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The trial of Dr. Denis Deonarine drew close scrutiny in the pain-management
world -- first-degree murder charges rarely are leveled at a doctor.
Pain-management advocates feared a conviction would have emboldened prosecutors
around the country to use the charge more frequently, but Deonarine was
acquitted Thursday of playing a role in a patient's overdose death.
There have been a few doctors convicted of delivering drugs that resulted in
patient deaths, since the pioneering prosecution of a Panhandle doctor several
Pensacola prosecutor Russ Edgar won the first manslaughter convictions in the
country against a doctor, James Graves, in February 2002. He thinks a
first-degree murder conviction could be a "barrier breaker."
Edgar considered a first-degree murder charge against Graves. "That was an
option in the case I did, but, quite frankly, we had never charged a doctor for
manslaughter for an OxyContin death. That was a barrier breaker, too."
Edgar said Thursday's murder acquittal might cause prosecutors to think twice
before using the charge against a doctor.
"It may discourage others, but I don't think it would discourage all because
cases are fact-specific," he said.
Drug investigators took note when Graves was convicted and sentenced to 63 years
in prison for four patient deaths, racketeering and unlawful delivery of a
Edgar's prosecution became the national model. He used the racketeering charge
to link the different elements of the case, which is more typical in complex
white-collar frauds. His tactics were adopted in the cases around the country
that followed, including Deonarine's.
"I've not only addressed groups of prosecutors, I've addressed conferences and
investigators from all over the country, both state and federal," Edgar said.
Each trial sparks the debate over whether doctors should be free to prescribe
large quantities of narcotics to pain sufferers. Prosecutors say they only
target doctors who cross ethical and legal boundaries, by ignoring that some
patients are abusing the drugs or selling them.
Pain management advocates say there is an epidemic of untreated pain. They say
they are under assault by law enforcement, and that patients continue to suffer
as a result.
"It's panicked the whole medical community, at least those who were treating
chronic pain, which was a small minority anyway," said Frank B. Fisher, a
Northern California doctor who was charged with five counts of murder in 1999 in
a case that eventually fell apart. "They have stopped practicing pain
management. Others have cut back or thrown out whole classes of patients."
Prosecutors make no apologies for going after bad doctors. Edgar says doctors
who too freely prescribe new, more powerful narcotics such as OxyContin are a
danger to patients.
"The script doctors then become potential killers. Sometimes you get a
pharmacist or doctor that is so far beyond their ethical and medical limits,
they don't seem to care," he said. "The results are deadly, and it is very, very
Pensacola attorney Hubert Edward Ellis Jr., who defended Graves, said
prosecutors likely wouldn't be able to win manslaughter or murder convictions
without using the racketeering allegations to bring in more prosecution
He said negligent doctors should face medical board reviews or civil suits, not
"I think it's overreaching by the prosecutor's office. I don't think it's a
first-degree murder case," he said. "I don't think any state attorney who
prosecutes any doctor could prevail on the case unless they have the
racketeering counts tied in. That is the only way to get a conviction."
Deonarine was acquitted of 75 counts, including murder, drug trafficking and
drug delivery, but convicted of 10 counts involving racketeering, Medicaid fraud
and drug trafficking. One of the trafficking charges carries a 25-year mandatory
Siobhan Reynolds, president of the patient advocacy group the Pain Relief
Network, said every prosecution of a pain specialist causes a chilling effect in
the medical community. "They're terrified. They are absolutely terrified," she
Not all pain management practitioners feel under siege. Dr. Lawrence Gorfine,
who runs the Southern Pain Center in Lake Worth, is one of them.
"Law enforcement has not changed the way I practice medicine. I am very cautious
in general about prescribing narcotics to patients," he said. "I am strongly
against any physician who is not adequately evaluating every patient and closely
following their medications. This is the incorrect practice of medicine and
should be severely dealt with in the right channels, but I don't know that
murder [charges are] the right way to deal with these issues."
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