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.

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.

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.

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.

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.

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

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

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.

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.

Complete fail.

(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.

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.