Aug 17, 2006
By: Eric Thomas
ABC 7 (KGO) (CA)
PART ONE
Nearly one-in-five Americans suffer from chronic pain, a statistic that’s pushed the pain management business in the US to more than $25-billion-a-year. But what happens when the government suspects a doctor is writing too many prescriptions for pain pills?
One doctor’s pain practice landed him in jail, accused of fraud and murder. In the mid and late 90’s, it was one of Shasta County’s most sensational stories.
A local doctor who runs a clinic for the poor is arrested and charged with murder in the deaths of some of his patients, and with dozens of counts of Medicare fraud. Why? In his small clinic, Dr. Frank Fisher was writing too many prescriptions for painkillers - prescriptions worth a million dollars a year.
Dr. Frank Fisher, El Cerrito: “If you talked to law enforcement, I was Dr. Feel Good.”
Because there was little evidence that his patients died from drug overdoses, a judge reduced and then threw out the murder charges. Another judge threw out the most serious fraud charges. Fisher was acquitted on the two fraud counts that remained.
Fisher says he was the victim of a witch hunt centered around law enforcement’s irrational fear of narcotic painkillers, like oxycontin.
Dr. Frank Fisher, El Cerrito: “I prescribed twenty-percent of the oxycontin to the entire medical population of California. Their assumption was that they couldn’t have been taking all those drugs, it would have killed them. So then they assumed they must have been selling them, and I must have been dealing drugs.”
Oxycontin can be addictive. Even conservative radio commentator Rush Limbaugh admitted he was hooked on it. Police say it sparks a rush of euphoria that is attracting more and more street junkies.
Fisher says when administered slowly, over time, oxycontin is safe - even in huge amounts. And he says he watched patients very closely for ill effects or addiction.
Not everyone agrees. One patient was interviewed not long after Fisher’s arrest. He prescribed her 900 pills in one month.
Patient, name withheld: “He just leaves you dangling. People are fooling themselves if they think he’s their god, or helping them.”
ABC7 asked the state attorney general’s office to comment on the case, since they prosecuted Fisher. A spokeswoman declined.
Meantime, Fisher gets to keep his medical license, but his life will never be the same. At age 53, he’s living with his parents again in the same house he lived in as a teenager. He hasn’t practiced medicine in six years, and he’s broke.
It’s not just him. Fisher says his case may scare other doctors out of doing their jobs.
Dr. Frank Fisher, El Cerrito: “That’s a quandary that every physician faces when he writes a prescription for controlled substances in this country. He asks himself every time: is this the one who’s going to put me in prison for life?”
But is that really the case? ABC7 put the question to experts and state regulators. You’ll see their answers Wednesday night on the ABC7 News at 6:00.
PART TWO
Do Prosecutions Hinder Prescriptions?
One leading doctor calls it The War on Pain: A new generation of physicians trained to use surgery, nerve blocks, and medications to ease chronic pain. And more importantly, a generation that believes untreated pain can cause permanent damage - even death. A few high-profile prosecutions may have some doctors looking over their shoulders when it comes to prescribing pain medicine.
Dr. Frank Fisher is the former Shasta County physician who was charged with murder and Medi-Cal fraud and lost his practice because the state thought he was writing too many prescriptions for painkillers. He says his case left one big question unanswered: what is too many?
Dr. Frank Fisher, El Cerrito: “The biggest problem we’re facing right now as physicians is that law enforcement hasn’t drawn a bright line about what’s legal and what’s illegal in terms of medical practice.”
A judge dismissed the most serious charges for lack of evidence. This book-length legal agreement with the state medical board allows Fisher to keep his medical license, with numerous restrictions.
Others haven’t been so lucky. In Ohio, Dr. William Hurwitz was sentenced this year to 25-years in federal prison for prescribing painkillers by the thousands; quantities that made him, in the eyes of the Justice Department, an international drug dealer.
On Nightline a couple of months ago, he was unapologetic.
Dr. William Hurwitz, convicted of dealing drugs: “I have nothing to apologize for. I didn’t do anything wrong.”
Hurwitz, Fisher, and their supporters say they were victims of a witch hunt that will scare other doctors out of prescribing needed painkillers.
Dr. Scott Fishman, UC Davis: “Doctors get easily frightened, because these cases are very public. But they’re few and far between.”
Dr. Scott Fishman is president of the American Association of Pain Medicine and a professor of Pain Management at UC Davis. He says Fisher was practicing an extreme brand of pain management that almost invited a visit from law enforcement. He says Hurwitz was writing prescriptions for almost anyone who came in, including known addicts.
He says those facts alone should comfort most doctors.
Dr. Scott Fishman, UC Davis: “Average practice, even aggressive practice, I don’t think will come under scrutiny. I don’t think doctors will come under scrutiny. And in fact, I think doctors are more at risk for ignoring pain than treating it aggressively.”
In fact, the California Medical Board, which regulates doctors, says it investigates about 30 cases of inappropriate prescribing a year. That’s an amount it calls “a relative drop in the bucket.”
In Fisher’s case, they ran his treatment records past a panel of experts.
Darrell Walker, investigator, California Medical Board: “Those experts came back with multiple departures in the standard of care.”
Which means, in the eyes of the board, he was prescribing too much. But the board denies it’s trying to tell doctors how to treat their patients, or that they’re counting every pill a physician prescribes.
Darrell Walker, investigator, California Medical Board: “But if the intent is to circumvent law, and the intent is to basically prescribe medication for other reasons besides providing good, quality medical care, then at that point you’re running into a different category.”
The medical board publishes on it’s website a list of six guidelines for physicians who prescribe pain medicine to help physicians decide what level of pain care is appropriate. They also hold seminars for groups of doctors who want to ask questions.
While the debate continues, Frank Fisher has begun moonlighting as an expert witness in trials of doctors accused of inappropriate prescribing. He also plans to take a job with a Berkeley doctor who is well known in the medical marijuana community.
But Fisher says he doesn’t plan to prescribe marijuana. For that matter, he doesn’t plan to prescribe anymore narcotic painkillers.
http://abclocal.go.com/kgo/story?section=local&id=3357299
