Opiophobia – The War Heats Up

After moving back to Houston following 25 years in Santa Fe, from 1998 to 2006 I practiced effective pain management in peace. I succeeded in helping over 2,000 patients regain the quality of their life. In strict conformance with the standard of care that became formalized recently in the Guidelines of the American Pain Society, published in February of this year, my patients improved their functionality, contained their pain and made often remarkable progress in their physical condition and psychological status. They did this all with no complications, adverse effects, overdoses, any symptom of abuse addiction or diversion. They were universally grateful, secure and committed to their contract of treatment.

Sadly, after all those tranquil years, in 2006 I got my first notice from the Texas Medical Board of a review of my pain management cases. From that date to April of 2009, they reviewed 19 cases. In every instance, to their total frustration, they could find no reviewer to fault my pain management. In September of 2009 they subpoenaed another 9 cases. Yesterday, on October 9, 2009, I attended an “Informal Settlement Conference” with two representatives of the Texas Medical Board, to review those cases.

This time they found two anonymous interventionalist anesthesiologists to allege that my prescription of pain medications involved “massive” and “excessive” doses; that I didn’t perform complete physical examinations on each visit and that my telephone follow-up visits used the wrong billing code (I don’t bill for my services as I accept no insurance assignments).

I responded by providing detailed evidence demonstrating that these allegations were completely baseless, and that the opinions of the Board’s “reviewers” were clearly the product of anachronistic opiophobia, and a complete lack of experience with the treatment of intractable pain. I also presented statements from all nine patients involved in this “investigation”, detailing the complete effectiveness of my care in saving their lives, restoring the quality of their life, and describing their complete satisfaction with my care - and the absence of any complications, adverse effects, abuse, diversion, overdose or the induction or worsening of any addictive disorder. They ignored it all, and it appears didn’t even bother to read the patients’ outcome letters. They knew what “outcome” they were looking for.

So sadly, the “Informal Settlement Conference” was a sham. The “settlement” they offered included 20 hours of Continuing Medical Education in Pain Management (their way), quarterly supervision of my cases for five years by a physician of their choice, submission to supervision of my billing by an external authority and a $10,000 administrative fine. They produced this offer (which is much more complicated than this brief summary) just twelve minutes after concluding their “review” and “deliberations”. It obviously had been prepared before the “conference” – it would have taken them more than twelve minutes just to write it.

A month before, in September, they subpoenaed all my prescriptive records from a pharmacy I use often, and the records of 14 more of my cases – all decent, deserving and successful pain patients whose suffering has been conquered simply by adequate titration of their medications to effectiveness – are being “reviewed”. It appears that they have now located “reviewers” who will do their opiophobic bidding (unlike their frustrations in 2006 and 2007).

I don’t think this will end until an end is enforced upon then. I am turning now to the courts, to restore law into pain management in Texas (I helped write the rules for pain treatment in Texas – now the Texas Medical Board will have to be legally compelled to follow them).

As is detailed in my Brief History of Experience with the Texas Medical Board, Texas, once the leader in the nation in enlightened pain care, has regressed to the dark ages under right-wing politics (thanks George Bush and co-conspirators).

In March of 2006 I gave testimony to the Texas legislature about the problems of pain management under this Medical Board.
http://www.txppr.org/newsletter.cfm?NewsletterID=35&CategoryID=0
I re-iterated my opinions before the “Sunset” Commission of the Texas Legislature in November of 2008. Earlier this year – 2009 - I was actively involved in the unsuccessful effort to get important revisions in the Texas Medical Practices Act. (We’ll be back in the next session of the legislature.)

I also have been very outspoken about pain management on my blog http://jfshmd.blogspot.com/, on the web site of the National Foundation for the Treatment of Pain http://www.paincare.org/about/intro_message.php and in the professional literature, and on the LISTserve of “The Project on Pain and Chemical Dependency”. Further, I founded the Pain Practice Liability Association (www.pplaonline.com) - an organization to bring physicians together to defend themselves against Opiophobia, State Medical Boards, the DEA and other persecutors of pain management.

Given all of this, my current issues with the Board cannot be just a coincidence. I know, also, that several insurance companies have filed complaints about my pain care – growing out of the cost to them of pain medication. Other players are also involved, still hidden behind the “anonymity” practices of the Texas Medical Board.

Further, I am by nature a libertarian, constitutionalist and rational thinker. This doesn’t sit well with bigots, racists, religious crack-pots, greedy corporations and their minions. (I have written often that Opiophobia can only be understood through the psychodynamics of racism.)

So, I am harvesting what I have sown. Although I am now an old warrior, I am not ready to retire from battle. New Mexico was just the first skirmish. There is too much to do and so much that can be accomplished.

I believe that Mr. Obama’s election was a turning point in the history of America. The Nobel Prize just given him is a testament to that. The dark forces that have corrupted our national ideals are vicious and desperate. They sense the sands of time sifting out from under them. So they are in a frenzy of last efforts. The Texas Medical Board is a relic of Medievalism, and it too shall pass. I need only to persevere as I try to be a midwife to its delivery into enlightenment.

There is no guarantee that I will succeed. But regardless of the outcome, I will know that I did the right thing. I’m not the kind of person who can sit passively and watch the trains go by to Auschwitz.

JSH
October 10, 2009