Federal agents began to investigate an East End physician assistant as a possible drug dealer in April after a surgeon reported how one of the assistant's oxycodone-addicted patients was so desperate for the drug that the patient took a pencil and reopened the stitches of a tonsillectomy.

The account of the surgeon's story was revealed in federal court in Central Islip Friday and in court papers by a federal prosecutor at a bail hearing for Michael Troyan.

Eastern District Assistant U.S. Attorney Allen Bode said that because the surgeon said the patient had become addicted while under Troyan's care, the federal Drug Enforcement Administration opened an investigation into the physician assistant's practice.

Neither the patient nor the surgeon were identified.

Troyan is the actual operator of two clinics on the East End -- one in Riverhead, the other in Wading River -- both under the name of East End Urgent and Primary Care, but he hires physicians to nominally supervise him so that he can prescribe oxycodone, according to officials.

Troyan was arrested Wednesday on charges of conspiracy, illegally attempting to distribute and distributing oxycodone. He pleaded not guilty.

U.S. Magistrate Gary Brown released Troyan on a bond backed by more than $1 million in property, including his house and his father's. A condition of the release is that Troyan can have no contact with dispensing narcotics, such as oxycodone.

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Both Bode and Troyan's attorney, Mark Musachio of Deer Park, said they were engaged in plea negotiations to resolve the case.

The prosecutor said that under federal sentencing guidelines, Troyan faces between 188 and 235 months in prison.

Both Bode and Musachio declined to comment afterward.

The Troyan investigation was initially handed to a Rockville Centre police officer on the DEA's Long Island task force, officials have said. The officer, along with other agents and police officers, determined that Troyan headed a ring in which at least 20 co-conspirators filled prescriptions he illegally gave them for 60,000 oxycodone pills between November 2011 and October 2015. The investigation into Troyan's associates is continuing, officials said.In all, the drug was sold on the street for an estimated $1.8 million in cash, with half going to Troyan, officials said.

Troyan was recorded on audio and video in September and October in his Riverhead clinic examination room discussing with a co-conspirator the illegal sale of the oxycodone pills, writing phony oxycodone prescriptions, talking about the price the pills were being sold for on the street and taking "large quantities of cash" owed to him for previous sales, court papers said.

At one point, Troyan discussed getting paid by a co-conspirator with an AR-15 assault rifle instead of the $800 in cash he was owed for one batch of street sales, Bode said in court.

But the prosecutor said the government would not permit the co-conspirator to give the weapon to Troyan.