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half of them coming over his back
fence and breaking in the back door. He was forced to the ground and
handcuffed. His pregnant wife awakened to shotguns in her face, and
she was handcuffed.
Their home was ransacked for four
hours while the officers chanted some battle song. Nothing was found
in his home, which was left in shambles. Simultaneously, 10 other
officers ransacked his office, intimidating and interrogating his
staff and patients. They seized opiate prescription medications that
belonged to patients, which Dr. White was monitoring for safety
reasons. All his patient records, computers, and triplicate forms were
seized.
Law enforcement told the press they
were investigating him for deaths of patients treated with methadone.
He was treating medically complicated patients under the Intractable
Pain Treatment Act, using methadone for some of his patients. Fifteen
months after the raid, no charges have been filed, but law enforcement
recently told the press that the "investigation" continues. He has
received none of his records or equipment back, although he has been
able to get new triplicate forms from the Bureau of Narcotic
Enforcement.
Beyond the terror inflicted on Dr.
White and his wife was the terror inflicted on his patients who had
their medications seized. Narcotic police endangered the lives of
these patients by putting them into acute opiate withdrawal. SINTF
went so far as to contact all local pharmacies, at times arriving in
SWAT gear, threatening criminal charges if they honored Dr. White's
prescriptions. Although he still had a valid license and opiate
prescribing privileges, the pharmacies were too frightened to fill any
prescriptions. Local physicians who might have been willing to assume
care were frightened that they, too, would become victims of a SWAT
raid.
How often do raids like this occur?
Frequently, but no one is keeping track. Four years ago, SINTF raided
another Redding physician in a pain management practice, a Dr. Charles
Fisher. He was charged with the deaths of a number of patients (one of
whom was a "passenger" in a fatal car accident). He was recently
cleared of all charges. But the psychological trauma, and the
destruction of reputations and practices, doesn't go away because a
physician is exonerated.
While these two doctors were pain
specialists, methadone programs have been frequent targets of SWAT
raids. Recently, a non-profit methadone clinic in the Bay Area was
raided by Department of Justice police investigating a Medi-Cal
billing question. Over 20 officers in SWAT gear stormed this small
facility. Staff at first thought they were being robbed by a gang of
criminals dressed as cops, because no one was told what was happening
and guns were pointed at the dispensing nurses. All staff, and even
some patients, were forced into a room at gunpoint and handcuffed.
Patient care was totally interrupted. Staff were told they couldn't
talk and had their personal belongings searched.
A series of SWAT raids targeted at
methadone programs occurred under former California Attorney General
Dan Lungren, investigating so-called Medi-Cal fraud. I have intimate
awareness of this — our two clinics were raided by 19 officers. We
experienced a raid that was conducted after patients had left the
clinic and no guns were drawn. The officers were professional. No
patients missed medications. We were allowed to copy records needed to
assure continuity of care. Staff, however, was still traumatized and
many had acute stress symptoms with insomnias and nightmares.
Although this raid was not
deliberately abusive, we must ask why medical practices are subject to
these assaults in the first place.
The billing issue which triggered
"our" raid was truly unbelievable. We were raided by 19 officers over
$600 in billing. I was able to show the officer in charge within a few
minutes of their arrival that this billing was for psychiatric
services not covered by drug Medi-Cal. We weren't double billing. We
were trying to provide psychiatric care.
We got all of our records back in 3
weeks with a comment that our records were the best they had seen.
While I felt relieved, I also knew that this whole thing should never
have occurred. Our attorney couldn't believe a judge had signed a
search warrant with such flimsy "evidence." The information on our
billing was available if anyone cared to just ask for it in an
appropriate way.
Physicians victimized by these raids
often feel abandoned by their colleagues. Any press is going to be bad
press, since one will be judged guilty by reason of being raided.
Organized medicine, especially the CMA, was of no help in either of
these two Redding cases, even though hundreds of patients were
"abandoned" because of law enforcement actions. The California Society
of Addiction Medicine did contact the Shasta county District Attorney
to offer experts to look at Dr. White's records. Their offer was
rejected.
Today, any physician is at risk for a
SWAT raid. Attorney John Wagner wrote in our magazine (May/June 2002)
of the criminalization of both reimbursement and medical
decision-making. He described these "strike attacks" on physician
offices, approaching with guns drawn, deliberately terrorizing staff
and patients — all justified by the suspicion of a billing problem.
What effect does this police-state style of enforcement have on
doctors' willingness to participate in vitally necessary government
supported healthcare?
Physicians are opting out of Medicare
in droves. Our past SSVMS president, Bryant Sheehy, has written about
opting out because he fears being caught committing some sin of
omission. I think that one of the main reasons most physicians won't
support a national healthcare plan to meet the needs of the millions
of uninsured is because they fear becoming targets of the cruelty that
increasingly characterizes government behavior.
Physicians were rightly frightened by
the enforcement arm of the Clinton health plan. The plan went under,
but the enforcement arm lived on. The Bush administration has now
ruled that doctors can be raided by SWAT teams over a billing dispute
with private health plans.
The problem of SWAT team assaults
against physicians and health clinics appears to not have been an
issue for organized medicine. But this Fall our Sierra Sacramento
Valley Medical Society endorsed a resolution that was recently
approved by the CMA House of Delegates. It asked the CMA to involve
law enforcement and the legislature in a process of finding
alternatives to terrifying raids concerning the use of opiates in the
management of pain or addiction.
Physician experts need to be involved
before a raid to make sure biases and ignorance are not the reasons
for the investigation. Patients need to be protected from the fallout
of raids or from a situation where there is a real problem with the
physician. Records must be made available to safety net physicians,
and the process needs to be monitored by physicians to be sure all
patients are cared for. Finally, there needs to be documentation and
monitoring of all these raids as to their necessity and methods. Rogue
law enforcement behavior needs to face public scrutiny and there must
be accountability for abuse of medical staff and endangerment of
patients.
Concurrently, state Senator Sam
Aanestad has introduced SB 995 in this legislative session to mandate
a regional board of five physicians and five law enforcement officials
to review questions about improper use of opiates for pain, prior to
any raid. Dr. Aanestad introduced the bill in response to the raid on
Dr. White, which occurred in his district.
This is critical legislation to
protect both physicians and patients, and it must be complemented by
similar legislation that addresses questions of so-called fraud, where
the use of terror tactics, like SWAT raids, is inappropriate.
Furthermore, because fraud units are "rewarded" with increased funding
for monies recouped, they are allowed to raid practices at will on the
flimsiest of "evidence," as I personally found out.
It seems to me the increasing and
unnecessary use of force against medical practices is part of a
prolonged pattern of increasing cruelty in our society. Americans are
now the most imprisoned people on earth. We have criminalized social
problems like homelessness, addiction, and mental illness.
Now we are criminalizing the practice
of medicine. Medical practices have no potential for violence, and
investigations should not be a form of punishment. Law enforcement has
been given too much latitude in the use of SWAT raids. Are we immune
to the terrifying and traumatic nature of having guns aimed with
malevolence? People should not be treated as guilty until proven
innocent.
One of the clear goals of the SINTF
"investigation" was to prevent Dr. White from practicing — without any
due process. And the investigation and "punishment" can be prolonged
for years, without even filing charges.
It is truly sad to see our society
come to rely more and more on such government terrorism to maintain
itself. None of this bodes well for health of individuals or society.
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