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Hurwitz Postmortem

Wednesday, February 16th, 2005

In addition to the striking letter from 30 state attorneys general confronting the DEA’s aggressive pursuit of physicians, here are a few other interesting items that have emerged from the trial that convicted Virginia pain specialist William Hurwitz, now facing a life sentence:

  • The judge allowed the prosecution to call over 60 witnesses to testify against Hurwitz. He permitted the defense to call just five patients to testify on Hurwitz’s behalf.
  • Court records show that in one case, Hurwitz was accused of prescribing a patient 1,600 pills per day. Turns out, that was a clerical error. A nurse mismultiplied the dosage. The mistake was caught by a pharmacist, and the patient was only given his required dosage.
  • This one comes from a friend of Hurwitz, so take it for what it’s worth. But apparently, of the 50+ convicted drug offenders called to testify against Hurwitz, all but two were subsequently released from prison. One of the two who wasn’t released was a prosecution witness whose testimony, much to the chagrin of prosecutors, tended to favor Hurwitz.
  • Some of the most damning evidence against Hurwitz came from Michael Ashburn, a past president of the American Pain Society, who testified that Hurwitz’s treatment methods were outside the bounds of accepted pain therapy. In a stunning and thorough rebuke, the previous eight presidents of that organizations subsequently sent a letter to Hurwitz’s lawyer condemning Ashburn’s testimony.

    Click “more” for the text of the letter.

    December 10, 2004

    Marvin D. Miller, Esq.
    P.O.Box 663
    1203 Duke Street
    Alexandria, VA 22313

    Dear Mr. Miller,

    We are Past Presidents of the American Pain Society and have decided to take an unusual step in writing you about the expert testimony that you have heard at the trial of Dr William Hurwitz. We are deeply concerned that serious misrepresentations in the testimony provided by the government¹s expert, Dr. Michael Ashburn, will undermine the welfare of patients who suffer in chronic pain.

    Our concern is that the role of key government expert will lend credibility to Dr. Ashburn¹s statements about the treatment of chronic pain, many of which we believe to be factually wrong or serious misstatements of consensus in the field. The credibility accorded this testimony, when disseminated or used to justify future investigations, threatens the public good. We felt morally compelled to inform you of our profound concern.

    There are several points of sharp disagreement:

    o Dr. Ashburn repeatedly stated that the use of ³high dose² opioid therapy is an indication of drug abuse in populations with chronic non-cancer pain. It is factually untrue that this is a consensus opinion of pain experts. We strongly hold the view that patients with non-cancer pain may benefit from opioid therapy and that the dose necessary to control pain may be high. Use of ³high dose² opioid therapy for chronic pain is clearly in the scope of medicine.

    o Dr. Ashburn asserts (page 23 of the transcript) that morphine at a dose of 195 mg/day constitutes a high dose. This statement is without foundation in the medical literature and we believe that it is, on its face, absurd.

    o Dr. Ashburn implies that opioid treatment of a patient with a known addiction is medically wrong and worsens the addiction. This is not the view of experienced clinicians in the field. It is unacceptable to promulgate the view that the disease of addiction automatically denies patients with severe pain the possibility of relief through careful opioid therapy.

    o He states (page 37) that high dose opioids produce hyperalgesia (increased pain) and therefore may worsen the clinical pain problem. Although this has been raised in the literature as a theoretical concern affecting some patients, neither the prevalence nor the clinical significance has been established and its putative risks have not led to any change in clinical guidelines.

    o Dr. Ashburn speculates (page 37) that high dose opioids may compromise the immune system. Again, this is considered to be a theoretical risk, one balanced by the potential dysimmune effects of unrelieved pain itself; it has not found its way into any accepted guideline for opioid use in any population.

    o In the past, each of us perceived Dr. Ashburn as a respected colleague and his selection as an expert by the government as understandable. We are stunned by his testimony. As leaders in this field, we feel compelled to correct the errors in his testimony, lest it be used in the future in a manner that worsens the national tragedy of untreated pain. We will try to correct the public record after the trial concludes and sincerely hope that the government and the court will consider this information now.

    Respectfully submitted,

    Russell K. Portenoy MD
    Chairman
    Department of Pain Medicine and Palliate Care
    Beth Israel Medical Center
    New York, New York

    Professor of Neurology and Anesthesiology
    Albert Einstein College of Medicine
    Bronx, New York

    Chief Medical Officer
    Continuum Hospice Care/The Jacob Perlow Hospice
    New York, New York

    James N. Campbell, M.D.
    Director, Blaustein Pain Treatment Center
    Johns Hopkins University Medical Center

    Kathleen Foley, M.D.
    Pain&Palliative Care Services
    Memorial Sloan-Kettering Cancer Center

    Charles Cleeland, Ph.D
    Director, Pain Research Group
    U.T.M.D. Anderson Cancer Center

    Christine Miaskowski, R.N. Ph.D. FAAN
    Professor & Chair, Department of Nursing
    University of CA San Francisco

    Richard Payne, M.D.
    Director, Duke University on Care at the End of Life
    Duke University Divinity School

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    This entry was posted on Wednesday, February 16th, 2005 at 10:50 am by Radley Balko and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

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