Posted on 8/6/2007, 6:14:36 AM by neverdem
At a recent congressional hearing, Joseph Rannazzisi, an official in the Drug Enforcement Administration's Office of Diversion Control, proclaimed his agency's "firm commitment to the balanced policy of promoting pain relief and preventing the abuse of pain medications." The DEA, he said, wants to "help physicians meet the challenge of ensuring that people who medically need drugs get them, and that those who are diverting them don't."
This "balanced policy" is a "challenge" because pain cannot be verified objectively. The only sure way of "preventing the abuse of pain medications" is to stop treating patients with them, which would leave millions of people in agony. The alternative, trusting patients when they say they're in pain, means taking a chance that some of them are faking or exaggerating, seeking narcotics to get high or to sell on the black market.
Fortunately, the DEA is there to help by arresting doctors who trust their patients too much. The day after Rannazzisi testified before a subcommittee of the House Judiciary Committee, one such doctor, William Hurwitz of McLean, Virginia, was sentenced to five years in federal prison.
That punishment was much lighter than the 25-year sentence Hurwitz had received after his first "drug trafficking" trial, but it was still pretty severe for someone who had not actually engaged in drug trafficking. Hurwitz's crime was prescribing painkillers for patients who turned out to be addicts or drug dealers.
In his first trial, the Justice Department argued that it did not matter whether Hurwitz had prescribed those pills in good faith, and U.S. District Judge Leonard Wexler instructed the jury accordingly. A federal appeals court disagreed and ordered a second trial.
In addition to new jury instructions, Hurwitz benefited from a more open-minded judge this time around. Although U.S. District Judge Leonie Brinkema said she was initially inclined to agree with the prosecution that the doses of narcotics Hurwitz had been prescribing were "absolutely crazy," the defense persuaded her that "an increasing body of respectable medical literature and expertise supports those types of high-dosage opioid medications" for patients suffering from severe chronic pain.
Before the case went to the jury, Brinkema dismissed three charges that carried 20-year mandatory minimum sentences, finding that the prosecution had not provided enough evidence to show that Hurwitz's prescriptions had resulted in the death of one patient and the severe injury of two others. The jury convicted him on 16 counts, compared to 50 in the original trial.
Instead of the life sentence the prosecution wanted, Brinkema chose a term of 57 months, most of which Hurwitz already has served. While the jury concluded that Hurwitz should have paid more attention to warning signs that some of his patients were not on the level, Brinkema noted that the vast majority of his patients were legitimate and that the rest had taken steps to deceive him.
In a sense, Hurwitz was lucky. Yet what doctor wants to take a chance of ending up in a situation anything like his, where honest mistakes could be treated as felonies?
Rannazzisi emphasized that the DEA investigates only a tiny percentage of doctors each year. But the chilling effect of cases like Hurwitz's extends far beyond the few who lose their prescription privileges or go to prison.
According to the DEA's reading of the Controlled Substances Act, a doctor who believes he is practicing good medicine is still breaking the law if he operates outside "the usual course of professional practice." Defense attorney John Flannery, who testified at the same hearing where Rannazzisi appeared, noted that one of his clients, now serving a 30-year sentence for prescriptions the DEA considered inappropriate, was accused of violating "professional norms" by prescribing more than 160 milligrams of OxyContin a day, one-sixth the maximum covered by Medicaid.
When inadequate treatment is the usual course of professional practice, doctors must be brave simply to prescribe the pain medication their patients need to function.
© Copyright 2007 by Creators Syndicate Inc.
Brinkema, Leonie M.
Born 1944 in Teaneck, NJ
Federal Judicial Service:
Judge, U. S. District Court, Eastern District of Virginia
Nominated by William J. Clinton on August 6, 1993
Wexler, Leonard D.
Born 1924 in Brooklyn, NY
Federal Judicial Service:
Judge, U. S. District Court, Eastern District of New York
Nominated by Ronald Reagan on May 11, 1983
“When inadequate treatment is the usual course of professional practice, doctors must be brave simply to prescribe the pain medication their patients need to function.”
A stash of Vicodin is nice to have around in case you get hurt really bad and can’t get to the doc right away, don’t want to go to ER, or you’re just in so much pain you can’t even function. I can make 100 pills last almost a year, and I do have pain issues.
It’s a shame the docs are all so paranoid about this that they treat everyone who needs pain relief as a potential junkie. Sometimes I get headaches so bad, I could eat motrin all day(which is far worse for you than vicodin, BTW), but 1/2 a vicodin will finally stop it in it’s tracks. If I can get it, it’s gold, and I ration it out very carefully.
I think it should be OTC with restrictions like sudafed, or iodine, which should have no restrictions, but do.
Thanks to the DEA and the Hurvitz atrocity, most doctors are terrified of treating legitimate chronic pain patients.
I’m no anti WOD Freeper, but if a certain percentage of pain killers go to the wrong people in the process of helping legitimate sufferers, so be it. People in pain need to be helped.
Agreed.
The wrong people will go to any lengths to get what they’re not supposed to have, no matter what the government does to try and control it.
As an example, let me point to the abysmal reality of gun control, which does not even belong on this thread-my apologies.
"Show me just what Mohammed brought that was new, and there you will find things only evil and inhuman, such as his command to spread by the sword the faith he preached." - Manuel II Palelologus
I've tried to follow this case. I was hoping that at most it would have been limited to time already served. IIRC, he can't practice medicine any more.
As long as you don't bring up immigration.
It's not as unrelated as you might think.
Connecting the War on Guns & Drugs [my title]
The war on guns: Joel Miller explains how drug cops are killing 2nd Amendment
Oldies, but goodies, anyone who hasn't read those articles should read them.
This is positively Orwellian.
The DEA is an utter failure at suppressing the trade in illegal drugs, so they’re turning on innocent men like rabid pit bulls on steroids.
\
They need to be shut down altogether, and their personnel barred from government employment.
I can empathize with you. My headaches can get so bad; I have to go to the hospital and get knocked out.
They are not after the drug cartels or dealers. And they are not going after them anytime soon. There is a lot of money to be had and some politicians and probably government employees don’t much care as long as they get part of the pie.
As a General Contractor in the Florida Keys, I can tell you for a fact that likely 50% or better of the skilled carpenters, concrete finishers, etc. that are over 50 years old, are taking some form of hydrocodone daily to work through the pain that comes with a lifetime of work in these professions. They aren’t taking it to get high....they are taking it to cope with physical stress and aging.
Hopefully, this will help someday in the not too distant future: http://www.metabolic.com.au/files/PTU5OO4V89/ASX_ACV1ClinicalTrialsUpdate_November2006.pdf The first Phase 2 trial discussed above (on sciatica) has now ended and results due to be made public in a couple weeks or less. Still, this drug remains a few years away from the market though, even if everything continues to go well.
Hopefully, this will help someday in the not too distant future:
The first Phase 2 trial discussed above (on sciatica) has now ended and results due to be made public in a couple weeks or less. Still, this drug remains a few years away from the market though, even if everything continues to go well.
You just described managed health care, or what was formerly known as medical insurance.
Absolutely not. But they decide most everything else for us, so why not this?
Carolyn
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.