Bushwhacked

Copyright © 2022 Dr. Muhammed Niaz.

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ISBN: 978-1-6632-2031-8 (sc)

ISBN: 978-1-6632-2033-2 (hc)

ISBN: 978-1-6632-2032-5 (e)

Library of Congress Control Number: 2022914048

iUniverse rev. date: 07/18/2022

CONTENTS

Preface

Chapter 1

Chapter 2

Chapter 3

Chapter 4

Chapter 5

Chapter 6

Chapter 7

Chapter 8

Chapter 9

Chapter 10

Chapter 11

Chapter 12

Appendix

PREFACE

I was working in my office when my office secretary asked if I could take a call from the vice president of Union Hospital. It was very unusual that the vice president himself would call, so I took the phone. He informed me that the Emergency Department was swamped with patients seeking pain medications, as their physicians had been suspended. I realized my civic responsibility and agreed to take them.

Subsequently, the office was immersed in patients on very high dosages of pain medicines. Many of them were on multiple pain medications, and they had been taking them for years. They were adamant that these medications were helping them, relieving their pain, and improving their functioning. Their medical histories were complex and vague, often complicated with multiple accidents and traumas. Information related to their treatment was insufficient. We tried to get information from the previous health care provider, but the office was shut down, so no one even picked up the phone.

The patients were in the office and expecting continuity of care. As the number of prescriptions written from the office climbed, it created a red flag. A pharmacist working for Walgreen’s pharmacy, while talking to a DEA agent, mentioned that she’s seen a sudden increase in prescriptions coming out of Tri-State Health, which sparked an investigation. That ended up in a thrilling drama.

This book is intended for the general public, people who are concerned about what can happen if they experience a painful condition in their lifetimes. The book is also helpful for health care workers, particularly those dealing with pain. My goal is to inform the regulatory authorities that when taking such actions, they should be based on science and research rather than on their perception. The statutory proceedings regarding such matters must be diligent and ensure that due process is maintained and improve transparency and justice.

This is a true story of a physician offering help to patients left stranded when the regulatory authorities launched adverse action against health care providers who prescribed pain medications. In 1995, pain was declared as the fifth vital, necessitating health care providers to ask about pain and provide pain management that might require narcotic pain medications. The first missing link differentiating pain with other vital signs was that pain is subjective.

Second, there is no specific definition of pain; it could be discomfort, suffering, distress, unpleasantness, ache, and so many other ways described by the patients.

Third, it could have psychosocial causes, with no bodily injury that can be ascertained or central causes that cannot be isolated by routine diagnostic testing.

Fourth, there was no standardized parameter that the health care providers could reliably use to measure pain, so it was merely a patient’s statement.

Fifth, no standardized pain management protocol was established; further, there were no specific standards or therapeutic dosages of narcotic pain medications, over which it could be considered abnormal, let alone overprescribing. The dose is dependent on the patient’s pain response and whether the patient is narcotic naïve or tolerant. To make this more complex, earlier research indicated addiction was a rare complication of pain medicine. The result was an influx of an enormous number of pain medications. Many drug companies started advertising, as a vast narcotic market built up in the USA.

Purdue paid certain doctors ostensibly to provide educational talks to other health care professionals and serve as consultants, but in reality to induce them to prescribe more OxyContin. Purdue paid kickbacks [and developed] contracts with certain specialty pharmacies to fill prescriptions for Purdue’s opioid drugs that other pharmacies had rejected as potentially lacking medical necessity.

Purdue was convincing doctors to prescribe its product, as it was a safe and effective treatment, and even paid for a doctor speaker program to induce those doctors to write more prescriptions of Purdue’s opioid products. Drug culture flourished in the USA. At the same time, many physicians were successfully sued for undertreatment of pain. The NIDA (National Institute of Drug Abuse) reported that prescriptions for opiates escalated from around 40 million in 1991 to nearly 180 million in 2007, with the US their biggest consumer.

Regulatory authorities initiated unprecedented attacks to suspend or restrict medical licenses of health care providers who, in their views, were overprescribing pain medicines. The actions were hectic, without considering the ground realities, consequences, education, and training needed to wean patients off pain medicines gradually, as well as future strict measures before initiating any narcotic pain medicines. Their actions were merely a manifestation of power, rather than the application of any research or science. The hectic approach overlooked continuity of care for patients who were dependent on pain medications. The goal was solely to suspend doctors, who were to be made an example for others; they thought it would resolve the prevailing drug culture. But patients who were dependent on these medicines became helpless, as health care providers declined to accept any new patients with pain.

Many patients who could not find any health care providers went to the street. Some of them were involved in criminal activities, like stealing drugs, forging prescriptions, robbing pain medication from other patients, or buying the drug on the street. Many committed suicide. With increasing demand, the street drug business boomed. New drugs were introduced to the market, and some of these new drugs were highly toxic and life-threatening, amounting to an astonishingly increased incidence of fatalities.

Bushwhacked is my story, the story of a physician who agreed to accept some of these stranded patients.

The story is entirely true, and it is my rationale for telling this cautionary tale and the source of my anguish and frustration. I hope it will help to provide better care for those who need pain management.

CHAPTER 1

I n December 2011, I was in Chicago, attending a conference conducted by the International Society for Clinical Densitometry (ISCD). Joseph, my DEXA scan technician, and I had prepared to participate in this conference for a long time.

I am basically an internal medicine–trained physician, with added qualifications in pain management, addiction, sleep medicine, and medical weight management. My objective was to provide comprehensive care, so I always wanted to add credentials to benefit my patients. The DEXA scan (which measures bone density and body composition) would help me quickly determine bone density, fracture risk, and exact body fat determination. The measurement of weight and BMI (Basic Metabolic Index) are the indirect determination of body composition, specifically fat. So we bought a DEXA scan and were learning its usage. To be certified in DEXA scan reading, I went for training and took a certification examination. The visit to Chicago to attend an annual conference, where they would provide training and CME (Continuing Medication Education). Joseph accompanied me, as he intended to acquire certification in the procedure’s technical part.

My goal always was to be a doctor and to serve the neediest populations, where doctors are hesitant to go. My journey to become a doctor—completing my residency to practicing medicine—was a struggle due to limited financial resources; furthermore, traveling to a foreign land to acquire higher education and training was extremely challenging. I graduated from medical college in Pakistan and dreamed to do residency in the United States. Hard work and focusing on the goal helped me to get over the hurdles I encountered. Doctors who earn their MD locally and who are US nationals are given first priority for residency training; then foreign doctors compete for the remaining residency positions. It’s often many years before many foreign doctors are accepted for residency in the States.

Joseph and I also wanted to see Chicago, which is known as an alpha city (or world city) for its worldwide economic and cultural influence. As much as I enjoy the culinary offerings in my hometown, Karachi, Pakistan, Devon Avenue in Chicago is famous for Indian and Pakistani-style restaurants, with a variety of options reflecting the flavors of subcontinents. Joseph and I were excited to see Chicago and to have the opportunity to enjoy eating food that was familiar to my history, culture, and palate in the restaurants on Devon Avenue.

The conference went smoothly, and the weekend ended quickly. Our flight was scheduled to depart for Delaware on Sunday evening.

We reached the airport on time, but our flight was delayed. We checked in and went to the preboarding area. As we waited for the plane, I checked my email and noticed one from my attorney, Mr. James Kipp. I immediately opened it and saw something I could not believe. I was shocked to see the message, which included a statement that read, The Secretary of State is issuing an order for immediate revocation or suspension to your Controlled Substance license.

I could not believe it! How could this have happened? What were the allegations? I considered this statement to be without merit and wondered if my email had been hacked. I was in shock and did not know what to do next.

My mind was flooded with thoughts. Apparently, my feelings of anxiety and confusion were clear on my face. I didn’t know what to do. Joseph, sitting next to me, saw the change in my complexion and asked, Dr. Niaz, are you OK?

I didn’t know how to express myself, but I explained, calmly and politely, My attorney has sent me an email asking me to meet with him immediately. The Secretary of State has issued a letter to take disciplinary action on my Controlled Substance license.

What? Why?

I shook my head. I do not know.

Joseph gave me a puzzled look, as if I might be hiding some facts, or perhaps he was skeptical about my not understanding the basis for the disciplinary action. Why don’t you call your attorney? he suggested.

It is Sunday evening. I don’t think I should bother him at this time.

Joseph, however, was adamant. You should call him.

At that moment, they announced it was time to board the plane. I knew I had extraordinarily little time to act, and if I did not, the journey would be harrowing for my peace of mind! By the time I would reach Delaware, it would be much too late to call Mr. Kipp or any other resource. I decided to call him.

To my surprise, Mr. Kipp answered the phone. After a rushed greeting, I asked him, Did you send me an email? I was still hopeful, even though this would be an unwelcome problem, that my email had been compromised and that the email was fraudulent.

Unfortunately, he replied, I did. When are you coming back?

I’m waiting to board the plane and should be back in a few hours.

He assured me I was in good hands, and he would defend me with a good outcome. He advised me to relax and to see him in the morning.

After that telephone conversation, I felt more at ease and was able to breathe, with more confidence that the order would be reversed. Confident in my ethical practice and standards, I felt strongly that there must have been a terrible misunderstanding or miscommunication. I told Joseph what my lawyer had to say, and he replied, Don’t worry; nothing will happen to you.

My father was a professor of accounting and wanted me to follow his profession. He grew up in Pratabgarh, Uttar Pradesh, India, and was employed by the army at the time of partition of the subcontinent into Pakistan and India. He had the option to choose between Pakistan or India, and he opted for Pakistan. He was his parents’ only son, so this was a very bold decision, as this required departing from ancestors’ land and a loving family, particularly parents. When he disclosed the news to his father, it was a real shock. My grandfather remained quiet, hiding his emotions, as he knew that if my father did not embark on this journey, he would lose his career.

For my father, he was emotional when he opted for Pakistan; it was excruciatingly painful. He packed up his stuff to leave several times, but he always found a reason to delay the day of departure. His mother (my grandmother) passed away when my father was very young. My grandfather never remarried, and he dedicated his life to raising his children. He also took early retirement so the children would not feel alone at home. So my father decided not to leave his father. He had already opted to join the army in Pakistan, so he would be unemployed in India, and delaying would risk losing his position in Pakistan. Finally, my grandfather assured him that he would follow my father to Pakistan, once he got settled, which provided him with enough courage to leave his home forever.

In Pakistan, he continued his education while working. Subsequently, he changed his career to teaching, as he enjoyed that, and he became a professor of accounting. The teaching position did not provide enough resources to raise the family. Therefore, he added another job,