In a drama that has been played out all too many times across the country in recent years, the Justice Department's campaign against prescription drug abuse -- if you can call it that -- came in crushing fashion to Haysville, Kansas, last month. Now, a popular pain management physician and his nurse wife are being held without bond and more than a thousand patients at his clinic are without a doctor, but the US Attorney and the Kansas Board of Healing Arts say they are protecting the public health.
It all started December 20, when federal agents arrested Dr. Stephen Schneider, operator of the Schneider Medical Clinic, and his wife and business manager, Linda, on a 34-count indictment charging them with operating a "pill mill" at their clinic. The indictment charges that Schneider and his assistants "unlawfully" wrote prescriptions for narcotic pain relievers, that at least 56 of Schneiders' patients died of drug overdoses between 2002 and 2007, and that Schneider and his assistants prescribed pain relievers "outside the course of usual medical practice and not for legitimate medical purpose."
In their press release announcing the arrests, federal prosecutors also said that four patients died "as a direct result of Schneider's actions," but the indictment does not charge Schneider or anyone else with murder, manslaughter, or negligent homicide. In all four deaths, the patients died of drug overdoses, with prosecutors claiming Schneider ignored signs they were becoming addicted to the drugs or abusing them.
A handful of Schneider's former patients have filed malpractice lawsuits, claiming they became addicted as a result of his treatments. The Kansas Board of Healing Arts was investigating several complaints against Schneider before it backed off at the beginning of 2007 at the request of federal prosecutors seeking to build their case. (The US Attorney's office in Wichita denies that it asked the board to desist, but the board insists that is in fact the case.)
Under pressure from state legislators, the board acted this week, suspending Schneider's license to practice and effectively shutting down his clinic, which had remained open with physicians' assistants writing prescriptions. That move came as a surprise to Schneider's patients and supporters, who had been engaged in negotiations with the board to keep the clinic open.
But if federal prosecutors, the state board and a few patients are painting Schneider as a Dr. Feelgood, for some of his patients, he was a life-send. Debbie Sauers was one of those patients. Suffering from the after-effects of a dissecting aortic aneurysm and chronic pain from four failed back surgeries, the former nurse said she now has nowhere to go. "The clinic is shut as of tomorrow, and today was the last day to get prescriptions filled," she said Wednesday. "Dr. Schneider was the only one who would treat me with pain medicine, and now I don't know what I'm going to do," she said.
Her efforts to find another doctor to take her on have been a stark exemplar of the stigmatization faced by pain patients whose physician is accused of being a pill-pusher. "I've had doctors' offices refuse to see me or laugh in my face or tell me to check into drug rehab when I tell them I was one of Dr. Schneider's patients," she said. "If you go to the ER, they hand you a list of drug rehab places. They put my doctor in jail, and no one will treat me now." Sauers is currently on massive doses of morphine and high-dose Lortab and says her cardiologist tells her a rapid withdrawal could kill her. "I don't know what to do," she repeated.
Darren Baker is another patient who swears by Dr. Schneider. The operator of a tree gardening service, Baker has bone spurs in his knees from years of climbing, and two years ago, he fell out of a tree, shattering both his heels. "They put all kinds of hardware in my heels, and I have to have pain medications just to walk," he said. "With the pain meds, I can't walk real well, but without them, I can't walk, period. Dr. Schneider was the only one who would treat me."
Now, like Sauers, Baker is in search of a doctor. "I haven't found one yet," he said. "I got a list today, but most of them are turning you away if you're associated with Dr. Schneider. If I can't get another doctor, I won't have any option except to retire and go on disability. I take my medicine to be a productive member of society," he said angrily. "I need my meds to survive and pay my bills and fight the daily grind. This really goes against our constitutional rights. How the hell can I pursue happiness lying in bed?"
If convicted, the Schneiders face a minimum of 20 years in federal prison, and given the multitude of counts, they could theoretically face centuries. While, since their arrests, they have been excoriated in the Kansas press and by politicians, they have also received strong support, not only from patients, but also from a national pain advocacy organization, the Pain Relief Network. Headed by Siobhan Reynolds, a former documentary film maker turned crusader after her life partner suffered horrendously from lack of adequate pain treatment before dying in 2006, the network has done highly effective advocacy on cases ranging from that of imprisoned Northern Virginia pain specialist Dr. William Hurwitz to wheelchair-bound, formerly imprisoned, and now pardoned Florida pain patient Richard Paey.
Reynolds senses a similar injustice on the Kansas prairies. "Dr. Schneider is a wonderful doctor and he ran a wonderful clinic," she said. "But the Justice Department comes in here and after the fact characterizes his medical practice as drug dealing and also after the fact decides that a patient death is caused not by a doctor but by a 'drug dealer,' making it now tantamount to murder, with a 20-year mandatory minimum. If anyone wonders why doctors don't take care of sick people, this is why."
The root of the problem, said Reynolds, is the Controlled Substances Act, under which the Justice Department determines what constitutes proper medical practice and what doesn't. "Under the act, the exchange of money for drugs is presumptively illegal, and doctors have to show they are doing medicine in an 'authorized fashion' approved by the Justice Department. Under the act, doctors are effectively presumed guilty until proven innocent. It's backwards, and it helps explain why it is so difficult to win these cases," she said.
The Pain Relief Network will shortly bring a federal lawsuit challenging the Controlled Substance Act, Reynolds said. "The act is profoundly unconstitutional and unlawful. It reverses the presumption of innocence, and we think we can win that challenge, even if we have to go to the Supreme Court."
While the network had vowed to file the lawsuit last month, it hasn't happened yet. That's because the network has been too busy putting out fires in Kansas, she said, adding that the lawsuit will be filed soon.
Meanwhile, Dr. Schneider and his wife remain jailed without bond at the request of federal prosecutors pending a first court date later this month. His patients are now scrambling to find replacement doctors with little success, especially now that other local doctors see what could await them if they apply aggressive opioid pain management treatments. And a chill as cold as the February wind is settling in over pain treatment on the Kansas plains.
Perhaps Dr. Schneider is guilty of failing to adequately screen his patients, said Darren Baker, but that's not a crime. "Pain meds are narcotics," he said. "Some people have to have them to survive, but other people just want them. I think Dr. Schneider should have covered his ass more. A drug addict is going to get his drugs, whether through a doctor or on the street. They can buffalo a doctor. But when they abuse their prescriptions, how can it be the doctor's fault? Maybe he could have done things differently, but he operated in good faith."