The Pain Relief Network

Aug 22, 2010
By: Roxana Hegeman
The Associated Press

WICHITA, Kan. – Siobhan Reynolds has spent years crusading on behalf of chronic pain patients – testifying before Congress, suing government drug regulators and speaking out against what she believes is a government crackdown on prescription painkillers that has left many patients needlessly suffering.

But as the case of a Kansas physician linked to 68 overdose deaths wraps up in a federal courtroom here, the fiery patient advocate has found herself in an uncomfortable new role: fighting a secret federal investigation targeting her over a possible conspiracy to obstruct justice for her involvement in that case.

Reynolds, the president of the Pain Relief Network, championed the defense of Dr. Stephen Schneider and his wife, Linda. The Haysville couple were convicted of unlawfully writing prescriptions leading to death, health care fraud and money laundering. Federal prosecutors want the couple, who face up to life in prison, to forfeit $4.2 million plus real estate and other assets.

Reynolds has become a leading voice for pain-relief advocates after the 2003 arrest of Dr. William Hurwitz, whose pain management clinic in a suburb of Washington, D.C. once treated Reynolds’ late husband, Sean Greenwood. He suffered from a painful connective tissue disorder that has been inherited by the couple’s son. After Hurwitz’s arrest, the family struggled to find another physician willing to prescribe for Greenwood high doses of painkillers. He died in 2006.

Her initial refusal to turn over e-mails and other subpoenaed documents related to the Kansas case has already led to a contempt citation and cost Reynolds and her nonprofit group $36,500 in fines before the money ran out. Faced with imminent jailing for contempt, Reynolds relented and turned over some 4,000 pages of subpoenaed material three weeks before the Schneiders’ trial.

“I am being beaten up in the dark by the government,” Reynolds said. “They have taken everything I have. They have coerced me into violating all kinds of oaths I had held firm. But when push came to shove at the very end here, I decided I would be more valuable to the Schneiders and this country out than in.”

Assistant U.S. Attorney Tanya Treadway declined to discuss the grand jury investigation, which has been vaguely referenced numerous times in public documents filed in the Schneider case. The doctor’s defense has argued in filings prosecutors have used the separate grand jury proceedings to improperly get defense work product in the Schneider case.

The government tried unsuccessfully in 2008 to get the judge overseeing the Schneider case to issue a gag order against Reynolds. In court documents, the government has portrayed Reynolds as having a “sycophantic or parasitic relationship” with the couple and claimed she is using the Schneiders to further PRN’s political agenda and her personal interests.

After the Schneiders’ arrest in 2007, Reynolds rallied his patients with petitions and demonstrations in a losing fight to keep the clinic open. The 49-year-old Santa Fe, N.M., woman helped the family line up attorneys experienced in physician prosecutions and provided the defense team with experts and information gleaned from her nine years of advocacy work.

To the chagrin of prosecutors, Reynolds also put up a highway billboard last year proclaiming: “Dr. Schneider never killed anyone.” Weeks after it went up, she got a subpoena seeking in part documents related to the sign.

“I put the billboard up to try to reawaken Wichita to the possibility that Dr. Schneider was entirely innocent – and I really thought it was within my First Amendment rights to do that,” Reynolds said.

Prosecutors alleged in a 2008 court document that after the Schneider clinic was closed Reynolds told a distraught pain patient that, if she was going to commit suicide because painkillers were no longer available, to “make it count” by doing it publicly.

Reynolds said many patients have told her they wanted to commit suicide and begged her to help them so it wouldn’t happen. She said that is why she tried to keep the Schneiders’ clinic open.

“PRN worked so hard, spent so much money to prevent that kind of thing,” Reynolds said. “Might I have said in a dark moment something like ‘well, make it count,’ I think I did, but the truth of the matter is I love people very much and I have spent every dime I ever had in my entire life to fight for their cause.”

She sees herself as a “theater director” – drawing upon her personal loss and her education in film to tell the story of chronic pain patients.

But malpractice attorney Larry Wall, who represents the families of several dead Schneider patients, said Reynolds has diverted attention from the true victims: “She has tried to concoct a phony excuse for a pill mill doctor and his actions.”

http://www.kansas.com/2010/08/20/1455552/doctors-advocate-targeted-in-grand.html

Jun 6, 2010
By Eric Snider
Creative Loafing News and Politics

Before the lid got blown off Tampa Bay’s pain-pill epidemic — before the TV exposés and high-profile raids, before the moratoriums on new facilities and emergency city hall ordinances — Creative Loafing received a letter from Bernie McCabe, state attorney for Pinellas and Pasco Counties, asking for the paper to reconsider running ads for pain clinics on the back page.

“We believe the physicians who prescribe these medications play a role in the prescription drug abuse and overdose epidemic that faces our community today,” the letter, dated March 2, said in part. “While we understand the right to freedom of the press, we feel this type of advertisement is a blatant invitation to easy access to powerful narcotics by persons who are drug seeking.”

CL’s initial response was: OK, there’s reason for concern. The paper can deny advertising if there is indication a business is operating illegally.

But McCabe’s letter had not said that any of the pain clinics on the back page were illegal. And editor David Warner didn’t want to tar advertisers as unscrupulous pill mills without cause. So he decided CL needed to do some investigating on its own. That’s when he called me, a former CL staffer.

The approach was simple: Contact some of the pain clinics, set up appointments and find out just how easy it is to score prescriptions for Oxycodone, Vicodin or other opiate pain meds. I have my share of pain — low back, knees, right shoulder, Achilles tendons — so it was reasonable that I would look into the clinics’ services. We agreed that I would not tell the facilities I was a reporter, but if asked I would divulge my identity and intent.

We wanted to find out if our advertisers were indeed scofflaw pill pushers — places where all you had to do was limp or cringe a little and walk out with a sheaf of prescriptions — or if the establishments vetted patients and required them to make a persuasive case that they needed opiates for legitimate pain therapy.

Honestly, we expected a free-for-all, pills for the asking. That’s not what we got.

First we wanted to talk to McCabe. I called his office and asked to speak to him by phone. A couple of days later, an assistant called me back with an appointment time to visit him the following week. When I met the State Attorney and Public Defender Bob Dillinger in a nondescript conference room in the Criminal Justice Center on 49th Street in Clearwater, McCabe said he was pleasantly surprised that Creative Loafing had responded to his letter. He eyed me warily for the first 10 minutes of our meeting. I told him the paper’s plan.

McCabe, who wore a yellow golf shirt with his office’s seal imprinted on the breast, did not use his blustery personality to pressure me to drop the ads. Instead, he handed me a sheaf of papers filled with statistics, press releases and newspaper stories about the pain pill epidemic.

• Prescription drug abuse has risen 500 percent since 2005.

• In 2008, 15.7 percent of Pinellas County high school students and 3.4 percent of middle school students reported using prescription pain relievers at least once in their lifetime.

• That same year, Florida’s Sixth Judicial Circuit — Pinellas and Pasco Counties — had the highest number of reported deaths in the state involving Oxycodone at 308, more than Xanax (250), Valium (145) and Methadone (108).

• Also in Circuit 6: From 2001-2008, reported deaths that involved Oxycodone rose from 61 to 308, or 404.9 percent.

McCabe went on to discuss the scourge of the clinics in general terms, without singling out any particular facilities. He said that the doctors working at the clinics should “rot in hell. They are taking advantage of addicts. They are killing people. It’s despicable.”

For his part, PD Dillinger said his office was deluged with drug cases and supported the overall effort to strike at one of the problem’s sources: pill mills.

The only insight the two offered regarding my investigation was that the clinics required prospective patients to present an MRI. They wished me luck, and said they were eager to hear my findings.

Then a bit of bad timing. Before I was able to visit my first facility as a supposed patient, the Pinellas County Commission issued a moratorium on new pain clinics, which suggested to me that clinics would likely circle the wagons, vet new patients more strictly.

Yet off I went a couple of days later to visit St. Petersburg Pain Management at 4900 33rd Ave. N. in St. Petersburg, which advertises “Chronic Pain Relief” in big yellow letters against a green background. Why this place? In part, because the ad said “FREE initial visit.” It’s an unfortunate reality that CL simply does not have the resources to fund an investigation that would require multiple office visits ranging from $150 to $300 a visit. Plus, St. Petersburg Pain also had what we considered the most blatant come-on, including “Dispenser Onsite!”

The facility is a converted one-story house on 49th Street with a circular driveway, where only a couple of cars were parked on the sunny late morning I visited. In the compact waiting room, I signed in and was quickly handed a stack of papers to fill out that was more extensive than any other doctor’s office I’d ever visited. I wrote down symptoms, medical history, signed waivers — all of it truthfully.

I asked when I could see a doctor. The woman behind the counter asked if I had a report from an MRI that was taken within the last six months. It just so happened I had an MRI on my right knee some weeks earlier, but it certainly was no ticket to Oxy Land. It said that I had a loose body in my knee but other than that was negative for damage to cartilage or ligaments. Still, I claimed pain in my knee and low back (both true).

The woman then asked me for a pharmacist’s report. I told her I didn’t have one, that a doctor had given me Vicodin samples and they really worked, they were the only thing that effectively eased the pain. That doc would not give me a prescription, I said. (This part was fabricated.) Would this doctor write me a script?

She gave me a quizzical look and said someone would call me.

I left. The call never came. I phoned a couple of days later asking when I could get my prescription and was told that someone would call me back. That call never came either.

At this point, it seemed apparent that the place advertising itself for “Chronic Pain Relief,” whose actual name is St. Petersburg Pain Management and Urgent Care, was not eager to have me as a patient. I figured my investigation had reached a dead end. No dispensers spitting out pills like slot machines for me. With a less-than-convincing MRI and no pharmacy record showing pain pill usage, it seemed untenable to continue our CL report.

After conferring with editor Warner, though, we decided to complete the project as best we could. I was to call all the pain-clinic advertisers on the back page of the CL Summer Guide (May 13-19) and finish what I started with St. Petersburg Pain Management and Urgent Care.

The seven clinics I telephoned all had essentially the same story:

I would need an MRI — if I didn’t have one, they could direct me to a facility where I could get one at a reasonable price. “We have to have some medical correlation to why you’re having pain,” said a woman from Quality Care Medical Group with offices in Brandon and Bradenton. “You say you’re having pain, but there has to be some issue going on with the body that explains why you’re having pain.”

The clinics I called also said I would need a pharmacy report documenting my prescriptions. Some required a urinalysis.

Initial office visits ranged from $125 to $300. If I qualified, I would need to return every 28 days, which cost from $110 to $125. Then there was the cost of the meds.

I couldn’t help but think: Kinda pricey to be a pillhead these days.

With one clinic, Medical Pain Management at 1010 E. Busch Blvd. in Tampa, a woman pitched me on injections that could get a person off alcohol and narcotics. She was adamant that the clinic should not be lumped in with pill mills. “They’re cracking down on clinics, but our doctors have never had problems,” she said. “We’re above board and clean. We’re the best. We’ve been here 17 years.”

I tried a bit of cajoling with the clinic staffers, whined about my chronic pain: Was there anything I could do to get around some of these restrictions? I was desperate.

I was shut down, politely, at every turn.

When I parked outside St. Petersburg Pain Management and Urgent Care for my second visit, a security car was in the lot. The clinic had recently been robbed at gunpoint at 3:35 p.m., with thieves stealing an undetermined amount of Oxycodone. An armed guard stood at the hallway leading from the lobby to the exam rooms.

During my two-hour wait, a small parade of obviously suffering people came through with varying tales of woe, most related to their inability to obtain pain pills. Some were there for monthly visits and left with prescriptions.

It took the staff a while to find my paperwork. A man dressed in scrubs said he would have to call the physician who authorized the MRI. After several attempts, he got through.

A doctor walked into the office area a few times — a slightly built, elderly man with thinning hair and a gaunt face. He made no attempt to interact with patients in the waiting area.

I waited a while longer, enduring the cigarette reek from bodies, reading the sign on the walls that said “All Patients Subject to Random Urinalysis,” thumbing through a Health magazine that was among a bunch in a plastic container on the wall.

Finally, the man in scrubs called me over. Said he had consulted with the pain doctor. “He says you should see an orthopedic doc first, who’ll determine whether you need pain management care,” the man said with such finality that I didn’t even put up an argument.

I walked out the door and into the sunlight, pill-less.

Editor’s Note: Subsequent to Eric’s visit to St. Petersburg Pain Management, we spoke with the clinic’s office manager, who made a forceful argument for the legitimacy of the business. “Whenever we have a new patient come in, we contact all the doctors that are in their pharmacy history,” she said. “We have an 18-page contract that they sign that says that they will not go anywhere else. And any doctors that they’ve seen previously we notify them by fax that the patient is here. So if the doctor has anything to say they will and do contact us. We are very cautious — we check everything out.”

Asked how she felt about the crackdown on clinics by law enforcement, she said, “It needs to be cracked down on. They should be strict. We’re strict.”

 http://tampa.creativeloafing.com:80/gyrobase/clinical_diagnosis_instead_of_meds_a_prospective_patient_runs_into_roadblocks_and_red_tape_at_area_pain_clinics/Content?oid=1115979

FOR IMMEDIATE RELEASE
Jul 9,2010

Press Conference and Argument: US Federal CourtSeattle, Washington
When: Monday, July 12th 2010 at 1:00pm

PRN TAKES ON THE STATE OF WASHINGTON
National Advocacy Group Working to End The Nationwide Witch hunt of people in pain and the doctors who treat them.

Responding to what doctors and patients are calling a dangerous crackdown on people with chronic pain, Pain Relief Network is seeking the protection of the courts, hoping to have the deadly disease of chronic pain declared a disability under the Americans With Disabilities Act.

Siobhan Reynolds, President of the Pain Relief Network and defender of people in pain sees Washington State as the patient’s last real opportunity to stop the War On Drugs from completely destroying a free and voluntary doctor/patient relationship, “Between Obamacare, The War On Drugs and the media’s rapacious focus on celebrity addiction, people in pain who merely want to live their lives and take care of their families are instead being herded like cattle into “safety programs’ which are anything but safe.” She goes on to say, “despite Washington State’s contentions that they are merely looking out for the welfare of citizens in pain, the data does not demonstrate that a public health crisis in overdose and addiction even exists. What the data does say is that some 25 to 33 percent of the American people suffer from the deadly disease of chronic non- cancer pain.”

Laura Cooper Esq. General Counsel for PRN and the lawyer who will be arguing on behalf of the doctor/patient relationship in Washington State from her wheel chair said, “Physician assisted suicide is now legal in Washington State but pain treatment is no longer supported in the law. So it’s ok for doctors to prescribe Controlled Substances to kill us but not to allow us to live. The courts have said they will step in if such a state of affairs comes to characterize pain treatment in the US and I am afraid that we are here.”

A recent article in Time Magazine explains the groundlessness of the state’s claims that a ‘wave of deaths by opioids’ necessitated this crackdown. According to one of the top medical experts in the world, the science around cause of death by opioids in people who were otherwise critically ill is far from exact. Dr. Steven Karch called the acceptance of the state’s word on the cause of death when pain medicines are present, “a giant miscarriage of justice.” He goes on to explain, “You can die from a drug and you can die with a drug, When you have four orders of magnitude separating either end of the curve, many of these deaths may not have to do with drugs at all.” http://www.time.com/time/health/article/0,8599,1996831,00.html?xid=rss- topstories#ixzz0tCmyzIMj

Jun 08, 2010
By: Ron Sylvester
The Wichita Eagle

An internationally recognized researcher on drug toxicology told jurors that it’s impossible to say why patients of a former Haysville doctor died.

Steven Karch testified Monday that the deaths of patients of the Schneider Medical Clinic might have resulted from serious maladies they suffered from, not just overdoses of drugs prescribed to them.

Karch, a medical doctor from Berkeley, Calif., is the author of the “Drug Abuse Handbook” and “Postmortem Toxicology of Abused Drugs.”

Those books have been used as a reference by doctors and scientists at the Sedgwick County Regional Forensic Science Center, whose work Karch criticized in a federal courtroom in Wichita.

Karch was testifying in defense of Stephen Schneider, a former doctor. Schneider and his wife, licensed practical nurse Linda Schneider, are charged with contributing to the deaths of dozens of patients.

The Schneiders are accused of illegally prescribing painkillers that resulted in the deaths of 68 patients. The couple are charged with directly contributing to the deaths of 21 patients.

Medical examiners and the chief toxicologist of Sedgwick County determined those patients died of mixed drug intoxication.

Karch said the patients also suffered from other medical conditions that could have killed them. He said one of the Schneider patients had such profound heart disease he’s going to include it in the next edition of his textbook.

Karch testified he has conducted research for years, trying to find ways to determine how drugs contribute to deaths. But he says no one has found a way to accurately draw conclusions about drug levels found in a person’s body after they die.

Karch said the research shows drug levels in the blood after death are not telltale signs of an overdose. Drugs stay in the body, Karch explained, even after it starts to deteriorate after death, causing the levels to rise dramatically.

“It doesn’t tell me about the cause of death because I don’t know what the number was when they died,” Karch said under direct questioning by defense lawyer Lawrence Williamson.

Assistant U.S. Attorney Tanya Treadway pointed out on cross-examination that Karch’s testimony contradicts what he has said in other cases.

Karch’s testimony helped convict English doctor Harold Shipman of killing 15 patients through overdoses of lethal drug mixtures.

Treadway also pointed out that despite Karch’s books on drug pathology, he is not a board-certified pathologist.

Karch said he found three Schneider patients he could say died of accidental drug overdoses. But none of them, Karch said, died of prescription medicines but rather illegal street drugs.

One man had a heart condition likely exacerbated by smoking marijuana, which Karch said speeds up the heart rate. Another man had high levels of methamphetamine, and another woman had ingested cocaine.

All interacted with other medical problems the people had, Karch said.

Karch said the other patients couldn’t be conclusively called overdoses.

“The confusing factor is the presence of large amounts of drugs” in the patients, Karch said of one man. “There is no way to tell whether the multiple drugs or heart disease did it.”

Karch said autopsies could have narrowed down the causes by doing drug hair tests that might show the presence of drugs. Such test had been shown to determine a person’s tolerance for drugs.

But Karch said such tests are expensive — about $1,200 a hair — and are cost prohibitive for publicly funded crime labs.

“Without that, it’s just a guess,” Karch said.

Jurors will have the ultimate decision of which witnesses to believe. But there will only be 11 of them deciding the verdict.

Alternates chosen at the beginning of the trial, which entered its seventh week Monday, had been released from duty for various reasons during the trial. Another was dismissed Monday morning by U.S. District Judge Monti Belot.

No reason was publicly given but both sides have agreed to go on with 11 jurors. Another juror loss could result in a mistrial.

“Be safe,” Belot told the jury as he dismissed them for the afternoon.

The trial continues Thursday. Belot said he hopes to be able to deliver the case to the jury early next week.

Feb 25, 2010
By: John Stossel
Fox Business Network

In this week’s show “Hands Off My Meds” (re-airing tonight at 10pm ET, Saturday at 7pm ET, and Sunday at 11pm ET), I ask: Why does the DEA, in its zeal to prosecute the disastrous War on Drugs, frequently harass and prosecute doctors who prescribe pain medicine with opiates—legal medications like oxycontin, vicodin and percocet—to patients with chronic pain? Ron Libby, a professor of political science at the University of North Florida and author of “The Criminalization of Medicine: America’s War on Doctors,” says this government crackdown leaves thousands of patients in pain. The Association of American Physicians and Surgeons says this to its members: “If you’re thinking about getting into pain management using opioids as appropriate: DON’T. Forget what you learned in medical school – drug agents [from the DEA] now set medical standards.”

The DEA declined to be interviewed. They sent us this instead:
DEA’s mission is to protect the public health and safety. In the performance of this mission, DEA targets and investigates those individuals who violate the law, regardless of their profession. American jurisprudence is deeply rooted on the fundamental principle of equal justice under the law. Coinciding with this basic principle is another overarching principle – no one is above the law. When seeking medical care, the American public must be able to trust their doctor. They have a right to know that their doctor isn’t going to trade prescriptions for sex, file millions of dollars worth of fraudulent insurance or Medicare claims, or be impaired from self abuse of controlled substances while treating patients. Fortunately, the vast majority of doctors are outstanding professionals who truly desire to provide medical care and treatment to patients, to heal. Doctors who issue controlled substance prescriptions for a legitimate medical purpose in the usual course of professional practice have nothing to fear from the DEA. But rather than extinguish this fear with facts, Mr. Libby stokes the ambers of fear with false or misleading information that only perpetuates misconceptions and fear. On average, DEA arrests only 85 doctors annually of the more than 750,000 medical doctors and doctors of osteopathic medicine. Most DEA investigations of physicians are initiated due to information provided by a medical or pharmacy board, an employee of the doctor, a patient or other law enforcement agency. More often than not DEA utilizes its regulatory authority rather than its criminal investigative authority to administratively sanction practitioners and other DEA registrants. If a criminal or civil case is warranted, the determination to prosecute rests with the State or Federal prosecutor. Mr. Libby, however, believes that is implausible for a doctor to commit a criminal offense or that they should somehow be immune from prosecution. He further believes that if law enforcement uncovers criminal activity involving a doctor, officials should simply advise the doctor to stop violating the law. Apparently, he believes that doctors should never be held accountable for their actions.

It is Mr. Libby’s belief that doctors are simply duped into committing criminal offenses. The facts, however, are quite different. The doctors investigated by the DEA have committed acts that are far from the mainstream of medical practice. For example, a doctor in Spring Hill, Florida anesthetized his patient and then attempted to have nonconsensual sex with the patient. Several physicians were associated with 34 rogue Internet pharmacies in 2006 who dispensed more than 98 million dosage units of controlled substances to patients they never met, examined, or performed diagnostic tests to make an appropriate diagnosis. . How about the pain clinic in Florida whose employees had to stage a burglary at the clinic to cover for the thousands of dosage units its doctor doled out as if every day were Halloween or the doctor in Taylor, MI who falsified and instructed others to falsify patient files; prescribed controlled substances in such combinations that they were likely to cause death; and provided prescriptions for controlled substances to individuals the doctor knew were addicted or who would sell the drugs illegally.

Mr. Libby has stated on several occasions that he is concerned about the under treatment of pain in the U.S. He apparently has not visited South Florida lately where there are more than 500 pain clinics in just a three-county area alone. These clinics advertise that walk-ins are welcome and that there is no waiting. However, of the top 100 practitioners that dispense oxycodone from their office, 96 of them are in Florida and 86 are in the same three-county area. The proliferation of pain clinics in one South Florida county has been so great that city and county officials are looking to enact ordinances to ban any new ones from opening. DEA is statutorily responsible for enforcing the Controlled Substances Act which is designed to prevent and detect the diversion of controlled substances. In executing its responsibilities, DEA does not enforce the law in a “cafeteria style” – picking and choosing which provisions of law it will enforce and which ones it won’t.

DEA does not target physicians based on their practice specialty or medical conditions that they diagnose and treat. DEA encourages doctors to treat pain, or any other medical condition, as medically warranted and under the regulations and standards established by the practitioner’s licensing/professional board. DEA does not want to interfere with the legitimate practice of medicine. DEA routinely meets with medical groups and medical associations to achieve an appropriate balance between the practice of medicine and law enforcement.
Mr. Libby claims that DEA is demonizing pain doctors for practicing medicine. Ironically, his accusations against DEA seem to demonize legitimate law enforcement.

I find Mr Libby much more convincing than the DEA.

http://stossel.blogs.foxbusiness.com/2010/02/26/dea-response-to-war-on-pain-medicine/