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November 18, 2022
Re: An Outcry Against the Evil Movement of Scapegoating Physicians
Jack Resneck, Jr., MD, President of AMA
James L. Madara, MD, CEO & Executive VP of AMA
AMA Plaza, 330 N. Wabash Ave. Suite 39300 Chicago, IL 60611-5885
Dear Drs. Resneck, Jr. and Madara:
I write to express my perpetual concern of the nation’s scapegoating-physician movement. (A few years ago, on several occasions, I had written to AMA, specifically, Dr. Barbara McAneny, the AMA President then, regarding the same issue.)
More than a decade ago, in his book, “The Criminalization of Medicine: America’s War on Doctors” (Praeger Publishers, 2008), Professor Ronald T. Libby, clearly articulated this evil scapegoating-physician movement:
“The government has made medical doctors scapegoats for the financial crisis of health care in the country and for the failed war on drugs. Physicians’ role as sacrificial lambs follows the long history of political scapegoats in the United States…Physicians have become the enemies of the country’s health care.” (p. 181)
“The physician as scapegoat is important to politicians both to blame for a major threat to society and it promises a relatively easy and inexpensive solution. The solution is to eliminate wealthy and corrupt doctors who threaten the nation’s health care. A tough law and order campaign against corrupt doctors therefore creates the illusion that the state is acting as the protector of the citizenry.” (p. 182)
The prosecution of Dr. J. Patrick Couch and myself exemplifies the movement of evil witch-hunt by the government. Dr. Couch and I were arrested in May 2015 during the “Operation Pilluted,” where 22 doctors and pharmacists from four Southern States were arrested. In 2016, we were indicted with a myriad of felonious charges including RICO conspiracy, drug trafficking conspiracies, multiple substantive drug dispensing, healthcare fraud conspiracy, kickback conspiracy, etc.. After a lengthy jury trial in 2017, we were convicted as “drug dealers” and “gangsters” and received 20 and 21 years of imprisonment, respectively.
Professor Libby in his book correctly pointed out the contributing role played by physicians themselves:
“Medical doctors fit the pattern of a group suffering from a collapse of their image. They do not recognize that there is a national political campaign against them for fraud, kickbacks, and drug diversion. Instead, they see themselves as victims of local vendettas by ambitious prosecutors, competitors, and troubled or greedy whistleblowers. Like other scapegoats, they tend to believe that their cases are individual and unique to them. THIS EXPLAINS THE FACT THAT PHYSICIANS TURNS THEIR BACKS ON OTHER DOCTORS who have been egregiously targeted by the government for investigation and prosecution. (emphasis added)
Indeed the absurdity of our trial is acutely apparent when contrasting the requisite specialty/subspecialty credentials of ours with that of the Government expert witnesses at our trial. Dr. Couch’s primary specialty was anesthesia; mine was physical medicine and rehabilitation. Both Dr. Couch and I were fellowship-trained in interventional pain management and had practiced full-time for over a decade at our own interventional pain clinic, Physicians’ Pain Specialists of Alabama (PPSA), Mobile, Alabama. Dr. Couch had achieved four board certifications, there of which were recognized by the American Board of Medical Specialties (ABMS); I had achieved eight board certifications, four of which were recognized by the ABMS. Both of us had the academic title of Adjunct Clinical Associate Professor from local medical institutions. Together Dr. Couch and I had over 120 publications under the PubMed.
By contrast, none of the three Government medical expert witnesses, namely Drs. G—- (AZ), A—- (MS), and V—- (MS), were fellowship trained; nor did they have any academic title. Dr. A—- was a hospitalist who had completed residency training only in internal medicine. Dr. G—- had no residency training whatsoever; he only completed one-year medical internship. Collectively Drs. G—-, A—-, and V—- had zero publication under the PubMed. Over the years, however, Drs. G—- and A—- each had received huge sum of money, namely $320,000 and $325,000, respectively, from DOJ/DEA, testifying as Government witnesses or consultants.
Remarkably, none of them were even qualified to testify as a pain expert in civil medical malpractice suits in the State of Alabama, yet they were allowed by the court to testify as “pain .experts;’ at our criminal trial. Their unreliable and biased trial testimony played important roles in misguiding the jury to convict Dr. Couch and myself as “drug dealers” and “mobsters.”
On June 27, 2022, the Supreme Court, in a 9:0 decision, reversed and vacated the judgment of the appellate court. The Court emphasized that the Government needed to prove that I knowingly or intentionally acted as a “drug dealer,” i.e. with a guilty intention, when prescribing controlled medicines in treating my patients. The significance of this ruling was discussed in the following attached articles: “The Supreme Court Decision on Federal Prescribing Rules for Controlled Substances,” by Matt Lamkin, JD, MA, published in JAMA (October 3, 2022); and “US Supreme Court Delivers Much-Needed Certainty to Controlled Substances Prescribing,” by healthcare-and-policy law professors, Kelly K. Dineen Gillespie, Taleed EI-Sabawi, and Jennifer D. Oliva, published in “Health Affairs” (November 1, 2022) Candidly, I consider the Court’s ruling a victory of physicians’ autonomy in the practice of medicine.
Here the critical question is: What should we do in order to change our image of societal scapegoats? Professor Libby insightfully admonished: “Scapegoats do not see the broader aspects of their collapsed credibility. Societal scapegoats are deemed to have violated a co.de of conduct. A scapegoat is already found guilty before he is indicted or tried; there is a widespread societal consensus that what he did was wrong.” (p. 182)
Professor Libby suggested a step-by-step approach in solving this problem:
“The history of scapegoats is that once they have been stigmatized, they will continue to be abused by the government in the future. The only way to transform a scapegoat’s public image is to first recognize that they are political scapegoats. This has occurred twice. The first time was during the 1920s when doctors were made scapegoats in the first war on drugs. It happened again in 1990, when MEDICAL ASSOCIATIONS THROUGHOUT THE UNITED STATES SUPPORTED A CALL BY THE AMERICAN MEDICAL ASSOCIATION (AMA) for the resignation of the Inspector General of the HHS for his role in Medicare/Medicaid fraud inspection abuses targeting doctors.” (emphasis added)
“In both instances, the leadership of the AMA called a halt to the senseless destruction of doctors’ careers and lives in the government’s vain pursuit of drug addicts who were treated by physicians and to stamp-out medical fraud. The president of the AMA contacted the president of the United States in both cases and demanded an end to the witch hunts.” (p. 183)
Needless to say, it is time for all physicians of this country, irrespective of our differences in specialties and subspecialties, to stand together as one, in a collective effort, demanding the halt of government’s evil witch hunt — the rabid criminalization of physicians. Further, we need to come up with a due measure within out medical profession, to condemn and sanction those unethical and unqualified physicians such as G—- and A—-, who shamelessly betrayed their fellow physician colleagues by becoming Government’s hired mouthpiece to say whatever the Government paid them to say to convict the accused physicians.
This is the reason I write to you and your organization. For your reference, I have also taken the liberty of including an earlier letter I wrote to the Alabama Board of Medical Examiners. From these writings, you may see that it was never one way or the other how the specialty of pain medicine was practiced. Rather, it was “Damned if You Do and Damned If You Don’t.” After all the criminal indictment was essentially a pretext or a special permit to allow the Government to seize physicians’ assets.
It is imperative that physicians of all specialties or subspecialties unite in protest against this scapegoating witch hunt so as to protect and preserve physicians’ collective reputation as well as the practice of medicine in this country. To fundamentally change the status of social scapegoats, we have to make every effort. Thank you very much for your attention to this matter.
Xiulu Ruan, MD