Is Justice Department tough enough on opioid-pushing doctors?

Doctors ensnared in the dragnet set by the Justice Department to catch them illegally dispensing opioid drugs are finding clever ways to escape serious legal consequences with the help of crafty lawyers.

Federal authorities need to prove that prescriptions were written and filled outside the course of normal medical practices and that they had no legitimate medical purpose. Doctors have been getting off with light punishment, even when evidence shows they have knowingly and willfully acted in an unlawful manner and are profiteering from drug-dependent patients.

The CDC has reported that 130 Americans die every day of an opioid-related overdose. The agency has been criticized for its 2016 guideline limiting daily opioid intake at 90 morphine milligram equivalents per day — equal to two 30-milligram oxycodone pills. State health departments, insurers and others have cited the guidelines to implement opioid limits.

 The doctor who treated pop star Prince in the weeks before his death from an opioid overdose was gently reprimanded by The Minnesota Board of Medical Practice last month and ordered to pay a civil penalty of $4,648. They did not order him to relinquish his medical license and he will not face criminal liability.

 Dr. Michael Schulenberg issued controlled substances to Prince’s bodyguard even though he was fully aware they were meant for the megastar. The 57-year-old singer died of an accidental fentanyl overdose at his Paisley Park studio home in Chanhassen, Minnesota, on April 21, 2016.

The board reprimanded Schulenberg for engaging in unethical or improper conduct, improper management of medical records and for failing to cooperate with an investigation of the board, all very unacceptable behavior for a doctor.

At first Schulenberg denied knowing that the painkillers he prescribed for Prince’s longtime friend and bodyguard Kirk Johnson were intended for Prince. The doctor also failed to record the information regarding the prescriptions.

The Drug Enforcement Agency searched his premises and discovered that Schulenberg had been prescribing powerful opioids but under Johnson’s name.  

Schulenberg entered into a settlement with the DEA after his admission. He paid $30,000 in 2018 to settle a federal civil violation alleging the drug was prescribed illegally.

 Alabama doctor Celia Lloyd-Turney 66, is also expected to get off lightly after pleading guilty to one count of unlawful distribution of controlled substances last Friday. The Justice Department produced evidence showing that from 2015 to 2017, Turney wrote multiple prescriptions for controlled substances to purported patients who were actively abusing other drugs, suffering from addiction, and selling the pills. Her defense argued that the doctor thought she was acting in her patients’ best interest.

  Lloyd-Turney pleaded guilty to distributing opioids from Choice Medicine Clinic, which she operated in Huntsville. Her guilty plea came while a federal jury in Huntsville was deliberating on whether to convict her on 15 criminal charges.

Prosecutors agreed to dismiss the remaining 14 charges in exchange for Lloyd-Turney’s plea. As part of the plea agreement, Lloyd-Turney agreed to surrender her medical license. She also agreed to never participate in a health care program, according to the agreement filed Friday in federal court.

Prosecutors agreed to recommend a sentence of five years’ probation and two years of home confinement. She could be sentenced to a maximum of 20 years and be fined up to $1,000,000.

The Justice Department also announced last Wednesday that federal prosecutors charged 31 doctors, seven pharmacists, eight nurse practitioners and seven other licensed medical professionals for alleged opioid pushing and health care fraud.

The cases involve more than 350,000 prescriptions for controlled substances and more than 32 million pills.  Assistant Attorney General Brian Benczkowski described the prescription count as the equivalent of a dose of opioids for “every man, woman and child,” across Ohio, Kentucky, Tennessee, Alabama and West Virginia.

The Department dispatched experienced fraud prosecutors across hard-hit regions in Appalachia in October 2018 for an operation called the Appalachian Regional Prescription Opioid (ARPO) Strike Force. It was formed to assist areas suffering from high numbers of opioid overdoses and deaths. It operates in 10 districts and has charged more than 70 defendants who are collectively responsible for distributing more than 40 million pills since its inception.

Offenders argue that pain patients and doctors are being unfairly targeted. They say the concerns of chronic pain sufferers should not be ignored based on CDC guidelines, and abandoning them could lead to injury from opioid withdrawal, even death.

Sharon Tsay, a medical officer with the CDC’s division of unintentional injury prevention told USA Today last May, “A lot of groups have taken that number and said, ‘We need to either taper down to that amount or we need to stop them. That was not the intention. Some individuals need higher levels. People have physical dependence, whether or not they have addiction. So it’s actually very unsafe.” The agency is currently conducting research to reassess its guidance for doctors.