No wonder Intractable Pain Patients can't get adequate pain treatment in California despite the State that is supposed to have the most progressive laws such as the IP Act and the Pain Patient's Bill of Rights. Tragically, a peek into the scandalous drama of Dr. Awad by most any California physician will cause him or her to send every pain patient packing. Fortunately for the sake of every pain patient and practitioner, Dr. Awad beat down his attackers last week in a dramatic Medical Board trial that witnessed the board's prosecuting attorney withdraw his accusations against Dr. Awad on the 3rd day of the trial, when much to his credit, he realized that he had been duped by a single medical board office.
The Awad scandal is a MUST review for all parties who want to see humane medical care for suffering pain patients. More important, it is a wake up call for legislators, judges, physicians, and patients to go to the drawing board and determine how we're going to see that the Intractable Pain Act, Pain Patient's Bill of Rights, & Medical Board Guidelines for Intractable Pain Treatment are going to be followed and honored.
Unilateral action by zealots in a single investigator or regional medical board office can't be allowed to force their biases and agendas on a suffering group of patients and dedicated practitioners who are supposed to be protected by legal statute.
Read on to see the laundry list of dirty, malicious tricks that were foisted on Dr. Awad. Old timers in California will recognize that many of these underhanded tricks were common in the days prior to the passage of our "so called", protective pain laws. Now they are back in force.
Who is Dr. Awad? He is a family practitioner in Anaheim. Some time ago he developed a sub-specialty in pain, so he maintains a small pain practice. An osteopathic graduate, he has taken additional training in Pain and Addiction Medicine. He belongs to the International Society for the Study of Pain and the American Society of Addiction Medicine.
One of the sad aspects of the scandal foisted on him is that the general public desperately needs more family practitioners to take some advanced training and treat pain patients who are having a difficult time finding treatment. There just aren't enough Anesthesiologists to fill the need for outpatient medical management of IP patients.
DIRTY TRICK # 1- HOW THE SCANDAL BEGAN
One of Dr. Awad's pain patients attempted to fill an opioid prescription at a Costco pharmacy & was confronted by a self- righteous pharmacist. He called the patient a drug addict & let him know that he didn't approve of Dr. Awad's opioid prescribing. Furthermore, he told the patient that he wouldn't fill his prescription whereupon the patient summarily grabbed back his prescriptions from the pharmacist and departed in hopes of finding another pharmacist with the decency to help. Rather than talk to Dr. Awad or the pain patient [*further], the know-all-there-is-to-know pharmacist reported Dr. Awad to the California Medical Board for excessive prescribing of opioids.
DIRTY TRICK # 2- ONLY COUNT NUMBERS-NOT DISEASE STATUS
In typical blame-the-doctor-first style, the regional Medical Board Office reviewed the number of opioids prescribed on triplicate prescriptions & determined that Dr. Awad, based solely on the number of opioids prescribed, was over prescribing and must be stopped. They didn't bother to talk to the involved patients to determine legitimacy. So much for consumer protection!
DIRTY TRICK # 3 - SELECTIVE RECORD RETRIEVAL
The Medical Board Office then used its legal subpoena power to retrieve only select pages of clinic visits and records of 5 of Dr. Awad's patients, whose number of opioids prescribed for pain they believed to be excessive and inappropriate. They didn't request or want the entire patient record because they could later, along with their "pain treatments consultants " claim there was no physical exam, consent agreements, diagnostic studies, or regular follow up. After all, without a complete record or interviews with the 5 patients of Dr. Awad, they could claim a violation of the Intractable Pain Act and Medical Board Guidelines for Pain Treatment.
DIRTY TRICK # 4- SELECTION OF PHONEY "PAIN CONSULTANTS"
Even though California Statute requires that accused physicians be reviewed by specialists who actively practice in the area of medical question, the Medical Board Office selected as their primary consultant, a physician who worked in a prison, had no pain practice, did not hold out as a pain specialist, & didn't even possess triplicate prescriptions. Just before Dr.Awad's trial, a second "pain consultant" was hired. As was the case with the primary consultant, he had no active pain practice & did not hold out as a pain specialist. Neither consultant belonged to any professional pain organization such as the American Pain Society, American Society of Pain Medicine, American Society of Pain Management, or International Society for the Study of Pain. Neither had published peer-review, scientific publications on pain treatment.
DIRTY TRICK # 5 - OSTEOPATHIC MEDICAL BOARD FAILED TO INSTRUCT CONSULTANTS ON CALIFORNIA INTRACTABLE PAIN LAWS
In an amazing 2-page letter to the "phony pain consultant" Linda Bergman, the Executive Director of the Osteopathic Medical Board, tells the consultant to only review Dr. Awad's "standard of care" as he sees it and classify it as negligent or incompetent. Worse, he is to determine this by the "standard of the community of licensees."
This letter flies totally in the face of the "Intractable Pain Act", and the "Pain Patients Bill of Rights". The entire purpose of these laws is to protect the physician from arbitrary claims of "excessive", "inappropriate", or " massive" prescribing to patients who are intractable (e. g. Incurable by any known means). Consultants who review pain cases are to only determine if the patient has legitimate, intractable pain and not condemn types or amounts of opioids that are prescribed, because an incurable, intractable patient will require nun-standard treatment.
The executive director's letter should obviously have been confined to a very short paragraph instructing the consultant to determine if the "Intractable Pain Act", "Pain Patient's Bill of Rights," and the "Medical Board Guidelines for Treatment of Intractable Pain" were followed by Dr. Awad. Since the Intractable Pain Act is over a decade old & the Medical Board Guidelines were adopted in 1994, one is bewildered that they not even mentioned in the letter. Apparently, the game here was to arbitrarily and capriciously condemn Dr.Awad by some mysterious, elusive prescribing standard that our pain laws were intended to eliminate.
DIRTY TRICK # 6 - CONSULTANT MAKES UNFOUNDED ACCUSATIONS
Although it is unclear whether the consultant saw all 5 complete records of Dr. Awad's patients, he falsely claimed on various patients there were no physical examinations, adequate visitation schedule, or diagnostic studies. He never mentioned the word "intractable" in his report, but he claims "no medical justification for massive dosages" regarding Dr. Awad's 5 patients. Incredibly the consultant states, in an attempt to de-license Dr. Awad, the following:
"Within a 24 month period, Dr. Awad has written 338 triplicate form narcotic prescriptions. As comparison, I would like to discern the number of forms in each book supplied by the State. In 12 years of my practice I utilized half of one of the three books issued to me. Upon my retirement, I returned 2 ½ unused books to the State."
Today many pain specialists write 338 triplicates in a week. The Medical Board Consultant unbelievably claims to report that "bonafide treatment of multiple sclerosis and/or Fibromyalgia would never include potent narcotics."
If Dr. Awad had been prosecuted this would have set the precedent that no fibromyalgia or multiple sclerosis patients could receive any opioids including Vicoden, Codeine, Percocet, etc.
The opinion highlights the dirty trick of making accusations without ever interviewing the patient who may have intractable pain.
The "Intractable Pain Patient's Bill of Rights" gives patients a right to what they and their doctor believe is "appropriate treatment". The most malicious dirty trick of the consultant was that he claimed, in writing without proof, Dr. Awad has a "dependency problem" and was "splitting the prescriptions with his patients." This statement was made without the consultant ever meeting Dr. Awad or any of the 5 patients. In Dr. Awad's trial the prosecuting attorney initially believed this bunk and quizzed Dr. Awad's patients about sharing their prescriptions with Dr.Awad. They of course vehemently denied any such practice, and one can only wonder about the motives of the consultant in making this totally unfounded charge [that is] apparently designed to ruin Dr. Awad's reputation. Even now this unscrupulous claim is a matter of public record.
DIRTY TRICK # 7 PATIENTS NOT INTERVEIWED PRIOR TO TRIAL
All the accusations were done without the Medical Board Office personally interviewing all of the patients who supposedly were over- prescribed with "massive" dosages of opioids. At the trial Dr. Awad's attorney wisely brought some of the pain patients to the stand. They clearly described their pain as severe and intractable, and some even claimed they would have committed suicide if it were not for the opioids prescribed by doctor Awad. All patients were able to simply state that non-opioid treatments had failed. The Board's medical consultant claimed that Dr.Awad prescribed opioids for non-medical reasons leaving the ugly impression that all the pain patients were addicts looking only for a fix.
Physicians everywhere need to understand the ramifications of this scandal. Surely the antics displayed here in an attempt to de-license Dr. Awad can't all be incompetent bungling. There must be motives. Whatever, Dr. Awad spent $150,000.00 and endured incredible harassment for over 2 years just to fight for his right to treat pain patients. One can only wonder if other California physicians [*or practitioners nationwide. TZ] are being targeted with the same tactics & dirty tricks.
One year ago the California Medical Board in its monthly bulletin clearly stated to California physicians that they should not fear reprisals if they prescribe controlled drugs to pain patients if their board's guidelines are followed. Although this message to California physicians by the Central Board in Sacramento was undoubtedly sincere and well intended, the Awad scandal makes it clear that a single investigator and or a regional Medical Board office outside of Sacramento can take thing into their own hands and try a bunch of dirty tricks under the guise of arbitrary "quality review" or "community standard" to get around the Intractable Pain Act, Pain Patient's Bill of Rights, and even the board's own Treatment Guidelines.
HOW DR. AWAD MIRACULOUSLY BEAT THE SCANDAL
Mr. James Kosnet, the dedicated attorney for Dr. Awad, consulted experts and put together a team of bonafide pain experts, patients, and character references who testified and backed Dr.Awad. Fortunately, this team realized the obvious and intentional scam to get around the Intractable Pain Act, Pain Patient's Bill of Rights, and the Medical Board's own "Guidelines for the Treatment of Intractable Pain."
At the trial, Mr. Kosnet asked the Medical board consultant if he could define intractable pain and explain the Pain Patient's Bill of Rights. The consultant said all he could do was "make a stab at it." The prosecuting attorney from the California Department of Justice, who was assigned to the case, wisely realized there was a miscarriage of justice afoot & dropped all charges on the 3rd day of the trial.
SPECIAL NOTES & CONTACTS ON THIS AFFAIR
Intractable Pain News has reported this scandal as accurately as it can and invites [*any and all] readers to confirm the facts.
Permission is granted to any party to post this newsletter on web sites and reproduce it.
Contacts on this page are parties to the case. Please call or fax them and leave your opinions on their phone recorder.
Mr. James Kosnet is now an attorney who knows all the "dirty tricks," so any physicians who may be a victim of [the California Medical Board] may want to contact him.
Dr. Awad informs us he is considering suing the pharmacist who started the scandal, the medical consultant who labeled him "drug dependent", and the Osteopathic medical board.
From Intractable Pain News, Sept/Oct 2002
Call in and leave your opinion with his office. Contacts: Aziz Awad, D.O
James Kosnet, Esq.
606 S. Euclid St.
Kosnet & Darchfort
Anaheim, CA. 92802
3699 Wilshire Blvd.
(714) 635-8570 Los Angeles,CA.90010
(213) 388-9968 FAX