9,500 patients left without a pain doctor thanks to the DEA

http://www.pharmaciststeve.com/?p=15224

The three doctors saw more than 200 of Dr. Eugene Gosy’s patients on their first day of filling in. The patients came in walkers and wheelchairs, some connected to oxygen tanks and others to pain pumps…

Milch and two other doctors – Nancy Nielsen and Christopher Kerr – did not know what to expect on May 16, the day they stepped in as temporary fill-ins for Gosy. Federal prosecutors three weeks earlier accused Gosy of operating a criminal conspiracy, issuing more than 300,000 illegal prescriptions over four years.

When his office closed, 9,500 patients were left without their pain doctor, and many were dependent on or addicted to narcotic painkillers. They were panicked over the prospect of withdrawal and who would treat them. The fill-in doctors’ encounters with Gosy’s patients have led them to question their preconceptions.

“I thought I was going to see 35-year-old guys on workers’ comp who didn’t want to go back to work,” Nielsen said. “That is not what I have seen.” …

Three weeks since they arrived, the three fill-in doctors are impressed with Gosy’s practice and the safeguards he put in place to spot drug seekers…

Gosy was the repository for all the cases doctors in the community didn’t want. The patients are legitimate and have nowhere else to go. Given the shortage of addiction treatment services, they can’t just be told to get off the drugs.

“These patients are really refugees in the medical system, unable to find a home,” said Nielsen, who played a key role in arranging the short-term fill-ins to keep open Gosy’s practice.

“The patients had no warning, had no ability to find alternative arrangements,” she said…

“A contradiction exists between the way these patients have been characterized and how they actually appear,” Kerr said. “What is most impressive is that we have yet to see a case that is not striking in its authenticity.” …

But any expectation that other doctors could or would take on Gosy’s patients turned out to be unrealistic. The remaining pain-management specialists in the region are saturated with patients. Primary-care physicians, usually the first stop for common medical problems, are increasingly reluctant to prescribe opioids.

Chronic pain can be difficult to diagnose and treat. Experts say more training is needed. And the prosecution of physicians has had a chilling effect. That’s why more than 2,000 physicians in the Buffalo area referred chronic pain cases to Gosy & Associates, according to his attorney, Joel Daniels…

But obstacles stood in the way. BlueCross BlueShield removed Gosy & Associates from its participating network after the office closed without a contingency plan for the health insurer’s members…

To Kerr, the unfolding events underscored a deeper problem. Doctors don’t want to treat chronic pain, he said. From his own experience, he noted that half of the calls to hospice result from physicians’ unwillingness to write opioid painkiller prescriptions for patients at the end of life or suffering from terminal illnesses.

“There is no consequence for not treating pain,” Kerr said. “And, there’s no equivalent in medicine. You can’t say you won’t treat hypertension or diabetes.”

The doctors remain worried about what will happen after the relief effort at Gosy’s office ends later this summer…

“Having no plan is a true public health crisis, as patients will end up in the hospital, on the street buying heroin, or dead,” she wrote.

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Infection via prolotherapy

http://www.pharmaciststeve.com/?p=15216

The Centers for Disease Control and Prevention (CDC) has found that a pain clinic in California that delivered prolotherapy for chronic pain infected seven patients with hepatitis C virus (HCV)…

According to the CDC, there are no practice guidelines for this procedure, nor are there formal training programs…

The county health department, the California Department of Public Health and the CDC began investigating other possible exposures, not only for HCV, but also HIV and hepatitis B virus (HBV). The agencies sent warning letters to 400 patients who were potentially infected with a bloodborne pathogen after visiting the clinic in the previous 10 months…