[Fwd: FW: Doctor Defends Prescribing Powerful Painkillers]
From: dtouch (dtouch@bellsouth.net)
Mon Feb 4 17:52:19 2002
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From: Frank B. Fisher, M.D. <frankbfisher@earthlink.net>
Date: Sun, 03 Feb 2002 08:36:23 -0800
To: Pain + Chemical Dependency <PAIN_CHEM_DEP@PEACH.EASE.LSOFT.COM>
Subject: Doctor Defends Prescribing Powerful Painkillers
February 1, 2002
DOCTOR DEFENDS PRESCRIBING POWERFUL PAINKILLERS
GROVER - One day after federal drug agents suspended his license to
prescribe narcotics, a Cleveland County family practitioner says he did the
right thing in prescribing powerful painkillers for almost all of his
patients.
Dr. Joseph Talley said four plain-clothes Drug Enforcement Administration
agents entered his clinic Wednesday, taking the plastic-encased federal drug
license off his desk and confiscating all narcotics from the office.
Meanwhile, state medical examiners allege he failed to take appropriate
steps to weed out drug abusers, or properly examine, diagnose and follow up
with more than 20 patients to whom he prescribed painkillers over the past
decade.
The N.C. Medical Board has scheduled a hearing next month at which his
license to practice medicine can be suspended or revoked. And state and
local police say they are investigating whether he improperly dispensed
narcotics to patients, at least one of whom died.
The action followed a Dec. 19 raid in which DEA agents seized patient
records, filling more than 30 boxes with files and documents. Talley said
one of his two partners at the Grover Medical Clinic resigned immediately
after the raid. He said two nurses also have quit since then.
DEA officials won't comment on Talley's case, saying it's part of an ongoing
investigation.
But Talley said Thursday he's been told to expect criminal charges, and he's
hired a criminal lawyer in Charlotte to defend him.
Talley, 64, acknowledges he prescribes large dosages of opioids -- powerful
opium-based drugs including morphine and OxyContin -- to patients for
chronic pain. For example, Talley says that while some doctors might
prescribe 30 or 60 milligrams of morphine, he might prescribe 300
milligrams. He's gotten popular as a result, with patients hailing from as
far away as California and Oklahoma and praising his practice on Web sites
for pain sufferers.
Talley says he's willing to risk being duped by the occasional abuser or
drug dealer if it means every person who's truly in pain gets relief from
the drugs he prescribes.
"The basic decision you've got to make is if society is better off -- if a
patient is better off -- if you let a drug addict dupe you and you play into
his hands, or let a patient down who really has pain?" Talley says. "It
seems to me to be a no-brainer."
He said he prescribes narcotics for about 97 percent of his 3,000 patients,
including about 1,300 who come in quarterly.
Talley said about half his patients fill their prescriptions at a nearby
pharmacy. A sign at his clinic, about 40 miles west of Charlotte on the
S.C. border, notes that two major chain stores will no longer fill his
prescriptions.
Today, Talley is wondering how many of his patients will bother coming to
see him since he can no longer prescribe the drugs they seek. He says he's
known as "the doctor of last resort" for patients whose own doctors won't
prescribe narcotics long-term.
The case against Talley comes as state medical boards, including North
Carolina's, publicly state physicians will not face scrutiny merely for
regularly prescribing opioids, which because they can be habit-forming were
not generally prescribed for long-term use.
But prescribing the drugs for relief of chronic pain, rather than to
terminal patients, requires higher vigilance on the part of doctors to
reduce the chance of being taken advantage of by a drug-seeker, officials
say.
"Any doctor can be duped. Even the best doctor can be duped. The question
is whether the overall pattern of conduct is such that they can be duped on
a regular basis," said David Joranson, senior scientist and director of the
Pain and Policy Studies Group at the University of Wisconsin.
Talley acknowledges his willingness to prescribe powerful painkillers, at
times without ordering standard diagnostic tests. Even sophisticated tests
can't always pinpoint the cause of chronic pain or help in treating it, he
said.
Talley says he has corresponded with members of the medical board for more
than a decade to advise them on how he's treating patients.
The lawyer who is defending him before the medical board, Robert Clay of
Raleigh, said that's a sticking point in the case.
"They've had the opportunity to look at what he's done for 11 years.
They've never given him any warning, expressed anything" wrong, he said.
"He's written to them on many occasions."
"The medical board has said in position statements that they want to
encourage doctors to do exactly what he's doing," he said. "The medical
board has said that doctors who practice within acceptable standards of care
need not fear the medical board."
On Thursday, Talley blinked away tears as he talked about patients who will
be in pain or suffer withdrawal without his prescriptions. He said he
expects some of his patients will "be vomiting and sweating and seeing a
little green monster or two."
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