PAIN RELIEF EXPERTS TESTIFY

RALEIGH - A pain specialist from Wake Forest University's medical school
said Friday he had concerns about how Dr. Joseph Talley prescribed narcotic
pain relief to patients without first performing physical examinations.

Dr. Richard Rauck, a professor of anesthesiology at Wake Forest University
Baptist Medical Center, spent most of the day testifying as an expert
witness during a second day of hearings before the N.C. Medical Board. The
board has accused Talley of deviating from accepted standards of practice
in his treatment of patients, particularly as he prescribed powerful
narcotics such as OxyContin, morphine and methadone. After the hearings,
board members will decide whether to revoke Talley's license, tender a
lesser sanction or clear him.

Talley, 64, contends he has done nothing wrong, and late Friday afternoon
he put on his own expert witness -- a nationally renowned pain expert from
Texas who said Talley's treatment was exemplary.

"He was well within the standard of care," testified Dr. C. Stratton Hill
Jr., professor emeritus from the University of Texas in Houston.

Reputation spreads

At the center of the medical board's examination are 12 specific cases of
patients, identified only by letters of the alphabet. "Patient X" was a
woman who received 4,875 mg of OxyContin for arthritis, osteoporosis and
degenerative disc disease; "Patient D" was a woman whom Talley kept on
methadone during her pregnancy; "Patient N" was a drug addict.

The patients flocked to Talley's practice across the street from a
bedspread mill in Grover, a tiny town south of Charlotte. Some came from as
far away as Michigan, having heard about Talley from other doctors who
treated chronic pain. And most received prescriptions for narcotics and
other drugs the government considers addictive.

As he examined Talley's files, Rauck said, he grew concerned that the
small-town doctor was failing to perform adequate physical examinations of
patients before prescribing drugs. In case after case -- Patient X, Patient
Q, Patient A -- Rauck noted the lack of an exam.

"A physical exam to most of us requires a component of a hands-on
examination of the patient," Rauck said. Simply watching whether someone
appears to have trouble getting up from a chair is not enough. "It's
observational."

In cross-examination, however, Talley's attorney pressed Rauck to read
further into the files. In each instance, the patients had provided Talley
with their files and charts from other doctors -- some of them specialists
who had conducted exhaustive diagnostic tests to pinpoint the source of
patients' ailments.

"Isn't it true he had all the information he needed in order to prescribe
for the patient?" attorney Robert Clay asked Rauck, referring to the case
of a steel worker from Michigan whom Talley was treating with OxyContin.

"That's true," Rauck conceded.

But Rauck added that all doctors ought to do their own exams on patients --
conditions can change, doctors can miss things. He said all doctors who
prescribe narcotics should also monitor their patients carefully for signs
of abuse. Urine tests can tell whether patients are taking the drugs they
are prescribed, instead of selling them to addicts or swapping them for
street drugs.

Costs kept low

Talley has said such safeguards are unnecessary, and his expert, Hill,
agreed. Talley told the medical board earlier that his approach to care was
specifically tailored to his patient base. The people who came to see him
were often poor or lacked insurance, so he set his fee at $55 and didn't
order up procedures he deemed redundant, wasteful and expensive.

Instead, he told the board, he relied on observations, discussions with
family members and gut reactions about how well his patients were doing. In
testimony Friday, Hill said Talley offered a worthy public service to his
patients.

Trust or verify?

What's more, Hill said, Talley was right to dismiss the validity of urine
tests and other measures designed to weed out drug abusers. People who
divert their narcotic prescriptions by selling them on the street are smart
enough to pop a pill before going to the doctor for a urine test.

Similarly, if someone is addicted to the narcotics and taking too many, no
urine test can determine the amount of drug in the system. Hill said such
tests compromise the trust inherent in doctor-patient relationships.

"I'm concerned about the attitude in North Carolina," Hill said, "where
patients are considered suspects."

Testimony is expected to end today. At some point afterward -- hours or
perhaps days -- the board will render its decision.