AT LEAST 20 YEARS AWAIT CONVICTED DOCTOR

Some Pain Specialists Fear William Hurwitz's Case Will Impair Their Ability
To Treat Patients

In a federal courtroom in suburban Washington today, a Stanford
University-educated pain doctor assailed by prosecutors as a common drug
pusher is expected to receive at least 20 years in prison for his December
conviction on drug trafficking.

The prosecution of Dr. William E. Hurwitz, 59, was surrounded by
controversy and the prospective long sentence is reverberating among
doctors who treat pain. Though he was charged with diverting potent opioid
drugs to two dozen dealers and addicts from his office in McLean, Va.,
Hurwitz is also regarded as a pioneer in pain treatment.

Along with tougher federal regulation of pain pills, the Hurwitz case has
roiled the medical and legal establishments, creating fear of prosecution
among some doctors who treat debilitating pain.

"We have a real legitimate worry that there is going to be greater
reluctance to prescribe pain medication and as a consequence more
under-treatment of chronic pain," said Dr. Russell K. Portenoy, chairman of
the pain medicine department at Beth Israel Medical Center in New York.

Since the Hurwitz case began, 30 state attorneys general have assailed the
Bush administration's Justice Department for its pain-pill policies, saying
in a joint letter in January that state and federal policies were
increasingly at odds on how to balance legitimate pain treatment with drug
enforcement.

And during the Hurwitz trial, a group of eminent medical authorities, all
past presidents of the American Pain Society, lambasted one of the Justice
Department's expert witnesses for "misrepresentations" that have damaged
the ability of doctors to treat pain without fear of prosecution.

But Justice Department officials insisted that the Hurwitz prosecution
should have no effect on legitimate doctors, saying Hurwitz knowingly
dispensed pills to patients reselling their Oxycontin and Dilaudid on the
streets. In a sentencing memorandum, prosecutors Gene Rossi and Mark Lytle
say that the only chilling effect on other doctors from the Hurwitz trial
results from his misrepresentations that he was duped by his patients.

During the trial, Hurwitz was described by some of his patients as a hero
who had successfully treated debilitating pain. The Pain Relief Network, a
patient group, said in a letter to President Bush this week that Hurwitz's
conviction was the result of deceptions by federal prosecutors.

Each day, the court was packed with dozens of supporters, including the
mother of a student at Yale University, who told prosecutors her son's
debilitating pain was cured by Hurwitz and that he was now unable to find
another doctor to treat him.

Prosecutors never disagreed that many of Hurwitz's 5,000 patients were
legitimate. But they charged that 24 of the patients were illegally getting
large prescriptions, even though Hurwitz knew they were either reselling
the drugs on the street or abusing them. Prosecutors asserted that Hurwitz
engaged in egregious and blatantly illegal behavior, writing prescriptions
for as many as 1,200 Dilaudid pills per day to one patient who was a known
cocaine abuser.

The Justice Department has attempted to turn up its fight against rapidly
growing abuse of pain pills, concerned by surveys that show 6.4 million
Americans abuse pain pills. But at the same time, medical experts say many
Americans are in profound chronic pain and could lead more normal lives if
they were put on regular doses of opioids.

Throughout the case, Hurwitz said he did not know about his patients' drug
dealing and that a doctor should not be held accountable for the illegal
behavior of others. And despite the allegations against him, Hurwitz
continued to receive strong support.

Dr. Frank Fisher, a California doctor who also was charged with dealing
drugs but exonerated last year after a long legal battle, attended every
day of the trail and kept Web logs that assailed the prosecution.

"We are burning Dr. Billy Hurwitz at the stake," Fisher said. "It is really
having a chilling effect on the treatment of pain. Surveys show that half
of terminally ill cancer patients die in agony."

Portenoy and other highly regarded pain doctors were on the witness list
for Hurwitz. In an interview Wednesday, Portenoy said he was concerned that
Hurwitz had engaged in many practices that seemed problematic, but that it
would have been better for the medical establishment to handle the matter
internally than to criminalize the treatment of pain.

Portenoy was among a panel of doctors that helped the Drug Enforcement
Administration write a question-and-answer policy statement to help doctors
avoid trouble in prescribing opioids. But shortly after the document was
posted on the Internet by the DEA, the defense team for Hurwitz saw that it
could exonerate their client. Prosecutors successfully blocked the document
from being introduced and then the DEA repudiated it.

Afterward, 30 attorneys general ( including California's Bill Lockyer (
wrote a letter to DEA Administrator Karen P. Tandy, saying the agency was
not properly balancing the need for stopping drug diversion with the need
to treat legitimate pain, specifically citing the withdrawn document.

"As attorneys general have worked to remove barriers to quality care for
citizens of our states at the end of life, we have learned that adequate
pain management is often difficult to obtain because many physicians fear
investigations and enforcement actions if they prescribe adequate levels of
opioids."

One issue that befuddles many experts is why Hurwitz would have engaged in
drug trafficking, as prosecutors alleged. Hurwitz not only has a medical
degree, but also a law degree from George Mason University in Virginia.

Some of his critics say that Hurwitz wanted to confront authority and
became infatuated with his notoriety, though his supporters say he was
morally committed to curing pain with high doses of pills even if it meant
occasionally erring in who he would treat.

U.S. District Judge Leonard D. Wexler denied Hurwitz bail in December
during an appeal of his conviction, saying he represented a flight risk.
Wexler noted that under federal sentencing guidelines, he would be forced
to hand down at least 20 years of prison time. Federal prosecutors have
asked for a life sentence.