Pubdate: Sun, 17 Mar 2002 Source: Shelby Star, The (NC) Copyright: 2002sThe Shelby Star Contact: http://www.shelbystar.com/ Details: http://www.mapinc.org/media/1722 Author: Cassie Tarpley PATIENTS FACE PAIN WITHOUT A PHYSICIAN While Dr. Joseph Talley and his lawyers prepare his defense to present this week before the N.C. Medical Board, hundreds of patients who depended on the Grover family doctor for narcotic pain medications are looking elsewhere for care. The search is a hard one, the doctor says. Talley, scheduled to appear before the board Thursday morning in Raleigh in a proceeding that could oust him from the medical profession, said his aggressive use of narcotics has been scrutinized for years. A 1996 change in position by the N.C. Medical Board "had us dancing in the streets" at what seemed a much more liberal stance, Talley said in earlier interviews. Charges brought against him by the board in October and the federal Drug Enforcement Administration's suspension of his narcotic prescribing privilege in January have left him and patients in the lurch, he said. "The people that didn't ask for this are the patients," he said. "I never dreamed after the 1996 position statement that this would happen." The N.C. Medical Board's Web site - www. docboard.org/nc - shows Talley's license status as "free and unrestricted." "That's correct from the medical board's standpoint," he told The Star Thursday, "but it does not feel that way," he said, without the DEA sanction to prescribe narcotics. The major portion of Talley's patients were receiving some kind of opioid therapy, often more than one medication. Since Jan. 30, when federal agents seized his DEA number, Talley has continued to see patients, but spends most of his time trying to get other doctors to take them, he said. He maintains his usual office schedule, from 6:30 a.m. to 9 or 10 at night, he said, except for Thursdays, his regular day off. However, the patient load is down to 10 or 12 a day. He used to average 20 or more, and 30 to 40 when colleagues were out of the office, he said. "It's been very difficult for me to place patients," he said. "I've got two or three (doctors) who I absolutely must not name that I can get patients to, but only a few of them. "I called one of the better family practices in Shelby last week and tried to refer a patient," he said. At first, he said he was put off gently, but when he pressed the question, was turned down outright. "I was told they had a meeting and decided they did not want to take any of my patients," Talley said. Talley said that when patients he has treated seek care themselves, they are held up to ridicule. In one example, he said, "My patients have told me over and over that they go to the ER (the emergency room at Cleveland Regional Medical Center) and are treated cordially enough until they say Talley is their doctor - then they are ridiculed, laughed at." Hospital spokeswoman Cindy Cook said while it is possible individuals could react that way, the hospital's policy and mission statement demand otherwise. "When any patient comes to Cleveland Regional, they are always treated with dignity and respect," Mrs. Cook said. "And that's regardless of their ability to pay. Our mission statement demands that of us." A doctor's reputation is not a factor in how his or her patients are treated, she said. Mrs. Cook said she consulted with Dr. Kevin O'Dell, medical director for the hospital's emergency department, before responding. "He told me that any patient that comes into the 'ED' is evaluated and treated appropriately, and if necessary, referred on to a physician," she said. "The ED is for acute situations," she said. "If somebody comes in and says they have chronic back pain and are out of their medicine, our doctors wouldn't write a prescription for 200 pills but might write them 5." Also, she said, the hospital doctors generally do not write prescriptions for or dispense the same type of narcotics prevalent in Talley's practice. "We treat whatever diagnosis is identified for that visit, prescribe interim medication if that is needed and refer," she said. "We had been seeing some of Dr. Talley's patients all along in emergency situations," she said, "but right now, we are seeing an increased number of them." Emergency room doctors have been referring Talley's patients to Shelby Anesthesiologists' pain clinic here in Shelby and one in Kings Mountain. Doctors with the anesthesiology group could not be reached for comment Friday. Jay Taylor, director of Pathways, declined to comment specifically on whether the substance abuse section of the mental health clinic is seeing an increase in Dr. Talley's patients seeking treatment for drug abuse. "It would not be appropriate to take a shot at any one place where patients are coming from," Taylor said. "If we run into or are contacted by someone experiencing withdrawal, we will evaluate that person based on their needs." Taylor said the clinic is "busy all the time" and it is difficult to say if there has been an increase in people seeking help in the last few months. "If our intake of clients has gone up it may or may not be due to Dr. Talley," he said. "An increase is more likely to be due to the bad economic times." Woody Hubbard, business administrator for Southeast Pain Care, with seven sites in the region including Kings Mountain, said Friday that any patient who comes to the clinics must be referred by a primary care physician. "Any time we have a situation where another clinic or group of physicians' patients need to come, they all must come from primary care referral," Hubbard said. "As a subspecialty, it's no different than seeing a cardiologist," he said. "It requires a referral." Hubbard said he did not know if Talley has contacted any of Southeast's sites. "I have not spoken with Dr. Talley myself," he said. Hubbard said of patients being laughed at because of their connection to Talley, "I doubt that would ever happen here." Dr. David Barker, co-chairman of the Cleveland Regional Medical Center ethics committee, was not available Friday to comment, but earlier said he was concerned about continuity of care for Talley's patients. "I think we probably have some problems coming," Barker said in February. "I'm concerned that there will be a lapse in these folks being able to identify the source for medicines they need. I am concerned that we don't have a readily available source of care for the type of patients he has been seeing." Barker queried, "Will the pain centers - that are being pushed and touted by the government - will they take time to work out the patients' needs in a way besides telling them to just sit at home and live with the pain?" - --- MAP posted-by: Josh