You have the drug seekers to thank

Yes, the old office line of “Go to the ER and a doctor is waiting for you.” The most mislieading statement that can be given to a patient.

Statement by patient of “I want to speak to a hospital administrator” will not make any friends. In my ER that statement will put you in the farthest corner chair and garantee you will be the last patient seen.

Most people know my position on this subject.

Once a doctor is accused or arrested for allegedly “overprescribing” opioid pain medications it becomes obvious that one is “Guilty until proven innocent” – not withstanding what the public has learned over the years that our constitution supposedly guarantees the opposite.

All the prosecutor has to do is get up and keep repeating the statute-and it sounds like the verbal truth to newspapers, the public, judges and, especially, juries.

In Pennsylvania – if the pain specialist practices in good faith, examines and counsels his patients and has no reason to believe his patient is an “addict,” the statute protects him [ supposedly ] from being convicted.

In federal courts [ especially the Fourth Circuit ] there is a requirement for direct patient testinomy that the doctor purposely issued a prescription knowing that it was designed or probably designed for diversion.[ U.S. v. Tran Trong Cuong ]

These are called the “Criminal standards” for conviction.

Most pain specialists practice in good faith. I did.

This doesn’t keep them from being prosecuted. They are prosecuting me.

Since there is no proof that I purposely wrote prescriptions just for profit or for the purpose of being diverted [ sold ], the prosecutors then turn to the “Civil standards’ for conviction; where they try to convince everyone that because a doctor has a lot of patients and prescribes higher dosages–they must be running a “Script Mill.”

In addition – I can prove that all patients were eamined.

A letter written to The DEA [ Karen Tandy ] in 2005 by 30 states attorneys general-including Pennsylvania’s – specifically goes on record to criticize prosecutors for using these “Civil standards” as “Indicia of diversion.”

This letter furthur outlines and emphasizes the fact that there are “Nuances” in practicing pain management which make it very hard to separate legitimate from illegitimate prescribing. Lots of pills and lots of patients doesn’t mean the doctor wasn’t doing the medically correct thing. The attorney general letter supports this.

Bottom line — there are no solid guidelines beyond which doctors cannot venture in order to be considered legitimate. In addition – there are no defined dosage ranges in ANY FEDERAL OR STATE STATUTE beyond which one cannot venture [ once having eamined the patient ] without being considered to be “Guilty” of overprescribing.

Despite this, the Attorney General of Pennsylvania has used the awesome power of the state, along with their website and press releases, to denigrate me, and some others [ Doctor Heberle, in Erie was found not guilty several months ago - despite similar attacks on his practice ]in their efforts to obtain convictions – at any cost.

It is a difficult thing for a caring and scientifically oriented pain specialist to have to be confronted with this type of situation. If I am convicted-without any solid evidence against me [ because I never violated the statute ] I would suggest to all of you that you proceed with etreme caution in treating pain patients.

I have given my career to treating chronic refractory pain-without aforethought for strict profit motivation.

The DEA letter from the attorneys general states that ‘pain specialists often see many patients because other doctors are afraid to treat them-for fear of being prosecuted.’

If you examine my case you’ll see why.

I am facing from 11 to 40 years in prison. They offered me a plea agreement to serve only one or two years for an exchange of pleading guilty to all 11 counts of overprescribing.

I said “No” because I believe to give in to their accusations places all pain patients at risk for being victimized by the other treatment options available to them–which most often don’t work; long term. [repeat series of epidural and neurolytic nerve blocks- repeat attempts with physical therapy ]

Many patients need high dose opioid therapy-until we find better drugs.

Against that background, the state prosecutors need to “Rack up” prosecutorial ‘counts’ to show the public they are doing something to win a war on drugs.

I was a perfect target because I saw lots of patients – but also turned a nearly equal number away. They don’t tell you that part – because it makes me look too legitimate.

I practiced “Due diligence.” they practice deceit. They may win because they have myth and prejudice on their side.

All I had was my medical opinion that the patients I treated needed their medications. Based on my solid clinical eperience and failure of patients to improve with interventional techniques.

The sad part for doctors is that my medical opinion may not have been enough.

Would you like it if they decided to prosecute doctors whose patients went into insulin coma or had an MI while not properly controlled by HBP medications?

Think it can’t happen? You better be sure.

Forgive my cynicism , but I took over a “Crohn’s” patient in terrible pain etc , etc who turned out to have …………narcotic bowel problems. His idiot family think that they should sue his previous GP for not treating his “pain” correctly.I would like to change his title to:
“A big F##CK you to drug seeking assholes who think every pain is a 10/10 emergency and proceed to be rude to the staff”