Dr. Richard A. Nelson called about 50 patients to his office last Thursday to deliver the news: federal officers had raided his office, seized records and told him to stop prescribing certain narcotic painkillers.
The patients, whom Nelson treated for chronic pain from injuries, cancer and other ailments, were shocked.
"We were angry and I guess a bit frightened about what we're going do, who's going to treat us," said Mike Bledsoe, 52, who has been seeing Nelson for about two years to ease the agony of a work-related injury and other problems. "It's a bad situation."
Some patients have contacted the office of Sen. Conrad Burns, R-Mont., asking about the April 20 visit by the Drug Enforcement Administration to Nelson's office.
"Something needs to be done," Bledsoe said. "This is not, as the DEA might put it, a drug-dealing doctor treating a bunch of junkies. That's not what's going on here."
DEA officials won't offer specifics about the case except that agents served an "administrative inspection warrant" at Nelson's office and seized records and some pharmaceuticals. The raid was low-key - no drawn guns or SWAT gear.
No one has been arrested and no criminal charges have been filed.
"This is an ongoing investigation," said Karen Flowers, a DEA spokeswoman in Denver.
The DEA in recent years has been cracking down on the illegal sale of pharmaceuticals, including the painkiller OxyContin. Flowers said an estimated 15 percent of all controlled substances make it to the illegal market - a process called "diversion" when a patient resells medication - accounting for about $25 million in sales each year.
"Somebody can make a lot of money in diversion," Flowers said.
Nelson, who said he has done nothing wrong, said the DEA never told him what the case is about.
"They just came in and grabbed the charts," said Nelson, a neurologist who has been practicing medicine in Montana since the 1970s and has an unblemished record with state medical officials.
Nelson has been in contact with lawyers and said he plans on speaking with a lawyer in San Francisco who has dealt with other pain-relief doctors who have had run-ins with the DEA.
Meanwhile, Nelson has stopped prescribing narcotic drugs that his patients have come to rely on, he said. Instead, he's referring them to alternatives that "muffle" the pain but may not be as effective.
Nelson started treating patients with chronic pain about three years ago. His office on South Frontage Road serves a wide range of patients, including some dealing with severe pain who need strong narcotic medications.
"A lot of people come in because they didn't have any place to go," Nelson said, adding that the situation emphasizes the need for a comprehensive pain management center in each city.
Bledsoe, one of Nelson's patients, hurt his back in January 2001 while working as a union electrician in Gillette, Wyo. Years of heavy industrial work also had taken a toll and, he later found out, his body was suffering arthritis, degenerative conditions and other problems.
Lifting a cup of coffee or climbing a set of stairs could be debilitating.
"The pain transforms your life," he said.
Bledsoe spent 18 months working with a doctor in Sheridan, Wyo., trying to find suitable medication. Finally, a little reluctantly, he tried OxyContin, a time-release narcotic that Bledsoe said provides some relief.
When he moved to Billings, Bledsoe checked in with several doctors and was eventually referred to Nelson. Bledsoe said the doctor was professional, cautious and thorough and helped find the right combination of medications "so I could be operational."
His heart sank at the meeting last week when Nelson told his patients that he'd been told by DEA not to prescribe certain medications. Bledsoe, who said he needs Roxicodone and Dilaudid, isn't sure whether he and other patients will be able to get the medication they need.
"It's going to put a lot of people back to a world of pain," he said.
Five of Nelson's patients contacted Burns' office concerned about what do, said Grant Toomey, a Burns spokesman. The patients were told to seek another doctor or go to a hospital emergency room.
"We'll certainly keep tabs on it, but as an ongoing (DEA) investigation, it really falls above our heads," Toomey said.
Similar situations have occurred elsewhere in recent years, according to Siobhan Reynolds, president of Pain Relief Network, a New York-based group that says it advocates for patients with chronic pain and the doctors who treat them.
"The DEA has been going after doctors en masse," Reynolds said. "It's mostly in out-of-the-way places like Erie (Pa.), Billings, Iowa and Indiana."
Last month, a nationally known pain specialist in Virginia was sentenced to 25 years in federal prison in a case where prosecutors said he was willfully ignorant that some of his patients were selling their prescription drugs or using them recreationally. A few of his patients also overdosed, prosecutors said.
Reynolds said the recent activity may have a "chilling effect" on other physicians who deal with management of severe and chronic pain, especially when they are targeted for the behavior of drug-selling patients.
"In any practice, a certain percentage of the patients are going to do that," she said. "It's an impossible situation for the physicians."
The American Medical Association in 2003 adopted a policy statement opposing "the harassment of physicians by DEA agents in response to the appropriate prescribing of controlled substances for pain management."
"The AMA is committed to the goal of protecting the legitimate use of prescription drugs for patients in pain," the AMA said on its Web site.
With his medications expired for the month, Bledsoe went to the emergency room on Tuesday afternoon. He was told that he can't get a scheduled appointment until next week and can't get a prescription for the medications he used to get through Nelson.
"I don't know what to do right now," he said.
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