DOCTORS DISCUSS TALLEY

GROVER - One local doctor calls prescribing narcotics "a double-edged
sword," one that has cut self-styled pain specialist Dr. Joseph Talley.

Area doctors who talked with The Star don't condemn the embattled Talley,
embroiled in investigations for his liberal prescribing of narcotic
painkillers, and linked by the federal Drug Enforcement Administration to
at least 23 drug-related deaths.

Labels from colleagues range from "thorough" to "narrow in his thinking."

The consensus, however, is that the 64-year-old family practitioner knew
that scrutiny from the N.C. Medical Board and DEA would come sooner or
later, as his penchant for prescribing the drugs grew over a 35-year practice.

Dr. Ron Delaney, who joined Talley's Grover Medical Clinic part time in
1998, when former partner Dr. Richard Crowley had heart surgery, said he
has prescribed some of the same narcotic medicines as those Talley is being
investigated for, but not to the same extent.

Delaney said the DEA crackdown on the man known as "the pain doctor" at the
"clinic of last resort" is "throwing out the baby with the bath water."

Across-town colleague Dr. Philip Day agreed.

"I don't think they handled it well," Day said of the federal
investigation, in which the DEA seized patient files and suspended Talley's
narcotics-prescribing privileges.

The answer, said Day, "is not to do away with these drugs altogether.
Doctors always have to weigh the risks against the benefits of the medicines."

From the inside

Delaney said working inside the practice, he saw nothing in four years that
warrants the current attacks.

However, outside the office, Delaney had been hearing rumors for so long,
that when the DEA arrived on Dec. 19, closed the office for the day and
removed hundreds of patient record files, he said, "I wasn't surprised."

DEA agents questioned him, as they did other staff members, he said.

"They said that morphine and Demerol were being diverted from this office.
I knew right away there was something wrong with that - we don't use
Demerol. It was either a crock or they were being misled."

Delaney said the informal interrogation was "not coercive," but "they had
some preconceived notions."

"What they normally find," he said, "is either a doctor with a drug
problem, or a doctor trading drugs for sex, or money or both. I have never
seen anything of the sort.

"And I think they thought there was a kickback thing going between the
clinic and the drugstore, MediFare.

"They came in and found nothing, but they want this clinic closed. It's
part of a DEA campaign across the country," he said.

"They'll have a hell of a time building a case, because there were no
drugs, no sex and no money, but they got Dr. Talley ruined, and I think
that was the object. If law enforcement had worked together in concert with
him, all of this could have been avoided."

Many Talley patients - many with mental disorders and/or chronic pain -
have been through the medical system and generally gotten poor results,
Delaney said.

"A lot of other physicians want nothing to do with these patients," he
said, because of the scrutiny. "It's easier to walk away, which most
physicians have elected to do, except Dr. Talley."

Talley has paid for his method of practice in other ways, Delaney said.

"He dispenses a lot of medical service for which he never gets paid," he
said. "These office facilities are outdated, he's here 12 to 15 hours and
more a day.

"Of doctors in Cleveland County, I'd say that Dr. Talley is at the bottom
of the totem pole in income."

Colleagues' opinions

Dr. David Barker said Talley has had an ongoing battle with the N.C.
Medical Board, "but he has not been trying to make a killing with pushing
drugs, which is what they would have you believe."

Barker, co-chairman of the Cleveland Regional Medical Center Ethics
Education Committee, said that since Talley does not practice in the
hospital, he doesn't come before the hospital ethics committee.

"But he's never had any ethical charges brought against him elsewhere,"
Barker said.

"He is very thorough in what he does, even if you don't agree with what he
does. I couldn't say that he had done things he had not thought through
ethically.

"I think he could have done it better and avoided a lot of conflict, but
that's not the way Joe works," he said.

"I really think that we're going to miss Joe Talley if this can't be worked
out. It's a shame his expertise is going to be silenced."

Barker credits Talley with "a level of academic understanding and the
empathy to work with patients."

"Few doctors are willing to sit down and spend time with these people, to
sort through their problems and give them a functional life."

Dr. Mike Miller with Shelby Family Practice has known Talley 25 years and
called his methods "certainly different" but not "wrong."

Miller, the other co-chairman of the ethics committee, said Talley "does a
lot more good than he does harm, but some patients have, I think, taken
advantage of him.

"I've heard him criticized for liberal use of medication. It is his
contention that many patients are undertreated and he is willing to step
into the role where some other doctors are unwilling to go."

Miller called narcotics prescribing "a double-edged sword that can swing
back and cut you."

"If patients are prescribed narcotics with good intent, and take them with
criminal or recreational intent, they can do themselves harm. Drug seekers
are very manipulative people and can be tremendously convincing. There's
not a doctor in practice five years who hasn't been faced with that."

Day, however, said Talley's tunnel-vision approach hurts him and patients.

"I've known Dr. Talley for years and known you could walk in for a work
excuse and walk out with Xanax," Day said. "He's narrow in his thinking
that way -thinking you can't get people addicted. I think you can get
people addicted."

Day runs the only other medical clinic in the town, and said he is already
seeing two to four Talley patients a day.

"It's going overboard to say, 'I'm not going to see any of his patients -
they're all drug addicts,' but I told him outright that my methods are
quite different from his.

"I have a reputation for being kind of stingy with meds, especially
narcotics," Day said. "I'm not prepared to say he's an overprescriber. He
primarily did a good job with what he did, but he attracted a lot of attention.

"The question for him is, in his own mind, did he do the right thing?"

Balance, said Day, is the key.

"I, like most doctors, try to strike a balance," he said. "Talley is on one
end of the spectrum. The other end is doctors who use baby aspirin for pain."

Being a good doctor, he said, "is informing patients about options. Let
them take an active role in their own care. There are reasonable people out
there who want options.

"Dr. Talley didn't give people options. There's no balance over there. He
is authoritative."

Where can patients go?

Talley admits he has no special credentials in pain management.

He went through standard medical training, getting his basic medical degree
in 1963 from the University of Virginia, intering in family practice at
Norfolk General Hospital for a year, then serving two years in the Navy
before moving to Charlotte Memorial Hospital, where he completed his
residency in 1967.

In the late 1980s, he served as clinical assistant professor in the
University of North Carolina's Department of Family Practice.

He became known as a pain specialist the same way he became known decades
earlier as a depression specialist, in his words, "because that's what kept
walking through the door."

Now, he says his concern is what is walking out the door.

"I've been watching patients as they were walking out of here - their
faces, their hopelessness.

"If they are all drug addicts, nobody will miss them at all, but legitimate
people in pain, there's going to be a huge load in emergency rooms, etc."
Talley said.

"I feel helpless and useless to them."

Others are also concerned.

"Off the cuff, I think we probably have some problems coming," Barker said.
"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," he said.

"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?"

Despite the controversy, Miller said, "Quality control is an important
aspect of any good industry, including the industry of medicine.

"Watchdog oversight is a healthy deterrent to misbehavior - I don't condemn
it."

However, he said, "I don't think there's that much impact on the great
majority of physicians, because they don't use medicines as aggressively as
(Talley) does."

Internal medicine specialist Dr. Ian Stamp said he would not comment on the
specifics of Talley's case.

"A doctor accused of a crime, until he's found guilty or innocent, one
cannot say he is guilty or innocent," he said.

"However," he added, "it is necessary for physicians to practice good
medicine, and what we swore by (in the Hippocratic Oath) is to do no harm
to patients."