• Controlled Substances Act,  Drugs,  Trials, Judges and Jurors

    Risk, Reward and Pain: Doctor Lessons from An Opioid Trial

    Opioid medications continue to be in the news, as demonstrated by the recent nationwide state attorneys-general investigation.  This situation only demands more attention from physicians and other healthcare providers who may face significant criminal sanctions. My law partner Brandon Essig recently wrote in Medical Economics: Over the past three decades, opioids have become a standard and effective component of pain management for many practitioners. They are effectively and safely prescribed in every conceivable clinical environment—primary care facilities, hospitals, pain management clinics and even dentist offices. They are prescribed to treat chronic and intractable pain, such as advanced stage cancer pain or severe burns, but they are also prescribed to treat soft…

  • Controlled Substances Act,  Health Care

    Stethoscopes, Handcuffs and Pain

    When does managing pain become a crime? And, what can a healthcare provider do to stay out of trouble in these days of the “opioid epidemic”, new federal legislation and the criminal prosecution of doctors? I make a few suggestions here in Pain Management News: That’s the question many physicians, nurse practitioners (NPs), certified registered nurse anesthetists (CRNAs) and physician assistants (PAs) are asking in the wake of a tidal wave of prosecutions related to pain medicine. This has been partly spurred on by the “opioid epidemic.” There has been a sharp spike in convictions—either by guilty plea or by conviction after a trial—of health care professionals involved in pain medicine.…

  • Cocktails

    Vermouth, Bitters and Black Coffee

    In speaking of the martini, Winston Churchill supposedly observed   “I would like to observe the vermouth from across the room while I drink my martini.”  Here is a recipe for a “Churchill martini,” which is basically a glass of cold gin. On the other hand, Julia Child supposedly went to the opposite extreme: a glass filled with vermouth and topped with gin, also known in this recipe as an “upside down martini.” I am no Churchill or Child, on several counts, but I have never understood the anti-vermouth wing of the martini party.  A martini is a cocktail.  A cocktail, by definition, is “an alcoholic drink consisting of a spirit or…

  • Congressional Investigations,  Impeachment

    Congressional Investigations, Criminal Cases and The Knights Who Say “Ni!”

    We are heading into what appears to be a summer of investigations along the Potomac, some of them in the House and Senate.  What are some of the things we might reasonably expect to see as investigations congressional and criminal cross paths?  And what does Monty Python have to do with it? Previously, I shared a few lessons about congressional investigations. First, the short-version video: Jack Sharman – Learning in Congress from Legal Filmworks Unlimited on Vimeo. Second, a longer how-to approach for lawyers and clients in a congressional investigation: In particular: We are in the summer months.  We have written before about  summer hearings: As a former oversight-and-investigations lawyer for…

  • Cocktails

    Needful of a Negroni Cocktail?

    I have been drinking Negroni cocktails recently.  The Negroni presents three virtues: it contains gin, it is bitter and it is simple to make (equal parts gin, Campari and sweet vermouth).  Its simplicity makes it superior for quiet mixing at home or when one is faced with modestly-adept bartenders, as noted by Kevin Sintumuang in the Wall Street Journal: “That’s it?” Yep. Boozy, bitter, bold and built right in the glass, the Negroni has become a steadfast sidekick for me when I need a proper cocktail at a not-so-proper bar, from dive to airport. And when I’m mixing at home, there’s no other drink that produces so much satisfaction with…

  • Health Care

    Electronic Medical Records and Federal Criminal Prosecution

    Electronic medical records (or “EMR”) were supposed to be a boon to the provision of healthcare. As two Boston-area physicians point out, EMR are anything but a benefit: Electronic medical records, or EMRs, were supposed to improve the quality, safety and efficiency of health care, and provide instant access to vital patient information. Instead, EMRs have become the bane of doctors and nurses everywhere. They are the medical equivalent of texting while driving, sucking the soul out of the practice of medicine while failing to improve care. Read the whole article: Death By A Thousand Clicks: Leading Boston Doctors Decry Electronic Medical Records The additional problem for healthcare professionals is that…

  • Controlled Substances Act,  Drugs,  Trials, Judges and Jurors

    Mute Oracle: The Controlled Substances Act and Physicians’ Criminal Conduct

    Criminal laws are supposed to give persons regulated by the law sufficient notice of what conduct, exactly, is prohibited.  Criminal laws, as interpreted by courts, are also supposed to provide clear standards for mens rea (that is, the level of intent the Government must prove at trial).  With regard to physicians and their prescribing practices, the federal Controlled Substances Act does neither. Or, as my Lightfoot colleagues Brandon Essig, Jeff Doss and I put it in a recent article for Law 360: With the Eleventh Circuit’s recent decision in United States v. Enmon, physicians continue to face two critical questions in the uncertain case law under the federal Controlled Substances Act. First, what conduct…

  • Controlled Substances Act,  Drugs,  Poetry,  Trials, Judges and Jurors

    Pill Mills, Poppy Flowers, Dead Poets and the Human Resources Department

    Having been through a seven-week federal criminal “pill mill” trial, I think a lot about enforcement of the Controlled Substances Act and its effect on physicians.  Aggressive enforcement effects others in healthcare as well, including management: “It’s very hard for medical professionals and those in upper management, such as hospital CFOs, CEOs, and CMOs, to see themselves as criminals,” says Jack Sharman, partner at Lightfoot, Franklin, and White, a law firm headquartered in Birmingham, AL. “This difficulty to perceive what someone else might think merits a criminal investigation impedes judgment and slows internal response.” While physicians might not see themselves as criminals for managing patients’ pain or making sure they…

  • Theology

    Christmas Movies and Serial Killers

    Today is the first Sunday in the season of Advent, a time in which Christians traditionally prepare themselves by reflection and prayer for the Incarnation, the birth of Jesus, God made flesh.  Ultimately, of course, Jesus was sacrificed upon the Cross for our sins, and “sacrifice” is a fit subject for Advent reflection: We may think of sacrifice in its patriotic or collective sense, as when we attended a Veterans’ Day parade or when an earlier generation watched a movie about World War II hero Audie Murphy (1925-1971). More commonly, we talk about sacrifice in its individual or instrumental sense, as when we say that an athlete has made sacrifices…

  • FBI,  Witnesses

    Handwriting On The Wall (And In The FBI’s Notes)

    As the father of a college-bound high school senior and an eventually college-bound high school sophomore, I pass along to them helpful articles.  Whether, in the ancient words of Archbishop Cramner in the Anglican liturgy, they actually “read, learn and inwardly digest” the articles I send them is an open question, but it gives me an uneasy assurance of the discharge of paternal duty. I passed along to my children a recent Wall Street Journal article that posed the question Can Handwriting Make You Smarter? The article concluded: Students who took handwritten notes generally outperformed students who typed their notes via computer, researchers at Princeton University and the University of California…