Michael Arnold Glueck and Robert J. Cihak
Wednesday, Feb. 4, 2004

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.

This last batch of census takers "got the message." As Solzhenitsyn reported in a different setting in "The Gulag Archipelago," doctored statistics in the Soviet Union weren't simply a matter of bureaucratic empire-building; your life literally depended on keeping the dictator happy.

This historical vignette 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 that they were incompetent slackers and wreckers who would do their job only under threat of dire punishment?

Idiotic, of course. But increasingly, this describes the relationship between America's doctors and America's government. The irony is that the medical system was working pretty well until the government resorted to its "shoot the doctors" approach to medicine.

We offer two ongoing examples.

The first pertains to the dangers doctors prescribing pain-controlling medication face if the feds decide they don't like the prescriptions. Their attitude is "guilty until proven innocent" whenever a doctor prescribes pain medication adequate to deal with serious and long-lasting pain.

And some doctors have been, literally, "under the gun" when government agents break down their office doors to investigate such heinous crimes as using a form of Vitamin B12 that didn't meet the government's idea of what a "good vitamin" should be, as actually happened in the case of Dr. Jonathan Wright of Washington state.

In March 2003, federal agents stormed the office of Dr. Jeri Hassman, a Tucson specialist in Rehabilitation Medicine, just as she was about to inject a patient, put her in handcuffs and took her to jail. Drug Enforcement Agency (DEA) agents had thought she was prescribing unusual quantities of opioid drugs, but then many of her patients suffered from chronic pain.

Prosecutors subsequently charged her with 320 counts of the crime of "prescribing controlled drugs [pain medicines] outside the normal practice of medicine" plus 42 counts of insurance billing fraud.

In January, instead of going to trial on these counts, Dr. Hassman pleaded guilty to four counts of being an "accessory after the fact," admitting to not calling the cops when she became aware of four patients having "possession of a controlled substance by subterfuge or deception."

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."

We're amazed that maintaining a private and confidential patient-doctor relationship and not calling the cops is a federal crime; we wonder if calling the cops would cause her to break the Health Insurance Portability and Accountability Act (HIPAA) and also put her at risk of time in the slammer.

And indeed, scores of doctors have faced these same guns. 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 those who need it most.

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

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

The result is that 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 one iota from the 130,000 pages of Medicare law (plus Official Government Regulations, plus contracted Insurance Carrier Policies) so complex that not even the enforcers understand it.

The vast majority of doctors who have "opted out" of the Medicare system, and those whom I know personally, are very happy with their decision to go back to the old system of offering competent care at reasonable cost.

So, what does this doctor recommend? Three things.

First, if you're medically "covered" by Medicare or any government program, be ever more aware that your doctor is working under constant threat of fine and/or imprisonment.

Second, if you're a pain patient, ask your doctor up front about whether or not you're getting what you need. If you're not, ask what you can do to help.

And third, if you're a Medicare patient and 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.

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

Or would you?

Editor's Note: Robert J. Cihak wrote this week's column.

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. Michael Arnold Glueck, M.D., is a multiple-award-winning writer who comments on medical-legal issues.

Contact Drs. Glueck and Cihak by e-mail.

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