Pain Wars in the Heartland: With Their Doctor Behind Bars, Kansas Patients Wonder Where To Turn

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."

Permission to Reprint: This article is licensed under a modified Creative Commons Attribution license.
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DEA Gestapo

The usual "Justice Department" DEA witch-hunt/hatchet job. Held without bail, facing CENTURIES of jail time, Dr. Stephen Schneider's career and all his assets have been destroyed. His wife is similarly incarcerated. Are there any children?

I have tentatively begun seeing a few chronic pain patients. However, I have made a decision after reading yet another DEA horror story to terminate these patients. Sorry, but I cannot have the DEA Gestapo breaking down my door.

(anonymous physician)

Stop passing out narcotics like candy!

Mr. anonymous physician, are you fricking crazy! Did you read that over 56 of this doctor's patients have died from overdoses. I can tell you from experience that most of the people are drug addicts that were created by the "good" doctor who is not screening nor helping his patients properly. Just give them what they want and put the check in the bank. If you act like this doctor then I hope DEA does bust your door down and puts you in jail with the drug addicts you have created!

candy and drugs

the reason we have people dying and laws like we do is because people are uninformed and have no common sense. They are essentially, stupid! It's people like you who keep this system in check. We need laws that say you take all narcotic substances at your own risk. What would you say about that? That goes for ALL PHYSICIANS. This means if you want to commit suicide, it is your choice. You don't need a prescription for rat poisoning, but then again, rat poisioning don't make you feel good. It's a shame the folks in pain have little access to pain medications.

Gestapo

You let the DEA become the monsters they are. We all did. They will go as far as they can. Get some balls and stand up to them. If all the doctors and the public stood up to them, there would no longer be such an organization. We only need a committee to keep our food safe. We cannot let our greedy government run over us and become like the old Soviet Union. What you are forgetting, the government are the citizen's slaves. We are letting things turn the other way. The DEA is nothing more than a bureaucratic organization wasting tax payer's money. It is another nazi-style organization in our government. We need to terminate all anti-American type organizations in America period or America will be doomed very soon. Common sense must be applied to many things and the governement we don't need! The FDA we need. The DEA will keep you in pain!

It's a nice thought.

It would be great if you could actually effect drug policy without billions of dollars, you can't. If you do "stand against" the government and get the medications you need without following the rules to the letter, you end up being put in prison as someone's bitch.

Frankly all drug need legalization just so we could empty out most of the jail/prison population, heavily tax drugs, eliminate drug cartels, stop the thousands of murders currently occurring right on our border with Mexico, frankly I could go all day on this. Think of the tax dollars saved. 1 inmate costs us approximately $50000 a year to keep locked up. And the tax revenues from just Cannabis would be in the Billions.

The reason Marijuana is currently illegal is racism against Mexicans. Opioids like morphine, codeine, heroin, and many others were because the Negro's might go crazy and rape white women.

And those people who want to keep medical decisions between a patient and doctors, with your signs showing Obama as Hitler, the government is already in your business telling your doctor what treatment you can and cannot have. Wake up America!!

Thank you, Drug War Chronicles...

Just a brief note to thank Phil Smith and David Borden for providing consistent and thorough coverage of the Dr. Schneider case and other PRN actions.

If anyone wants to quickly review the overall media coverage of the case, I am maintaining an updated news archive on the Pain Relief Network's new Chronic Pain Forums, in the Topic Newsflash - PRN in Kansas, which is in the "PRN - Hot off the Presses" forum.

Also, Siobhan Reynolds wrote a brief essay about the case which is an interesting change of pace from all the journalism, I think: PRN Rocks the KASBAH (Kansas State Board of Healing Arts).

Thanks Drug War Chronicles and Commentors for your interest - this really is important, a refreshingly direct legal approach.

Sincerely,

..alex...
Alexander DeLuca, M.D., MPH
Senior consultant, PRN
http://doctordeluca.com/forum/

Enter the Autocrats

Anytime there’s a drug issue related to something, priorities get reversed in favor of an autocratic ideology that favors drug enforcement and ultimately makes no sense.

In the foregoing case, the devils of addiction have priority over pain management; this despite the fact that it’s been well known since the late 19th century that most morphine addicts can maintain their addiction and live a fairly normal, healthy life as long as their supply of morphine remains uninterrupted and pharmaceutically pure.

This phenomenon of perceiving drugs as devils has repeated itself many times throughout recent medical history.  For example, the last execution for witchcraft in Scotland was carried out in 1696 against an 18-year-old medical student named Aikenhead who had advocated the use of anesthesia for childbirth.  Using an anesthetic such as chloroform during childbirth was seen by some punitive Christian religions as thwarting God’s primeval curse on women, referring to Eve’s punishment for having tempted Adam in the Garden of Eden.

The belief that the use of a natural substance to cure or prevent a disease was a practice contrary to God’s will continued through the early 1800s.  Beginning in 1772 in England, and in 1801 in America, the Anti-Vaccination Society condemned the use of smallpox vaccinations.  Given that smallpox fatalities were responsible for an estimated ten-percent of Europe’s annual mortality rate, the Anti-Vaccination Society could be expected to self-eliminate. And it did.

Nineteenth century science cast serious doubts on the Christian assumptions of human biology and biochemistry that had crippled medical progress for centuries.  In 1828, theologians as well as scientists were absolutely stunned when a young German chemist named Dr. Friedrich Wöhler synthesized a chemical called urea from inert chemicals.  Urea was classified as a living chemical, one that had been thought to exist only in living organisms.  Its synthesis from non-living materials effectively breached a religious belief system that had previously distinguished human biochemistry from its ordinary material constituents.

The cognitive dissonance between chemicals and the human body continues to recreate itself in societies today by posing in new and plausible disguises.  The same conflict resurfaces in the acceptance and use of human embryo stem cells in research, anti-depressants, birth control, RU-486, etc.

I think that the best defense (or preferably offense) that can be used when confronting these drug or chemical superstitions, in the Schneider case anyway, is not to follow the money trail, but rather to follow the madness trail left by the drug warriors.  You will find it.  And when you do you can put the authoritarian lunatics who’ve created it on a witness stand and make it obvious to any jury in America just how crazy these people really are.

Giordano

There must be an element of sadism in this

The sheer joy of a sadist in knowing that others are suffering unnecessarily.

Why won't the American Police (incl. DEA) leave Doctors alone?

I'm unfortunate to suffer from chronic pain (as a result of arthritis) and be a young man (30) whose longterm medical prognosis is that my condition will almost certainly worsen and my levels of physical pain will almost definitely increase and keep increasing until the day I die.

I consider myself fortunate (and blessed) to be a resident of and live in the UK where the police trust medical professionals to do their job and self-govern themselves through the General Medical Council, which deals with the rare instances of malpractice which do occur; and Doctors who do not play by the rules will swiftly find their licences to practice revoked.

I have worked my way up the analgesic "ladder" over the last 10 years: starting with paracetamol; then paracetamol and small amounts of codeine compunds; then paracetamol with higher levels of codeine compunds; then dihydrocodeine (which is twice the strength of codeine); then tramadol in addition to the dihydrocodeine; then duragesic patches (fentanyl) with the dihydrocodeine; then fentanyl with methadone and finally I'm stabilised on a regime of three-times daily methadone.

Thank-god that my GPs over the years have been able to prescribe exactly whatever pain medication they consider appropriate to deal with my pain, and not have to worry for a second that the police are going to come knocking accusing them of being drug dealers.

I'm cautiously optimistic for the future of pain-treatment in America thanks to the existence of organisations such as StopTheDrugWar.Org and the Pain Relief Network.The StopTheDrugWar Chronicle, along with the aforementioned lobbying groups, deserves praise of the highest order for going up against the hugely powerful forces of American law enforcement agencies such as the DEA who seem unable to differentiate between drug dealers and doctors doing their best to treat the pain of their patients.

Of course there will, sadly, always be some doctors recklessly prescribing narcotics (and maybe even a few who are actually drug dealers) and these "bad apples" must be brought to justice and stripped of their licenses to practice but I suspect that the majority of doctors being hassled by the legal authorities are guilty of no crime whatsoever and the American medical profession should be trusted to police itself.

I pray that common sense will prevail in the case of Dr Schneider and his wife if they are not drug dealers (as the testimonies of some of his patients seems to indicate) and that his patients are not simply hung out to dry and dumped by the wayside to suffer from their pain without the help of modern painkillers.

A doctor friend of mine once said to me "in this day and age there is no reason whatsoever why anyone should have to put up with pain"; and anyone ever unfortunate enough to be burdened with chronic pain will surely agree.

Pain Wars in the Heartland

COME TO WI. DRS. ARE UNDERSTANDING ABOUT PAIN,AND THERE ARE MANY PAIN CLINICS. A PERSON HAS TO ATTEND A CLINIC IST. THEN THE PATIENT CAN HAVE WHAT EVER IT TAKES WITH IN LIMITS. MADISON, FDL, OSHKOSH NEENAH
AND RACINE .JUST TO NAME A FEW . I HAVE BEEN DEALING WITH PAIN FOR 12 YRS. AND HAVE YET TO FIND A DR. THAT REFUSED TREATMENT. GOOD LUCK PEOPLE.

docalex's picture

PRN vs Kansas and the DOJ - The Complete Lawsuit

Dear Drug War Chronicles, Thanks as always. I wanted to make this documentation available to your readers. I strongly urge people to read the lawsuit, which is not dense legal'ese, but which is a quite remarkable document, asserting pain relief as a fundamental human right, for starters, and demonstrating the unconstitutionality of the Controlled Substances Act.

I am not a legal mind, but it seems to me Siobhan Reynolds is staking out very interesting new legal ground here, and I am frankly puzzled by the lack of educated commentary from the mainstream anti-drug-war orgs (Chronicles being the exception that proves the rule), or the libertarian blogs, etc - despite heavy national mainstream media coverage courtesy of the Associated Press.

Anyway, here it is, the complete case: PRN vs Kansas - The Complete Lawsuit (text, footnotes, appendix, and all exhibits)

In related news, PRN and the patients of Dr. Schneider held a press conference today on the steps of the Federal Courthouse in Wichita, Kansas. TV-video of the event is included: PRN at Fed. Court - Reynolds and Patients Try to Reopen Schneider Clinic - Associated Press; WIBW TV; 2008-02-19.

Thanks,

..alex...
Alex DeLuca, M.D., MPH
Senior consultant, Pain Relief Network

God Bless the Pain Doctors

To the Anonymous Physician With a Heart,

Please do not let the DEA scare you away from taking on a few chronic pain patients. You can protect yourself reasonably well by following the strict guidelines that most pain clinics are following.

1. You must see your patients every 2 weeks until you get to know them for a few months and only then extend the time to 3 or 4 weeks between refills.

2. Make sure you have their patient histories and previous medical records. If they don't exist and the patients have insurance then have the tests redone.

3. Do random blood and urine testing on the patients. Make sure you tell them that it's for their own good (to keep their doctor safe).

4. Have patients turn in their used prescription bottles every time they come in so you can verify that they are using the same pharmacy. It wouldn't hurt for you to establish a relationship with 2 or 3 of the largest pharmacies in town so that you could send your patients to one of them. You may even be able to be financially compensated for your referral -- check with your accountant.

5. Of course the usual stuff: ask them each time if they've been getting meds from other doctors, if they've been compliant, have them rate their pain, and do the standard BP/heart rate/O2 saturation check/weight/temp. Ask about depression, COPD, constipation etc and treat if needed.

6. Write the pain pill prescription for the exact number of days between doctor visits -- none of that standard "30-day supply" stuff. If they're coming back in 2 weeks, then they get a 14 day supply. It will prevent the patient from obtaining extra pills through sloppy prescribing.

7. Have a fixed procedure for non-compliance and give each new patient a copy. For example, some offenses will result in immediate termination - such as a dirty urine or blood test, getting meds from other doctors, etc., Using the pills too early should not be a terminating event -- they should get a couple of chances at this because this often only indicates that the prescription level is too low. Once titration is adequately achieved most patients won't run out early.

8. Use prescription pads that are non-copyable and individually numbered and use the kind that makes 2 or 3 carbonless copies so that you have an exact record of the prescription you wrote.

9. Post signs through the office warning patients not to discuss their pain meds with one another - tell them it's for their own safety and for privacy compliance. Also, encourage them to dress nicely for office visits -- but not too nicely -- because the DEA often gauges compliance by this. If they're dressed too poorly then they're seen as druggie bums and if they're dressed too nicely then they must be drug sellers.

10. Remember, your pain patients are desperate people -- it's really hard to find a doctor who will provide opiates and if you do then you'll become an oasis in the desert and people from all over will find you and come to you. They'll be willing to tolerate all sorts of abuse. For example, you can over-schedule them so they'll end up waiting for hours for their appointments. And you don't have to bother making the chairs comfortable, or the office warm or cooled enough because it doesn't matter -- they're in pain anyhow. Also -- and here's the real silver lining! -- you can require them to undergo all sorts of tests and painful, obtuse treatments from spinal injections to physical therapy and psychological counseling (all of which you will, of course, do in-house so that the profit will be yours). Tell them that they won't get their pain meds unless they are compliant with your "treatment plan." After all, the more aggressive you are in treating their pain, the more "proof" you'll have that you were not just a pill-pusher when the DEA comes knock-knock-knockin' at your back door!

9. Rest assured that even if you do all this, even if you are as diligent as possible to ensure that the government will be satisfied with your precautions, please realize that it will never be enough. The U.S. government is on a century-long witch hunt and at the end of the day they will meet their quotas. You will be caught, tried and convicted. Make sure that you have all of your money safely invested in offshore accounts and other safe havens so that when you get out of prison you'll be able to enjoy your retirement.

10. And here's the thing -- even though you will no longer be practicing medicine, you can be glad that you really did help out a few people who had no other place to turn in their agony. And even though a third of them committed suicide within a few weeks of your arrest, and another third took so many NSAIDs that they died from internal bleeding, rest assured that the last third found another doctor -- someone like yourself...compassionate....competent....with the sincere desire to alleviate human suffering -- and started the process all over...God bless you for being willing... God bless you for being human.

Ruth F.

.

wise woman

my god this brought me to tears, hit the nail right on the head! how true your words are, all of them. the crap i have put up with and i know i am not alone. god bless doctors who will not let people suffer!!!!!!!!!!!

If I was on his jury

If I was on his jury I would find them NOT guilty....56 died over 5 years not bad look at how many people he had seen over the years...People are born to die,all doctors have people die from all kinds of treatments all the time...I hate to even go to a doctor...I warn the doctor "you hurt me,I hurt you" and over 43 years only one doctor found out...

Migraines

For the last 6 years, I have been dealing with migraines due to MSG allergies. I have relied on my neurologist to keep me in liquid dilaudid. I use 4 doses per month. Hardly a drug addict. He decided to just be done with me as he is shitting his pants about the DEA. I took responsibility for myself and have stopped using foods or beverages with MSG. Others are not quite so fortunate as I. They need narcotic pain relivers due to massive trauma of one kind or another. It is time to stand up to the government on all levels and take our country back.

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