Posted on 02/24/2004 3:43:38 AM PST by Prospero
Dr. Bruce W. Wilkin, a rural physician in Nevada, has recently been in the news. He is one of thousands of physicians who are facing legal challenges for his professional treatment of patients in pain.
CPAIN.ORG has been provided with this Press Release in which Dr. Wilkin tells his side of the story.
RURAL NEVADA DOCTOR FACES
THREATENED LICENSE REVOCATION FOR
TREATING CHRONIC PAIN PATIENTS
February 19, 2004
Deputy Attorney General, Richard J. Legarza, legal counsel for the Nevada State Board of Medical Examiners, has filed 19 unspecified charges of malpractice against Bruce W. Wilkin, M.D., a 64 year-old physician who has been practicing in Ely, Nevada for the past 26 years. The Board and Mr. Legarza have refused to provide Dr. Wilkin and his attorney with any details supporting these charges which simply allege “malpractice” in prescribing controlled substances---which he is legally licensed to do! Of the patients listed in the Board’s complaint, most have been known and treated by Dr. Wilkin for chronic pain over the past 10 to 20 years or more.
Dr. Wilkin was born and raised in Pioche, a small mining town located in eastern Nevada, 160 miles north of Las Vegas. After serving four years on active duty with the U. S. Army, he worked his way through college and graduated from the University of Utah with a B. S. degree in Pharmacy in 1967. As a registered pharmacist doing relief work in six different communities in southern Utah and eastern Nevada during the next five years, Dr. Wilkin observed first hand the chronic shortage of doctors in rural America. Noting that the majority of doctors in rural communities grew up within a few hundred miles of where they set up practice, he enrolled in Nevada’s newly created two-year School of Medicine in Reno with the intent of returning to rural Nevada to practice. With a wife and three young children, he continued to work full time as a pharmacist in Reno while attending medical school full time. After graduating from the University of Alabama-Birmingham School of Medicine in 1976, he had hoped to complete a three-year family practice residency. However, the doctor shortage was so critical in Ely that the doctors already practicing there urged him to just do a one-year rotating internship before returning to Nevada.
In 1977, Dr. Wilkin began his medical practice in association with two other general practitioners and the area’s only general surgeon. During his first twenty years in Ely, Dr. Wilkin delivered over 1,000 babies in his practice which included pediatrics, geriatrics, and everything in between. He covered the Emergency Room more than any other doctor in Ely, and could always be counted on to provide coverage in the hospital, the ER, and do OB back-up when the other doctors wanted to leave town.
All of this took a heavy toll on his health and family life. He has suffered four life-threatening events as a direct result of his demanding and stressful practice as a rural family physician, including two heart attacks, pulmonary emboli (blood clots in both lungs), and a severe endocrine imbalance due to overwhelming physical exhaustion. These experiences brought him even greater insight and empathy for the problems his patients experience, and also caused him to study and learn everything available in many areas of endocrinology, hormone replacement and anti-aging medicine. There is nothing in medicine that a physician understands with more certainty than that which he has experienced and has seen successfully treated in himself and his patients. Even after these events, he found it impossible to slow down.
When he returned to the clinic from his hospitalization for the pulmonary emboli in September 2003, an investigator from the Board was in the clinic re-copying the medical charts of the original 19 patients named in its June, 2003 complaint, and also copied the medical charts of another 12 patients for whom no complaints had been filed! All of this was done without the knowledge or permission of any of these patients and there was never any court order or subpoena issued to obtain these records. Again, none of these patients have complained about Dr. Wilkin’s care. This appears to be a flagrant mockery of the HIPPA law which was passed by Congress to protect the privacy of patient records and the doctor-patient relationship.
Despite repeated requests, the Board has refused to specify why Dr. Wilkin was charged with “malpractice” for treating intractable pain in his chronic pain patients. Under Nevada law, every physician licensed by the State Board, including Dr. Wilkin, is authorized to treat chronic pain by prescribing controlled substances which are effective for pain relief, thus the Board’s complaint charges malpractice for simply practicing within the scope of his license. Under Nevada Revised Statues, Section 630.3066, “a physician is not subject to disciplinary action solely for: (1) Prescribing or administering to a patient under his care a controlled substance….if the controlled substance is lawfully prescribed or administered for the treatment of intractable pain….” Yet, the Board has Dr. Wilkin in its crosshairs to discipline him for prescribing controlled substances in nineteen cases for treatment of intractable pain. Nevada has no specific guidelines on how to approach pain management when prescribing controlled substances. Instead, it judges the doctor’s treatment by hindsight. The Board has failed to offer any suggestions as to how much medicine is too much or too little when the goal is to provide pain patients some quality of life. Although the State Board has amassed a $5 Million surplus in recent years by overcharging doctors for their biannual licensing fees, it has made no effort to provide doctors with readily available continuing medical education courses or guidelines on pain management which are desperately needed.
With the so-called “War on Drugs” being waged in this country, the medical profession has become afraid to prescribe pain therapy out of fear of being prosecuted by State Boards or law enforcement agencies. Recent studies indicate that two-thirds of all chronic pain patients in the United States are given inadequate treatment to control their pain, and only about five percent of doctors across the country are still willing to treat severe chronic pain. Are the people of this country willing to let attorneys such as Mr. Legarza decide whether the treatment of pain is adequate or is denied? If not, then the medical community and the voting public will have to bring about legislative changes as to how politically appointed medical boards such as Nevada’s are run. By turning over the day-to-day operation of the Board to an attorney such as Mr. Legarza, it is apparent that our Board has utterly failed to live up to their public trust to oversee the providing of quality medical care for all residents of our State.
The State Board’s actions through Mr. Legarza have forced Dr. Wilkin to defend himself against unspecified charges because he refused the Board’s “settlement offer” which would:
(1) “Force him to retire and give up the practice of medicine by January 1, 2004,” or:
(2) Plead “no contest (Guilty)” to all nineteen (19) unspecified charges of malpractice, and
(3) Forfeit all of his civil and constitutional rights to ever have a full hearing before the State Board or in any Court of Law regarding this matter.
Whichever poison Dr. Wilkin chose to accept, the Board’s offer also demanded that he:
(4) Agree to pay for all Board expenses relating to past and future investigations, with the open threat that other investigations concerning him were proceeding and it was guaranteed that additional unspecified charges would be filed. (Importantly, malpractice insurance coverage does not provide for defense of disciplinary actions brought by the Board, so Dr. Wilkin is being forced to personally pay all costs for defending himself out of his own pocket),
(5) Surrender his license to prescribe any narcotic pain medications or even cough syrups, which would effectively prevent Dr. Wilkin from providing any further hospital practice, obstetrical care and deliveries or any emergency room care, and
(6) Be forbidden from discussing the history or care of any of his patients with any other doctor, effectively forcing him to abandon his patients and deprive them of all continuity of care. This alone vividly illustrates the total lack of concern by Mr. Legarza and the State Board for patient care and safety.
When Dr. Wilkin refused to succumb to the intimidation and coercion on the part of Mr. Legarza and the State Board, two investigators from the State Board were immediately sent to Ely on a declared “emergency basis” to copy and take back to Reno an additional 74 patient medical records from the clinic where Dr. Wilkin works. So far, more than 100 patient records have been copied and taken out of the clinic without the knowledge or permission of the patients. For more than 80 of these patients whose records were taken, no Board complaint is even pending! This apparent witch-hunt is attempting to find anything which could be used against Dr. Wilkin, possibly to retroactively justify calling out the dogs in the first place.
Appallingly, even the rural hospital, where Dr. Wilkin has served tirelessly for the past 26 years, has succumbed to the Board’s scare tactics by labeling Dr. Wilkin’s chronic pain patients “drug addicts” and threatening Dr. Wilkin with loss of all hospital privileges unless he severely restricts his treatment of these patients with intractable pain. This substantially increases the cost and difficulty in accessing health care by requiring pain patients to see the doctor and pay for more frequent clinic visits than the law requires just to have prescriptions written. This also disproportionately burdens already disabled patients, thus both stigmatizes and discriminates against the disabled in probable direct violation of the Americans with Disabilities Act. These actions by the hospital chief-of-staff and the State Board in trying to prevent Dr. Wilkin from treating chronic pain patients are also in direct conflict with the intent of the State Legislature. During the 2003 legislative session significant changes in pharmacy regulations relating to Schedule II (narcotic) prescriptions were passed in order to make health care more accessible and affordable for patients being treated for chronic health problems.
Health care needs in rural Nevada are already underserved enough without these “ready, fire, aim” tactics by the State Board. Many of Dr. Wilkin’s patients are totally disabled and living on a very limited income, so they cannot afford to visit the doctor every week or every month and still afford to pay for food and rent. What physician will ever again want to practice in this type of rural setting with little back up or support, if a rural doctor can be forced to give up his license for simply trying to do his best to relieve pain and suffering. The continuity of health care in Ely and other communities in Nevada will be severely compromised if the State Board has its way in this matter. The Board should recognize that in pursuing their case against Dr. Wilkin they are setting an ominous precedent for every chronic pain patient who gains some improvement in quality of life through adequate pain relief.
Dr. Wilkin is urging all of his patients and concerned citizens in Nevada to contact Governor Guinn and members of the State Legislature concerning these outrageous actions of Mr. Legarza and the State Board of Medical Examiners. Everyone needs to understand that with these actions against Dr. Wilkin, both charged and threatened, the wholesale copying of patient records, and the libelous characterization of intractable pain patients as “drug addicts,” the State is effectively discarding its disabled, poor and pain riddled citizens if this is allowed to go unchallenged. This same thing can happen to any patient in our State and Nation, along with any dedicated and caring professional brave enough to treat them.
THIS TYRANNY MUST BE STOPPED!!
BUMP!
FMCDH
Yes, but the wrong of helping create a dependency on opiate pain-killers is a far lesser wrong than that of insisting people suffer needlessly to accommodate state policy. This is not a perfect world, and the attempt to make it so by government is purely diabolical
IMNSHO.
Exactly, the patients, doctors all lose while the attorneys run the show.
Generally not. That's why it'll get harder to get pain treated aggressively. The greater risk in in the prescribing.
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