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Hurwitz Takes the Stand
Jury begins deliberations on the 62-count indictment against McLean ‘pain doctor.’

by Ken Moore; The Connection Newspapers; 2004-12-09. Posted: 2004-12-10; Modified: 2006-08-31.
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Related resources:
War on Docs Academic, Legal and Official documents  ;  War on Docs Journalism collection

See also (from The Dr. William Hurwitz collection):
Pain Doctor William Hurwitz Wins Appeal, Gets New Trial - Drug War Chronicle #450; 2006-08-25
The Doctor is Not a Criminal - Jacob Sullum; National Review; 2005-05-23
Back to Square One: Fed Appeals Court Order New Trial for Hurwitz -
Ken Moore; The Connection; 2004
War on Doctors/Pain Crisis blog and RSS feed

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  Photo: Ken Moore

[Skip to SIDEBAR: 'Doctors story', and Hurwitz testimony excerpts, follows the article text]

Some past patients say Dr. William E. Hurwitz saved their lives.

Before he found Hurwitz on the Internet, Sylvester Boyd testified Friday, Dec. 3 that he suffered 12 years with "constant, nagging, unrelenting pain - just pain, pain, pain - it nearly destroyed my life."

"I was at the end of my rope. It gets to a point where shockingly suicide is not an option you're willing to dismiss," testified Boyd, 50, who suffered bone fractures, muscle and cartilage tears in his back during a fall at an ice skating party he held for his daughter about 15 years ago.

Boyd was not the only grateful patient.

"Dr. Hurwitz saved my wife's life, said Charles Barnhart, of New Mexico, following his wife Molly Shaw's testimony last Thursday. "I hope she got to the jury; I know every time she talks about it, it gets to me."

PROSECUTORS DON'T DISCOUNT the care some patients received from Hurwitz, 59.

But the 1,879,677 pills prescribed by Hurwitz to just 24 of the 400-plus patients he treated from 1998-2002 led to drug addiction, drug dependency and death, according to Assistant U.S. Attorneys Eugene J. Rossi and Mark D. Lytle.

Kilee Hoskin's uncle, Rennie Buras of New Orleans, died in 1999, under treatment by Hurwitz. "This man built planes and boats and things with his bare hands," testified Hoskin, 25, during the third week of Hurwitz's trial, which began Thursday, Nov. 4. "[Paramedics] thought he was retarded, that's how the pills affected him."

Prescriptions Hurwitz wrote for OxyContin, including the 68,700 total pills he prescribed for Bret McCarter and the 63,530 pills Hurwitz prescribed for Kevin Fuller, led to illegal drug sales in Manassas, other parts of Virginia and Tennessee, according to prosecutors.
More than 15 convicted felons, most from Manassas and many related to each other, testified against Hurwitz.

"I think he enjoyed it. I think he lived vicariously through us," testified Timothy Urbani, 34, who faces 20 years in federal prison for charges including conspiracy to distribute OxyContin and robbery of OxyContin from a pharmacy. "At the time, I thought [the pills] were helping me, but I'm in all this trouble now. … I wasn't there for my kids for three to four years, now I won't be there for a long time."

Hurwitz's defense attorneys Patrick S. Hallinan, Kenneth H. Wine and Marvin D. Miller called the convicted dealers "predators" who abused the doctor's trust, lying about or exaggerating their pain to obtain drugs from the nationally-known doctor who specialized in high-dose opioid therapy for people with unrelenting chronic pain.

FOLLOWING 19 DAYS of testimony, from 63 witnesses for the prosecution and nine witnesses for the defense, Hurwitz took the stand on Monday, Dec. 6, in the United States District Court for the Eastern District of Virginia before Senior Judge Leonard D. Wexler.

Hurwitz testified Monday that he showed all potential patients literature suggesting that "opioid treatment is not for everyone."

"It was an attempt to discourage people from opioid therapy unless they have exhausted other options," Hurwitz testified. "I wanted patients to understand that treatment with opioids was a complicated practice with risks."

Hurwitz, who closed his practice in December 2002, faces a 62-count indictment, including charges of conspiracy to traffic in controlled substances, drug trafficking resulting in death, drug trafficking resulting in serious bodily injury, drug trafficking distributions, engaging in continuing criminal enterprise and health care fraud.

Still posted on Hurwitz's Web site is a request to patients, foreshadowing the possible 20 years in jail or more that he faces for each count of the indictment.

"More than in most clinical circumstances, the failure of patients to act intelligently, responsibly and honestly can lead to disaster," reads the Web site. "For all of these reasons, patients who undertake opioid maintenance therapy should behave in a way that is beyond reproach or suspicion in all matters relating to their use of medications. Patients who are unwilling or unable to do so jeopardize not only their own health and safety, but the health and safety of other patients with chronic pain."

Advocates for patients with chronic, severe pain are watching the trial closely. The treatment of pain is a human rights issue, said Mary Baluss, director of the Pain Law Initiative, who has attended most of the trial.

"I'm worried that high-profile trials will have a negative impact on the treatment of pain," said Dr. Steven Passik after serving as a witness for the defense.

THROUGHOUT THE TRIAL, prosecutors Rossi and Lytle emphasized that Hurwitz deliberately ignored obvious "red flags" of abuse and distribution, giving examples of patients who:

* Gave frequent excuses about lost or stolen prescriptions

* Ran out of medication early

* Tested positive for illicit narcotics

* Tested negative for medications Hurwitz prescribed

* Injected medications, which should have been taken orally

* Had track marks and ulcers on arms

* Showed cocaine rashes on skin

* Reported current or past addiction

* Were arrested for distributing Hurwitz's medications or illicit substances.

Bret McCarter, whose street name was "Mav," testified that he smoked crack before visits to Hurwitz so "I could look straightened out when I made an appearance."

McCarter paid $15,000 to $20,000 a month to fill prescriptions for OxyContin, Dilaudid and Methadone, he testified, and said Hurwitz called him a "high-risk patient."

"At the end, he would always continue writing the prescriptions," McCarter testified.

Hurwitz testified that McCarter was one of his high-dose patients who was treated for pain resulting from failed back surgery. McCarter's mother wrote Hurwitz a letter saying she was subsidizing her son's treatment, Hurwitz testified.

HURWITZ'S TESTIMONY was scheduled to continue Tuesday with prosecutor Rossi's cross-examination, after The Connection's press time. Defense attorneys plan to introduce a few more expert witnesses, after Hurwitz’s testimony concludes.

After closing arguments by the prosecution and defense, the jury is expected to begin deliberations later this week.

Hurwitz's attorneys say he is not guilty of any of the charges, that he cared for patients who could not get adequate care elsewhere.

ABOUT 50 PEOPLE including Hurwitz's two daughters, mother and two brothers watched his testimony Monday.

"Imagine the feeling of betrayal," said his brother Kenneth Hurwitz, senior associate with Human Rights First. "He has gone out of his way to help people and give people the benefit of the doubt.

"It all seems so incredibly unjust. If he made mistakes, they were mistakes that were out of his good faith and his attempt to help people," Kenneth Hurwitz said.

From 1998-2002, Hurwitz, who has remained free after posting a $2 million bond, treated more than 400 people for chronic pain. He testified that he terminated treatment for 17 patients, but sometimes continued treatment for problematic patients that he thought he could help.

"I believe all the patients have pain," Hurwitz testified.

SIDEBAR:  Doctor's Story

Dr. William E. Hurwitz, of McLean, took the stand at his trial on Monday, Dec. 6, at 10:45 a.m. Following questions from his defense attorney Marvin D. Miller, of Alexandria, Assistant U.S. Attorney Eugene J. Rossi's cross-examination of Hurwitz began at 4:50 p.m. Rossi's cross examination continued Tuesday, Dec. 7, after The Connection's press deadline. Hurwitz faces a 62-count indictment. Closing arguments in his trial are expected to be presented this week.

Dr. William E. Hurwitz began by answering questions from his attorney about how he came to specialize in pain treatment and the difficulties he had with it over more than a decade.

Hurwitz was sanctioned by the Washington, D.C. Board of Medicine in 1991. Trouble for Hurwitz occurred, he testified, after he prescribed medication to one of his patients whose wife was dying of breast cancer and provided a stock bottle of Percocet to a doctor in Paraguay.

"The experience before the D.C. Board introduced me to literature about pain as well as to people who were involved with pain research," testified Hurwitz, who volunteered as the medical director for Peace Corps Brazil in the 1970s and practiced internal medicine in Washington, D.C. from 1978-1991.

By that time, Hurwitz, who treated his first patient with chronic pain in 1978, had five chronic pain patients.

"Having a patient with a problem focuses your attention," he testified.

The number of patients he treated for chronic pain grew to 200 as his understanding of treatment with opioid therapy grew, he testified. "There is no clinical limit to what a patient may require to experience relief," he said, addressing the very high doses of pain medications he prescribed for many of his patients. "Opioid exposure appears not to cause any damage."

But in 1996, Hurwitz's license was revoked by the Virginia Board of Medicine and he was required to complete continuing medical education in the pharmacology and physiologic actions of drugs, psychiatry and addictionology and in record keeping and practice management.

When he resumed a practice specializing in opioid therapy in 1998, he required patients to fill out a consent agreement form, letting patients know they would be terminated if they abused medication, illicit drugs, sought prescriptions from other doctors or sold drugs that he prescribed.

"This gave me the flexibility to discharge a patient," he said. Hurwitz testified that he counseled patients, alerting them to the dangers of opioid therapy and the associated social complications and financial burdens.

Hurwitz said his $1,000 initiation fee and his monthly fee, which ranged from $125 to $250 during the course of his practice, covered the cost of all visits no matter how many. "I wanted patients to talk to me, and not to worry if they could incur further charges. I wanted them to have open access to me."

He also trusted patients to monitor their own pain relief. "Pain fluctuates from patient to patient, I believed my approach with patients should be to give them freedom to control pain," he testified.

By the fall of 2001, Hurwitz said he started ordering drug screens of patients when he said he realized a percentage of his patients were abusing cocaine and his prescribed medications.

"I didn't have a concept of red flags, I had concept of aberrant or problematic behaviors."

"I was aware of the investigation of me beginning in early 2002,"
testified Hurwitz, who said he was "shaken up" by a number of his patients' positive urine screens for cocaine use.

"I was wrestling with this issue, trying to reconcile how to deal with these patients," Hurwitz said.

But abrupt termination was never a reasonable option, only tapering patients down from high doses, he testified.
"[Abrupt stoppage of opioid medication] subjects people to a form of torture."

Hurwitz announced the closure of his practice on Sept. 1, 2002.

4:50 P.M., MONDAY, DEC. 6
Prosecutor Rossi greeted Hurwitz on the stand.

"Good afternoon, Dr. Hurwitz."

"Good afternoon, Mr. Rossi," Hurwitz replied.

Rossi then referred to the 1996 order by the Virginia Board of Medicine, which revoked Hurwitz's license in 1996.

"Stephen Bresko passed away on Jan. 15, 1996 in Pigeon Forge, Tennessee. Is it true that he was a patient of Dr. William Hurwitz?" Rossi asked.

"True," Hurwitz replied.

Rossi repeated this process for one other patient mentioned in the Virginia order and with two of Hurwitz's patients who died between 1998-2002.

"From January 1996 to February 2001, you were prohibited from practicing for 23 months. So in 39 months you had four patient deaths and a patient come near death," Rossi said. "You averaged a death every eight or nine months, true?" …

"The charges in this court order are eerily similar, if not identical to many of the things we heard from patients and their records in this trial, true?" Rossi asked

"The charges appear similar," Hurwitz said.



Dr. DeLuca's Addiction, Pain, and Public Health Website

Alexander DeLuca, M.D., FASAM

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Originally posted:  2004-12-10

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