Of cash cows and cookie jars

In the Sunday Pittsburgh Tribune-Review.  The sad story of a physician gone very, very bad,

Oliver Herndon, MD. 40 year old guy, trained at some of the most prestigious institutions in the country. UCLA, Stanford. Specialized in pain management, Board certified in Internal Medicine and Palliative Medicine. Said by many to be a regular guy, worked hard, did a good job. Internet patient ratings three stars out of four (for what that’s worth). Married, five kids, living in an upscale community.

Pleaded guilty last Monday to defrauding insurers and drug trafficking. Finally busted by a DEA undercover plant who made an appointment and received a prescription for Oxycontin for a trivial complaint after a brief interview and no physical exam.

http://triblive.com/news/1867518-74/herndon-patients-investigators-prescriptions-employee-pharmacists-doctor-drug-federal-2011

How can this be?  Here’s a hard working guy with a family, trained in the big leagues with impeccable credentials, committed specifically to helping those with pain and suffering.

It’s the old, old story. Herndon entered the world of expensive interests that turned into obsessions exceeding his ability to finance them.  Multiple expensive homes. Big game hunting junkets to Africa. Once he tasted them, it was impossible to go back. He found it only too easy to finance them by alternate means. His waiting room was packed with dirt balls urinating on the walls. His office is said to have taken in US$60,000 cash in one week. Average time interviewing a patient was under three minutes. “Investigators described him as the largest source of illegally obtained oxycodone and oxymorphone in Western Pennsylvania and said his March arrest cut supplies so much that the street value of oxycodone doubled to $40 a pill”.

More importantly, how did he get away with for as long as he did. It was all there, local pharmacists refused to fill his prescriptions for weeks. Herndon told his patients the further they got from Pittsburgh, the easier it would be to get them filled. His patients when squeezed by the police, turned him in as their source. Like Bernie Maddoff, he surely must have known he had a limited time to make this work and presumably tried to enjoy it to the inevitable end.

It’s a scary prophesy with the potential to plague us all. Applicants to medical school are said to be carefully screened for honesty and an authentic  service orientation? Not necessarily. They’re screened for grades, book learning and community service they all commit to because they know admissions panels desire it. They can be all those things but they don’t have to. They know what’s expected and they know how to play the game.  The reality is there is no way to screen out potential Herndons. We just hope for the best.

Physicians have the potential to live the dream, and common sense would dictate a desire and ability to do so within the limits of their better-than-average income and social status. But the cookie jar is always there and it’s always open. Once the taste for La Dolce Vita occurs, it’s a vice that can be hard to regulate.

Herndon will appropriately go to jail and the DEA will continue to ferret out the many similar physicians still out there, some more successfully than others. Some physicians will continue to commit fraud in their billing and dispense anything that brings in cash.  If there is any way to fix this situation, I don’t know what it might be. The rest of us will live the dream also, knowing that the hazards are always present and those hazards don’t necessarily select for the weakest of us. We are all at risk and that bears some recognition.

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