else going on?
JB: Regulatory policy varies greatly
between jurisdictions. But a hidden
factor may be contributing significantly
to the aggressiveness of
Federal investigators. Federal
Agencies may grant financial bonuses
to their in-house diversion
investigators, based on the volume
of fines collected from doctors,
nurse practitioners, physicians assistants
and others whom they investigate.
No law enforcement
agency at any level should be rewarded
with monetary gain and/or
promotion due to their work efforts
or successes. This practice has always
worried me with Federal investigators
and is unheard of at the
local or state levels of enforcement.
RL: Commander Burke’s revelation
hit me like a thunder-clap. It
would explain many of the complaints
I have heard from doctors
who have been “investigated” or
prosecuted. It’s a well known principle
that when we subsidize a behavior,
we get more of it. Financial
rewards to investigators must inevitably
foster a “bounty hunter” mentality
in some. It seems at least
plausible that such bonuses might
lead DEA regulators to focus on
“low hanging fruit” among doctors
who may not be able to defend
themselves without being ruined
financially. The practice is at the
very least unethical. Arguably it
can be corrupting.
I read complaints from doctors that
they have been pursued on trumped
-up grounds, coerced and denied
appropriate legal defense by confiscation
of their assets – which are
then added to agency funds for further
actions against other doctors.
Investigations are also commonly
announced prominently, even before
indictments are obtained – a
step that seems calculated to destroy
the doctor’s practice, regardless
of legal outcomes. Some reports
indicate that DEA or State
authorities have threatened employees
with prosecution if they do not
confirm improper practices by the
doctor. Do you believe such practices
are common?
JB: I hear the same reports you do
– and the irony is that such tactics
are unnecessary. Lacking an accepted
standard for overprescribing,
the gross volume of a
doctor’s prescriptions or the dose
levels prescribed to their patients
can be poor indicators of professional
misbehavior. Investigators
should instead be looking into the
totality of the case, which can include
patient reports of poor doctor
oversight, overdose-related hospital
admissions, and patterns of overdose
related deaths that may be
linked to a “cocktail” of illicit prescribing.
Especially important can
be information gleaned from confidential
informants – with independent
verification – prior patients, and
pharmacy information.
RL: No formal legal prosecution
should ever proceed from the testimony
of only one witness — even
one as well informed as Commander
John Burke. But it seems to me
that it is high time for the US Senate
Judiciary Committee to invite
the testimony of others in open
public hearings, concerning the
practice of possible bounty hunting
among Federal investigators.
Richard A Lawhern, Ph.D. has 21
years experience as a technically
trained non-physician advocate for
people in pain. His articles and
columns have been published by
the National Institutes for Neurological
Disorder and Stroke, the
Association for Humanistic Psychology,
Wikipedia, The Crime
Report, The Journal of Medicine,
the US College of Physicians,
Practical Pain Management,
Pain News Network, National Pain
Report, iPain Living Magazine, and
other media.
Internaonal Pain Foundaon—47