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Medical Forum / Diseases and Disorders / Arthritis / April 2005

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"Drug doctor" goes to prison

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firechief - 19 Apr 2005 02:56 GMT
A prominent pain-management doctor in Alexandria, VA who
prescribed high does of drugs such as morphine and Oxy-
Contin to patients around the country was sentenced to
25 years in prison Thursday.

William E. Hurwitz, 59, whose pain clinic drew patients
from more than 39 states, was conviced in December of
drug trafficking resulting in the death of a patient,
along with other charges including health care fraud
and illegal drug distribution.

Presecutors saind Hurwitz turned a blind eye to patients
who were obviouse drug dealers and addicts, and that his
waiting room was at times filled with stones, sleeping
patients with track marks on their arms.
Mary Z - 19 Apr 2005 03:53 GMT
> Presecutors saind Hurwitz turned a blind eye to patients
> who were obviouse drug dealers and addicts, and that his
> waiting room was at times filled with stones, sleeping
> patients with track marks on their arms.

To other patients he liberated them from unbearable pain.   My fear is
Drs will be reluctant to treat pain effectively. He had many
supporters in that court room as well. -- MZ

Visit my website:
http://www.mzuschlag.com
Rosemarie Shiver - 19 Apr 2005 07:14 GMT
  In all fairness there was a bait and switch tactic used by the DEA
against him. The prescribing guidelines were published ( and posted) and
were yanked shortly b4 he was arrested and replaced with more draconian ones
just like that <snap>.

  Hurwitz was convicted according to the new guidelines when the
observations of his practice took place under the old. Which were deep sixed
but not so deep that they aren't still available on the 'Net.

  'Twas dirty pool on the part of the DEA.

Hugs from Rosie

Signature

"If you wanna get it done, you gotta fight for yourself" -- Meat Loaf, Bat
Outta Hell II

>
> > Presecutors saind Hurwitz turned a blind eye to patients
[quoted text clipped - 8 lines]
> Visit my website:
> http://www.mzuschlag.com
d'huit - 19 Apr 2005 15:40 GMT
>   In all fairness there was a bait and switch tactic used by the DEA
> against him. The prescribing guidelines were published ( and posted) and
[quoted text clipped - 10 lines]
>
> Hugs from Rosie

what bothers me about this "bait and switch/dirty pool" senario, rosie, is
that surely the doctor could afford a decent attorney who would have brought
out "all" of the facts about the old guidelines versus the new guidelines
and how they applied to this specific case.  entrapment is illegal and this
"bait and switch/dirty pool" perspective makes it sound as though the dea
was "out to get" specifically this doctor (which the dea may or may not have
been attempting to do).

a good (or even a mediocre) defense attorney would not have allowed the
deep-sixing of pertinent facts in the case, like the "dates" involved in the
criminal investigation of this doctor's activities and the "dates" involved
in both sets of guidelines.

something doesn't feel or smell right to me about this "bait and
switch/dirty pool" perspective of this case.  my sense is that there had to
be more to this case than that and than meets the casual observer's eye.
i'd need to know a lot more about this case, before i'd buy into the "bait
and switch/dirty pool" perspective of this particular case.

kate

>> > Presecutors saind Hurwitz turned a blind eye to patients
>> > who were obviouse drug dealers and addicts, and that his
[quoted text clipped - 7 lines]
>> Visit my website:
>> http://www.mzuschlag.com
Smokie Darling (Annie) - 19 Apr 2005 16:00 GMT
> >   In all fairness there was a bait and switch tactic used by the DEA
> > against him. The prescribing guidelines were published ( and posted) and
[quoted text clipped - 31 lines]
>
> kate

This is my opinion only, I'm not positive of the facts or even sure
I've gotten some of them correctly.  Anyway, Hurwitz was a man who took
care of patients and tried to do right by them.  However, he also
prescribed medication to people who were then turning around and
selling it on the street.

One of the most blatant items, that had been proven to be in error, was
a 'script written for 1600 pills (I believe it Oxy) a DAY.  This was
presented to the jury as fact (even though it was known to be a
"typo"), his defense explained it hadn't been written that way (nor was
it dispensed that way).
Didn't matter, after finding out that he had patients who were lying to
him to get drugs in order to sell, abuse, give away (whatever), and he
was still treating them (I believe it was shown that he "must/should"
have known something was up, in other words he didn't cover his own
butt very well), the jury just bought the whole story, that he was a
"drug dealer" who just *happened* to be treating some chronic pain
patients.

Now, a couple of years previous, Hurwitz had beaten the DEA on similar
charges.  We all known how much the gov't *loves* to lose high profile
cases, right?  No doubt he had a good to great lawyer, but I also think
there was some arrogance on his part (after all, he *was* treating
chronic pain patients, but he got buried by scam artists or possibly
even "plants" by the DEA).

Juries can't see *pain*, so I don't imagine have a CPer on the stand
helped him much, they probably saw nothing but a drug seeker (and I
can't tell you how sad that is).  And the media has certainly done its
job of making *any* Oxy an evil drug with no helpful things about it
(heck even the former surgeon general Koop is doing commercials about
CPers who are addicted to pain medication, but call it "dependance").
Oooooh, don't get me started, this is one of those things that drives
me right up the wall.

Smokie Darling (Annie)
d'huit - 19 Apr 2005 17:50 GMT
>> >   In all fairness there was a bait and switch tactic used by the
> DEA
[quoted text clipped - 84 lines]
>
> Smokie Darling (Annie)

w0w.  it's a complicated case.  showing/proving hurwitz received kickbacks
from drug companies, or from the people who resold the drugs from his
prescriptions on the street, would have made him a drug dealer to me.
however, while being stupid and arrogant is not a crime, it can be perceived
as being unwittingly complicit/contributive in criminal activity.  somewhere
along the line, it appears, his good judgment and methodology was badly
impared.  sadly, the good that he may have been doing was corrupted and over
shadowed by his lack of wisdom and oversight.

truth be told, i would suggest that most if not all doctors have, because of
their huge patient loads (because of the private practice patient load and
appointment time managment paradigms---heck, my pcp told me she has 6000
patients), at least a few such deceitful, drug abusing/seeking patients.
sounds like he had more than just a few and just didn't bother to
scrutinize.

my perception and opinion is that juries are generally never made up of
one's peers, unfortunately.   jury members are often poorly equipped to
understand the complexities of fields outside of their individual expertise
(which makes the term "peers" a misnomer in that sense).  as a result, in
cases like this, juries often rely upon their emotions to decide their
verdicts, despite admonitions to the contrary from the bench.

people will choose not to see what they don't want to see, what is painful
for them to see.  the physical pain of others is palpable to all the senses,
if one is allowing oneself to pay attention.  from what you've described,
this jury was predisposed in their verdict.

as to the media and koop, grrrrrr . . .   i wish the media would stay out of
trials completely, until after the fact, to report about them.  the media
does have influence and the "talking heads" speculations are simply
exercises in bias, sensationalism and appealing to the baser tendancies of
the human condition.   when it comes to medications, the media's penchant
for shallow sound bites does a great disservice to millions and actually
causes many situations to worsen.  and yet, because i'm a mass of
contradictions<smile>, the press needs to remain unfettered, but should
monitor its info-tainment more circumspectly.  as for koop and his
assertions, i wish we could put our moccasins on him for awhile to see if he
maintains his assertions and we know he wouldn't.  of course chronic pain
sufferers are dependent upon pain medications!  how in the heck could many
function, on even the most basic levels, without these meds?  people are
also dependent on anti-biotics and all kinds of organ sustaining meds, and
on electricity and gasoline and jobs, to go about and live their daily
lives.  that doesn't make people addicts.

kate
Rosemarie Shiver - 19 Apr 2005 16:45 GMT
Google Huwitz + DEA guidelines.

Looky here, Kate:

http://www.washingtonpost.com/wp-dyn/articles/A49719-2004Oct20.html

http://www.doctordeluca.com/Library/WOD/NewDeaDocChilling04.htm

http://www.hannity.com/forum/archive/index.php/t-584.html

There's much more commentary like this. Plus, what Smokie sez is true, as
well.

  This is a major big deal for those taking opiates for their chronic pain.

Hugs from Rosie

Signature

"If you wanna get it done, you gotta fight for yourself" -- Meat Loaf, Bat
Outta Hell II

>
> >   In all fairness there was a bait and switch tactic used by the DEA
[quoted text clipped - 44 lines]
> >> Visit my website:
> >> http://www.mzuschlag.com
Smokie Darling (Annie) - 19 Apr 2005 16:59 GMT
> Google Huwitz + DEA guidelines.
>
[quoted text clipped - 16 lines]
> "If you wanna get it done, you gotta fight for yourself" -- Meat Loaf, Bat
> Outta Hell II

Thanks Rosie, I wasn't (and still am not) positive about the facts
(since a great deal of the information has been bastardized by the
media to fit the "spin" they want on it, i.e., the evils of narcotics).
The first time I read the 1600 pill a day thing, I thought, "Well,
heck, Hurwitz is getting what he deserves, no one needs that much
medication in a day."  Then of course, I discovered it was an error.

I think that Hurwitz just "forgot" about CYA.  When it's (CYA) done
correctly, then the DEA would have zero to have taken him down with.
It's a pain the butt for the CPer, but if it protects the doc and gets
the patient what he/she needs, then I'm all for it.

I worry about doctors getting caught in "stings" (which I feel is
partially what happened with Hurwitz).  Temptation, whether it's for
monetary gain or to actually make a fellow being feel more a part of
life (hence the doc is "god" like), is a terrible thing.  The DEA
guidelines, which were "rescinded", seemed to be a step in the right
direction for CPers.  Now we are all back to square one, and we have to
try again (Lordy, but that gets old).

Smokie Darling (Annie) - Am I the only one who's noticed that the Koop
commericals began when the Hurwitz trial did, and now that it's over,
they have stopped?
Paul T. Holland - 19 Apr 2005 23:08 GMT
i can add a bit of personal fact/experiance to at least one point:

the dea, in conjunction with a national panel of certified pain specialists
worked up an advisory that was a) distributed to doctors nationwide, and b)
posted on the .gov website as 'the' guidelines for responsible practices in
this field.

in the progress of the hurwitz case, his defense atty's filed the
appropriate motions required by law (on the record) - amongst the line
items involved, was the stated intention of introducing these guidelines to
show 'explicitly that hurwitz was within the guidelines [this does not
involve the questions of what he may or may not have known about a
particular patient, just his general practices].

24 hours after [prosecutors] received notice - the web pages were
withdrawn...permanantly

the prosecution then filed motion to suppress the introduction because they
did not reflect 'current' policy.

this is irrefutable fact, and i personally read them, and noted their
removal -

whatever the merits of the balance of the case, i can't think it expresses
'fairness' that he was denied the opportunity to use at least that part in
his defense.

jmo

paul

> > Google Huwitz + DEA guidelines.
> >
[quoted text clipped - 43 lines]
> commericals began when the Hurwitz trial did, and now that it's over,
> they have stopped?
d'huit - 20 Apr 2005 03:38 GMT
>i can add a bit of personal fact/experiance to at least one point:
>
[quoted text clipped - 31 lines]
>
> paul

imo, your opinion is valid, paul.    to me, that is withholding/surpressing
pertinent information by the prosecution.  i can't help wondering why the
judge went along with it.

seems to me, if a speed limit sign of 65 mph was posted last year on a
highway, how could you now be held accountable and fined for going over the
current 55 limit retrospectively, just because that new speed limit reflects
the current policy?  boy, all of us would have outstanding traffic ticket
warrants outstanding.

i believe old evidence is not allowable in appeals.  but this "old evidence"
was manipulated by the prosecution and that deliberate manipulation itself
should be considered new evidence and grounds for appeal.

kate

>> > Google Huwitz + DEA guidelines.
>> >
[quoted text clipped - 43 lines]
>> commericals began when the Hurwitz trial did, and now that it's over,
>> they have stopped?
d'huit - 19 Apr 2005 16:33 GMT
>> Presecutors saind Hurwitz turned a blind eye to patients
>> who were obviouse drug dealers and addicts, and that his
[quoted text clipped - 4 lines]
> Drs will be reluctant to treat pain effectively. He had many
> supporters in that court room as well. -- MZ

it seems to me that most doctors already are very, and perhaps overly,
cautious about prescribing for good/effective pain managment, especially in
cases where a patient has not been one of the specific doctor's patients for
a good number of years.   and who can fault doctors for that?  they've
invested and sacrificed a lot of themselves, their lives, their finite time,
money and energies, into becoming practicing physicians.  they have a lot to
lose, in the broader view, through the deceptions of others.

we all know there are drug seekers who are simply looking for relief of pain
that is not physical, while misusing physical pain meds and manipulating
others to do that.  there are also other patients who, through no fault of
their own (nor their doctors), are in chronic physical pain and whose pain
medications have lost effectiveness in managing their pain.  so these
patients are constantly seeking relief from very real physical pain, often
by switching doctors (based upon any of a number of "beliefs" about the
preceding doctor).

the body is a funny thing and can only be "fooled" into complying with the
designed intent of a particular medication.  after awhile on a particular
med (for whatever physical need), it is often the case that the body simply
says (behaves as though it were saying), "you can't fool me with that drug
anymore."  i suspect that's another reason why there are so many drugs in
the same class (aside from the fact that some bodies do not respond
initially, as hoped, to some drugs in class).

many of us here have been frustrated by what seems to us like our new doctor
"trying to re-invent the wheel" by redoing tests, imaging and procedures
that have been done before, and that we've transferred the records of, to
this new physician.  sometimes, i think that could be, in part, the
situation of the doctor practicing defensive medicine--protecting him or
herself from the possibility that the new patient is not "what" s/he
presents to the new doctor.

i don't know what the solution is for genuine chronic pain sufferers, nor
for their doctors.  but i think all the problems and issues, as a whole and
in specific, need to be defined better.  and maybe then, these problems and
issues can be dealt with better, by doctors in their practices and by
revised legislation and guidelines.

kate

> Visit my website:
> http://www.mzuschlag.com 
Rosemarie Shiver - 19 Apr 2005 16:49 GMT
  See my answer above. The negotiations and acceptance of guidelines were
done in good faith, collaboratively with Pain docs, then unilaterally pulled
by the DEA to be 'redefined' any which way the DEA wants.

 Whutcha think about all this, Kate? I think it's an outrage.

Hugs from Rosie

Signature

"If you wanna get it done, you gotta fight for yourself" -- Meat Loaf, Bat
Outta Hell II

>
> >> Presecutors saind Hurwitz turned a blind eye to patients
[quoted text clipped - 49 lines]
> > Visit my website:
> > http://www.mzuschlag.com
d'huit - 19 Apr 2005 18:59 GMT
>   See my answer above. The negotiations and acceptance of guidelines were
> done in good faith, collaboratively with Pain docs, then unilaterally
[quoted text clipped - 4 lines]
>
> Hugs from Rosie

to me, it sounds like the gov't and the dea is trying to kill gnats by using
a nuclear bomb.  the process (and those implementing it) is not conscious
of, nor anticipating, the inflicted lateral damage.  this has to be driving
doctors nuts with frustration!

these kinds of guidelines about patient care should be and really "must" be
left to professional medical concensus, where the expertise resides and the
mandate to "do no harm" exists.  how effective would the dea be if
electricians dictated the guidelines under which the dea functioned?

outrage?  i think it's more like arrogant and usurpant stupidity (and we
sure see this shortsighted mentality a lot, lately, in various gov't
agencies).  while i understand and sympathize with the dea's aims, its means
to those ends are definitely lacking in realistic understanding of the
fundamental and underlying issues and problems involved---namely criminals
and criminal behavior, not chonically ill people.  they've actually muddied
the real problem (the criminal aspects), by trying to more broadly control
and limit the non-criminals' access to necessary medications.

kate

>> >> Presecutors saind Hurwitz turned a blind eye to patients
>> >> who were obviouse drug dealers and addicts, and that his
[quoted text clipped - 62 lines]
>> > Visit my website:
>> > http://www.mzuschlag.com
Rosemarie Shiver - 19 Apr 2005 20:11 GMT
Beautifully stated, O Kate! :-) That's one sharp mind yer totin'. <g>

Hugs from Rosie
Signature

"If you wanna get it done, you gotta fight for yourself" -- Meat Loaf, Bat
Outta Hell II

>
> >   See my answer above. The negotiations and acceptance of guidelines were
[quoted text clipped - 93 lines]
> >> > Visit my website:
> >> > http://www.mzuschlag.com
d'huit - 19 Apr 2005 21:47 GMT
> Beautifully stated, O Kate! :-) That's one sharp mind yer totin'. <g>
>
> Hugs from Rosie

nah.  i probably plagiarized it from someplace.  bet it came from my "i
wanna be like rosie" book. :-)

kate

>> >   See my answer above. The negotiations and acceptance of guidelines
> were
[quoted text clipped - 124 lines]
>> >> > Visit my website:
>> >> > http://www.mzuschlag.com
Mary Z - 22 Apr 2005 00:52 GMT
>to me, it sounds like the gov't and the dea is trying to kill gnats by using
>a nuclear bomb.

It is also like holding gun dealers responsible for murders committed
by consumers who buy the guns.  I guess guns are ok but opiates are
not.  I find it fascinating what we value. -- MZ

Visit my website:
http://www.mzuschlag.com
d'huit - 22 Apr 2005 23:35 GMT
>>to me, it sounds like the gov't and the dea is trying to kill gnats by
>>using
[quoted text clipped - 3 lines]
> by consumers who buy the guns.  I guess guns are ok but opiates are
> not.  I find it fascinating what we value. -- MZ

it IS, kinda.  and i agree with you, mary.  both guns and opiates in the
hands of people with criminal intent are destructive.  but there's the
rub---how do you pre-determine intent (most doctors are on top of that
primary intent issue with meds), or even secondary intent once the gun or
opiate has left the legal person's possession (by theft or whatnot)?  i've
got a bag of large marshmallows in my cupboard---somebody with criminal
intent can and might steal them to unrelentingly stuff them down somebody
else's throat to choke and kill that person, if they are so inclined.  even
the benign can be lethal.

and now, the media is pushing the issue of teenagers stealing their parents
meds from medicine chests, to addict themselves on their parents' legal
prescriptions.  guess we need lockboxes for prescriptions (or locks on our
medicine chests), as well as ammunition (though lockboxes for ammo doesn't
seem to deter determined kids, either.)  that's not really where the problem
lies.

it's pretty obvious that there is much more going on here than
accessibility.  there is an entire and large segment of the population with
a "socialization process" that has failed or is simply lacking.  i know for
a fact that it doesn't have anything to do with religion or or parental
social standing.  back in the 60s, the largest, wildest groups of druggies
and drunks i ever knew were PK's and CK's (preacher's kids and cop's kids).
i suppose it could be said that it was adolescent rebellion to authority,
but somehow that doesn't ring true to me, either.

it is more like there was/is a basic underlying disrespect for one's
adolescent self that has been permitted to run uncontrollably towards
self-destruction.  it is easy to tell kids to just say "no", but tie that
"no" to something they can possess/own that is visceral to them!--not just
to a scripted mindset that can be set aside at a later date.   there are and
have always been plenty of parents who just say, "no! stop it!" or else,
"i'll beat your a.s into next week."  but what about making the kid feel it
is really about the kid, "because i love you, want better for you and want
you to learn to how to want better for yourself."

oh.  sorry.  i went journeying off on one of my idealist tangential rants,
i'm afraid.

kate

> Visit my website:
> http://www.mzuschlag.com 
Nann Bell - 23 Apr 2005 19:00 GMT
>>> to me, it sounds like the gov't and the dea is trying to kill gnats by
>>> using
[quoted text clipped - 47 lines]
>> Visit my website:
>> http://www.mzuschlag.com 

I saw the same report on the news about kids and their parents' medicine
cabinets.  Well, when I was in high school my mom had a Tylenol 3
prescription for her brutal sinus headaches (later discovered to be partly
due to a CSF leak, but that's getting way off the subject).  From time to
time I took one of those for my majorly messed up ankle.  But I never went
plowing into them on my own.  And by then my dad had had RA for several
years.  I'm not sure what he was on then besides gold, but there were several
meds in their collection.

So, the news report got me wondering why I didn't play with my parents' meds.
It's because of two factors in how our parents raised us.  1) we were taught
to respect medications and not to abuse them.  A lot of this was done through
modeling and was reinforced by my folks telling us you only take meds you
need and you are careful about doing it.  And we saw them dealing with major
aches and pains and stiffness with the least amount of medication they coould
get by with so we believed that was just how you did things.  Heh, I guess
that helped me out in learning to be *happy* with a pain level of 4!

2) Our parents treated us with respect, in general, and expected to be
treated respectfully in return.  In fact, they taught us to treat all people
respectfully and to respect others' belongings, too.  Thinking about it now,
I realize I learned that the concept of not stealing was more complex than
just being "wrong", it has to do with how you treat other people.  That's
true of stealing from your parents' medicine cabinet, too.

I truly wish there were a lot more open-access parenting classes out there.  
So many folks just don't know much about good parenting techniques and at
least some of them would be happy to learn skills that would work better.  
But folks just learn to parent from the people around them for the most part.
 If the folks around them don't know how to teach respectful behavior, then
they themselves won't know it.  Have you seen that show "The Nanny"?  I'm
surprised at what folks DON'T know about raising kids, but I am so glad that
the show is on - perhaps it will have a ripple effect in our culture.

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