Date: Sat, 28 Jul 2001 14:44:16 -0400 From: freematt@coil.com (Matthew Gaylor) Subject: DEA Incompetence Illustrated To: freematt@coil.com (Matthew Gaylor)
Date: Fri, 27 Jul 2001 12:26:22 +0000 To: drugnews@yahoogroups.com, drugnews@psychedelic-library.org From: Peter Webster <vignes@monaco.mc> Subject: [] DEA Incompetence Illustrated
[A note received from a DrugNews subscriber]
Peter:
On this page is Pat Good's speech in Dallas, accepting the pain treatment guidelines. Then under it is a letter t John Ashcroft from a doctor who has been arrested by the DEA for going by those "Guidelines" that Pat Good claimed the DEA accepted! Dr. Moore's letter is amazing, and the two documents together show just how deceptive and incompetent the DEA really is:
http://www.asappain.com/Patspeach.html [excerpts follow}
Skip -- Skip Baker, President, ASAP, American Society for Action on Pain. P.O. Box 3046, Williamsburg, VA 23187 (757) 229-8536. "ADEQUATE and Ongoing Pain Medication, for ALL who suffer" ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
DEA Approves Federation Guidelines:
On March 17, 1998, the Federation of United States Medical Boards had invited doctors, pain researchers, the DEA and myself, to Dallas to discuss their new "Pain Treatment Guidelines." Take a printout of this to your doctor to show him or her that the DEA supports the Pain Treatment Guidelines of the Federation of State Medical Boards if you're trying to get help. Ms. Pat Good from Washington spoke for the DEA accepting the guidelines thusly:
The DEA on Pain Treatment with Opioids March 17, 1998 Dallas, Texas Item #3 of the ASAP Patient's Letter in the Tool Kit
Take this to your doctor to show DEA support for the Guidelines
INTRODUCTION
"Good morning ladies and gentlemen. My name is Pat Good and I am Chief of the Liaison and Policy Section of the Drug Enforcement Administration's Office of Diversion control appreciate the opportunity to have reviewed, and to be able to comment upon, the Federation of State Medical Boards' Proposed Model Guidelines for the Use of Controlled Substances in the Treatment of Pain. Perhaps some of you have heard my predecessor, Tom Gitchel, speak about DEA's recognition of the need for pain management guidelines, and its support of the development of pain management guidelines such as the ones you propose. Today I am going to reemphasize a number comments he made in the past."
"THE FEDERAL LAW ENFORCEMENT ROLE"
"DEA comes out the mandates of the Controlled Substances Act (CSA) to prevent, detect and investigate the diversion of controlled substances by legitimate handlers. The provisions of the CSA related to prescription drugs exist so that controlled substances are available for legitimate purposes while maintaining reasonable control to prevent their diversion. DEA has consistently emphasized and supported the prescriptive authority of a physician under the CSA to prescribe, dispense or administer controlled substances for the treatment of pain within acceptable medical standards."
THE CSA (Controlled Substances Act) - APPROPRIATE USE
"The CSA specially recognizes the essential medical purpose of the controlled substances, declaring that "the drugs . . . have useful and legitimate medical purpose and are necessary to maintain the health and general welfare of the American people." The requirement under the CSA regarding a controlled substances prescription is that it must be issued for a legitimate medical purpose by a practitioner acting in the usual course of professional practice." 21 C.F.R. 1306.04(a).
"DEA has consistently empathized and stated that a physician should not hesitate to prescribe, administer or dispense controlled substances when they are indicated for a legitimate purpose."
"3 (Drug Enforcement Administration, Physician's Manual, Rev. Mar. 1990, 21). However, the CSA by design does not define "legitimate medical purpose" nor does it set forth standards of medical practice. These issues can only be defined by the medical community and its internal review processes."
"DEA concurs that a physician's medical judgment is the first step in determining the appropriate course of action in the treatment of pain. This judgment must be based upon professional training, medical specialty and practice guidelines."
"That judgment, in concert with the establishment of a bona fide physician-patient relationship which includes thorough examination of the patient, a review of the patient's medical history, and proper follow-up and monitoring, combine to constitute legitimate medical practice. 17 the physician has a continuing responsibility to monitor the patient receiving controlled substances and to reevaluate their original judgment on an on-going basis. The proposed guidelines serve to institutionalize this philosophy. Professional conferences and peer-reviewed research also greatly assist in providing a physician with clarification as to what constitutes acceptable medical practice for the management of pain with controlled substances.* Since the proposed model guidelines reflect the latest currently acceptable standards, they will prove invaluable in helping a physician form his medical judgment in making pain management decisions, in providing the elements necessary for legitimate pain treatment, and in allaying any fear of adverse consequences from licensing boards or investigative agencies when none is justified."
"In short, the guidelines assist everyone concerned in better defining the elements of legitimate pain treatment, thereby providing the courts and licensing boards a sound and definitive basis to judge instances which clearly fall outside acceptable norms."
"Although the proposed model guidelines under consideration do not intend to define the complete or best medical practice, they do communicate what state medical boards consider to be within the boundaries of professional practice and eliminate some currently existing "gray areas. 3 DRUG Enforcement Administration, Physician's Manual Rev. Mar. 1990, 21."
"THE NEED FOR REGULATORY AND LAW ENFORCEMENT SCRUTINY"
"Drugs used in pain management are addictive, abused and trafficked. Unfortunately, there are dishonest physicians and other health professionals who willingly abuse the public trust conveyed by their license and knowingly sell these drugs to abusers or addicts."
"While we recognize that the these physicians are practicing within accepted medical standards, their "doctor shopping" patients generate law enforcement and regulatory scrutiny. Physicians engaging in pain treatment must maintain certain levels of responsibility to minimize the risk of inappropriate prescribing and diversion."
"Although the element of motivation varies between the dishonest and negligent physicians, the actions of each can result in the diversion of controlled substances. Better education of all health care professionals in the field of pain management is essential and should include training about patient scams, diversion and abuse. Likewise, the proposed model guidelines serve to educate both the health care professionals and regulators as so the property of pain management treatment elements. From a law enforcement standpoint, the guidelines will help pierce the veil of pain management legitimacy that some unscrupulous physicians hide behind to divert drugs for non medical use."
"DEA has consistently emphasized and supported the prescriptive authority of a physician under the CSA to prescribe, dispense or administer controlled substances for the treatment of pain within acceptable medical standards."
"DEA Investigations"
"The DEA receives complaints or first encounters unusual prescribing patterns or illegal sales of the prescribed drugs by patients, DEA and its state counterparts pursue information to first determine whether it appears that the prescribing actuality is legitimate. State medical boards, empowered by their state legislatures and composed of physicians, are generally the first line monitoring the medical professional and disciplining physicians who prescribe controlled substances, including narcotics, in a manner which constitutes questionable practice. The medical boards review practices against standards of acceptable medical practice. The proposed model guidelines, in setting out the required elements of legitimate pain practice, minimize the importance of historically suspicious factors such as prescribing quantity and frequency and place them in the proper context of other factors present in legitimate treatment."
"DEA generally refers more questionable practices to the appropriate state medical board for determination of whether the practitioner complied with the standard of acceptable medical practice."
"DEA will actively pursue action when a physician's activities are clearly outside the scope of legitimate medical practice and pursues prosecution or licensing action. Even then, enforcement authorities and the courts rely upon the testimony of medical experts to distinguish acceptable treatment from criminal, unethical or negligent activities."
"But a physician need not fear DEA action if prescribing controlled substances in good faith for a legitimate medical purpose with the acceptable scope of professional practice, with appropriate documentation. The proposed model guidelines help clarify whether a physician's controlled substance handling falls within or without acceptable standards of medical practice."
"Conclusion"
"In conclusion, there is no Federal law or regulation inhibiting a physician from treating a patient with controlled substances other than the requirement that the treatment occur in accordance with acceptable medical standards and with in the usual course of professional practice. DEA advocates appropriate medical prescribing of controlled substances for bona fide patients."
"DEA investigates and takes actions against registrants when the controlled substance prescribing is clearly outside "the usual course of professional practice."Gray areas" of practice are generally referred to the appropriate state medical board for determination of these standards. The proposed guidelines help eliminate "gray areas" of practice."
"DEA having encouraged the developing education programs and practice guidelines in this area to better inform practitioners of both the proper treatment of pain and appropriate prescribing practices, as well as of the safeguards to proven patient diversion and abuse. A delicate balance exists between efforts to control drug diversion and abuse and the legitimate practice of medicine and the availability of controlled substances for patients in need. The proposed model guidelines will go far in helping to preserve this delicate balance. The guidelines will help physicians comply with acceptable pain management standards and will help DEA and other regulators define farther such treatment is appropriate under the circumstances. Perhaps most importantly, the guidelines will help ensure patient access to needed controlled substances for pain management."
End of DEA Speech.
"Perhaps most importantly, the guidelines will help ensure patient access to needed controlled substances for pain management."
Dr. Benjamin R. Moore to John Ashcroft, Attorney General of the United States:
Benjamin R. Moore DO PO Box 7253 Myrtle Beach, SC 29572
John Ashcroft 950 Penn NW Washington DC 20530-0001
Dear Mr. Ashcroft
I have been doing locum tenens work for about 7 years (after residency) and most of it was either in an urgent care setting or family practice. I have never had any difficulty with any medical board or DEA. That is until I worked at a chronic pain center in Myrtle Beach, SC. I was brought to work there by Med-Pro, a locum tenens agency, who assured me the doctor I was working for had a good reputation.
Since I had done a residency in neurology and had attended many CME's that included the recent trends in chronic nonmalignant pain and the use of long-term opioids, I felt comfortable prescribing them in the setting of a "chronic pain" clinic. As a matter of fact, without exception, the speakers at these CME's who spoke on the subject chronic nonmalignant pain were all proponents of long acting oxycodone (oxycontin) as the ideal medication because it was non-abusable and considered safe! Anyhow I reviewed the literature, looked at the 1999 policy set by the SC Board of Medical Examiners, and compared it to the clinic's protocol used at the clinic. It seemed to be above board and included all the elements included in the Medical Board's policy.
The DEA agents in South Carolina, however, unbeknownst to me at the time, don't recognize the Medical Board's authority or policy on the subject according to Linda Traube, lead investigator. I found this only after speaking with her over the phone. Her opinion was that only terminal cancer patients should be prescribed opiate medications.* This of course flies in the face of DEA public testimony found at http://www.medsch.wisc.edu/painpolicy . I tried to find out what specifically if anything she found wrong with the practice. She told me that opiates were only for "terminal cancer" patients.** Other than her uninformed opinion, she would not tell me anything, she said ask an attorney. I did and he said what I was doing was proper and was done in accordance with the State Board's policy.
Of all the doctors that ever worked in that clinic, I was the most conservative with respect to prescribing opiates. The only schedule II medication I ever prescribed was Oxycontin, because it was considered safe and virtually non-abusable according to its maker Perdue Pharma. I routinely did urine drug screens and therapeutic opiate blood levels (to rule out diversion). I terminated over 200 patients personally over the previous year for suspected diversion or doctor shopping. I did not tolerate being used by addicts, and made it clear to my patients that they had better be legitimate.***
Over previous years I'd seen pain management specialists speak at numerous CME meetings throughout the country on the subject of opioids and its proper place in the setting of chronic non-malignant pain relief if all else failed. In the majority of our patients, "all else failed". On initial workups if the patient didn't bring adequate records or didn't agree to a trial of conservative non-opiate therapy, I didn't continue to see them as a patient.
Recently, because of the continuing news stories about oxycontin diversion and abuse, I decided to stop prescribing it altogether. I let local physicians and pharmacists know of my decision and asked that it be passed on to the DEA.
However, despite the fact that I followed the protocol approved by the SC Board of Medical Examiners and the Federation of State Medical Boards. And despite the fact that I decided to stop prescribing any Schedule II medications, within two weeks of my decision, (while either discontinuing oxycontin, or weaning it from the clinic's patients) DEA agents marched into the office unannounced and served me with a suspension. Since I was the only doctor left practicing in the clinic after DEA forced 4 physicians out on an improper address issue, patients were left with no help to wean them off medications and/or no pain specialist to continue therapy.
Prior to working in chronic pain management I never prescribed any controlled substance on a chronic or regular basis. Not in a family practice, urgent care, or neurology practice. I have never had difficulty saying "no" to patients demanding opiate medication for their pain. I practiced very conservatively. The only reason I employed opiate medication and anxiolytics on a regular basis at Comprehensive Care and Pain Management was because this was a chronic pain management center. This was not a family practice, an urgent care or a neurologist's office. In the setting of pain management within the appropriate parameters, these medications were life restoring to a great many people. I was told by the legal profession that what I was doing at the clinic was legal and proper. The numerous lectures I attended during CME meetings on the subject of chronic non-malignant pain re-enforced the belief that my practice was proper. I was also re-assured by information gleaned from the American Pain Society's, the Journal of the American Medical Association's recent article on opiate use for non-malignant pain. I read and re-read the SC State Board of Medical Examiners policy, which was directly adopted from the Federation of State Medical Boards. To further re-assure myself I contacted my alma mater at UNC in Chapel Hill where I had done training in pain management. They also used opioids in the setting of chronic nonmalignant pain. So I felt assured that there should be no repercussions as long as I followed the state's pain management protocol. (Since his practice was "Proper and Legal" then interfearing with same the way the DEA has done, is impirical proof of their Illegal Operation against Opioid Pain Control put forth by the CSA and that they agreed to above at the Dallas Meeting. Skip).
In regards to Comprehensive Care and Pain Management Center the DEA chose to ignore anything that was done right. The only medical opinions they were interested in were those of local addiction specialists.**** Those specialist locally held quite the opposite view of the use of opiates and anxiolytics in the chronic nonmalignant pain. They see tolerance and dependence as addiction. They don't see anxiolytics as appropriate in combination with opiate medication. Even in the organized "house of medicine" these two groups may vary widely in their opinions on the subject of pain management and chemical dependency. (See Vol. 279 No. 1, January 7, 1998, Letters to the editor). For more information on the subject of chronic pain management reference Portenoy RK. Opioid therapy for chronic nonmalignant pain: clinician's perspective. Journal of Law, Medicine & Ethics. 1996, 24:296-309. Available at http://208.234.16.94/research/mayday_jlme/24.4g.html
and Schneider JP. Management of chronic non-cancer pain: a guide to appropriate use of opioids Journal of Care Management. August 1998. Available at
http://www.jenniferschneider.com/articles/opiods.html
In the end I am convinced that my medical records will bear out the truth. The truth being that I meticulously adhered to a standard pain management protocol and it is that protocol that is part and partial of the Federation of State Medical Boards and that of the state of South Carolina.***** I did not act as a "pill mill" and I plan to have my DEA return to an unrestricted status. When I do. I will no longer treat pain in the chronic setting, unless it is with only non-scheduled adjunctive medications.****** In the future those patients needing more treatment will be referred elsewhere. Practicing in this murky, ethical quagmire is certainly not worth the risk of having the heavy hand of governmental regulatory agencies (such as the DEA) second-guessing my medical decisions.
The last time I heard from the DEA or the clinic, lead investigating DEA agents Cheri Crowley and Alan Alexander were taking trophy pictures of each other outside the clinic next to the sign that read "clinic closed by DEA"!
At my last count 11 physicians in Myrtle Beach have had restrictions placed on their DEA in the month of June 2001.*******
Dr. Benjamin Moore (M.D.)
* (That of course shows that Ms. Good's acceptance of the Pain Treatment Guidelines above in Dallas Texas, had no effect in the field whatsoever. Skip).
** (I'd be DEAD now if THAT uninformed Agent's Opinion was right! Skip)
*** (That shows that even the most careful doctors cannot treat pain because of the DEA's Deliberate and Law Breaking Purge of Pain Doctors nationwide. Since the CSA provides that all pain patients, including non cancer patients, have a right to opioid medicine, the DEA is in violation of it's own rules, laws and Charter. That officials of the DEA should be indicted without delay. See the Torture & Extortion that they protected. Skip).
**** (Who know nothing about real pain control. Skip).
***** ("Truth" is held in such low esteem by DEA Agents, be sure to look for my upcoming article on how such staggering dishonesty in Law Enforcement came to be. Skip).
****** (The DEA has put yet another "Pain Doctor" out of the art form, leaving more patients with no place to turn, putting their lives in danger because the "Suicide Rate" for pain patients was already at 900% above the average long before the DEA Created OxyContin Crisis and that "Con Job" came into being. Does this show they never did intend to stand by the Dallas Agreement stated above? Skip).
******* (I feel that vindicates my statements in the past that they have a concerted effort to stop ALL pain management with opioids nationwide by deceiving The Congress into thinking they support the Pain Treatment Guidelines, when in fact they do all they can to defeat them and any doctor who dares to treat pain. For a look at the kind of suffering this has caused, read the 1400 "Remarks" by pain patients in the Solomon Case. Skip)
Hi Skip,
"Below is what happens to those doctors who follow the "accepted" Opioid prescribing guidelines that even the DEA and Federation of State Medical Boards signed. If we can get more info on this, then we can prove that the DEA is out of control, and there is NOTHING doctors can do to protect themselves from this kind of tyranny! Congress HAS TO make the Federation's guidelines federal law, and if followed, a doctor must not be able to be prosecuted EVER!
http://www.mapinc.org/drugnews/v01/n1306/a01.html?186
US SC: Suspended Doctor Says He Followed Protocol
URL: http://www.mapinc.org/drugnews/v01/n1306/a01.html
Newshawk: chip Pubdate: Wed, 18 Jul 2001 Source: Sun News (SC) Copyright: 2001 Sun Publishing Co. Contact: opinions@thesunnews.com Website: http://web.thesunnews.com/ Details: http://www.mapinc.org/media/987 Author: Elaine Gaston Bookmark: http://www.mapinc.org/find?186 (Oxycontin)
SUSPENDED DOCTOR SAYS HE FOLLOWED PROTOCOL
[Photo caption] Comprehensive Care & Pain Management Center, at 7714 N. Kings Highway in Myrtle Beach, remains closed after recent sanctions by the DEA.
A doctor who has temporarily lost his right to prescribe drugs said he did nothing wrong while working at a Myrtle Beach pain management clinic that's under investigation by the Drug Enforcement Administration.
The DEA has not disclosed details about the investigation, but the American Medical Association reported in June that Comprehensive Care and Pain Management Center at 7714 N. Kings Highway is being investigated for its prescribing methods, particularly involving OxyContin, a potent pain medication. The clinic has closed.
The AMA article said Dr. Benjamin Moore's DEA license was suspended for improperly prescribing OxyContin and other drugs while working at the clinic.
Moore, a neurologist, said this week he did nothing wrong. He said he was following pain management protocol approved by the S.C. Board of Medical Examiners and the Feder- ation of State Medical Boards.
"I was practicing within those guidelines," Moore said. "They made it look like I was wantonly wanting to make people addicted, and that is simply untrue. I had no financial incentive to get people hooked. I had a flat salary. I got paid whether patients came or didn't come to the clinic."
The pain management clinic shut down in mid-June after DEA sanctions. A DEA spokesman refused to release details about the sanctions because the agency is still investigating.
Dr. D. Michael Woodward, the clinic's chief executive officer, has been navailable for comment.
After the clinic closed, area emergency rooms and treatment centers reported more people seeking help with pain management or pain medications, most citing problems with OxyContin dependencies, health officials said. Officials blamed the increased patient load on the clinic's closing. The National Institute of Drug Abuse officials say prescription drugs are safe but can be dangerous, addicting or fatal when used improperly.
Grand Strand Regional Medical Center is continuing to see eight to 10 patients a day seeking help for pain management and medications, according to Joan Carroza, hospital spokeswoman.
"It is still pretty steady; it really hasn't declined," Carroza said.
People seeking help also continue to visit South Strand Ambulatory Care Center in south Myrtle Beach.
"We're still seeing some but the numbers are declining," said Dr. Brian Kelleher, medical director of Conway Hospital's emergency department and a South Strand Ambulatory Care Center emergency medical physician.
The future of the Comprehensive Care and Pain Management Center is uncertain.
Moore said Woodward had planned to sell the clinic. Moore said he had hoped to become medical director.
Woodward's attorney, Joseph McCulloch of Columbia, has said the closing of the clinic was a business decision and had nothing to do with the DEA investigation.
Moore, who is not currently working, said he is awaiting official notification from the DEA about his suspension.
Moore said he believed he was "guilty by association."
"I have to go to court to prove myself innocent," he said. "[The DEA] had a vendetta against the clinic and I'm collateral damage." ###
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