Pubdate: Mon, 09 May 2005
Source: Richmond Times-Dispatch (VA)
Copyright: 2005 Richmond Newspapers Inc.
Contact:  http://www.timesdispatch.com/
Details: http://www.mapinc.org/media/365
Author: Bill Mckelway
Bookmark: http://www.mapinc.org/find?232 (Chronic Pain)
Bookmark: http://www.mapinc.org/oxycontin.htm (Oxycontin/Oxycodone)

DOCTOR'S CAREER REMAINS IN LIMBO

He's Still Suspended, But Parents Of Son Who Died Angered By Vague Ruling

WILLIAMSBURG -- Crisply dressed, unbent and silent after a three-day 
hearing, Dr. J. Howard Shegog faced weary members of the state Board of 
Medicine in the wee hours of yesterday morning and learned that his 
decades-long medical career still hangs in limbo.

Shegog closed his Newport News medical practice in March when his license 
was suspended by an emergency order after the death of a chronic pain 
patient. But his bid to return to work under strict conditions failed 
yesterday after a grueling and emotional hearing that examined dozens of 
charges and events preceding the deaths of nine patients over a four-year 
period.

The proceedings ended at 2 a.m. with a decision that Shegog's license will 
remain suspended. He can apply for reinstatement in September, the board 
concluded, but there were no conditions offered by the medical board that 
would make a return to practice possible.

Board members, including board president Dr. Thomas B. Leecost, of 
Richmond, declined to comment.

The vague decision left both the doctor and alleged victims of his care 
grappling for closure.

"Obviously, we're very disappointed," William Devine, one of Shegog's four 
lawyers, said as he guided the doctor, his wife and family friends out of a 
Williamsburg conference center where the hearing was held.

Shegog, 65, who is also under federal investigation in connection with his 
pain practice and is a past president of the Old Dominion Medical 
Association, did not testify.

Devine had argued that Shegog was being held to an unfair standard of care 
given the uncertainty of guidelines associated with the care of chronic 
pain patients. They repre-sented "a thin sliver" of Shegog's respected 
practice, said Devine, who will appeal the decision.

But the mother of one of Shegog's patients, a man who died from a toxic 
reaction to drugs prescribed for him by Shegog, bitterly criticized the 
board for not revoking Shegog's license.

"How many more people have to die?" she said. "I'm just sick, sick to death 
of the system. He'll just wait a while and get his license back."

The woman was unidentified when she testified and she asked reporters not 
to publicly identify her. She said she was stunned when board member the 
Rev. Alvin Edwards, the only nonmedical member of the eight-person panel 
hearing the case, asked her if her divorce may have contributed to her 
30-year-old son's drug addiction.

"My God. That happened when Michael was 3. What could this man be 
thinking?" said the woman, who sat with her equally distraught former 
husband through much of the hearing.

On the witness stand, the woman said that she found pill bottles and 
prescriptions indicating that Shegog had prescribed large doses of drugs 
for her son, the day before his death. He had a long history of drug 
problems, she said, and had been treated at a clinic in Richmond.

Within hours of her son's death, she called Shegog and accused him of 
murder, she testified.

Medical records examined by the board showed that Shegog had issued the man 
large doses of drugs on his initial visit with five refills but had no 
clear documentation of the man's health history or drug use.

But Devine, in the case of the woman's son and other deaths, said there was 
no evidence that Shegog's care was directly linked to any of the patients' 
deaths.

Instead, he said Shegog was a compassionate and respected physician. 
Underlying his care was a vast underprescribed population of legitimate 
chronic pain patients who cannot receive care because of physician fears of 
disciplinary action and criminal investigation.

Devine questioned one board expert who outlined the need for strict 
criteria, detailed patient histories and patient contracts in prescribing 
opiates for pain patients. Yet the witness, a Northern Virginia pain 
specialist, refused to treat the severest cases.

"That's an ivory-tower practice," Devine said.

Shegog "was the only barrier between [the patients most in need] and the 
street," Devine said. "That's what the evidence and the reality showed."

Longtime medical professionals on the Peninsula testified that Shegog was a 
respected, loving physician whom they had known for 20 years or more; but 
none of them had a firsthand knowledge of Shegog's medical records and 
treatment plans.

Virginia is one of the country's hot spots for illegal use of OxyContin and 
other addictive pain medications. Federal investigators are carrying out 
several investigations of Virginia doctors known for prescribing the drugs.

Much of Shegog's hearing was monitored by federal drug and criminal 
investigators. Testimony and various hearing documents indicate that Shegog 
has been under state or federal investigation since the mid-1990s.

Assistant Attorney General William C. Garrett and several board members 
returned again and again to Shegog's patient records, which showed little 
effort to track patient progress, pain levels, pill counts and past drug use.

He prescribed to one patient who lived more than 200 miles away and whom he 
hadn't seen for months, failed to develop information about possible 
multiple suppliers for drug-seeking patients, and sometimes allegedly 
disregarded pleas from other caregivers not to continue prescribing certain 
drugs to addicted patients.

Catherine Welsh, a nurse who worked with Shegog for several years, 
described a practice that had become top-heavy with chronic pain sufferers, 
at times reaching 80 percent of the caseload.

She said disruptions occurred in office practices. At closing time the 
office would be besieged by patients exhibiting slurred speech, stumbling 
and other drug-seeking behaviors.

"It was overwhelming," she said, conceding that at times she recovered 
prescriptions for waiting addicts because, "I was afraid not to."

When confronted by staff, Shegog simply said that he was "comfortable" 
handling the patients, but medical records showed he has had little 
training in pain medication.

Welsh said that as conditions worsened, nurses and other staff began seeing 
the names of patients in the obituary pages.

"When people started dying that was a whole different animal," she said. 
"We just wanted it to stop."

Shegog, she said, "was a simple man who got confused between compassion and 
value" of care. "I don't know how it went haywire, but it did."

Unmentioned during the hearing last week were investigations of Shegog's 
drug-prescribing habits in the mid-1990s. State records show he was brought 
before the medical board for allegedly overprescribing thousands of dosages 
of narcotics. The medical board dismissed the case.

That decision came in the same conference center where Shegog's case was 
heard over the weekend, just a few yards away in another room.

"I don't feel like things progress very fast with the board of medicine," 
said the mother who'd testified about her son's death.

"I was hoping that my son's death would help keep other parents from having 
to go through this. Now I don't think so."
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