Doctors, Patients, Latest Drug War Casualties
By Radley Balko
It=92s uncomfortable to hear Dr. Frank Fisher speak. His eyes are
usually glassed over, seemingly on the verge of tears.
Above them rests a sweeping coif of white hair; below, a thick, well-
manicured white beard. A gentle man, he speaks softly, with jaws and
temples tensed, projecting a belabored voice that toils to get from
sentence to sentence. As he talks, you get the impression that he=92s
just a small dose of bad news away from shattering into a thousand
pieces.
And with good reason. Fisher, a Harvard-trained physician, once
specialized in the treatment of chronic pain. He served a
predominantly rural and poor population in California. About 5-10
percent of his 3,000 clients were pain patients, victims of illnesses
like cancer, steep falls, or car accidents.
A little more than five years ago, California Attorney General Bill
Lockyer initiated a high-profile campaign against pain doctors who
prescribe high doses of opioids =97 drugs such as Oxycontin, Vicodin and
codeine.
Lockyer made Frank Fisher his example. Lockyer and other California
prosecutors likened Fisher to a crack dealer. Then, to a mass
murderer. Fisher was charged with multiple counts of drug
distribution, fraud, and most sensationally, 15 counts of murder. The
state seized his assets. His bail was set at $15 million and he faced
a possible life sentence
Over the next five years, all of the charges against Fisher flitted
away. A judge immediately threw out the murder charges in a
preliminary hearing. Four years later, another judge threw out the
other felony charges =97 manslaughter and fraud. In May of this year, a
jury considered the remaining misdemeanor charges against Fisher and
acquitted him on every one of them. One juror said Fisher had been the
victim of a =93witch hunt.=94
Frank Fisher is still a broken man. He spent five months in prison and
paid hundreds of thousands of dollars in legal fees. He has yet to get
his assets back from the state of California, and he still faces the
possible revocation of his medical license.
=93To add insult to injury,=94 the 50-year-old man says, =93I=92ve been
for=
ced
to move back in with my parents.=94
Fisher=92s case isn=92t unusual. According to the U.S. Drug Enforcement
Administration, doctors all over the country have been or are being
targeted. Professor Ronald Libby of the University of North Florida,
who has a book coming out on the topic, said the DEA began targeting
pain doctors in 1999. That=92s the year a General Accounting Office
re****t rebuked the DEA for failing to decrease the illegal drug
supply, despite a 30-year effort armed with an annual budget of
billions of dollars.
Shortly after that GAO re****t, Libby says, the Department of Justice
identified prescription drug abuse as the =93primary drug threat to the
U.S. population,=94 and two years later put a plan in place to go after
licensed doctors. Prescription drug abuse became a measurable,
achievable way for the DEA to justify its budget. A federal prosecutor
in Alexandria, Va., told the Wa****ngton Post at the time, =93Our office
will try our best to root out [prescription pain doctors] like the
Taliban.=94
The media gladly assisted. Despite little sup****tive evidence,
television and newspaper re****ters spun up a maelstrom of coverage on
how prescription painkillers such as Oxycontin had become the designer
drugs du jour. In 2003, the Orlando Sentinel published what was
probably the height of the hysteria with a series called =93The
Accidental Addict,=94 about doctors who unknowingly addict their pain
patients to opioids.
After months of criticism from patient advocates who poked gaping
holes in the series, the paper finally printed an apology and
retraction.
But by then, the painkiller myth had been loosed, and local, state and
federal officials were collecting trophies. Estimates vary among
patient advocates, researchers and the DEA, but between 50 and 300
doctors per year have been brought up on federal charges related to
prescribing high doses of narcotics since 2001.
According to the Pain Relief Network's Siobhan Reynolds, many more
have been prosecuted at the state and local level. Others have lost
their medical licenses, or had their malpractice insurance cancelled.
Consequently, Reynolds said, the number of doctors willing to treat
chronic pain has dwindled, and even among those remaining, there=92s a
growing fear of prosecution, meaning most will err on the side of
under-treatment.
Of course, under-treating pain can subject those same doctors to
malpractice suits from frustrated patients. For doctors, it=92s damned
if you do, damned if you don=92t. It=92s of no surprise then that many of
them have fled the field altogether, Reynolds said.
That=92s devastating news for the 48 million Americans who suffer from
chronic pain. For them, it=92s getting more and more difficult to get a
prescription for the drugs they need. And they=92re turning to ever more
desperate measures for relief.
That=92s what happened with Florida pain patient Richard Paey. After a
car accident and a botched back surgery confined him to a wheelchair,
Paey developed multiple sclerosis. He moved his family to Florida in
1994, but had trouble finding a doctor willing to write the
prescriptions he needed.
Out of desperation, Paey turned to his former doctor in New Jersey,
who wrote Paey undated prescriptions, which Paey then photocopied.
Paey=92s prosecutor acknowledged that all of the medicine in Paey=92s
possession was for his own use. Nevertheless, he charged Paey with
intent to distribute. After three trials, Paey was convicted.
Mandatory minimum drug sentencing laws gave Paey=92s judge no choice but
to send him to prison for 25 years, with a $500,000 fine. At least
one juror has since expressed regret for the verdict. Paey today sits
in his wheelchair in a Florida penitentiary.
This crackdown on pain medication is obscene. We now have a system
where law enforcement officials tell doctors how to treat their
patients. Physicians are required to turn in patients they suspect of
opioid addiction. At the same time, cops are posing as pain patients
attempting to lure doctors into writing bad scripts, or threatening
patients with prosecution unless they testify against their doctors.
The result, patient and doctor advocates say, is that pain patients
don=92t trust their doctors, and pain doctors don=92t trust their
patients. It casts a pall over the doctor-patient relation****p, and
makes honest dialogue between the two impossible. It=92s a disgrace.
The Pain Relief Network and the American Association of Physicians and
Surgeons re****t that many of the patients of doctors either
prosecuted, suspended, or otherwise run out of the field by this ugly
new face of the drug war have deteriorated into dysfunction, lost
their jobs, endured divorce or other shattered relation****ps, or
turned to underground drugs for relief. Many have committed suicide.
Two patients interviewed for this column say they=92re down to their
last doctor, and they=92re fearful of what they=92ll do if that doctor
gets targeted, or decides treating pain patients isn=92t worth risking
his savings, his license, or his freedom.
There are tens of millions of Americans in chronic pain, some of it
unimaginably severe. At the same time, we have an abundant supply of
drugs with a proven record in alleviating their suffering. It=92s
shameful that America=92s backward, uncompromising drug war has built an
ever-widening schism between the two.
Radley Balko maintains a Weblog at: www.TheAgitator.com.
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