Prominent Northern Virginia pain management specialist Dr. William Hurwitz was viewed as a savior by his patients, some of whom traveled hundreds of miles to see him, but a federal jury in Alexandria, Virginia, yesterday found him guilty of being a drug dealer. After six weeks of testimony and four days of deliberations, the jury convicted Dr. Hurwitz on 50 counts of a 62-count indictment, acquitted him on nine others, and was unable to reach a verdict on the remaining three counts.
On the orders of presiding Judge Leonard Wexler, the nationally known pain treatment pioneer was immediately hustled off to jail. In the best case -- assuming the verdicts will be overturned on appeal -- Dr. Hurwitz will probably spend between two and three years behind bars. In the worst case, he will die in prison as a convicted drug dealer.
Testimony showed that Dr. Hurwitz had prescribed huge amounts of opioid pain relievers to his patients, some of whom diverted some of them to the black market. But expert defense witnesses testified that while Dr. Hurwitz's prescriptions might appear outlandish to medical novices, in reality they were in line with accepted medical practice in opioid pain treatment.
The case has focused national attention on the increasingly heated dispute between federal law enforcers and pain care advocates over whether aggressive opioid pain treatment is good medicine or criminal drug-dealing. In recent years, dozens of doctors across the country have been subjected to criminal trials for prescribing pain pills, while hundreds more have been taken before state medical boards. The contradiction between the imperatives of pain management and those of drug law enforcement has only heightened this year, as the Drug Enforcement Administration (DEA) and the federal drug czar, John Walters, unleashed a campaign against prescription drug diversion and abuse.
Hurwitz patients and pain treatment advocates attended the trial and reacted to the verdict with anger and disappointment. "I just feel very sad, very bad for Billy and the Hurwitz family," said Siobhan Reynolds, director of the Pain Relief Network (http://www.painreliefnetwork.org), a leading advocacy group for pain patients and doctors. "It is really frightening to see this whole federal drug apparatus go into high gear to destroy that which it has targeted. To watch what is really a cynical political prosecution being carried out in what used to be our hallowed courts is really distressing," she told DRCNet. "We are so far away from our original ideals. We are letting federal law enforcement regulate medicine through the criminal courts and allowing the opinions of prosecutors to override the medical judgments of highly trained physicians. If this doesn't serve as a wake-up call, then I don't know what does."
Unsurprisingly, US Attorney Paul McNulty, whose office prosecuted the case, had a different take. "This sends a major message to anyone who would use the treatment of pain as a cover for being a drug trafficker," he told reporters after the verdicts were read.
Reynolds agreed that the verdict sent a strong message, but said that message was one that would result in people in chronic pain going untreated. "Any doctor encountering a patient in pain will now run for the hills," she said. "We are already hearing reports of doctors saying they will be more punitive with patients who make them nervous. This is a public health disaster. Twenty years ago, many doctors were afraid to treat patients with AIDS, and the government took steps to ease that fear. In this case, we have the same sort of public health catastrophe, but instead of helping the problem, the government is only exacerbating it."
"No doctor in his right mind would prescribe for chronic pain patients now, knowing that their misuse of the drugs could be tied back to the doctor and he could be accused of being a drug dealer," said attorney Ken Wine, part of Dr. Hurwitz' defense team. "It is as if each prescription he writes is like heroin being sold on the street. There is no middle ground in the law: Either the prescribing is okay or you might as well be selling crack on the street. The only defense doctors traditionally have is the good faith defense, but that did not work here," he told DRCNet.
Much of the most damaging testimony against Dr. Hurwitz came from a group of related patients from Manassas who had been arrested on drug charges and who worked with prosecutors in the effort to win a conviction. Those patients testified that they duped Hurwitz into prescribing large amounts of opioids, then sold them on the black market. While they did not testify that Dr. Hurwitz was a knowing conspirator in their drug trafficking, their cumulative testimony aided prosecutors in portraying him as a doctor who ignored signs of drug abuse among his patients.
If those patients were Dr. Hurwitz' downfall, other patients testified fervently that the physician was the only one who would help them with their chronic pain. They testified that Dr. Hurwitz was a caring and courageous physician who was willing to prescribe what it took to treat them.
But jurors were more interested in the patients who took advantage of Dr. Hurwitz than those he helped. In their first question to the judge after they began deliberations, the jurors asked whether it was illegal to prescribe opioids to people who use illicit drugs. While the answer to that question is yes -- patients with substance abuse problems can be treated for their addiction at the same time they are being treated for pain -- Judge Wexler refused to instruct the jury thus.
"There will be an appeal, and it will be on the jury instructions," said Wine. "The judge basically refused to allow the good faith defense. Under the law, if he practiced medicine with good intentions, the jury could not find him guilty. But the judge limited the jury instructions so severely that it had little choice but to come back with a guilty verdict."
Now, Dr. Hurwitz is a federal prisoner, and more prosecutions of pain management doctors are already in the pipeline. In the battle between the imperatives of the drug war and those of medicine, the drug warriors have prevailed for now. But as Wine noted, "This is just one battle; the war is far from over."
For the Pain Relief Network, the Hurwitz verdict has prompted a call for an immediate moratorium on DEA prosecutions of physicians and a public examination of the Controlled Substances Act. "This is the 21st Century. The Department of Justice is imposing its antiquated notions about opioid pain medicines on the American people. Millions of innocent sick people are suffering horribly," said Reynolds. "This simply has to end."