By Mark David Blum, Esq.
I am not allowed to tell this tale. It may be true. It may not. Parts of it may be true or created wholly from the addled mind of a confused and frustrated lawyer. Every night, however, I am being beaten over the head by what I know are lies and every night I have to sit silent and watch as those around me I know follow the rabbit down the endless hole to wonderland. Should anybody recognize themselves in what follows; too bad. Whatever truth may be told, I assure you is gleaned from public record. Trust me, I would love to name names because there are some names who should be mentioned for public shaming. I would welcome their feigned public outrage and have my QB VII defense all set.
So what has my fists up and ready for a fight? Doctors; specifically doctors who work for a living. I have a great deal of respect for the medical profession and verily believe that those who enter it do so because of their giving and compassionate personalities. I also believe they do it because it is an honorable profession that can provide a long term and stable income. But at this stage in my life, I have a million war stories that have really turned me cynical toward doctors. As a lawyer, I know – hypocrite.
Why doctors? Because right now, medicine works in such a way as to be causing a serious out break of heroin use and abuse in our society. I have stood shoulder to shoulder with people whose lives were destroyed not by the heroin they were using but by the doctors that got them addicted. What really infuriates me is how pompous and arrogant doctors can be as they stand there on the evening news saying we have to do something about this heroin epidemic. Doctor, hold up a mirror and see the root cause of the problem.
We live in a society that is preoccupied with whether a person gets intoxicated. Collectively over history, we have built a Babel-esque tower of rules, regulations, codes, morals, traditions, limitations, prohibitions, and murderous criminal laws all centered around anything that might cause one human being to become intoxicated. We don’t like this. For some reason we “tolerate” it. But we cannot admit to ourselves that we, as human beings, like to escape reality and, if you will forgive me, get “fucked up” sometimes.
But society fights that. Among the warriors for constant and absolute sobriety are doctors. Ever since Congress enacted the Harrison Act back in the early 1900’s, doctors have set themselves aside as being a parent whose job is it to keep us sober and responsible at all costs. Doctors will turn a blind eye to a patient in pain out of fear that the relief may cause intoxication and there is the risk, and I say risk, of addiction. People suffer because doctors have such a professionally ingrained stance in opposition to escape. (How many are hypocrites to the hypocratic oath? Another discussion, another day).
As an aside: does anybody see the irony that the State of Oklahoma and in fact, all the death penalty States struggle to come up with a single pain free cocktail to execute a citizen and have to go through all these machinations. At the same time, arent these the same governments who tell me I cant use certain drugs because if I do too much of them, IT COULD KILL ME? How about keep pumping a prisoner’s arm full of morphine until he stops breathing. Easy, simple, cheap, pain free; but we can’t have a prisoner dying stoned and at peace, now can we? If heroin is so toxic and deadly, then take a baggie from the prison locker room where all the contraband is stored and give the prisoner a hotshot. It is cheaper than a bullet and less mess.
Back to doctors and drugs: There are many issues I have identified over the years as what I attribute to leading up to the crisis we see in modern medicine. This comes from my personal experience and well as professional dealings. Also there was a point in my life where I “worked” in medicine which subsequently resulted in me always having an insider’s look at every procedure and action I witnessed and experienced. I could tell many stories and give many examples. My stand out example of what is wrong is modern medicine happened here last summer when I was seated in the waiting room at my doctor’s office at a large medical complex near where I live. As I paced impatiently, a man walked in and told the receptionist he had a tick in his leg and asked for help to remove it. “No”, said they. Not a doctor, not a nurse, not a PA, not a phlebotomist, not a single employee would help this man. He was told to go to Urgent Care. I could have removed the damn tick. Because of rules and regulations and refusal to deal with anything outside the small sphere each doctor has built around them, the man with the tick had to spend extra hours at Urgent Care, sap precious Urgent Care resources needed for the truly needy, and cost the man significantly more money for a simple treatment than had he just been seen at the doctor’s office.
It is this refusal to accept responsibility that offends me so. Doctors are great people and I can count one of them as being among my friends. (Well, there is also one psychiatrist, but he is nuts and I love him for it). But doctors have a fatal flaw that has created an entire industry. For some reason, they feel that they deserve to be paid in full up front for every procedure; be it $100.00 or $100,000.00. What other industry can make a demand like that? Certainly not mine. It is nice to demand and even nicer to get it. But many are the times I have to work with clients on payments, on reducing prices, and on other personal adjustments that are done on a human being to human being level. Doctors wont even let you in their offices if you have not already guaranteed payment. The reason is funny: A Doctor MUST treat the patient before him/her. Thus, if the office can keep you away from the doctor, they don’t have to treat you. If you cant pay or are too much trouble, go on down the hall. Hence, the rise of Insurance and the mess we face today.
This all comes together around a young man I met a couple years ago. Charged with a serious gun felony and a string of misdemeanors, his life and future were a mess. There was not even anything to litigate as police had his smiling face on video committing the crime; gun in hand.
As I started to put together the pieces of this man’s life, speaking with him and others, hiring a professional agency to go out and do a background investigation, and reviewing hundreds of pages of medical records, letters, police reports, stirred in with my own secret sauce, the story that came out was one I had been hearing more and more, over and over. Oxycontin induced Heroin addiction is spiking. It had been the headlines in this market for several days and is still the topic on the news during every sweeps period. Of course, when a bad batch of heroin arrives and 24 people end up dead or ill, then people start to care. But unless it becomes a white suburban problem, it won’t be a real problem for the rest of society. It is a problem of the poor, the unseen, the unwanted, the lost; certainly not in Manlius.
Before I get to it, also let me say that current efforts against the heroin problem are working against the needed cure. Current efforts, in my opinion, are escalating the problem and increasing crime. I really recommend a serious rethink of the whole process. If you see it only in its’ parts, then your response will be in error. See the forest and the pathway through is clear.
What I learned while investigating the client is that he was a really wonderful, kindhearted, good, honorable man. He was established with a nice apartment, nice goodies, nice wheels, hot girlfriend, strong job and future, and was getting his life together as much as any young 20 something can be expected to do. The man I met on paper was someone I wouldn’t mind having in my home or babysitting my children.
At the same time, he was an accused thief, allegedly caught with drugs, lived on the streets, lost everything he owned, was in and out of bum hotels, and was unwelcome even to his own family. He had a bad drug addiction to heroin which was brought to a screeching halt when he walked into a business one day and brandished a gun. The money he got away with he used to shoot up his arm in an apparent suicide attempt. When police found him, he went voluntarily with them until he arrived at the jail. He was so high when he was removed from the unit at the sallyport, he started to walk away thinking his ride had been in a cab. He is presently in the custody of the New York State Department of Corrections until nearly the end of the decade; living large on the honor block.
So, what caused this tectonic shift in the personality and momentum of this young man’s life trajectory? Doctors. Well not all doctors, just one in a particular whose name I am aching to mention but cannot. In a nutshell, here is the tale: Our hero one day on the job hurt his back. His was a labor job so a back injury lifting heavy weight is not unheard of. Sent by his employer and paid for by employer provided health coverage, the young man as treated for his injury. Doctors determined it bad enough to warrant prescribing the pain medication ‘Oxycontin’ for relief. Yes, this drug will get you high. But, the way the drug chemically interacts with the body, it is a dopamine hunter which first seeks out pain receptors and finding none needing attention, only then goes for pleasure centers. Hence, when the course of treatment started, according to the doctor, the pain was bad enough to warrant the Oxycontin. But as is also fairly common, the Oxycontin was not working at the doses prescribed. Doctors will help; but only to a point. Pain management versus pain eradication is a major debate in medicine. We have the technology for both. Which do you prefer when you are in pain?
I have been an eyewitness to this in my own personal world. Someone very close to me was in severe pain for many months and for the first four months, was on high doses of Oxycontin. I witnessed how it provides some pain relief for severe pain, making it tolerable. Also, I saw how it does fuck up your head but the person doesn’t feel “high”. Last, I could see how a person could easily increase their dosage on the theory that some is good, more is better.
The young man used the Oxycontin long term and in ever increasing prescribed dosages. He also at some point returned to work. Whether it was the medical costs of treatment and have a back-injured employee on payroll that caused the man to be fired or whether it was him being under the influence of Oxycontin while at work; for some reason, the man lost his job. But his treatment had not ended.
So now we have a man in pain whose body is used to high doses of Oxycontin for pain relief and perhaps the buzz. One day, he no longer has a job and hence no more medical coverage and thus his doctor wont see him anymore. *Poof*. Just like that goes the prescription for the medicine. If only pain responded accordingly.
Imagine yourself in the situation. You need this drug. You cannot afford the doctor. What do you do? Seriously? You cannot just walk into an Emergency Room and ask for Oxy. The DEA has made sure of that. You cannot just walk into a free clinic and ask for Oxy. The law has made sure of that as well. Anybody who tried would be seen as a “drug addict” and treated accordingly. If the person got the prescription, police would likely arrest them and off we go.
You need the drug. The pain is still there. First place you go is everybody and everywhere you know. The only option is to hit the streets and buy Oxycontin on the black market. The price, per pill, is exorbitant due to high demand. Eventually, the young man ran out of money, had sold all his stuff, and was out of options.
On the streets there are so many like the man here. Hundreds, if not thousands of people, are all hunting the same drug. They talk to each other and learn how to deal with defeat. One learns fast that an equally effective, less expensive, much more available product is on the market -- heroin. (Think about that: Despite 45 years of a War on Drugs, heroin is cheaper and easier to get than a regulated drug). Over time and as their lives deteriorate, one by one, ten by ten, these Oxycontin addicts switch over to heroin. Our hero is no exception.
As expected, with no job and no stuff, no home and no friends, but still dealing with his drug dependency, the logical next step is a life of crime. It starts out allegedly simple enough; steal from your friends and family every chance you get until they wont let you be around them. Then your circle of crime expands to quick and easy bucks, petty thefts and pawns. Anything at all, people will do, to get the money to get the drug.
So where is the doctor? The one who got him addicted disappeared into the good night? I am sure he is doing well and living the good life. Our hero sought help from other doctors who, one by one, turned him down because he had no money or insurance, couldn’t qualify for public assistance, and the doctors couldn’t get paid. No money, no service. Suboxone was offered at one time as a treatment program but again, no money means no prescription.
Eventually he hit rock bottom. That is when I found him. Together we picked up the pieces and found the quickest easiest path for him to return to his life. My prayers are with him daily. Despite his drug problems, he never changed as to who he is at his core. Prison I am sure will have its’ effect. I am confident he is strong enough to be quickly returned to normal when he is released.
But I am not done. That doctor needs to answer for his sins. The entire medical system needs to stand and look hard in the mirror before it starts handing out indictments to others for “the heroin problem.” The heroin problem, at least the Oxycontin to Heroin route, is medically fueled by no other reason than greed.
In my opinion, my state legislators should immediately act. A doctor who has a patient in his or her care and that patient is undergoing ongoing treatment and is at risk of medical injury if that treatment were to halt, should not be allowed to stop treatment
because the patient has run out of money. A patient who walks out of a doctor’s office should still be considered “in front” of the doctor so long as treatment is continuing over time. Going home to await the next visit does not end the treatment. Doctor, treat the patient in front you; not the acute situation, but the whole patient. That, after all, is what doctors signed up for. They should finish.
I, as a defense attorney, do not have the luxury of walking away because the client ran out of money. This is why we push very hard to be paid as much if not all up front as the courts have said that a defense attorney cannot be relieved as counsel for simple non-payment. While I would like to think that what I do walks that line between life and death of the client, I know there is less at stake sometimes than a patient needing continuing medical care.
Doctors, heal yourselves. Then please, finish healing me. The rule of Do No Harm has to follow the patient out the door. Hopefully, lawmakers will agree.