Doctor Accused of Overprescribing Opioids Fights to Keep Her License

By Pat Anson, PNN Editor

A northern California doctor who is beloved by many of her patients could lose her medical license because of allegations by the state medical board that she overprescribed opioid medication and other drugs. Dr. Corrine (Connie) Basch runs a solo primary care practice in Arcata, a small city in rural Humboldt county.

“They were looking to put a head on a spike so they could claim they were doing something about the opioid crisis,” Basch told PNN. “I am not considered a negligent doctor in town, nor am I a pill mill. And it would have taken them all of ten minutes to figure that out if they had asked anyone in my community if there was a problem here.”

A formal complaint against Basch by the Medical Board of California, first reported by the Lost Coast Outpost, centers on her treatment of five pain patients on relatively high doses of opioids and benzodiazepines, an anti-anxiety medication. Although Basch had tapered them to lower doses, the complaint alleges the amounts are still excessive and the combination of drugs places the patients at risk of overdose and death.

Board Executive Director Kimberly Kirchmeyer is seeking the revocation or suspension of Basch’s license for excessive prescribing, gross negligence and failure to maintain adequate medical records.

At no point in the 25-page complaint is it alleged that any of Basch’s patients have overdosed or been harmed while under her care.  The board began its investigation of Basch in early 2018 but didn’t file the accusation until last month – suggesting it didn’t think there was any imminent threat to her patients.

“They went after me for no good reason, conducted an ‘investigation’ that was so obviously flawed, published a defamatory accusation on the Internet prior to giving me a chance to defend myself or even correct the factual errors, revealed private details of my patients’ cases on the Internet when those people live in a small town where people already know each other’s business, and would force a small town doc who treats poor people  to come up with several years’ income to defend herself and her license,” Basch said.   

DR. CONNIE BASCH

DR. CONNIE BASCH

All five of the patients in the medical board complaint were already on high doses of opioids and benzodiazepines before Basch started treating them. She tapered these “legacy” patients to lower doses, but some remained on opioid doses as high as 664 MME (morphine milligram equivalent) – well above the CDC guideline’s recommended ceiling of 90 MME.   

The CDC and FDA recently acknowledged that patients should not be forcibly tapered to lower doses and that doctors should “work with patients” before tapering or discontinuing opioids. Basch was already using that approach in her own practice. She says patients who’ve become tolerant to opioids should be weaned slowly and it could take 6-12 months just to get them off benzodiazepines.

“I’ve helped a lot of people get off pain meds,” she said. “Some of my patients stay on meds. I have a patient who is super functional on 145 MME. She’s comfortable, she can sleep through the night, and she works. I don’t see a need to lower her, except that she’s afraid. They’re all feeling insecure. They want to get off (pain meds) because there will be literally no one left to prescribe.”

Afraid to Prescribe

In recent years, California’s medical board has aggressively gone after doctors who prescribe opioids at high doses. The state’s controversial “Death Certificate Project” has resulted in threats of disciplinary action against hundreds of physicians, often years after they wrote an opioid prescription for a patient who fatally overdosed. Some doctors received warning letters even though the cause of death was suicide or involved multiple drugs – both legal and illegal.

These and other enforcement actions have had a chilling effect on doctors statewide.

“What we’re finding is that more and more primary care doctors are afraid to prescribe and more of those patients are showing up on our doorsteps,” Dr. Robert Wailes, a pain specialist and chair of the California Medical Association’s Board of Trustees, told Kaiser Health News.

Should Basch lose her license or stop practicing, all 1,500 of her patients would have to find new doctors, not a simple task in a remote community where healthcare choices are already limited, especially for pain patients.

“There are now two docs I know of in our area who have retired early because of similar accusations, and another older doc who lives in a small coastal community south of us who is going through a similar thing right now,” said Basch. “There’s nowhere even to get primary care up here. And if you call and say you want to be a new patient and chronic pain is anywhere on your problem list, you are denied. So these people are literally going to be left with no one.” 

‘Medical Board Malpractice’

Basch has received over 300 letters of support from patients and several from colleagues in the medical community. Her attorney plans to present them as evidence to the medical board.

“Dr. Corrine Basch is my beloved primary care physician,” one patient wrote. “Taking away her right to assess her individual patients for risk vs benefit, forcing a bureaucratic, possibly ill-conceived set of ‘guidelines’ is what I consider Medical Board Malpractice.

“FEAR caused by actions such as yours are keeping legitimately suffering human beings from having a quality of life they deserve. THIS IS SHAMEFUL.”

“I have had my share of doctors over the years but I never had a doctor like Connie. She has ultimately saved my life and I am not just saying that,” wrote another patient who credits Basch for his sobriety after years of addiction to pills and alcohol.

“You don’t punish someone for doing the right thing and helping people get off of drugs. That is not how you fix the opiate problem plaguing America you do it by employing more people like Dr. Connie who knows the right way to get a person clean.”

Basch, who is 55, continues to practice and is gathering evidence to support her case. A hearing date has not been set on the medical board’s complaint.

“They went after the wrong person this time,” she says. “Shaming and humiliating doctors who have lived lives of service, and placing them in a position where they have to give up their calling because the cost of defense is too great late in their careers, is shameful.”   

Doctors Prosecuted for Opioid Prescribing Should Fight Back

(Editor’s note: In 2016, Dr. Mark Ibsen’s medical license was suspended by the Montana Board of Medical Examiners for his opioid prescribing practices. Two years later, the suspension was overturned by a judge who ruled that the board made numerous errors and deprived Ibsen of his legal right to due process.)

By Mark Ibsen, MD, Guest Columnist

The headlines are pretty typical: “60 Doctors Charged in Federal Opioid Sting.” The story that follows will include multiple damning allegations and innuendos, including a claim by prosecutors that they are “targeting the worst of the worst doctors.”

Sometimes there is a trial, but often the doctors plead guilty to lesser charges and give up their license rather than mount a lengthy and costly legal defense.

Why are doctors losing every case to their medical boards and DEA? Are there that many criminal doctors? If so, what happened to our profession?

I see a pattern emerging: A doctor sees patients and treats pain in the course of their practice. As other doctors give up prescribing opiates for fear of going to prison or losing their license, the ones left end up seeing more and more patients.

bigstock--157700663.jpg

They soon become the leading prescribers of opioids in their state and become suspect just based on the volume of opioids they prescribe.

Given that law enforcement and medical board investigators usually don’t have training in statistics (or medicine), they are unable to see that the number of pain patients remains the same, but there are fewer practitioners willing to treat them.

“The Criminalization of Medicine: America’s War on Doctors” was published in 2007, but is even more relevant today.   

“Physicians have been tried and given longer prison sentences than convicted murderers; many have lost their practices, their licenses to practice medicine, their homes, their savings and everything they own,” wrote author Ronald Libby. “Some have even committed suicide rather than face the public humiliation of being treated as criminals.”

Libby wrote over a decade ago about doctors’ homes and offices being raided, DEA agents posing as pain patients to entrap them, and law enforcement task forces being created to target doctors for fraud, kickbacks and drug diversion.

Sound familiar?

I was reviewing a case about a nurse practitioner in Michigan who recently had her license suspended because she prescribed opioids “contrary to CDC guidelines” and “ranked among Michigan’s highest-volume prescribers of commonly abused and diverted controlled substances.”

This unsubstantiated crap put out by the Michigan Board of Nursing and its investigator is unethical and immoral. It should lead to a mistrial in court or dismissal at hearings. 

Fight Fire With Fire

This is an Amber alert for physicians. While pejorative headlines contaminate the discourse, the prescriber’s reputation bleeds away. The Montana Board of Medical Examiners did this in my case, and since I knew that the board was relentlessly after my license for “overprescribing” opioids, I gave up any hope of fairness.

My proposal: Lawyers representing doctors must counter the negative headlines with their own, and doctors should use whatever goodwill is left to rally their staff and patients, counteracting the pressure to testify against the doctor. 

I used what was left of my bully pulpit to save my own license and freedom. How? My assistant assembled my patients in large crowds at my hearings. I also made myself available to the media to counter the narrative put out by Mike Fanning, the board’s attorney, who went so far as to publicly question my sanity.

Fanning’s title was special assistant Attorney General, which told me the medical board works for DOJ in my state. I knew this for sure when DEA agents came to my office and tried to intimidate me.

“Doctor Ibsen, you are risking your license and your freedom by treating patients like these.”

Patients like what?

“Patients who might divert their medicine.”

Might? Isn’t that everyone? What would you have me do?

“We can’t tell you, we’re not doctors.”

My plea to doctors: Let’s reinvent our defense. The DEA and medical boards have a formula. It’s winning. 

We need a new response: Fight back and hold on. Just like with any bully, reveal their game and fight fire with fire.

IMG_0793.jpg

Dr. Mark Ibsen continues to practice medicine in Montana, but focuses on medical marijuana as a treatment. He no longer prescribes opioids. Six of his former patients have died after losing access to Dr. Ibsen’s care, three by suicide.

Do you have a story you want to share on PNN? Send it to: editor@painnewsnetwork.org.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Why We Should Keep Those Letters Coming

By Janice Reynolds, Guest Columnist

I have been a pain management and oncology nurse for over 20 years, and have long been a patient advocate.

Eight years ago, I joined the ranks of those living with a chronic pain syndrome (persistent post craniotomy pain), and in the last year spent an ungodly amount of time in acute pain.

As a patient advocate, I have written emails and letters for over 15 years to politicians, newspapers and online media, columnists, and book authors -- usually with poor results. But it is that one letter out of a dozen that makes it worthwhile.

My hometown newspaper, the Portland Press Herald, has refused to print any of my letters or editorials for several years now. I know they had good results when they did, because I would receive letters and calls from individuals thanking me or asking me questions.

wp-content-uploads-2014-05-supermanwriter.jpg

Letters to the editor that were published by the Press Herald in response to my letters tended to be on the malicious side. Politicians were defensive or accused me of being wrong. 

I have had responses from two authors. One actually thanked me and said his source was obviously misinformed.  The other was on the nasty side. Her son is an orthopedic surgeon in the Army, and she said he knows what he is talking about – that our military and veterans are nearly all becoming addicts because of their pain treatment! She was a little more conciliatory when I wrote her back, but still didn’t understand why what she wrote was misleading and dangerous, which I found even more scary.

I still owe Stephen King a letter for the misinformation he presented on pain management, addiction and how opioids work in “Under the Dome,” which I recently re-read. Even though the book is fiction, people will believe what they read.

Capitol-Ink-10-18-17.jpg

It was my latest email which brings me to writing this. Recently there was a political cartoon which really upset me.  It showed a bottle labeled “opioids” pouring pills onto the U.S. Capitol and nearly covering it.

The cartoon is based on a recent story by 60 Minutes and The Washington Post that was critical of a law that limited the ability of the DEA to go after pharmaceutical distributors.

I looked up the cartoonist – R.J. Matson -- on the Internet and sent him an email.  It basically told the other side of the story and how the current situation is harming not only people in pain but those in the future as well. 

I did use the term “witch hunt” and my analogy of the four pillars of the so-called opioid epidemic: McCarthyism, Fear-mongering, Yellow Journalism, and Bigotry towards People in Pain with a foundation built on Opiophobia.

I received a reply back almost immediately.

“Far from a witch hunt, the United States Congress, at the behest of lobbyists for the pharmaceutical industry, passed legislation preventing the DEA from monitoring opioid abuse in the medical profession and taking action against that abuse,” Matson wrote to me. “The prevention of responsible oversight of the pharmaceutical industry and doctors who profit from overprescribing pain medication is the subject here.

“Do you applaud the Congress taking away the ability of the DEA to do its job?”

Actually, if this happens, I do applaud Congress.  The DEA’s job is to prevent the illicit use of drugs, not to harass providers and patients or make medical decisions for them.

One of the key words in Matson’s response is “overprescribing.” There is no evidence to support this word and anyone who uses it should be deeply ashamed.  You are saying the provider should only prescribe “X” amount to patients and any amount more than that is too much.  If you mean they are prescribing inappropriately, then you should also be ashamed. This is a judgment call between the patient and provider. What knowledge or expertise do you have to say otherwise?

As for the reasons for the law, I seriously doubt it was “at the behest of lobbyists for the pharmaceutical industry.” Pharmaceutical companies are responsible for many wrongs -- like direct to consumer advertising -- but pushing addiction is not one of them.  If Pharma was trying to "behest" anything, it has more to do with the prevention of widespread terrorism the DEA has inflicted on physicians and their patients. 

This is why I believe it is tremendously important to write letters. You may get a response like mine, but at least you got a dialogue going. Here are other reasons: 

  • Telling “our” story may help weaken the stance of non-compassion.
  • Review facts we know are wrong and point out why.
  • Review facts we know are true and why we know this.
  • Explain why opioid addiction is a fictional epidemic or has little relationship to prescribed opioids.
  • Call people on the use of fictional terminology like “overprescribing." I once read an AP story where the reporter actually wrote, “everyone knows people become addicted by taking opioids for pain.”
  • Remind everyone they are only one accident, one surgery, one illness or one disease away from severe acute pain that may become chronic if not treated correctly.  
  • Remind everyone of the ethical and moral issues raised by ignoring and undertreating pain.  Medical professionals are required to know them. Should media and politicians be held to lesser standards?

A single letter may cause someone to think and put a crack in the wall of propaganda.  Many more letters may be powerful enough to break that wall down. 

Letters and emails are our strength and hope.  Changing the current situation may seem overwhelming, but to borrow a phrase from a famous World War II poster: “We Can Do It.” 

Janice Reynolds.jpg

Janice Reynolds is a retired nurse who specialized in pain management, oncology and palliative care. She has lectured across the country on pain and co-authored several articles in peer reviewed medical journals. 

Janice has lived with persistent post craniotomy pain since 2009.  She is active with The Pain Community and writes several blogs for them.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.