Net.World.com

                                                              
Pain Control or State Control?
Miguel A. Faria Jr., M.D.                                 
Friday, June 8, 2001                                       
                                                                               

You may have heard about the story of the psychiatrist 
who was prosecuted for murder because he prescribed pain  
medication for several patients who ultimately died.  
Nevertheless, you may not have thought about the 
implications of this news story or about how it may 
affect you and your loved ones. 
                                 

Yes, last year, Dr. Robert Weitzel, a physician who also 
happened to be a psychiatrist, was prosecuted for 
allegedly killing five elderly patients with the 
effective and legal narcotic analgesic (painkiller) 
morphine. His intention was to treat their pain, not to 
kill them; nevertheless, serious complications can arise, 
including death, in the best of treatment rendered by the 
most devoted and caring of physicians. Be that as it may, 
his trial and prosecution are having a cumulative, 
chilling effect on physicians when they are called upon 
to treat patients suffering from chronic pain disorders. 
                                                          

On the one hand, Dr. Weitzel asserts that ultimately it 
will be patients who will suffer because their physicians 
will now more than ever be afraid of prescribing the  
proper analgesic medications to treat their patients' 
pain. On the other hand, state prosecutors said that Dr. 
Weitzel over prescribed sedatives and caused the deaths 
of the patients with lethal doses of morphine. While Dr. 
Weitzel was convicted last year of lesser charges, last 
month a court ruled that the physician was entitled to a 
new trial. Suffice to say, the criminalization of 
medicine continues unabated, and as a result patients are 
suffering because of the government's progressive 
intrusion in the patient-doctor relationship and the 
practice of medicine.  
                                                                                                                            

More and more physicians are being prosecuted for a 
variety of alleged transgressions, from either 

prescribing too much or too little to making 
clerical errors and miscoding violations in third-party 
reimbursements (i.e., so-called fraud and abuse 
statutes). Thus, the state and federal courts have 
wittingly or unwittingly unleashed a veritable police 
state of medicine in which physicians are afraid to use 
all of the tools they have available to ameliorate 
suffering and combat pain and disease. (1) The government 
assault is most severe on solo practitioners and small 
groups, but every physician is vulnerable, and it seems 
that the more personal and caring, the more vulnerable 
the physician. The situation is becoming reminiscent of 
authoritarian states like the former Soviet Union where

it was said: "Show me the man, and I will show you
his crime." And yes, the laws are so voluminous and 
cryptic the State can call any physician guilty whenever 
it likes! 
                                                        

As it is, physicians are quitting medicine and retiring 
early, not only because they fear prosecution for 
innocent mistakes, which are now deemed criminal by the 
government, but also because of the present adversarial, 
litigious climate in which physicians practice medicine.  
As it concerns the specific case of Dr. Weitzel, Dr. Jane 
Orient, executive director of the Association of American 
of Physicians and Surgeons wrote County Attorney Melvin

Wilson and other Utah state officials urging them not to 
prosecute Weitzel a second time. "Prosecution of a physician

for murder or manslaughter for prescribing pain relief 
would have and enormous chilling effect on all physicians," 

asserted Dr. Orient. "Do you dare provide 
adequate pain care to patients?" By doing so, "are you 
risking your liberty and your medical license?" 
                                                      

Representing the view of organized medicine, Mark 
Fotheringham of the Utah Medical Association says he is 
not worried. He told The Salt Lake Tribune, "Publicity 
about the [Weitzel] case has made end-of-life issues more 
prevalent in the minds of physicians. But it's probably a 
good thing that people are looking at their practices and 
wanting to do it right." (2)  
                                                        

And yet, even before Dr. Weitzel's case, physicians were 
fearful of prescribing adequate doses of narcotic 
analgesics for their patients with pain disorders, afraid 
of being sanctioned by their state medical boards, which 
now more than ever seem to be competing for the scalps of 
physicians with increasingly draconian disciplinary 
actions. Indeed, despite the findings of a voluminous 
body of scientific studies showing, paradoxically, that 
physicians should not be afraid of using adequate doses 
of painkillers for their patients, particularly 
terminally ill patients with chronic pain, the fact 
remains they are afraid to do so because they fear being 
a victim, another scalp, in the destructive process of 
the criminalization of medicine. Who has not met a person 
or had a friend or family member who has suffered pain 
because of a physician's reluctance to prescribe the 
proper type and amount of medication? 

It's well known now that over 40 percent of nursing home 
patients, for example, suffer persistent pain because of 
under prescribing of pain medication by physicians.  
Government officials repeatedly state that physicians who 
followed recognized guidelines have nothing to fear when 
they prescribe these controlled substances (i.e., 
sedatives and narcotic painkillers), but is that really 
the case? 
                                                     

Dr. William Hurwitz of Washington, D.C., had his Virginia 
medical license revoked without a prior hearing because 
of his efforts to relieve chronic, intractable, 
non-cancer pain in his patients using lawfully available 
narcotics, such as morphine. Dr. Hurwitz and four of his 
patients were forced to file a federal lawsuit on the 
grounds that summary suspension without due process 
violated the U.S. Constitution and his patients' 
constitutional right to seek medical treatment for the 
relief of pain. Dr. Hurwitz contended that for patients 
with chronic pain disorders, narcotic analgesics are a 
better alternative than the Kevorkian method. (3) He has 
a point! Among Kevorkian's victims there were a number of 
patients who succumbed to "physician-assisted suicide" 
for that very same reason: They did not want to live with 
chronic pain, pain which could have been relieved by 
adequate doses of narcotics, which their doctors were 
afraid to prescribe because of the draconian police state 
of medicine.

To the regulatory State I invoke Hippocrates' central 
dictum: Primum non nocere, "First, do no harm!" 

References

1. Faria MA Jr. The police state of medicine : the nature 
of the beast. Medical Sentinel 1998;3(4):119-122, 138.  
http://www.haciendapub.com. 

2. Hunt S. Weitzel case raises concerns for doctors. The 
Salt Lake Tribune, May 29, 2001 

3. Hurwitz WE. The police state of medicine: reflections 
on a case of regulatory abuse. Medical Sentinel 
1998;3(4):131-133. 
http://www.haciendapub.com. 

                          ***

Miguel A. Faria Jr., M.D., is editor in chief of Medical 
Sentinel of the Association of American Physicians and 
Surgeons (AAPS) and author of "Vandals at the Gates of 
Medicine" (1995) and "Medical Warrior: Fighting Corporate 
Socialized Medicine" (1997). He is currently working on a 
book on Cuba. Web sites: HaciendaPub.com and 
AAPSOnline.org 

   focusIN Specialty Web Network 

<<Back to Home Page