Angel Dust and Devil Doctors: Cruelty V. Compassion Part II

The Kafka-esque quality of the current prosecutions of physicians for "overprescribing" pain medication is hard to overstate-- so far, they've included witnesses who've admitted lying about having exchanged sex for drugs with one doctor and a witness who couldn't even identify the physician who'd allegedly sold him marijuana, either in the courtroom or in photos. But the following example-- from the case against pain specialist Paul Heberle-- beautifully illustrates the moral bankruptcy of these prosecutions in a way that should shame everyone associated with them.

An expert witness for the prosecution, Dr. Gus Mantia, reviewed Heberle's case files. Mantia's position was that Heberle's patients' health would have been better served had the doctor immediately expelled them from his practice and seemingly, that no one with a past history of addiction suffers pain severe enough to require medication.

One such instance from the trial stands out. The patient had HIV, Hepatitis C and an anxiety disorder. He was a former alcoholic, who had years of sobriety. He had HIV-related neuropathy (an extremely painful condition due to nerve damage) and a chronic, degenerative disease of the spine, which can also cause severe pain. His medical records read as follows:

Patient here for scheduled appointment and prescription renewal; going out of town for three weeks...Feels like he is catching a cold--was exposed to PCP by a friend.

The record also notes that Dr. Heberle was monitoring him for lung problems and prescribed antibiotics. According to the defense expert, the "out of town" trip was because his lover was dying of cancer. He'd been given a month to live and they were visiting their families to say their goodbyes.

Now, here's a quiz: What does PCP mean in this context?

Is it

a) pneumocystis carinii pneumonia, a lung infection that was an early killer of numerous AIDS patients


b) the drug PCP, otherwise known as "angel dust" which often produces psychosis-like symptoms and
is not known for causing cold-like symptoms.

If you guessed a), you're probably not being paid by the prosecution in an "overprescribing" trial. Even the former addicts I ran the anecdote by knew immediately that PCP, in the context of AIDS, is an opportunistic infection, not a recreational drug. And of course, no addict would voluntarily admit PCP use during a medical visit aimed at getting a prescription refilled.

If you google "HIV PCP," there are 1,460,000 listings-- and they overwhelmingly (at least as far as I looked through) cover the disease, not the drug. By contrast, googling HIV and "angel dust" gives a mere 26,400 listings and the words only co-occur because lots of pages devoted to drug use in general also cover HIV issues, unsurprisingly.

Mantia, on the other hand, insisted that the medical record meant that the patient had admitted using angel dust and that this should have led Heberle to immediately stop prescribing pain medication for him. Under cross-examination, Mantia was given a chance to retract the idea that "PCP" in the record meant the drug. But he stood by his claim that in his expert medical opinion, Heberle was prescribing opioids to a patient, who voluntarily and for no apparent reason admitted taking angel dust in a discussion about upper respiratory symptoms.

Heberle's wife, Christine Heberle reports that Mantia testified that "no doctor anywhere, would continue to treat this patient. Dr. Heberle acted with blatant disregard and he was without a doubt outside the standard of care."

According to those who attended the trial, courtroom spectators responded to this colloquy as though they felt embarrassed for the witness and were startled by his refusal to accept the greater plausibility of the alternative explanation.

It certainly should have been embarrassing-- and these cases continue to be an embarrassment to our justice system and our country. Even if this man *had* taken angel dust, does anyone seriously believe that dropping an AIDS patient from medical care in this situation and putting him into withdrawal from pain medication, thus preventing him from accompanying his dying lover on his last visit to his family is the right thing to do? When will patients, politicians, physicians stand up and put a stop to them?