Patients Caught in Crossfire as Bureaucrats Take Aim at Doctors

Published March 1, 2004

In the 1930s, Joseph Stalin noted the Soviet population wasn’t growing fast enough to build his workers’ paradise quickly enough. So he shot the census takers. The next batch of census takers weren’t any better.

But the third generation of census takers reported enough population growth to keep Stalin happy–and keep their own lives in the process.

This last batch of census takers “got the message.” As Solzhenitsyn reported in The Gulag Archipelago, doctored statistics in the Soviet Union weren’t simply a matter of bureaucratic empire-building; a census taker’s life literally depended on keeping the dictator happy.

This anecdote from history exhibits a double idiocy. What did Stalin know about taking a census? And how would shooting the census takers cause population growth … unless it is presumed they were incompetent slackers who would do their job only under threat of dire punishment?

Increasingly, the story of the Soviet census-takers describes the relationship between America’s doctors and America’s government. The irony is that the medical system here was working pretty well until the government resorted to its “shoot the doctors” approach to medicine.

Two Ongoing Examples

The first example pertains to the threats faced by doctors prescribing pain-controlling medication to their patients. Federal government officials have taken a “guilty until proven innocent” attitude toward doctors who prescribe pain medication they believe appropriate to address serious and long-lasting pain.

Some doctors have been literally “under the gun.” Government agents broke down the doors of Dr. Jonathan Wright’s office in Washington state, seeking to investigate the heinous crime of using a form of Vitamin B12 that didn’t meet the government’s idea of what a “good vitamin” should be.

In March 2003, federal agents stormed the office of Dr. Jeri Hassman, a Tucson pain specialist, put her in handcuffs, and took her to jail. Drug Enforcement Agency (DEA) agents had noticed she was prescribing unusual quantities of morphine-based drugs and concluded Hassman was “prescribing controlled drugs outside the normal practice of medicine.” They charged her with 362 counts of that crime.

In January, Hassman entered a guilty plea to four counts, thus avoiding the possibility of nearly 30 years in prison. She faces six months in jail and five years’ probation.

If Hassman is indeed a criminal–362 counts is a lot–why did she get off so easily? Or did the feds just load her down with so many counts she couldn’t afford to fight? The message seems clear: “Beware, physicians of America! This could happen to you if we don’t like your prescription-writing.”

Scores of doctors have faced such intimidation. Some have been imprisoned. One has committed suicide. Many have lost their medical licenses, run up ruinous legal bills, and gone bankrupt.

The lessons have not been lost on honest doctors, many of whom grow ever more reluctant to prescribe serious pain medication to their patients who need it most.

Medicare, Not

A second area where the government has been busily threatening to “shoot first, ask questions later” involves Medicare. By law, doctors may treat Medicare patients only in accordance with what the government sanctions.

Moreover, a doctor may not treat any Medicare-eligible patient privately outside the Medicare system if the doctor accepts a penny of Medicare money.

As a result, more and more doctors are refusing to treat Medicare patients at all. They’re simply fed up with the limits on their ability to treat patients appropriately, the paperwork, and the constant threat of legal action, including prison, if they deviate at all, even inadvertently, from the 130,000 pages of Medicare law (plus Official Government Regulations, plus contracted Insurance Carrier Policies). It’s a regulatory labyrinth so complex not even the enforcers understand it.

I know personally many doctors who have “opted out” of the Medicare system. They are very happy with their decision to go back to the old system of offering competent care at reasonable cost.

Where from Here

So, what should patients caught in the crossfire do?

First, if you’re covered by Medicare or any government health care program, be aware that your doctor is working under constant threat of fine and/or imprisonment.

Second, if you’re a pain patient, ask your doctor upfront whether you’re getting the medication you need. If you’re not, ask what you can do to help make that happen.

And third, if you’re a Medicare patient looking for a doctor whose top priority is to take care of you instead of pleasing the Medicare bureaucracy, find a doctor who has opted out of government-run health care.

After all, you wouldn’t shoot a census taker just because the numbers didn’t suit you. Would you?

Robert J. Cihak, M.D., is a senior fellow and board member of the Discovery Institute and a past president of the Association of American Physicians and Surgeons (AAPS). He can be reached at [email protected].