Like Robert Centor at MedRants, Chris Rangel MD and many, many others I’m a strong opponent of the War on Drugs, but I rarely bring that up in THCB. That’s because the Drug War is largely a political, social and criminal justice issue rather than a health care issue. However, in one arena, the War on Drugs–as prosecuted both by Ashcroft’s justice department and many Republican and Democrat state and local attorneys-general is not only completely out of control, but is a direct assault on health care provision.
I’m referring of course to the draconian prosecutions of physicians who treat chronic pain by prescribing opiates. Given my other recent posts on access to rural healthcare in California, the case of Dr. Frank Fisher is very relevant. Fisher is a Harvard trained doc, who until 1999 was running a general health center for the poorer residents of Shasta county–a very rural area in far northern California–including pain management. Some time around 1996 the California and Federal authorities decided to come after him because a few people had died with only the vaguest connections to his prescribing of opiates. One had been in a car crash where he was the passenger. The charges faced by Fisher? Murder!
Last week, five years later, Fisher was cleared at trial of the only remaining criminal charge. That charge was of defrauding Medi-Cal of, wait for it, $150! (I know THCB has been critical of non-prosecution of fraud in the Medi-Cal system, but that wasn’t what we meant!). So now Fisher has to get the state medical board to give him his license back in order to go back to work. Given the history of outright lying and corrupt behavior by prosecutors in this case, that ought to be simple. Whether any of those individuals will be held accountable is less likely.
Meanwhile, what do you think happened to the patients at his clinic, which was destroyed by this action? Go read the full interview with Fisher at DRCNet, but this is an extract about what happened to the people he was serving. As you might have guessed their transition from his care to that of others in that rural underserved area was not exactly smooth:
You ran a large clinic serving a predominantly poor and rural clientele. What happened to your patients after your practice was shut down?
Fisher: The impact on the patients has been devastating, it’s been an unmitigated disaster. Their health has deteriorated, they’ve been unable to get medical care, some appear to have aged 20 years in five years, others haven’t even survived. Some patients have gained enormous amounts of weight, others have their blood pressure out of control. I suspect there has been at least one suicide. Patients are having to travel great distances to get their care; they go to Eugene or Fresno or San Francisco. Of the patients I still talk to, I don’t think a single one is being adequately treated.
Chronicle: The majority of your patients were Medi-Cal patients, poor people. Is there a class issue involved in the availability of pain treatment?
Fisher: The availability of pain management for poor people is even worse than for the rest of us. And it’s not good for the rest of us. Everyone who develops chronic pain is likely to be killed by it because of medical neglect. It’s a malignancy in the sense that if it is not controlled, it will spread and progress. My patients were effectively tossed out on the street to fend for themselves. The local medical clinic saw them as drug addicts who needed to be detoxed.