. Alan listened, his mind bogged by opioids.

“I honestly did believe that if he had told me that the moon was made out of cheese, I would have believed that he was telling me the truth.”

Alan agreed, and they scheduled the procedure. I remember coming out of the back surgery and being an excruciating amount of pain, where they then put me on even more pain medication.

I should have never had that second back surgery.

Not only did I wish I hadn't had it, I wish I would have died as a result of having had the surgery, because I was in too much pain on an ongoing basis. After nine months of excruciating pain, Alan finally decided he needed a second opinion. He hobbled into a new doctor's office alongside his wife. As he slowly sat down, the doctor began asking questions. When did this all start? What's going on?

“It was Dr. Michael Copeland, Dr. Schneider's former colleague. It already seemed this can.”

Your first thought is Schneider. Now, he needed to break the news to Alan.

So, my task then was to say, you never needed an operation.

You don't want to hit him over the head with that, but at the same time it's the truth, so he can't really skirt around it. He put it in terms of, I know you're not going to like what I have to tell you, but your back is an absolute train rack. And there's no way to straighten out your back except through the most radical surgery that we can do on a person. My wife and I were both kind of just in shock. It was just a whole mess to then have me say that, oh and you never needed any of that, was just too much.

When Copeland operated, he says the hardware was unstable from the middle of Alan's back down to his pelvis. He found plastic spacers so loose they could be removed with his fingers. One had been hammered so deep between his vertebra that it was poking into Alan's abdominal cavity. Dr. Schneider says that Copeland's allegation stem from professional jealousy. And he denies that he was to blame for Alan's failed back fusion.

Instead, the problem as Schneider saw it was the patient himself. In his blog, he described Alan as, quote, a drug-addicted miscreant who's tobacco and alcohol ruined his spine. Alan says that his reliance on prescription painkillers was a result of the complications he suffered after Dr. Schneider's surgeries. It was only later that Alan discovered the truth. If I had known that he had had his license suspended, I wouldn't have a lot of him to do surgery on me.

He also didn't know that the Wyoming Board of Medicine was aware of multiple complaints about Dr. Schneider.

“I think my gosh, you would have thought that the Wyoming Board of Medicine would have stopped him after they had gotten one.”

If not two cases filed against him, if they were really being prudent about what they do. We put that to Kevin Bonn and Bust, the Board's Executive Director. We cannot keep him suspended if we cannot with a straight face say there's an imminent threat, public health and safety. And so that's the hard part because to this patient, yeah, he was an imminent threat. When it happens that we have multiple complaints and things like that, what our prosecutor will normally do is he's going to go with the best cases he's got.

And so, what is the ultimate objective? It doesn't mean that other complaining patients didn't matter. It doesn't mean that their cases weren't important at all, not in the least.

more than two full years after Russell Monaco's death.

“They've found 33 counts against him for violating the Medical Practice Act, all tied to Russell's case.”

Dr. Schneider contested the case against him. In his view, the problem lay with his physician assistant, Harley Morrell. Dr. Schneider accused Harley of having gone rogue and acting without his knowledge or authority. We did reach out to Harley Morrell.

At first he was open to an interview, but the next day he changed his mind because rehashing everything was too upsetting.

He says, "Cathy and Russell Monaco were like family and it makes him shake to think about what happened." He told a city feels deep remorse for Russell's death and wishes that he had done more to stand up to Dr. Schneider. He feels that Dr. Schneider threw him under the bus to try to protect himself.

“The Board of Medicine did not find Dr. Schneider's defense persuasive.”

They described Schneider's testimony as "not credible or believable." The expert he chose to back him was also considered "not credible or worthy of belief." In the end of the 33 counts, 29 were upheld. The Board of Medicine issued its punishment. It fined Dr. Schneider and stripped him of his license to practice medicine in the state of Wyoming.

Schneider was cornered, his business was gone, and more malpractice accusations were stacking up against him. He needed to plot his next move. So he shifted his remaining assets into trusts and businesses in his wife's and his children's names.

There was the luxury ranch near Cody known as whispering winds, a $1.9 million home in California and other properties too.

He called it a state planning. Others would call it fraud. And even without his Wyoming medical license, Schneider wasn't done being a surgeon. As we've seen in past seasons of this show, it can be surprisingly easy for a doctor who suspended in one state to reinvent himself in another. Dr. Schneider would set out to stake a claim on a new frontier, hired to operate on military veterans through the VA hospital system. But this time, the law was on his trail.

“VA to say any scrutiny to wrong people, and you know what?”

It looks like you finally crossed the line, and this is your day of reckoning.

That's coming up next time, on Dr. Death. Listen to Dr. Death, the Cowboy, on the audible app, or wherever you get your podcasts. Audible subscribers can binge all episodes of Dr. Death, the Cowboy, early and ad-free right now. Join audible in the audible app, or by subscribing on Apple Podcasts. This has been an audible original.

I'm your host Laura Beal. Executive producers are Russell Finch and Marshall Louis. Our senior reporter is Zachary Staufer. Tom Wright is our senior producer. Our associate producer is Muhammad Ahmed. Joe Wheeler is the senior story editor. Senior development producer is Rachel B. Doyle.

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