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Pain Clinic Doctor [Guenther] Ignored Protocol
 

 
Michelle Krupa; The Times-Picayune (New Orleans); 2006-07-09. Posted: 2006-07-15.
[Identifier: http://www.doctordeluca.com/Library/WOD/WPS13-NoPillMill/NoPillMillDocIgnoredProtocol06.htm]
[Source: http://www.nola.com/search/index.ssf?/base/library-106/1152429862258250.xml?ZZLIBB&coll=1]
 
Related resources:
PAIN RELIEF NETWORK website
 
War on Doctors Academic and Legal archives  ;  Drug War Journalism and Advocacy archives
  
See also:
The New Orleans 'Pill Mill' Case - Venal Pols and Prosecutors Conspire to Ban Pain Management
WAR ON PAIN SUFFERERS #13; compiled by Alexander DeLuca; 2006-07-15
 
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A physician who has admitted to writing hundreds of prescriptions for an addictive drug cocktail while he worked at three suburban New Orleans pain-management clinics told a federal jury Saturday that he complained to the clinics' manager that lapses in medical protocol were allowing patients with little evidence of injury to be seen by doctors.

Dr. Joseph Guenther, who pleaded guilty last month to four felony counts of prescribing narcotics without a legitimate medical reason and one count of conspiracy, said he told Cherlyn "Cookie" Armstrong in 2002 or 2003 that patients with outdated or phony medical-imaging test results, or with no medical reports at all, were getting appointments at Scherer's Medical Clinics in Metairie, Gretna and Slidell.

He also described substandard facilities, such as examining rooms without patient tables. But Guenther said that despite the inferior conditions, he continued to sign pre-typed prescription forms authorizing a potent combination of drugs -- painkiller hydrocodone, anxiety drug Xanax and muscle relaxant Soma -- for patients who paid cash for their appointments and for the medications at Armstrong's pharmacies.

Also taking the stand Saturday in the trial of Armstrong and Dr. Suzette Cullins was the mother of a former patient of the Metairie clinic and pharmacy who said she faced a communications barrier when she tried to contact Cullins and Armstrong. The mother, Debbie Smith, said she wanted to tell them that her 21-year-old son had become addicted to the pill cocktail and to beg them to stop treating him.

Armstrong, a registered nurse, and Cullins face charges of conspiracy to illegally dispense controlled substances without a medical purpose. Armstrong, who is also charged with money laundering, is accused of running a bogus medical business where virtually anyone who showed up with cash could get an appointment at one of the three storefront clinics. Guenther said he took his complaints about office procedure directly to Armstrong. In the end, he said, he saw no change in operations.

"I approached Cookie," Guenther said.

"And what was her response?" Assistant U.S. Attorney William McSherry asked.

" 'I'll take care of it,' " the doctor said.

"Did the patients (without legitimate MRIs) continue to present to you?" McSherry asked.

"Yes," Guenther said.

Mother's testimony
Smith told jurors that her son, Joshua Smith, visited the Metairie clinic from 2003 to 2005, returning home each time with bottles of hydrocodone, Soma and oxycodone prescribed by Cullins and at least two other physicians.

Smith testified that she and her husband called paramedics several times after discovering their son unconscious with pill bottles strewn near his body. After reading the labels on the bottles, Smith said, she tried to contact a prescribing doctor.

"I called Scherer's clinic and asked to speak with Dr. Cullins," Smith said. "I told them that my son, Joshua Smith, was a patient of theirs and that he was an addict. They told me that there were (federal patient privacy) laws and they didn't want to hear it."

Smith also said she sought help from the Justice Department's Drug Enforcement Administration, which spent several years investigating Scherer's before shutting down the chain in a series of raids in April 2005.

Prosecutors on Saturday played tapes of three conversations recorded secretly by the DEA during which Smith tried to leave messages for Armstrong and Cullins with Scherer's receptionists.

Smith testified that Armstrong returned one of her calls, though Smith could not talk with her at the time because she was at a local hospital attending to her son, who had overdosed on pills prescribed at the clinic. Smith said Scherer's managers never responded to a letter she sent in August 2004 describing her son's addiction.

Longtime customers
McSherry displayed for jurors an armful of Joshua Smith's amber plastic pill bottles that Smith said she had turned over to the DEA. But sifting through the bottles, defense attorney Richard Westling pointed out that several of them were unlabeled or had stickers indicating they had not been prescribed by Cullins.

Defense attorney Jeffrey Smith, no relation to the witness, also challenged Debbie Smith on why she had not urged her son's probation officer, or the prosecutor or judge who dealt with him in a 2002 felony drug case, to get him sent back to jail for violating probation by misusing prescription medicine. Smith said that in an attempt to help her son quit the prescription medications, she had told the probation officer and a Jefferson Parish assistant district attorney about Joshua Smith's addiction but did not realize she could take her plea to the judge.

Prosecutors continued Saturday to lay out their case that Scherer's clinics were "pill mills" where patients could return every two weeks to receive a fresh stockpile of medication, after visiting with doctors for less than four minutes.

Devin Johnson, who worked as a nurse technician for Armstrong for three years, and Felicia Thomas, who managed records and completed patient assessments for four months in late 2004, testified that despite the written mission of the clinic to treat pain for short periods of time, most of the roughly 200 people who came through the three clinics each day were longtime customers.

Most patients, they said, regularly said their pain registered at a 7, 8 or 9 on a scale of 0 to 10, despite years of treatment with the three medications, known as the "holy trinity."

Johnson said she believed that only about half the patients she saw actually were in pain, while 25 percent were misusing the prescribed drugs, possibly by selling them on the street; the remainder were addicts, she said.

But Johnson, who said she had no medical training at the time she worked at Scherer's, testified that she never told her bosses about her suspicions.

"It was my obligation to do the patient assessment, and they have the doctors to determine if the patient was actually in pain," she said.

Michelle Krupa can be reached at mkrupa@timespicayune.com or (504) 826-3312.

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