Know Thy Enemy

In my last post, I mentioned that I will be launching a website for my writing projects, in particular the book I’ve written about federal prosecution of pain doctors, including my husband, Cecil. I expect the site to go live in August. Meanwhile, I plan to post excerpts from my book every now and then here on TigerBird Sunrise. This week, I am sharing something that happened early-on in the fed’s investigation into Cecil’s medical practice. This incident woke us up to the fact that, when the feds are after you, there is no corner of your life in which to feel safe.

In August of 2001, the feds had begun going after pain docs as a means of curbing the flow of Oxycontin and other narcotics. They had raided Cecil’s medical office and our home a month earlier, so we knew he was under investigation. At that early stage, though, we were thinking they would realize their mistake and back off. We were still naïve then. It took the full onslaught, tactic after disturbing tactic, before we would become wise to their ways.  

It was early evening. Cecil and our son, Dru, had taken two neighborhood boys to swim at our local lake. Our daughter, Kirstyn, and I were at the house. One of the boys with Cecil lived next door. I was standing at the stove when the boy’s father came running out his front door and yelled across the fence that Cecil and the kids had been in an accident on the way back from the lake.

I grabbed my keys and yelled for Kirstyn. We jumped into the car and headed for the lake. There was only one route he would have taken.

About half-way there, we came upon a line of traffic. Lights lit up the sky to the right across a field. “That’s them, isn’t it?” Kirstyn spoke, almost in a guttural tone. “Probably,” I mumbled. Our windows were up and there was an eerie silence. Everything seemed to be moving in slow motion. I drove as close as I could get, then stopped. As Kirstyn and I jumped out, a jolt of noise and chaos hit us. We both started running. Kirstyn streaked ahead. “Dad! Dad!” She screamed into the night.

 Fire trucks and ambulances cluttered the street. Police and rescue vehicles were everywhere. People yelled back and forth, but I couldn’t tell what they were saying. As I got close, I could smell fuel and I saw fire hoses snaking across the ground. Someone tried to stop me, but I just kept going. I was all animal at that point: senses on high alert and very little thinking.

I followed the chaos with my eyes and felt a wrenching from the inside out when I saw Cecil’s truck. It was in someone’s front yard, upside down and in three pieces. Two huge evergreens that had been taken out by the truck engulfed its wreckage.

I wasn’t sure where to go first. An ambulance was off to my left. I ran over to it and found Dru and one of the other boys inside, strapped onto stretchers. Dru was wearing a neck brace.

“Oh God,” I said aloud, afraid to go forward, at the same time I was jumping in. “What happened, Baby?” I tried not to scare him. Dru said people had screamed for him to get out of the truck before it blew up. As he scrambled through a window, he looked back at his dad, hanging upside down, trapped by his seatbelt. Dru crawled away from the truck and rescue workers scooped him up. He yelled for Cecil but was whisked away, expecting to hear the explosion any minute.

In the ambulance, Dru was beside himself over his father. I tried to reassure him. “It’s okay, honey, the truck didn’t blow up. I saw it. Are you hurt? Can you move everything?” He wasn’t sure at that point.

My thoughts were all over the place. I wanted to stay with Dru, but I also wanted to find Cecil. I looked out of the ambulance and scanned the scene. I couldn’t see him anywhere, so decided to run out real quick to make sure he was all right. Dru was clutching my hand, but nodded for me to go and let his grip slacken. “Come right back, okay?” He was trying not to cry. I gave him a kiss and promised I’d be gone for just a minute. Then I jumped out, feeling the tug of motherhood trying to pull me back.

I ran around the crash scene looking for Cecil and found him in another ambulance. Medics were working over him. He was dazed and disoriented. His eyes fixed on me as soon as I appeared at the door. He wanted to know about the boys, then he told me to go back and make sure they were okay. I stood frozen. “Donna, go be with Dru,” Cecil insisted. I hoped he knew how hard it was for me to leave.

I made my way back toward Dru and the other boys. Before I could get there, Dru’s ambulance pulled out, threw on its lights and left the scene. “WAIT!” I screamed at the tail lights that were leaving without me. I called Kirstyn’s name and she came from nowhere. We ran down the street to our car, moving in sync, sharing the same frightened heartbeat that pounds in the chest of every person who senses they are on the verge of losing someone they love. Off in the distance, I heard the siren, that horrible sound that tells you someone is in trouble. This time it was my son.

A second ambulance pulled out and I swung my car in behind it. Together we raced down the highway. Lights were on inside and I could see the medic working over the third boy. That left Cecil at the scene. I expected to hear the cry of the ambulance that carried him come from behind at any minute, but it never did.

At the E.R. we ran through some doors and were made to wait with the other families. Another siren arrived. “That’s probably Dad,” Kirstyn said, without moving. I imagined him dying before they could get to him. I prepared myself for raising a son who could no longer walk or move on his own. Every minute was long enough to imagine a lifetime of horrors.

Eventually a nurse came in and told us we could go back and see everyone. The families pushed through the doors and down the hall to where the children were lying in beds. There were no tubes or monitors, no life-saving dramas. After having seen the wreckage, it was difficult to fathom but, apparently, there was no urgency for any of them. The pall of disaster began to drift away. I settled Dru into his bed and asked him what happened.

“A car came from the other direction and Dad moved over to make room and our tires went off into a ditch and Dad turned the wheel real hard to stay on the road and the truck started going crazy. We flew off onto grass and went into trees, and then flipped over. It happened really fast.”

The boys were in a room that formed the dead end of the hall. From their door I could see the entire hallway. While Dru was talking, I looked down the hall at police officers who were scampering about. One of them disappeared with an air of secrecy into a small room. They all seemed up to something.

I left the boys’ room and headed toward the activity. A voice was talking in hushed tones behind the closed door of the small room. It was one side of a conversation; someone was on the telephone. The door opened and an officer came out. He averted his eyes and walked into another room a couple doors down. I followed on his heels and found Cecil standing there.

He seemed basically stable. There was a large bloody area on the left side of his head. Blood vessels had obviously burst in his eyes because they looked like road maps. He was still somewhat dazed, but he had his wits about him. “They want a blood sample,” he said, as I walked in. “They’re charging me with DUI.”

“DUI?” I stared at the officer. “He was swimming with the boys at the lake!”

“Dr. Knox,” the officer continued, as though I were not in the room. “Will you consent to a blood test?” It was odd that the guy called him Doctor Knox. Why didn’t he call him Mister like everyone else who doesn’t know him enough to know he’s a doctor?

I struggled to remember some remnants of criminal law and asked if they’d offered Cecil a breathalyzer, like they're supposed to. No, they hadn’t. They wanted a blood sample now and, if I didn’t mind, would I please step back. Yes, I did mind. In fact, since they were about to place Cecil under arrest, I would now be acting as his attorney and they were not to speak directly to him again.  

I asked the basis of their professed belief that Cecil had been drinking. The officer seemed to squirm the slightest bit. He wasn’t at liberty to discuss that with me at this time. They just wanted a blood sample.

It’s common for different law enforcement agencies to work together. Badges and vests from a number of agencies had come through the door when they’d raided Cecil’s office and our house. Now, these guys were asking for blood. Visions of agents switching vials–or infusing Cecil’s–crept into my mind. I asked about the chain of custody of the sample. More squirming. He wasn’t at liberty to discuss that, either.

“Then Dr. Knox is not prepared to give you a blood sample. I’d like a few minutes with my husband, please.” The officer and the nurse left the room. I turned to Cecil. “If you refuse a sample they’ll suspend your driver’s license for a year. But I don’t trust them. I think they’re talking to the feds in that room. The feds would love to come up with a report that says you’ve got drugs in your system. What do you want to do?” Cecil insisted he hadn’t been drinking and that he wasn’t concerned about his blood alcohol level.

I was still suspicious. Once they had his blood we would lose control of the situation. What if they just flat-out falsified the report? They’d shown up at our door with a battering ram and rifled through crawl spaces in the basement. They’d threatened patients who didn't want to cooperate in setting Cecil up. I had no idea what these guys were capable of doing and they were refusing to tell me who would take custody of the blood sample.

Cecil sat and stared off for a few seconds. “Okay. Tell ‘em no blood.” I opened the door to talk to the police officer and he all but fell into the room, standing just a little too close. “There will be no sample, officer.”

On October 25^th Cecil was tried on a DUI charge, as well as his refusal to consent to a blood alcohol test. Reckless driving had been thrown in for good measure. All of this generated publicity, something we would later have to get used to. To no one’s surprise, sitting in the back of the courtroom were the feds’ lead investigator and his side kick, notebooks in hand, ready to take it all down.

The prosecutor put a police officer on the witness stand, then offered the Implied Consent Form into evidence. This was the document that showed Cecil had refused to give a blood sample. The judge took the form. “This is a copy, Counselor. Where is the original?”

The prosecutor didn’t spend much time looking through his file. “I’m sorry, Your Honor, but I don’t have the original.”

“If you don’t have the original, I am dismissing the Refusal. You can’t prosecute on a copy.” It was a technicality, an evidentiary ruling. The judge seemed irritated. He had a “You know this as well as I do” tone in his voice. In the end, the judge dismissed the DUI and the Refusal, and took the Reckless Driving under advisement. He ordered Cecil into VASAP, which is an alcohol education program. It was an affront, but better than losing his license for a year.

As we left the courtroom, I saw that the agents had disappeared. Cecil looked at their empty seats and took my hand. “I’ll bet I know who has the original.”

I understood at that moment what, and who, we were dealing with. And deal with them we did, for the next five years.

Searching for a Pain Doc: Part 2

You might remember when Oxycontin came out. It became the drug of choice in treating pain patients because it didn’t destroy the liver and other organs like some pain medications did. Unfortunately, it didn’t take long for a few people to figure out they could defeat the drug’s unique time release mechanism by crushing and snorting the pills. And then it didn’t take long for people to start dying from overdoses. And then it didn’t take long for the feds to get involved.

Headlines about ‘Hillbilly Heroin’ started popping up around the country. What could the government do to stop it? The DEA formed a task force. Next thing you know, they were going after doctors. The prescription pad was the source of Oxycontin, so that’s where they would dry it up. If they took a few docs down…hard…other docs would be afraid to prescribe narcotics for fear of being next. Everyone could save for another day the question of how legitimate pain patients might find relief. It was a simple plan.

It might seem they would have worked with the docs to solve the problem, but there’s the whole culture thing: prosecutors like to prosecute. They’re what you might call a breed unto themselves. I used to buy the notion they were do-gooders trying to rid society of its shadier types. Then I interned in the U.S. Attorney’s office during my third year in law school and saw a rather scary mentality lurking about, just off in the corner where everyone could tap into it on a regular basis. It was kind of a ‘Let’s get ‘em cuz we can’ combined with a ‘How dare they resist; now they’re really asking for it’ type thing.

So, the Task Force edict went out. They started looking for targets. My husband, Cecil, made a good one. What legitimate doctor wears holey jeans and keeps his office like Bubba’s fraternity house?

They came after him like he was some kind of Mafioso. And when he didn’t like having feds raid his office and his home with guns and battering rams, when he didn’t care for them hauling out his patients’ charts by the truck load, they ramped things up and kept coming, and kept coming some more. There were seven indictments before they were done.

So, first thousands of patients found the pain doc they’d been searching for. Then the feds found him and took him down… hard. People looked on, largely aghast. But that didn’t stop the show.

To be fair, if I really stretched my imagination, I could say the prosecutors and their agents and the experts they brought in probably thought they were doing the right thing, on some level. There’s room to rationalize it. And we might all appreciate having Big Brother out there hovering over our lives, except, last time any of us checked, not that many cops or prosecutors had gone to medical school. 

Searching for a Pain Doc: Part 1

     More than fifty million Americans suffer from chronic pain. Many more suffer from protracted pain that doesn’t qualify as chronic.

     Let’s take a minute to think about pain. There’s the hang nail. How you baby the afflicted hand for days. You yelp every time you bump the thing and soon it feels like the whole finger is infected. Next you’re holding it up and away as you do stuff and you can think of nothing else.

     Then there’s the pulled muscle. My God, will it never end? You limp along, wincing every time you move, clutching and grabbing to ease your suffering. Forget bending over. And it’s not your fault you cry out like a little girl when you happen to sneeze or cough or do something to call into question the enflamed area, which, by the way, might as well be on fire. It hurts that much.

     And surgery…what can we say? You’re a basket case and need a hand-maiden for weeks, no questions asked.

     So what about the poor guy who falls three stories to the ground and lives through it? Or the one whose neck whips back and forth like a rubber band when his car is hit from behind by a guy going fifty?  Or even the guy whose left leg is two inches shorter than his right, so his spine twists and his muscles pull and contract and torture him all day every day no matter what he does?

     When we have pain, we can buck up for a few days but, by gum, things had better turn around after that or we find ourselves fit to be tied. For many people, the relief never comes. They suffer in ways most of us cannot fathom. Some of them are barely hanging on and, pretty soon, they’re thinking they’d rather just let go.They roam from doctor to doctor in search of relief. Maybe, the next one will think of something different.

     Then they come upon Cecil Knox, the guy from Texas with a pony tail hanging down his back. His cowboy boots are worn. So are his jeans. There’s a POW flag flying off the roof, a peace hatchet stuck into a stump in the corner, and sacred ash hanging over the door jam. He’s ‘eccentric’. He’s ‘interesting’. They call him Cecil instead of Dr. Knox. As it turns out, he is the doctor that will try everything until he has helped them.

     This doctor is at the office before dawn and late into the night, fretting over what he can do for Patient A or Patient B. He’s down in the basement on weekends developing braces to relieve their pain. Everyone has his home phone number and he thinks nothing of piling out in the middle of the night because a patient is feeling down. Does he get creative? Well, if stretching doesn’t work, maybe orthotics or bracing will. And there’s always physical therapy, Rolfing, acupuncture, cranio sacral therapy, aqua therapy and OMT. Mental health counseling might help. You might try colostrum and other supplements. I could go on.

     When you find a Dr. Knox, he becomes your friend, your lifeline. He is the one you have been searching for.

     Unfortunately, there is a ‘but’ to this story. It goes like this: But, most pain patients also require pain medication. Narcotics. When the powerful narcotic, Oxycontin, came on the market in the mid-1990’s, it was seen as a Wonder Drug in the treatment of chronic pain.

     In my next post, I’ll talk about what happened with Oxycontin and how it all went bad.