I Ain't Scared of You. . .

What's that light at the end of the tunnel?. . .

It could be the daylight of peace and tranquility or it could be the proverbial freight train of more and worse to come, or maybe just another mirage to extend hope a little while longer. I arose this morning to learn that a favorite comedian Bernie Mac was dead at age 50 and Senator John Edwards had confessed to the rumors in The National Enquirer putting his political career in ruins, for the time being at least. These shocking realities saddened me but also caused me to realize how blessed I am. In the past couple of years I have faced the threats and realities of divorce, foreclosure, bankruptcy, death of family, business failure... Every doctor fears the humiliation of being published in the quarterly newsletter of the Medical Board for facing disciplinary intervention. We all understand that is the way the profession polices itself since most physicians are quite conscientious and feel bad when they commit a regrettable act on occasion. For most it would be preferable to secretly spend thirty days in the County Jail than to endure unfair or unwarranted public scrutiny. I had prepared myself for the inevitability of making the Newsletter. I definitely was not prepared for newspaper and television news involvement. I never read the article nor saw what was reported on the evening news. Some who support me described it as B.S. It makes me feel good to know that not everyone is programmed to automatically accept everything they are fed at face value.

In order to move on with my career and my life it is important for me to speak for myself and make sure the record is set straight. Those who really know me are aware of my competence as a practitioner and my caring nature. There is really no power given to any human or group of humans capable of changing those two facts. The Medical Board became involved with my practice of medicine because of complaints from outsiders who drew their own conclusions to how I found it most appropriate to treat opioid dependence and chronic pain patients. Many would comment that you shouldn't have been treating them in the first place. My answer to that would be that if our health care system functioned as it is suppose to I never would have been treating such patients. Maybe so many other doctors would not avoid such patients if the inappropriate patients received appropriate intervention medically and legally. The real problem is not legitimate chronic pain patients. The real problem is the addict who has chosen to willfully engage in unlawful behavior. A person of such character has no regard for anyone but self and they deep down don't really even care for self or they would not choose such a self destructive pathway to live. I have little compassion for a person who is willfully dishonest and deceitful. Many have been discharged from my care once the truth became known. Such people are the other source of complaints and false information supplied to the Medical Board. Aside from that, the Board reviewed five of my charts dating back 1 to 2 years. During previous meetings with them I was told what was deficient in my documentation and what needed to change in the future to continue treating chronic pain patients. The Board left me believing that completing the Continuing Medical Education I took at Portland State would be sufficient to prevent them from going forward with any legal proceedings. They made a compilation of all I had told them in good faith and used charts they already knew were representative of the pre remedial situation to justify a public smear of my practice of medicine.

So what could be the worst possible outcome? That of course is easy to answer. I could lose my privilege to practice medicine permanently. Is that likely to happen? Absolutely not. Most of the Board's leverage comes from embarrassing a doctor publicly when they want that doctor to comply. After that, they tend to show a display of overwhelming force to show that doctor that he or she cannot possibly win against them. They have nothing to do with the actual practice of medicine but everything to do with who is allowed to practice medicine and what their scope of practice can entail. They mask everything behind protecting the public. In my case the main people protected by them are ones who regularly break the law. Others such as legitimate sufferers of pain from chronic conditions will be again told they can't be treated in the most appropriate manner because of intervention by their government agencies.

How much wrong have I really done? First of all, I don't really want to treat a lot of chronic pain patients. For the vast majority of patients I have prescribed an opioid to I think it is for the best for them to be treated elsewhere. Where that elsewhere is, I'm not sure. This catch 22 cannot be resolved by me. The pain clinics can go only so far with them, the orthopods and neurosurgeons would rather not be bothered, family docs don't have the time to address the addictive component associated with many of these patients' condition. A subset of patients found the perfect home with me and have done exceptionally well. They have found adequate relief to have their life back, to a degree. Without such relief some patients would consider suicide. To the Medical Board this would be preferable to me continuing their treatment. I'm sorry but that really bothers me. That's why I encouraged such patients to write the Medical Board themselves to express their feelings about their right to treatment being tampered with for bureaucratic purposes. Some patients simply do need a medication such as methadone to control their chronic pain. I think it is probably unethical to deprive them of the treatment they need in the name of protecting them. As Dr. Deluca with the Pain Relief Network has stated in his video interview, few people in America receive the true standard of care for chronic pain for the simple reason that the average doctor fears the repercussions for attempting to provide such treatment to the degree that may be necessary. I feel if I had never prescribed methadone for chronic pain treatment the Board would never have taken things this far. The DEA is a federal institution and could only charge me for a criminal act or for using narcotics for non medical use or for treating substance abuse disorders without the proper licensing. Physicians usually use certain narcotics for the treatment of a diagnosis of a chronic medical pain condition. This is perfectly legal in the United States. But... the State Medical Boards make the criteria for what is deemed a legitimate medical condition. Most doctors are not aware of the detailed criteria in the policies until it's too late. By that time the Boards can have enough against a particular doctor to use against them in any way they see fit to suit their purposes. In my case, the remediation done as requested was irrelevant but it would give them justification to allow me to continue treating pain patients if that was their desire. They hold all of the cards.

I have been advised against going through with the hearing for it would more than likely be pointless and could make things worse in the long run. However, if I had the legal backing and finances I think the cause is worthwhile to fight for. Without such support no individual citizen can expect to beat the State. That much has become clear to me. The norm in such a case as mine is have a consent order issued that allows the Board to feel it has acted sufficiently on behalf of The People of The State of North Carolina.  Basically, the doctor is ordered to do as they say and the doctor consents. This consent frees the doctor to not have them on his or her back any longer. The doctor's license is usually restricted for a year as a technicality but things go on as usual as long as the doctor stays out of trouble in the future.

All but a few of the patients I have treated for chronic pain seem to be handling the news ok that I will be ordered to no longer treat their condition. At times I wish I had forced myself to cap my chronic patients at the 10 or 12 that I find it most rewarding to treat. Had I done that, I believe that none of this would have happened. I can only hope and pray that they will find one willing and able to provide the treatment they need. Those patients are most dear to me because they constantly remind me that I did do some good in this context and that in principle I have been right. Despite that, there still often comes a time when one must let go because ones limits have been reached for a situation.

Dr. Alex Deluca, Pain Relief Network

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Comments

[Just another crazy person]

I came across your site while looking for health effects on mental health workers. You are a funny man. I worked in mental health for 18 yrs as a clerical worker. I am sure I am not the norm on this as I really was interested in psychology and still am. I would read about disorders and anything else that would interest me. Anyway, good luck with that medical board thing. Unfortunately, what I have learned is that they treat a person as guilty until proven innocent.