PATIENTS FACE PAIN WITHOUT A PHYSICIAN

While Dr. Joseph Talley and his lawyers prepare his defense to
present this week before the N.C. Medical Board, hundreds of patients
who depended on the Grover family doctor for narcotic pain
medications are looking elsewhere for care.

The search is a hard one, the doctor says.

Talley, scheduled to appear before the board Thursday morning in
Raleigh in a proceeding that could oust him from the medical
profession, said his aggressive use of narcotics has been scrutinized
for years.

A 1996 change in position by the N.C. Medical Board "had us dancing
in the streets" at what seemed a much more liberal stance, Talley
said in earlier interviews.

Charges brought against him by the board in October and the federal
Drug Enforcement Administration's suspension of his narcotic
prescribing privilege in January have left him and patients in the
lurch, he said.

"The people that didn't ask for this are the patients," he said. "I
never dreamed after the 1996 position statement that this would
happen."

The N.C. Medical Board's Web site - www. docboard.org/nc - shows
Talley's license status as "free and unrestricted."

"That's correct from the medical board's standpoint," he told The
Star Thursday, "but it does not feel that way," he said, without the
DEA sanction to prescribe narcotics.

The major portion of Talley's patients were receiving some kind of
opioid therapy, often more than one medication.

Since Jan. 30, when federal agents seized his DEA number, Talley has
continued to see patients, but spends most of his time trying to get
other doctors to take them, he said.

He maintains his usual office schedule, from 6:30 a.m. to 9 or 10 at
night, he said, except for Thursdays, his regular day off.

However, the patient load is down to 10 or 12 a day. He used to
average 20 or more, and 30 to 40 when colleagues were out of the
office, he said.

"It's been very difficult for me to place patients," he said. "I've
got two or three (doctors) who I absolutely must not name that I can
get patients to, but only a few of them.

"I called one of the better family practices in Shelby last week and
tried to refer a patient," he said.

At first, he said he was put off gently, but when he pressed the
question, was turned down outright.

"I was told they had a meeting and decided they did not want to take
any of my patients," Talley said.

Talley said that when patients he has treated seek care themselves,
they are held up to ridicule.

In one example, he said, "My patients have told me over and over that
they go to the ER (the emergency room at Cleveland Regional Medical
Center) and are treated cordially enough until they say Talley is
their doctor - then they are ridiculed, laughed at."

Hospital spokeswoman Cindy Cook said while it is possible individuals
could react that way, the hospital's policy and mission statement
demand otherwise.

"When any patient comes to Cleveland Regional, they are always
treated with dignity and respect," Mrs. Cook said. "And that's
regardless of their ability to pay. Our mission statement demands
that of us."

A doctor's reputation is not a factor in how his or her patients are
treated, she said.

Mrs. Cook said she consulted with Dr. Kevin O'Dell, medical director
for the hospital's emergency department, before responding.

"He told me that any patient that comes into the 'ED' is evaluated
and treated appropriately, and if necessary, referred on to a
physician," she said.

"The ED is for acute situations," she said. "If somebody comes in and
says they have chronic back pain and are out of their medicine, our
doctors wouldn't write a prescription for 200 pills but might write
them 5."

Also, she said, the hospital doctors generally do not write
prescriptions for or dispense the same type of narcotics prevalent in
Talley's practice.

"We treat whatever diagnosis is identified for that visit, prescribe
interim medication if that is needed and refer," she said.

"We had been seeing some of Dr. Talley's patients all along in
emergency situations," she said, "but right now, we are seeing an
increased number of them."

Emergency room doctors have been referring Talley's patients to
Shelby Anesthesiologists' pain clinic here in Shelby and one in Kings
Mountain.

Doctors with the anesthesiology group could not be reached for comment Friday.

Jay Taylor, director of Pathways, declined to comment specifically on
whether the substance abuse section of the mental health clinic is
seeing an increase in Dr. Talley's patients seeking treatment for
drug abuse.

"It would not be appropriate to take a shot at any one place where
patients are coming from," Taylor said. "If we run into or are
contacted by someone experiencing withdrawal, we will evaluate that
person based on their needs."

Taylor said the clinic is "busy all the time" and it is difficult to
say if there has been an increase in people seeking help in the last
few months.

"If our intake of clients has gone up it may or may not be due to Dr.
Talley," he said. "An increase is more likely to be due to the bad
economic times."

Woody Hubbard, business administrator for Southeast Pain Care, with
seven sites in the region including Kings Mountain, said Friday that
any patient who comes to the clinics must be referred by a primary
care physician.

"Any time we have a situation where another clinic or group of
physicians' patients need to come, they all must come from primary
care referral," Hubbard said.

"As a subspecialty, it's no different than seeing a cardiologist," he
said. "It requires a referral."

Hubbard said he did not know if Talley has contacted any of Southeast's sites.

"I have not spoken with Dr. Talley myself," he said.

Hubbard said of patients being laughed at because of their connection
to Talley, "I doubt that would ever happen here."

Dr. David Barker, co-chairman of the Cleveland Regional Medical
Center ethics committee, was not available Friday to comment, but
earlier said he was concerned about continuity of care for Talley's
patients.

"I think we probably have some problems coming," Barker said in
February. "I'm concerned that there will be a lapse in these folks
being able to identify the source for medicines they need. I am
concerned that we don't have a readily available source of care for
the type of patients he has been seeing."

Barker queried, "Will the pain centers - that are being pushed and
touted by the government - will they take time to work out the
patients' needs in a way besides telling them to just sit at home and
live with the pain?"