April 11, 2004 - The Las Vegas Review-Journal (NV) Drug War Victims: And Let The Patients Suffer Rural Nevada Doctor Could Lose License for Treating Those in Chronic Pain By Vin Suprynowicz, Review-Journal

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On March 2, the White House announced that for the first time President Bush's national anti-drug strategy will now target the abuse of prescription pain relievers, sedatives and stimulants, a problem the White House says "has exploded in the past decade."

The Drug Policy Alliance, a New York-based group that promotes alternatives, including the legalization of marijuana for medical use, is skeptical of the new plan. To say the least. The alliance says the unintended consequences of this misguided assault on legitimate medical practitioners will end up causing more pain and suffering - lots more.

"The principal impact of this campaign when you step up the law-enforcement response is that doctors will err on the side of undertreating pain," alliance Executive Director Ethan Nadelmann told The Wall Street Journal. "So any time a doctor is dealing with a patient in pain, (his) first instinct is not to prescribe enough."

Those who worry doctors are being discouraged from the proper treatment of legitimate pain have scheduled an "America's in Pain" rally against the "DEA War on Doctors, Pharmacists and Pain Patients" in Washington, D.C., April 18-20. One Nevada physician who may attend is Dr. Bruce Wilkin of Ely.

In September 2002, the William Bee Ririe Hospital in Ely settled a lawsuit brought by an attorney for the family of Judy Bishop, a local woman who had died of a drug overdose the year before, at the age of 35 or 36 (accounts differ).

Liability by hospitals for deaths which result when a patient overdoses on drugs are limited to $50,000 per "victim." (There should be no liability at all, of course -- adult patients are responsible for their own actions -- but welcome to the cradle-to-grave therapeutic state.) Letters from attorneys involved in the suit indicate the hospital settled the claims on behalf of Ms. Bishop's surviving relatives -- the "victims" -- for $100,000.

Dr. Wilkin, 64, practices at the William Bee Ririe Hospital, and had prescribed painkilling drugs to Ms. Bishop on an out-patient basis, though he says he was not specifically named as a defendant in that civil suit, nor consulted when the hospital decided to settle.

Dr. Wilkin now faces possible revocation of his license to practice medicine by Nevada's State Board of Medical Examiners, which contends he committed malpractice in prescribing painkilling drugs such as Oxycontin to 19 patients, though the board refuses to specify -- even to Dr. Wilkin and his attorney -- what it was about those prescriptions, specifically, that constituted malpractice.

The complaint simply says he prescribed pain-killing drugs to 19 patients, and that this constitutes "malpractice." The patients are identified in the repetitive complaint as "Patient A," "Patient B," etc.

But in fact, sources familiar with the case say "Patient A" was Judy Bishop.

Bruce Wilkin's attorney, Mary Marsh Linde of Truckee, Calif., says the Bishop case is what kicked off the disciplinary proceedings.

"Of course it did," she said. "That's how his DEA (Drug Enforcement Agency) number came up on the radar screen. What doctor in his right mind is going to give any kind of pain relief if this is the pattern of what happens to you?"

Bruce Wilkin was born and raised in Pioche, a small mining town in eastern Nevada, 160 miles north of Las Vegas. After serving four years active duty with the U.S. Army, he worked his way through college and graduated from the University of Utah with a B.S. degree in pharmacy in 1967. As a registered pharmacist doing relief work in six different communities in southern Utah and eastern Nevada during the next five years, Dr. Wilkin says he observed first-hand the chronic shortage of doctors in those rural areas.

After graduating from the University of Alabama-Birmingham School of Medicine in 1976, he entered practice in Ely in association with two other general practitioners and the area's only general surgeon. During his first 20 years in Ely, Dr. Wilkin says he has delivered more than 1,000 babies.

The charges under which the Medical Review Board now threatens to take away his license "seem to be based on the number of prescriptions and the fact it's gone on for several years," Dr. Wilkin told me over the phone from his office in Ely this winter. "Well, with chronic pain patients, that's the definition of chronic and intractable: You're gonna have to treat this for the rest of their lives. ...

"Other doctors are reluctant to treat these pain patients, absolutely," Dr. Wilkin says. "They're afraid to treat these patients because they could lose their license for writing 'too many' prescriptions. The American Society of Law, Medicine & Ethics, every year has had a full quarterly journal dedicated to the undertreatment of pain in this country. Nobody else will treat these patients, so they took it from the pharmacy records that I was treating more patients for pain than anybody else. So consequently that put me up to be investigated.

"The patient who died three years ago, that was from a prescription she stole from someone else. There was no case there, it never went to court, except the malpractice attorney who filed it and the hospital settled without my knowledge.

"Her name was Judy Bishop, she was 35. ... I didn't even know until just a couple months ago that they'd settled; I was never notified of that."

Linde contends the drugs that caused Bishop's death weren't the ones we were unsuccessful because Kenny Guinn just protected them like crazy," she said in a subsequent telephone interview. "In fact he even had his staff members sitting with them in our committee hearings. They have just been regular stinkers, I think, to both the public and the doctors themselves. Trying to get information from them has just been like pulling hens' teeth. They just stonewall you. Doctors can't tell what's going on and I don't think they ever get back to the public with information they've requested. ...

"The arrogance of the board has just been astonishing," Sen. O'Connell says. "You ask them why don't you have an office down here in Southern Nevada. We had a bill that would have required them to open a Southern Nevada office, where doctors and the public could go in and get information, because the majority of doctors and the public are down here. You would have thought we were asking for the moon. ... I don't know why they have trouble with listening."

In a follow-up interview last month, Linde argued it's time "somebody stood up to this medical board. ... There is an institutional discrimination against pain victims. If you look at the definition under the Americans with Disabilities Act, disability is defined as a condition that impairs one or more significant life functions. I think by definition then, someone who is a chronic pain patient is disabled, and the law prohibits discrimination against anyone with a disability. And yet there is a concerted discrimination against any poor S.O.B. that has a need for pain medication. And I think those boards should have to walk a mile in those moccasins."

The Wilkin case "has national repercussions," Linde concludes. "If they're going to do this to a rural general practitioner of 26 years, no one is exempt. And ... the easiest thing to do is just not take any pain patients, close the doors of medical access."

In her prepared summary of the case, Linde writes that, "Health care needs in rural Nevada are already underserved enough without these 'ready, fire, aim' tactics by the state board. ... What physician will ever again want to practice in this type of rural setting with little back up or support, if a rural doctor can be forced to give up his license for simply trying to do his best to relieve pain and suffering?

"The continuity of health care in Ely and other communities in Nevada will be severely compromised if the state board has its way in this matter. The board should recognize that in pursuing their case against Dr. Wilkin they are setting an ominous precedent for every chronic pain patient who gains some improvement in quality of life through adequate pain relief."