Thanks to My Supporters

 I will drop the third person routine due to the seriousness of the current situation...

I couldn't have made it through the last week if I didn't know there were people who supported and believed in me, so I must thank those of you who made the sympathizing comments on both sites. The situation is much like a death in that my reputation has been attacked and killed in an underhanded an unnecessary manner. When one knows they have done wrong and are caught is much different from when one makes an effort to do the right thing and others use their power and influence to make that person appear to be wrong.

I don't want to use words such as "witch hunt" or "framed" but those words in a sense could be seen as appropriate. Since this has happened to me I have researched the history of the issue and read about the Harrison Act of 1914 that led to thousands of physicians being arrested and jailed for treating patients with opioid medications for medical reasons. That was almost a hundred years ago. I thought things might be different now. The technique is different with the media available to reach so many people in a subliminal manner today. I suppose if I read and heard the things that were published about me I would assume the subject to be a terrible person as I'm sure many people do. The funny thing is that for those who aren't aware or that support me it doesn't make one bit of difference or makes the alliance even stronger. I feel worst for those who are divided such as my family who I never shared with the fact I was trying to resolve this issue with the Board for the past three years. They find out on the evening news and of course are shocked and devastated, mostly from a lack of understanding of what it all means. They just sense that I am in a lot of trouble.

I am thankful it is the Medical Board and not the DEA since they are capable of being more fair about things and they were until they decided to go ahead with this consent order. The only real problem I have is feeling betrayed by being forthcoming and providing them everything they asked for and them cherry picking just the things that would support their case, much of which is inaccurate information, some provided from drug addicts who became hostile when not given what they wanted. I was wrong to assume that the Board would side with me. They are a governing body and politics always play a role with governing bodies. This whole thing is more about them appearing to do their job and has very little to do with me and my patients because most of us are happy and content without their intervention. I do feel it to be unfair because I do know of doctors who have done things that have actually hurt people and it never made the news.

All I can say at this time is that I'll let my conscience be my guide and I'll try and practice what I preach to others. When I'm counseling others I often say that a lot of good can come from the bad situations we face in life. For one, it lets us know who our true friends are for they will always stick by us and never doubt us no matter what others say. I love practicing psychiatry but I hate the climate I have to practice in. There are so many forces to contend with. The comments I received have reassured me that not every force is adversarial and for that I am thankful. Regardless of the outcome of my situation I believe in the long run it will make me a stronger and a better person. I have committed no crime and have been charged with no crime. I have done my best to practice according to the Hippocratic Oath but this is not the day of Hippocrates. It takes a whole lot more than just good intention in this day and time.

War on Pain Doctors

Bad News for The HEADoc

 It troubles the HEADoc to make today's entry. . .

but he must as a matter of principle. A reporter from the local paper was courteous enough to contact The HEADoc before printing information about a Consent Order from the NC Medical Board to run this weekend. Gossip usually doesn't bother The HEADoc for he knows that the truth always wins with enough time. There are always two sides to every story with the truth usually caught up somewhere in the middle. A consent order from a board is equivalent to an indictment in the traditional criminal court but should not be equated with a criminal act. It simply states that it has been determined that there is sufficient evidence for a case to be heard in the appropriate legal forum for the purpose of settling the complaint. The accused could be dealt with any number of ways. It could be determined that nothing further is required to remedy the situation or problem. Sometimes a doctor's license is restricted or suspended for a set amount of time. In the most serious cases a doctor will have his license to practice medicine taken away. The process serves to promote self regulation of the behavior of all members in a profession basically by public humiliation of the one accused of violating or deviating from what has been deemed the norm for that profession. Having information available on a website is one thing but editorializing it in a public newspaper is another. This is why the HEADoc must speak for himself. He has nothing to hide but just wishes to be treated fairly and understood from his own point of view. He will allow his reputation to speak for itself and those who truly know The HEADoc will stand by him because they know his heart and his devotion and intent to strive to do the right thing at all times. Those who don't really know The HEADoc can make up their own minds, if they even care about the matter at hand. The haters can think what they want.

One of the HEADoc's traits that has tended to cause him difficulties in the past has been a tendency to over extend himself for the sake of others. He chose the medical profession and psychiatry in particular because he didn't like seeing people hurt and suffer. The HEADoc is not ashamed to say that he believes himself to be gifted in the area of connecting with those suffering emotionally. He did not learn that in medical school. Even if he weren't trained as a physician, that would still remain. Being a physician has in a sense provided the necessary authority that those in need would have trust. The HEADoc believes in helping patients grow spiritually. Self destructive behaviors and addictions are the greatest hindrance to this occurring. No person can change such behaviors until they decide for themselves they are ready to let the denial go, seek and accept appropriate help, and make the necessary commitment to work toward their goals.

So what does any of this have to do with the Medical Board one might ask? The Board became involved because a pharmacist didn't think The HEADoc should treat chronic pain patients with methadone and made a complaint. The HEADoc knows of multiple cases of chronic pain where the use of methadone has given a much higher quality of life to that patient. The Board itself has encouraged physicians not to undertreat chronic pain due to fear of being disciplined by them. On the other hand, North Carolina is 5th in the nation in overdose deaths from methadone. This problem was major before The HEADoc even knew what methadone was. That's where the Board comes in. The facts are that 80% of the deaths are from wreckless or naive polysubstance abusers who weren't prescribed the drug from any doctor. When tested on autopsy such a person would have at least 3 other drugs of abuse in their system. Who is truly responsible here? Is it the government who continues to cut funding for mental health and substance abuse treatment? Is it society or is it that people should be more accountable for their own behavior? The HEADoc takes accountability that he did not document his treatment in the manner the Board thought that he should. At times addicts have been skilled enough to pass themselves off as legitimate pain patients, which the HEADoc regrets. Is not the more important question why are people so desperate that they would go to any length to obtain narcotics and other mind altering substances? Is The HEADoc responsible for this?

For a period of time The HEADoc found himself amidst a town that was recently voted to be in the top 5 best places to live of the nation. This is perplexing in that illegal drug use seems to be completely out of control and very little done about it in this great town. Is society that blind, that this problem can be that easily overlooked? Maybe The HEADoc is the one who is delusional. So what has the HEADoc done in the name of self accountability? Since everything will be exposed publicly this weekend he may as well speak for himself in regards to this. The HEADoc has got the heck out of Dodge, with Dodge being the town mentioned above that was voted one of the 5 best in the country to live. The HEADoc witnessed mostly despair economically and emotionally for many people. Being the only provider accepting Medicaid or Uninsured may have led to a skewed view but what The HEADoc saw was real. While reporting to the Board since 2005, The HEADoc set up policies in his practice that included a written agreement with patients prescribed narcotic medications for their medical condition. Violation of the agreement would lead to termination of treatment and referral to the appropriate substance abuse treatment facility or pain clinic, none of which really exist in a functional capacity. Well over 150 patients were screened and dismissed from the practice through policy enforcement in the years 2006 through 2008. The HEADoc attended a 13 hour course at Portland State University on appropriate prescribing of controlled medications to please the Board. On his own he did 20+ hours of self study and attended several lectures involving the management of chronic pain. He recently completed training for office based opioid dependency treatment with Bupenorphrine. In the new office all patients with suspected addiction problems receive routine drug screening. The HEADoc knows that discharging those who violate their agreement with referrals to places they won't even go to or won't accept them anyway is a futile gesture but it puts him in compliance with the Board. Those patients will return to that pool of patients doctors have been conditioned to avoid until another doctor accepts the risk of trying to treat one of their many problems.

So let the unofficial record state that no matter what you read in the papers about The HEADoc, he is not a quack. He is not a drug dealer or murderer. He abides by the law of the land. He has made every effort to work with the Medical Board in the past and present. He has tried to make a positive difference and he has done so with many patients. He is learning to recognize his limits and acknowledge that some problems are too big for any one person to tackle and attempting to do so can be self defeating in the long run. The HEADoc knows that the Board is the ultimate authority and will be well aware of that at his hearing on August 20th. He may be ordered to stop treating chronic pain or his license could be restricted or suspended. Whatever happens to The HEADoc will have little bearing on the real problems that have led to this situation. The HEADoc knows that the world is not a perfect place and he feels good about the patients he has helped in the past. Not treating chronic pain patients will actually be a relief for The HEADoc but he worries about many who won't have access to such treatment. From a political standpoint the Board may feel that it has done its job and publicizing this case will certainly put fear into other doctors of what to avoid doing in their practice of medicine.

  War on Pain Doctors http://www.doctordeluca.com

Risk of Violence in the Workplace

 Every now and then The HEADoc finds himself in an undesirable inescapable situation. . .

Last week The HEADoc was trying to forge an alliance with the most delicate of cases; a teenager facing the difficult reality of the first psychotic break of Paranoid Schizophrenia. Failing to make a trusting bond with such a patient could adversely affect his future treatment outcome in many ways. This is the type of case that can truly test the psychiatrist's clinical abilities. As the patient made an effort to let down his psychological walls of defense for the first time, a ruckus was undeniably overheard coming from the front. The situation seemed to be escalating. It was a drug seeker unable to obtain his drug of choice from the local ER after claiming to have unlikely side effects from what he had been prescribed by The HEADoc the previous week. Profanities shouted at the nurse and receptionist along with racial slurs and demands for something to be done immediately reached the point they could no longer be ignored or overlooked.  Thus, the limit was reached. In the words of Beyonce', "he must not know 'bout me." In the field of psychiatry, there are times when an emergency arises that cannot wait for reinforcements to arrive.

So The HEADoc finds himself in quite the predicament. He is in an important session with his most vulnerable case while being disturbed by his least desirable patient type. His staff is being verbally abused and threatened and his waiting room milieu has been disrupted in the most rude and disrespectful manner. In a previous entry where the HEADoc wrote of violent behavior becoming imminent in the office setting, a commenter criticized his angry confrontational manner of handling a 16 year old girl who was threatening violence. The commenter suggested offering her something to eat or drink to help calm the situation. In certain situations the textbook must go out the window. Risk management is crucial but mental health care is a risky business and shiggety inevitibly will happen. Statistically, over 80% of those who work in ER's or Mental Health clinics will personally encounter violence at some point during their career. One really doesn't know what their reaction will be until finding the situation arise for them. Restoring order with minimal harm becomes the ultimate objective.

So how did the HEADoc react? Hint: not with milk and cookies. This person had crossed the line clearly and the negotiation/compromise stage had expired into the enforcement stage. There does exist a legitimate career known as a bouncer who provides security to certain establishments. Most businesses just hope that situation where someone must be physically removed from the premises never arises. The police are not readily available and are a non factor in most of these situations. Without providing details, the violator was removed and threats to take out assault charges against The HEADoc were made. That is just a case that will have to be proven in court. The HEADoc describes the whole incident as regrettable and unfortunate for all involved but feels he did what he had to do and will do it again if the situation calls for such an interventive measure.

Feelings of guilt usually follow feelings of rage or anger, in normal people. How could The HEADoc return to his session with the young man he had to excuse himself from to try and restore the peace? Interestingly, the young man was not at all emotionally traumatized by the events. He in fact was able to see The HEADoc as a real human being with real emotions. The patient offered the doctor empathy and understanding and an avenue opened for him to discuss some of his own thought content in a therapeutic setting. Thus, a potential disaster turned into something positive.