The nation’s largest educational conference for health care providers in the field of pain management opened in Las Vegas with yet another reminder of the legal and ethical dangers faced by physicians who prescribe opioid analgesics.
An Iowa doctor was charged Wednesday with involuntary manslaughter for allegedly prescribing powerful painkillers to eight patients who overdosed. Dr. Daniel Baldi pleaded innocent to the charges in a Des Moines courtroom.
When told of the criminal charges against Baldi before the keynote address at PAINWeek, the audience groaned. Nearly 2,000 doctors, nurses and other frontline practitioners are attending PAINWeek to learn about the latest research and trends in pain management. It’s no accident that some of the courses being taught also focus on medical board investigations and tougher government regulation of opioid prescribing.
Many pain physicians feel they are being singled out — and sometimes targeted by law enforcement agencies — for the mistakes of a few doctors who wrongly prescribed opioids.
“There are always a few bad apples and there are people who do bad things,” said Michael R. Clark, MD, Vice Chair of Clinical Affairs at Johns Hopkins School of Medicine, who says some his colleagues have stopped prescribing opioids, rather than run the risk of a legal problem over the painkillers.
“The scrutiny in cases like you heard about tonight has driven people out of doing this,” Clark told American News Report. “A friend of mine just today told me about going to her doctor and her doctor saying to her ‘I’ll take care of all your problems, but I won’t prescribe opioids anymore because I just don’t want to be part this mess.’ That’s pretty scary.
“I think one of the reasons why many practitioners don’t prescribe opioids is that they’re afraid of the government or law enforcement or somebody coming after them in some way, much in the same way we talked about McCarthyism.”
Caught in the middle are pain patients, who are suddenly being denied medications they’ve taken for months or even years.
“Sadly we see patients coming to us because they are at their wits end,” said Paul Gileno, founder and president of the U.S. Pain Foundation, a non profit group that represents pain patients. “They’re not getting the appropriate care in many states because doctors are just cutting patients off. We’re hearing horror story after horror story from patients who say ‘I was being treated fine and now my doctor doesn’t want to treat me’ or ‘now I have to drive three or four hours to see a pain doctor that will see me.’ ”
Gileno said the problem was particularly acute in Florida, Washington, Hawaii and Idaho, although there are “pockets” of physicians refusing to prescribe opioids in other states.
“It’s an issue everywhere. We actually had a few stories from California recently where doctors didn’t want to prescribe to cancer patients,” said Gileno, who adds that some pharmacists are refusing to fill opioid prescriptions or are not keeping some pain medications in stock.
Prosecutors in Iowa say Dr. Baldi prescribed powerful pain medication to known addicts and frequently prescribed high doses of methadone and darvocet. One of Baldi’s patients, bassist Paul Gray of the heavy metal band SlipKnot, died in 2010 from an overdose of morphine.
“It is unprecedented to turn unfortunate deaths or medical results into a crime against a doctor,” Baldi’s attorney, Guy Cook, wrote in an email to The Associated Press. “Unexpected deaths can occur in severe chronic pain patients unrelated to medical treatment. This is especially true with patients who are drug addicts or drug abusers,” Cook said.