DIFFERENT RESPONSES TO DOCTOR'S PRACTICE

Prosecutors Harsher Than Regulators

A Northern Virginia doctor whose decades-old practice dealt in the care of
patients in intense pain has received vastly different treatment at the
hands of regulatory and criminal authorities in Virginia.

A federal grand jury this week in Alexandria returned a 47-count criminal
indictment against Dr. William E. Hurwitz. If convicted, he faces a
possible life sentence in prison. Allegations range from contributing to
the deaths of patients to overprescribing highly addictive drugs, or
opioids, for pain relief.

But after the Virginia Board of Medicine heard similar accusations against
Hurwitz in May, he was told he could continue practicing and keep his license.

Hurwitz was placed on indefinite probation and told to adhere to a long
list of supervisory instructions should he reopen his office.

On the medical board's Web site, Hurwitz's license is listed as current and
active; it won't expire until late next year. And the Web site includes
dozens of pages of accusations brought by the medical board, dating to
1996, when his license was briefly revoked.

"I think the real point is, my patients are all of a sudden sent a message
by the board: Drop Dead," Hurwitz said then.

Dr. William L. Harp, the board's executive director, said yesterday that
because Hurwitz had agreed to close his practice last year, he no longer
represented a possible threat to the public.

Revoking his license, rather than placing Hurwitz on probation, would not
have had any additional practical effect, Harp said.

Sometime next year, Hurwitz will defend himself again on many of the same
charges in a federal courtroom with perhaps hugely different consequences.

"My sense of it is that there's a lot of overlap," Hurwitz's lawyer, James
Hundley, said yesterday when asked about the differing responses to
Hurwitz's practice.

"This doctor has been before the medical boards in Maryland, Virginia, and
the District of Columbia for years, in fact working with them and the Drug
Enforcement Administration to set up protocols for his practice."

At issue is the point at which a doctor becomes criminally liable for his
as well as his patients' conduct.

While Hundley yesterday characterized Hurwitz as "the top guy in his field"
and as a man who "never had anything but the best care in mind for his
patients," the federal government sees Hurwitz in another light.

U.S. Attorney Paul J. McNulty, in a news conference Thursday, described
Hurwitz as a physician who "dispensed misery and death," furthered the
illicit distribution of highly addictive drugs such as OxyContin, ignored
clear evidence of drug addiction in his patients, and generated nearly $2
million in profits.

Hurwitz was arrested by federal agents without notice early Thursday during
a visit to see his children, Hundley said.

"His spirits were strong. Obviously, he's very concerned, but he's
emotionally calm," Hundley said after visiting the doctor in a holding
cell. A bond hearing is scheduled Monday.

Hurwitz has made headlines and generated high-profile television
appearances for years. His practice, he has said, is breaking new ground in
the little-understood area of relief from chronic pain.

When the state's medical board first took up allegations against him in
1996, a hearing in Richmond drew scores of his supporters. Medical board
members were so concerned about the tense atmosphere that they summoned police.

When state regulators briefly took Hurwitz's license, patients said they
feared agonizing withdrawals from medication. Many talked of death; at
least one patient committed suicide.

But the families of patients who died while under Hurwitz's care openly
blamed Hurwitz. And patients have testified that his treatments produced
erratic behavior, lacked caution, and seemed experimental.

A Maryland man, for instance, said in 1996 that he received prescriptions
for more than 3,000 painkillers after two brief office visits.

The medical board allowed Hurwitz five years ago to continue his practice
under a protocol that Hurwitz himself developed. The Drug Enforcement
Agency, which registers doctors who prescribe addictive drugs, reinstated
his registration.

In May of this year, the Virginia board again heard a long list of
allegations against Hurwitz, including those involving three new patient
deaths, allegations of substandard and grossly negligent care, poor
record-keeping, and a failure to refer patients to other doctors or to
recognize alternative treatments.

In one instance, Hurwitz's records continued to reflect vital signs for a
patient who had died from toxic levels of morphine.

But for Hurwitz's many advocates, news of his indictment shuts down hope
for a source of vital help.

"The government is telling physicians that their oath to care for people
must be second to investigating whether their patients are drug addicts. It
forces doctors to become policemen," said Laura Cooper, who moved to Oregon
from Virginia when Hurwitz closed his McLean office last year.

"It's worse in Oregon," said Cooper, who has multiple sclerosis. "Here it's
easier for a doctor to euthanize me than to give me medicine that will help
my pain."