Dr. Phil Astin pleaded guilty to a 175 count federal indictment against him alleging that he indiscriminately prescribed multiple pain medications and other narcotics to known addicts for years. According to the indictment, “at least two of Astin’s patients died because of his lax oversight of what medicines they were taking.”
One of Dr. Astin’s patients was Chris Benoit, the professional wrestler who murdered his wife and child, then committed suicide in 2007.
The federal investigation into Dr. Astin’s practice discovered that he often wrote prescriptions without conducting physical exams, gave multiple simultaneous prescriptions for strong pain medications, and prescribed combinations of multiple pain medications that would have an additive effect such as Percocet plus Oxycontin plus Vicodin. Many of the prescriptions were deemed not to have been written for “legitimate medical purposes.”
Most doctors would agree that practices such as those above are inappropriate.
But there are exceptions. And sometimes it is difficult to draw the line between what is “legitimate” and what is not “legitimate” for pain management.
In the hearing on Dr. Astin’s sentencing, U.S. Attorney David E. Nahmias made the statement that Dr. Astin engaged in “illegal drug dealing.” Then there was Assistant U.S. Attorney John Horn, who, according to this article, reportedly made the idiotic statement that “Medical doctors know that after a period of time, if the prescriptions are not working, you get them off.”
“Sorry, ma’am, I know you have advanced metastatic bone cancer and your progressive pain is not being controlled by your Duragesic patches and Percocets, but because Assistant US Attorney John Horn says so, I have to “get you off” all your medications so you can die in agony. Wouldn’t want to go to prison, you know.”
The whole case brings up a difficult ethical issue. On one hand, some bad apples are prescribing narcotics for fun and profit. On the other hand, some patients really need large doses of pain medications to control their pain.
If the facts of the case are as stated in the news articles, Dr. Astin deserved a harsh penalty. I can’t comment on the whole prison thing other than to mention that if you think doctors practice defensive medicine to avoid lawsuits, watch and see what happens if they think there’s a possibility they could go to prison for prescribing pain meds.
I continue to believe that we need to do a better job policing physicians that prescribe medications in the manner that Dr. Astin did. Part of the problem lies in oversight. How is it that the feds have to wait for someone to die before they investigate a physician that is prescribing medications in this manner? If federal investigators can get the prescription records years after the fact, they can get them shortly after the prescriptions are written and/or filled. The DEA and/or state licensing boards should be more proactive in this regard if there are concerns.
On the other hand, when everyone hears some ill-informed statement like that made by John Horn, what effect do you think will have on doctors being willing to prescribe pain medications for patients who are in legitimate pain?