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

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/

Dec 25, 2009
By: Karen McCowan
The Register-Guard
An Oregon native is honored for her work to help others in pain

Most people would not use the word “gift” to describe a diagnosis of not one but two chronic, debilitating diseases.

Laura Cooper is not most people.

The Eugene lawyer has embraced as opportunities her multiple sclerosis and a condition that causes painful spinal tumors. With her living expenses now covered by disability payments and an annuity from her days as a private finance attorney, she is free to practice an area of law she is passionate about: advocating for the rights of patients in pain.

Cooper cares so deeply about the issue that, last year alone, she donated more than 1,200 hours in legal services to the cause, earning her a top pro bono award from the Oregon State Bar.

Often working literally from her sickbed, she has helped prepare a class action lawsuit now before the U.S. Ninth Circuit Court of Appeals. Filed on behalf of Spokane physician Dr. Merle Janes and 27 Eastern Washington pain patients, the case challenges that state’s “Opiod Dosing Guidelines.” The suit alleges that Washington’s efforts to enforce the guidelines have prevented Janes from providing — and patients from receiving — adequate pain treatment.

The premise of the suit: Patients needing medical pain management with opioid drugs must be accommodated under the Americans with Disabilities Act. Opiods are a class of opium-based and synthetic drugs prescribed by a physician for medical purposes.

“It’s been a godsend,” Cooper said of her forced early retirement from paid legal practice. “My disability allows me to do the kind of work everybody would do if they could. I can work on things that matter in my heart.”

As pro bono (unpaid) counsel to the national Pain Relief Network, she has worked mostly over the Internet, consulting with other attorneys nationwide to research, draft and file motions in the case. Not only is she working to correct what she considers a grave injustice, but in a cutting-edge area of the law. By tackling the issue of pain patients’ rights, “I’m able to deal with a lot of meaty issues,” she said.

The Oregon State Bar’s New Lawyers Division recently gave her its Pro Bono Challenge Award for her work on Janes vs. Washington. The award spotlights “the highest level of pro bono service,” with Cooper honored in the sole practitioner category.

Oregon State Bar President Gerry Gaydos, also a Eugene lawyer, put Coop­er’s 1,200 hours in context.

“Last year, we had 56,000 pro bono hours reported by 1,800 Oregon lawyers,” he said — an average of about 32 hours per reporting attorney.

“You look at Laura’s service compared to that, and it is remarkable,” he said. “She’s encouraged a lot of people with pain to believe in the future, both by her personal modeling and by her legal work.”

Oregon native returns home

Cooper, 53, grew up in Reedsport. She earned an undergraduate general science degree from the University of Oregon before being diagnosed with multiple sclerosis at age 23. She experienced a rapid onset of the disease, which attacks the central nervous system.

“Within a year I was involuntarily placed in a nursing home,” she said.

Determined not to stay there, she decided a law degree would be her best ticket to regaining financial and other control over her life. She graduated from the University of Washington Law School in 1986, clerked in New Orleans for the Fifth Circuit U.S. Court of Appeals, then went to work at a San Francisco firm. While there, she served as outside counsel to the Federal Savings and Loan Insurance Corp. during the scandals rocking that industry. That work led to a Washington, D.C., job as counsel to the chairman of the Interstate Commerce Commission.

Then, in 1992, she was diagnosed with intradural extramedullary spinal cysts, a rare, progressive condition that causes weakness, pain and numbness.

“Technically, it’s a terminal condition,” she quipped during a recent interview. “But I’ve been ‘terminal’ for years. Shhhh!”

No longer able to handle the pressure, stress and long hours of her profession, she decided to return to Oregon and create a living space where she could still use her legal skills on behalf of pain patients and doctors who fear prosecution for adequately treating them. Cooper remodeled a ranch house off Oakway Road, removing walls and adding skylights and space to create a light-filled, wheelchair-friendly room where she can move easily between her hospital-style bed and a nearby desk.

“I can literally do all this work from my sickbed, which is kind of cool,” she said. “It’s a testament to the fact that people don’t have to stop doing what they do when they become disabled. You just have to find a different way to do it.”

Oregon a leader in pain treatment

Cooper said she’s also happy to be back in her home state because it is a leader in considering the distinctive needs of pain patients in its drug law enforcement practices. Oregon is the only state in the nation with a Pain Management Commission to represent the concerns of pain patients to the governor and the Legislature, to require seven hours of pain management training for all medical professionals, and to support research and policy analysis in the field. Oregon also is the only state with a full-time pain management coordinator appointed by and advising the governor.

Even so, there are still “whole areas of Oregon where it’s impossible for patients to get adequate pain care,” said Eugene nurse Jennifer Wagner, who holds the pain management coordinator position. “And one of the top three reasons is physician concerns about regulatory scrutiny for opiod prescriptions.”

Wagner declined to comment on the specifics of the Janes case, but said national pain management groups have expressed concern about Washington state’s guidelines. And she affirmed what Cooper describes as a bottom line in the case.

“People in pain have a right to timely, appropriate and effective pain care,” she said, noting that the American Pain Foundation recently reported that chronic pain afflicts an estimated 72.6 million U.S. residents.

Cooper attributes much of Oregon’s pain treatment progressiveness to passage of its Death with Dignity Act in 1994.

“That forced some soul-searching, when people realized that some are going to commit suicide because they can’t get adequate pain relief,” she said.

And the state went all the way to the U.S. Supreme Court to successfully fight a 2001 policy announced by then-U.S. Attorney General John Ashcroft warning physicians they would be violating federal law if they prescribed narcotics for terminally ill patients seeking to end their lives.

Cooper said she cites as precedent in Janes vs. Washington a section from Supreme Court Justice Anthony Kennedy’s majority opinion in that federal case.

“In layman’s language, he said, ‘Your authority is limited to prosecuting drug-dealing as conventionally understood. You are not to be prosecuting based on medical practice,’ ” Cooper said.

Personal history prompts legal work

Cooper said her own personal history with pain treatment prompted her fierce interest in government treatment of pain doctors and patients.

The galvanizing event for her was the prosecution, conviction and imprisonment of Dr. William Hurwitz, a Virginia pain specialist whom Cooper credits with saving her life. Hurwitz was convicted of drug trafficking after some of his patients were caught selling pain medication he’d prescribed to them.

He was sentenced in 2007 to nearly five years in prison, even though the judge said most of Hurwitz’s “high-dosage opiod” prescriptions for pain patients were legitimate and supported by “an increasing body of respectable medical literature and expertise.”

Cooper credits Hurwitz with diagnosing scarring in her trachea caused by repeated insertion of breathing tubes during flare-ups of her MS. Laser treatments of the scar tissue eased her pain and breathing difficulties, she said.

“And he came up with an MS treatment that stopped me from being hospitalized all the time,” she said.

In Cooper’s eyes, doctors such as Hurwitz and Janes “are being persecuted for ‘over-prescribing’ pain medication even if it’s standard-of-care treatment. And people in chronic pain who need those medications can’t get them because of doctors’ fears of regulatory authority.”

Pain patients pay an excruciating price for what Cooper considers fear- and ignorance-driven government policies restricting the use of opiods for legitimate medical purposes.

Too many government officials “view addiction as not a public health issue, but a legal and criminal issue,” she said. “Doctors are pressured to be a cog in the war on drugs, even though science demonstrates that when people have actual pain, they can take these drugs around the clock and can’t get high.”

Aggressive prosecution of pain management specialists may prevent some people from feigning intractable pain to obtain drugs for illicit purposes, she acknowledged. But she contends the approach has increased public health problems — and costs — by driving hundreds of thousands of actual pain patients to rely on less-effective alternatives with lethal side effects.

“The Drug Enforcement Administration only sees deaths from (controlled substances),” she said. “But no one is comparing those deaths with Food and Drug Administration data showing that more people died from side effects of over-the-counter pain relievers.”

Pain patients are dying of gastrointestinal bleeding from ibuprofen and end-stage liver disease from acetaminophen, she said.

One aim of Janes vs. Washington, she said, is to “bring together two arms of federal government at war with each other.”

As a lawyer, Cooper said she is thrilled to be tackling the issue in civil court as a civil rights matter, saying a favorable Ninth Circuit decision would be a gift to hundreds of thousands of patients in pain.

“Instead of constantly defending individual (doctors) in criminal court, this lets us get at the policies,” she said. “That’s the heart of the issue.”

“My disability allows me to do the kind of work everybody would do if they could. I can work on things that matter in my heart.”

Laura Cooper

http://www.registerguard.com/csp/cms/sites/web/news/cityregion/24262709-41/pain-cooper-oregon-patients-washington.csp?utm_source=Email+Contact+List&utm_campaign=7791c2c306-priceofspeech_PRN_20099_2_2009&utm_medium=email