[Fwd: FW: Doctor Defends Prescribing Powerful Painkillers]

From: dtouch (dtouch@bellsouth.net)
Mon Feb 4 17:52:19 2002


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------ Forwarded Message From: Frank B. Fisher, M.D. <frankbfisher@earthlink.net> Date: Sun, 03 Feb 2002 08:36:23 -0800 To: Pain + Chemical Dependency <PAIN_CHEM_DEP@PEACH.EASE.LSOFT.COM> Subject: Doctor Defends Prescribing Powerful Painkillers

February 1, 2002 DOCTOR DEFENDS PRESCRIBING POWERFUL PAINKILLERS GROVER - One day after federal drug agents suspended his license to prescribe narcotics, a Cleveland County family practitioner says he did the right thing in prescribing powerful painkillers for almost all of his patients. Dr.  Joseph Talley said four plain-clothes Drug Enforcement Administration agents entered his clinic Wednesday, taking the plastic-encased federal drug license off his desk and confiscating all narcotics from the office. Meanwhile, state medical examiners allege he failed to take appropriate steps to weed out drug abusers, or properly examine, diagnose and follow up with more than 20 patients to whom he prescribed painkillers over the past decade. The N.C.  Medical Board has scheduled a hearing next month at which his license to practice medicine can be suspended or revoked.  And state and local police say they are investigating whether he improperly dispensed narcotics to patients, at least one of whom died. The action followed a Dec.  19 raid in which DEA agents seized patient records, filling more than 30 boxes with files and documents.  Talley said one of his two partners at the Grover Medical Clinic resigned immediately after the raid.  He said two nurses also have quit since then. DEA officials won't comment on Talley's case, saying it's part of an ongoing investigation. But Talley said Thursday he's been told to expect criminal charges, and he's hired a criminal lawyer in Charlotte to defend him. Talley, 64, acknowledges he prescribes large dosages of opioids -- powerful opium-based drugs including morphine and OxyContin -- to patients for chronic pain.  For example, Talley says that while some doctors might prescribe 30 or 60 milligrams of morphine, he might prescribe 300 milligrams.  He's gotten popular as a result, with patients hailing from as far away as California and Oklahoma and praising his practice on Web sites for pain sufferers. Talley says he's willing to risk being duped by the occasional abuser or drug dealer if it means every person who's truly in pain gets relief from the drugs he prescribes. "The basic decision you've got to make is if society is better off -- if a patient is better off -- if you let a drug addict dupe you and you play into his hands, or let a patient down who really has pain?" Talley says.  "It seems to me to be a no-brainer." He said he prescribes narcotics for about 97 percent of his 3,000 patients, including about 1,300 who come in quarterly. Talley said about half his patients fill their prescriptions at a nearby pharmacy.  A sign at his clinic, about 40 miles west of Charlotte on the S.C.  border, notes that two major chain stores will no longer fill his prescriptions. Today, Talley is wondering how many of his patients will bother coming to see him since he can no longer prescribe the drugs they seek.  He says he's known as "the doctor of last resort" for patients whose own doctors won't prescribe narcotics long-term. The case against Talley comes as state medical boards, including North Carolina's, publicly state physicians will not face scrutiny merely for regularly prescribing opioids, which because they can be habit-forming were not generally prescribed for long-term use. But prescribing the drugs for relief of chronic pain, rather than to terminal patients, requires higher vigilance on the part of doctors to reduce the chance of being taken advantage of by a drug-seeker, officials say. "Any doctor can be duped.  Even the best doctor can be duped.  The question is whether the overall pattern of conduct is such that they can be duped on a regular basis," said David Joranson, senior scientist and director of the Pain and Policy Studies Group at the University of Wisconsin. Talley acknowledges his willingness to prescribe powerful painkillers, at times without ordering standard diagnostic tests.  Even sophisticated tests can't always pinpoint the cause of chronic pain or help in treating it, he said. Talley says he has corresponded with members of the medical board for more than a decade to advise them on how he's treating patients. The lawyer who is defending him before the medical board, Robert Clay of Raleigh, said that's a sticking point in the case. "They've had the opportunity to look at what he's done for 11 years.  They've never given him any warning, expressed anything" wrong, he said.  "He's written to them on many occasions." "The medical board has said in position statements that they want to encourage doctors to do exactly what he's doing," he said.  "The medical board has said that doctors who practice within acceptable standards of care need not fear the medical board." On Thursday, Talley blinked away tears as he talked about patients who will be in pain or suffer withdrawal without his prescriptions.  He said he expects some of his patients will "be vomiting and sweating and seeing a little green monster or two."

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