With federal prosecutors driven to a frenzy by Oxycontin mania, a nationwide federal investigation of doctors who prescribe large amounts of painkilling drugs underway, and other pain doctors being arrested, prosecuted, and even imprisoned over their pain management practices, one of the nation's most prominent pain management physicians has decided it is unsafe for both himself and his patients for his practice to continue. McLean, Virginia, physician Dr. William Hurwitz will shut down his practice at year's end, he told DRCNet this week.
Hurwitz and fellow Virginia physician Joseph Statkus have been publicly identified by federal prosecutors as the primary targets in a criminal investigation targeting doctors whom the feds believe have been selling Oxycontin and other potent painkillers that have been diverted from legitimate medical uses. For more than a year, a dozen federal agencies and numerous state and local officials have been attempting to build cases against Hurwitz, Statkus and other pain management physicians.
"The growing national plague of Oxy addictions, overdoses and deaths caused by the illegal activity of some doctors, pharmacists, and patients has been focused on like a laser beam by this office and other US Attorney's offices," Alexandria, Virginia, federal prosecutor Gene Rossi told the Washington Post earlier this month. "If any person falls into one of those three categories, our office will try our best to root out that person like the Taliban. Stay tuned," he blustered.
Hurwitz told DRCNet he was doing nothing illegal, but that he was a target nonetheless. He owed it to his patients to close up shop in a responsible manner, he said.
"My feeling is that if they're targeting me for criminal prosecution and the risk of summary shutdown of my practice, I don't want the horror show of 300 patients suddenly cut off from all support," said Hurwitz. "I will shut down in December; I have decided to announce this now so my patients have due notice to either taper off or try to find another doctor to take care of them."
Hurwitz told DRCNet he had attempted to reach an agreement on acceptable practices with the DEA to no avail. "We have offered to have open discussions with the DEA and prosecutors about problematic areas of this practice, but have been spurned," he said. That attitude contributed to his decision to end his practice, he said.
"That's terrible," said Skip Baker, director of the American Society for Action on Pain (http://www.actiononpain.org). "Bill Hurwitz has saved so many lives, yet they've intimidated him so much that he feels he has to go out of business," he told DRCNet. "This is a real disaster. Dr. Hurwitz was the last chance for so many patients in intractable pain. What a sad day it will be when he is gone."
One of Hurwitz's patients, who asked to be identified only as a Pennsylvania resident named Marianne, agreed that Hurwitz' imminent departure was a disaster. "I have degenerative joint disease -- every one of my discs and joints is affected -- and the only thing that worked for me was opioids," she told DRCNet. "I tried acupuncture, biofeedback, physical therapy, you name it. After my last physician refused to prescribe me any more opioids, I was about ready to do myself in. Dr. Hurwitz was a godsend. He agreed to see me quickly, and within five days of titrating [adjusting the dosage for] me, I was walking and working again," she said. "Dr. Hurwitz is a brilliant, dedicated man. I am heart broken that he is closing his practice. I feel like he saved my life, and I appreciate that."
Jim Klimek, a Hurwitz patient from Kentucky who lost all his body beneath the waist in a truck accident, feels betrayed -- not by Hurwitz but by the federal government. "I just don't understand their thinking," he told DRCNet. "There are people bombing us. Don't they have better things to do than shutting down a bunch of doctors? I don't know what to think about this country anymore," he said.
Neither does Klimek know where to turn for help. "I don't know what I'll do now," he said. "I'll just have to try to find another doctor, but it's hard to find one here who will prescribe adequate medications. I'll just have to go at it day by day," he said.
Hurwitz told DRCNet he recognized there are legitimate concerns about diversion of pain medicines for recreational use, but argued that the federal government is unable or unwilling to engage in a process of working with doctors to address those concerns. "Anyone would recognize there is a problem with leakage from legitimate prescribing," he said, "but there are certainly different instrumentalities other than prosecuting pain doctors that would minimize that problem. Unfortunately, they don't want to talk to us. The attitude of the prosecutors is that I'm a drug pusher with a license."
"Dr. Hurwitz is no Dr. Feelgood," said Marianne. "There are doctors who are operating pill mills, and I say it's great when they get shut down, but Hurwitz isn't one of those. He may get deceived occasionally because he gives the benefit of the doubt to patients. But people like me aren't taking these drugs to get high or abuse them; they are my lifeline."
But for doctors, it may be becoming too dangerous to extend that lifeline. "The real problem is as long as this police regime continues," said Hurwitz, "no one should be doing what I was doing. It's not safe. Not for patients, not for doctors. We have a bunch of naïve doctors who were conned by patients and now they're spending time in jail or facing the threat of prosecution. This is a horrible, draconian response; it is a pseudo-solution to a real problem foisted on the American public. A handful of doctors have become scapegoats for the sins of our society."
And support from either the medical establishment or the pharmaceutical companies that profit from the sale of opioid pain medications has been nil, said Hurwitz. "I'm waiting for support," Hurwitz laughed grimly. "I would call upon the leaders of the Academy of Pain Medicine and other groups to convene an urgent summit with their counterparts in government to review the impact of present policy on the ability of pain patients to get access to their medicine," he said. "Asa Hutchinson said they were only going after a few bad apples, but it ain't so," he said. As for the drug companies, "those guys have avoided any backing," said Hurwitz. "They don't want to be contaminated by the possibility of a guilty doctor."
Hurwitz told DRCNet that doctors in pain management needed a legal defense fund to come to their aid. As for himself, "I've engaged counsel."
And the patients are out of luck.
See our October 1996 report on Dr. Hurwitz's major battle with the Virginia medical board and the patients who rallied to his defense -- http://www.drcnet.org/guide10-96/pain.html -- includes photographs.