Doctor Fights State Over Opioid Tapering Ethics

Doctor Declines State’s Offer In Battle Over Opioid Tapering Ethics – Redheaded Blackbelt

Here’s another courageous doctor fighting back for us, staring down the medical board, refusing to taper her patients faster than medically appropriate, no matter what the medical board or the DEA says.

In an update with Humboldt Last Week, Arcata doctor Connie Basch said she’s declined an offer from the Medical Board of California to receive probation in exchange for an admittance of guilt in her case involving the overprescription of opioids.

The complaint against Basch surrounds what she would call five “legacy” patients that came to her several years ago on high doses of opioids and anti-anxiety meds.  

The state alleges even though she tapered them to lower doses, she wasn’t doing so fast enough in adherence with state-mandated schedules.

While the instances cited in the complaint date back a few years, Basch has continued to legally treat over a thousand patients at The Full Circle Center for Integrative Medicine while battling the state over what she believes are harmful policies that even the feds don’t agree with.

“No standard opioid tapering schedule exists that is suitable for all patients,” the FDA acknowledged last year. 

Basch believes legacy opioid patients who are not tapered properly are more susceptible to heroin use, suicide, and other detrimental outcomes.

Her case is likely to go before the medical board sometime this fall. She says she doesn’t have the estimated $150,000 to spend on defense funds and will likely lose her case because she’ll be defending herself without a lawyer. 

“Our government is focused on the ‘look good’ that is appearance over substance,” she said. “They are able to claim low numbers of COVID-19 infection by refusing to test most of the people who likely have it.”

To me, this seems similar to the ‘doing something about the opioid crisis’ that results in stable pain patients being converted to unstable heroin users, being relegated to unrelieved pain, or committing suicide.

It looks like the number of prescriptions have gone down, despite the death rate and overall misery rate going up.”

Last time I looked there were 101 very interesting comments. I’ve left our a lot out in my excerpts from this article, so you can read it in full at: https://kymkemp.com/2020/03/09/doctor-declines-states-offer-in-battle-over-opioid-tapering-ethics/

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From Dr. Connie Baschon her clinic’s website:

Full Circle | HomePage

We are currently closed to new patients, since Connie is only one person. We apologize to those we would love to see but simply cannot right now.

ALERT: Current issue with the Medical Board of California

The Medical Board of California is accusing Dr. Basch (me) of negligence for continuing to prescribe opioids for legacy* patients living with chronic pain.

This was not based on any adverse outcome for any individual patient.

This is so typical of today’s opioid witch hunt: some bureaucrat in some agency looking at MME totals somewhere finds a high number and instantly calls in the enforcers: medical boards now coordinating with the  DEA.

This shatters my confidence in medical boards to do the “right thing”. They are just as culpable as law enforcement in disrupting our usual medical care.

I have declined a probation offer because it requires me to stipulate the accuracy of all elements of the Accusation, which I cannot do, given it is riddled with factual inaccuracies and misinterpretations.

They also asked me to stop prescribing controlled substances right in the midst of the above Public Health crisis. Were I to do that, they SHOULD accuse me of patient abandonment, since there are extremely limited alternative options for these patients.

The Hearing for this matter is tentatively scheduled for October 26,2020 in Oakland. They have denied our request to move it up to Humboldt.

For the 5 patients mentioned in the complaint, I did not escalate pain medication use for any of these patients to the dosage levels on which they arrived at my practice, but I have worked with them where they are and doses went up when they had surgery or new injuries, then coming down over time.

All are currently at lower doses of medication than when they established care with me.

I take “Do No Harm” very seriously and have studied Pain Management in great depth, even teaching about this topic at several national conferences.

In our pain management program I have helped more patients lower their doses or get off opioids than I have maintained.

This is not what you’d expect from a doctor being accused of over-prescribing opioids.

This is exactly what you’d expect from a doctor who treats pain patients with compassion and respect, working closely with them to find any possible non-opioid treatment, but prescribing opioids for pain for those who truly need them.

I feel my care is compassionate and evidence-based, and that I am a conscientious objector to the current pendulum swing in pain management.

This is a good way to put it: conscientious objector. Dr. Basch is another doctor advocating for us pain patients along with several others I’ve posted about here.

Nonetheless, I acknowledge there are reasonable differences of opinion about what is the correct medical approach to such patients, and the care of human beings, who do not always follow their doctors’ advice, can be messy.

I have written more For those who want more details

We will be posting information about this issue as well as updates on the status of the practice as time allows, but are continuing to care for patients right now, which is of course a higher priority.

-Connie Basch, MD

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Full Circle | For those who want more details

Why is this Happening?

The investigation was purportedly started because of an anonymous allegation that I was overprescribing to someone who I knew was selling their pills.

I would never do that, the investigation found no evidence of that, and that suspicion is actually a reason that patients have been discharged from my practice in the past. (Another doc who has communicated with me was investigated because of a patient who died of a stroke, but there had been a question about whether it may have been an overdose death.)

Once the investigation starts, however, the original complaint is no longer relevant.

The investigation was not based on a random sampling of patients or any queries to local providers or other effort to get a balanced view of my prescribing or the practice. Had they done that they might have discovered:

I have been helping people get off opioids since 2005.

The critical point is that she has “been helping people”, not coercing or forcing them to taper even when their pain increases.

I’ve always believed that the current insistence that people come off opioids despite their pain is just cruel. If a doctor found me any alternatives that work as well as opioids, I’d stop taking them immediately. (No more constipation! No more fear I’ll be cut off! No more careful calculations about how much pain relief I can allow myself within the bounds of my current prescription!)

There are a great number of patients here and now elsewhere who have stopped opioids, gotten off disability, gone back to school and so on as a result of my care.

Most of my patients are somewhere in a taper process, but I actually monitor that process, rather than announcing it and proceeding regardless of response.

Who am I as a Physician?

I am a driven, dedicated physician who goes to great lengths to provide Service to vulnerable patients. See Letters of Support for the words of my patients regarding that.

My focus on documentation is that patients have a clear understanding of sometimes complex treatment plans, and the bulk of my time and energy goes into my interactions and counseling with patients, not to the work on my charting. 

What would you prefer YOUR doctor to focus on?

I hope that you will therefore keep an open mind that perhaps my stance on this issue of pain management in legacy pain patients is also based on an attempt to protect my patients, even at the expense of my personal interests.

The Accusation Against Me

Regarding Negligence:

If the Medical Board is trying to shame me publicly, there are a number of true and unkind things they could say about me:

• I am obese
• I am a workaholic
• I am late – I almost never run on schedule in the office
• I am hypocritical– I counsel people about exercise and yet spend 16+ hours per day sitting at a computer
• I am naïve – I thought they were going to praise my pain program when they found out what I have been able to accomplish on a shoestring in this remote part of the state, and how dedicated I am in continuing to work with such difficult patients.
• I may be codependent, in that I try to help people who have messed up, including my diabetics who eat donuts, my chronic lung disease patients who continue to smoke, and my patients wth chronic pain who have, in desperation, continued their previous doses of pain medication rather than sticking to the taper I asked them to try.

The label that I feel does NOT fit, however, is negligent.

I have taken the “Do No Harm” oath very seriously.

I do not drink, use drugs, cross sexual boundaries with patients, or profiteer with my license (in fact, I continue to see people with any insurance, including Partnership, at tremendous personal financial sacrifice.)