Federal prosecutors yesterday portrayed prominent pain doctor William E. Hurwitz as a man who used his white coat and prescription pad to traffic in narcotics, spreading the abuse of addictive painkillers nationwide and ultimately leading to the deaths of several patients.
During the opening day of his trial in U.S. District Court in Alexandria, prosecutors outlined a 62-count indictment against the McLean doctor that includes charges of drug trafficking resulting in death and serious bodily injury, conspiracy to traffic in controlled substances and health care fraud.
During the trial, which is expected to last as long as eight weeks and has drawn national attention from advocates for patients with chronic pain, prosecutors intend to prove that Hurwitz, 59, was "a drug dealer in his own right," entering into sketchy financial agreements with patients whom he provided with countless prescriptions for painkillers such as OxyContin -- sometimes up to 600 pills per day.
Prosecutors said those patients used the drugs both to fuel their own addictions and to make huge profits on the black market.
"The indictment tells the story of someone who crossed over from a self-proclaimed healer to a drug dealer," Assistant U.S. Attorney Mark Lytle told the jury during opening statements. "Dr. Hurwitz was playing the role of an illegal drug supplier."
Hurwitz's attorneys have denounced the charges against their client as an attempt by the government to criminalize good medical practice. They say Hurwitz was providing needed pain management to a class of patients whose chronic suffering "destroys your body . . . your soul."
"This case is not about drug dealing," said defense attorney Patrick S. Hallinan, who is based in San Francisco. "This is a case about new science: the treatment of chronic pain with high opioid doses to ameliorate that pain."
The trial is the culmination of a two-year federal investigation into doctors, pharmacists and patients suspected of selling potent and addictive painkillers. About 50 people have been convicted. Law enforcement sources said the probe is ongoing, though Hurwitz was one of the ultimate targets.
Before he closed his practice in 2002, Hurwitz was considered a major figure in pain management. If convicted of the most serious counts, Hurwitz, who has been free on $2 million bond, faces up to life in prison.
During the government's presentation yesterday, prosecutors showed the jury enlarged photographs of medical records allegedly written by Hurwitz that mention a patient's arrest for selling drugs. Although prosecutors said evidence -- including a recording of a conversation between Hurwitz and one of his patients -- will show that the doctor knew his patients were abusing drugs and in some cases selling them, Hallinan said the opposite is true.
"For goodness sake," Hallinan said, "these medical records are in stone. You think someone involved in a scam selling pills would put it down in the records?"
Hallinan told the jury that his client would "never tolerate the dissemination of medications into the community" and denied prosecutors' claims that patients told Hurwitz they were actively selling the drugs.
Rather, he said his client was the victim of "professional predators" who took advantage of his medical practice in order to obtain drugs and sell them for a profit.
If Hurwitz worked in Beverly Hills or healed only "the upper middle class," Hallinan said, he would not be in this predicament.
"These were poor people who couldn't resist . . . the temptation to get more pills than they need and sell them," said Hallinan, describing one of Hurwitz's patients who later agreed to cooperate with investigators and wore a wire to tape their conversations.
Prosecutors contend that a conversation includes Hurwitz suggesting that his patient get an unnecessary MRI to falsely support his heavy prescriptions. Prosecutors say the patient also discloses his arrest for possession of cocaine. Still, they said, Hurwitz prescribed the patient 300 tablets of OxyContin.
"That tape recording provides a window into the real Dr. Hurwitz," Lytle told the jury. "As a doctor, he thought he could hide behind the pain he treated."
Prosecutors allege that Hurwitz made large profits by charging an initiation fee of $1,000 for each patient and then $250 a month for maintenance. They said Hurwitz had about 470 patients in his clinic over the last five years, resulting in millions of dollars in profit.
Several of those patients died and others overdosed, prosecutors said yesterday, telling the jury they can link the incidents to Hurwitz's overzealous dosages.
Several of Hurwitz's friends and former patients were in the courtroom yesterday to lend support.
Siobhan Reynolds is executive director of the Pain Relief Network. Her former husband suffers from a congenital tissue disorder that she said has left him with intractable pain. He was a patient of Hurwitz's until the practice was closed.
"He saved my husband's life for sure," said Reynolds, adding that Hurwitz was "brave enough" to give her husband the care and the medication he needed -- extraordinarily high doses of OxyContin, Dilaudid and Fentanyl -- when other doctors were afraid to act.
"Other doctors who might have been persuaded to get involved see this as a precautionary tale," she said, referring to the trial. "Who wants this?"