The U.S. Attorney’s Office has positioned four Brazilian nationals charged in connection with a black market pharmacy operation in Framingham as exploiting a community’s trust by masquerading as licensed health-care professionals.
But there’s another side to the story that deserves attention, according to one defense attorney on the case.
The illegal pharmacy that purportedly catered to the area’s Portuguese-speaking population — raided by federal agents in early March at a Framingham apartment complex — was meeting a need, Attorney Keith Halpern recently argued in front of a federal magistrate judge.
Its customers weren’t people abusing drugs or reselling them, he contended. Rather, they were individuals of undocumented status who were afraid to visit a doctor’s office or hospital — or couldn’t be seen in a timely manner.
“I think that they were making a judgment that the risk of getting deported outweighed the risk of buying medication illegally,” Halpern said during a March 13 federal court hearing in the case. “And it’s horrible that they’re in that position and have to make that judgment.”
In addition to the fear element, immigrant and health care advocates told MassLive that even if an undocumented individual actively seeks care, waitlists across the state are long enough to be a deterrence.
“For (undocumented individuals) to find a PCP (primary care physician) or anything like that, any doctor, they have to go to community health centers, but they are overwhelmed right now,” said Liliane Costa, executive director at the Brazilian-American Center (BRACE) in Framingham. “Most of them have waiting lists, long waiting lists. It’s very difficult for them to find health care right now.”
The Edward M. Kennedy Community Health Center in Framingham, where more than 70% of patients speak a language other than English, has told some patients there’s a two-year wait, Costa said.
The state’s 50 federally-qualified community health centers, which serve vast numbers of immigrants, are working “as quickly as we can,” said Steve Kerrigan, president and CEO of the Edward M. Kennedy Community Health Center.
“It’s a fact of life in a health care delivery system that is where it is in the United States,” Kerrigan said. “We have a primary care crisis in Massachusetts and this country. With fewer people entering primary care and more and more folks in need of preventative primary care, the numbers just don’t add up.”
There are also free clinics across the state, which are funded by grants and individual donations. But they, too, are swamped like any other health-care facility.
Black market pharmacy investigation
What started with an anonymous tip in 2023 led to search warrants executed at The Green at 9 & 90 apartment complex on Worcester Road in Framingham this month. On March 10, federal authorities discovered a unit outfitted as an organized pharmacy with a set-up similar to a doctor’s office consultation/waiting area.
There, they found kilos-worth of prescription drugs (both controlled and non-controlled substances) illegally imported from Brazil, as well as syringes used to inject patients, law enforcement said.
A U.S. postal inspector testified during a recent court hearing that approximately 500 customers were mailed a total of 600 packages over the course of the investigation. Those numbers do not include local hand-to-hand transactions.
Facing charges in the case, and up to 20 years in prison, are two men — Douglas Reis de Souza, 40, and Dekny Marcos de Carvalho Reis, 33 — and two women — Dekmara de Carvalho Reis, 34, and Wandis Cleia Ferreira de Souza Guimaraes, 41.
Federal authorities contend Reis de Souza ran the operation, portraying himself to Framingham’s Portuguese-speaking community as a legitimate pharmacist with 22 years of experience. But at no time was he licensed in the U.S., they said.
According to court documents, he did business as “Droga Reis,” which is Portuguese for “Drug Kings,” and communicated with customers via Whatsapp.
Reis de Souza’s electronic business card advertised in Portuguese “remedies from Brazil,” including “medicines for adult and pediatric use, contraceptive pills and injectables, injectable cocktail to treat muscular and orthopedic problems and perforation of ear cells,” court documents show.
Oscar Cruz, Reis de Souza’s attorney, declined to comment for this story.
An apartment complex resident told Telumundo New England in Portuguese that she had used the pharmacy, which made it easier for area Brazilians without insurance to get medications, she said.
‘You can be on a waitlist for six months, a year’
Defense attorney Halpern, who represents defendant Dekny Marcos de Carvalho Reis, said the pharmacy’s clientele represented the “huge percentage” of undocumented individuals in the area.
Framingham has the largest Brazilian community in Massachusetts and one of the largest in the U.S.
“Everybody knows what’s going on here,” Halpern said. “This is a customer base of people who are afraid to go to the doctor, who are afraid to go to the emergency room, seeking medications which they want for their treatment. Not because they’re addicted, not because they want to abuse it.”
Halpern said he “appreciated” the prosecution’s assertions that the illegal pharmacy posed a danger to the community. But he implored a judge to consider the more significant issues that allowed the illicit operation to flourish.
Those included limited care access for immigrants, the perplexity of navigating insurance options and fear instilled by the second Trump administration, according to Hannah Frigand, senior director of HelpLine and public programs at the nonprofit Health Care for All.
In Massachusetts, people who are undocumented are eligible for limited forms of MassHealth coverage. MassHealth Limited provides coverage of emergency services only, for example, while the Health Safety Net allows individuals to be seen at community health centers. Coverage eligibility varies based on citizenship status, or where someone sits in the pipeline.
That means vast swaths of people in Massachusetts are restricted to seeking care at community health centers and free clinics. And in a landscape where the average person struggles to find care from a primary care physician, it’s even harder for those with varying immigration statuses.
“Because of that, you can be on a waitlist for six months, a year,” Frigand said. “It can be a very long time. So I think that speaks to the need and needs of the community, especially when it comes to if you just need to access prescriptions and you’re going without prescriptions. That’s a really difficult issue for people to navigate, particularly when you might be new to the U.S. health care system.”
At Health Care For All, Frigand oversees the organization’s consumer helpline, which answers between 20,000 and 27,000 calls annually in English, Spanish, Portuguese, Haitian Creole and French. Seventy percent of calls are conducted in a language other than English.
Many callers seek an interpreter’s help to make an appointment. Others need assistance understanding what MassHealth coverage they might be eligible for. The helpline gets calls when someone has a baby or loses a job.
“If you’re calling around to find a doctor and you can’t talk to the front desk person, you’re not going to be able to be seen by that office,” Frigand said. “We see this issue, unfortunately, a lot. At every decision point, it can create extra hardships for people who are new to the system or cannot speak English.”
Community health centers are often thought of as safe places in that regard — their staff, from the front desk to providers, often speak many languages.
Kerrigan, of the Edward M. Kennedy Community Health Center, which has locations in Worcester, Framingham and Milford, said they spend more than $1 million a year on interpreter services.
In July 2023, 48% of staff spoke a language other than English, representing more than 30 languages. The center is able to interpret more than 90 languages using its comprehensive interpreter services program.
And yet, Frigand said, Framingham is one of the areas Health Care For All hears about most often when it comes to people not being able to access care, speaking to the greater need.
“They (the community health center) just have so many people going to them,” she said.
Afraid to visit a doctor’s office
Frigand said they’ve seen elevated fear in immigrant communities since President Donald Trump returned to office in January with promises of mass deportations.
This week, U.S. Immigration and Customs Enforcement announced it arrested 370 people in Massachusetts during a six-day operation in March, for example.
Some immigrants have unenrolled from health insurance coverage as a means of protecting themselves, Frigand said.
“It can mean they don’t get necessary care because they’re scared that ICE could come to the doctor’s office,” she said. “ It can mean they don’t apply for coverage they qualify for. And this is people with green cards. It’s not just people who are undocumented. People at every immigration level are concerned.”
Kerrigan implored people who need immediate health care not to seek out other potentially illegal avenues that could be unsafe. Assistant U.S. Attorney Evan Panich has said there were “no controls” to ensure safety at the Framingham pharmacy operation.
“We encourage anybody who is in desperate need of care to reach out to us, to the free clinics in the area,” Kerrigan said. “If we can get you in, we’ll get you in. We just don’t want folks falling for scams because there are a lot of folks when there is a crisis who are taking advantage of that.”
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