PAIN PATIENTS ASSURED THEY CAN GET HELP

A Montana senator has assured a group of chronic-pain sufferers whose
Billings doctor is under federal investigation that their medical
needs will be evaluated by a local clinic.

Sen. Max Baucus, D-Mont., secured a promise from Deering Clinic that
the county-run medical center will offer patients of neurologist
Richard A. Nelson "the opportunity to be assessed by their staff for a
continued pain-management care plan."

The Drug Enforcement Administration in April suspended Nelson's
privileges to write prescriptions for certain painkillers pending a
criminal investigation into his West End medical practice. Nelson has
not been charged with a crime and remains in good standing with the
Montana Board of Medical Examiners.

Many of his patients claim they have been blackballed by the local
medical community because of their association with him, and some
contacted Baucus' office for help.

In a letter to Siobhan Reynolds, president of the New York City-based
Pain Relief Network, Baucus said he could not address the DEA's
investigation into Nelson. Reynolds traveled to Billings recently to
help Nelson's patients seek care.

"My legislative office has no jurisdiction over judicial matters and I
maintain a strict policy of not interfering with criminal
investigations," Baucus wrote.

But the senator contacted Deering Clinic on the patients' behalf, and
he encouraged the patients to seek treatment there.

The clinic's promise to evaluate the patients was not a guarantee to
continue the treatment prescribed by Nelson. In a letter signed by
medical director Dr. James Guyer, the clinic said its providers would
work with patients to establish a plan for care.

"The plan may include new or updated tests, and is likely to include
treatments other than medicines, to help you function at your best,"
it reads.

After receiving a copy of Baucus' letter, pain sufferer Greg Wilkinson
visited Deering in hopes of securing a narcotic prescription to ease
his chronic neck and back pain. But, he said, doctors recommended
surgery and resisted dispensing any painkillers.

"They are basically going to make me go through a full medical review
twice," Wilkinson said after the appointment. "This isn't an
assessment. This is an insult."

Ultimately, the clinic gave Wilkinson a prescription for methadone,
which he said does not eliminate his pain.

"Their treatment plan is to refer me to a surgeon I don't have the
money for," he said.

Wilkinson and other patients of Nelson's blame the DEA for their
inability to get adequate pain relief. They claim Nelson was unfairly
targeted by DEA agents and that other local doctors refuse to treat
them for fear of the agency.

The patients are circulating a petition that asks Montana's
congressional delegation to initiate a Senate Judiciary Committee
investigation into the DEA's actions.

"A doctor cannot do his job if Big Brother is sitting over his
shoulder," Wilkinson said.

Billings' largest medical facilities - Deaconess Billings Clinic, St.
Vincent Healthcare and Deering - deny that fear of federal
investigators affects the way they treat patients.

But Montana's attorney general, Mike McGrath, is worried that pressure
from the federal government is preventing the state's doctors from
adequately treating patients who suffer from chronic pain.

McGrath was among 30 attorneys general who signed two letters
addressed to the DEA that question the agency's investigations into
physicians who prescribe narcotic painkillers.

The DEA is sending mixed messages to the medical community that are
"likely to discourage appropriate prescribing for the management of
pain," according to one of the letters. It was authored in March by
Oklahoma Attorney General Drew Edmondson.

"Whenever possible, physicians and other health care providers should
not be put in the position of having to choose between protecting
themselves and providing the best possible care for the patients who
need their services," the letter reads. But the DEA has made it clear
that "any physician (or other health care provider) can be
investigated at any time for any reason."

A spokeswoman for McGrath confirmed that the attorney general signed
the letters but said his office had no additional comment.

The March letter is critical of a DEA policy statement that reads, in
part, "the government can investigate merely on suspicion that the law
is being violated or even just because it wants assurances that it is
not."

DEA spokeswoman Karen Flowers said the agency's broad investigative
powers stem from a U.S. Supreme Court decision.

Doctors who prescribe narcotic painkillers make up a small portion of
the DEA's prescription-drug cases, Flowers said. Of the more than 1
million doctors with DEA permission to prescribe narcotics, 42 were
successfully prosecuted last year.

"The DEA recognizes people are in pain and they need medicine to
alleviate that pain," Flowers said. "On the other side of that coin,
we are duty-bound to protect the public from abuse of those drugs.

"Doctors acting in good faith and in accordance with established
medical practices should remain confident in their ability to
prescribe pain medication to their patients."