Patients Lament Clinic's Closing: Many Unaware of Troubles Until Arriving

Out of pills, the pain returns.

The constant pain that started with everything from a car crash to trying
to move furniture that was too heavy.

The people who pull off of I-77 in New Philadelphia and into the parking
lot of the Professional Pain Management of Ohio clinic say relief for them
comes in the form of hydrocodone pills from Drs. Edward DeHaas and William
Napoli.

The Tuesday raid on their pain management clinic by police agencies, the
Tuscarawas County prosecutor's office and the Ohio Pharmacy Board didn't
stop patients from showing up Wednesday, Thursday or Friday.

"I really don't understand," said Patricia Spaulding, who arrived for her
regularly scheduled appointment Friday morning. She lives in Maryville,
Tenn., a 4 1/2-hour drive to New Philadelphia. She was injured in a car
crash in 1990, and has been coming to DeHaas' clinic for about four months.

"This is the only place that's ever helped me at all," she said.

The clinic's doctors haven't been charged criminally, but their patients'
medical charts were seized. Without them, the doctors had no medical
history from which to draw and, therefore, could not treat patients.

"Can't they just start a new chart?" asked one patient who drove more than
four hours for a regularly scheduled appointment. She had hoped for a
refill on her Lorcet medication. Lorcet is a highly addictive painkiller.

DeHaas shook his head and looked down, crestfallen.

"That would take an MRI and a referral and all their medical history all
over again," said the Stark County doctor, who opened the clinic in
February. Napoli left his practice in Carrollton in July to join him.

Assistant Tuscarawas County Prosecutor David Hipp refused to return the
charts, despite protests by the doctors' attorney, John A. Tscholl. DeHaas
announced Thursday night that the clinic would reopen to newly referred
patients, but his hopes were dashed Friday morning. Tscholl announced the
place remained closed with no reopening in sight.

Investigators questioned the doctors' referral practice, which Hipp said
involved three area chiropractors. The clinic can only take patients by
referral from other doctors. Hipp claims the clinic would give potential
patients a list of chiropractors, who then would refer the patients back to
the clinic within as little as a couple hours.

DeHaas said his patients come from 11 states, yet Hipp said all of the
license plates in the parking lot during the raid were from Kentucky.
Tscholl said the prosecutor targeted Kentucky residents solely out of
prejudice, calling the searches of Kentucky residents "an unusual form of
profiling only those of Appalachian origin."

Kentucky has a problem with prescription-drug abuse.

"The problem is almost epidemic," said Ewell Balltrip, executive director
of the Kentucky Appalachian Commission. "It is without question one of the
major human resource problems that this region has."

Law enforcement officials have been battling with increasing frequency
illegal trafficking of OxyContin, a morphine derivative used as a
painkiller and commonly referred to by law enforcement as "hillbilly
heroin." Hydrocodone is a relative of that drug, Hipp said, and contains
many of the same addictive characteristics. Even radio personality Rush
Limbaugh has admitted addiction to the painkillers.

"Counties in eastern Kentucky lead the nation in terms of grams of narcotic
pain medications distributed on a per capita basis," according to the U.S.
Drug Enforcement Administration's Web site at www.dea.gov

The DEA included the trade names of hydrocodone drugs called Lorcet,
Anexia, Tussionex, Tylox and Vicodin.

"The OxyContin and the Lorcets and really almost any other of this type of
painkiller seem to be the most prominent among the abusers and misusers, at
least in the form of the anecdotal information that we receive," Balltrip said.

He was not surprised that Kentucky residents would brave the 4 1/2 -hour
drive to the New Philadelphia clinic to get the pills.

"I think it goes to the issue of supply and demand. They're willing to go
where the drug is," he said.

Nikki Maynard of Johnson, Ky., who showed up at the clinic Friday for a
regularly scheduled appointment said, "It's hard to find someone who'll
treat you for pain." DeHaas prescribed Lorcet for her about a year ago for
pain she suffers from a cracked tailbone, and, she said, "it's hard to get
off of it after that long."

Debbie Muncy of Maryville, Tenn., which is south of Knoxville, said she's
been coming to the New Philadelphia clinic for about four months after
"word of mouth" led her here. She hurt her back moving furniture in 1989
and a car crash worsened it. A heart condition and other medical problems,
she said, made her a high risk for back surgery, but DeHaas, 64, and
Napoli, 47, are "the only doctors who could help me."

For the first time in years, she said, she could clean her house, something
pain had, until now, prevented.

Earley and Abigail Muncy drove from Kermit, W.Va., an hour south of
Charleston, on Friday for an appointment.

"You're in pain and you go into an emergency room and they tell you that
you have to go to a pain management clinic," Earley Muncy said.

His wife added, "These doctors are the only ones who have been able to help me.

"There are people who abuse these drugs, but we're not here because we have
a drug problem. We're here because we have pain and we need our medicine."

Kelly Meese, a medical assistant at the clinic, tried to describe the
chronic pain many suffer: "Imagine having a really bad toothache every day
of your life. That's what it's like," she said.

The clinic, which includes eight full-time and two part-time staff members,
serves patients from 11 states, DeHaas said. Hipp said the clinic sees
about 90 patients a day at $195 cash for the first visit and $145 cash for
subsequent appointments.

"They have nowhere else to go," DeHaas said. "We've helped so many people.
Many of them can sleep for the first time in years. Others have lost
weight. Others have gone back to work and some have gotten off psychotropic
medicines."

He said that most doctors hesitate to treat pain by prescribing appropriate
medication because they fear investigation and sanctions by regulatory
agencies. As a result, he said, people in pain do not easily function in
their everyday lives. He said he treats amputees as well as people injured
working in coalmines in the Appalachian region.

"I've never heard of any doctors in Kentucky or anywhere else refusing to
treat patients," Hipp said. "They may have problems with doctors out in the
sticks, but they don't have to travel 4 1/2 hours to get here to see one."

Balltrip said that while portions of Kentucky are "medically underserved,"
competent doctors and pain clinics do exist there.

"We have adequate physicians in the county where I'm located in the heart
of the coal fields, and there are pain management clinics in Eastern
Kentucky and in some of the nearby metropolitan areas," he said.

"The abuse of these medications is not necessarily linked to a coal-mining
population. It's across the board.

"What we have encountered are instances where health-care professionals
have said that there is a fine line that doctors have to walk in
prescribing these pain medications for folks who have a legitimate need for
them."

Still, he said, the doctors do not refuse to prescribe them.

The real problem is the people who abuse the drugs, Spaulding, one of the
patients, said.

"This is really awful," she said. "Other people abuse their drugs and it
causes those of us that need these drugs to do without and that's what hurts."