Pubdate: Wed, 11 Aug 2004
Source: Redding Record Searchlight (CA)
Copyright: 2004 Record Searchlight - The E.W. Scripps Co.


In early 1999, state officials spun a tale involving a drug-abusing 
physician whose greed and contempt for the law led him to run a pill mill 
that created thousands of addicts and left a trail of dead bodies. They 
charged him with multiple counts of murder and set his bail at $15 million.

Five years later, a jury acquitted the doctor of even misdemeanor fraud 
charges. As for the deaths, the original murder charges were reduced to 
involuntary manslaughter, delayed for years, then dismissed in 2003. State 
prosecutors say medicine has evolved and the practices that made Dr. Frank 
Fisher a menace to society then would not be worth bringing before a jury 

The utter collapse of the state's case against Fisher and Stephen and 
Madeline Miller, former owners of the Shasta Pharmacy, shows the hazards of 
trying to answer medical questions in the criminal courts.

OxyContin -- the opiate painkiller at the heart of the case -- is both 
highly effective and powerfully addictive. It has given patients relief 
from chronic crippling pain but also spawned crime waves fed in part by 
patients who resell their prescription pills. Where is the divide between 
aggressive pain treatment and reckless dispensing of addictive drugs?

To the state, it originally seemed obvious that Fisher and the Millers were 
far over the line. In 1998, Fisher prescribed and Shasta Pharmacy dispensed 
huge quantities of oxycodone, the generic name for OxyContin. Shasta 
Pharmacy was by far the state's largest retail distributor of the drug, 
largely because of Fisher's prescriptions. And, of course, people had died.

But OxyContin had come on the market in 1996, and its use was quickly 
spreading. Today its manufacturer, Purdue Pharma, sells about $1.2 billion 
worth a year. Fisher may simply have been ahead of the curve in his 
practice, which should not be a crime.

It would be too easy to say that the police should never intrude on the 
doctor-patient relationship. Physicians are not saints. Criminals abuse the 
system. Vast sums of taxpayer money are spent on Medicare and Medi-Cal, and 
the government must pursue suspected fraud.

Still, there are clear signs of a system out of balance. The Association of 
American Physicians and Surgeons recommends that doctors avoid using 
opiates in pain management because the risk of prosecution is too steep.

That fear is entirely justified. Doctors around the country are serving 
long prison terms after being prosecuted on charges related to 
overprescribing painkillers. Fisher and the Millers have lost their homes, 
livelihoods and reputations, but having their freedom leaves them better 
off than some.

Prosecution of suspected wrongdoers is not a problem -- it is law 
enforcement's job -- but a climate of paranoia that prevents legitimate 
pain patients from receiving treatment only causes needless suffering. The 
system must guard against abuse, but our medical standards should be set by 
doctors and patients, not cops and robbers.
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MAP posted-by: Keith Brilhart