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POLICY: The War On Pain Doctors gets to the big time

NY Times Op-Ed columnist John Tierney (the guy who is the replacement for long-time conservative columnist William Safire) has written two excellent articles; one on the war on patients and one on pain doctors — basically exposing the DEA for the corrupt, vicious organization that it is. I’m very glad that this issue is getting off the more limited pages of the anti-drug war crowd’s blogs and into the mainstream.  I have posted about this on THCB plenty of times, but it’s great that it’s getting more mainstream.  What’s tragic is how bad things have become before the major media in this nation has noticed at all.

If you are in the least interested in this issue — and if you are about health care and/or freedom you should be — I urge you to visit the Pain Relief Network site, to see Radley Balko’s excellent posting on the Karen Tandy, the head of the DEA’s pathetic response to his earlier article, to see Ron Libby of Cato’s long article on the subject.

And finally, why has the AMA not gotten involved? This is a national medical disgrace (so much so that my venerable surgeon father has sent money to William Hurwitz MD’s appeal fund).

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  1. Murph, you are absolutely right. Ever since the DEA started this sh)(*, doctors are afraid to prescribe opiates for even the most disabled individuals. Just an investigation can bankrupt them and they could lose their license, thus their livelihood for the future.
    I have five conditions that most people can’t even spell, much less define, that have caused severe degeneration in my spine and the cushioning in between, leaving me in severe pain 24/7. I did well on Vioxx, muscle relaxants, an anti-depressant, and Darvocet (a very mild opiate) for pain, for nearly 7 years and two different doctors.
    I was dropped by my last rheumatologist, presumably because I didn’t have insurance, or possibly seen as a drug seeker. I have x-rays and an MRI, and lots of medical records to prove my claims. I spent an entire day at a new doctor last week, who refused to give me ANYTHING for my pain! He actually TOLD me that “we don’t believe in treating chronic pain with narcotics. In fact, if I knew about them [doctors treating chronic pain with narcotics] he would turn them in to the DEA!!! I wish I had someone to turn HIM in to.
    When I asked him what I could do when the pain was so bad I was always crying, always nauseous, he REFUSED to answer. He also REFUSED to answer my questions about the risks of Tylenol, Advil, etc. giving you an ulcer or harming your liver. When I told him that I’d done a lot of research, and some say there is a difference between dependence and addiction, he said, “Well, I don’t know about that; all I know is that I’ve seen a lot of people addicted!” I know there IS a difference. This doctor’s conduct is in direct opposition to the AMA, as well as state and federal laws and prescription guildelines!
    After 6+ years of prosecutions, pain doctors are leaving the business and shutting down. The few that are left are either scamming (refusing to prescribe ANY medications and instead forcing people to undergo costly, dangerous procedures like epidurals, steriod injections, and surgeries) or aren’t taking new patients. Trying to see a doctor without inusurance is like trying to pull hen’s teeth – I have been refused an appointment many times! Is this against the law? I would really like to know that!
    Thanks for letting me ramble.

  2. I, as one, am not likely going to ever practice pain management again. Being trained by the American Academy of Pain Management, taking the two year course from the University of the Pacicic in pain management, Passing their certification exam twice and depending on an Intractable Pain Act and medical board regulations to protect me, I found myself in big trouble. I also was board certified in General Surgery.
    (There was another problem of getting involved with a patient that I am now going to marry, but it was an affair and ended up in two divorces. Pretty bad behavior for a person who once thought of himself as a charismatic Christian)So my case is tainted. Should have been the president I guess! HA!
    I hired a lawyer , $10,000. reviewed the cases with him. Got an expert witness$1200. Worked with the medical board lawyer , got two extensions then three days before the trial realized that I was going to be treated just the same as I had in past instances, before the laws and regulations existed. I was asvised having my expert witness testify “would be bad for me”. (He was the only doctor -Dr Kale- in the state ever found not guilty of overprescribing) I had no time to bring the patients in to testify and even if I could have contacted them the hearing is too short for good testimony.(half hour sessions) My lawyer allowed the expert witness testimony from the board without contesting the facts as we had previously discussed. I ws also told not to argue or “it would be bad for me”. I do not repect this system and feel it was more like gestapo techiques or being lynched. I worry about being outspoken because it may bring medical board repercussions but I have big problems anyway. I don’t have $7,600 to go to the Sante Center in Texas for a psychiatric evaluation. I likely will lose my stay that was put on the revocation of my license.
    Even if I survive this, I will not likley take the risk again of caring for intractable pain patients. I have been bankrupted and have no credit (IRS liens)because of the decison to try to be a compassionate caring physician and care for these people in chronic pain.
    Michael Langley,MD

  3. //you might not get any pain medications to ease your painful suffering because of trials like Dr. Hurwitz! //
    This is what I think this is what juries fail to consider when they make decisions based on the drama of the situation or gut reactions. They don’t think of the larger implications or the message they are sending. It makes things worse that it’s easy to judge a person than an organization or a system: but when you villify the person who fights the system, you help the system grow and get away with larger evils. The further back people step from a situation, the more precarious the moral certitudes become. Giving one person closure for a personal tragedy is not justice if the example sets up the conditions for a thousand other personal tragedies.
    That said – I don’t know anything about the Hurwitz case. The Paey case is a travesty, though.

  4. Dear Jennifer,
    I too am sorry that your Mother died as I, and many others have lost loved ones and it is a terrible, terrible thing, so my condolences.
    However, Dr. Hurwitz was, and is, an innocent man inprisoned because of many factors, none of which are that he was guilty of anything criminal to do with his medical treatment of pain. Sure he was not perfect, and even may have messed up, but criminal, no. He did nothing criminal and certainly nothing to spend even one day in prison!
    I hate to say this and point this out to you at this time, but I feel compelled to let you, and all know that the next time you, I, or a loved one goes to a Hosptial or Doctor because of a painful condition, you might not get any pain medications to ease your painful suffering because of trials like Dr. Hurwitz! The fact of the matter is that the most fearful thing people note about Hospitals and/or medical care, as well as end of life issues, is being in pain or dying in pain suffering the hell that it is!
    Pain is terribly under-treated in the USA, partly because of this fiasco with the DEA not being able to set some bright-line, or in lay terms, a firm statement of what is, and is not, acceptable, or a “safe-harbor” where in pain management they know they are safe if they follow certain things — the DEA refuses to nail down exactly what is and is not acceptable and too many “grey” areas exist in pain management today (despite repeated requests for such “safe harbors”) — to threaten prison time if you mess up ONCE in any job is outrageous. Think about your job (or former job), and if you messed up ONCE, and your gone to prison (And now think that it takes 10, 15 years to be an expert pain Doctor).
    Dr. Hurwitz was trying to help his patients — I and many others in these fields know this for a fact. Thier isn’t a criminal bone is his body. It is against his nature. He was not out to make millions and did not do such treatment for the money. Sure, he was paid in accordance with acceptable medical billing procedures, as all of us want paid for our time, but he was more concerned with treating chronic pain, and those tough cases who could not get treated for it (chronic pain) anywhere else.
    Unfortunately, his practice was “infiltrated” with a few bad apples that sought out this trusting man and used him so they could commit the crime of drug dealing — they admitted it at trial and even went so far as to tell the Court he (Dr. H) was concerned so much about their condition BASED ON what they TOLD HIM (which as it turns out were lies) — if he was guilty of anything he was guilty of being too trusting — something most people respect in a person today!! People took advantage of this character “flaw” so they could deal drugs, and then turned around and terstified against him so they could walk!
    A perversion of justice is what Dr. H’s trial is — the Guilty walk and the innocent do hard time!
    All patients in pain in the USA are paying the price and it will only get worse if it is allowed to continue. So, the next time someone you know and/or love is injured and needs medical treatment (and the inevitable pain management if it is serious) the pain management Doctor may not be around (or they prescribe is two asprin and call me in the morning)! So, don’t be surprised if this happens. This will be the inevitable result if we keep lynching our profession pain Doctors when a few bad apple-criminals infiltrate their practice and lie that they are in pain to them and they trust the “patient” and prescribe something to treat the pain more powerful than asprin.
    Soon, if this attack on professional, ethical, and conscienceious pain Doctors continues, Doctors in general won’t be able to believe what you tell him are your symptoms if it includes “pain” — if the pain Docs who take the worst complex patients in pain can’t treat appropiately and agressively as they are taught (when the are taught)which is what I would want if I was in terrible acute pain, soon all Doctors will follow suit and not treat pain as being too risky (prison for the first mess up?).
    Indeed, its already happening as even today most of the US chronic pain patients, even those with clear proof of a known pain-causing injury or disease cannot get appropiate treatment in their area. Some are forced, if they are lucky, have to travel long distances for treatment, as chronic pain is simply no longer treated by family Doctors any more.
    In most of the US, if you say you are in “chronic pain”, you are sent to a “pain clinic” that will probably do all sorts of invasive shots, procedures, and tests on you, ALONG WITH THE HIGH COSTS OF SUCH THINGS, but ask for a simple opiate prescription medication which might be better all around AND CHEAPER you are told “sorry, we don’t prescribe opiates” and shown the door because you are now “drug seeking”! Forgive me, but people ask for certain medications all the time with today’s advertising, but, do it for a pain med, and your shown the door in most practices today.
    So, although I truly understand your issues and know what your anger is like, and your grief, do you really want to end pain treatment that has saved the human race countless suffering over centuries and made people’s passing terribke suffering? Would you prefer those in pain suffer through their last days and hours when a prescription for a well known pain medication, that has worked for thousands of years and is and safe and effective, stays safely in the Doctor’s office?
    Personally, I cannot see anyone suffer when I know safe and effective pain medications are available — if only we can could count on those Doctors being around — because if the attack on them continues their won’t be anyone to help stop someone’s painful suffering! We cannot allow this to happen as we will be gowing backwards thousands of years!
    Murph

  5. Jennifer. I’m sorry that your mother died. Medicine is not an exact science. Unfortunately any death of any patient is used by the DEA and prosecuters in these cases as though they were deliberate murders. In Frank Field MD’s trial the death of a patient as a PASSENGER in a car was treated as a manslaughter charge.
    In the vast majority of drug related medical trials, including this one, witnesses and evidence are withheld from juries. Five past Presidents of the American Pain Society wrote to the judge expressing that view, and I’m afraid that I take their opinion over yours. In addition in the Hurwitz trial the only time that an “absurd” amount of opiates was “prescribed” was a clerical error that was corrected and the prescription was never filled. Every other amount was within the guidelines that the DEA had themselves agreed, but guidelines they withdrew when Hurwitz proposed using them in his defense.
    Your mother died and I’m sorry, but there are many, many more who are living in unbearable pain and cannot get easily available medical help because of the policies of the DOJ and DEA. How putting Hurwitz in jail for longer than mass murderers helps them or your mother is beyond me.

  6. These men are not all innocent. Hurwitz killed a patient within 33 hours of her initial visit. She was no drug addict, she was a mother of 3, a wife, a daughter, and in pain. She went to him to seek relief, he gave her meds for the first day, sent her to her hotel, the next day he DOUBLED the amount – sent her to her grave. He KNOWINGLY perscribed absurd amounts of drugs to dealers. Sending money to his legal aid fund is a joke. He divorced his wife – giving her all assets, but never moved out of the home, it was all a ploy to hide assets and you saps are sending an already very rich man – more money. The old saying – a fool and his money are soon parted….He was indicted on over 60 counts and found guilty on 59. that is a lot of evidence, and crimes to be found guilty of. There was no mistake. The man lost his license once, was warned by the medical board FOUR times – he knew damn well he was practicing medicine outside the bounds and never even slowed down. He got what he deserved. My mother however died – I assure you that she did not deserve death!

  7. This really made me mad, too:
    //Mr. Paey was to blame for refusing a plea bargain that would have kept him out of jail.//
    It’s nothing but State extortion to pressure someone to plead instead of dealing with their possible innocence. Jerks.

  8. Matthew:
    Perhaps we should post the contact info for the Hurtwitz appeal fund on the site?

  9. The Paey situation is unbelievable. It seems to me even if he is released from jail, there’s nothing that will make up for the ill treatment and public embarrassment that he’s already been through. Didn’t anyone stop to think that the doctor had a pretty strong motivation to lie? In this case the State is just like a rowdy little boy breaking all the dishes in the kitchen and then calling for “time out” after maximum damage has been done.
    It’s not just that the State and legal system have been turned inside out to destroy the citizens that they are supposed to defend, protect, and keep free – this article hints at the public attitudes that play a role. Paey’s wife commented, “At first I was mad at him for not being able to get better without the medicines,”. To me, this is emblematic of the way people prefer to punish their fellow human beings before helping them. Other people have become potential burdens, treated with suspicion, disapproval, and disdain. Either their problems don’t matter because they’re someone else’s or they’re dragging people into their problems if they show you how their problems do indeed have wider implications. I have nothing but sympathy for Paey in this case and outrage at a society that would let this happen to him. A few people might wring their hands over this article, but no one is actually going to do anything to help him. 🙁

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