The Impact of the Investigation, and Finances


This process, from the drop-in inspection in November 2017, to the interview in Ukiah in June 2018, to our receipt of the Accusation in May of 2019 has been very disruptive. I may have more to say about the tone of the "investigation" and the way in which it was conducted in future posts, but for now I will just say it temporarily caused me to have doubts in my convictions, and to do some things with patients that were out of character. I failed to rescue Patient P1 on one occasion when she overused her medications, and of all the things that have happened here, that is the one that will haunt me, that I allowed my own fear for my license to induce me to cause suffering in a medically fragile elderly woman. The state may consider enforcing that narcotic contract to be the only non-negligent choice, but I know in my heart that is wrong, and that I was wrong.

Financial Impact

The other piece of this that has been distressing is the financial impact of the process. I am fortunate in that my malpractice insurance covers up to $50,000 for administrative matters, which this is considered. Unfortunately, as I have stated elsewhere, my lawyer estimates the cost of a formal Hearing is likely to be $150,000. The average income of a Family Physician in the US is $225,000 per year, so that would not be a problem for many doctors, but my income was under $50,000 last year because I care for poor people, I take the time in appointments to really listen and to educate, I employ enough staff to be able to get needed authorizations, to coordinate care with our sometimes dysfunctional local hospitals (Anyone tried to schedule an xray at St. Joe's recently?) and so on. See The Finances of the Practice - and why legal fees are a challenge if you want more information about this.

Rural docs under siege

There are now two docs I know of in our area who have retired early because of similar accusations, and at least two docs who live in small communities south of us who are going through a similar ordeal right now. Shaming and humiliating doctors who have lived lives of service, and placing them in a position where they have to accept probation for providing compassionate care or give up their calling because the cost of defense is too great late in their careers, is shameful. Self defense from sanctions is financially ruinous even when the doctor is right and regulators are wrong.

A flawed process

There are a number of factual inaccuracies in the Accusation that could easily be addressed if I am able to provide guidance to the reviewer, and have internet access so I can access the records (which I did not have during the initial interview.) The potentially dangerous combination of benzos with opioids is something these patients arrived on and had demonstrated tolerance to, and which all of them were counseled on. I have statements from family members of several of these patients addressing the irony of the fact that the doc who stabilized their mental status and tried to address the clinically evident overmedication on their arrival in the practice is the one being prosecuted for negligence. . . . I would be happy to share these with the investigators.

No need for Expert Witnesses - the literature is there

In addition, there is plenty of support in the medical literature for my approach - it has the support of more pain experts than the current draconian insistence on forced tapers and non-patient-centered care. The Darnall et al article(external link) is just one of many. Flying in Expert Witnesses to address the fact that the guidelines are being misapplied when the CDC website(external link) states that seems crazy, and taking up the time of an entire courtroom of people to address questions that I could very easily address in an adequate interview also seems excessive.

Why is this being approached like a trial for murder, with a Judge, when it would more appropriately be addressed by a peer review committee of physicians? There is no allegation that I have sold prescriptions, or knowingly prescribed to anyone who was selling pills, that I have assaulted or molested anyone, or done anything else criminal, simply a question about whether I have the clinical judgment to decide whether a patient is endangered by their particular drug regimen, or whether they are tolerating it and a rapid forced taper will produce more harm than good.

No Thanks to a Go Fund Me

A number of generous souls have offered to establish a Go Fund Me account to help pay for legal defense, but I am declining that for now. It is ridiculous that our financially strapped community should be asked to support lawyers for something like this. The resources we have would be better spent on the Angel Fund through the Humboldt Health Foundation(external link), providing assistance to patients who have to travel 6 hours one way to see specialists, or who need things like walkers or air purifiers to improve their health. Using the legal system to assault health care in small rural counties that already have major problems with poverty and all sorts of adverse health outcomes(external link) and further diminish our pool of docs when we are already medically underserved is a travesty.