Physicians' intents should be considered in pain cases

The federal court ruling's broader impact on pain medicine remains uncertain.

By Kevin B. O'Reilly, AMNews staff. Sept. 11, 2006.

A federal appeals court overturned drug-trafficking convictions of controversial, high-profile pain specialist William E. Hurwitz, MD, because the trial judge told the jury it could not consider the doctor's good-faith intentions for treating his patients.

While the ruling improved Dr. Hurwitz's odds of escaping a 25-year prison sentence, experts were hesitant to say whether it will make it more difficult to prosecute physicians who use opioids and other controlled substances to treat chronic pain.

"Exactly what this means and what the consequences will be not only for Billy Hurwitz but for other similarly tried and convicted doctors is unclear," said Ronald T. Libby, a political scientist at the University of North Florida who is writing a book, Medical McCarthyism: The War on Doctors, about criminal prosecutions of physicians.

A three-judge panel from the 4th U.S. Circuit Court of Appeals last month ruled that the trial court "erred by concluding that good faith is not relevant when a registered physician is charged with violating" federal drug-trafficking laws. In December 2004, a jury convicted Dr. Hurwitz of 50 counts of drug trafficking, including one count of drug trafficking resulting in death. But the jury found the physician, who first gained notoriety when he was profiled on TV's "60 Minutes," not guilty on two counts of health care fraud for which it was instructed to consider good faith.

"We are very gratified that the court of appeals unanimously agreed with us that a doctor is entitled to present a defense that he believed in good faith that his medical care for patients conformed to professional responsibility," said Lawrence S. Robbins, Dr. Hurwitz's attorney.