Re: DEA maintains that people in pain have nothing to fear from the crackdown. I guess that proves Dr's aren't People

Juba wrote:
Top posted:

This appears to be the essence of the DEA's attitude about painkillers:

"...the DEA must fight pain control
because functional patients on high doses of opioids
threaten its authority."

Where did this quote come from?



The Wolf With the Red Roses <after-dark-arms@xxxxxxx> wrote in message:
2khqe3lfea5sn8s9sbqpeu0p4vq02vb2fl@xxxxxxx,


Dr. Feelscared

Drug warriors put the fear of prosecution in physicians who dare to
treat pain.

Maia Szalavitz | August/September 2004 Print Edition

On February 1, 2002, Cecil Knox was seeing patients in his Roanoke,
Virginia, clinic when more than a dozen federal agents burst through
the doors with guns drawn. Helmeted, shielded, and wearing
bullet-proof vests, they terrified waiting patients and employees. One
worker later told the Pain Relief Network, a patient advocacy group,
she thought she and her husband, who was helping her in the office
that day, would be shot. She looked on in horror as an agent put a gun
to his head and ordered, "Get off the phone! Now!"

Knox, a pain management specialist who had been practicing medicine in
Roanoke for seven years, was dragged out in handcuffs and leg irons.
The local U.S. attorney's wife, a TV reporter, was among the
journalists tipped about the raid in advance. She stood outside with a
gaggle of other media people to announce her husband's triumph. Knox's
assets were frozen and bond set at $200,000. He and several employees
soon faced a 313-count indictment, including charges of drug
distribution resulting in death or serious bodily injury, prescription
of drugs without a medical purpose, conspiracy, mail fraud, and health
care fraud. Prosecutors said Knox had illegally distributed millions
of dollars' worth of OxyContin, a timed-release version of the
narcotic painkiller oxycodone.

William Hurwitz, a McLean, Virginia, internist and prominent pain
specialist, received similarly heavy-handed treatment when he was
arrested last fall. Hurwitz, who is Jewish, was visiting his children
on Rosh Hashanah eve when federal agents descended upon his ex-wife's
house in McLean and took him away in handcuffs. As with Knox, the
government froze Hurwitz's assets; his bail was set at $2 million. He
was charged with 49 felony counts, including drug trafficking
resulting in death or serious injury, conspiracy, and running a
criminal enterprise.

Like Knox, Hurwitz attracted attention largely because of his
OxyContin prescriptions. Attorney General John Ashcroft said "the
indictment and arrests in Virginia demonstrate our commitment to bring
to justice all those who traffic in this very dangerous drug."
Prosecutors said Hurwitz was "no better than a street corner crack
dealer" who "dispenses misery and death." Assistant U.S. Attorney Gene
Rossi had earlier declared that the feds would "root out" such doctors
"like the Taliban."

Knox and Hurwitz are just two recent targets of an aggressive push by
the Drug Enforcement Administration (DEA) and the Department of
Justice (DOJ) to impose their judgments about the proper use of opioid
painkillers (drugs derived from opium and synthetics that resemble
them) on doctors throughout the country. In their attempt to prevent
prescription drug abuse, the DEA and the DOJ in effect have taken upon
themselves the authority to regulate the practice of medicine,
traditionally the province of the states. Worse, they have transformed
disagreements about treatment decisions into criminal prosecutions,
scaring physicians away from opioids and compounding the suffering of
patients who have trouble getting the drugs they need to relieve their
pain.

Drug Control vs. Pain Control
Few disagree that pain is already poorly treated in the U.S. "Even the
DEA admits that 30 to 50 million people are undertreated for pain,"
says Ronald Libby, a professor of political science at the University
of North Florida who has studied the issue. A 1999 survey of 805
chronic pain patients conducted by Roper Starch for the American Pain
Society and Jannsen Pharmaceutica found that roughly half of those
with serious chronic pain could not find relief -- and that the more
severe the pain, the less likely it was to be alleviated. Other
surveys have yielded similar results. Only a tiny fraction of the
nation's nearly 1 million health care professionals licensed to
prescribe controlled substances are willing to consistently use opioid
medications, recognized as the best drugs for severe pain. A 2003
analysis by the Ft. Lauderdale Sun-Sentinel found that less than 3
percent of Florida's doctors prescribed the majority of opioids for
Medicaid patients there.

During the 1990s, pain experts, patient advocates, and drug makers
sought to reduce exaggerated fears about opioids and increase
prescribing. Research and clinical experience had shown that few
patients without a prior history of serious drug abuse get hooked on
narcotics during pain treatment, resulting in addiction rates no
higher than those seen in the general population. In one important
study, reported in the journal Pain in 1982, the researchers surveyed
181 staffers of 93 burn units who had seen more than 10,000 patients
and worked in the field an average of six years. Most patients had
been given opioids to cope with agonizing debridement treatments, but
the staff could recall no cases of addiction in anyone without a prior
history of it. A study of 100 people taking opioids for chronic pain
over prolonged periods, reported in the Journal of Pain and Symptom
Management in 1992, likewise found that none became addicted. No new
evidence has contradicted this research, and a study of prescribing
from 1990 to 1996, published in 2000 in The Journal of the American
Medical Association, found that massive increases in the use of
particular opioids were not associated with proportional increases in
misuse; in fact, as use of some medications rose, emergency room
"mentions" of them dropped.

But in the minds of police and prosecutors, such reassuring findings
were overwhelmed by concerns about what was dubbed the OxyContin
"epidemic." Introduced by Purdue in 1995, OxyContin was designed to
deliver steady pain relief over an extended period of time, avoiding
the peaks and valleys of shorter-acting pills that have to be taken
several times a day. It soon became a $1 billion blockbuster. When
illegal drug users figured out how to defeat its timed-release
mechanism and get all the oxycodone at once, street demand -- and
media coverage -- soared. (See "The Agony and the Ecstasy," April
2003.)

Most news stories neglected to mention that OxyContin abusers
generally were not new addicts freshly minted from innocent patients
by irresponsible doctors. Rather, they were drug aficionados who
scammed physicians for the latest media-hyped high. According to data
from the federal government's National Survey on Drug Use and Health,
some 90 percent of illicit OxyContin users have also used cocaine,
psychedelics, and other painkillers. The typical profile is a person
who has abused many drugs in many combinations for many years.
OxyContin poses no greater addiction risk than other opioids when
taken as directed. But the media helped teach addicts and thrill
seekers how to do otherwise.

In 2002 the Charleston Daily Mail quoted former Surgeon General C.
Everett Koop as saying "exaggerated news stories" have "hyped
[OxyContin] for recreational use into being almost irresistible." In
some cases, OxyContin-related pharmacy robberies followed local
exposés. On February 16, 2001, less than a week after the Cleveland
Plain Dealer reported on the OxyContin "epidemic," someone robbed a
local pharmacy at gunpoint, taking only OxyContin. The Cleveland Free
Times quoted a drug dealer who said a customer had shown him a
newspaper clipping about OxyContin, asking where he could get it.

While the OxyContin panic does not seem to have deterred addicts, it
has scared doctors. "Every time there is one of these trials," says
Libby, "another 50 to 60 doctors drop off from prescribing." Among the
doctors recently targeted by federal or state prosecutors are Frank
Fisher of Anderson, California, charged with three counts of murder
and 24 drug- and fraud-related charges; Jeri Hassman of Tucson,
Arizona, charged with 362 counts of "drug dealing with a pen"; James
Graves of Pace, Florida, convicted in 2002 of causing the deaths of
four patients and sentenced to 63 years in prison; Denis Deonarine of
West Palm Beach, Florida, charged with 79 felony counts, including
first-degree murder, based on a patient's death from a
self-administered overdose; and Deborah Bordeaux of Myrtle Beach,
South Carolina, who in February was sentenced to eight years in prison
for working less than two months at a pain clinic targeted by the feds
as a "pill mill."

The sheer number of charges in these cases makes defending the doctors
difficult because it's natural for jurors to think that with so many
counts, some crime must have occurred. But this impression is
misleading. The essence of the prosecutors' cases is that ordinary
events in a doctor's office become criminal when the doctor steps
outside the bounds of legitimate medicine. It's easy to generate
lengthy indictments by portraying the doctor's entire practice as a
criminal enterprise and redefining everyday activities related to the
practice as offenses.

Each prescription of a controlled substance can be made into several
crimes. In addition to drug distribution, it can be described as
health care fraud because charging or billing third parties for
practices that aren't really medicine is illegal. If the prescription
or a bill has been sent through the mail, it can also be mail fraud.
Every deposit of the physician's paycheck becomes money laundering.
Seeing a patient who turns out to be a drug dealer or addict can lead
to a conspiracy count, as can working with one's colleagues. Most
shocking of all, any death that can in any way be connected to use of
the doctor's prescriptions becomes a charge of drug dispensing
resulting in death or serious injury -- even if the person who died
stole the drug from a legitimate patient, lied to get the drug, used
it with other drugs or alcohol, or expired while suffering from a
potentially fatal illness.

Physicians face these daunting indictments with their assets frozen,
their bail set as if they were drug kingpins, and their livelihoods
ruined by license suspensions or bail conditions. In these
circumstances, mounting a defense is extremely difficult. "It makes it
impossible to retain private counsel," says Virginia attorney James
Hundley, who represented William Hurwitz prior to his indictment. (He
is now using a public defender.) California attorney Patrick Hallinan,
who has represented Frank Fisher and has advised Hurwitz, says,
"They're throwing the entire penal code at them."

The tremendous pressure that such charges bring to bear is illustrated
by the 2002 federal indictment of eight doctors who worked at the
Comprehensive Care and Pain Management Center in Myrtle Beach, South
Carolina. Threatened with hundreds of years in prison and fearful that
his wife (an employee) could also be indicted, clinic owner Michael
Woodward pleaded guilty and testified that he had schemed with the
other doctors, including Deborah Bordeaux, to sell drugs. South
Carolina is a conservative state, and Woodward had seen his clinic
repeatedly attacked in the news media. The Woodwards may also have
feared that their young children could lose both parents to long
prison terms.

Another clinic doctor, Benjamin Moore, told Siobhan Reynolds, founder
of the Pain Relief Network, that he and his colleagues had done
nothing wrong. When he, too, found that he faced life in prison, he
pleaded guilty in desperation. But according to his brother, he could
not go through with testifying against co-workers he believed to be
innocent. Instead he hanged himself from a tree in his mother's
backyard.

Doctors As Dealers
In fiscal year 2003, according to the DEA, the federal government
investigated 557 physicians and arrested 34. Betsy Willis, chief of
the Operations Section of the DEA's Office of Diversion Control, says
"the numbers of federal prosecutions have been relatively consistent
for the last four years." The DEA reports 81 arrests in fiscal year
1999, 83 in fiscal year 2000, 78 in fiscal year 2001, and 68 in fiscal
year 2002.

Even if the number of federal prosecutions has declined, they have
received much more attention since the news media began highlighting
OxyContin abuse in 2001. And the alarm about OxyContin clearly has led
to increased enforcement efforts: Last year the DEA doubled controlled
substance licensing fees for health care providers to fund more
investigations, and in March the Office of National Drug Control
Policy unveiled "a coordinated drug strategy to confront the illegal
diversion and abuse of prescription drugs."

The strategy includes closer monitoring of prescriptions, coupled with
"outreach" and "education" aimed at making doctors more skeptical of
patient requests for painkillers.

Until recently, investigators would approach a physician if they
suspected a patient of diversion; now they try to build a case against
the doctor. "This is new in my experience, and I have been doing this
for 25 years," says David Brushwood, a professor of pharmacy at the
University of Florida. "I've always seen drug control and health care
work together....They were never really at odds until the last two
years....The way it used to be was that when drug control officials
saw the beginnings of a pattern of diversion, they would say to the
doctor, 'It looks like a problem is developing; let's work together to
fix it.' Now when they see a small problem, they conduct surveillance
and wait for it to be-come big, then swoop in with a massive show of
force."

Even when there is no direct evidence of diversion, investigators and
prosecutors may decide a doctor is being too generous with painkillers
because they are influenced by an outmoded view of addiction.
According to this view, the essence of addiction is "physical
dependence," changes in the body that result in withdrawal symptoms
when drug use is halted. Based on this criterion, all pain patients
become addicts when they take opioids long enough.

In recent decades, researchers have recognized the inadequacy of this
definition. On the one hand, some drugs that don't cause physical
withdrawal symptoms (for example, cocaine) clearly can produce a
potentially self-destructive desire for more. On the other hand, the
vast majority of those who try even the most addictive substances
don't develop lasting habits. Researchers therefore redefined
addiction to emphasize craving and negative consequences rather than
withdrawal symptoms. The diagnostic manual of the American Psychiatric
Association now recognizes that physical dependence is neither
necessary nor sufficient for addiction, which is characterized by
continued use of a substance despite ongoing drug-related problems.
For pain patients, of course, the drug produces fewer problems and
greater functioning, rather than the reverse.

Some patient advocates say drug warriors can't accept this reality
because it undermines the logic of prohibition: If most people don't
get hooked when exposed to the "hardest" of all categories of drugs,
if patients' lives get dramatically better and they function perfectly
well on doses that are supposed to incapacitate, stupefy, and derange,
why is it so important for the government to protect us from these
substances? From this point of view, the DEA must fight pain control
because functional patients on high doses of opioids threaten its
authority.

"It completely puts the lie to the whole criminal approach because it
shows that these molecules are not evil, that people can and do
function well on them," says the Pain Relief Network's Siobhan
Reynolds. "It undermines the whole basis for the war on drugs and
makes it a strictly scientific/medical issue."

Whatever their reasons, law enforcement officials (along with most of
the public and many physicians) still cling to the old-fashioned view
of addiction as a biochemical process that inevitably results from
extended use of certain drugs. In the Myrtle Beach case, federal
prosecutors said in court (before being forced to retract their claim
due to contrary testimony) that none of the clinic's 3,000 patients
was "legitimate"; in other words, in their view every pain patient of
all eight doctors was an addict.

The DEA defines addicts as "habitual" users of narcotics who have
"lost the power of self control with reference to [their] addiction"
or whose use "endangers the public morals, health, safety, or
welfare." From this perspective, pain patients could be considered
addicts who have "lost control" in the sense of needing the drug to
function.

Many prosecutors do not understand the distinction between addiction
and physical dependence or recognize the growing acceptance of opioids
in medicine. Says John Burke, vice president of the National
Association of Drug Diversion Investigators, "Do I think some
prosecutors and law enforcement officers are not well educated?
Absolutely." A 2003 study published in the Journal of Law, Medicine,
and Ethics found that nearly three-quarters of prosecutors in four
states believed simply taking opiates poses a moderate or high risk of
addiction. Holding that view was one of the best predictors of who
would choose to prosecute physicians in a hypothetical case designed
to reflect good pain practice. Just under half of prosecutors surveyed
said they would recommend a police investigation merely on the basis
of evidence that a physician was prescribing high doses of opioids to
some patients for more than a month, something that is perfectly
legitimate in cases involving severe chronic pain.

Prescriptions for Trouble
Frank Fisher seems to have been targeted based on just this sort of
suspicion. At his Northern California clinic, the Harvard Medical
School graduate accepted patients on Medicaid and Medi-Cal
(California's health insurance for the poor) that most other
physicians refused, and he tried to treat their pain as aggressively
as he would treat anyone else's. In February 1999 state law
enforcement agents raided Fisher's clinic and arrested him for drug
dealing, fraud, and murder. His bail was set at $15 million. State
prosecutors accused him of "creating a public health epidemic" of
OxyContin abuse and death. They implied that he must be a drug dealer
because he was the largest prescriber of the drug under Medi-Cal.

But in a context where fear of prosecution leads most doctors to
under-prescribe, anyone who prescribes what is necessary for severe
pain will be a top prescriber. Even Burke admits that prosecuting
doctors has a chilling effect on their colleagues' treatment
decisions. "I know from lecturing thousands of physicians that there
is no question but that it does," he says. "The thing we don't want to
happen is that physicians don't prescribe appropriately because of
these cases, but I know that it happens. I have to be honest." Burke
also recognizes that there is no ceiling on opioid doses: When
patients develop tolerance, they may need massive doses that would
kill someone who had never taken the drug. "Physicians should not be
targeted simply on volume," he says. "That can be a huge mistake."

The DEA insists physicians aren't targeted based on volume alone. But
Fisher believes he was. While patients with moderate pain can be
treated effectively with low doses of opioids, he explains, severe
pain requires that the dose be adjusted ("titrated") to a level that
maximizes pain relief and minimizes side effects. "To get a sense," he
says, "I titrated about two dozen patients, and they ended up taking
almost half of the OxyContin 80-milligram pills prescribed in
California in 1998. What that tells you is that nobody else titrated."

Fisher was jailed for five months, during which time the prosecution's
case began to evaporate. First, the murder charges were reduced to
manslaughter by the judge, who saw no proof of intent. Then the truth
about these "killings" came out. One death involved a passenger who
died when her spine was severed in a van accident. Fisher was charged
with her "murder" because she had high levels of OxyContin in her
blood. Another "victim" had taken drugs stolen from a patient, while a
third died of a self-administered overdose two weeks after Fisher was
incarcerated.

During cross-examination in pretrial hearings, it was revealed that
seven attempts by undercover agents to get drugs from Fisher had been
rebuffed. "I had a screening process for those who tried to get
controlled substances," he says. "I screened out 60 percent of those,
and apparently the agents were amongst them."

In January 2003, four years after Fisher's arrest, a state judge
dismissed all the charges against him because prosecutors had tried
repeatedly to delay the trial. But this year prosecutors decided to
pursue another set of charges against him. Instead of homicide, drug
dealing, and felony fraud involving $2 million in Medi-Cal
reimbursements, they charged him with eight misdemeanor counts of
fraud. Prosecutors would not put a dollar value on the offenses, but
Fisher said they added up to $150. The jury agreed with Fisher's
expert, who said the billings in question didn't warrant civil
penalties, let alone criminal charges, and he was acquitted of all
counts in May. He still faces possible disciplinary action by the
state medical board as well as civil suits by patients' relatives.
Fisher forwarded an e-mail message from a juror who said: "Now that I
am home and can read about you on the Internet, my heart really goes
out to you...I was upset that the prosecutor wasted my time and the
court's time on such a weak case. But now that I know what you have
really been through I feel embarrassed and selfish to be thinking
about my own time. I hope you can reopen your clinic some day and get
back to practicing medicine...Thanks for doing the job most doctors
won't."

Unlike Fisher, other doctors fighting prosecutions based on their
opioid prescriptions so far have enjoyed only partial victories. Last
fall Cecil Knox's federal trial in Virginia got off to an inauspicious
start for prosecutors when their first witness, who claimed Knox had
traded prescriptions for marijuana, couldn't identify him in the
courtroom or from photographs. The jurors ultimately acquitted Knox of
about 30 out of 69 charges. But due to a single holdout who voted
guilty, they hung on the remaining charges, including the most
serious. In January prosecutors refiled the case, this time with 95
charges.

Also in January 2004, federal prosecutors agreed to drop 358 of their
362 charges against Tucson pain specialist Jeri Hassman, who pleaded
guilty only to four counts of failing to report patients for
infractions such as taking a recently deceased relative's OxyContin.
On the same day, a Florida judge rejected a first-degree murder charge
against West Palm Beach physician Denis Deonarine, based on the death
of a patient who succumbed to "polydrug toxicity" after a night of
drinking and drug use. But in March state prosecutors filed a new
murder charge under a different statute, and Deonarine also faces 79
other charges stemming from his prescription of OxyContin and other
opioids.

Second Opinions
Eli Stutsman, an appeals attorney who is representing Myrtle Beach
physician Deborah Bordeaux at the behest of the Pain Relief Network,
thinks he may have found a way to stop such prosecutions, at least at
the federal level. Stutsman also represents the state of Oregon in its
thus-far successful battle with Attorney General Ashcroft over
physician-assisted suicide, a dispute that hinges on what the federal
drug laws mean and how they should be enforced. A federal appeals
court's decision in that case suggests the DEA is overstepping its
statutory authority when it tells doctors how controlled substances
should be prescribed.

In 2001 Ashcroft tried to nullify Oregon's assisted suicide law with a
directive that declared the prescription of drugs for suicide a
violation of the Controlled Substances Act (CSA).

Under the CSA, a prescription is "authorized" if it is "issued for a
legitimate medical purpose by an individual practitioner acting in the
usual course of professional practice." If a doctor writes
prescriptions to order for money, trades drugs for sex, or prescribes
drugs for resale, he is operating outside "the usual course of
professional practice." In such cases, the CSA authorizes the DEA to
revoke the registration that allows physicians to prescribe controlled
substances and to pursue criminal charges.

But Stutsman concluded that in recent cases the DEA has taken the
statute's language out of context, improperly reading "for a
legitimate medical purpose" as a requirement separate from prescribing
in "the usual course of professional practice." Instead of claiming
that the accused doctors weren't sincerely trying to treat patients,
federal prosecutors have argued that the defendants wrote
prescriptions that weren't "medically necessary" or that had no
"legitimate medical purpose." Thus the DEA claims the authority to
determine what doses of which drugs a doctor may use and what medical
purposes are legitimate. Those are questions about the standard of
medical care -- the sort of questions addressed in malpractice
litigation and civil actions by state medical boards.

The DEA insists it is correctly interpreting the law. "We're only
looking at instances where we have information [that] practices
outside of the norm are taking place," says Pat Good, acting deputy
director of the DEA's Division of Diversion Control. "We're not
talking about avant-garde medicine where patients are doing really
well. We're talking about cases where patients are selling drugs on
the street, using fictitious names on prescriptions, overdosing, and
getting arrested."

But in Oregon v. Ashcroft, the assisted suicide case, U.S. District
Judge Robert Jones found Stutsman's reasoning compelling. Ashcroft had
argued that the CSA gave federal prosecutors the right to decide that
assisting suicide is not part of legitimate medical practice. Jones
disagreed: "The CSA was never intended, and the USDOJ and the DEA were
never authorized, to establish a national medical practice [standard]
or act as a national medical board. To allow an attorney general -- an
appointed executive whose tenure depends entirely on whatever
administration occupies the White House -- to determine the legitimacy
of a particular medical practice without a specific congressional
grant of such authority would be unprecedented and extraordinary."
Last May the U.S. Court of Appeals for the 9th Circuit affirmed Jones'
decision, finding that "the attorney general's unilateral attemp to
regulate general medical practices historically entrusted to state
lawmakers...far exceeds the scope of his authority under federal law."

Stutsman intends to use similar reasoning in his appeal of Deborah
Bordeaux's conviction. Her prescribing never exceeded manufacturers'
recommendations or those of her state medical board; there was no
exchange of drugs for sex or other evidence that she was not
practicing real medicine. "What makes this particularly outrageous,"
says Stutsman, "is their confusion of civil and criminal standards to
start with. It's an excessive exercise of federal power based on a
misapplication of federal law."

Suicide Is Painless
Kathryn Serkes, spokesperson for the Association of American
Physicians and Surgeons (AAPS), sees these cases as part of a
long-term trend toward increased prosecutorial power that includes
sentencing guidelines, mandatory minimums, and forfeiture laws. The
Coalition Against Prosecutorial Abuses, a group she is organizing to
fight this trend, declares: "There's still one group of trial lawyers
that has been left alone to go about their dirty work with few
restrictions -- and all at taxpayers' expense. These are the
government prosecutors."

The AAPS, along with the Pain Relief Network, has been vocal in
denouncing the federal and state doctor prosecutions. The group's Web
site warns: "If you're thinking about getting into pain management
using opioids as appropriate: DON'T. Forget what you learned in
medical school -- drug agents now set medical standards." The AAPS
urges doctors inclined to ignore this advice to be aware of the risks,
including "years of harassment and legal fees," loss of income and
assets, and professional ostracism.

Despite increasing outrage from physicians and patient advocates, the
DEA maintains that people in pain have nothing to fear from the
crackdown. "A legitimate patient with legitimate medical problems
should have no problem getting another doctor if their doctor has been
arrested," says the DEA's Willis.

Anti-pain activists vigorously dispute that. "This is causing doctors
not to prescribe," says the Pain Relief Network's Siobhan Reynolds,
"and that means patients will be in hell." Several of the prosecutions
have been associated with suicides by devastated patients who couldn't
get effective treatment elsewhere. Common Sense for Drug Policy
reports that one of William Hurwitz's patients killed herself on March
16. Frank Fisher says one of his patients drove her car in front of a
train.

In a forthcoming documentary by Reynolds, pain patient Skip Baker
says, "It's a devastating health care crisis, to the point that
thousands are committing suicide that nobody knows about. Most pain
patients know -- everybody's planning to run into this bridge abutment
or that tree or whatever to make it look like an accident." Ronald
Myers, a Mississippi physician and minister who founded the American
Pain Institute, observes:

"They want to talk about deaths associated with OxyContin. But no one
wants to talk about these deaths. There's been an epidemic of
suicide."

Laura Cooper, an attorney with multiple sclerosis and a former patient
of Hurwitz, moved to Oregon when his practice was shutting down. Her
new doctor "is also under the microscope," she says. "All of these
guys are on their way out -- if not on their own, the government is on
the way to putting them out. Anybody who would treat me the way I need
to be treated is not long for American medicine. When my doctor goes
down, I don't know what I'll do."

Since Cooper lives in Oregon, she notes, "by law I can get drugs to
kill myself, but not to treat my pain. The doctor could say, in
effect, 'I'm not trying to treat pain; I'm trying to kill her,' and
that would be more acceptable. Clearly, something's a little off
kilter. My medical needs are less important than their war on drugs."




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