Providers, patients face tough choices after clinic loses ability to prescribe

The columbian ^ | April 20, 2009 | LAURA MCVICKER

[Bean Counter]

Hundreds of former Payette Clinic patients, riddled with chronic pain or a severe addiction to painkillers, have swarmed Clark County hospitals and pain clinics in recent weeks.

Many of them are being turned away or placed on months-long waiting lists. Even those being treated in emergency rooms or by primary care doctors say they are being told to fend for themselves because of doctors' fear of medical liability.

Payette Clinic was the subject of a Washington Department of Health investigation last month that found nurse practitioner and clinic co-owner Kelly M. Bell was prescribing "extremely high doses of opioids." As part of the investigation, Bell and her staff had to surrender their credentials to prescribe controlled substances.

The fallout has been overwhelming for physicians and devastating for some patients.

"As soon as we say 'Payette Clinic,' no one wants to help us," said Larae Corzine, whose husband, Steve, was a Payette patient for several years. He was treated for reflex sympathetic dystrophy, a chronic neurological syndrome characterized by severe burning pain. "Now, he can't even get out of bed. He wants to live. He's only 40 years old."

Southwest Washington Medical Center officials estimate about 800 patients no longer receiving prescriptions from Payette are beginning to inundate hospitals, urgent care centers and treatment centers. Of the 800, 120 patients have already been referred to Southwest Washington Medical Center's Interventional Pain Clinic.

"They're getting 10 times what they're used to," said Dr. Michael Bernstein, director of Southwest Washington Medical Center's Department of Behavioral Health. "They've tried to increase time and availability of practitioners. They've done everything they can to tweak capacity."

Some will just have to wait. "It's going to be months to get through 120 patients," said Christine Gauf, the Interventional Pain Clinic's director. "We're asking those patients to be patient. We only have so many providers, and there are only so many hours in the day."

Attempts to reach an official of the Payette Clinic were unsuccessful.

Another dilemma for physicians? Deciding how to best treat these patients, many of whom are addicted to painkillers and still suffer enough chronic pain to warrant a narcotic.

Physicians aren't inclined to continue prescribing painkillers, especially at high doses.

"It's pretty clear that no one felt comfortable continuing patients on these narcotics," Bernstein said. "They all thought it would be malpractice to give them a prescription."

Bernstein is spearheading a committee of physicians and treatment specialists countywide to assess how to handle Payette patients.

The committee has circulated memos to local family care physicians, treatment centers, pain clinics and hospital officials, urging providers to taper patients off medications or detox them. Still, each patient is being handled on a case-by-case basis, physicians say.

Severe withdrawals

Some patients are turning up at local hospitals' emergency departments with severe withdrawal symptoms.

Kim Manning said her sister, who prefers to not be identified, was a Payette patient for chronic migraines. For the past several years, Manning's sister's doses gradually increased to 750 mg of morphine, which doctors say is 10 times the usual dose of morphine for a pain patient.

**SCHNIPP**

[Bean Counter]

This is the rest of the iceberg beginning to reveal itself. Prescription drug abuse is rampant in this Country, it is killing school children (and adults) from coast to coast, and outfits like Payette Clinic need to be held accountable for what sounds to me like hundreds of potential felonies.

I am sympathetic and empathetic with people who are in long term pain as I fall into that category myself. But watching a relative self-medicate with 750 mg of morphine over any period of time, and outside of a hospital, should ring alarm bells in anyone's mind. That is a massive dose for anyone to take outside of an Intensive Care ward, because it's enough to kill a normal person several times over. That much morphine is enough to make you stop breathing in minutes. It is a lethal dose, and irresponsibly giving anyone that much ought to be prosecutable as attempted murder.

Great job on this story by Laura McVicker, and I hope she keeps following this as the story continues, unfortunately, to develop. The damage done to this Community and others by Payette Clinic is only starting to be felt.

Washington and Oregon *PING*

[theFIRMbss]

>fear of medical liability

I know a woman
who switched her career path from
pre-med to nursing

because nurses are
better "shielded" against
liability!

[fleagle]

I am sympathetic to chronic pain patients also. But there is responsible pain management, and there is 750 mg of morphine.

[FormerACLUmember]

Give a quack nurse prescibing privileges and massive legal narcotics for cash resulted.

[sionnsar]

Thanks to Bean Counter for the ping.

Say WA? Evergreen State ping

Quick link: WA State Board

FReepmail sionnsar if you want on or off this ping list.

Ping sionnsar if you see a Washington state related thread.

[Oldpuppymax]

I suffer from degenerative disc disease and degenerative spinal stenosis. A number of back surgeries have left me partially paralized. I’ll have chronic back and leg pain for the rest of my days. I’ve taken schedule II narcotics for 8 years and would have no appreciable quality of life without them. Yet thanks to bureaucrats and self-important political hacks, doctors and pharmacists nationwide are perpetually intimidated and harrassed for prescribing the medications which I and millions like me are required—perhaps doomed—to take each and every day. The self-richeous exercise of unenlightened authority is far more dangerous and a much more addictive drug than anything I could possibly take. And those who suffer from chronic, unrelenting pain must face this tragic fact of life.

[Bean Counter]

For background, a 16 year old girl died over in Oregon last December, after she smoked a 30 mg oxycodone pill that was given to her by an 18 year old patient of the Payette Clinic.

That’s the key event that started this ball rolling, and why Payette Clinic is mentioned so prominently.

[CurlyDave]

For background, a 16 year old girl died over in Oregon last December, after she smoked a 30 mg oxycodone pill that was given to her by an 18 year old patient of the Payette Clinic.

Leaving aside the illegality of the drug transfer, what part of the prescription said to smoke this pill ?

The fact that humans develop tolerance to narcotics and require larger doses to suppress pain is well-documented. What are these people supposed to do?

Pain management clinics are legitimate medical enterprises. The real problem is our laws demonizing narcotics.

[4woodenboats]

Some will just have to wait. "It's going to be months to get through 120 patients," said Christine Gauf, the Interventional Pain Clinic's director. "We're asking those patients to be patient. We only have so many providers, and there are only so many hours in the day."

If a patient has an ongoing prescription for chronic pain, why don't they at least reduce the prescription - or in the case of the 750 mg of morphine, change it to a mild dose of vicodin until this is sorted out. That would take a couple days at most. Determining whether oral or injected steroids or surgery can alleviate the pain can be dealt with in the coming months. This Be patient while you're bedridden in agony from pain and withdrawals while I CMA might very well cost a life.

[jimt]

That is a massive dose for anyone to take outside of an Intensive Care ward, because it's enough to kill a normal person several times over. That much morphine is enough to make you stop breathing in minutes. It is a lethal dose, and irresponsibly giving anyone that much ought to be prosecutable as attempted murder.

If you were giving that to someone unused to it, your starement is true. For someone whose dose has increased over time to that level, it's absolutely false.

Patients who have developed a tolerance can take "lethal" doses without any problem whatsoever. In fact, you'd probably notice very little change in the person. So giving that amount after a person has become habituated is not remotely close to murder.

On a personal note I know that when I was in the hospital for a herniated disc they gave me what they called a "large dose" of morphine, and I noticed nothing whatsoever in terms of pain decrease. Morphine simply doesn't do anything for me, even in a supposedly "large dose". I finally got them to give me 10 mg hydrocodone, which I had been taking regularly, and that did work somewhat.

Not everybody's the same, and chronic pain is debilitating and a severe health risk. When going to see my new "primary care" physician (old one retired), I had to stop on the way (every hundred feet) because it hurt so damn bad. When I got into the office my blood pressure was 195 over 135. Stroke or heart attack, anyone ?

Cutting these people off because of some artificial limit is exceptionally cruel, and could be fatal.

[Marie]

I broke my back when I was four years old from a 30 foot fall.

I didn't start having problems with it until I was in my early 20’s.

About a year and a half ago my doc put me on 4, 7.5mg vicodine a day.

For the first time in years, I can clean the house, go to the store, paint, read, sleep... I'm happy. Before that, I was just buying time until I could cash it in.

If I want to do more (which I do!) like put in a garden, start a small hobby farm or start physical therapy, I'm going to need more pain killers. The problem is, my doctor is afraid to give me more. So get to live on the very edge of life, trying not to do too much and push myself over that threshold.

I hate these laws. I don't understand why a woman can murder her baby and that's between a woman and her doctor, but a doctor can't prescribe medications without the state's interference.

[Bean Counter]

Pain relief is one thing, the levels of abuse involved in this case are quite another.

My wife and I know of a young man who is under treatment here locally for prescription abuse. He had to go through medically supervised with drawl because he was using 600 500 Mg Vicodin a month. That’s 300,000 units of vicodin a month, or 10,000 units a day. That level of abuse cost this man his job, his family, and will cost him his life if he doesn’t clean up. I don’t know if he’s a patient of this “pain clinic”, but he fits the profile of the people who are flooding out local ERs.

Again, this is not about controlling pain as much as it is about making addicts, and supplying their needs. At some point you are attempting to control the pain of addiction instead of the original pain from the injury. We simply cannot allow these “Pain Clinics” like Payette, to operate as little more than modern-day opium dens.

Keep in mind that this particular story began late last year when an investigation into the death of a 16 year old girl led to the vast prescription abuse at the Payette Clinic.

To All: This story is NOT about cutting people off from their needed medications. Please do some reading to understand the scope of this problem.

A couple of additional links:

Federal agents raid Vancouver pain clinic, seize records

http://www.oregonlive.com/news/index.ssf/2009/03/federal_agents_raid_vancouver.html

Charges allege improper prescribing

http://www.oregonlive.com/news/oregonian/index.ssf?/base/news/12384699056810.xml&coll=7