Dr. Naramore Under ‘Investigation’

Dr. L. Stanley Naramore Under ‘Investigation’ – Again. Alex DeLuca; Pain Relief Network; 2007-06-29. Additional excerpt from news item added in brown, 2007-06-30; image added: 2008-04-04; link to PDF of court’s ‘98 decision overturning Kan. v. Naramore on appeal; added: 2008-10-24.

Permalink: http://doctordeluca.com/wordpress/archive/naramore-under-investigation/
See also:
Pain Relief Network Clinical Litigation Project
and,
Pain Relief Network Sues State of WA – PRN; 2008
and,
PRN v. Kansas + the DOJ (ZIP) – PRN; 2008
and especially,
PRN audio/video Archives – (new in 2008!)

From reporter Gregory Korte of The Enquirer – Cincinnati.com, comes “Painkiller Prescriptions Probed” (article no longer available), dated 2007-06-24, (which is, by the way, largely plagiarized from the less inflammatory Associated Press article under various titles, including “State Probes Ohio Doctor for Prescribing Painkillers”, or Board investigates doctor’s prescriptions; AP; 2007-06-26. Or AP plagiarized The Enquirer. Or whatever.)

A doctor whose murder conviction was overturned on appeal a decade ago is now being investigated for prescribing large quantities of OxyContin and other painkillers…

The Ohio Board of Pharmacy began investigating Dr. L. Stan Naramore in May 2006, when it first received complaints from suspicious pharmacists… Some of [Dr. Naramore's] patients told investigators they sold the pills on the street for a profit…

Innuendo and an ‘investigation is all it takes to ruin a doc and cause the abandonment of his patients. Just ask Dr. Nelson and his patients in Billings, Montana.

Dr. Naramore (pictured left, circa 1996) is obviously no media neophyte, and he gets several important points across very effectively in the article:

“The undertreatment of pain is a serious problem in America,” he said. “Physicians are afraid of persecution and prosecution for adequately treating pain. No American should suffer pain.” …

“What kinds of patients see a physician who treats drug addicts? Drug addicts,” he said. “Do we have a lot of drug addicts in our practice that treats drug addicts? Of course we do.” …

“Naramore said he’s troubled that the state pharmacy board has a database that allows investigators to track, patient by patient, the prescription patterns of doctors who prescribe controlled substances.” [See also: Do We Really Want e-Prescription Monitoring?; DeLuca; 2007-05-08]

“I only hope that patients who were being treated for drug addiction and patients who were planning to be treated for their drug addiction will not now be forced to return to illegal and dangerous drug use, because of fear of the loss of their privacy,” he said. “We need to seduce patients into treatment, not scare them away.”

My kind of doctor; I like this guy.

But what you also need to know about Dr. Naramore is that he is living war-on-doctors history. Dr. Naramore was convicted of murder by medication in 1996 in a case that involved two patient deaths. In 1998 the Kansas Court of Appeals Reversed the conviction also available as PDF:

This is not a situation where the evidence in the defendant’s favor is trifling. It is extremely strong… supporting a reasonable, noncriminal explanation for the doctor’s actions, [and] it cannot be said that there is no reasonable doubt of criminal guilt. [The] only way the defendant’s actions may be found to be criminal is through expert testimony, and that testimony is strongly controverted in every detail…

With no direct evidence of criminal intent, it is highly disturbing that testimony by such an impressive array of apparently objective medical experts, who found the defendant’s actions to be not only noncriminal, but medically appropriate, can be dismissed as “unbelievable” and not even capable of generating reasonable doubt.

The quality and quantity of evidence necessary to establish criminal guilt was not presented in this case… Reversed.

No. 77,069; STATE OF KANSAS, Appellee, v. L. STAN NARAMORE, D.O., Appellant – Syllabus of the Court, also available in (PDF format)

Ethicist Ben Rich, JD, PhD, uses Naramore’s 1996 conviction for murder by medication as a case study of a drug war criminal liability conviction in his 2005 article, “Overcoming Legal Barriers to Competent and Compassionate Pain Relief for the Dying Patient” published in the APS Bulletin, in which he reviews the Naramore prosecution, the Appeal, and lessons learned.

In 1992, after the retirement of their only local physician, the community hospital of the rural town of St. Francis, Kansas recruited Dr. Stan Naramore (Alpers, 1998). Naramore quickly became the subject of rumor, innuendo, and hostility because he did not fit the community’s perception of a model physician. He used tobacco and alcohol, drove his red Lincoln at a high rate of speed, and was reputed to enjoy gambling. To add insult to injury, he made a practice of publicly criticizing local civic and political leaders…

The thrust of the Kansas Court of Appeals decision is that no jury may find beyond a reasonable doubt that a physician had the requisite intent to harm his patient (technically referred to as mens rea, guilty mind ) if competent and credible expert testimony is offered that his or her actions were consistent with good medical practice…

Naramore’s ultimate vindication by the Kansas Court of Appeals will strike many practicing physicians as offering extremely cold comfort, however. [In a] recent survey, prosecutors were asked to give their opinions about a hypothetical scenario in which a hospice physician gradually increased doses of morphine for a 25-year-old patient dying of AIDS… The survey results revealed that 50% of prosecutors did not know whether a criminal act had been committed, while another 20% believed one had.
 
[Ziegler, S.J., and Lovrich, Jr., N.P. (2003). Pain relief, prescription drugs, and prosecution: A four-state survey of chief prosecutors. Journal of Law, Medicine and Ethics, 31: 75-100.] (emphasis mine)

Doc Naramore is an interesting and courageous man, I think. He sounds tough as nails, even though he is recovering from recent open heart surgery, and I have no doubt he could command a very impressive array of expert witnesses this time around too, should the Attorney General of Ohio care to pursue what strikes me as a weak basis for justifying an ‘investigation’ much less ‘Ohio v. Naramore.’

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