A prominent former pain doctor on trial for alleged drug trafficking defended his treatment methods yesterday, saying he prescribed large dosages of narcotics to patients who had been arrested or failed drug screenings because he believed they were in chronic pain.
In one instance, William E. Hurwitz testified, he refilled a Dilaudid prescription for a woman who said her dog had eaten the original one. "The issue of whether the excuse was believable or credible or truthful is hard to assess," said Hurwitz, who practiced in McLean until 2002. "I think it is possible that someone's dog may have mangled a prescription."
Another time, Hurwitz acknowledged, he prescribed 200 OxyContin pills for a man with severe neck and back pain who had been arrested on drug charges and failed a urine screening. "He told me he had been framed," Hurwitz said on the stand in U.S. District Court in Alexandria. "He'd had dirty urine in the past, but he'd also had clean urine in the past."
Asked by his own attorney why he continued to treat patients who displayed so many "problem signs," Hurwitz said he "was wrestling with these issues and trying to reconcile how to deal with problematic patients. . . . I believe all the patients had pain."
Hurwitz, 59, is charged in a 62-count indictment with leading a broad conspiracy to traffic in prescription narcotics that prosecutors say led to the deaths of three patients. Prosecutors say that he prescribed excessive quantities of dangerous narcotics, sometimes as much as 600 pills a day, and that some patients then sold the drugs on the lucrative black market.
The case has attracted national attention from advocates for patients with chronic pain who criticize the government for what they consider an effort to criminalize good medicine. Government officials counter that the prosecutions of Hurwitz and other doctors have helped stem growing abuse of potent painkillers.
The trial culminates a two-year federal investigation into doctors, pharmacists and patients suspected of selling potent and addictive painkillers. Hurwitz was one of the ultimate targets of the probe, in which about 50 people have been convicted.
More than 25 supporters crowded the courtroom yesterday for the testimony of Hurwitz, who was considered a major figure in national pain management circles.
"The stakes are cosmic," said Mary Baluss, director of the Pain Law Initiative, a District-based corporation that advocates for people with chronic pain. "If Hurwitz is convicted, it will show that a doctor who is very widely respected in the pain management community . . . cannot be safe."
Baluss said she thought Hurwitz's testimony was effective and "conveyed a respected line of thought that says it's okay to treat addicts who have pain."
Hurwitz's testimony came in the sixth week of the trial before U.S. District Judge Leonard D. Wexler. If convicted, Hurwitz could face up to life in prison.
In his cross-examination of Hurwitz, begun late yesterday, Assistant U.S. Attorney Gene Rossi pointed out that while getting his law degree in 1996, Hurwitz took a class about recognizing aberrant behavior called "Red Flags & Loud Gongs."
Under questioning from defense attorney Marvin D. Miller, Hurwitz said he had dropped 17 patients, some for abusing or selling medication. But he said he would still treat patients with addictions or other warning signs if he felt he could have a "morally persuasive" relationship with them.