Skip to comments."The Doctor Wasn't Cruel Enough" - How one physician escaped the panic over prescription drugs
Posted on 06/05/2006 6:58:32 PM PDT by neverdem
When Dr. Paul Heberle was arrested last April, dozens of chronic pain patients were left in agony. One of Heberle's patients called no fewer than 37 doctors seeking careall of whom refused to see him once he revealed the name of his prior provider. Finally, Robert Holmes, a 40-year-old man who suffers from a lung injury and requires supplemental oxygen to breathe, resorted to visiting a methadone clinic for drug addicts. He was turned away there, too. More than twenty others reported similar experiences at a meeting of patients affected by the arrest. Six would later attempt suicide.
For many patients, the situation was devastatingly familiar. Heberle had agreed to care for many of them after their previous physician was arrested and then convicted on some of the same charges that Heberle now faced: illegal prescribing of narcotics. That doctor, David Klees, got 12 to 24 years in prison. This time, however, the government would find it wasn't so easy to railroad a pain doctor.
In the last five yearssince a media panic over prescription drug abuse began with law-enforcement-driven reports of an "Oxycontin epidemic"dozens of doctors have been prosecuted for "overprescribing" painkillers. The Justice Department and the DEA have pushed this aggressive new campaign in the war on drugs.
Overwhelmingly, these cases have resulted in convictions with heavy prison termsor plea bargains with shorter sentences that nonetheless drove the doctors out of medicine. Advocates for pain patients report that, as a result, relief has been increasingly hard to find.
Fortunately, Heberle had an ally that Klees didn't: Siobhan Reynolds and her Pain Relief Network. As the DEA and local prosecutors went as far as creating a poster with Dr. Heberle's picture and the words "overprescribing controlled substances" and "Medicaid fraud" on it, Reynolds visited Erie, PA, to organize Heberle's patients and, for once, get their side of the story into the media.
Nearly all of the prior cases have followed a similar pattern. First, prosecutors blitz local media with reports of out-of-control prescription drug abuse problems and discuss the problem of "pill mills." Then, they swoop in with a SWAT team and arrest any doctor brave enough to actually treat chronic pain with doses of opioid medication large enough to work. They call him a "drug dealer" and "pusher with a pen."
Next, the prosecution brings out addicts for the cameras, who claim the doctor treated them without examining them and "caused" them to develop drug problemsbut they don't mention the addicts' motivation for cooperating. In virtually all of these cases, addicts are motivated by reduced or dropped sentences charges from prosecutors, or by the hope of suing the doctors who got them "hooked." Prosecutors also usually fail to note that for most of these addicts, this is far from their first run-in with drug problems or the law.
At some point, however, the government team brings out its most devastating weapon: weeping relatives of patients who have died while under the doctor's care. Reporters are rarely keen to grill the grieving, so their stories tend to stress the prosecution's talking points rather than the fact that these deaths are virtually always either deliberate suicides or overdoses resulting from deliberate misuse of prescription medication. In the Heberle case, the death that started the investigation involved someone who had eaten a patch meant to be worn on the skinthus immediately ingesting three days-worth of drugs.
Usually, the media buy the tale of evil substances and vile physician-pushers. But Reynolds offered a more compelling alternative narrative. She brought the suffering patients into the media eye. Rather than telling the tale of an evil drug-dealing doctor who brings down the poor addict, she and the patients provided another version of the story, in which the wonderful healer allows his grateful patients to functionuntil the cops drag him away.
And in fact, Reynolds' account is more accurate. Some 90 percent of people who abuse Oxycontin also have histories of using cocaine and psychedelic drugs. Were most of these people innocent "victims" of evil doctors? Isn't it more likely that they were prior heavy drug users who sought additional drugs and, because there's no objective way of measuring pain, were able to get them from compassionate doctors? Aren't doctors who do believe people's accounts of pain exactly the ones we want in practice?
In the Heberle case, one prosecution expert told the Erie Times-News that the doctor was:
prescribing painkillers to patients with documented prior substance-abuse problems and/or mental impairment.
The paper didn't note that there is nothing illegal about this. Nor did the reporter seem to realize that there's something profoundly sick about assuming that people who are mentally impaired or have a history of drug problems never need strong pain medication.
Fortunately, in the Heberle case, the jury didn't buy the lies. Heberle made no profit from the prescriptions he wrote; he was a former addict himself who was monitored for abstinence. What possible reason could such a person have for deliberately supplying addicts? The only sensible way to see him was as a caring physician, who, like anyone else, does not have a "pain-o-meter" or fool-proof lie detection device in his head or office.
The defense presented expert testimony that laid out the complexities of pain treatment. Although the prosecution essentially put on a malpractice caserepresenting violations of the standard of care as criminal when they actually are civil violationsthe defense beat them back. Their cross examination of a prosecution witness who claimed that certain opioids should only be used for cancer pain was especially effective. The defense simply exhibited a small practice guide which shows that the medications are recommended for other pain as well.
Also effective was the defense expert, Frank Fisher, MD, one of the few physicians to be exonerated after being prosecuted for over-prescribing. He called the prosecution "a crime against humanity," and in conjunction with the defense team, debunked the idea that cutting off pain medication to people with past or even present addictions does anything to help them.
"They showed addictionology for the sham science that it is," says Reynolds, explaining that in previous cases, the defense often had a hard time getting the jury to see that medications can't "make" people into addicts and that no one, addicted or otherwise, benefits from a system where doctors presume all pain is faked.
"The government position is that the doctor wasn't cruel enough," she adds, describing how hard it was for previous defense teams to debunk the notion that addiction can be prevented or treated by stopping or failing to prescribe pain medication.
"By making the pain patients real, we made the good guys and the bad guys change placesand that's hard to do," she says.
Last week, Heberle was found not guilty on all charges. Unfortunately, at least one patient did not live to see the verdict she had committed suicide, unable to find another doctor to prescribe the medications she needed. And Heberle, like Fisher, will no longer practice medicine, leaving many patients still without help.
As Reynolds asks, "How can they call this protecting the public health?" We hope the Heberle case is the beginning of the end of these senseless prosecutions.
Maia Szalavitz is a senior fellow at stats.org, a media watchdog group, and author of Help At Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids.
We hope the Heberle case is the beginning of the end of these senseless prosecutions.
Yeah, good luck with that.
I'm sick of it. I'm a chronic pain sufferer and have been hard pressed to find an MD who will prescribe what I require for relief. It's bullshit. People wonder why some other people go off the wall.......Well, maybe it's because this so called "WAR ON DRUGS" does no good in getting the REAL CRIMINALS, it only turns honest people to go to the street and become "criminals" themselves, just for some deserved relief from their pain.
The "WAR ON DRUGS" is a farce, and all who support it know it and should feel some of the pain I do.
Bunch of sanctimonious sacks of shiite.
You let me know if you ever find some "lawmaker" who doesn't get the painkillers he or she needs. Just let me know.
dozens of doctors have been prosecuted for "overprescribing" painkillers.
AND....just what is to be considered "over-prescribing"? Doctors are required to treat for pain. There is no measurement for pain. There are no tests to determine how much pain a patient is suffering. How can they( the medical professionals) win?
Yeah, as long as it is directed at the people who help you.
I swear, I have never felt so violated by my own country as I do today. These assualts< I believe, are planned to divide and conquer America. Planned by people like Soros and that idiot, Soros. If they weren't; we wouldn't see innocent people being proscuted.
It's all about money, and keeping the DEA parasites on the government teat.
My doctor lost his licence for 2 years for over prescribing pain killers to his terminally ill patients.
I volunteered at hospice, they could give as many drugs as they wanted to their patients. I even asked them about it. They said they will give whatever is needed to get rid of their pain. They had no limit.
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While one has empathy for the genuine patient who has pain and needs these meds for pain control, it should be noted that some, and by no means not all, of these patients are conniving, cunning drug seekers who manipulate these doctors to get their pills. I have heard some of these folks trade info regarding doctors, as to how to contrive to get Oxy's, xanax, benzo's and other drugs, what to say and how to act. Their goal in life is to score the drug. They are not, in my opinion, as innocent as this article makes them seem.
It's not about the patients, it's about the drugs. Far better that thousands suffer than that one gets too much relief. Or, more cynically, it's just part of the War On Medicine being waged by the GOP.
I am not a naturalist. I believe in medicine.lots of it. i take tons of medicine every day for asthma, for migraines for depression and I have a great life. Without it I would have a not great life. I think the people all bent out of shape about Barry Bonds are off base -- he is the one who has the drive and the talent and the raw ability to connect with the ball, I think lawyers ought to stay out of pain med prosecutions and most possession for use prosecutions. The state of the law does not accurately reflect the needs or the good of our society.
The problem is pain treatment is a subjective science. How does the doctor know the patient is in pain and how much? On top of that is these pain medications are potentially addictive.
Have you ever been in chronic high pain?
It steals your life.
"Quis custodiet ipsos Custodes?" ( "Who guards the guardians?")
Honestly, who cares? So some junky manages to score some prescription drugs. It really has no impact at all on my life and only the addict is responsible for or can confront his addiction. On the other hand we all know someone at some point who is in chronic pain and needs relief, (it may even turn out to be ourselves), and I'd much rather err on the side of the suffering getting the medication they need.
The doctors are getting more protective because of prosecutions. Some have over-prescribed (like Elvis') but many are just plain scared now. Oxycontin is relatively cheap as a prescription (about $60-90 for 30 pills, I think) but work about $1800 on the street.
Pain pills only work short-term anyway. Chronic pain is a very difficult situation for the patients.
"Planned by people like Soros and that idiot, Soros..."
are you joking? its the DEA! our fed government doing this. wtf does soros have to do with it?
Convictions=funding=jobs=advancement opportunity=pay grade increases=better standard of living/retirement. Retirement is best enjoyed by those who do not get injured or killed on the job.
Why try to chase down Columbian narcotraffickers who are probably armed and will shoot you, when you can bust doctors for writing pain pill prescriptions?
Just bureaucops following the path of least resistance to career enhancement when they should be out going after the non-pharmaceutical crap on the streets.
(Denny Crane: "Every one should carry a gun strapped to their waist. We need more - not less guns.")
are you joking? its the DEA! our fed government doing this. wtf does soros have to do with it?
(Denny Crane: "Every one should carry a gun strapped to their waist. We need more - not less guns.")
The asinine reps in DC said:
"No. They might become addicted."
I wonder if, since then, any of these sanctimonious priggs have had to sit by the side of a loved one as they scream in unrelenting pain that the "allowed" drugs can't abate...and watch them die a long, barbaric death.
it's been going on for decades - and it's all the GOP
Funny, I remember when my son was going thru the worst of his cancer - Carter was pres...
The current way of validating these "real" cases (i.e. the patient commits suicide in despair) leaves much to be desired.
True - but why deny them to terminal cancer patients, for example, that are in excruciating pain - They wont live long enough to become "addicted" but this is the excuse the sleazy reps in DC used...
No, they have the wealth and connections to send these unfortunates to, say, Sweden where they will not suffer that way.
That is not true. The patient's doctor has to prescribe the medication. "Hospice" can't prescribe anything.
Depends on who is running the hospice. My Dad was in the only hospice available in his small town; it was in the hospital, and governed by the Doctors. He writhed in anguish while the idiots put morphine cream on his wrists.
We demanded in the last few days, after he was completely incoherent, that they sedate him. We were told that the Doctors were "afraid" to accidentally overdose him...a terminally ill cancer patient.
They upped the drugs; but not enough.
They also took out his saline IV without our permission...using the "no extraordinary means" provision that he had signed a few months earlier. That actually caused his incoherence and death. His lips cracked, while we desperately tried to get him any fluid that we could with their little "swabs."
The Doctors that allow this are ghouls and they should be forced to sit in the room twenty-four hours per day, right next to the family members, watching the biological effects that their decisions have on patients. The DEA agents who have caused this type of decision-making should be sitting right next to them.
And they banned Vioxx, that has to really stink.
I have chronic pain in my knees.
I take about 15 Naproxen pills a day, which scares the heck out of me.
Do you know of any other pain relievers that work?
There's a good possibility that a new class of pain relievers (not nsaids, acetominophen, nor opiates) based on poisons secreted by frogs will be available soon. The early results show promise. We can hope they are available sooner rather than later.
So is alcohol, yet you can buy as much as you want OTC if you are over 21.
Do you favor all chronic pain sufferes to just 'deal with it' because someone MIGHT be lying?
Why are government agents so cruel, heartless and vindiuctive towards suffering human beings?
Because, like a dog licking his testicles, they can!
I volunteered at hospice, they could give as many drugs as they wanted to their patients.Depends on who is running the hospice. My Dad was in the only hospice available in his small town; it was in the hospital, and governed by the Doctors.
My mother passed in May, she had colon cancer. My mother was cared for at home. Hospice came in once a week to check on her and one of the things they were suppose to do is make sure she was pain free. The last four months of her life, we (father and I) were constantly requesting that her pain medicine be increased. Every time we asked, the hospice doctor had to be called.
At one point, a couple of weeks before she passed, the dumb doctor prescribed that she go from 15mg of methadone every 6 hours, to 20mg of methadone every 8 hours. Which, when you do the math, is exactly the same amount of methadone she was taking already, 60mg a day. Her 15mg dose wasn't lasting six hours. That was with oxycodone (20mg) every four hours. Somehow he expected a 20mg. dose to last her an even longer period (8 hours) and drop the oxycodone. The nurse said he was a "very conservative doctor". She said that she had to recommend what the doctor prescribed. I told her that I didn't agree with "their" doctor and that my mother was going to be free of pain, She said she could only say what the doctor recommended, but that she agreed, it didn't make any sense.
It was up to us, after she left we put her on the 20mg dose of methadone every 6 hours and took her off the oxycodone every 4 hours. It helped her tremendously and I don't regret "over ruling" the doctor, not one bit.
So, for the last month on my mother's life, I managed her pain. Her "hospice doctor" for some reason, had other things to "worry about" and they had nothing to do with whether mother was in pain or not. I still don't understand what the doctor was concerned about, it couldn't be that she would become addicted, she was dying. Maybe a lawsuit? Maybe an overdose? Maybe it was just because she was at home and he had only seen her once the entire 4 months she was bedridden? Maybe he was worried about what the government or a lawyer was going to do to him FIRST and what he should be doing for mother(the patient)LAST. Who knows?
One of the "benefits" of the War on Drugs.
Libby's paper outlines a particularly heartbreaking example of opiophobia from Time magazine a few years ago: A doctor tells the reporter about a young boy who's in the final stages of terminal cancer. He's in agonizing pain. His father refuses to let the physician give the kid the morphine that would prevent him from spending his last days in pain. Why? He told the doctor, "I don't want my son to die a drug addict."
That is a shame. I did not know there was such a big difference between places. The hospice center I was at never said "NO" to anyone.
The nurses asked people 10 times a day the level of pain they had. They just had the doctors increase their meds, and they did. No questions asked.
If fact, that was their policy. Whatever it takes. No one should suffer from lack of pain meds.
They knew people become immune after awhile and will need more and more to manage their pain.
Not giving adequate meds is in itself medical malpractice! What a horrible article. Those who have chronic pain know what it's like to try and manage on over the counter crap. It doesn't work.
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