Outspoken Helena doctor to stop treating pain patients

http://ravallirepublic.com/news/local/article_669903bc-540a-11e5-9480-8b21610dba53.html

Dr. Mark Ibsen of Helena has been an outspoken advocate for providing chronic pain patients with the medications, including opiates, they need to carry on with their lives.

This week, in a short note, Ibsen told his patients he would no longer be able to do that.

Ibsen’s decision follows the Ravalli County indictment of Dr. Chris Christensen of Florence on 400 felonies, including two counts of negligent homicide.

Prosecutors allege that Christensen distributed prescription drugs to patients outside the course of his professional practice, including providing methadone to two Missoula patients who overdosed and died.

Ibsen’s note read: “To our patients: in solidarity with Dr. Christianson (sic), and in acknowledging the extreme hostility of the regulatory environment in which we are operating, Dr. Ibsen will no longer be prescribing any pain medications to chronic pain patients. Dr. Ibsen will be taking some time off to plan the next safe course of action. We wish you all the best.”

Ibsen’s announcement set off a panic for the hundreds of people who depend on him to treat their chronic pain, said Kate Lamport of Helena.

She knows. She’s one of them.

A mother of four, the 32-year-old Lamport suffers from fibromyalgia, a chronic disorder characterized by deep, general pain, fatigue and tenderness.

“My entire body hurts,” she said. “My joints feel swollen. Bending over and standing hurts. My muscles ache and spasm to the point I can’t use my arms. I lose feeling in parts of my body. I drop things. I fall. I run into things.”

When Lamport’s previous physician was unable to treat her pain, she turned to Ibsen.

“He listened to me,” she said. “I spent two or three hours with him that first day … He’s a person who listens to you and explores alternatives. He wants you to get better. He doesn’t just say ‘take these medications’ and then sends you on your way.”

Ibsen prescribed a course of medications, including opiates, that Lamport said helped her function again.

Lamport was so impressed with Ibsen that she began volunteering at his Helena clinic to help other chronic pain patients fill out forms and find alternative resources.

Many of those patients are now contacting her and looking for answers that she can’t give.

“I get messages all day,” she said. “People are saying to me: ‘What am I going to do? No doctor will treat me. I’ve called all over.’”

Lamport said she doesn’t know what to tell them.

“They really don’t have any choices,” Lamport said. “They don’t have a doctor they can turn to. Every doctor that I called, especially after this Christensen thing, does not want to take anybody with a pain condition.

“They call up asking me for help, and I don’t have an answer,” she said. “That’s because I really don’t know. Some of them can’t even afford to get a medical marijuana card.”

Lamport is quickly weaning herself off her medications while looking for some alternative ways to treat her chronic pain.

“Withdrawal is not fun,” she said.

Before she received treatment from Ibsen, her days were often spent curled up on her bed or her couch crying out in pain, she said.

“Right now, I’m afraid of going back to my couch,” Lamport said. “There are so many of us who are just trying to live our lives. I just want to be able to make dinner for my kids and go to their football games. My kids are what keep me going. Without them, I would have given up a long time ago.”

Ibsen said last week that his decision to stop prescribing pain medications to his patients with chronic pain was heartbreaking.

“I tried to figure out a way to cut down on the volume of chronic patients that I treat,” he said. “How do you make the decision on who gets thrown off the island?”

His decision has been a long time coming.

In June, a state examiner found that the Montana Board of Medical Examiners had failed to meet its burden of proof that the longtime Helena doctor had over-prescribed pain medication to nine patients. The examiner did rule that Ibsen needed to improve his record keeping.

The board brought the action two years earlier against Ibsen, owner of Urgent Care Plus and a former emergency department doctor at St. Peter’s Hospital.

Ibsen said the matter was incredibly stressful.

The action by the board was initially filed in July 2013 after a former employee made allegations that Ibsen over-prescribed medications to nine patients. The investigation later expanded to include 21 former patients of Christensen who sought Ibsen’s care after a drug task force raided and shut down the Florence clinic.

Ibsen is certain that he’s still being investigated by the federal Drug Enforcement Administration (DEA).

In 2014, Ibsen said a DEA agent told him: “You are not only risking your license by prescribing to these folks, you are risking your freedom.”

Ibsen said he asked the agent what he could do to ensure that he was doing things right.

He said the agent replied: “I can’t tell you. We’re not doctors.”

Since then, Ibsen said he’s taken to wearing a GoPro video recorder around his neck to document all of his interactions with patients.

After hearing about the charges against Christensen and reading a similar story from Florida where authorities are seeking the death penalty against a physician in a similar case, Ibsen said it was “too dangerous” for him to continue in this regulatory climate.

“That was pretty much it for me,” he said. “These guys are not going to stop.”

Ibsen said he has already heard from patients who are preparing themselves for a life without the medications that have kept their chronic pain at bay.

One patient suffers from a relatively unknown malady called adhesive arachnoiditis that causes unbearable chronic pain.

“Under my care, she has gone on pain medications that allowed her to go back to work,” Ibsen said. “She couldn’t work before that happened. She can’t function without high doses of opiates … She told me she’s going to quit her job because she knows she won’t be able to do it.

“I have case after case after case like that,” he said. “It’s heartbreaking.”

He said the stress has finally taken its toll.

“I can’t even think straight any more,” he said.

Ibsen said his staff was on board with his decision to take some time off to consider his options.

“I think we need to return to the urgent-care model,” Ibsen said. “We’ll have to limit how many prescriptions for pain medication that we write … I treated the most difficult patients. Other doctors wouldn’t do it. I now see why.

“I’ve done my best for my patients and I wish them well,” he said. “I’m on some kind of path and I’m not sure where it’s going to take me.”

Pain-patient advocate Terri Anderson of Hamilton said it’s time for chronic-pain patients and their families to step forward and let regulators know about this growing health care crisis.

“Pain patients are committing suicide, and families don’t want to talk about this as they view it as bringing shame on them,” Anderson said.

Anderson said 40 percent of all suicides in Montana are directly related to chronic pain and illness.

Anderson suffers from adhesive arachnoiditis caused by a failed medical procedure that misplaced steroids in her spine. She lost her civil engineering career with the U.S. Forest Service because of it.

Anderson will rely on high powered opiates for the rest of her life to address the “suicide-level pain” that’s been created, she said.

“Spinal injections expose patients to many risks for temporary benefits,” Anderson said. “Patients are bullied, shamed, dismissed and abandoned if they do not submit to profitable procedures in Montana pain clinics.”

Anderson said it’s time for patients and their families to file complaints with the Board of Medical Examiners if they are coerced to undergo risky procedures or if they are denied appropriate medications.

“Only then will we get the attention of the regulators,” she said.

The Montana Medical Association did not return a phone call for comment on this story.

The inability of chronic-pain patients to obtain medications will drive some to look to the black market, Lamport said.

“There will be a rise in the number of people using heroin and other street drugs,” she said. “This is a health care crisis. Everyone is afraid.

“There’s only so much pain a person can endure before they give in,” Lamport said. “That’s just the reality of our lives. When you can’t eat, can’t get out of bed and you just lay there in a ball crying all day and all night, there’s just only so much you can take.

“If a doctor can give you a medication that allows you to work and be a productive member of your community and take care of your family, why would you take that away?” she said. “This is really inhumane. We’re backed into a corner without any treatment options. It’s just not right.”

Filed under: General Problems