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." - --- MAP posted-by: Beth