Doctors’ second opinion
Most of the readers I heard from shared my outrage that Dr. Daniel Healy, called the “candy man” by drug-seeking patients, was sentenced to only four years in prison instead of the 17 years prosecutors sought.
But the condemnation wasn’t universal. I heard from a former patient of Healy’s, who described the family practice physician in the 1990s as a “conscientious care giver” who probably “never set out to be a drug dealer … but was enticed one time too many.”
And some readers were bothered less by Healy’s light sentence than by the intrusion of prosecutors and the Drug Enforcement Administration in the doctor-patient equation.
“While abusive dispensing of narcotics cannot be condoned, there is also a downside to enforcement,” wrote reader Robert Park. “With the DEA peeking over doctors’ shoulders, they will be afraid to prescribe needed narcotics for cancer patients and others who are suffering.”
It’s a concern I heard from several doctors this week: Physicians aiming to help patients manage pain feel chastened by the prospect of legal scrutiny.
“I’m supposed to be a healer; I’ve trained for years to do just that,” wrote a family practice physician who specializes in pain management and treatment of AIDS and HIV. “I try so hard to practice compassionate care…. But now I have to look at each patient as a criminal, a potential ‘diverter’ who could get my license revoked.”
I met with the doctor over lunch, near his Mid-City medical office. He was too worried about drawing attention from the DEA to let me use his name in my column.
He described himself as a “high-volume prescriber” because he consults for a hospice firm that provides palliative care to dying patients. “I prescribe so much narcotics, it would make Dr. Healy look like an amateur,” he told me.
He keeps careful records and follows such strict procedures, “sometimes it feels like the DEA is there, with the patient, in my office,” he said.
He requires urine tests and checks medication levels to make sure patients aren’t diverting their drugs to other users. “I have to witness it, so they don’t switch the cups. It’s terrible.… I apologize, but I can feel the chill in the room. I’m supposed to be their advocate, but I have to be an investigator. Every patient is a potential threat. Because if the DEA comes after you, your reputation is gone, even if you win.”
Medical attorney Alan I. Kaplan said that perception is more common than outsiders realize. At recent hospital seminars, he polled doctors and found as many as one in five felt they couldn’t just rely on their medical judgment in dispensing controlled medications. “They feel like they have to be looking over their shoulders for the DEA,” he said.
“Because of people like [Healy], legitimate doctors are fearful and legitimate care is compromised,” Kaplan said. “That leads to under-treatment of pain; suffering people not getting the care they need.
“And that’s a more important issue than how much time this one guy does in jail.”
Twenty years ago, not much attention was paid to chronic pain as a separate medical problem. Cancer patients might get dosed up with morphine, but the patient with the botched neck surgery or deteriorating disk mostly had to suck it up.
California was the second state in the nation to adopt a shield protecting physicians who appropriately prescribe narcotics for pain relief from medical board or criminal sanctions. Ten years ago, state legislators made pain the “fifth vital sign” that health facilities are required to assess and treat.
But unlike pulse, temperature, respiration and blood pressure, pain can’t be measured objectively. There’s no one-size-fits-all standard for appropriate treatment. That’s why trials of doctors accused of overprescribing narcotics typically rest on the testimony of dueling experts.
The feds are not gunning for physicians, said Asst. U. S. Atty. David Herzog, who prosecuted Healy’s case. “We don’t, in any way, want to chill doctors who are legitimately treating their patients,” he said.
Kaplan said there are safeguards doctors can employ to insulate themselves and protect their patients.
“Be skeptical,” he advised. Take a detailed history, try less-potent painkillers first, solicit a second opinion, require urine tests. Track patients in the state’s database, use contracts that require patients to commit to using only one doctor and pharmacy and listen to family members’ concerns and complaints.
Studies by medical researchers suggest that 100 million Americans suffer from chronic pain and the number grows as the nation grays.
In fact, the majority of people who overdose on prescription drugs are middle-aged folks who mix legitimately prescribed medications, become dependent or inadvertently take too much.
That’s what makes prescription-mill doctors so dangerous. They’re betraying patients who trust them.
If there’s a lesson in Healy’s case for me, it’s that we’re better able to trust our healers when we understand what they’re up against.
It’s easy to feel cheated when you ask for painkillers for an aching neck and your doctor sends you to physical therapy instead.
I know, because that happened to me. I felt vaguely like a suspect then. Now I realize the moment might have been just as awkward for my physician.
And exercise just might be a better option than urine tests, contracts and inquisitions.