The War on Doctors
According to the Los Angeles Times, former San Francisco district attorney Patrick Hallinan "says that honest doctors all over the country are being targeted by the DEA under the supposition that their patients were violating the law without the doctor's knowledge" by selling their prescriptions on the street, and that the agents are using the same tactics against them that are used against narcotics dealers. "There isn't any doubt," he added, "that these prosecutions are increasing under the Bush administration. It is like busting a car dealer because somebody runs off the road and kills somebody." The campaign began under Janet Reno and has increased in intensity under John Ashcroft?including the storming of clinics in SWAT-style gear and the ransacking of doctors' offices.
Here's a case history of a family physician I know. He practices in a small town and calls himself "a country doctor." I first met "Dr. L" at the height of the anthrax scare, right after envelopes containing the virus had been sent to ABC and NBC. Tom Brokaw ended the evening news by saying, "God bless Cipro," referring to the antibiotic that would counteract the effects of anthrax if not the hysteria. Before I could even tell Dr. L. my medical emergency?an attack of diverticulosis causing severe stomach pain?he said, "I suppose you want a prescription for Cipro." He had already gotten several requests for the drug that week.
I explained the purpose of my visit, but he acted as though I was faking it in order to obtain a painkiller. When he determined that my condition was real, he prescribed antibiotics and a painkiller. Ultimately we became friends, and I learned the reason for his suspicious approach. Dr. L. had been convicted for what he sardonically describes in an essay on the Association of American Physicians and Surgeons' website as "the heinous crime of prescribing Tylenol codeine for the treatment of migraine syndrome in a couple of ladies." They turned out to be undercover operatives for the Medical Board of California.
"This story is not unique," he writes. "It is being repeated across the United States every day. Our country seems to be slipping into a fascist regime with dictatorial, uncontrolled, coercive state power."
Over a period of several days, the two women, who were wired, "visited Dr. L's office, complaining of symptoms that were consistent with migraine headaches." After listening to their history, he gave each of them 30 Tylenol codeine tablets until he could obtain their previous records. "He even called one of the physicians who had been listed in the intake form?a doctor in Oshkosh, WI?but an elderly telephone operator told him she had lived in that town for 70 years and had never heard of such a doctor."
Some weeks later, agents with drawn guns served a search warrant. They were from the DEA, BNA (a state agency comparable to the DEA) and the local police. This is a common practice of ass-covering: no single agency can be blamed if anything goes wrong. The raid had a terrible effect on the economic health of Dr. L's family practice, a standard mix of obstetrics, pediatrics and internal medicine. A story was planted in the local media?via press releases from those government agencies?stating that he was a drug-dealing doctor and would lose his license. He was shunned by colleagues.
"Several weeks later," he writes, "I was arrested at my office while many startled patients watched in utter disbelief as their doctor was handcuffed and led away. The arresting officers would not let me take off my clinic coat or stethoscope?this picture was worth more with them on. I was booked and subsequently released on bail."
His trial didn't come up until six years later. After 10 days in court, he was found guilty, sentenced to six months in jail, fined more than $11,000 and required to perform 200 hours of community service. The case went to the Court of Appeals and later to the California Supreme Court, where, on the last day of the session, a hearing was denied. He was now in debt for legal fees in excess of $300,000. Moreover, in order to serve his sentence, he had to close his office. And, "based on the felony convictions?at a hearing that he could not attend because he was in custody?his medical license was revoked."
An additional appeal resulted in a decision against the prosecutor, accusing him of "lying, deceit, skullduggery, prevarication," you name it, and another hearing was ordered by the Medical Board. Dr. L was placed on five years probation. But his nightmare continued.
"Subsequently," he writes, "Medicare, Medi-Cal and Champus certifications were revoked. In addition, my name was added to the nefarious National Practitioners Data Bank. Thus, no HMO would consider me for employment, no malpractice carrier would insure me and I was even ineligible for hire by a state prison because of my felonious status. Physicians are the number one target for prosecution by the DEA and the 50 states operating in tandem. This prosecutorial targeting of physicians, which definitely includes entrapment and selective prosecution, has come about, I believe, because of an erroneous and nefarious assumption that our prescriptions are sold on the street to satisfy the needs of addicts. This fallacious exercise in logic is called 'diversion' and the general claim had been made by the DEA that physicians bear the blame for the failed war on drugs."
"This circular illogic and self-fulfilling prophecy is used as a pretext for promoting the greatly undeserved Bad Doctor Syndrome. There are unlimited funds available for such government investigations. Often they are triggered by a complaint a local pharmacist registers with the Pharmacy Board about a physician he believes uses too many drugs for the relief of pain."
Conversely, a California jury recently awarded $1.5 million to the family of an 85-year-old man whose doctor failed to treat him adequately for pain for a few days as he lay dying of lung cancer. That verdict was only the third in American history for the undertreatment of pain, and the first against a doctor. It was also the first time a jury awarded such a verdict under elder abuse laws instead of a medical negligence lawsuit.
Kathryn Tucker, director of legal affairs for the Compassion in Dying Federation, pointed out that this case could serve as the catalyst for better pain management by the medical profession and educate the public that it should take action when these needs are ignored. Nor is there any shortage of potential lawsuits. As reported in the San Francisco Chronicle, a 2001 study published in the Journal of the American Medical Association found that 40 percent of nursing home patients with acute or chronic pain are not getting pain treatment that brings relief.
Dr. L shakes his head as he contemplates the overwhelming irony. "I spend six months in jail," he observes, "while now one gets a malpractice lawsuit for inappropriate relief of pain. What a most interesting and contravening juxtaposition in such a few years. I don't really think that we have a system of justice?merely a system of laws." Recently, his medical license was reinstated, and his family practice clinic can now be diagnosed as vigorously healthy.
[paulkrassner.com]