Pubdate: Wed, 01 Oct 2008
Source: Fort Worth Weekly (TX)
Copyright: 2008 Fort Worth Weekly
Author: Jeff Prince
Bookmark: (Oxycontin/Oxycodone)


David Noblett -- and dozens of other patients -- just wanted their
doctor back.

A white-haired little man with piercing blue eyes, wearing an Army cap
and carrying a briefcase, came to the Fort Worth Weekly office a few
weeks ago, entering what seemed to him a door of last resort. He hoped
we'd help him expose something he considered an injustice, and he
wasted no time launching into his story, speaking quickly, almost
desperately, like a man who'd told it many times before to people who
weren't interested, as indeed he had.

His problem: The Texas Medical Board, which regulates the practice of
medicine in Texas, had suspended the license of his doctor, William D.
Littlejohn, a specialist in treating chronic pain. Noblett and others
believed Littlejohn had a strong defense against the single complaint
brought against him, but for two years the agency has left the
physician in limbo, his license suspended, but with no permanent
ruling on the case. That left 300 patients in the Fort Worth area
unable to get prescription medicines because there aren't many doctors
willing to specialize in -- or write painkiller prescriptions for -- a
field of medicine that is drawing the wrath of regulators.

The popular perception, particularly among board examiners and federal
regulators, is that chronic pain patients are "legal drug addicts" and
their physicians are "pill pushers," Noblett said. Opioids are
addictive, and in the past decade, painkillers such as OxyContin have
become more abused and used recreationally, a hot party drug for kids
who have increasingly become overdose victims. Cutting up time-release
pills for quicker rushes or mixing them with alcohol can be lethal.

But for Noblett and other chronic pain patients, oxycodone is a
miracle drug when used correctly. Now the federal government is
cracking down, and the state medical board is following that lead in
Texas. The medical board, which got in deep trouble a few years ago
for its lax treatment of corrupt and incompetent doctors, has changed
its tune -- so much so that one national doctor's group believes it
has gone overboard in the other direction, suspending and removing
doctors' licenses without cause. Caught in the crossfire are the patients.

"There is a huge difference between a drug addict and a legitimate,
bona fide chronic pain patient," said Noblett, who sustained severe
back injuries in the Vietnam war that gave him decades of agony. "A
drug addict takes medication in order to cop out, to escape. A pain
patient takes medication so that they can get back on their feet and
be a productive member of society and support and provide for their

Littlejohn fought his suspension but eventually ran out of money.
Noblett had called and written medical board members and the person
who appoints them, Gov. Rick Perry. He contacted legislators and the
state attorney general. He'd taken his story to the Fort Worth
Star-Telegram and had high hopes of a major story being published, but
that effort eventually came to naught. He rallied a group of 64
patients to threaten a class-action lawsuit.

And, after two years, Noblett had little to show. The medical board
was unresponsive. Nobody seemed to listen or even care, he said. The
patients, even collectively, couldn't come up with money for a lawyer.
Many of them live on small or fixed incomes, unable to work or leave
their houses because of chronic pain.

Littlejohn figured he was being punished for treating patients the
best way he knew how, even when it included a controversial but legal

"I recognized there were a lot of people suffering who didn't need to
be suffering," said Littlejohn, affectionately called "Doc" or "Doc
LJ" by his patients. "But if you [prescribe oxycodone], you're
sticking your neck out. I didn't get anything resembling due process.
Child-raping murderers get more due process."

Four of his patients have killed themselves since his license was
suspended, Littlejohn said.

Noblett, the military veteran, chose to fight rather than give in to
his misery. But neither did he live to see the end of the story.

Noblett couldn't believe he and other pain patients could be stripped
of their doctor and lose their access to medicine with so little due
process. The medical board's decision to investigate Littlejohn came
after a single complaint. A woman who had been Littlejohn's patient
was involved in a divorce and had hired a local attorney for
representation. The woman and her attorney were at Littlejohn's office
one day and, according to witnesses, the lawyer manhandled her,
causing her to fall and injure herself. Littlejohn reported the
incident to police and the Tarrant County district attorney's office,
but no charges were filed.

Not long afterward, the woman and her attorney filed a complaint
against Littlejohn with the medical board, accusing the doctor of
overprescribing addictive medicine and coercing the woman out of much
of her divorce settlement money.

Board members spoke with the doctor in a brief closed-door hearing in
November 2006 and didn't like what they saw, describing him in an
"order for temporary suspension" as distracted, disoriented, and
exhausted. They also questioned what appeared to be a business
relationship with the patient and whether Littlejohn had ended up with
much of her money.

There is no record of the conversation between Littlejohn and the
medical board, since investigations and hearings are private, and
board members will not discuss them. But the board's order of
suspension is public record and sheds light on the agency's reasons
for the suspension.

The news media have spotlighted the ruckus between Texas doctors and
the Texas Medical Board in recent years, portraying a pendulum
swinging from one extreme to another. About 10 years ago,
investigative reports showed the board had been slow and weak in
punishing bad doctors. Legislators responded by providing more money
and regulatory power, and the number of investigations opened and
disciplinary actions taken by the board has almost tripled since 2001.

Many doctors, not surprisingly, don't see that as necessarily good
news. In December, the Association of American Physicians and Surgeons
filed a federal lawsuit against the agency. The conservative,
politically active association, formed in 1943, accused the state
agency of violating due process in its zeal to discipline doctors.

"The situation has reached the crisis point for patients and doctors,"
the association's executive director, Jane M. Orient, said. The
medical board denies any wrongdoing, and the federal case is making
its slow crawl toward a settlement or court date.

In Littlejohn's case, he was eager to meet with the board and explain
the complicated situation. Before the hearing, the woman had recanted
her complaint in writing and said that she had made up lies against
her doctor under the direction of her attorney, who was promising to
use his influence to ensure she ended up with custody of her children.
In a letter addressed to the medical board, the woman characterized
Littlejohn as having "the utmost integrity and professional ethics,"
while using words such as "underhanded," "despicable" and "a disgrace"
to describe her attorney.

The hearing didn't go well. Littlejohn is something of a character --
tall, with seasoned features and a gray beard, verbose and opinionated
but usually speaking in a rambling mumble. He said the board was
condescending and disrespectful from the get-go, treating him like he
was guilty before he'd even been given a chance to tell his side of
the story, and asking him right away when he planned to retire. He
decided he was facing a "kangaroo court" and "clammed up rather than
blow up," he said.

The hearing wasn't recorded, and medical board officials won't comment
on what happened. But Littlejohn said he was shocked by what he
described as brusque treatment by board president Roberta Kalafut. She
had "piss-poor credentials," Littlejohn said, and questioned a Valium
prescription he'd written, calling it a very addictive drug.

"She's ignorant; Valium is one of the safest drugs," he said. "I was

The medical board's suspension order reflects that Kalafut was
concerned with the doctor's substandard record-keeping,
overprescribing of medicine, and being "disoriented and unable to
focus on questions." The board suspended his license, but there has
been no permanent resolution. The agency says Littlejohn has delayed
subsequent hearings. He says the only notice he received for a new
hearing was left at his gate and consequently eaten by his dog, but it
wouldn't matter anyway -- he refuses to go before a board that carries
itself like a "star chamber." He said he might seek justice in a
federal courtroom.

Littlejohn wrote to board members accusing them of forcing him to
abandon his patients and demanding an emergency reinstatement of his
license so he could at least oversee patients during the process of
going off their medications. Withdrawal from opioids can be dangerous.
The scarcity of pain physicians and the difficulty pain patients face
in getting prescriptions is a disaster waiting to happen, he wrote.
Some patients had already said "they are on the verge of committing
suicide if they do not soon find relief from their constant pain and
suffering," he wrote in February 2007.

The medical board didn't respond.

The news media have paid less attention to the effects of the medical
board's new direction on patients such as Littlejohn's, who have
supported their physician against the board. In their case, it's been
difficult or impossible to find other physicians willing to stick
their necks out.

"I didn't find another pain management doctor who would take me," said
Fort Worth resident Ann Price, who had been Littlejohn's patient for
12 years. "When they ask you who your previous doctor was and you tell
them Dr. Littlejohn, they say they aren't taking any new patients.
They all know what happened to him."

Price, 59, suffers from back injuries sustained during a car wreck
about 25 years ago. After Littlejohn's license was suspended, Price
found a local doctor willing to prescribe weaker medicine, but none
that allowed her to live in the manner she desired -- agile enough to
do housework, putter in the yard, shop, and play with her grandkids.
Now she has trouble doing much of anything except sitting around the
house and hurting.

"I still hurt constantly because these drugs aren't strong enough, but
[her new doctor] is afraid to give anything else because of the Texas
Medical Board, and those are the exact words out of his mouth to me,"
she said. "I think half that board ought to be arrested. To say Doc LJ
is mentally incompetent is stupid. I know he mumbles when he talks and
has a low, deep voice, but that's just Doc."

Noblett went to the Fort Worth Star-Telegram last year with their
predicament. For several months, he said, staff writer Bryon Okada
worked on the story, even meeting with a dozen patients at a motel
room for interviews and pictures. The story was pegged for a
high-profile spot -- front page on a Sunday -- and Noblett's group was
giddy with anticipation.

But the story was delayed and then cancelled altogether. Noblett said
Okada and news editors ignored his many calls and e-mails asking for
an explanation. Noblett wrote a five-page letter to his class-action
group, characterizing the newspaper's decision as cowardly and
ignorant. He copied the letter to the Star-Telegram, and City Editor
Lee Williams responded with a short e-mail saying the story was killed
because Littlejohn didn't "best illustrate" a story "dealing with the
controversy of pain therapy through medication."

The Weekly contacted Okada, and he sent an e-mail in response. He said
Noblett's story "held a lot of promise," but he'd been unable to
substantiate his claims, in part because the state agency didn't
record the hearing. He decided to wait until the patient group filed
their class-action lawsuit, he said, but then the story began to fall
apart, with one key source, for example, deciding not to go on the
record. "I don't believe I ever actually had a story that David or his
fellow patients would have wanted to see -- where I could show that
the state had wronged Dr. Littlejohn," Okada wrote. "I believe my
editor, Lee Williams, explained the situation to David on more than
one occasion."

In July, the medical board held a town hall meeting at Texas Christian
University. One of the speakers that day was Ben Davis, who'd been one
of Littlejohn's patients for 10 years, a former law enforcement
officer who suffered from back pain and was finding it difficult to
get the medicine his former doctor had prescribed. Davis talked that
day about chronic pain patients and lamented Littlejohn's treatment by
the board. Afterward, however, he told Noblett he doubted if anything
they said would make a difference. A few days after the town hall
meeting, Davis shot himself fatally.

Littlejohn lives in a cluttered house on a small spread of land just
west of Fort Worth. A brick entryway reveals that, at one time, the
house had been handsome. Now it's tired and in need of repairs and
fresh paint. Littlejohn has never been rich. His patients describe him
as an old country doctor willing to make house calls and spend as much
time with patients as they want. Before the medical board forced him
to close his Fort Worth practice, Littlejohn's waiting room at his
office on Cherry Lane was often crowded because he spent so much time
with patients that his schedule was usually backed up. Patients rarely
complained. They knew they'd get the same attention when it was their
turn. As it turned out, socializing in the waiting room and getting to
know one another would make it easier for them to organize into a
class-action group later.

"It's hard to find a doctor that will put you first," said Lisa Owens,
a Burleson resident who sustained whiplash injuries in a 1992 car
wreck and has pain from scar tissue and arthritis on her spine. "He's
gone through hell because he did what he thought was right for us.
He's like a dad to us. We're not a number. We're not a dollar sign to
him. He doesn't live high on the hog. He's just an old poor doctor
that cares about the people he takes care of."

Littlejohn dropped out of ninth grade when he was a teenager in
Oklahoma City in the 1940s. Fleeing an abusive stepfather, he ended up
in Fort Worth flophouse, working as a pinsetter at a bowling alley. In
1954, he joined the Air Force, and during that six-year enlistment he
took a medical technician class, worked with medics, and decided to
become a doctor. After his military service, he earned a medical
degree at the University of Texas Southwestern Medical School in 1967,
interned for two years at John Peter Smith hospital, and then opened a
family practice in Fort Worth in 1969.

Over the next 20 years, Littlejohn noticed more and more patients
living in constant pain. The doctor felt hogtied in his ability to
treat them and in the early 1990s decided to get more

"At a time when most doctors are thinking about retiring, Doc LJ took
a sabbatical for a full year from his practice and became re-trained
in pain medicine, then he came back and that's what he began to
specialize in," Noblett said. "By seeing me and other chronic pain
patients, he made a very critical personal decision -- he decided he
could no longer ignore or face the frustration of not being able to
successfully treat us."

His devotion made him a hero to his patients, and they rallied to his
defense after he lost his license.

Since the license suspension, Littlejohn finds himself in the same
position as his patients, trying to come up with money to get a lawyer
and sue the board in a case he expects to win if he lives long enough
to see a court date.

"I can move a jury," he said.

But the person who stepped up and took the lead role in fighting for
both Littlejohn and his patients was the little gnome-like war veteran
with the white beard and intense blue eyes who, after two years of
frustration, had finally come to the Weekly seeking help.

On that first visit, Noblett tried to tell a long, complicated story
as briefly and clearly as possible. His back was severely injured in
the Vietnam War and, despite several surgeries, he was in pain every
day of his life after that. A surgeon had told him 20 years ago that
any future back surgeries could be life-threatening. Oxycodone eased
his pain.

"I have three feet of titanium steel cages and brackets and screws
holding my spine together," he said, pulling up his shirt to reveal
long scars crisscrossing his stomach and back.

He carried a thick notebook filled with hundreds of documents,
timelines, synopses, public documents, copies of state law, and so on.
When I asked how he'd hurt his back, he searched for and found a
particular document, and pushed it toward me.

"Can't you just tell me?" I asked.

He tapped the paper intently, looking at me with pleading eyes. I
later learned from his fellow patients that Noblett was shy to the
point of phobic about discussing the war.

He lowered his eyes, stared at his hands on the table in front of him,
and quietly began describing a firefight on July 3, 1969. His
seven-man squad, on patrol, came upon enemy soldiers. They clashed in
a brutal, close-range combat. Noblett's hands began trembling as he
described how he and several comrades were bunched together during the

"They were close enough that one of the enemy hurled a satchel charge
bomb that landed in the middle of our squad," he said. "It landed at
the feet of Michael Blanchfield from Chicago -- 19 years old. Without
hesitation he threw himself bodily over the bomb, taking the full
impact of the explosion upon himself. It killed him and another squad
member. The blast picked me up and threw me a good 30 feet in the air.
I landed on the upper portion of my back and neck, immediately
knocking me unconscious. Michael won the Congressional Medal of Honor
for laying his life down for us."

In recent years, a second injury from that war also came back to
trouble him. Noblett's skin had become cancerous in spots -- he
attributed it to exposure to Agent Orange -- forcing surgery that left
large scars on his scalp.

In July, Noblett went to that town hall meeting at TCU along with his
friend Ben Davis. Noblett did something completely out of character
that day -- he donned his old Army fatigue jacket.

"I've always had a hesitation or fear of talking about my service in
the military and Vietnam," Noblett said. "I've seen so many people
that claim to be Vietnam vets and really weren't or claimed to do
things in the war and really didn't. I've always kept my mouth shut
about it. I'm telling you so you'll understand how much this has
affected me. For the first time since I got back from Vietnam, that
night at that town hall meeting -- I'd never done this before and it
must have been a powerful thing that got me to do it that night, and
I'll probably never do it again -- but I got my old fatigue jacket out
of mothballs, and I got out all the medals and decorations and covered
the front of the jacket, hung 'em on there, and I wore that down to
the meeting. I know people were probably looking at me like I was some
kind of a nut or some Vietnam vet suffering from post-traumatic stress

Standing before a medical board member and other chronic pain
patients, Noblett had questioned the board's heavy-handed dealings
with Littlejohn. He told about fellow patients who had committed
suicide because they couldn't deal with their pain after they could no
longer get prescriptions.

"I wanted to make a statement," Noblett said, his voice quivering and
his eyes beginning to well up with tears. His words starting coming
more slowly, and the pitch of his voice rose.

"Because when I think of Mike, who was 19 years old and threw his body
on that bomb to save my life, and I think of 19-year-old Duane Kyle
from Detroit; shrapnel caught him in his lungs. After I regained
consciousness, I stumbled and fell upon him, and I picked him up in my
arms, and he died in my arms, drowning in his own blood. And these two
young men would never be able to go on through life like I would, and
I saw how they gave their lives, and I remembered that. And now here
is this board trying to deny Texas physicians [the right] to treat
their patients and deny citizens the medical treatment they have a
right to. These are things that my friends laid their lives down for.

"I couldn't let the medical board get away with what they had done,"
he continued, "and how they had turned a deaf ear and a blind eye to
citizens who this day are wishing they were dead or have already
committed suicide and more who will commit suicide because of the
board's decisions. The hundreds of Texas citizens that Doc has been
able to deliver from being disabled and putting hope back in their
lives =85 . That's what they robbed us of. They don't even care, they
don't even know. So that's =85"

He stopped in mid-sentence, weeping, unable to say more for a few

"That's why I'm doing what I'm doing," he said finally. "I can't
describe to you the time and effort and progress and setbacks I've
gone through since this started. Trying to get people to listen. They
look at you like, `Oh, pain patients -- drugs.' That's all they can

Last Friday, I called Noblett and asked if he would don his uniform
and medals one more time for a cover photo. He hesitated. "I don't
really feel comfortable=85 ." he stuttered.

How about if he just pulled out the uniform and held it up for a

"I guess that would be OK," he said.

It was 11:30 a.m., and he suggested we meet in 30 minutes at his house
and take photos in his backyard.

At noon, I knocked on his door. No answer. The sound of a talk-radio
program drifted through an open window, where the blinds were drawn. I
called through the window. No response.

In the backyard I saw his fatigue jacket hanging on the door of a tool
shed. Having never served in the military myself, I had little
knowledge of what the medals meant. His dachshund, Sparky, was sitting
nearby, barking. I went back to the front door and knocked harder. The
door moved a bit under my hand. I pushed it open and went in.

Noblett was sitting in a chair in front of a computer screen in his
living room. His arms hung at his side, head laid back, mouth wide
open. Eyes that had already lost some of their trademark blueness were
fixed unblinking on the ceiling. Skin that had been disfigured and
bleached, perhaps by Agent Orange exposure almost 40 years ago, was
paler than usual and tinted yellow. His chest was still -- no rise, no
fall, no breath.

I picked up a phone next to his computer and called 911. The operator
told me how to lay Noblett on his back on the floor, prop his head
back, and look into his mouth for any obstructions. Then I was told to
pump on his chest until the ambulance arrived. But life never returned
to the man who had cheated death in Vietnam and become as impassioned
a warrior in his waning years as he had ever been during his youthful
war service.

An ambulance, a fire truck, and a couple of police cars arrived
quickly. I told Police Officer Chris Fearneyhough what I knew and led
him around to the backyard to show him the jacket. The dachshund was
still barking. Fearneyhough approached the tool shed, slowing his pace
as he came closer. His reverence was obvious. He too had served in the

A Bronze Star hung among rows of other medals and decorations,
including, of course, a Purple Heart. Two of them indicated that
Noblett was a master with the M-16 and M-14, guns that the military no
longer uses. Marksmen must hit 40 of 40 range targets with each rifle
to earn those recognitions, Fearneyhough said.

The medical crew loaded Noblett's body into an ambulance and drove
away, no siren needed. Curious neighbors went back inside. I started
to drive off, but remembered the jacket still hanging on the tool
shed. I knocked on a neighbor's door and asked if she would keep the
uniform safe, and we walked to the backyard to retrieve it. The little
dog became agitated when I picked up the uniform and for the first
time tried to escape the yard as I left. The woman had to block the
dog while I squeezed through the gate.

Police asked me about Noblett's next of kin, but I didn't know of any.
He was estranged from his family and had said several times during our
interviews that his dearest and most respected friend was Littlejohn.
I called the old doctor.

Three hours later, we met at Noblett's house. Also there was Ann
Price, Noblett's helper in organizing documents for the patient
class-action group. Price sat in the chair where Noblett had died just
a few hours earlier and vowed to continue the battle.

"I hope this doesn't dissuade the group," she said. "This just makes
me want to fight harder. David was the leader. He kept all our morale
and hopes up. I've got big shoes to fill, but I'll do it until I die
=85 Dammit!"

Later on, Littlejohn showed me boxes of personal possessions in
Noblett's house containing letters, photos, and information about his
friend's life: a scrapbook filled with photos of a scrawny Noblett
during his Vietnam stint, wearing fatigues, with a full head of hair,
smiling, posing with other young men putting on brave faces while
stuck in an unfamiliar jungle. Photos depicting dead Vietnamese lying
on the battlefield. Another showing Noblett talking to a group of
Vietnamese youngsters wearing big conical hats and smiling broadly at
whatever he's saying.

A citation showed Noblett was awarded the Bronze Star for valor in
ground operations against hostile forces in 1969. "His loyalty,
diligence, and devotion to duty=85reflect great credit upon himself
and the United States Army," it read.

A dusty frame holding a yellowed certificate showed Noblett had
attended the Christ for the Nations Bible College in Dallas and become
an ordained minister in 1976. More recently, he'd written and
self-published a prayer booklet called God Centered, which included a
short biography. As a youngster, Noblett had joined a gang of Fort
Worth street toughs and been arrested and jailed on suspicion of an
armed robbery. At 16, he ran away to California but was jailed again
and told by authorities to go back to Texas and "never come back here

At 17, he joined the Army. "It will make me a man!" he

He was right. He served in an elite brigade but rarely discussed
Vietnam. In a letter written to a friend in May, he explained his
tight-lipped nature: His actions were no better than those of
thousands of others who'd fought and died.

In addition to his back and skin problems, Noblett was also diabetic
and rarely could afford his medicine, Littlejohn said. Maybe that's
what killed him. The Tarrant County Medical Examiners Office told
Littlejohn they wouldn't know the cause of death until a toxicology
report was available.

"They asked me if I would take care of the funeral arrangements," he
said. "I said I certainly will, even if I have to pick up aluminum
cans until I'm 85 to pay for it."

The neighbor had come by and laid the Army jacket on a couch. Sparky
was curled up on it, growling at anyone who came near. Twice the dog
tried to bite when someone attempted to move him.

"He won't get up off that shirt," Price said.

The doctor picked up a cap that sported a 173rd Airborne Brigade patch
- -- Noblett's old outfit. He'd recently given it as a present to
Noblett, who'd worn the cap when he first visited the Weekly.

"I'll put this on his casket," Littlejohn said.

He held the cap, looked at it, rolled the bill in his hands, then
glanced at the uniform on the couch, still guarded by Sparky.

"David was my greatest champion, a great man, my greatest friend," he
said. "If we were in a foxhole together, I wouldn't want anybody else
covering my back."
- ---
MAP posted-by: Larry Seguin