The following letter received no response:
May 24, 2007
Honorable members of the legislature, esteemed colleagues:
All over the state of Virginia doctors are being attacked for being “real” doctors. For being true to the Hippocratic oath of relieving suffering. These doctors are doctors who treat pain. We need your protection and your support.
The Justice Department in our country sees pain management as only an avenue for drug diversion or drug abuse, and a way for the government to make money. They therefore attack the doctor. Gentlemen and ladies, doctors are not the cause of drug abuse. I could go into the cause of drug abuse, but we do not have the years that I have devoted to the study to even give you a thumbnail sketch of the reasons. Let me just say that putting good, caring doctors in prison for 20 years is not the solution.
Right now, there is a 20-year minimum sentence for anyone found guilty of even one charge in our courts that doctors such as myself are faced with. There are good doctors right now serving this abhorrent sentence. The juries do not know that they are sending these doctors to prison for 20 years. That information is prevented to be disclosed at the trial. The justice department slams 300 counts of felonies against the doctor when the trial begins, usually ridiculous charges of “prescribing without justified medical purpose”, when it is the justice department deciding what a “justifiable medical purpose” is, not the medical profession. The jury finds them not guilty of 299, thinking they are showing the doctor support, but he/she must be guilty of something, or he would be in the defendant chair, so they leave one charge to find them guilty. Unbeknownst to them, the doctor spends the next 20 years in prison. What is the sense of this witch hunt? It is only for the political maneuvering of power-seekers in our government, and an attempt on the government’s part to make money off of the doctor. Putting a doctor in jail is easy. We are easy targets. As one former US Attorney put it at a seminar—”they go to where the money is and the guns aren’t.”
As I said in the beginning—we need your help. The 20-year minimum must be discarded. Judges should have the final say in whether a doctor spends even one day behind bars. Murderers have that right of judicial guidance, why don’t doctors? And the witchhunts should stop. Make the government accountable. If they swarm into a doctor’s office in this state terrorizing the staff and patients, for no real reason than to look for something to charge the doctor with, they shouldn’t be able to walk away free of any penalty. Why should I, a good doctor, have to sell my home, lose my patients, have no income, and lose my reputation because I treat pain? Some of you may have even had the experience of having your doctor fail to treat you or a loved one properly for pain because of fear of reprisal from our government. We need to be able to recoup our losses from the government, when they raid our offices and find nothing substantial to try us for. And it isn’t fair for us to have to go to court and fight again for our compensation. I think a flat rate of, say, $5 million would help to repay us for the damage done to us physically, psychologically, and professionally. We might be able to get more in the court system, but many of us would be too traumatized already, we would rather just put it behind us and move on.
We need education of doctors in how to treat pain. It is the number one reason a patient seeks medical attention. Failure of primary care physicians to treat pain properly sends patients to the ER. Since most of these patients in this area are already on government insurance, the costs to us skyrocket. Most medical schools and residencies, if they teach how to treat pain at all, the education is poor and usually involved Lortab, the most abused opiate in the country, and one that is killing off people’s livers. We need required pain management education at the medical school and residency level for all specialties, especially primary care. We need required continued medical education for all physicians in pain management, as is currently being done in California. We need appropriate compensation for doctors that are willing to treat pain. The office visit level should automatically be a moderate complexity level of 99214 for pain management. The extent of history questions, evaluation, and danger of morbidity/mortality is enough to make each visit a 99214, and yet insurance companies nit pick the records to reduce the level visit. Making pain management automatically a 99214 visit would be incentive to primary care physicians to learn pain management (along with mandated CME) and we will keep pain management at the primary care level to a larger degree. The pain management specialists are currently being overwhelmed by simple pain patients that PCPs are just turfing to them to get them out of their office. This increases health care costs tremendously, as it usually involves some form of interventional therapy that the pain management specialist thinks must be necessary because that is what he does to make a living.
We need alternative medicine techniques to be approved by government insurance so that they can be used to treat and help heal conditions that are simply being maintained on drugs. Prolotherapy, for example, is a natural technique that can repair damaged ligaments, tendons, and joints, making the person pain free. I do this technique and have seen remarkable results. Prolotherapy is the injection of glucose into the ligamentous attachment. It is mixed with lidocaine for injection. You can inject lidocaine, a short-term symptom reliever and get paid. Add 1 cc of glucose to the syringe, inject the same spot, and it is not covered. This procedure has been done since 1930. Why isn’t it covered? Because no drug company would make millions of dollars on it. 50cc of glucose solution costs 50 cents.
There are multiple other instances where homeopathic medicine can fix a problem while drugs simply maintain it. Colds ended in 2 days, for example.
The MSV is trying to get the legislature to outlaw naturopathic physicians from the state. I stand before you and ask that instead of outlawing them, give them licensure. This would stop the people claiming to be “naturopaths” that practice in this state without the training. Naturopathic physicians know more than the complement of physicians in this room. They not only know the same information we know, and the effects of the drugs, but the cause of the problem at a holistic level, and the remedies that will correct the problem, not just maintain it for life.
We can’t get drug companies to test alternative medicines correctly because there is no money to be made to pay back the $40 million cost to get a drug approved. What the legislatures need to do, both federal and state, is allow people with government insurance to choose their care from a knowledgable physician, and to pay for whatever treatment that physician recommends, whether it be conventional or alternative. Our population is already guinea pigs for drug testing, as the tests required by the FDA run an average of 3 wks, and the FDA is now in bed with big Pharma, with the corporate leaders now running the show at the FDA to get drugs approved quicker now. Let the people decide. If they chose the healthful alternative of alternative medicine, pay for it. It is a lot cheaper than the drugs that have to be continued for life. Opening the door to alternatives will allow people to heal and get out of the sickness care loop that our current system supports. Pass laws that require insurance companies to pay for alternative remedies. Basically, if a doctor prescribes it, it should be covered by insurance. Put the health care back in the place where it belongs—the physician/patient relationship.
Next year I am organizing a ride across America for pain management and alternative medicine. I will start in California and, riding horseback, make my way from town to town, city to city, election campaign to election campaign, protesting the witch hunts on doctors and the need for alternative medicine that helps people heal. I am asking for any help that anyone can offer me. I am a solo practice physician currently under attack from the government, trying to run a practice alone, and train 10 thoroughbred horses to ride. Any experienced horse people to take on the care/upkeep and training of one of my horses, web-site designers, lawyers to make me an non-profit organization to accept donations, cash donations, or any other support you can offer me would be greatly appreciated. I will need a physician willing to run my practice without much income so the bills get paid, in my absence. Maybe someone retired would take that on. But most of all, I need prayers. I truly believe God appointed this task to me, but he will have to help me carry it out. Got can turn the evil acts of man into good. I know he is going to do that with the attack on me and my office. I’ve had faith all along because I have done no wrong.
My last comment is to my fellow physicians. One thing my lawyer told me that is true, is we are our own worst enemy. We turn our backs on our fellow physicians when the raid comes. We automatically think “They must be doing something illegal.” I stand here before you today, an example of just the opposite. I have never done a dishonest act knowingly. I am a Christian and live by the 10 commandments given to us by God through Moses. And yet my colleagues do not support me for the most part. A few good ones have. Dr Daum, in Roanoke, if you know him, you love him. He sent me a letter of support and encouragement the week of the raid, and through patient contacts, I know his prayers and support are still with me and he believes in me. The doctors in Pulaski that, on the other hand, have been telling patients that I am quitting, leaving town, etc. continue to be surprised at my stamina and failure to do their bidding. Just today, I had a patient tell me that one of the Pulaski physicians that treated her in the hospital when she had fallen and broken her hip, told her that she needed to change physicians, or she was going to die. I’m sorry, folks, but there is no place in medicine for comments like that. That patient, having just lost her husband last month, whom I saved from an earlier death from lupus with my use of gemmotherapies, and herself, who had been a patient of the Pulaski group in past years. I took over her care of severe COPD and gave her 10 years of productive life with seldom having to go to the hospital.
Stop thinking “That is them, and it couldn’t happen to me, because I do everything right.” Well, I’m speaking to you as a physician who has done everything right, and it still happened. Support legislation to protect those of us that know how to treat pain and do it well. Do not think the worst of people that have found themselves under the crosshairs of the justice department. The thing that probably brought me to their attention was the number of Schedule 2s I was writing. That is due to the fact that I had 2 nurse practitioners working for me that couldn’t write schedule twos, and I have a policy that I write scripts for only 2 wks at a time, to ensure that the patient doesn’t have long to live without medicine should they be lost or stolen. And I don’t write Lortab or Percocet because they clog the liver and prevent detoxification. So the numbers of scripts in my name, all appropriate, were probably more than anyone else in SW Virginia. But to my credit, when I did a PMP check on my patients in January, only 4 had been double dipping, and they got turned in to the law. How many of you, if you treat pain, can quote that tight a ship, especially if ¾ of your practice was prescribing opiates?
Thank you for your time, and I hope, for your support.
Linda Cheek, MD, DAAPM.