PATIENTS SEEK ALTERNATIVES TO PAIN CLINIC

Hundreds of people with chronic pain problems still are searching for
an alternative to the pain management center that Virginia
Commonwealth University's Medical College of Virginia plans to close
at the end of next month .

Some patients are turning to the three doctors recommended by MCV in
its April 1 announcement that it would close the pain center operated
by its department of anesthesiology since 1973.

But one of the physicians, Dr. Michael J. Decker, said there aren't
enough pain specialists in the community to handle all of the patients that
depended on the center.

"These people are in the clinic they're in because they're not going
to get better in a few days or a few weeks," said Decker, a pain
specialist on the faculty of MCV's Department of Physical Medicine and
Rehabilitation.

He said his private practice had received "a surprisingly small
number" of phone calls from patients of the center.

The man who started the center, Dr. Amir Rafii, fears that patients
who don't have private insurance will be left in the lurch.

"I think it's horrible to have a patient on narcotics, then all of a
sudden no one is going to prescribe them," Rafii said yesterday from
his home in Scottsdale, Ariz. "If it stops abruptly, they go through
withdrawal .*.*. It's the most horrible thing. It is torture. They
are suffering."

And Dr. William Hurwitz, a Northern Virginia pain management
specialist who temporarily lost his medical license after he was
charged with excessive prescribing of opiates, said patients without
insurance "will be orphaned and condemned to go through withdrawal and have
more pain."

He said primary-care doctors are unlikely to take over managing the
center's patients because state and federal regulators have shown
little tolerance for doctors who prescribe narcotics in large doses.

But the number of patients affected by the clinic closing isn't as
large as MCV officials originally feared, when they said 5,000 to
7,000 patients were served by the pain center.

The clinic actually has just under 850 active patients.

A special task force will meet next week to try to set up a new clinic
drawing on MCV's other pain management programs, including those in
neurology, psychiatry, orthopedics, surgery, substance abuse, the
Massey Cancer Center and physical medicine and rehabilitation.

The letter to patients announcing the center's closing did not mention
MCV's efforts to set up a substitute or that Dr. Lawrence S. Gorfine,
director of pain management services, was leaving to return to private
practice in Florida.

Gorfine and Dr. Wayne K. Marshall, anesthesia department chairman,
said the center suffered financial problems because it treats so many
uninsured patients and because managed-care companies had cut the fees
they pay.

Dr. Hermes A. Kontos, dean of the medical school and vice president of
health sciences at VCU, said he agreed to shut down the center because
Marshall could not find a replacement for Gorfine.

Gorfine would not say why he was leaving but denied that his
resignation was responsible for the center's closing.

MCV said 265 of the center's 843 patients, or 31 percent, do not have
insurance. It said it could not determine how many of those patients
are too poor to pay for their care.

Kontos dismissed the suggestion that the center is closing because of
financial problems, saying it had lost money for years. The anesthesia
department received $38,000 from MCV Hospitals to compensate it for
caring for the indigent.

He said he expected many of the center's uninsured patients would
continue

to seek care at MCV. "I think the {insured} patients are going to make
their own arrangements," he said yesterday. "The uninsured are going
to stay with us - I'm confident about that."