Three doctors—Robert Milch, Nancy Nielsen and Christopher Kerr—all medical leaders in their fields, filled in temporarily for Dr. Gosy from May 16 to August 1, 2016. Their observations definitely supported my first post conclusions. In the first day they saw more than 200 complicated patients, some of which arrived in wheelchairs, some connected to oxygen tanks or pain pumps, and were waiting hours before the 7 AM opening. 9500 patients were affected by the closing of Dr. Gosy’s office—legitimate patients that other doctors didn’t want and have nowhere else to go. They can’t just be told to get off the drugs.
Dr. Kerr said. “I’m more than a little impressed by the quality of the practice. The nurse practitioners – they are really, really good.” “A contradiction exists between the way these patients have been characterized and how they actually appear,” he said. “What is most impressive is that we have yet to see a case that is not striking in its authenticity.” He added, “The patients we see in hospice are trying to find their way to grace and comfort. These patients are struggling with function in the face of adversity. They are trying to be parents, trying to be employed.”
After Gosy’s indictment, officials simply recommended that patients consult their insurance company and primary care physician for assistance. But that was simply “turfing” the problem unrealistically. The remaining pain-management specialists in the region were already saturated with patients. Primary-care physicians are reluctant to prescribe opioids. That’s why more than 2,000 physicians in the Buffalo area referred chronic pain cases to Dr. Gosy. As Dr. Kerr put it, “Gosy never said no. His practice became a repository for the symptoms others didn’t want to look at.”
Patients were faced with running out of medication. Many rationed their prescriptions and tried to squeeze into the packed offices of other pain specialists. They began to show up in emergency rooms. One former patient went into a Lockport hospital with two rifles demanding drugs. It was only a matter of time before they would be forced to the street to self-treat their pain with whatever they could get their hands on.
In an attempt to offset the situation, the Health Department secured a 30-day waiver, with the potential for an extension, to allow non-authorized doctors to treat and bill for Workers Compensation patients. The medical society also received assurances from the agency that doctors who prescribe controlled substances for Gosy’s patients will not fall under increased scrutiny if their usual prescribing pattern suddenly changes. But even if the region’s doctors tried to absorb the patients, they could never do it soon enough. So talk turned to finding a way to rely on the expertise of the nurse practitioners and physician assistant at Gosy’s practice. They knew the patients. Their office held the records. Nielsen, senior associate dean for health policy at the University at Buffalo’s Jacobs School of Medicine and Biomedical Sciences, spearheaded the work to get the patients covered, and recruited Kerr and Milch. They got cooperation from the insurers and the government.
But the difficulties they had providing coverage exposed a deeper problem. With the threat of persecution, doctors don’t want to treat chronic pain. “There is no consequence for not treating pain,” Kerr said. “And, there’s no equivalent in medicine. You can’t say you won’t treat hypertension or diabetes.” Nielsen wrote a letter to the current AMA president, Dr. Steven Stack. In it, she warned that if law enforcement authorities ramp up actions against doctors related to painkillers, steps must be taken to enlist other physicians to help patients left in the lurch. “Having no plan is a true public health crisis, as patients will end up in the hospital, on the street buying heroin, or dead,” she wrote.
That response, however, bothers me. Even after seeing that the patients of a physician under attack are legitimate, doctors still turn belly up to aggressive, illegal government attacks. These doctors should become activists working to stop these attacks in the first place.
The temporary arrangement is now over, but luckily another doctor has stepped up to the plate. Dr. James Hitt begin working August 1st as medical director. Dr. Hitt is an advocate of non-narcotic treatments such as acupuncture and cognitive and physical therapies. He has experience working in pain management with cancer patients at Roswell Park Cancer Institute and veterans at the Buffalo VA Medical Center. His goal is to adopt a strategy promoted in the VA and elsewhere to reduce the reliance on narcotic painkillers as a first-line therapy. Drs. Nielsen and Milch will support Hitt until he is settled into the practice. Another action to help the situation is that U.S. Magistrate Judge H. Kenneth Schroeder Jr. approved a change in Gosy’s bail conditions that allowed him to return to his practice and, under the direction of a supervising physician, make recommendations on the use of painkillers and other narcotics. Dr. Hitt will fill that role of supervisor.
The reporting of Dr. Gozy’s practice has been primarily the work of reporters for The Buffalo News. I would like to give credit to Henry Davis and Sandra Tan for their most recent coverage of the situation. It was a tremendous improvement over the first reporter covered in the post Eugene J. Gosy, MD. Thank you for a job well-done.