In 2017, the Department of Justice under Attorney General Jeff Sessions decided to target and destroy the careers and liberty of physicians practicing medicine in a manner that insurance companies and law enforcement agents did not approve of. And the Biden administration has done nothing to correct this terrible injustice. It all started with a basic confusion on the part of the DOJ between the average practice of medicine and the “usual” practice of medicine, a confusion that persists today. The argument seems to be that if medicine is truly a science, then there should be just one “right” way to treat someone with a particular condition. Right? So, why should there be a second opinion? If medical science is so exact and doctors really know what they are doing, why would any two of them have different opinions? This question seems to convince federal law enforcement that one or the other of these physicians is practicing outside the “usual” practice of medicine or committing fraud and needs federal confinement therapy to get back on the straight and narrow. These attacks have destroyed the practice of pain management and addiction in America.
First, no physician has ever seen an average patient. Ever. As nonsensical as this sounds, false metrics like these are fed into AI algorithms, which are then used to pronounce a physician as being “criminal” since their treatment of a patient was not “average” and therefore was outside the “usual” practice of medicine. Human beings are much too varied for this simplistic “cookbook” approach. If you think that I am being hyperbolic, let me give some examples.
Doctor Xiulu Ruan was the most educated physician ever to treat pain in the United States of America. That is not my opinion. That is a fact, according to the World Record Academy. Dr. Ruan had not just one but seven individual board certifications. Despite the incredible dedication this accomplishment shows, Dr. Ruan’s judgments on medical practice were disregarded, when the DOJ’s AI “beast,” their words, not mine, labeled his practice a “pill mill” because a) patients were traveling a long way to see him, b) he prescribed a lot of opiates and c) there was a “high percentage” of patient overdoses. Now, let’s take a look at the patients who would be referred to Dr. Ruan. And that’s an important point. Other physicians were sending these patients to Dr. Ruan for a reason. That reason being the other doctors couldn’t figure out how to treat them effectively. These would be the most complicated patients possible. Patients who had been seen by primary care providers and pain experts and no one could solve their problems. Of course these patients would travel long distances to be seen by an esteemed expert like Dr. Ruan.
The government seems to think that all of these patients should have been living next door to Dr. Ruan, but this is ludicrous. They would come from all over the country to see the ONLY physician in all of America with these qualifications. That also means that these would be the most problematic and hardest to treat patients in the country, patients who had most likely spent years trying this procedure and that medication and were at the end of their rope. Literally. If you agree to see those who are suffering the most, then you are increasing the likelihood that one of your patients will give up and use their medications to end their existence. This is a tragedy that is now compounded by the fact that the federal government will use this metric to deprive every other patient of your physician’s expertise. Leaving patients with nowhere to turn. And what does Dr. Ruan’s prosecution teach the rest of us? If they do not differ from the opinion of the most educated pain specialist on the planet, then what chance do you have? The message is clear. Don’t accept complicated patients for pain treatment. But it doesn’t just stop with pain.
First, let’s make something clear. Even the CDC and DHHS acknowledge that it is legal to treat pain in someone with addiction, as long as the controlled medication is prescribed for the purpose of treating the pain. But now, the DOJ is targeting doctors who treat addiction also and have managed to put hundreds of physicians in prison by convincing a jury otherwise. Let’s look at the case of Dr. Meredith Norris. Dr. Norris had helped lawmakers develop opioid policy and treatment access decisions. In October of 2022, Dr. Norris was a specialist in both pain treatment and addiction. She had opened the Graceful Recovery Drug Treatment in Kennebunk, Maine. She had helped thousands of patients manage their pain and conquer addiction. As a recognized specialist, many physicians in the area would send her the most complicated patients. Complicated patients are, by definition, unusual, and will require unusual treatment. This fact alone allows the government to make “outside the usual” claims. This led to her being targeted by the New England Prescription Opioid Strike Force. One of several such strike forces composed of DHHS, FBI, OIG, and DEA agents, this one decided that Dr. Norris was outside of “the usual course of professional practice” and was prescribing medications “without a legitimate medical purpose.” Dr. Norris was accused of prescribing “dangerous, highly addictive, and often diverted narcotics”, which is, of course, exactly what doctors who treat pain are supposed to be doing. Who else should be deciding who gets these? The DEA?
It was also alleged that at least one patient was on 1,000 MME, which they note is ten times the “recommended safe dosage from the CDC”. It doesn’t mention the entire categories of patient that even the CDC agreed was outside their guidelines, or the patient who is unresponsive to lower doses, or comes to her already on a very high dose. All exceptions the DEA ignores. Once again, we fall into the complicated and unusual patient being used against a physician. This started out with ten counts but has since been expanded. One of the costs of daring to argue that you might be innocent is that the government will try to bury you in sensational and false claims. The reason they do this is that when a jury isn’t sure what to do, they think that acquitting a doctor of some charges but convicting them on a few others is somehow “fair.” Something to the tune of “I’m 70% sure the doctor is innocent, so let’s only convict on 30 of the 100 charges.”. Not understanding that at sentencing, they will be enhanced for everything plus whatever else the prosecutor wants to throw in. A single conviction gives the government everything they need to bury you. Dr. Norris had her charts reviewed by a medical “expert.” Dr. Terry King. Much has been written about Dr. King. Including the claim that he never prescribed opiates. Which, in my opinion, would put him far outside the “usual” practice of medicine. This doctor’s extreme opinions are then propagated to the jury as if they were the standard by which all physicians should practice, a “national standard.”
Dr. Norris and Dr. Ruan are both exceptional physicians who are now being prosecuted for treating complicated patients whose medical course makes them, by definition, outside the “average” practice of medicine. But this does not mean they are outside what should be the legal definition of “usual practice of medicine.” It is usual for exceptional physicians to treat exceptional patients with exceptional therapies. The justice department, enabled by an AI just as ignorant about the proper practice of medicine as they are, has displayed a complete lack of respect for a physician’s training and expertise. Deciding instead that, since some patients have a bad outcome, they are bad doctors. The message is clear. To be safe, don’t treat patients with complicated conditions and histories, and especially, don’t treat those at the end of their rope because if they let go, it will be used to hang you.