Pubdate: Thu, 09 Dec 2004
Source: McLean Connection (VA)
Copyright: 2004 Connection Newspapers
Contact:  http://www.connectionnewspapers.com/paper.asp?paper=68
Details: http://www.mapinc.org/media/3564
Author: Ken Moore
Bookmark: http://www.mapinc.org/people/Hurwitz (Dr. Hurwitz)
Bookmark: http://www.mapinc.org/find?232 (Chronic Pain)

HURWITZ TAKES THE STAND

Jury Begins Deliberations on the 62-Count Indictment Against Mclean 'Pain 
Doctor.'

Some past patients say Dr. William E. Hurwitz saved their lives.

Before he found Hurwitz on the Internet, Sylvester Boyd testified
Friday, Dec. 3 that he suffered 12 years with "constant, nagging,
unrelenting pain - just pain, pain, pain - it nearly destroyed my
life." "I was at the end of my rope. It gets to a point where
shockingly suicide is not an option you're willing to dismiss,"
testified Boyd, 50, who suffered bone fractures, muscle and cartilage
tears in his back during a fall at an ice skating party he held for
his daughter about 15 years ago. Boyd was not the only grateful
patient. "Dr. Hurwitz saved my wife's life, said Charles Barnhart, of
New Mexico, following his wife Molly Shaw's testimony last Thursday.
"I hope she got to the jury; I know every time she talks about it, it
gets to me."

PROSECUTORS DON'T DISCOUNT the care some patients received from
Hurwitz, 59. But the 1,879,677 pills prescribed by Hurwitz to just 24
of the 400-plus patients he treated from 1998-2002 led to drug
addiction, drug dependency and death, according to Assistant U.S.
Attorneys Eugene J. Rossi and Mark D. Lytle. Kilee Hoskin's uncle,
Rennie Buras of New Orleans, died in 1999, under treatment by Hurwitz.
"This man built planes and boats and things with his bare hands,"
testified Hoskin, 25, during the third week of Hurwitz's trial, which
began Thursday, Nov. 4. "[Paramedics] thought he was retarded, that's
how the pills affected him." Prescriptions Hurwitz wrote for
OxyContin, including the 68,700 total pills he prescribed for Bret
McCarter and the 63,530 pills Hurwitz prescribed for Kevin Fuller, led
to illegal drug sales in Manassas, other parts of Virginia and
Tennessee, according to prosecutors. More than 15 convicted felons,
most from Manassas and many related to each other, testified against
Hurwitz. "I think he enjoyed it. I think he lived vicariously through
us," testified Timothy Urbani, 34, who faces 20 years in federal
prison for charges including conspiracy to distribute OxyContin and
robbery of OxyContin from a pharmacy. "At the time, I thought [the
pills] were helping me, but I'm in all this trouble now. . I wasn't
there for my kids for three to four years, now I won't be there for a
long time." Hurwitz's defense attorneys Patrick S. Hallinan, Kenneth
H. Wine and Marvin D. Miller called the convicted dealers "predators"
who abused the doctor's trust, lying about or exaggerating their pain
to obtain drugs from the nationally-known doctor who specialized in
high-dose opioid therapy for people with unrelenting chronic pain.

FOLLOWING 19 DAYS of testimony, from 63 witnesses for the prosecution
and nine witnesses for the defense, Hurwitz took the stand on Monday,
Dec. 6, in the United States District Court for the Eastern District
of Virginia before Senior Judge Leonard D. Wexler. Hurwitz testified
Monday that he showed all potential patients literature suggesting
that "opioid treatment is not for everyone." "It was an attempt to
discourage people from opioid therapy unless they have exhausted other
options," Hurwitz testified. "I wanted patients to understand that
treatment with opioids was a complicated practice with risks."
Hurwitz, who closed his practice in December 2002, faces a 62-count
indictment, including charges of conspiracy to traffic in controlled
substances, drug trafficking resulting in death, drug trafficking
resulting in serious bodily injury, drug trafficking distributions,
engaging in continuing criminal enterprise and health care fraud.
Still posted on Hurwitz's Web site is a request to patients,
foreshadowing the possible 20 years in jail or more that he faces for
each count of the indictment. "More than in most clinical
circumstances, the failure of patients to act intelligently,
responsibly and honestly can lead to disaster," reads the Web site.
"For all of these reasons, patients who undertake opioid maintenance
therapy should behave in a way that is beyond reproach or suspicion in
all matters relating to their use of medications. Patients who are
unwilling or unable to do so jeopardize not only their own health and
safety, but the health and safety of other patients with chronic
pain." Advocates for patients with chronic, severe pain are watching
the trial closely. The treatment of pain is a human rights issue, said
Mary Baluss, director of the Pain Law Initiative, who has attended
most of the trial. "I'm worried that high-profile trials will have a
negative impact on the treatment of pain," said Dr. Steven Passik
after serving as a witness for the defense.

THROUGHOUT THE TRIAL, prosecutors Rossi and Lytle emphasized that
Hurwitz deliberately ignored obvious "red flags" of abuse and
distribution, giving examples of patients who: * Gave frequent excuses
about lost or stolen prescriptions * Ran out of medication early *
Tested positive for illicit narcotics * Tested negative for
medications Hurwitz prescribed * Injected medications, which should
have been taken orally * Had track marks and ulcers on arms * Showed
cocaine rashes on skin * Reported current or past addiction * Were
arrested for distributing Hurwitz's medications or illicit substances.
Bret McCarter, whose street name was "Mav," testified that he smoked
crack before visits to Hurwitz so "I could look straightened out when
I made an appearance." McCarter paid $15,000 to $20,000 a month to
fill prescriptions for OxyContin, Dilaudid and Methadone, he
testified, and said Hurwitz called him a "high-risk patient." "At the
end, he would always continue writing the prescriptions," McCarter
testified. Hurwitz testified that McCarter was one of his high-dose
patients who was treated for pain resulting from failed back surgery.

McCarter's mother wrote Hurwitz a letter saying she was subsidizing
her son's treatment, Hurwitz testified.

HURWITZ'S TESTIMONYwas scheduled to continue Tuesday with prosecutor
Rossi's cross-examination, after The Connection's presstime.

Defense attorneys plan to introduce a few more expert witnesses, after
Hurwitz's testimony concludes. After closing arguments by the
prosecution and defense, the jury is expected to begin deliberations
later this week. Hurwitz's attorneys say he is not guilty of any of
the charges, that he cared for patients who could not get adequate
care elsewhere.

ABOUT 50 PEOPLE including Hurwitz's two daughters, mother and two
brothers watched his testimony Monday. "Imagine the feeling of
betrayal," said his brother Kenneth Hurwitz, senior associate with
Human Rights First. "He has gone out of his way to help people and
give people the benefit of the doubt. "It all seems so incredibly unjust.

If he made mistakes, they were mistakes that were out of his good
faith and his attempt to help people," Kenneth Hurwitz said. From
1998-2002, Hurwitz, who has remained free after posting a $2 million
bond, treated more than 400 people for chronic pain. He testified that
he terminated treatment for 17 patients, but sometimes continued
treatment for problematic patients that he thought he could help. "I
believe all the patients have pain," Hurwitz testified.

Sidebar

Doctor's Story Dr. William E. Hurwitz, of McLean, took the stand at
his trial on Monday, Dec. 6, at 10:45 a.m. Following questions from
his defense attorney Marvin D. Miller, of Alexandria, Assistant U.S.
Attorney Eugene J. Rossi's cross-examination of Hurwitz began at 4:50
p.m. Rossi's cross examination continued Tuesday, Dec. 7, after The
Connection's press deadline.

Hurwitz faces a 62-count indictment. Closing arguments in his trial
are expected to be presented this week.

ALEXANDRIA, VA, 10:45 A.M., MONDAY, DEC. 6 Dr. William E. Hurwitz
began by answering questions from his attorney about how he came to
specialize in pain treatment and the difficulties he had with it over
more than a decade. Hurwitz was sanctioned by the Washington, D.C.
Board of Medicine in 1991. Trouble for Hurwitz occurred, he testified,
after he prescribed medication to one of his patients whose wife was
dying of breast cancer and provided a stock bottle of Percocet to a
doctor in Paraguay. "The experience before the D.C. Board introduced
me to literature about pain as well as to people who were involved
with pain research," testified Hurwitz, who volunteered as the medical
director for Peace Corps Brazil in the 1970s and practiced internal
medicine in Washington, D.C. from 1978-1991. By that time, Hurwitz,
who treated his first patient with chronic pain in 1978, had five
chronic pain patients. "Having a patient with a problem focuses your
attention," he testified. The number of patients he treated for
chronic pain grew to 200 as his understanding of treatment with opioid
therapy grew, he testified. "There is no clinical limit to what a
patient may require to experience relief," he said, addressing the
very high doses of pain medications he prescribed for many of his
patients. "Opioid exposure appears not to cause any damage." But in
1996, Hurwitz's license was revoked by the Virginia Board of Medicine
and he was required to complete continuing medical education in the
pharmacology and physiologic actions of drugs, psychiatry and
addictionology and in record keeping and practice management. When he
resumed a practice specializing in opioid therapy in 1998, he required
patients to fill out a consent agreement form, letting patients know
they would be terminated if they abused medication, illicit drugs,
sought prescriptions from other doctors or sold drugs that he
prescribed. "This gave me the flexibility to discharge a patient," he
said. Hurwitz testified that he counseled patients, alerting them to
the dangers of opioid therapy and the associated social complications
and financial burdens. Hurwitz said his $1,000 initiation fee and his
monthly fee, which ranged from $125 to $250 during the course of his
practice, covered the cost of all visits no matter how many. "I wanted
patients to talk to me, and not to worry if they could incur further
charges.

I wanted them to have open access to me." He also trusted patients to
monitor their own pain relief. "Pain fluctuates from patient to
patient, I believed my approach with patients should be to give them
freedom to control pain," he testified. By the fall of 2001, Hurwitz
said he started ordering drug screens of patients when he said he
realized a percentage of his patients were abusing cocaine and his
prescribed medications. "I didn't have a concept of red flags, I had
concept of aberrant or problematic behaviors." "I was aware of the
investigation of me beginning in early 2002," testified Hurwitz, who
said he was "shaken up" by a number of his patients' positive urine
screens for cocaine use. "I was wrestling with this issue, trying to
reconcile how to deal with these patients," Hurwitz said. But abrupt
termination was never a reasonable option, only tapering patients down
from high doses, he testified. "[Abrupt stoppage of medication]
subjects people to a form of torture." Hurwitz announced the closure
of his practice on Sept. 1, 2002.

4:50 P.M., MONDAY, DEC. 6 Prosecutor Rossi greeted Hurwitz on the
stand. "Good afternoon, ." "Good afternoon, Mr. Rossi,"
Hurwitz replied. Rossi then referred to the 1996 order by the Virginia
Board of Medicine, which revoked Hurwitz's license in 1996. "Stephen
Bresko passed away on Jan. 15, 1996 in Pigeon Forge, Tennessee. Is it
true that he was a patient of Dr. William Hurwitz?" Rossi asked.
"True," Hurwitz replied. Rossi repeated this process for one other
patient mentioned in the Virginia order and with two of Hurwitz's
patients who died between 1998-2002. "From January 1996 to February
2001, you were prohibited from practicing for 23 months.

So in 39 months you had four patient deaths and a patient come near
death," Rossi said. "You averaged a death every eight or nine months,
true?" . "The charges in this court order are eerily similar, if not
identical to many of the things we heard from patients and their
records in this trial, true?" Rossi asked. "The charges appear
similar," Hurwitz said. 
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