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[Deonarine] Murder Trial Sparked Concern among Pain Specialists

 
by Peter Franceschina; South Florida Sun-Sentinel; 2005-05-20
Originally posted 2005-05-21: [www.doctordeluca.com/Library/WOD/DeonarineMurderTrial05.htm]
Source: [http://www.sun-sentinel.com/news/local/palmbeach/sfl-pdrugdocmay20,0,6133220.story?coll=sfla-news-palm]
 
See also:
"Trial Opens for Doctor [Deonarine] Accused [of Murder] in Drug OD Death" by Missy Stoddard; Sun-Sentinel; 5/4/2005
 

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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 years ago.

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 controlled substance.

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 disturbing."

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 evidence.

He said negligent doctors should face medical board reviews or civil suits, not murder charges.

"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 prison sentence.

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 said.

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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