Last summer, the state decided that they would summarily close down Seattle Pain Centers, a chain of pain clinics throughout Washington State, by suspending the medical license of it’s chief director (and owner) with no advance notice to patients. That the state would do this, assuming that the medical community had the capacity to pick up the 8,000 patients of these clinics, could almost, in and of itself, be described as an act of gross negligence. The crackdown on pain med prescribers has, in fact, been happening around the state, including in Port Townsend a couple of years ago. No charges have been filed in the case of Dr. Li (who denies the allegations) and I could not find and any public record that Dr. Rotchford was charged with a crime. In fact, Dr. Rotchford’s clinic has reopened since this story in 2011. However, Li’s patients have been left in limbo, which this story, by the Seattle Times, clearly shows.
A 58-year-old former patient of Seattle Pain Centers committed suicide last month, leaving notes claiming he could find no help for his chronic pain after the chain of clinics closed in July following state sanctions.
As described by the Times, and reported to me over the last few years by local medical providers, there is a reticence by primary care physicians to take on patients in severe chronic pain, such as the person in this article. The possibility of random raids by the State (as has happened to Dr. Li) and the Department of Drug Enforcement, which manages the licensing of medical providers to prescribe opiates, and the state’s own guidelines which are mentioned in the article, have told providers to send these patients to specialty clinics. Some providers don’t seem to have a great deal of sympathy for addicted patients, because they can’t tell which ones might be faking it, they know some might be reselling the meds on the black market, and the providers don’t get paid enough for these patients to make it worth their while to spend a lot of time on them. Reimbursement rates are falling everywhere for medical providers. Now, because a small number of these patients have died (12 out of 25,000) the state has decided that this is negligence on behalf of Dr. Li. While I don’t pretend to be an expert in the statistics behind these numbers, it does not seem out of line that 12 patients, being treated for chronic pain, (ongoing unrelenting pain) would end up overdosing. Are we really saying that if our medical providers don’t get a zero number of people dying that we are going to shut them down? It seems that the State owes the public an explanation of what they really are trying to achieve in this case. Isn’t there an assumption that by closing these clinics, that patients may take to more dangerous drugs, like heroin? Or that they may turn to crime to feed the habit?
A sad reality is that the medical prescription for severe chronic pain is usually opiates. These by their very nature are addictive, and the providers know this. It makes them very leery of taking on patients who they know will become addicted. So specialists, like Dr. Li and others here on the Peninsula, take great risks by taking them on. Some of these patients are going to become seriously addicted, and some will likely overdose on their own. Getting them off opiates does not guarantee that they will become pain free. And where do they go to get help if the pain is chronic and doctor’s don’t have options? This appears to be the case with some of Li’s patients that the State has discussed. Is that the Doctor’s fault? Or the patients? Or society for setting up this situation that appears to have a built in failure mode? It seems that this story points up that there needs to be a serious re-evaluation by both the state, the DEA and the medical community of how these patients are going to be treated.
Read the following story. For any of you that have not had to deal with a patient, loved one, or even your own pain after a surgery or aftermath of an injury, this might be an eye opener. I appreciate that the Times did a very evenhanded and thorough approach to this.