How to Retire Without Really Wanting To
Charles Harris, MD
Shortly after retiring, I was invited to become the third associate of two "retired" physicians conducting a walk-in practice dealing to a great extent with the medically indigent. Shortly thereafter, medical problems claimed my two associates and they quit: I continued solo five mornings a week.
Although I rarely, if ever, prescribed "pain killers" or anything more than non-steroidal anti-inflammatory drugs (NSAIDs) for the bulk of my mainly itinerant patients, I inherited about 10-15 Chronic Pain patients for whom I prescribed methadone. Chronic Pain patients treated with narcotics will become narcotic dependent, a simple fact that causes turbulence in the posse mentality of authorities and galvanizes them to action.
Within a brief period, I became the target of a major investigation by the State of New Jersey, and in March 1995, my medical records were subpoenaed. Prior to that period, as I later discovered, the state sent an undercover operative to my office posing as a Chronic Pain patient to demand methadone. When I refused, she was coached by the police (huddled in a nearby van, á la Kojak, waiting to arrest me) to return and reissue her frantic pleas for methadone. I prescribed some Darvocet and advised her to go to an addiction clinic for relief, since I couldn't verify her medical history. All of this is recorded.
In September 1995, I was summoned to a "Fair Hearing" attended by a deputy attorney general and chaired by a podiatrist. New Jersey's idea of peer review is an attorney general, and a 16-member Board of Medical Examiners (BME), 8 of whom are laypersons, and one podiatrist, none of whom ever talk with you.
The podiatrist was confused about several issues, but, nonetheless, pursued me like a barracuda after mullet, as if getting rid of me would validate his entire professional life. He plied me with questions generated by an "expert's" report on my medical records. Not having been given access to that report, I was unable to prepare answers to some of the questions posed.
Mistaken in the belief that the "Fair Hearing" would be both a fair and friendly fact-finding mission, I appeared without an attorney. That was a mistake. The state and BME made no effort to interview patients, thus had no palpable sense of the realities of the problem of Chronic Pain. Since I had broken no laws or regulations, the state's fall back position, usual in these cases, was poor record-keeping, although it was adequate for medical purposes. Just think how much time is wasted constructing records for legal purposes.
Shortly thereafter, a Deputy Attorney General called, and because I had broken no laws or regulations, ("we know you are not venal," he said), offered me the following:
I must surrender my license to practice medicine, or else:
· My license would be suspended (depriving me of the means of subsidizing a defense).
· I could have a trial 6 to 9 months down the road.
· The remainder of my practice would be subpoenaed and I would be liable to fines of $2500 for each infraction found.
· Notified me that I already owed the state $12,000+ for their investigation.
Since I was now past 70 years of age, I saw no point in spending $100,000 to mount a defense, so I surrendered my license.
What Was the Net Result of This Assault?
· A doctor serving the community was disenfranchised.
· A neighborhood of patients was inconvenienced.
· A compassionate and convenient medical office was closed.
· Chronic Pain patients dependent on their medication were suddenly deprived of it by the state of New Jersey.
· The Board of Medical Examiners created to protect patients, would take no steps to insure continued prescriptions for the narcotic dependent, Chronic Pain patients, thus forcing some to go to the street for drugs, the very problem the entire proceedings was designed to avert.
In short, this destructive episode was a senseless example of bureaucratic meddling, and paradoxically, indifference to the public weal. It accomplished nothing of value, and secondarily, adversely affected many people. It served no social purpose other than to gather another scalp for the Attorney General's office and the members of the medical board. And a year or so later, this same board created new regulations which, had they been in place earlier, would have exempted me from scrutiny. But puritanical convictions too often yield to witch hunts.
The mindless position of the State of New Jersey, and other states as well (which may slowly be reversing with respect to narcotic prescriptions), has defrocked physicians and needlessly harmed patients. The most recent sentiment (an editorial by David Joranson in the Bulletin of the American Pain Society, September/October 1997) recognizes that many Chronic Pain patients will require narcotics until something better comes along, to enable them to obtain enough relief to get through the day. He also feels that methadone (my drug of choice because it is the least progressive and best tolerated of the narcotics) would be best for long-term care of Chronic Pain.
We have here a flailing by misguided authoritarian regulators. Doctors are somehow blamed for the plague of addiction that besets our society. It is easier and less dangerous to single out doctors as culprits than to patrol the street in search of drug pushers. It is far safer to hold doctors hostage than to engage the real enemy.
What major lessons can we learn from my ordeal? Foremost, that the criminal justice system regulates the criminals, whereas the bureaucracy regulates the rest of us; those of us attacked by the bureaucracy have fewer protections and legal rights than those caught up in the criminal justice system, which is paradoxical, since fewer of us are criminals than those caught up in the criminal justice system.
Lastly, that because systems are automatic they are inhumane, thus, they endanger our health, and menace our liberties.
Dr. Harris is a retired physician. His address is Box C, Island Heights, New Jersey 08732, (732) 929-0340.
Originally published in the Medical Sentinel 1998;3(4):144, 148. Copyright © 1998 Association of American Physicians and Surgeons (AAPS).