Grover Pain Doctor Guilty

MEDICAL BOARD RULES ON TALLEY

RALEIGH - The N.C. Medical Board, after deliberating for two hours in a
rare Saturday session, found Dr. Joseph Talley guilty of deviating from
acceptable standards of care for his treatment of patients with narcotic
pain relievers.

The board deferred punishment until its meeting in April. It could revoke
Talley's license outright, or suspend him from practicing for some period
of time.

Talley, 64, has been a cause celebre among pain sufferers and the focus of
national media for his prescribing practices as small-town doctor in
Grover, a textile mill village west of Charlotte.

Last year, the Drug Enforcement Administration characterized Talley's
practice as the leading prescriber of the narcotic pain reliever OxyContin,
but one of Talley's lawyer said a trade group that monitors prescriptions
said he isn't even in the top 25.

Talley left before the board rendered its decision, and could not be
reached for comment.

During his final testimony Saturday before the board's verdict, Talley
appeared at once contrite and unrepentant.

He apologized for his outspoken and often colorful opinions -- in
particular, a characterization of Virginia's board of medicine as a board
of morons for sanctioning a pain doctor in that state. The quip did not
amuse the North Carolina panel.

But Talley denied that his treatment of patients fell below standards when
he chose not to perform physical examinations on patients before
prescribing drugs.

"It's a matter of professional judgment," Talley said.

The board disagreed.

"Examination. Examination. Examination," said William H. Breeze Jr., who
prosecuted the case before the medical board. "If you don't do that, you
don't have a practice of medicine."

Talley's troubles erupted last fall when the medical board charged him with
a dozen instances of violating standards of care for his patients.

In Saturday's decision, the board not only found him guilty of failing to
perform physical exams, but also of failing to monitor patients and guard
against addiction problems.

Talley also faces a federal probe by the Drug Enforcement Administration,
which may lead to a criminal indictment. The DEA has accused him of
prescribing narcotics to 23 people who later died.

Just Friday, a Florida doctor, James Graves, was sentenced to 63 years in
prison on manslaughter and racketeering charges stemming from his
prescriptions of OxyContin to four patients who overdosed. OxyContin is a
slow-release narcotic that lasts about 12 hours. Addicts have found they
can get a quick, heroinlike high by chewing the pills or crushing them and
snorting or injecting the drug.

At the heart of both cases are the narcotics, which Talley prescribed
enthusiastically. Although the medical community has grown more liberal in
its view of narcotics to relieve chronic, noncancer pain, the issue remains
controversial.

Many doctors simply refuse to prescribe the powerful drugs out of fear that
they will be targeted by the DEA or their medical boards.

Dr. Richard Rauck, a pain specialist from Wake Forest University Baptist
Medical Center in Winston-Salem, testified during Talley's hearing that an
atmosphere of fear persists, despite a 1996 medical board statement
promising "no physician need fear reprisals from the board" for prescribing
even large amounts of narcotics for pain.

Rauck said the best way to counter the fear is diligence in examining,
diagnosing, treating and monitoring patients who are prescribed narcotics
for intractable pain.

"If you're going to treat pain and be a pain physician," Rauck said, "there
is a right way to treat it and a wrong way."

Talley, Rauck testified, was going about it the wrong way.

Rebel image

In the three days of testimony before the board, a portrait of Talley
emerged as a doctor who willingly flouted the medical establishment.

"My father is an iconoclast," Dr. Rebecca Talley said after hearing.

She said her father could have practiced anywhere, but chose to work in a
poorer, rural community out of a sense of calling. All of the Talley
children worked in the medical practice from an early age, filing,
receiving patients, wallpapering walls, mowing grass.

"It was a family practice, in every sense of the word," Rebecca Talley
said. "It was part of our home."

Rebecca Talley, a physician herself who practices in Georgia, said she
realized that her father's ideas were not always well received -- at least
not initially. She said his work with depression, while first considered
quirky, helped guide family practitioners in their treatment of the
illness. By the time she went through medical school, she said she was
frequently approached by instructors who commended her father's work.

"I was always proud of him," Rebecca Talley said.

That work, however, attracted the attention of the medical board in 1990,
which questioned why a mill-village doctor was prescribing large amounts of
anti-depressants. While the board took no action then, it never let up in
its scrutiny of Talley.

Over the next 12 years, his practice evolved to pain management with
narcotics. He estimated that 70 percent of his patients saw him for pain
killers. All the while, investigators periodically visited or called Talley
at his office, sometimes pulling files.

That scrutiny became part of Talley's defense in his most recent battle
with the board. He contended that the charges against him were invalid,
because the board had never once, despite its investigations, told him he
was doing anything wrong.

"Usually there's a collegial attitude," Talley's attorney, Robert Clay of
Raleigh, said in his closing arguments to the board. "You ring a warning
before a doctor gets in trouble. ... It would be monstrously unjust to
penalize him."

The board rejected that defense. In their questions to Talley, board
members pressed him about his philosophy as a doctor, challenged the way he
kept his patient charts, and suggested he was not billing under the proper
insurance codes.

At issue were the cases of 12 patients who had begun seeing Talley for pain
treatment. Some came from as far away as Michigan, having heard about
Talley through a network of doctors and patients who advocate for
aggressive narcotic treatment for chronic pain.

The 12 patients, identified only by letters of the alphabet, included a
pregnant woman whom Talley treated with methadone, a drug addict who later
died from injecting OxyContin, and a steel mill worker from Michigan.

In making his case, Breeze used a large blue chart propped up on an easel
at the back of the hearing room. At the top of the chart were the patients,
identified by their letters -- patient A, patient D, patient L. On the side
were the deviations from standards of care. Pink dots, indicating treatment
failures, filled the chart.

"I'm going to tell you we proved our case here," Breeze said.

Nine of the 12 board members attended the three-day hearing, and a majority
voted to find Talley guilty of substandard care; all left without commenting.

"I'm really disappointed," Clay said after the decision. "I believe he's a
good doctor doing the best he could. Obviously, we'll work for the least
punishment possible."

Clay said he will argue that Talley's license should merely be suspended,
with the suspension set aside so that Talley could continue to practice.
That is a common punishment. Last year, the board issued 13 suspensions and
set aside 8 with stipulations.

Doctors who had been accused of sexual misconduct, for instance, were
allowed to continue practicing if they had a nurse present during exams.
Other doctors who had had problems with drug and alcohol abuse have been
allowed to continue practicing if they got treatment.

Rebecca Talley said the medical board's action is just one of her father's
worries with the prospect of a federal case looming. If a criminal
indictment is issued and Talley is found guilty, he could face prison.

After sitting through three days of testimony and closing argument, Rebecca
Talley said nothing had changed her impression of her father. "He's my
father," she said, holding back tears. "He's a role model to me."