At Trial, Pain Has a Witness NY Times

Discussion in 'Fibromyalgia Main Forum' started by ephemera, Apr 23, 2007.

  1. ephemera

    ephemera New Member

    April 24, 2007 from NY Times
    At Trial, Pain Has a Witness
    By JOHN TIERNEY

    ALEXANDRIA, Va. —William E. Hurwitz, the prominent doctor on trial here for drug trafficking, spent more than two days on the witness stand last week telling a jury why he had prescribed painkillers to patients who turned out to be drug dealers and addicts. But the clearest explanation of his actions — and of the problem facing patients who are in pain — came earlier in the trial.

    It occurred, oddly enough, during the appearance of a hostile witness, Dr. Robin Hamill-Ruth, one of the experts who was paid by the federal prosecutors to analyze Dr. Hurwitz’s prescriptions for OxyContin and other opioids.

    Dr. Hamill-Ruth, who noted that she never prescribed the highest-strength OxyContin tablet, said some of Dr. Hurwitz’s actions were “illegal and immoral” because he prescribed high doses despite warning signs in patient behavior that the opioids were being resold or misused.

    Then, during cross-examination by the defense, Dr. Hamill-Ruth was shown records of a patient who had switched to Dr. Hurwitz after being under her care at the University of Virginia Pain Management Center. This patient, Kathleen Lohrey, an occupational therapist living in Charlottesville, Va., complained of migraine headaches so severe that she stayed in bed most days.

    Mrs. Lohrey had frequently gone to emergency rooms and had once been taken in handcuffs to a mental-health facility because she was suicidal. In 2001, after five years of headaches and an assortment of doctors, tests, therapies and medicines, she went to Dr. Hamill-Ruth’s clinic and said that the only relief she had ever gotten was by taking Percocet and Vicodin, which contain opioids.

    Mrs. Lohrey was informed that the clinic’s philosophy “includes avoidance of all opioids in chronic headache management,” according to the clinic’s record. The clinic offered an injection to anesthetize a nerve in her forehead, but noted that “the patient is not eager to pursue this option.” Mrs. Lohrey was referred to a psychologist and given a prescription for BuSpar, a drug to treat anxiety, not pain.

    “You gave her BuSpar and told her to come back in two and a half months?” Richard Sauber, Dr. Hurwitz’s lawyer, asked Dr. Hamill-Ruth. Dr. Hamill-Ruth replied that unfortunately, the clinic was too short-staffed at that point to see Mrs. Lohrey sooner. Under further questioning Dr. Hamill-Ruth said that she was not aware that BuSpar’s side effects included headaches.

    Mrs. Lohrey looked elsewhere for help. Having seen Dr. Hurwitz on television _ — “60 Minutes” and other programs had featured his controversial high-dose opioid treatments — she sent him a letter describing her pain and the accompanying nausea and vertigo.

    “I have lost hope of retrieving my life as it was,” she wrote, because she could find no doctor to take her seriously. “I currently have a physician who has said that I am psychologically manufacturing my headaches, and that I am addicted to narcotic pain relief. This of course is not the first time that I have been treated as a ‘nut’ or a ‘junkie.’ ”

    It was the kind of letter Dr. Hurwitz received from people across the country. His office in the Virginia suburbs of Washington was like a Lourdes for people with pain, one of the most widespread health problems. Surveys have found that one in five adults deals with chronic pain, and that it is treated adequately only about half the time.

    Prescribing opioids was once taboo because of concerns over patients’ becoming addicted. But medical opinion gradually shifted over the past two decades as researchers concluded that high doses of opioids could sometimes be safer and more effective than alternatives like surgery or injections.

    Two of the leading pain experts, Dr. Russell K. Portenoy of Beth-Israel Medical Center and Dr. James N. Campbell of Johns Hopkins University, testified without pay as experts for the defense. They said Dr. Hurwitz was widely known as a knowledgeable physician and passionate advocate of giving patients full pain relief, unlike many doctors who were reluctant to prescribe opioids because they feared legal repercussions, particularly when dealing with patients who sometimes used illegal drugs.

    Such “problem patients” consumed so much time and energy that most doctors refused to treat them “regardless of what the consequences would be for the patient,” Dr. Campbell testified. He said that he had been initially skeptical of some of Dr. Hurwitz’s high-dose treatments, but was then impressed by the results in patients he sent to Dr. Hurwitz.

    He said some doctors might argue that Dr. Hurwitz was guilty in some instances of negligence that would make him liable for damages in a civil case. But Dr. Campbell contradicted the prosecution’s experts by testifying that all the prescriptions were clearly within the “bounds of medical practice.”

    That legal phrase is the crucial distinction in this criminal case, which the jury was deliberating as this column went to press: Did Dr. Hurwitz knowingly prescribe drugs to be used for nonmedical purposes? (For updates on the case, see www.nytimes.com/tierneylab.)

    When Dr. Hurwitz testified last week, he spent hours going through the histories of those he called his “misbehaving patients,” telling why he believed they all had genuine problems. “Ultimately, pain is what the patient says it is,” he told the jury, contrasting his approach with what he called the traditional “Father Knows Best” approach of old-school doctors.

    In retrospect, he acknowledged, he should have been more suspicious of patients who asked for early refills, reported losing prescriptions and tested positive for illegal drugs. He did get rid of the worst patients, he said, but he believed others were reforming, and he feared they would not get help anywhere else if he dismissed them.

    “I felt that I had a duty to the patients,” he said. “I hated the idea of inflicting the pain of withdrawal on them.” After the closure of his practice in 2002, he said, two of his patients committed suicide because they gave up hope of finding pain relief.

    The most moving testimony came from Mrs. Lohrey and other patients who described their despondency before finding Dr. Hurwitz. They said they were amazed not just at the pain relief he provided but at the way he listened to them, and gave them his cellphone number with instructions to call whenever they wanted.

    “I felt like I was his only patient,” Mrs. Lohrey testified. “I think he truly understood the nature of what I was going through.” When she lost her health insurance, she said, Dr. Hurwitz continued treating her at no charge, and helped her enroll in a program that paid for her opioid prescriptions. After Dr. Hurwitz’s practice was shut down, she could not find anyone to treat her for seven months. Eventually, she found a doctor willing to prescribe small numbers of low-dose Percocet, but she said she was not getting enough medicine to consistently blunt the headaches.

    “The last two weeks, I was pretty much in bed and sick with the headaches and the nausea and the whole nine yards,” she said, explaining that she had deliberately undergone the two weeks of pain in order not to use up any of her pills.

    “I had to save up medication,” she testified, “so I could be here today.”

  2. victoria

    victoria New Member

    Things were supposed to change, I seem to remember legislation being passed at one time to allow MDs to treat chronic pain pts humanely... it's a shame they're on another witch-hunt! I'm glad this got published in the NY Times, and hope it brings heat on those MDs that don't even attempt to understand.

  3. rosemarie

    rosemarie Member

    I was listening to the local news a few or so ago when I heard of a doctor who had set up a " FAKE" pain /weight clinic. He did not have any "Real" patients. It was others people who found people to go and see this doctor a.No matter what was wrong with them they all were given scripts containing large dose's of oxycontin.

    The "patients" would fill the scripts and bring the pills back to the office where they would be paid a good deal of money. Then others would hep to disturbute the pills to the public.

    IN the news report it was reported that there were over 200 people that have been charged in this case. At the time of the news report the procutor has taken about 150 people to trial and they are still that many case's yet to go to trial. Hopefully they will have all the defendants proscuted by late summer.

    This report made me sick. I am one who sees a pain doctor and I am taking strong pain meds. But I have had to sign papers stating that I will only see one MD for my pain meds and go to one pharmacy to fill the scripts. For me as a chronic pain patient I have to follow the rules to the letter or I will not be able to get the meds I need to function semi normally in my life.

    I don't get meds just handed to me , no I have to see a doctor each adn every month so that I can get my scripts writen and filled at one pahrmacy. If I so much as ask for my meds a few days early I could be cut off and have the doctor not treat me anymore as I don't follow the instructions.


    What has happend to our society? We just let the drug abuser get high with out any doctor visit , yet I have to be screened and sign my life away before I will receive so much a one pill. this is so wrong and makes me sick. It needs to stop.

    Why do I a real patient have to go through hoops to get my 30 days supply of my pain meds and if I have had t hem stolen or taken from me I am pusnished adn will be banned from amy treating doctor.

    But if I know the right people I can just go and buy the drugs I need. Since I don't know anyone adn would not do that any way it just makes me sick to know that i have had to prove that I am a honest person who is willing to follow the instructions I am given.

    My doctor has about 90 % of his patients are law abiding people who just happen to have to live with a chronic pain syndrome and see the doctor once a month, and follow his orders to the letter of the law.

    I am so disapointed in those people who feel the need to sell their meds, and it makes me sick to learn of doctors who are willing and in on the illeagal persctibing of narcoitcs. This just makes it harder for those of us who are in need of these strong pain meds like MScontin, Oxycontin, DAluidid to name a few.

    We are doing all we can to live a "Normal life" and having people who are willing to sell their perscriptions and having doctors that are willing to prescribe these meds to people who have no medical need of them .

    Doctors who do this should get caught and spend a long time in jail and pay a HUGE fine. The doctor in SLC is possiably going to go to prison for 5-10 years and will have to pay a $50,000 fine to pay for the investagation of this case.
    I am one of the most naive person there is. I thought that all people did just as their doctors tell them to do. But surpise to me , people don't do that and these people don't need any thing for pain as they are not hurt. They are selling it as a comidity.

    See what I can sell you. The longer this continues the harder it will be for patients like me who reuire the strong pain meds sto be able to live our lives more normally. I see my doctor and have to follow all the doctors rules to the letter. But the "other patient can jstu find some one that will let them buy all that they can afford. This makes me ill.

    I hate to go to the ER for any reason. AS I am judged by the medications I am taking. Doctors, nurse's assume that your faking the pain just to get a script for more. I had a badexperence in the ER. I fell sand shattered my left wrist very badly.

    I needed to have it set and would need surgey asap. I had a huge chance that I would lose the function in my wrist. I went to the ER the day I injured it and was given several large doses of fentyanl and versed to help me relax so that the doctor could set this nasty break.

    LIttle did I know that the next day when I can back with blue fingers that the nurse would yell so loudly that i was the lady who was here last night and was given copiously large amounts of femtynal and versed then walked out on my own. The doctor who treated me that second night would not give me any thing to ease the pain as he ro pped the sticky sp lint I had on .

    He pulled to hard that he pulled it aout of aligenemt. causeing me to have excuratationg pain. I fially was given two injection of morphine. But it had been told that if I was his patient I would not have gotten the injection f morphine m Just a lortab 5 that was all. I was jsut being a baby over nothing.

    NOthing else happened except that now if I go to the ER I will always have a doctor pissed off at me. I will be made to look like I am a drug seeker.

    NOw that I know that their are doctors who are out there in private practice , telling everyone that tehy are treating chronic pain patients when in all realitiy they are just the top of the drug ring , selling drugs to who ever can afford to buy them on the street.

    This is so sickening and makes it so much harder for those of us who really need these medications to live our lives. Why is it so easy for them but as a patient I have to almost beg to get the relief for my pain.
    Sorry that this is so long.

    I just wanted to let you know that there are doctors even in Utah who are willing to sell their souls for money and have not scruptles in knowing that the drugs that they prescribed to a "fake pain patient" are now being sold to anyone that can afford them or who can get the money any way they can.
    I want this to stop and soon but I know it will not. AS long as some one can make a profit at some one else's expence they will do it in a heart beat. How sickening this is to me.
    I don't want much just to have honest doctors who are wiling to prescribe medicataion for those who are in real pain and not to those who use it like it is candy. I am appaled at the way doctors treat chronic pain patients, I feel that the drug abusers get better treatment than we how follow the rules and regulatations. How unfair this is to us.
    Thanks for letting me share this with you.Sorry this is so long.
    Rosemarie