The Persecution Of Pain Management Doctors


 
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                                                       By L. Joseph Parker, MD

The call came in during a busy workday. My comprehensive primary care clinic had been built over a decade of hard work and had a general practice clinic staffed by a very capable former surgeon and several nurse practitioners, as well as a pain management program and an addiction treatment clinic. We also had several counselors on staff. I immediately recognized the voice on the other end of the line as a friend of mine who was a pain specialist. Her office was at the other end of the state from mine, but we had worked together off and on for over twelve years. She told me that the medical board had called her down and complained that she had some patients on opiate therapy at more than 90 MDE. She had argued that the CDC clearly meant the guidelines for primary care physicians, not specialists. They were not responsive to this argument and immediately suspended her medical license.

She and I had discussed the dangers of continuing to treat pain, knowing that the DEA wanted to make some examples, and several doctors in our state had suffered criminal charges. The complaints published about their practices left us bewildered. They had charged cash, treated patients under the age of fifty, and had patients that traveled long distances. Another was charged with complaints of his having treated people he knew (or should have known) suffered from addiction. They were also criticized that a percentage of their patients had criminal records, quoting a percentage. I wondered where the doctor could go to get accurate criminal record information. More importantly, when I checked the quoted percentage, it was lower than our state average. But more importantly, since when can a doctor not treat someone who has a criminal conviction? Finally, I noticed that the DEA was quoting morphine dose/milligram equivalents, leaving the press and the public with the impression that these were individual pills. I wrote a letter to the reporter trying to correct these misstatements but never saw a correction.

Then a third doctor was hit. She had prescribed Xanax to a patient in crisis at a McDonald’s parking lot. Not a crime, but then she panicked and lied about it when questioned by federal agents, allowing herself to fall victim to 18USC1001: lying to a federal agent. The first physician was 71 years old, pleaded guilty to one count of prescribing a Schedule IV medication, which was supposed to have a maximum term of five years in prison. But the government argued what it calls “relevant conduct,” at which they attribute any patient deaths as “related to” the prescriptions. The doctor was sentenced to 120 months in federal prison. The second doctor pleaded guilty to wrongfully prescribing alprazolam and was sentenced to four years in prison. Finally, the third doctor was sentenced, also for alprazolam. In this case, the government agreed that no prison time was necessary, but the judge felt that a message should be sent to physicians treating pain and sentenced her to three years.

These events were worrisome as none of the complaints listed are actually crimes. I had, in fact, taken hundreds of hours of CME in pain management and addiction, and no one had listed age, criminal history, or payment method as problems. My practice had set up very strict procedures and protocols to avoid diversion and monitor for signs of addiction. I had joined both the American Academy of Pain Medicine and the American Society of Addiction Medicine and was taking board review courses, as I find these to be excellent ways to stay up to date. I had even traveled to take in-person classes held by Harvard Medical School. Everyone in our practice who received controlled medications had counseling made available to them, and we would not accept a patient for opiate therapy unless they came to us already on opiates with a chronic pain diagnosis made and confirmed byother medical professionals and specialists. We did make an exception for patients with cancer, as oncologists were referring patients to us for maintenance treatment.

I searched my calendar to see how I could reschedule patients to help my friend keep her practice alive until she could retain counsel and defend herself to the board. While I was doing this, my receptionist told me that a sheriff’s deputy wanted to see me. A cold feeling came over me, and I woodenly shook his hand and accepted the envelope he handed me. Inside was my emergency order of suspension from the medical board. It turned out that a disgruntled former employee had called an insurance company pretending to be a patient and had complained that I was “treating addicts.” The insurance investigated and found that some patients had died within thirty days of being treated by us. Since we saw all of our patients every thirty days, this would be the case no matter why they had died. It turns out that today, any patient that dies while taking opiates is listed as an “opiate-associated” death, even if they die in hospice or by suicide. I even had a patient who died in police custody, twenty hours after last taking his medications and after being denied proper medical care. The jail told his family he had died of an overdose, despite the coroner’s finding on autopsy that he died from a cardiac condition.

The insurance company investigation found that our treatment had been reasonable but felt they had to notify the medical board. The medical board felt they had to issue an emergency order of suspension without giving me a chance to defend my practice. When I finally went in front of them, the suspension of my license was lifted, and I thought the ordeal was over. Instead, law enforcement officers went on the news to say that the board had been too easy on me, and I was indicted that same day. I did not plead guilty but took it to trial. The government wanted to give me twenty to life for the patient who died in police custody. I took the stand in my defense and tried to help the jury understand the complications of medical practice and the risks and benefits of opiate therapy. I explained that I was certified to treat addiction, and that while my patients on opiate therapy did not have addiction, even if they did, the benefits of treatment could outweigh the risks. The government’s expert testified that MRIs were not objective, that a veteran treated with methadone for pain meant he had addiction, that a man with a hand crushed so badly that a finger was pulled off did not have “real” pain and should not have been treated. The fact that I had cut him back from three opiates to two and from two benzodiazepines to one on that first visit went right over the jury’s heads, as well as the fact that I had reduced his opiates sixty days and his benzodiazepines thirty days before his death.

The government’s expert testified that when my chart notes referenced my concern about the potential for addiction, that this was absolute proof that the patient had addiction. The prosecutor told the jury in closing that we only accepted patients already on opiates because it was easier to get them addicted. None of these statements are true, but I was shocked to find that you can’t use the textbook in your defense. You also cannot use the content of your CME in your defense. You have to rely on experts, most of whom are now too terrified to testify for the defense, and the government can have their witness make statements completely contrary to the scientific practice of medicine. I was found not responsible for the death but convicted for treating the patient at all, as I had placed him “at risk” of addiction. I was also convicted for treating the veteran who had been prescribed methadone, despite him testifying that I was a compassionate doctor who had always tried to help him reduce the opiate medications he came to me on. I am waiting for sentencing and looking at up to twenty years in prison. If I could offer any word of advice, it would be for all primary care physicians to stop treating pain until this insanity is rectified, as it is impossible to educate a jury in a week. And there is no limit to what the government can say to get a conviction. They are not bound by truth or science. Also, if you come under prosecution, hire only a health care prosecution specialized attorney. Do not trust that any other attorney will understand things well enough to adequately defend you.

L. Joseph Parker is a research physician.


 
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COMMENTS

  • Michael Swift

    August 16, 2023 22:56 44

    Thank you for sharing the reality of "this Insanity". The only evidence i have to offer, is in support of Dr. Parker's assessment. I come for the state of Oregon, and can tell you the members of "The Oregon Health Authority" instrumental in proliferating "anti-opoid rhetoric", were all hand-picked by a special interest group led by a Naturopathic Physician who had only one thing going for him, which was to elevate his platform fed by nothing but his narccistic and dysfunctional character - un-quenchably fiery passion to control and gain public notoriety and fame. He also retained a very limited clientele of dedicated patients. My second state of facts were derived from my wife, who for years, performed detailed surveys that were so obviously edited, that anyone could decipher the extreme bias that was replaced by the redaction of scientific evidence. In fact, the questions laid out in these surveys were all in multiple choice format, completely unsupported by even the weakest form of facts, and most of them out an out lies.

  • What a terrible thing to happen.

  • "I even had a patient who died in police custody, twenty hours after last taking his medications and after being denied proper medical care. The jail told his family he had died of an overdose, despite the coroner’s finding on autopsy that he died from a cardiac condition." Um, not having his medication likely CAUSED the heart condition and killed him!! WITHDRAWAL KILLS!!

  • Richard A Lawhern PhD

    August 16, 2023 02:57 24

    As a healthcare writer and subject matter expert on public health policy for the regulation of prescription opioids, I see the same conditions that Dr Parker eloquently describes in this paper. The behavior of the US DEA can aptly be described as that of a Racketeer Influenced and Corrupt Organization under the meaning of RICO laws. However, the US CDC and Veterans Administration have been major accessories to these crimes. It has been demonstrated conclusively that 2016 and revised 2022 CDC opioid prescribing guidelines are fatally flawed and should be repudiated. We see in them cherry-picked and misinterpreted research, mandatory recommendations based on very weak evidence, naive claims that non-opioid and non-pharmaceutical treatments are "preferable" to opioids despite a total absence of comparative trials, use of MMED junk science to support one-size-fits-all maximum dose thresholds, and total absence of consideration for effects of genetically mediated opioid metabolism. There is also ample evidence of bad faith and unacknowledged professional conflicts of interest in at least one of the guideline writers. The CDC and VA have labored mightily and produced a mouse. It is time for clinicians who treat pain to stand up and demand of Congress that both organizations be banned from public policy deliberations on the practice of pain medicine, and that their "guidelines" be withdrawn without replacement. The American Academy of Family Physicians and five other clinical associations representing over 500,000 doctors and medical students went on public record in 2019 demanding an end to political interference in the practice of evidence based medicine. It is time for that demand to be nailed to the doors of Congress and backed by class action suits on the part of millions of patients denied safe and effective pain treatment, and thousands of clinicians who are being persecuted or intimidated out of practice.

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    • Editor-in Chief:
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      Cynthia Casteneda Avina
      Ronald Harvinger
      Lisa Andonis

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