Not a War on Doctors Patients

Wednesday, March 26th, 2008

Steven Schneider of Kansas is the latest doctor in the federal government’s crosshairs for over-prescribing painkillers. Schneider ans his wife (who was also arrested) have enlisted the help of pain activist Siobhan Reynolds and her organization, the Pain Relief Network. Reynolds has mounted an aggressive counter-campaign on behalf of Schneider and his patients (who overwhelmingly support him) that goes so far as to question the constitutionality of the Controlled Substances Act (a move that’s admirable, but not likely to be successful).

State and federal authorities have responded by threatening Reynolds with criminal penalties for practicing law without a license. Schneider’s patients now say federal investigators are illegally entering their homes and intimidating them.

Now several Schneider patients say federal agents are forcing their way into their homes without warrants, asking a lot of questions, and even taking items that don’t belong to them.

“They grabbed the door and jerked it open,” says one patient who spoke to KAKE News on a condition of anonymity. “And then they grabbed my left arm and pulled it up behind me. They said we can do this the easy way or the hard way.”

This patient says the agents even took a hand written letter that Schneider wrote her from prison.

The US Attorney’s Office says they can’t comment on specific cases, but they say a warrant is required in order to search someone’s home or to force a person to hand over something that belongs to them. However, a warrant is not needed to talk to someone or to ask for something.

Schneider’s former patients now can’t find doctors to treat even their ailments not related to pain because of the taint that comes with being the patient of an indicted doctor. No doctor wants to risk his own federal investigation. And merely seeing the patient of a doctor under indictment–particularly a pain patient–is enough to get federal authorities sniffing around your office.

The federal government has been particularly underhanded in this case. Early on, they argued against allowing the Schneiders to have a court-appointed attorney, citing the couple’s $700,000 in assets. Problem is, the government was simultaneously attempting to seize those assets under forfeiture laws, meaning any lawyer who took the case stood a good chance of not getting paid. Which meant the couple’s only real hope was a lawyer willing to take the case pro bono.

As with all of these prosecutions of doctors, it’s entirely possible that there were drug addicts among the couple’s patients. The questions here are (1) are addicts allowed to be treated by doctors, too? (2) should doctors who get duped by addicts be held liable for being gullible? (3) should they be held criminally liable? (4) should drug cops and political appointees with no medical training be dictating the difference between acceptable medical treatment and the criminal prescribing of opioid pain medication?

You can probably guess how I’d answer those questions. Meanwhile, it becomes increasingly difficult for people in chronic pain to find doctors willing to treat them. Everybody is scared. And a promising new treatment–high-dose opioid therapy–is being held hostage by overly aggressive cops and prosecutors.

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49 Responses to “Not a War on Doctors Patients”

  1. #1 |  UCrawford | 

    Radley,

    It’s important to keep in mind that the doctor wasn’t being investigated just for giving out drugs, but because the drugs he was giving out had been linked to 56 overdose deaths. Granted, it appears that a number of his patients were drug addicts, and that they bore most of the responsibility for how they handled their addiction, but it also brings up the very reasonable question of whether Schneider was engaging in medical malpractice…possibly intentionally over-prescribing drugs to dependent patients and causing their deaths.

    In fact, the federal investigation arose because attorneys handling malpractice suits against Schneider worked with the feds on this…they claim because they’re more interested in putting Schneider out of business than collecting money from him.

    http://www.hdnews.net/wirestories/k1163-BC-KS-Doctor-Indicted-02-06-0950

    I actually live in Wichita, and there’s not a ton of sympathy for the guy here. It’s one thing for the government to frivolously prosecute a doctor for just treating his patients because they’re trying to make headlines…it’s quite another for the feds to prosecute him because what he’s doing is very possibly resulting in patient deaths.

  2. #2 |  UCrawford | 

    And just to add some perspective…Wichita is a town of roughly 344,000 people. For one doctor in a suburb to be linked to the overdose deaths of 56 patients should definite raise red flags with the authorities.

    And the indictment against him indicates that he wasn’t doing this out of any kind of moral concern for the pain management of his patients:

    http://www.medicalmalpractice.com/state-resources.cfm/state/Kansas/Article/110846/Kansas-Doctor-Charged-in-Deadly-Prescrip.html

  3. #3 |  The Democratic Republican | 

    The doctor is not “linked” to 56 overdose deaths — rather, the indictment links him to those deaths. If the past conduct of federal investigators is any indication, we should suspend judgment until all the facts are heard.

    Besides, this doesn’t speak to how many of these overdoses were the result of a wish to die on the part of the patient or an unintended consequence for a desired prescription. And it certainly doesn’t speak to the normative issues of whether or not any of that should be law enforcement’s business.

    The level of public support is irrelevant.

  4. #4 |  The Democratic Republican | 

    It’s also worth noting that of the 34 counts on the indictment, only 5 are related to the actual distribution of controlled substances. But that’s not as flashy as saying they’ve been “linked” to 56 overdose deaths, is it?

  5. #5 |  Radley Balko | 

    It’s also important to understand the breadth with which the feds will use the word “linked.” If there was a drug this doctor prescribed in the system of a patient who died, that’s good enough for them to use the phrase “linked to.”

    It’s the same way the NIDAA determines bogus statistics like “marijuana-related emergency room incidents.” It doesn’t mean marijuana caused the incident. It means someone went to the emergency room for, say, a broken leg, and admitted to the doctor that they had smoked marijuana in the last few days.

    That said, this doctor may well be guilty of malpractice. I don’t know enough about the case (though I do generally trust Siobhan’s judgment). But if that’s the case, it should be a medical board issue, not a criminal case. And the tactics the feds are using (attempting to deny the couple representation) are unfortunate.

  6. #6 |  Dave Krueger | 

    I’m getting the impression the U.S. is becoming a nation divided into two types of people: law enforcement people and bad guys. There are no innocents; just those who haven’t been caught yet.

  7. #7 |  UCrawford | 

    DR,

    But that’s not as flashy as saying they’ve been “linked” to 56 overdose deaths, is it?

    56 patients in a medium-sized city dying of the same cause (drug overdose) in a 5 year period after being treated by the same doctor should rightly raise red flags with any law enforcement official. Particularly when that doctor has a reputation for only doing 10 minute consults before prescribing the meds. All 56 deaths were described as “accidental” overdoses…indicating that there was no obvious evidence that those patients planned to commit suicide. So that indicates that they went to the doctor to obtain drugs with an intention other than dying…which he apparently screwed up more than 10 times per year.

    The feds went after him, I suspect, not so much because of the drugs themselves, but because of the $4 million tab he stuck public health care with.

    And just to be clear, I’ve got no problem with patients who want to get high…so long as they’re the ones paying for it, not me. I’ve got no problem with doctors who help patients to die…so long as that’s what the patients have requested. I’ve got no problem with doctors who prescribe drugs to addicted patients…so long as they’re not negligently endangering patients’ lives just to turn a buck or so they can engage in fraud. But I think Radley started judging this case without examining the full reasoning behind what the government did because he wanted to make a larger point about the wrongness of the war on drugs (which I also dislike), government intervening in medical care (which I’m usually opposed to)…and it wasn’t very well supported by this particular case. Not every situation is purely black-and-white.

    About the only point I thought was well-supported in this post was his problem with the premature asset forfeiture, which I’d agree was wrong because it hinders the doctor’s ability to mount his defense.

  8. #8 |  UCrawford | 

    Radley,

    But if that’s the case, it should be a medical board issue, not a criminal case.

    It appears to be a criminal case because there’s a significant number of deaths over a five year period and despite a large number of malpractice claims, the medical board apparently did nothing. This isn’t uncommon in Kansas, by the way. The feds appear to have gotten involved because the doctor seems to have defrauded the federal government of a significant amount of money…which a state medical board is probably ill-equipped to deal with.

    And the tactics the feds are using (attempting to deny the couple representation) are unfortunate.

    No disagreements with you there.

  9. #9 |  The Democratic Republican | 

    UC — I agree; I’m not saying this case is black and white. I’m just saying I’m skeptical of the flashy statistics. “Linked” to 56 “accidental overdoses.” All I’m saying is, let’s hear ALL the facts. The “facts” so far are coming from the indictment.

    Additionally, as I said before, if the doctor was seen to be responsible for “10 overdoses a year,” why did the indictment contain only 5 charges of wrongfully distributing controlled substances in relation to 4 deaths?

    And doctors regularly schedule patients 15 minutes apart. The fact that these people did them 10 minutes apart doesn’t prove anything in and of itself.

    Finally, as Radley said, if there was such a strong connection, why didn’t the investigation begin when there were only 10 deaths? How many cases did these malpractice attorneys press ahead with before deciding to cooperate with the feds? Doesn’t it strike you as odd that people who make money on malpractice voluntarily decided to cooperate with the investigation? Or isn’t it possible that if they put this guy away on criminal charges it will make it easier for them to win civil malpractice suits?

  10. #10 |  The Democratic Republican | 

    UC — In response to Radley, you said the main thing: the feds got involved because they wanted their money, not to protect patients. At least that would be the impression you would get if you looked at the number of financial indictments versus the number of wrongful death indictments. Which makes me more skeptical of these 56 “linked” deaths.

  11. #11 |  UCrawford | 

    DR,

    I think we’re on the same page about facts…I’m just saying that I think what the authorities found so far merits this doctor being prosecuted and the facts sorted through in a court of law. I wholeheartedly agree with Radley’s position that what the feds are doing in regards to asset forfeiture is wrong, though, and harms the defendant’s ability to mount an effective defense.

    Additionally, as I said before, if the doctor was seen to be responsible for “10 overdoses a year,” why did the indictment contain only 5 charges of wrongfully distributing controlled substances in relation to 4 deaths?

    Because apparently those 4 are the only deaths they’ve been able to determine were actually caused by the specific drugs that Schneider prescribed. And that’s enough to merit this case going to court. As for the other deaths, perhaps Radley is right and the authorities reached…or perhaps it’s because those patients were all addicts who OD’d on a cocktail and the particular drug that killed them or its source couldn’t be determined. In which case, the authorities charged what they felt they could prove…and the other deaths may factor in during the trial somehow. We’ll see when it happens.

    Finally, as Radley said, if there was such a strong connection, why didn’t the investigation begin when there were only 10 deaths?

    The evidence may not have been strong enough at that point to tie the deaths to the drugs received at the clinic. Perhaps the four deaths they could definitively tie to Schneider’s prescriptions hadn’t yet occured. Again, it’ll probably come up during trial.

    Doesn’t it strike you as odd that people who make money on malpractice voluntarily decided to cooperate with the investigation? Or isn’t it possible that if they put this guy away on criminal charges it will make it easier for them to win civil malpractice suits?

    It strikes me as a self-interested move, yes. But that also doesn’t mean that the attorneys aren’t doing it for the reasons they say they are. Particularly since the feds are seizing the assets which I’m assuming would hinder the plaintiffs’ ability to collect damages after the civil suits.

  12. #12 |  UCrawford | 

    DR,

    the feds got involved because they wanted their money, not to protect patients

    Based on my earlier comments, you can probably guess that I’m no fan of government health care payouts and I wouldn’t give a damn if Medicare/Medicaid went away tomorrow. But that said, I’ve got no problem with the feds chasing down people committing Medicare or insurance fraud, because ultimately those people committing fraud aren’t just stealing from the government…they’re stealing from the tax dollars that you and I contribute (which often leads to government requiring more funds for their crappy services). Just because we think a government program is wrong does not mean that it’s acceptable to allow people to defraud that program. Also, my knee-jerk reaction to this is that what this doctor was doing (if he is guilty) went on for five years without the state government intervening when patients under this doctor’s care were dying…very possibly as a result of intentional negligence and fraud. If the state government/medical board/authorities were unwilling or unable to investigate or prosecute, then I think the feds have a duty to step in…even if the preservation of life was not their primary motivation.

  13. #13 |  Dave Krueger | 

    Yeah, the government loves the word “link”. I’m surprised they didn’t try and link the 56 deaths to al qaeda.

    I’m linked to a number of deaths where I live. I just happen to drive on the very same streets where other people have had fatal car accidents. They haven’t charged me with anything yet, but I think they have their eye on me…

  14. #14 |  matt | 

    I have a hard time believing the governments claim that he was ‘linked’ to 56 overdose deaths. Especially when the indictment only says he was indirectly responsible for 11 and directly responsible for 4. What happened to the other 41? I guess they just expect us to take their word for it. Also I’d like to know how many of these overdose deaths were a result of multiple drugs. As Radley has already stated, the government goes to great lengths to ‘link’ things to each other. I could very well see them ‘linking’ him to a death where somebody ate their pills and then though it was safe to have a few drinks and then overdosed.

    And UC, i know its really minor point, but article doesn’t state that he has a reputation for 10 minute consultations. It says that he has a reputation for ‘scheduling patients 10 minutes apart’. The two are entirely different. These articles are trying to make it look as if he is seeing a new patient every 10 minutes. I’m sure that wasn’t the case. Think about it… the government has made prescribing opiates very difficult. Doctors can only write a prescription for a month at a time. So a pain management doctor will have to see all his patients every month to write them prescriptions for their medicine. Given the fact that these types of doctors are scarce, due to the government’s crack down, i’m sure he had more than his share of patients, which would require tight scheduling.

  15. #15 |  UCrawford | 

    I tend to distrust the goverment’s intentions as well…but that doesn’t mean I’m automatically going to assume that everything the government is doing is evil and wrong. Same as I don’t automatically assume that everything doctors do is noble and right and done with the best of intentions, or that they’re always capable of policing themselves:

    http://en.wikipedia.org/wiki/Harold_shipman

    http://www.theagitator.com/2008/03/01/mississippi-supreme-court-set-to-hear-two-cases-involving-dr-hayne/

    In this case I think the government is doing what they should be doing (except for the asset forfeiture, of course).

  16. #16 |  Radley Balko | 

    UCrawford —

    I’d also caution against putting too much credence in what the government is saying about this case. Remember, DoJ also said Dr. Rottschaefer was trading sex for Oxy scripts — until their star witness admitted in letters to her boyfriend she was lying. In the past, they’ve held up big bags of pills in an effort to dramatize how much medication a doctor was prescribing, but don’t explain that some chronic pain patients can take 40-50 pills per day.

    See also Ron Libby’s Cato paper on the persecution of pain doctors to see how they manipulate evidence to make doctors look as bad as possible.

    Again, I don’t know much about this case. I do know that it fits a familiar pattern, and that Siobhan tends to choose the cases she takes on very carefully.

  17. #17 |  Jerri Lynn Ward | 

    “The feds appear to have gotten involved because the doctor seems to have defrauded the federal government of a significant amount of money…which a state medical board is probably ill-equipped to deal with.”

    The way this can work is that the feds claim that making Medicare/Medicaid claims for payment when the care (for which the claims were made) is substandard is fraud. So, if the feds are claiming that the doctor was negligently prescribing these controlled substances and then he made a claim with CMS for the office visit–he has committed fraud.

    I have a feeling that this is where the fraud allegations arise. If he was upcoding, then that should have been detected by the OIG and made a civil matter.

  18. #18 |  AV | 

    Are the pain meds being mis-used by otherwise healthy people or are we talking about people “Accidentally-on-purpose” overdosing that have a serious disease?

    56 healthy people dying because they want to get high warrants government review. 50 or so people dying because they can’t get decent pain management for a major illness is not as serious an issue.

  19. #19 |  Jerri Lynn Ward | 

    “So, if the feds are claiming that the doctor was negligently prescribing these controlled substances and then he made a claim with CMS for the office visit–he has committed fraud.”

    The above came out garbled. I should have said that, in the eyes of the feds, he has “allegedly” committed fraud if he allegedly gave negligent care, i.e. over-prescribing medication.

  20. #20 |  UCrawford | 

    Radley,

    I understand that he may very well be innocent and should be presumed as such in a court of law until proven otherwise. I’m just saying that there’s more to this case than you included in your column. And just because federal prosecutors were wrong in the Rottschaefer case and engaged in shady tactics does not mean that this is the case here as well. I’m also saying that if a doctor is linked to 56 patient deaths in a town of this size, what he’s doing should probably be scrutinized and investigated, and if the federal government feels they’re able to prove that the four deaths they’re charging are a direct result of willfull malpractice by Schneider, this case should be heard in a court of law.

  21. #21 |  UCrawford | 

    Jerri,

    I should have said that, in the eyes of the feds, he has “allegedly” committed fraud if he allegedly gave negligent care, i.e. over-prescribing medication.

    That’s a valid point…but it can also be because the doctor was basically double-billing. Charging addict patients under the table for the medications he prescribed and then charging Medicare. In the town where I grew up in southern Kansas we had a local doctor who was infamous for that, until my uncle (also a doctor) and some of his colleagues were finally able to put a stop to it and run the guy out of town. I’m not saying that this is the case in this situation…but we’ll find out more about what happened when this court case proceeds.

  22. #22 |  Jerri Lynn Ward | 

    I just read this at Siobhan’s site:

    “Ms. Reynolds may be in what could be best described as a sycophantic or parasitic relationship with the defendants,” prosecutors argued in the motion. “By telling them what they want to hear, she is able to appear supportive and helpful, while using the defendants to further her own personal interests.”

    The feds are claiming that they have standing to raise this issue in order to preemptively deflect later claims of “ineffective counsel”. The feds also bemoan the possibility that the Network may be helping pay the defendant’s lawyers.

    First, the allegation of practicing law without a license is ludicrous because these people have lawyers who are responsible for representation and it’s not like she is filing motions and the like. Second, as she points out, this is no different than the Castle Coalition or Institute for Justice assisting the victims of eminent domain and the like. If she is willing to contribute resources, she has a right to do that. I don’t see the legal or moral standing to challenge her motives in helping these people.

    The description of the motion sickens me. The feds are attempting to cut off every avenue of defense resources. I have to tell you that if I were Siobhan, I would be doing some research to determine if there is a basis to refer the law licenses of these prosecutors for filing something like this. Meanwhile, I feel compelled to go take a shower to wash away the slime oozing from these prosecutors.

  23. #23 |  UCrawford | 

    Radley,

    And I understand that your friend is selective about the cases she takes on and I generally agree with her positions (as I’m about as pro-legalization as you’re going to get, short of being an anarchist). I’m just not so sure she’s in the right on this particular case. But I’m glad that she’s representing Schneider because everyone deserves a defense and it appears that the feds would have crippled his ability to mount one if not for her group.

  24. #24 |  UCrawford | 

    matt,

    And UC, i know its really minor point, but article doesn’t state that he has a reputation for 10 minute consultations. It says that he has a reputation for ’scheduling patients 10 minutes apart’. The two are entirely different. These articles are trying to make it look as if he is seeing a new patient every 10 minutes.

    If the patients are being scheduled 10 minutes apart (which I took to mean people who called in ahead of time, not walk ins), that would mean he saw a new patient every 10 minutes…not that he had a 10 minute break between patients. At least that’s what I got from it.

  25. #25 |  UCrawford | 

    matt,

    Assuming my interpretation of that link is correct, I guess another question would be…if scheduling patients every 10 minutes was a standard practice and employees were berated for moving too slowly, what kind of quality medical care could they have possibly offered besides handing out drugs?

  26. #26 |  Kid Handsome | 

    UCrawford,

    While I tend to be skeptical of anything the government asserts in this realm, I have to commend you for making good, rational arguments in this comments section. I appreciate your responses and your tone – it’s rare in the world of anonymous comment sections.

    I will say, that the government has itself been guilty of a pattern of behavior in these cases that is reprehensible at best and downright criminal in many cases. The completely fraudulent sex for drugs case is the most egregious example, and that doesn’t even take into consideration the inherent advantages that the Federal Government has built in to the system for prosecutors.

  27. #27 |  Dave Krueger | 

    I think my doctor schedules patients about ten minutes apart. And I don’t even get any drugs. No wonder I’m so damn bitter.

  28. #28 |  UCrawford | 

    Mine too…but nobody seems to tell my doctor to hurry up when he’s running behind :)

  29. #29 |  matt | 

    UC, i guess the part of the article in question is not very clear. I took it the other way around, that he had a 10 minute break between patients. But in re-reading it, i realize that the author probably meant it to be taken the way you viewed it.

    Also i should clarify what i meant by ‘new’ patients. By that i meant a patient that has never been to his practice before (ie somebody doctor shopping). If the patients in question are mostly returning patients, who are just there to pick up their prescriptions, i don’t see any reason why they would require a visit longer than 10 – 20 minutes.

  30. #30 |  kaptinemo | 

    WRT to this idea of the Feds going after pain management doctors as part of an effort to appear to be ‘doing something’ about the ‘drug problem’ in this country (which we didn’t seem to have until the government became involved courtesy of the Harrison Narcotics Act) the truth is that this is nothing new at all. It is in fact ‘old news'; this kind of thing was taking place back in the 1920’s, with doctors being arrested for treating addicts.

    (Link to relevant A Drug War Carol page and proceed from there, but the entire document richly deserves a look-see. History is repeating itself once more; the main difference now is that the Feds and local LEOs have the added incentive of forfeiture to fuel their efforts.)

    Had the issue of drugs not been used as the ‘wedge’ it is unlikely that this latest matter would have received what notoriety that it has.

  31. #31 |  scottp | 

    AV:56 healthy people dying because they want to get high warrants government review. 50 or so people dying because they can’t get decent pain management for a major illness is not as serious an issue.

    Complete fail.

  32. #32 |  Red Green | 

    Fed prosecution is just so much, “G MEN”, all over again. The DEA is always suspect these days. Can’t wait to hear about the …..TRIAL, which is so, “JUSTICE”, and all.

  33. #33 |  UCrawford | 

    Kid,

    I will say, that the government has itself been guilty of a pattern of behavior in these cases that is reprehensible at best and downright criminal in many cases.

    I completely agree with you and I’m generally skeptical of the whole “pill mill” crusade that the government’s on. In this case, though, I think they’ve got a reason to go after the guy. And I think that so long as we have Medicare and Medicaid that we will always have some doctors (not most, or even a large percentage, but some) who will attempt to engage in fraud so they can milk the system. And when it appears that they’re doing so at the cost of patients’ lives…as there appears to reasonable evidence of in this case (at least from what’s been publicly released)…I think the government is justified in investigating and/or prosecuting.

    Basically, though, if you want to stop pill mills and if you want the government to back off on the War on Drugs, I believe the place to attack first is publicly-subsidized health care, whose inherent inefficiency (like with all government programs) creates a nice fat target for scam artists. A lot of the government’s zealousness in chasing these guys down appears to be the fruit of that poisonous tree.

  34. #34 |  UCrawford | 

    Matt,

    If the patients in question are mostly returning patients, who are just there to pick up their prescriptions, i don’t see any reason why they would require a visit longer than 10 – 20 minutes.

    That’s a really good point too. My question would be, however, what kind of diagnosis and work was the doctor doing besides doling out pills. If someone comes in repeatedly requiring a prescription…and the doctor’s only response is to continue giving them pills but doing no further diagnosis to determine the cause of the pain or possibly cures for it, then the doctor isn’t actually treating the patient, he’s simply masking their symptoms. That’s not always a bad thing, of course…sometimes even with the best diagnoses a doctor doesn’t know what’s wrong with a patient and simply medicating them may be the best solution, which I’ve got no problem with (and which most of the commenters here seem to think the government’s trying to stop).

    The problem I have comes when the doctor’s reason for treating that patient in this way is not because they’re attempting to act in the patient’s best interests (as they’re more or less contractually obligated to do when they accept the patient) but because they’re using the patient to do something to benefit themselves and which acts to the detriment of that patient. If Dr. Schneider was prescribing his patients drugs that killed them because he was attempting to milk Medicare for a lot of money (as the government and the malpractice attorneys seem to think he was doing) and not because he was trying to help patients, then he deserves to be prosecuted and jailed for it. That said, I also realize that we haven’t heard all of the evidence, that the government may very well have overstated their case, and that our final judgment on his guilt or innocence should wait until we’ve heard all the facts. I’m just saying that, right now, the case appears to have more to it than a standard “the state is trying to moralize about drugs” situation that we rightfully like to bash the government for.

  35. #35 |  Frank | 

    The only way this is going to stop is if doctors call a strike on law enforcement and their families. Any of them want pain relief, they get Tylenol and told to suck it up. And when they complain, inform them that their agency wants to put their doctor in jail for the ‘crime’ of pain relief.

    Are you a cop or related to a cop? No prescription. No way.

  36. #36 |  Michael | 

    Well, Ucrawford,

    Being one who has been through the guessing game with someone always watching over your shoulder, I learned to follow the rules set up by systems that regularyly used high dose opioids. It included contracts, full history and physical, medical records review, pill counts, drug testing, etc. But after years of harrassment the medical board got me. (for getting involved with an aquatitance, who was a patient. We are married, now, and she has been much better than the first two, who only saw dollar signs!
    There are plenty of doctors out there who schdule a hundred patients a day. Considereing half the morning was spent in the hospital doing rounds, that left very little time to see one hundred patients. Was he seeing them all? Likely not. But, the government does not care if you say you are seeing them for 15 minutes each, but only take three! It never gets investigated, so far as I know. And People being herded through does not prove for good patient care, as you state. But, it is rapidly becoming standard of care! I was chastised while working for other doctors in doc i n the box type sttings and private offices. They did not like it tha I often spent fifteen to twenty minutes with my patients. But, what would an HMO director say? “You’re fired!” most likely. Three minutes a patient. That is the rule! But, in those cases, doctors are employees!

    I will try to addres other valid statements that you made. But, the thing about the DEA is that they have a booklet out on exactly how to bring done any doctor who is prescribing high dose opiods for his patients! I guess that woudl seem like targeting , unfairly, I might add, the doctor who is willing totake the time ato maintain the pain control of patients with chrtonic intractable pain. They often show up on the doorstep with every test in the book in their charts, and no discovery of what iis rsponsible for the chronic intractable pain! (reminds me of the old guy that I put a laparoscope in, whtn the regional hospital could find notheing wrong. I found out enough, by doing that, to send him home to die, with cancer throughout his abdominal cavity!) that is why the patients are continually evaluated to try and rid them, permanently of their pain. But, should they not be treated, for the pain, while looking for the cause, that dozens of doctors, before him, have not found? I feel that this may be an anti-dctor attitude to assume that nothing was done. No one has any sympathy for me, for loosing my practice. They seem to gloat, at times! Another “rich mdoctor” bites the dust. Does rich doctor include pain doctors who work for $70,000 a year while the specialists come down with

  37. #37 |  Michael | 

    Well, Ucrawford,

    Being one who has been through the guessing game with someone always watching over your shoulder, I learned to follow the rules set up by systems that regularly used high dose opioids. It included contracts, full history and physical, medical records review, pill counts, drug testing, etc. But after years of harassment the medical board got me. (for getting involved with an acquittance, who was a patient. We are married, now, and she has been much better than the first two, who only saw dollar signs!)

    There are plenty of doctors out there who schedule a hundred patients a day. Considering half the morning was spent in the hospital doing rounds, that left very little time to see one hundred patients. Was he seeing them all? Likely not. But, the government does not care if you say you are seeing them for 15 minutes each, but only take three! It never gets investigated, so far as I know. And, people being herded through does not prove for good patient care, as you state. But, it is rapidly becoming “standard of care!” I was chastised while working for other doctors in doc-in-the-box type settings and private offices. They did not like it that I often spent fifteen to twenty minutes with my patients. But, what would an HMO director say? “You’re fired!” most likely. Three minutes a patient. That is the rule! But, in those cases, doctors are employees!

    I will try to address other valid statements that you made. But, the thing about the DEA is that they have a booklet out on exactly how to bring done any doctor who is prescribing high dose opiods for his patients! I guess that would seem like targeting, unfairly, I might add, the doctor who is willing to take the time to maintain the pain control of patients with chronic intractable pain. They often show up on the doorstep, with every test in the book in their charts, and no discovery of what is responsible for the chronic intractable pain! (reminds me of the old guy that I put a laparoscope in, when the regional hospital could find nothing wrong. I found out enough, by doing that, to send him home to die, with cancer throughout his abdominal cavity!) That is why the patients are continually evaluated to try and rid them, permanently of their pain. But, should they not be treated, for the pain, while looking for the cause, that dozens of doctors, before him, have not found? (that is why we ended up with so many pain patients. No other doctor cared enough to try to figure out the problem. (Heck, I figured out two, while chatting with patients over the Internet!) I feel that this may be an, anti-doctor, attitude to assume that nothing was done. No one has any sympathy for me, for loosing my practice. They seem to gloat, at times! Another “rich doctor” bites the dust. (Little matter that I spent almost double in my education time, most people!) Does rich doctor include pain doctors who work for $70,000 a year, while other specialists (anesthesia pain doctors) come down with quarter million dollar practices? Don’t make too many assumptions, with the junk the media and the DEA is feeding to them!

    The fraud is just legalese for “get as much as we can, on him, so we can bargain more with the chump, before we put him away!” There are, most likely, many doctors committing the fraud I noted about seeing too many people in a day, to account for the charges made! Six hours would mean you could see twenty four patients, period! That is not happening! There are other practices. I was asked to do, that I thought were illegal, in ER’s. That is why I stopped working for them, as well! But, that does not involve drugs that we doctors are supposed to be trained to prescribe! (charges for drug distribution)

    And,most doctors do not dispense medication, out of their offices, any more. There are too many hassles, not to mention the dangers of being robbed! But, it is even more unlikely that this doctor is giving out controlled drugs in his practice. It requires, way too much, paper work, to stay legal. And the DEA would find something you did wrong! You know, even we doctors are not perfect! Many of us still act like human beings!

    Many of the patients would be on Medicare and Medicaid, because they were unable to work. Those, that I did keep working, are now out of jobs. So much for keeping them off welfare!

    And, I would resent anyone saying the my patients were my first concern. Many became friends! They like not being herded through. And, the fact that I actually conversed with them during the time they were seen, was probably helpful in keeping them as patients, too!

    And how many people do you think a regular practice loses every year?! More than ten? I had one guy that was pain related. After six days, with absolutely no sleep, he put a gun to his head and ended it. He did not use the pills! He was tolerant and likely would have survived, even if he had taken them like that! Many chronic intractable pain patients develop heart disease and other ailments, just from the stress that living in chronic undertreated or untreated pain can cause! Ther are other reasons these patients are at a higher srisk of dying. But, most would rather do that than suffer 24/7 from chronic untreated intractable pain. You just don’t know what it is like!

    I had so much more to say, but this will get way too long!

    Don’t make assumptions, especially based on what the media and DEA (your new doctors) say! They are misleading us, like lawyers do!

    But, with less stress, I do feel healthier.

  38. #38 |  UCrawford | 

    Michael,

    I’ve actually got no problem with doctors, and I’m generally very supportive of them. As I mentioned earlier my uncle’s a doctor, I respect him as much as or more than anyone on the planet and I consider him one of the wisest people I’ve ever known. I also respect doctors for the breadth of knowledge that they possess, the sacrifices they make to obtain that knowledge, the exorbitant financial sacrifice they have to pay to attend medical school, start their careers and set up their practices, and consider the high compensation they receive well-justified (people who complain about all doctors being “overpaid” or “money-hungry” will usually get stinging and often extremely hostile rebukes from me).

    That said, I also recognize that the relationship between doctor and patient is a unique one. It is often one of dependence (patient depending upon doctor) and that doctors hold most of the power. The patient usually doesn’t have the expertise to effectively question the doctor’s decisions as long as those decisions aren’t blatantly wrong. If a doctor makes a bad decision or half-asses the job, it is the patient who will generally pay the consequences (sometimes with their life). And although the overwhelming majority of doctors do the best they can to operate in their patients’ best interests, there are still those who will abuse that relationship and compromise the quality care their patients receive for personal gain. So for that reason, I believe there are circumstances where it is right for the government to intervene on the patients’ behalf. And in this particular case, based on what we’ve heard so far, I believe that the state had sufficient reason to investigate Schneider and proceed with an indictment…not least of which because advocates (the malpractice attorneys) for some of Schneider’s patients brought their concerns to the government.

  39. #39 |  UCrawford | 

    Michael,

    But, it is even more unlikely that this doctor is giving out controlled drugs in his practice. It requires, way too much, paper work, to stay legal. And the DEA would find something you did wrong

    I referenced earlier a doctor in my hometown whose entire (rather lucrative) practice largely consisted of dispensing medication to addicts and insurance fraud (not just Medicare, but also workman’s comp). He practiced, as I recall, for about 10-20 years without attracting the attention of the DEA, the feds, the licensing board, or the state until my uncle and some other local doctors were able to get his hospital privileges yanked and ran him out of town. Regardless of all the laws in place, if there’s money to be made by committing fraud there’s always going to be someone willing to risk the consequences and try it if the payout is high enough. Thanks to the illegality of drugs and the existence of often inefficient and often poorly-overseen government health programs the payout usually is sufficient to offset the risk.

  40. #40 |  Bronwyn | 

    I do wish Siobhan Reynolds would finagle a good clinical toxicologist to testify. Any toxicologist worth their salt should be able to look at the medication lists from each of these patients and determine whether they really overdosed on one drug or if their repertoire of concomitant medications put them in danger.

    We see it in our group every day – certain members of our group spend much of their time giving testimony on the topic – patients are given a host of drugs and the prescribing physician (it’s worse if there are multiple Rxs from multiple physicians) doesn’t understand that certain drugs alter the metabolism of others. Doctors inadvertently kill or at least sicken their patients more often than you want to know simply because of ignorance of pharmacokinetics.

    Even better would be if my company could genotype all of those deceased patients (of course, only possible if there are archived blood samples hanging out somewhere) to look for variant genotypes which could explain certain aberrant drug responses and elucidate urine blood testing results that suggest “non-compliance”.

    Please don’t misunderstand me. I’m not at all suggesting that Dr. Schneider is guilty of any responsibility in these patient deaths. I don’t know enough about the case to make a judgment one way or another. I’m merely suggesting that, without proper toxicology analyses, and without the added knowledge of pharmacogenetics, no one can possibly know exactly what happened to the patients with sufficient confidence to make a judgment.

  41. #41 |  UCrawford | 

    Bronwyn,

    I hope they go that route too. If the state really has no proof that what Schneider did killed those patients, it would be good to see that accusation discredited.

  42. #42 |  Jen | 

    First of all i am very sad that so many people are judging others and they dont even know what the whole story is i want the whole world to know Doctor schneider and Linda Schneider are very wonderful people i have been a patient for a long time and Doctor Schneider is not just a pain management Doctor he helps all that he can i want you all to know i live hear in KS and he and his wife have hundreds of supporters and i thought we where innocent until proven guilty but we are not society has made us guilty until proven innocent it is not our job to judge others that is our father in heavens job the judge doesnt even get a chance to judge them before the world does and Siobhan Reynolds is a great person who just wants to help others and she should get a gold medal i just hope and pray someday you dont get judged by the world before the judge can do his job the familys are having a hard time also so remember when the read stuff that is not true about there love ones how that makes them feel how would that make you feel may God Bless you all

  43. #43 |  Lloyd Flack | 

    It is a little surprising but hardly astonishing that drug warriors are harrassing critics. They cannot see how reasonable and decent people might see them.They cannot bear to look critically at their own actions. They believe that anyone opposed to their holy cause has to be evil or a dupe. The want the buzz of feeling righteous so much that they act like addicts in order to get it.

  44. #44 |  Jen | 

    I hope the world can see people for who they are and not what this world thinks they are. I hope we all realize we should make our own judgement not take the word of others. The Bible says take the log out of your own eye before trying to take the speck out of your brothers eye.I just think some watch to much t.v. and are just looking for a reason to worry about what everyone else is doing. Dr Schneider was a awesome doctor i feel the reason they are after him is because he stood up to them and didnt let them (them meaning feds) run him off. They always took the time to find the problem and fix it and not just send you home feeling the same way you came in at least you knew what was wrong with you and he always spent 15 to 20 min with you. He loves his patients and no matter what he was there for us. And if he couldnt find the problem he found someone that could i just hope and pray you all see the truth through all the lies, media, radio. May God Bless You All!!!!

  45. #45 |  The Agitator » Blog Archive » Update on Kansas Pain Case | 

    […] first attempting to deny them the right to counsel, the government is now seeking a gag order to prevent a defendant pain physician, his wife, their […]

  46. #46 |  Jen | 

    I am so sick and tired of these people just bulling the Schneider’s around. YA that gag order what is that all about ? Around ever turn there is always something going down trying to taking there freedom of speech away they cant do that. We think we live in a free country i know now we don’t. It seems like we should watch over our shoulder all the time even when we haven’t done anything wrong. What happened to our freedom of speech i feel that is only allowed when we are saying what they want us to say. Our government doesn’t work for us we work for them that is not the way it is suppose to be .And Siobhan Reynolds is so wonderful i just cant thank her enough for all her hard work she is sent to us by God i know she is a true blessing. Let me tell you this world is going to have to understand they are going to have face judgement some day i thank God i am not in there shoes. May God Bless You All

  47. #47 |  Jen | 

    I believe Doc Schneider being let out on bond shows the world that God is bigger then the Feds. We can move a mountain if it is Gods will and if we believe. I just cant wait until you all realize he is innocent I hope the Lord blesses you all and your familys praise the lord in all you do and may the lord bless all you do.

  48. #48 |  j davis | 

    Hopefully whoever becomes the next president will seriously consider abolishing the DEA. The DEA is the best example I can think of a government agency totally out of control. I would hate for any of these sociopaths to have anything to do with my medical care or end of life issues. Hundreds of thousands of patients suffer needlessly because of these asshats! Millions are incarcerated for no good reason and are POW’s in the ridiculous ‘war on drugs’. I have seen a close relative suffer needlessly because of their penchant for arresting the few compassionate doctors there are.

  49. #49 |  Reason | 

    Just remember when you are dying helplessly in your bed in extreme pain, that it is you who put all the compassionate doctors out of business. Someone should publish a list of the prosecutors and their families who are putting this compassionate doctors out of business. When the tears of pain are running down their mother’s cheeks as she dies in needless pain from cancer, these know it all conservative prosecutors will begin to understand what they have done to others by putting these doctors out of business. May god have mercy on your souls. You know not what you have done.

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