DEA Ends Investigation of Pain Doctor
In 2013, it came to light that three year’s earlier the Drug Enforcement Administration (DEA) had opened an investigation of then-president-elect of the American Academy of Pain Medicine (AAPM) Lynn Webster, MD, related to overdose deaths at Dr. Webster’s Lifetree Pain Clinic in Salt Lake City. [Editor’s note: Pain Medicine News was one of the news publications that reported the story.] Recently, the U.S. Attorney for the District of Utah declined to pursue charges, effectively ending the investigation. Pain Medicine News spoke with Dr. Webster, now immediate past-president of the AAPM, about his four-year ordeal.
Pain Medicine News: Dr. Webster, thank you for speaking with us. Let’s start by asking what ran through your mind when you first found out the DEA investigation was over?
Lynn Webster, MD: Relief. Not for me alone, but for my family and friends, who were supportive throughout this, and for my dedicated professional colleagues of more than 15 years, who treated a majority of the patients at the clinic during the period leading up to the DEA visit. This dark shadow hung over us for four years, and we had no way of knowing when—or even if—it would end. My attorney told me that there is usually no notice of an end to such an investigation. It can linger for the rest of your life, leaving suspicion of possible wrongdoing. I was always confident that our clinic had complied with the law and did the right thing. But, these days, that doesn’t protect anyone from an allegation of wrongdoing. So, we are thankful that a period was placed at the end of our story, allowing all of us from the clinic to move forward.
PMN: You recently wrote an opinion piece on the prosecution of pain doctor Daniel Baldi, MD (Pain Medicine News August 2014, page 1). Can you discuss how your personal situation over the past several years has shaped your interest and stance on physician prosecution?
Dr. Webster: My personal experience alone doesn’t necessarily shape my view. My views are formulated by what is happening in our field to my colleagues and our patients. The pressure to reverse the prescription drug problem has resulted in calls for stricter policies and more law enforcement. We should all be aware that there are unsavory physicians who dispense pills for profit without a legitimate medical need. Crossing the line in this manner has disrupted the ability of real doctors to treat patients with real pain when opioids are involved.
Physicians practicing in good faith who use opioids to treat some types of chronic pain face negative judgments, literally and figuratively, if a death occurs in their practice. This is unlike any other area of medicine. In some cases, the line between civil liability and criminal behavior has been blurred, in which clinical judgments retrospectively can be viewed as reckless and with willful intent to cause harm. Even a bad outcome without evidence of error can be investigated or prosecuted criminally. Ultimately, injustices such as these pose serious threats to people with chronic pain. Today, many physicians refuse to risk treating people in pain with opioids, even in cases where other therapies have failed or would be ineffective. A vocal contingent opposes prescribing opioids to patients with chronic pain, inexplicably unless the patients have cancer. I wish they would first listen to the stories of people who are crying for help and who have no clinically viable alternatives. It is too infrequent that policymakers, regulators, members of the press and government officials ever express concern for these people. That saddens me.
PMN: Critics have called this discussion of physician prosecution a “false narrative.” What is your response to that?
Dr. Webster: If you mean that it is false that there may be overreach by some regulators and prosecutors, I would say the facts state otherwise. Look at the case of Daniel Baldi, a doctor of osteopathic medicine and a pain physician in Des Moines, Iowa. He was recently charged with nine counts of involuntary manslaughter in patients who died of overdoses, complicated by multiple factors that included worsening medical conditions, medications prescribed by others and the co-ingestion of illicit drugs. In one case, Dr. Baldi had not seen the patient for months leading up to the death; in another, Dr. Baldi had only seen the patient once. However, the common denominator was that each patient had been prescribed opioids. The deaths were tragic, but the charges were unconscionable. The judge dismissed two counts, and the jury acquitted him of the rest. Regardless, Dr. Baldi’s career and finances are ruined, although it was clear in court he had practiced in good faith and did all he could to help his patients. Other physicians throughout the country are being forced into plea bargains because they can’t afford a defense. Aside from prosecution, regulators target “high prescribers” for investigation without sufficient context to evaluate the type of practice they run or the patients they treat. Actions like these clearly create a chilling effect. There is no false narrative.
PMN: You were the subject of a CNN story by Dr. Sanjay Gupta last year. The story centered around the deaths of two former patients from your clinic. Do you feel vindicated given that the U.S. Attorney declined the case?
Dr. Webster: Vindication implies that I was accused of wrongdoing. I was never accused of any wrongdoing, but when the DEA makes an inquiry, the implication is that there is something fishy and the perception of wrongdoing takes root. As a physician who has treated people in pain all my professional life, I always grieved for patients we treated but died. The fact is that some patients at our clinic died in spite of their treatment, but not because of it. This underscores the complexity and, sadly, inability of society to address the crisis of chronic pain.
As for CNN, I do not take issue with them producing a story for national consumption, but how they did it. The processes, by which they collect, analyze, verify and double-check the facts calls into question the network’s professionalism and journalistic integrity. I’ve made some of the inaccuracies in their story known to them and they’ve acknowledged this in correspondence with me. I did not participate in an interview with CNN, and I had no obligation to participate. However, that does not relieve CNN of its obligation as journalists to ensure their stories are free of error, bias and guesswork. This they did not do.
PMN: You have long said opioids need to be replaced as viable treatments for pain. Where should we go from here as a society to make that happen?
Dr. Webster: This is true. It would be morally reprehensible to abandon our societal obligation to treat mankind’s primal enemy: pain. There is controversy now about how many people in America actually suffer from chronic pain. Regardless, pain is the No. 1 reason people visit a physician. It will take time, but it is imperative to find safer and more effective alternatives to opioids. Not only because of the politics surrounding opioids but because, as medications, opioids are not effective enough and cause too much harm and grief. As a country, we should invest heavily in better therapies because of the prevalence and financial cost to society of untreated pain and addictions. We need a short-term strategy and a long-term strategy. In the near term, we must increase access to effective alternative therapies, which exist but are too seldom covered by insurers. Every time a regulator complains about the harm from opioids, he or she should also offer to support making available effective alternatives. We need guaranteed minimum insurance coverage for pain therapies. We also need better education about the risks and benefits of all treatment options, not just opioids. In the long term, we need Congress to create incentives for industry to develop safer and more effective therapies. We can do better if we have the will.
PMN: What do you look forward to accomplishing going forward?
Dr. Webster: My mission during the four years of the investigation was the same as it has always been: to help people living with pain and to prevent opioid abuse and overdose deaths. Going forward, I plan to adhere to that core mission. I agree with the Institute of Medicine that we need a cultural transformation. Access to appropriate and safe pain treatment should be viewed as a human right—a civil liberty. I am working on a television documentary profiling the lives of people in pain, which, tentatively, is planned for national broadcast in fall 2015. I am also working on a book. It is not a book about how to treat pain or the politics of pain. It is an experiential journey with some of the people I have treated. Their stories, the documentary and efforts to promote the National Pain Strategy through the National Institutes of Health is where I will invest much of my energy for the next couple of years. Then I will see where we are. I hope it’s a better place.