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Society, the Addict and the Physician: Contaminated, Condemned

[These notes are substantially what I presented to the court in 1997 in an attempt to clear my professional reputation so I could continue my work.]

The following are unpolished notes which refer to the experiences I have suffered from a more than decade-long collusion against me by Colorado State and Federal employees. At no time have I had the benefit of due process of law. My professional status, financial stability and health have all been severely damaged as a result of these events. Further, I am convinced most of these matters have arisen from a deep-seated cultural hatred against persons who suffer the disease of drug addiction, directed against me as one of those who would help them recover. That constitutes a deprivation of my civil rights and their rights to treatment for their illness.

Because this document is quite condensed it may be difficult to follow. I will be glad to make myself available to clarify or amplify any point.

Thank you for your interest.

Abbreviated Approximate Ordinal Listing

1972 Graduation from medical school

1973 Oklahoma medical licensure

1975 Colorado medical licensure

Physician for Denver Department of Health and Hospitals (DHH)

1979 Medical Director of Substance Treatment Services (DHH)

1980 Applied for parallel position at Addiction Research and Treatment Services Mills and Pottle enforce ‘hospital’ rule against me at Mount Airey and Porter Hospitals

Establish private practice, continuing as medical director at STS Foote Commission planning budget cuts for City of Denver

I ask Mayor McNichols to let me help close STS smoothly

1981 STS Patients’ injunction to keep clinic open

Licensed to dispense methadone in my private office

1983 First dispensed methadone to treat a patient in my office

Crowley hires Jayne for both jobs (STS and ARTS), as she replaces me at STS (the double job he told me was ‘conflict of interest’)

1984 I take on ‘difficult’ pain cases to keep them out of other offices

1985 Organization of Colorado Task Force on Prescription Drug Abuse

1986 Pharmacist calls to say DEA and State Pharmacy Inspectors don’t like my prescriptions

Meetings with Mike Simmons and Bill Williamson

First ‘twenty day’ letter from Board of Medical Examiners

Asked by ADAD to help Galen Rogers and Robert Kahn start a new private clinic

1987 Second ‘twenty day” letter and dismissal of the first

1988 Angry dismissal of the second ‘twenty day’ letter by Tom Beckett (after I got an attorney) Unannounced visit from DEA

1989 ‘Disallocation’ of Diskettes to Colorado

I close methadone operations by necessity, out of fear

1990 Letter from U.S. Attorney

First coronary occlusion

Agreement with DEA worked out

Before agreement is finalized, Fred Pottle (ADAD) calls my employer (a breach of the agreement)

U.S. Attorney refuses to apologize, but disclaims control over misbehavior of State employees (e.g., Pottle)

I continue trying to arrange job in New Mexico

Expand work with CATS (fearing isolation from other professionals)

1991 Move into new building with CATS (second coronary on moving day)

Plan expansion of outpatient services, license arrangements approved by Pottle

1992 Business arrangements disintegrate, try to arrange with many other physicians and clinics, all of whom identify me as one who treats drug addicts, avoid me grossly and obviously

Pursue previous New Mexico project, encounter obstacle with New Mexico Board of Medical Examiners, specifically communication from DEA about “5.45 grams of methadone unaccounted for” U.S. Attorney denies Denver DEA sent it, but won’t put anything into writing, says it must have been the Albuquerque office

Albuquerque office won’t talk on the phone, says go to Washington through Freedom of Information Act

New Mexico job is denied me, probably because of uncertainty of licensure

 

***

Many of us fear or are convinced our culture is faulty. I know it to be hopelessly corrupt. I have been one of the very privileged--a doctor’s child, a doctor--but I have suffered also. I do not hate American culture (society, politics, economics, institutions, values, and such), but I no longer love all this. I spent five decades doing what I could to repair the larger and smaller holes in my family and in my society and its citizens, but until the last few years I made little progress to repair the holes in myself. By continuing to write like this I make it obvious I am still trying. However, I no longer feel the passionate love which previously drove me.

Every one of us knows a great deal about what is going on here, what has always gone on. We know so much we tend to hide from it. If I were to try to tell everything I would overwhelm myself and blow a few fuses. Instead, I shall focus on one small part of my own experience, what happened to me as a physician because I treated drug addicts, and the lengthy intricate conspiracies of government agencies to destroy me because they couldn’t control me. I know these sorts of things have happened to others, but I will not rely on their experiences to validate my own. I am here today simply to tell you my own story. I don’t need to tell it for my own sake, for I already know it more deeply than I wish. I do not tell it merely for your sake, for you are as powerless as I to change things. I tell it for the sake of this society and culture I still love despite my disclaimers. (A knowing friend brought me a t-shirt picturing a rosy-cheeked dunce stepping off a precipice into the snapping jaws of a sea of wolves––“A romantic enters the world”.) I recite this story as a sort of prayer for the sake of all of us together, a sort of confession that we need help from something bigger than we are––that higher power which constantly showers us with miraculous opportunities.

***

The Altruist Who Would Care for Addicts: clinicians who are “altruistic narcissists” or Buber’s “man of ethics”

Many millions of us are clinicians. We care for others in their private bodies, souls and lives. All of these clinicians are motivated by altruism, concern for the welfare of the other person. Circumstances and culture tend to beat us out of our altruism, to make physicians (for instance) seem motivated by greed. Altruism can be bent out of shape, used in ways that enhance dependence in the patient or drain the life out of the clinician. To avoid self-centered greed on the one hand, and to avoid self-sacrificing pathologic altruism on the other, is my tight-wire as a clinician.

I know some of the factors that made me the way I have been, but I can’t tell you what portion of it is good or bad, I can tell you what is so. My father was an avant garde high-tech radiologist who studied in the nineteen-thirties. His mother’s illness (which orphaned him at ten), and his brother’s incurable illness probably had something to do with his looking for new techniques and applications in medicine. The talent which allowed him to do his best work in radiologic diagnosis was his profound understanding of anatomy and pathology––the structure of the human body and the shapes of the things that change in it as results of disease. Despite appearances, he cared very much about the patients he saw, but he had little contact with them, nor, I fear, was he competent to communicate on an intimate human level.

I resolved to be a teacher, having been disappointed with the shallow hypocrisy of the clergy. I knew physicians as mercenary quacks who wrote off trips to Acapulco and worked long hours to keep up with their wives’ spending. At about twenty-one I began tutoring disturbed children, which led me to work as a group therapist with children who were outpatients at the children’s psychiatric hospital where at age eight I had myself been an outpatient for evaluation of my school problems. I felt something I hadn’t before experienced as a student or a poet––I felt like a real person in relation to my patients, the children and their parents. I resolved, more clearly than I could have done previously, to be something, and I was willing to do whatever was required. My task was to become a good psychotherapist to children, so my considerations came to psychology or psychiatry. Because I wanted to offer the broadest expertise to my patients I chose medical school over graduate school. I was shocked to see myself becoming a doctor like my father, and resolved to be a doctor unlike my father. (Later my father and I discovered the hidden obvious, that we shared the same altruism amalgamated with the same love of knowledge.)

Altruism is little studied. It comes not only from guilt that manifests as responsibility, but it has a good measure of grandiosity. To think you are powerful enough to help an ailing other is grandiose, but to fall for the myths of modern medical science in this society, that you can keep every patient from suffering and dying and that you never make mistakes, these become a form of madness. Martin Buber expressed it something like this: The person with ethics is constantly casting the shreds of his own heart into the abyss between Is and Ought, between impersonal society and true human community, as if he could thereby bridge the chasm between them.¹

I hope I don’t need to waste many words to convince you I am imperfect, grandiose and unrealistic in many facets. To criticize other persons doesn’t help me at all, only shows I am bit testy today. I do, however, know much of my own feelings and motivations, and I know I have meant to do good for others, and that I often have done good for others. When I am accused of greed because I am a doctor or lawlessness because I have treated patients who were addicted I feel anger and hurt. After all, I am human, and still growing.

In this culture generally medicine and other clinical enterprise have been conducted sterilely, mechanically and impersonally. Cultural myths of painless immortality through technology were the basis of passivity in each patient and the apotheosis of the physician as the powerful healer. Since before 1980 marketing competition and government regulatory programs have amplified the insurance industry’s numerical cataloguing of conditions and procedures to intensify depersonalization. The hospitals and institutions couldn’t survive without advertising, the politicians couldn’t win without “cutting costs” (increasing expenditures and cutting services), and the insurance industry is motivated by the same greed for money and power as are the hospitals and politicians. Today doctors are more like technicians than gods, but they still don’t know how to become human. I don’t either, but I have tried. That’s one root cause of my troubles with the authorities.

I take longer with patients. That’s not a crime in this culture, but it soon will be. During that “wasted” time I find out who the patient is, and I engage in a dialogue with that person, asking from out of who I am, from what I see and understand, listening to who the patient is.

I fill in all the blanks on the forms with the appropriate code numbers, but not with great joy. I see each patient not only as a unique individual but as someone always growing and changing. The diagnostic code number I put on the form for a patient one day may be different from the week before. (I don’t fall in with protocols easily.) I try, sometimes succeed, to keep bureaucratic and commercial concerns in my mind, but often I become the myopic clinician who considers only the welfare of the patient, because I see that as my job (taught too well by my Koan teacher Hippocrates).

Some professionals propose a consumeristic formula for a commercialized competitive health care marketplace.² Because I know no patient is in the position to understand or judge well on her or his own, because the patient (even if it is I) is never “objective” enough to perceive or judge wholistically, I cannot see that a consumerist approach will succeed for us. As a clinician I liberate patients by helping them, rather than rendering them more dependent and obedient as a result of authoritarian treatment.

***

Addicts and Addiction

Addicted patients are as deeply and chronically afflicted as any. Even so, they are simple to deal with in terms of diagnosis and treatment because despite their individual human uniqueness their circumstances and symptoms cover only a narrow spectrum. In our culture and society addicts’ drug needs are to be supplied only in the cases of chronic opioid addiction who choose maintenance on methadone [or now, buprenorphine]. Those addicted to other drugs (such as alcohol, cocaine, marijuana, benzodiazapenes) are not to be supplied with those drugs. If an addicted person is to be maintained on drug a special dependent relationship will be established between the person who is addicted and the clinicians who supply the drug. The supplying of drug through government regulated clinics is the funnel which narrows to the same pattern the preoccupations and behaviors of all addicted patients in methadone maintenance programs, makes all seem similar.

I have said it is simple to treat addicted persons, but not necessarily easy. For me there are some simple principles that arise in their treatment, but I will not remember all of them (so please don’t use my words in place of your own experience):

Addicted persons are not hedonistically motivated by pleasure and impulse, but (quite the opposite) are motivated to avoid pain (or why would they work so hard to take pain-relievers?)

Addicted persons are not disorganized and inefficient. It takes great organization, effectiveness and hard work to supply a drug habit.

Addiction may be considered a psychosis of relationship, in that an inert substance is treated with the love sanely invested only in some other person (even if that person is a pet, a ghost or a deity). Although usually unaware of it, the addicted person so loves the substance, the setting, the appurtenances and the effects of the use of drug that he is deprived of any effective love relationship with a real other person. As a result of such deprivation comes the deprivation of one’s own person, the neglect or abuse of the body which is a part of one’s own person, and the neglect or abuse of the self-esteem which might integrate that person.

The effective treatment of the affliction called addiction is personal, and supplying drug, or preoccupation with interdicting the use of drug is only a temporizing which may make room for the gradual development of relation with persons and the development of self-image and self-esteem.

These statements are too general to apply with ease to all cases, and too incomplete to be used as any sort of tool or canon of diagnosis and treatment. I offer them as the sorts of simple suggestions which have been helpful to me in my work, and to show I do not need to traffic in drug legally or otherwise to do my work as a physician.

To accept and attend to the person who is addicted is a privilege. It is much easier to understand and communicate about a narrow range of symptoms to a community of individuals who suffer addiction than it is to do so in cases of heart disease or lung disease or cancer. The sharing of similar experiences is tighter in those who are addicted.

Professionals, especially physicians, are reluctant to have anything to do with addicts. Generally they want them out of the office, the emergency room, the hospital. They believe addicts are difficult to deal with, dishonest, drug-seeking, hopeless. Their irrational prejudices against addicts are based on lack of training, lack of experience, lack of imagination. Their irrational prejudices are powered mostly by unacknowledged fear of government regulatory authorities, especially the Federal Drug Enforcement Administration and the State Board of Medical Examiners. They fear these agencies will punish them for attending to addicts, and although such fear is irrational and wrong, it is true. This brief story is intended to inform you that government agencies do not follow rules of clinical rationality or law, but of lawless condemnation without due process, and lawless tactics of coercion, extortion and intimidation.

***

The Structure of Authority and the Attitudes of Enforcers

Naively I considered society a complex structure with simple principles, a machine intended to meet the needs of its constituent individuals. As a token compromise with reputed reality I considered perhaps there were also constituent groups, but that those groups were formulated of individuals (the only form of human being I can feel as real, relate to with my own humanness).

Health care has to apply to individuals essentially, in their uniquenesses and confidentialities. If groups of any sort are involved in health care they are included only at the level of contracts between institutions, not included primarily in the patient-clinician relationship. The laws applying to the clinical relationship without exception apply to the responsibilities of the clinician or tangentially to the clinical institution, not to the corporations that grab dollars nor to the politicians and regulators who grab power.

Among the many written communications and telephone calls I had with Washington during the past fifteen years one in particular had a positive emotional effect on me.  I was speaking for the first time with the new legal expert at the National Institute on Drug Addiction.

“Hi.  This is Nathan Pollack in Denver.  Welcome on board.  I just want to clarify a couple simple points on the regulations.”

“Certainly.  I’ll help you if I can.”

“Is it true there is no law against being addicted?  There are only laws about how you can get a supply of drug?”

“Yes, come to think of it, that is so.”

“And the purpose of all the regulations is to avert diversion of drug, to avoid the overdoses, new addictions and criminal activities which result from illicit drug traffic?”

“Yes.  I think that is the central purpose of the regulations.”

“And the one who must decide in each case whether someone is addicted, and how that person can be treated, is the licensed physician?”

“Yes.”

“Thank you.  You have been very helpful.”

And having hung up the phone I clairvoyantly heard that lawyer exclaim to the others in his office, “Amazing!  Some hick in Colorado just called me and summarized in three clauses the contents of these eighteen volumes.”

I followed all the regulations, and understood their purposes.  How could I be so wrong?  Society is not as I had seen it, nor are regulations so simply comprehensible.

Society is a structure that may be leaner or more massive, but its purpose is in no way the welfare of the people.  Elected, appointed or employed societal agents mediate every social occurrence.  Their purpose is to be employed and to stay employed.  Unless they are threatened with losing their personal securities they will do nothing to benefit one or some or all the people.  They must be pressured or they will not work for our sakes.  They need not be removed wholesale, for their replacements will be their clones.

Regulations are blank checks (so to speak) that will be used, interpreted or ignored in the interest of the authority.  The meaning of the text of a regulation has no bearing on its application.  Regulators are likely to consider themselves experts on the regulations, and summarily disregard any reading counter to their interests.  Their interests are to maintain power, to withhold power from anyone else, and to withhold information from any other party. 

They consider the primary value to be the maintenance of the structures in which they have power and from which they take sustenance.  I was in error to consider the primary value of “public servants” to be service to the people.  Another dazzling confusion is to see society as the arena in which individuals and groups compete for what they think they want (like the “free market” model of health care).  That only replaces the selfishness of the authority with the selfishness of the self-interest group.

***

A Brief Summary of My Story

Over thirty years ago John S, then Deputy Manager for Medical Affairs of the Denver Department of Health and Hospitals, said to me,

“Nathan, I have just the job for you.”

“What is it, John, the addicts, the alcoholics or the schizophrenics?” 

“The addicts, of course.  You’ll love it.”

“Of course I will.  Everyone is a good patient as far as I’m concerned.  What I don’t understand is why no one else will touch them.”

A few months ago Doctor S, still my mentor, still my friend, no longer my supervisor, said:

“Nathan, if you can get out of Colorado, if you can get a license and a job some place else, just don’t treat addicts and you’ll be okay.”

“But, John, if I remember correctly you are the one who said it was just the job for me.”

“Sorry.  I was wrong.”

“Thanks for the advice, John.  I’ll try to follow it.”  (And I thought to myself, “I’ll do it again in a minute if I can, if someone needs me.”)

What happened in those few years?  First, it happened from the beginning, not in the middle or at the end.  You already know the bare bones of the story from what you have read above, that I stubbornly remained the Hippocratic physician, that I took a humanistic individualistic attitude which abraded many bureaucrats’ institutional authoritarian attitudes, that my headstrong mother-hen attitudes ruffled their power-hoarding feathers, and that they early decided to get me by any means but never got me into prison or removed my license because I had never committed any crime.  They did ruin me professionally and financially.  I don’t blame them, really.  They were wrong all along, but I provoked it by breaking all the unwritten rules.  I have no sense of what not to say and how not to say it, no sense of personal survival, no respect for authority qua authority––I am a political psychotic.

I started as physician for Substance Treatment Services to replace a physician who was diverting and prescribing drugs for addicted patients, using drugs with them, having sex with them, and on at least one occasion failing to report a gunshot wound.  He has confirmed these things, recanted, recovered from his own addiction, and now rehabilitated has national prominence as a smilingly popular certified expert in the field of addiction treatment.

There were two twin competing methadone programs in Denver then, the City’s STS and the State’s clinic ARTS (Addiction Research and Treatment Services).  Along with the two and one-half other programs in the state these were the wards of the State Authority, the methadone monitoring division of the Colorado State Health Department’s Alcohol and Drug Abuse Division (ADAD).  In or near Washington were the National Institute on Drug Abuse, the Food and Drug Administration Methadone Monitoring Division and the Drug Enforcement Administration.  The Region VIII offices of the FDA and DEA were conveniently in Denver, and their agents regularly came with the State authorities on inspections.

In any unusual or complex case––especially any patient traveling to other clinics in the country temporarily or as a transfer, any patient needing take-out privileges for any period (not to come to the clinic for drug every day) or any patient requiring higher than usual doses of the drug––telephone and written approval had to come from ADAD and, perhaps, Washington.  The State authorities (about a half a dozen of them) were sometimes all unavailable for approval.  Depending on the patient’s condition I would sometimes leave a message summarizing my assessment and plan, welcome further suggestions, and proceed with treatment.

There were periodic meetings of representatives of all the methadone programs to discuss problems, to give input into policy revision and to receive revisions of the rules.  I had infrequent occasion to attend such meetings, but between the inspection processes and the meetings I had managed to abrade at least two of the State’s staff, probably by not making it clear I had listened to “how we do things around here” and too quickly coming out with “it seems to me” statements.

As long as I was a full-time City employee things went relatively smoothly, but I came to resign my Career Service position to establish my own office in general medicine. In order to offer smooth transition for the sake of the staff and the several hundred patients, I continued as Medical Director at STS only until they could replace me.  Two and one-half years later they found a replacement.

I had become familiar with methadone treatment.  Even though it certainly was no cure-all it was a useful tool in voluntary cases.  The treatment of persons who were addicted appealed to me as a professional, as I have outlined above.  I had hoped for some professional fraternity in these regards from Tom Crowley, the Medical Director of ARTS, but, as I quickly learned, there was a sense of aloof superiority at ARTS actively promoted by Doctor Crowley.  Patients transferring from ARTS as well as articles, speeches and other interchanges from ARTS showed me Doctor Crowley’s authoritarian behaviorist approach would be difficult to reconcile with my liberal individualist approach, but I tried.  I never said one disparaging word to any patient about ARTS, their clinical approach or some of the martinets on the ARTS staff.

I wonder how it came about that the State employees became polarized against me, at ARTS (part of the University of Colorado Health Sciences Center) and at ADAD (part of the State Health Department).  I guess I knew something of it then, but I certainly came to know more clearly as time went by, and it seemed I was unable to do anything to repair the breach.  They wanted addicted patients to be well-behaved addicts; I sought to help suffering addicts become more liberated individuals free to become unaddicted, each by their own unique paths with support from the professional staff, sharing health with others who had suffered similarly.  They gave priority to the regulations and regulators, I to the persons who were patients.  They were not wrong to emphasize structure as that which could best support the patient and protect society.  I was not purely right to focus mostly on the patient.

Shortly after establishing my own medical office, and while I continued to serve as Medical Director of STS, I procured special licenses for the use of methadone in the treatment of opioid addiction, from the State, from the DEA, from the FDA.  It was about a year and a half before I procured any medication or began to treat patients there.  I had intended as a matter of principle to make available a licensed treatment setting in which an addicted physician, nurse, pharmacist, dentist or veterinarian might be seen.  I hadn’t thought to try to make a living at drug treatment (and indeed did not, as I collected only a fraction of my modest fees).

Doctor Crowley and I had not agreed in ADAD conferences.  He said, “They aren’t privileged characters.  They can stand in a dispensing line like anyone else.”  I agreed there are no privileged characters, but we were talking about persons who likely had access to potent drugs, and if ninety-nine per cent of the other patients were to respect that person’s confidentiality completely, the other one per cent would be a considerable half a dozen of intensely drug-oriented blackmailers and extortionists.  Also, clinicians do not become patients gracefully, may deserve special programs which respect their higher than average stubbornness.

I sought a brief audience with the State Board of Medical Examiners to offer what I had.  I was somewhat ignorant of (or carefully ignored) the fact that Doctor Crowley already had a monopoly in the treatment of alcoholic and addicted physicians, that in addition to his public salary he received all referrals from the Board of Medical Examiners, collected weekly fees from his captive patients using the threat of loss of licensure as his stick.  I never received one referral from the Board.

The first patient I treated under my special licenses was a retired physician who had been treated with methadone since before the regulations were established.  He was of a family of physicians who had prescribed for his addiction before the present laws were formulated.  The physician who had been treating him was retiring, and exactly the broader exposure he feared faced him in those dispensing lines.  His progressive severe arthritis and heart condition made it unfeasible or impossible for him to detoxify, to go without any pain medication.

In all I had thirty-one patients in the course of my license, hardly a “methadone mill” peddling drugs for profit.  There was no profit, as I am a poor businessman, a poor bill collector, and in one two-year period I under-collected from these patients by nearly fifty thousand dollars.

Clinical professionals usually should not be maintained on methadone because to continue working they will better enter a residential setting for some months to detoxify and rehabilitate, or they can relinquish license and clinical work if they feel they must be maintained on drug.  Most of my patients were not clinical professionals, but persons whose addictions were further complicated by painful medical or surgical conditions, by disabling psychiatric conditions, and other intricate circumstances.

So, even before I had left the “public sector” I had become the entirety of the “private sector” in Denver’s methadone treatment.  Innuendo and overt attacks intensified against me from Crowley’s staff and from ADAD (State employees).  The old personality assassinations continued, but also strong prejudices erupted that anyone in the private sector who offered methadone was in it only to maximize volume, and to maximize dollar income with no concern for the welfare of the patient.  The coarsest personal insults against me were made by Crowley’s underlings, especially Tom Brewster, even in meetings chaired by and under the auspices of the State Health Department, and none of those in charge interfered at all.  It was clear to me then that my existence as a “methadone program” threatened their personal wealth and power, but I was not willing to go away to please them.  I intended to continue to do what I could to help patients.

The drug treatment regulations applied to persons who were primarily addicted.  According to the law, if (for instance) a person were more pained than addicted that person’s physician could continue to prescribe opioids indefinitely, as long as the drug-dependence was incidental to the painful condition.  It was the physician who was responsible to make the discrimination.  A number of the patients under my care came under that rubric.  Because they were attached to drug as well as pained I did them the service of dispensing the drugs to them on a daily or every-other-daily basis, the same as I did methadone for the patients who were primarily addicted and had to be treated under the regulations for addicts.

I became familiar with the regulations not because I like playing lawyer but because I wanted to help my patients at least for once understand and be in harmony with the rules.  When it was legal and clinically feasible to treat a patient without the stringent restrictions of licensed treatment I was willing to try it.  After all, as soon as it wasn’t working we could shift that person into licensed treatment.  None of those patients ever diverted drugs as far as I know.  Some of them progressed, as they had to, slowly.

I requested approval from the authorities in Denver and in Washington for the treatment of a few patients, selected one by one, as I have just described.  Denver (the Colorado State Department of Health, Alcohol and Drug Abuse Division) said absolutely no, once an addict always an addict, that the only ways out of licensed treatment were cure, street or death.  Washington (the Methadone Monitoring Division of the Food and Drug Administration) said yes on the phone repeatedly, but for about four years repeatedly failed to put that answer in writing as promised.  The letter finally came which described what I have above described, that the patient who is not primarily addicted can be prescribed to, and Washington in fact preferred only those primarily addicted be admitted to licensed treatment.  In response to that letter the State authorities said, “Of course.  That’s what we told you all along.“  No wonder they hated me.

I was glad to help my old supervisor and friend, Stephen Dilts³, when he and the Director of the State Health Department, Tom Vernon, organized the quasi-official Colorado Task Force on Prescription Drug Abuse.  Several benefits might be promoted:  clarification of state and federal regulations; communication between clinicians who treat drug-abusing patients and enforcers of the laws; a fuller understanding of the nature of good treatment and the need for it; and much more, no doubt.

I was familiar with several sides of the problems.  I had served as the Attorney General’s witness in a few cases when doctors seemed to be peddling prescription drugs (although I soon found the adversary legal system unpalatable because each side aggressively aimed for its goal but neither seemed interested in the truth).  I had hundreds of patients whose addiction was promoted by their technically legal supplies from doctors who sold prescriptions out of greed or ignorance.  I didn’t care a lot about molecules, but the patients and doctors and the culture we shared were obsessed with molecules (“the society itself addicted”).  I had become familiar with the regulations, so I knew how confusing they could seem, that discussion of them and education would be salutary.

The Committee on Prescribing of the Colorado Task Force on Prescription Drug Abuse had prepared a report for approval of the body at its next meeting.  The chairperson of the Committee and of the Task Force as a whole was Stephen Dilts, MD.  I had received a copy of the committee report, as had the other members of the Task Force.  It was a fully prepared pamphlet ready for mailing out to all the physicians and prescribers in the state.  The only minor problems I saw were that in two regards it contradicted federal regulations as I understood them.

At the meeting I purposely sat next to Tom Crowley, to show myself I could live in the world without antipathy.  When the Committee on Prescribing came up in the agenda I restrained myself, let someone else ask the first question.  When no one seemed to press for further discussion I raised my hand.  Steve recognized me, and I briefly stated my concerns, one of which was the implication that hospitals were not required to have special licenses to dispense methadone in the treatment of addictions.

“But we’ve never needed a special license at Denver General,” Steve said confidently.

“I don’t know what’s enforced, Steve, but the way it reads to me hospitals also need special licenses for these purposes.”

Many voices said no.

“How lucky we are!  Here are Fred Pottle of the State Health Department and Betsy Mills of the DEA.  Clarify this for us, will you?  As I remember, you two certainly have enforced these regulations against me.”

It was almost sixty seconds of frozen silence before Betsy and Fred gave tiny little nods, one each.

“What do you want us to do, Nathan?”

“All I’m suggesting, Steve, is that the Committee review these things one more time to be sure they are to the Committee’s satisfaction.  I know these rules will never be enforced against Denver General Hospital.  So, perhaps the pamphlet is just the way it should be.”

“I take that as a motion to table the motion to accept the Committee report.  Do I hear a second?”

Someone behind me seconded (I’ll never know who), so that day I was not absolutely alone.  I thank him for delaying my first angry coronary.  The numbers gave me a sardonic private joke––the vote was ninety-nine to one.

***

How It Came Down for Me

I got a call from a pharmacist.

“Doctor, did you write this prescription?” which he proceeded to describe accurately.

“Yes.  I believe I have discussed that patient with you before, his paralysis, his chronic neurologic pain.  It’s legitimate.  That’s the way I wrote it.  He will bring it to my office to be dispensed three times a week.  Don’t worry––the patient won’t have to handle a month’s worth at a time.”

“I’m sorry, but the DEA and the State Pharmacy Inspector have told us they don’t like the way you prescribe, so we just can’t fill your prescriptions any more.”

“Who was it?  Which inspector are you talking about?  It wasn’t Charlie, was it?  Are you sure about what you’re saying to me?  Are you willing to jot me a note that says what you just said?”

“I don’t think I should talk with you any more.  Goodbye.”

That very day I left my busy office to go to the chiefs of the State Board of Pharmacy Examiners, Mike Simmons, and Bill Williamson, the chief of the Region VIII office of the DEA Compliance branch.  I saw Simmons in his office, explained my concern about the phone call, that it meant either that someone was saying untrue things about one of his inspectors, or worse, that one of his inspectors was feloniously abusing me.  His response was simple,

“We don’t do things against the rules, so it’s just your own little problem with this pharmacist.”

“But if pharmacists are paranoid about prescriptions, if they don’t know the rules, or if they believe the Board of Pharmacy Examiners would act this way, isn’t there something you can do to put them more at ease?  I will help you any way I can.”

“There’s nothing we can do.  We’ve done nothing wrong, and we don’t have the budget to go around taking care of other people’s business.”

Williamson wasn’t in his office that day, but I had a similar conversation with him a few days later, and the answers were identical.  Neither of them would even ask their agents if such a felony occurred, nor would they call that pharmacist to ask if he had said what he had said or if it were true.

My first inquiry from the Board of Medical Examiners came in the mail within the week.  It listed some of the chronically pained patients I have mentioned (in all about a dozen and a half of the several thousand active patients in my practice), named no specifics, and was continued under investigation about two years.  When the Board finally reviewed the complaints it dismissed them, but before I received notification of that dismissal I had received another set of complaints of identical nature, which were pending for nearly two more years.

With the encouragement of friends I finally consulted an attorney.  I remember our first meeting, just after I had prepared a response to the Board investigator’s latest set of questions.

“Thank you for seeing me.  Here is a file of the latest material I have sent the Board, for you to look over at your convenience, of course.”

He looked at me calmly, took a few moments to flip through the file, looked at me again, and with a soft tone of pity in his voice said, “You have produced a one hundred page response to a half-page letter.  Yes, I do believe you can benefit from legal counsel.”

After he had worked with me many months he too became impatient and wrote the Attorney General representing the Board of Medical Examiners either to charge me and try me or to drop the charges, that keeping investigation pending indefinitely was unfair and even unconstitutional.  The angry response from the Board through its new administrator, Tom Beckett, was to indignantly deny any wrongdoing on the Board’s part, to admit there may have been some sort of delay occasioned by a former clerical employee, that the complaints would be dropped due to that minor technicality, but that it should be understood clearly if there were any future questionable behavior on my part it would be thoroughly and energetically pursued.

Within the week two DEA agents came into my office unannounced, during my then-busy schedule.  (I no longer have a busy schedule nor an office.)  They were grinning as they asked, “Doctor, where is your license?”

I was proud to be able to reach into the stacks of papers on my desk (“chronologically filed”), to hand them the DEA prescribing license that I had renewed on time the previous March.  “No, we mean your methadone license.”

I looked a bit more, but could not find it.  I showed them my copies of the applications and the sequential checks entered in my check register for the twenty-five dollar fee on each license.

“I actually remember mailing those envelopes myself.  That’s strange.  Someone in your Washington office must have processed and mailed back the one but not the other.  Thanks for pointing this out to me.  I’ll ask you guys to check it out and make sure I get that license.  Thanks.”

“We want to see all your methadone accounting records.”

“Sure.  I keep them locked here, in my own office.”  As I handed them ledger sheets, receipts for stock, and dispensing records, I tried to be helpful by explaining, “The numbers are all right.  Only the nurse and I have access to the drug, and we have worked together in methadone treatment for years.  We have never lost a milligram.  Some of these receipts I didn’t initial because of the supply system set up by Betsy Mills of your agency. The wholesaler was reluctant to set up an account for an individual physician, but was willing to work through the pharmacy in this building. Betsy coordinated the confusion, ‘brokered the deal’ you might say, so my patients wouldn’t risk a lapse of supply.  Since the supply was received into the safe in the pharmacy I wasn’t always available to initial my copy of the receipt when the shipment arrived.  Instead of noting the serial numbers on the receipt we keep them in the log book.  Technically,” I said joking honestly, “that’s against regulations, not to initial the receipts.”

Some time later when they returned my books they told me the numbers were right and that no drug was unaccounted for.  They never told me how the copy of my renewal license had been misplaced in Washington.  I was only slightly concerned not to have my license because I trusted they were working on it, that if there were any question of the validity of my license I would be notified and an inquiry would be made with due legal process.  No question had been asked, and I knew I had done nothing wrong.  I never received an inquiry, but I never received the piece of paper either.

Soon methadone supplies simply did not arrive.  That worried me to distraction because a number of my patients were absolutely dependent upon it for their health and stability.  I could legally and effectively procure small amounts of tablets, but that was a short-term solution indeed.  I came to understand the wholesaler was having difficulty obtaining it from the manufacturer.  There was further delay.  The pharmacist told me that form of methadone had been disallocated to the entire state of Colorado.  I thanked him for his kindness and rapidly transferred all those patients to other treatment settings knowing I had been shut down by the DEA without due process or recourse.  “Disallocation” was the act of some state or federal authority to make a particular drug illegal in this state, and I was the only one in the state using it.  I didn’t dare inquire further.  It was easier to stop using one small clinical tool (methadone) than to subject these delicate patients to such powerful and lawless tyranny, or to foolishly argue with armed federal agents and risk being shot down as a case of “he was trying to escape”.

Over a year after the initial visit from the DEA I got a letter from the Assistant United States Attorney stating that numerous civil charges had been prepared against me.

“I know there’s good news here,” I said to my patient and friend, a judge, “but I don’t know what it is,” as I handed him the letter I had received that morning.

He perused the letter and told me what I needed to know, “The word ‘criminal’ appears nowhere in this document.”

I was confident not in me or my own powers, but in my irrational faith in justice and harmony in the universe.  I wasn’t quite as serene as I wished to be (my first heart attack followed within two weeks of that letter).  I knew I was being driven from my home, work and friends, but I didn’t know where or how to go.  I wasn’t surprised, but I was badly hurt.  I would have to get licensed in some other state, but could I get a job, and would the DEA and the Colorado Board of Medical Examiners interfere?  They couldn’t take away my Colorado license unless they could prove something against me...or could they?

Though charges were never filed, I saw the charges they had prepared:  practicing “without a license” and not initialing the receipts.  The U.S. Attorney wanted to make an agreement that I voluntarily relinquish prescribing Class II narcotics, that I never again own or manage a methadone clinic, and that I pay them a lot of money.

“If there is any justice they will lose this in court.”

“Yes, Nathan,” said my attorney, “but that will be ten years, a quarter of a million dollars in legal fees and three more heart attacks from now.  Pay them and stay alive a little longer,”

I hate compromising but I love to try to compromise.  I paid the five thousand dollars extortion (it can’t be called a fine, but it was fine with me because it was a lot less than the quarter of a million they had originally demanded).  I easily agreed to stop prescribing Class II narcotics, for any drug to me is a mere adjunct of treatment, not essential.  I did not agree to sever myself from methadone treatment, for the patients and the staff in the clinics I consulted were very important to me.  I did not hesitate to promise never again to own or manage a methadone clinic, for in truth I never again wish to own or manage anything.

Their part of the agreement was that no guilt would be attributed to my actions prior to that date and that the circumstance would be respected as confidential (that only necessary and proper communications with government agencies would take place).

They breached the agreement even before it was finalized.  During the previous years I had been medical director of four of the five programs in Denver, all but ARTS (for which I applied, but Crowley declined to consider me because it would be a “conflict of interest” to have the post at both ARTS and STS, and almost immediately he hired one of his protégées for both jobs).  I got a call from the owner of the single methadone clinic I still served as medical director.  Fred Pottle of the State Health Department had called her to tell her she would have to get a new medical director immediately, that I had made an agreement with the DEA never to work in a drug treatment clinic again.  Fred was the one who had sworn repeatedly since a decade earlier to destroy me.  She told him she was familiar with the agreement because I had told her of it, but that her understanding was the opposite, that my right to continue that work had been preserved.  She called me, I called my attorney, he called Assistant U.S. Attorney Paul Johns, he called Pottle, and by the time I returned from the store to get quarters to do my laundry and called to tell her again how much I really wanted to continue working with the patients and the staff at the clinic, the secretary told me, “She can’t talk right now.  She’s involved in some complicated conversation with Fred Pottle.”

I told my lawyer to tell them I rescinded the agreement even before I had received a signed copy from their end, and to tear up the check for five thousand, not to deliver it.  I would not subject myself to any agreement with dishonest people (which the State and Federal officials certainly were).  In the course of time he convinced me I would be back in an intolerably expensive defense of my innocence.  I insisted, then, on a letter of apology for the breach of confidence and the breach of the contract.  Johns sent a letter denying the DEA or the U.S. Attorney’s office had done any wrong, and that they could not take responsibility for the misbehavior of State employees.  I accepted that, and did not push further the obvious question, “How then, Mister Johns, did Fred Pottle receive any information before the agreement was formally finalized?  Who called him, if not the DEA?”

Tom Vernon, director of the State Health Department, was leaving Colorado for another job.  I went to see him, to wish him good luck and to complain how much I had been hurt by employees in his department.

“Tom, I couldn’t come to you before because I was afraid, afraid even that I would be shot down in the street.  Until I had something, even the flimsy protection of this agreement with the DEA, I had nothing to protect me but the truth.”

“I’m sorry to hear what you tell me, Nathan.  I’ll look into it as well as I can, but I’m on my way out, you understand.  Pottle can’t be fired; he has too many years in the Department.”

“I just wanted you to hear me, Tom.  Do whatever is best, or do nothing at all.  Good luck in Pennsylvania.”

After some months hearing nothing from the State Health Department I called Joel Kohn, the interim director who had taken on Vernon’s duties.  I gave him a detailed, itemized chronologic complaint (oral) that he promised to pursue.  I have not heard further of it.

I hated to admit it to myself, but I had become quite isolated in my profession.  Hospital administrations and staffs had investigated my hospitalized cases often, because of the occasional addicted patient I treated.  I had been treated like the smaller end of the ninety-nine to one minority I had experienced in the Task Force, an experience repeated in Medical Society committees, on HMO staffs, in the excuses pharmacists gave when questioning my prescriptions even for non-controlled drugs.  I hated to admit it, so I denied it.  I hated to admit no one would work with me except methadone clinics that wanted to use me, underpay me, make me take responsibility for the actions of the whole staff and administration, and let me be the target if there ever were a suit.

I was ready to make my way out of Colorado before the first letter had come from the Assistant U.S. Attorney.  I had had plans earlier to find better work, a better life, but like many fathers I stayed to be in the same city as my children, and (not to seem to put some moral burden on them) like many mortals I was afraid of change.

The woman who owned the methadone clinic mentioned above was leasing space, but she and her husband (a construction contractor) wanted to buy a building.  We agreed it would be easier to work together in the same place, so I cooperated in their plans for a building (spent much time and energy looking and planning with them), and I thought they were cooperating with my plans for complex clinical programs and staff.  To support her application for a Small Business Administration guaranteed loan I signed what I considered a sham lease (to be refined in a second version to better suit our purposes), but she never signed the partnership agreement which was to structure our clinical and business arrangements.  I moved in as scheduled without the agreement, thinking it was imminent (and I admit now I would have taken anything then that felt like professional acceptance, that looked like I was not completely isolated).

My second coronary came at the time of that move.  Transitions seem dangerous, especially if they make me feel trapped.  I’ll have to work on that, try to spare myself the next one.  I didn’t have one through the trials that followed the disintegration of my business, the suit those putative partners won against me for three years rent and damages (none of those claims seemed plausible to me, of course), and my second bankruptcy.

As moving from their building was impending I tried with all my energy to transfer my medical practice intact, with or without me in it.  I will not recite the dozens of contacts who couldn’t find room in their budgets or buildings, or the many more who simply did not return my calls.  One physician in the neighborhood whom I liked was anxious to have another good doctor in with his practice, but when he talked with the hospital that owned him they simply said if he had anything to do with me his note for more than a hundred thousand dollars would immediately come due.

One hospital system had an outlying clinic in the neighborhood that had been losing money consistently for years because of low volume.  I offered to bring my established practice in part-time, pay rent and expenses, and two days a week be their employee.  Then I offered them all the income if they would pay me an hourly wage.  They declined my patients under any conditions, but offered me a part-time hourly job on a probationary status.  (The recent administrator of that system was incredulous at my report when serendipitously I met her at her new job with the University of Colorado Health Sciences Center’s A.F. Williams Family Practice Center.  She knew their chronic deficits and thought they could not afford to turn down two thousand new patients.)

I had volunteered time teaching residents at A.F. Williams several years earlier, each year receiving a free meal for my efforts.  From time to time had given draft chapters of my book on clinical relationship and ethics to Larry Green and Wilson Pace.  Even then they made no comment nor did they acknowledge receipt of my work.  Some time after that they were active on peer review committees at Rose Medical Center investigating my hospitalized patients, especially any who were addicted.  They never found any reason to censure me, even when they called on Tom Crowley as a consultant to the committee.  I almost had the dubious honor of being the first physician thrown off the staff at Rose for being late on charting, but when Neil Chisholm (then Chairman of Family Practice, as Larry Green was subsequently) and Melvin Klein, then President of the Medical Staff of the hospital, met with me to give me the axe it became obvious that the charts which were late had been unavailable to me to finish, and had in fact been tied up in Wilson’s committee for months.  With terse bitterness they rescinded my expulsion.  When I asked Mel Klein why I was being persecuted he came through with his Kermit-philosophical “It ain’t easy being green.”⁴ The next president of the staff, Stanley Ginsburg, in whom I had observed manifest independent thinking on some occasions prior to his appointment, put it this way, “We may regret this in ten years, but right now this is how we have to do it.”

With trepidation, having looked for friendlier corners, I called Larry Green; I suggested there might be some animus for me held by him or Wilson Pace.  Acrimoniously he denied there was any such thing, but encouraged me to call Wilson and ask.  That seemed a sage suggestion, so I did.  Wilson plausibly averred he could recall no cause for animosity between us, that he remembered spending time on a committee reviewing my charts some years before, but recalled they were finally cleared as adequate.  I had explained my situation to Green and Pace, that I needed a place for my practice, that I would very much like to treat patients and to teach residents and students.  They conveyed to me they were in need of expanding the clinic’s volume and would gladly consider taking on my patients, that they would consider taking me on the faculty separately (a separate committee would decide that one) and it would be done without prejudice.  The above-mentioned new administrator was again incredulous when she dutifully reported to me that the committee declined to take my patients “because we don’t have room enough to store the charts”.  I didn’t see much reason to complete the application forms for the faculty position.

Rod Gottula was the Medical Director of the Department of Corrections.  I was quite willing to travel about the state caring for prisoners.  I had spent much of my nearly thirty years as a clinician working in mental hospitals, ghettos, addiction treatment facilities––the places I found patients who were worthy challenges to my skills and whose lives were worthy of attention for the sake of their improvement.  Rod and I talked several times with mutual interest.  I left a curriculum vitae and a few of my essays at his office.  We talked again.  He explained the position was half Department of Corrections and half as faculty at the A.F. Williams Family Practice Center.  I told him how much I would like to do just that, but when he said he’d talk to Larry Green I knew there was no chance.  I never heard from him again.

I had to find a place for my patients, went to a hard-working colleague who had a large solo practice, made a deal with him and his wife (the manager of the office) to transfer the charts and to work about two days a week for an hourly wage.  I left town for a few days, and before I returned the wife had decided she didn’t like me (nor, do I believe, did she like me the twenty years previous, but she had already gotten the charts and the business with them).  There was nothing for it, so for more than six months I was completely unemployed.  I wrote a few books.  Maybe some day I’ll find an agent.

I sought work, especially my dearest dream of work, to go back to my old college in New Mexico, to be school doctor and at the same time teach.  I had made preliminary contacts about such a possibility several years earlier.  I dared to outline my proposal to the Dean, and we pursued several months of talks and letters and visits.

I applied for licensure to the New Mexico Board of Medical Examiners, a necessarily detailed and lengthy process.  They were cordial, one of the most personal bureaucratic offices I have ever encountered.  During my interview Doctor Levitt discreetly communicated to me in indirect language that the DEA had sent something about “4.45 grams of methadone unaccounted for”.  I was truly calm.  I asked for a copy.  She said she could not give it to me, that I would have to get it from the DEA.  It was my task to rectify any misleading communication, and I assured her I would do that without delay.  We set an appointment for me to meet with the entire Board a few weeks hence, clearly (but not explicitly stated) to satisfy this question.

I was calm, but I needed moral support.  I called my attorney in his office from the phone in my car on the way back to Denver.  All he could do was to talk with Paul Johns, the Assistant U.S. Attorney.  I wanted to be there.  I was dissuaded.

The Denver DEA office denied having sent anything, even though it was to them I had sent the request for information for the New Mexico Board.  The Denver DEA agents said it must have been the Albuquerque office.  The Albuquerque agents declined to talk with me on the phone, told me to go to Washington under the Freedom of Information Act.  They all had decided (without seeing what had been sent or knowing who had sent it) that the “4.45 grams” was an overage, not an underage, a usual result of their methods of bookkeeping, and should not be a problem for me.  No one in the DEA nor Johns would put one word of this in writing, and my meeting with the New Mexico Board was a few days away.  My attorney wrote a letter reporting his conversation with Johns, and I returned to Santa Fe.

I showed the Board my agreement with the DEA, the draft of charges which had been prepared against me.  I told them everything I knew.  I dropped by the college to see the Dean, told him I hoped to get New Mexico licensure (necessary, of course, for the position), and acknowledged my frustration at the delay.  His three-line letter declining my offer arrived soon thereafter.

***

A Powerful Bigotry against Addicts is Denied (but Not Hidden)

What is the point?  To me this is as simple as life itself, which often seems anything but simple.  The social context within which I live was not designed to benefit any person, despite its being the oldest one that claims to be dedicated to personal freedom.

I don’t have to confess my idiosyncrasy or my occasional provocativeness, for those are not the issues.  I have lived by the law and have been lawlessly abused by the agents of the law.  I say this calmly.  It is not news.  Without a thought most of us conform to unwritten rules among which are included not to think or act or feel as an individual.  It may be ineluctable.  Individuality and freedom may not be attainable in human life.  Self-centered corruption and abuse of power may be necessary to the perpetuation of society.  I wish it were not so, but my wishes do not count at all.

If the general point is that personal freedom truly does not exist here, then the particular point is that in this society addicts (and other slime) should die.  It is a moral prejudice hidden from me no longer.  It is as deep and obdurate as racism, maybe more intense because it is further from the surface.  Of course it is based on irrational fears, especially each bigot’s hidden fear of being addicted or otherwise himself compelled and dependent.  Each of us out of our own sicknesses hates and fears the sickness of the addict, so we hate the addict’s freedom to act sick.  Hence, we come to hate freedom and to hate anyone who nurtures it.

I have cared for addicts (and homosexuals and schizophrenics and racial minorities in urban ghettoes) and I have been punished by the authorities for doing so.  I have had no “due process of law” because such process would bring to the surface the hidden prejudices (which belong to our entire culture) against individual freedom or a right to heal and learn and grow.  I have been hounded and conspired against by the authorities and blackballed by clinical professionals and institutions as subsets of society (not always as individuals).  As far as I can understand all these insidious things have consistently progressed because in the American mind I was contaminated by association with persons who were addicted, condemned as an agent for heroin.  I know nothing further I can do but put my case before you.

Thank you for your kind attention.

NMP
4-5-93

***

A recent letter to which I received no response, just my DEA license in the mail, and an old letter I had attached to that recent one:

February 4, 2010

DEA
(202) 305-7202 (fax)

Dear Pamela,

Thank you for helping me with my on-line application renewal for my DEA license XXxxxxxx.  As I reported to you, the difficulty I have is that your computerized form automatically marks my responses to questions of previous charges or convictions as “Yes” for that section, which is not only in error but constitutes a danger to my reputation and work.  This is the situation I have faced in the past.  I have no way to rectify it without your help.  I have tried to fill in the answers your computer program forces me into.  What all that adds up to is summarized in the attached letter to Scott Collier, Supervisor of the Diversion Group in this Region, 10-05-99.

Please refer to your files for pertinent documentation that I have never been charged or convicted and that my full prescribing privileges have been restored some years ago.  Please correct your computerized form in my case so that I will not have to go through this ordeal at my next on-line renewal.  Please obliterate or correct any record that implies or states that I have been charged or convicted in this regard at any time.

Thank you for your help.

Be well.

Nathan Pollack, MD

***

Nathan Pollack, MD
Denver, Colorado
October 5, 1999

Scott Collier, Supervisor of the Diversion Group
Drug Enforcement Agency
115 Inverness Drive East
Englewood, Colorado 80112

Dear Mister Collier,

I write you in all good faith, hoping you can accomplish resolution for me and your agency of a discrepancy which has persisted for nearly twenty years.  Please consider my request of March 28, 1998 (a copy attached) to restore my prescribing privileges entire.  In my communications with Dave Gauthraux last year he assured me there was no reason not to restore my Class II privileges other than my then active complaint in the Federal District Court (filed January 2, 1997), a main purpose of which was to clear my record in this same regard.  Since then I have come to be informed that Judge Daniel dismissed my claim in June, 1998.  When I renewed contact with you in late August of this year I believed there was no reason at all for further delay in this matter.  None the less, no progress seems to have been made toward that resolution since my renewal of contact with Mister Gauthraux and Paul Jaster of your agency (who said such surrender of privileges is ordinarily limited to five years; mine is now over ten).

Allow me briefly to summarize for you the history of this matter:  In the 1970’s and 1980’s in the course of my practice of medicine I came to treat pained and addicted patients in specially licensed drug treatment programs.  I was stigmatized by your agents for “coddling addicts” despite the entirely legal, ethical and altruistic character of my professional behavior.  By about 1987 my methadone license renewal was withheld by your agency without notification or due process, my office was raided by your agents during working hours, and subsequently (after a two year investigation gave you no toe-hold for any criminal charge) I was offered a package of civil charges, including “practicing without a license”.  Subsequent to that raid, Methadose, a methadone preparation which only I used in the State of Colorado, was without notice or hearing “disallocated” to Colorado in order to cut off supply to my patients and to interfere in my practice.  I was intimidated by that into discontinuing treating pained and addicted patients (actually fearing I would be gunned down on the streets by your agents).  When you offered to file civil charges against me in 1990 I suffered my first heart attack.  I engaged an attorney to protect me against what I considered groundless charges, but he advised me that I would ultimately win in the Supreme Court “only after ten more years, hundreds of thousands of dollars in legal fees and more heart attacks.”  Your threats and lawlessness and my attorney persuaded me to pay you $5000 and relinquish Class II prescribing privileges even though no charges were ever filed against me.  My subsequent heart attacks each immediately followed pivotal events in my experience of threats and hostility from you, despite my conscious efforts to avoid such disastrous physiologic reactions.  Throughout the 1980’s these manipulations by your agency were exactly coordinated with similar maneuvers by the State Board of Medical Examiners and by the State Department of Health.  In 1992 your agency lawlessly interfered in my efforts to obtain licensure in the State of New Mexico (by insinuating I had diverted methadone, which, as you had proven, I had not) and you have consistently since then denied that misbehavior and withheld documents in order to cover it up.  Neither the President nor the Attorney General of the United States deigned to respond to my formal complaints about your program against me.  In 1996, having received documentation to substantiate your deceits, I prepared to file a complaint, representing myself because I was too broken financially and psychologically to do otherwise.  When I tried to serve subpoenas on your agency, delivered by local law enforcement officials at my expense, you simply declined to be served.  I suspect unsuccessful service of subpoenas was one of Judge Daniel’s pretexts for dismissal (though I cannot be sure because despite my pleas that he hear me he did not, nor did the Court notify me of his order to dismiss in June of 1998).  I recently inquired as to the status of my complaint only because a professional credentialing service requested a more detailed explanation from me of my lack of Class II privileges other than “under appeal since 1990”.

Now I ask you to send me a new renewal application and to restore my full prescribing privileges forthwith, or give written formal notice why you should not do so.

Thank you.

Sincerely,

Nathan Pollack, MD

Cc:
President Clinton
Attorney General Reno
Judge Daniel

___________________________________________________

¹ Buber, Martin, I and Thou, p. (?)153.

² Veatch, Robert, Medical Ethics (see “In Defense of ‘The Oath’”).

³ It reassures me of the protective power, the harmony of the universe, that exactly now as I sit outside the coffee shop this spring afternoon writing this very paragraph about him Steve Dilts, the calm and kindly psychiatrist, addictionologist and public servant walks by with his latté-to-go.  When we say hello we mean it, and when the synchronicities rain down on us we appreciate them.

⁴ This vignette is dear to me:  Mel and I left the room when our meeting with Neil was over and we walked down the hall together.  He said, “People around here don’t understand how you practice medicine.  They just don’t trust you.”  “That’s funny,” I said, “because I am the only one on this medical staff who ever wrote a book about exactly how he practices medicine.”  “Yeah.  I know.  I have a copy of your book on my shelf.”  “That’s right…Now I remember, you wouldn’t give me money to pay for the ink and paper, so I gave you that book.  Have you ever read it?”  “I have better things to do with my time than to read what you write.”  A warm flush of relief washed over me.  I was grateful that the veils were off, that I knew where things stood.  When the reappointment application came in the mail I could not bring myself to fill it out and send it in.  Besides, I didn’t have enough money in the bank to pay my staff dues.

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