Federal prosecutors waging war on Oxycontin have won pill-pushing convictions against two Southwest Virginia doctors in the past month and a third has been raided and awaits possible indictment. In the past two years, three other physicians have also been convicted of dispensing powerful pain relief medications without proper medical reason in Southwest Virginia, now in the midst of what local authorities refer to as "an epidemic" of Oxycontin abuse. The trio of doctors recently convicted or under official suspicion all prescribed Oxycontin to large numbers of pain patients, some of whom have said in sworn testimony that they were drug abusers.
On June 22, a federal jury convicted Grundy, Virginia, physician Franklin J. Sutherland, 46, on 427 counts of writing prescriptions for no legitimate medical purpose. A month later, another federal jury convicted Dr. Lowell Clark, 43, of nearby Bland, Virginia of 266 counts on similar charges. Clark faces 15 years in prison, and Sutherland over 100 years, plus millions of dollars in fines. Both were prosecuted by Assistant US Attorney Randy Ramseyer, who has been working with a federal task force, including the FBI and DEA, as well as local police agencies in Virginia, West Virginia and Tennessee, investigating diverted drugs and health insurance fraud in the region.
Meanwhile, Roanoke, Virginia, Dr. Cecil Knox waits to see if he too will face the weight of the federal government. Federal agents raided his practice on June 27 looking for evidence that he prescribed Oxycontin and other pain relief drugs to drug dealers or abusers. According to the Roanoke Times, an affidavit filed in support of the search warrant said Knox was being investigated for prescribing drugs for no legitimate medical reason and defrauding medical insurance programs. The affidavit noted that Knox was the second largest prescriber of Oxycontin for Trigon Blue Cross Blue Shield, Virginia's largest managed health care company.
The next day, Dr. Knox was back at work at the Southwest Virginia Physical Medicine and Rehabilitation clinic, which provides physical therapy and pain management for chronic pain patients. "He takes his Hippocratic oath very seriously," attorney Debbie Caldwell-Bono told the Times. "He may be a leading prescriber of this type of pain medication. But at the same time, you have to realize that he is a leading caregiver of chronic pain sufferers in this area. He emphatically denies any wrongdoing by himself or his staff," Caldwell-Bono added.
As federal and state investigators sift through thousands of pages of medical records searching for indictable offenses, Dr. Knox continues to practice without further public comment.
This assault on pain doctors as scrip-happy Dr. Feelgoods comes amidst a local level of concern over Oxycontin abuse that approaches a classical moral panic. With police and prosecutors hyping the threat of Oxycontin abuse and local newspapers faithfully parroting what they hear from law enforcement officials, local juries are quick to convict and local authorities are quick to conjure up new solutions to the latest drug menace.
In Pulaski, Virginia, police have provided fingerprint kits to six local pharmacies, to be used for customers filling Oxycontin prescriptions, the Roanoke Times reported. According to the Times, the kits' manufacturer said this was the first time the fingerprint kits had been used in pharmacies. They are typically used at check-cashing businesses. According to the same article, police in Pulaski logged a whopping 1,800 drug cases in the first six months of this year. The town has a population of just under 10,000.
A Virginia lawyer, Strother Smith of Abingdon, has also gotten in on the fun, filing a $5.2 billion state lawsuit against Oxycontin's manufacturer, Purdue Pharma of Connecticut, on behalf of five individuals who claim to have become addicted to the drug. Smith has referred to Purdue Pharma as "corporate drug dealers." One of Smith's clients claims to have become addicted to the drug after taking one dose.
In the cases of Drs. Sutherland and Clark, federal prosecutors told jurors the physicians prescribed Oxycontin to people they knew or should have known were abusing the drug and presented witnesses who testified they were abusing drugs while receiving prescriptions.
In Sutherland's trial, Brian Elswick, a former deputy sheriff and professed addict, told the court he persuaded Sutherland to phone in prescriptions in the names of the deputy's former fiancee and father. He testified that he told Sutherland he had pain in his back, elbow, or leg, and the doctor would phone in a prescription.
US Assistant Attorney Ramseyer also called the deputy's fiancee, Summer Chambers, who testified that: "I knew that [Sutherland] had to know there was a problem." She did not explain precisely how she knew this.
Testifying in his own defense, Sutherland admitted filling 11 prescriptions to Elswick's father and fiancee without examining them. "I trusted Brian completely," he testified. "I made a terrible mistake." He told the jury many of his patients suffered from severe, chronic pain and that the medications he prescribed helped them lead more normal lives. "I just tried to do the best job I could with the patients, to treat them as best as I know how," he testified.
But the jury was not in a mood to buy it. After three days of deliberations, they convicted him of hundreds of counts of improper prescribing. He will be sentenced on September 10.
The jury didn't swing Dr. Freeman Clark's way this week either, in a trial strikingly reminiscent of Sutherland's. Testifying for the prosecution was another professed former drug abuser, Elizabeth Diane Ritchie, who told the court Clark prescribed her pain pills after other doctors refused to do so. "I was still in pain, and my family said [Clark] would write narcotics," she testified. I told him I was snorting the pills. It just seemed like it worked faster," said the former fast-food worker who had undergone three surgeries to her back and neck. Still, said Ritchie, she did not think Clark had done anything wrong. "He was a good doctor," she testified, "he took time with you."
Another prosecution witness, former minister and drug abuser Harold Underwood, also testified that he abused the drugs prescribed him for back and neck pain. But he, too, testified that Clark was unaware of his drug abuse problem. "He had no way of knowing that," said Underwood. "I never got to the point where I was completely out of it. He always examined me, it was never just ask for medicine and get it."
Yet another patient, Connie Hatfield, testified that she began seeing Clark because no other doctors would take her as a patient. "I had called several doctors' offices, but as soon as I told them I had chronic pain, they said they weren't taking any more patients." Clark prescribed Oxycontin, she told the court, and she continues to use it for back pain. "I can't function without my pain medication," she said, adding that she was not a drug abuser.
Clark's cause was damaged by his admission in court that he had suffered from depression and prescription drug abuse before establishing his practice in the area. He said he last tested positive for drugs in 1999 and since then he had passed 88 consecutive random drug screenings. He also testified that as a doctor new to the area, he had to take patients no one else wanted: the poor, those with multiple medical problems and chronic pain sufferers. "I actually inherited a lot of patients no one else wanted to see," he told the jury. "I didn't care. This was the first time in my life that I had a practice I could call my own."
And the last time, unless his conviction is overturned on appeal.
In both cases, local internist Dr. Adam Steinberg, apparently building a nascent career as a professional witness, testified that hundreds of prescriptions were unwarranted. But in Dr. Steinberg's opinion, no one with a drug problem should be given opioids for pain. "It's not a legitimate medical purpose to issue a narcotic for a known drug abuser," he testified.
Steinberg did not say what such people who are in pain should do, and his views are sharply at variance with those who specialize in pain treatment. The intersection of chronic pain and chemical dependency is a complex medical issue, but a consensus exists among pain treatment leaders that such patients should receive adequate treatment for their pain, even if it is narcotics (http://www.ampainsoc.org/pub/bulletin/mar99/president.htm).
Assistant US Attorney Ramseyer, in a post-conviction press conference, called the verdict a message to doctors. "With pills, it's not like cocaine or marijuana. They can't get onto the street unless doctors are prescribing them," he said. "So many people are affected by [the abuse of] these pills in Southwest Virginia. It's hurting people who have a legitimate need for these medications." Ramseyer did not explain how sending doctors to prison for dozens of years in an area where physicians are increasingly loathe to prescribe strong pain medications would help those people.