PATIENTS BATTLE PAIN, SUSPICION

The arrest of an Indianapolis pain doctor on federal Medicaid fraud charges
has put hundreds of patients in crisis, unable to get vital medication and
at risk of severe side effects from withdrawal.

Dr. Randolph W. Lievertz, who was arrested late last month, is accused of
writing dozens of prescriptions for the powerful narcotic OxyContin, which
later was sold on the street.

One patient also was charged, and Assistant U.S. Attorney Josh J. Minkler
said investigators suspect others might have been selling the highly
addictive painkiller, which when crushed and ingested by an abuser can
produce a high similar to heroin.

As a result of the investigation, Lievertz's patients -- court records
indicate there might be up to 1,000 -- are battling a cloud of suspicion.

Notified recently that Lievertz is out of business, and with prescriptions
running out, legitimate patients are finding many pharmacists refusing to
refill prescriptions and family doctors reluctant to write them. Patients
who get referrals to pain clinics might have to wait weeks for an
appointment, which could lead to debilitating side effects -- from nausea
to sleeplessness to intense pain -- if they run out of the medication.

"They're going to be pretty desperate. They're going to get sick, and
they're going to withdraw. . . . I would guess a lot of emergency rooms
will be full," said Dr. Douglas Molin of the Marten Center for
Complementary Medicine and Pain Management at St. Vincent Hospital.

One patient affected is Susan Pisarzewski, 42, who needs a walker to get
around her tiny mobile home in Wheatfield. A degenerative back problem and
several failed surgeries have left her unable to sit up straight -- most of
the time she leans forward, her elbows on her knees.

"It feels like someone has taken a spear and jabbed it right into your hip.
Then the pain travels down your leg, and it feels like the toes are going
to blow off your foot," she said. "It's a crushing, heavy weight, like my
back is just going to fall apart."

Pisarzewski had been under Lievertz's care for more than four years. She
takes 44 pills each day, including OxyContin.

But since the physician's arrest, Pisarzewski has had trouble getting her
OxyContin. Her pharmacist asked if she was a drug dealer. Her primary care
doctor wouldn't help. A nurse practitioner who has cared for her daughter
also refused.

Finally, she got in to see a new doctor after telling him she needed
treatment for a rash. After meeting her in person, he agreed to write her a
prescription for morphine so she can avoid withdrawal. But Pisarzewski
fears the pain will become overwhelming while she waits for an appointment
with a new pain specialist next month.

Skip Baker, president of the American Society for Action on Pain, a patient
advocacy group in Virginia, said similar scenarios are unfolding nationwide
as authorities crack down on illegal OxyContin use. Some pain patients need
emergency counseling to prevent them from committing suicide if they are
cut off from their medications, he said.

"People who haven't been through it have no idea how bad it is," he said.
"It's very hard to find doctors who understand this."

Molin said people in pain cannot get high from OxyContin because the drug,
which has a time-release mechanism, travels to the distressed nerve endings
throughout their bodies rather than to their brains. Yet many patients are
incorrectly labeled addicts.

"Pharmacists look strangely at our patients, and some don't even fill the
prescription," he said. "Doctors are that way, too. (They think) if you're
taking opiate medication, you're an addict."

Dr. Palmer J. MacKie, director of the integrated pain center at Wishard
Memorial Hospital, said primary care physicians need to help their patients
through the rough transition to finding another pain specialist.

MacKie said the family doctors shouldn't let suspicions about addiction
scare them into neglecting their patients.

"I suspect they are (scared), and they're behaving irresponsibly," he said.
"Sure, it's a little bit worrisome, and it may be a bit questionable. But
that's all the more reason to get involved and help your patient."

It's especially important because many patients face lengthy waits for
appointments. At the Wishard pain clinic, there is an eight-week wait for
an appointment. The Marten Center is similarly booked.

Molin hopes area pain specialists can work out an emergency plan to help
Lievertz's former patients. Molin said he's willing to risk writing a few
prescriptions to drug abusers if it means he can help people who genuinely
are suffering.

"If I have two patients, one an addict and one legitimately in pain, I
would rather give out two prescriptions than deny the person who is in pain
the medication," he said.