Alexander DeLuca, M.D.
Addiction, Pain, & Public Health website

[Home] [Library]  [Slides]  [Search]  [Medline]  [Links]
 
Statement of Purpose; Privacy policy; Email Confidentiality Policy; Statements of Ownership & Sponsorship; Advertising policy

'War on Doctors' Hits Where it Hurts

 
Sid Pranke; Pulse of the Twin Cities; 2005-12-15; Posted: 2005-12-15; Modified: 2006-06-07.
[Identifier: http://www.doctordeluca.com/Library/WOD/WodHurts05.htm]
[Source: http://www.pulsetc.com/article.php?sid=2211]

Related resources:  War on Doctors Journalism and Advocacy collection
 
See also:
WAR ON PAIN SUFFERERS #6 : The Myrtle Beach Massacre (Drs. Bordeaux, Alerre, Jackson, and Woodward)
 
War on Doctors and Pain Crisis Weekly - RSS feed:   HTML view:
 

[Full Text of this Article in Adobe PDF format]

Dr. Stephen Zuckerman, who like any other medical doctor who has treated patients complaining of pain, knows that finding out "where it hurts" matters. He designed "pain-o-meter ratings," which can range from annoying (try Advil, Aleve, Tylenol or aspirin) to I Want Drugs Now! (Co-Tylenol, Vicoden, Percoset). Besides devising the pain ratings, Zuckerman went many steps further in educating himself on how to best treat his East Lake Street patients who suffered from chronic pain.

About six years ago, he had to make a choice-either drop out of treating "shunned" patients who need opiate therapy on a chronic basis (prescription drugs like Vicoden) because of the difficulties of determining whether opiates should be part of a patient's treatment-or step up to the challenge. He stepped up-taking a 30-hour course on the subject offered by the state's Board of Medical Practice. In addition, he attended talks on opiate use, read voraciously on the subject, and since 2001, developed and began using an "opiate contract" for every one of his patients on chronic opiate treatment. He conferred with Twin Cities area pain specialists, and developed a "mentorship" program, an idea he had experience with in rural areas of Minnesota. The new program's focus was meant to be educational on pain management issues, and involved experts addressing real case problems.

Since then, Zuckerman's practice has changed dramatically. On the basis of only one case, he got into trouble with the state's medical board. He was reprimanded by the board, and although not as serious as suspension or revocation of his medical license, the experience "scared him off" of treating chronic pain patients who need opiates as part of their care.

After spending $30,000 on legal fees and suffering through months of frustration, Zuckerman feels he was mistreated by the state. Zuckerman argues that the board had no real basis for going after him, since the case it looked at was a single mistake, not "a pattern of substandard care" that the board is supposed to evaluate, he said.

Zuckerman said that in the case of one patient, he was "slow to appreciate" what had become an addiction for them, and that he "felt bad that this person had become an [prescription drug] abuser."

The very real difficulties and dangers associated with continuing to treat patients who need opiates on a chronic basis was enough to scare off Dr. Zuckerman, though he continues to worry about who will treat them if he doesn't. As he states in a recent letter to state board: "The result of the inquisition was to shock and frighten me. I stopped accepting 'pain' patients and tried to discharge my patients on chronic opiates for pain management to other physicians. Not surprisingly, I found almost no one was willing to care for these people … I was asked to continue to practice pain management at Aspen, but I said absolutely no. I had lost all confidence that no matter how I practiced, I would still be vulnerable to 'prosecution and punishment' by the Attorney General's office and the board. Apparently, all of my colleagues had already figured that out."

Other doctors around the country are figuring that out too. According to a recent article in the "Drug War Chronicle," three doctors who ran the Comprehensive Care and Pain Management Center in Myrtle Beach, S.C., believed they were following accepted medical practices for prescribing opiates for chronic pain management; instead, now, they face hard time. Drs. Deborah Bordeaux, Ricardo Alerre and Michael Jacksen now face 24, 19 and eight years in prison, respectively. The doctors have appealed, and have the support of national advocates, the "Pain Relief Network," although it is not clear whether that will help them fight federal Drug Enforcement Administration (DEA) charges. The article says the doctors' prosecutions are part of a trend, as the DEA "attempts to clamp down on prescription drug abuse," though medical boards deny the so-called trend.

There is no comprehensive data source on whether DEA investigations or other actions targeting physicians have increased, according to a recent issue of Practical Pain Management. (However, the Federation of State Medical Boards does keep a database of all state medical board actions.)

DEA opiate guidelines for medical doctors and their patients, while perceived as being in flux at this time, have involved screening the number of opiate patients in a doctor's care as well as duration of opiate therapy, and also monitoring something called "serial prescribing"-which a DEA website has described as a practice of preparing multiple prescriptions with instructions not to fill them until a specific future date.

Other methods of determining whether patients truly require opiate care (or whether they are already addicts) include urine testing and referral to specialists such as neurologists. Zuckerman has suggestions as well for the state medical board to help ensure that other doctors are still willing to treat chronic opiate patients. They include: first time "offenders" who clearly mean to do the right thing should be investigated and educated, not prosecuted and punished; investigation documents produced by state bodies or agencies should be reviewed by a knowledgeable medical authority before publishing it, to detect and eliminate significant errors; the state board and the Attorney General's office should promote development of a confidential "registry" bearing names of patients with proven addictive histories. "The [state medical] board should not use facts reporting that the number of physicians disciplined for improper use of opiates has not increased over the years to allay physician fears … no increase in disciplinary action may only mean that the board has been successful at 'scaring physicians off.' This is certainly true in my case," Zuckerman said.

[Full Text of this Article in Adobe PDF format]

[END]