In the Seattle Times yesterday: "State slow to suspend pain doc's license".

Front page news. Dr. Frank Li has gotten his license pulled. He runs, I mean ran, 8 pain clinics in Washington. Opioids. Other medicines, but the problem is the opioids.

That means the physician's assistants who actually saw the patients and prescribed can no longer prescribe. The clinics have not closed but have lost their contract with medicaid. So it is the disabled and the poor who will hit the streets. Some of them ARE addicted, but hello, isn't that an illness as well?

This is over overdose deaths and he is accused of medicaid fraud. Of charging for urine drug screens that the state does not cover. And deaths. He oversaw 5 physician's assistants. Though when I divide 25,000 patients by 6 providers, that is over 4000 people each. Say they work 5 days a week and get 4 weeks off a year. That means 4166 visits a year/ 5 days a week/ so over 17 patients a day.....and I have the numbers wrong. It is doctors and midlevels but the clinics have lost their contract with medicaid. The patients would have to self pay... but X said that 7 out of the 8 clinics have shut their doors. And the website won't show me providers.

Chronic pain patients are complex. Pill mills or not, what are these people supposed to do?

But I got my first call yesterday. A patient X who has a primary care doctor. X is on morphine 30 mg twice a day. X's doctor went to my residency. 60mg of morphine is only half the state law limit of 120mg morphine dose equivalent daily. X says that the primary care doctor says that their clinic doesn't do that: what, I say, prescribe medicine? Take care of their patients?

X was driving 114 miles from home to one of those pain clinics. Because that is where X could get in. X has been on the morphine for six years and moved from another state.

I will call X's doctor today. I can't take 25,000 patients. They all have a month of pills. The prescriptions all expire in August. Well, the heroin cartel had better do some serious booting up: because where in hell are these people going to go? Washington State is going to have horror quest live in August and September. Imagine 25,000 people withdrawing at once.

The emergency rooms and the urgent care clinics are going to be slammed. August is usually slow and health care workers take vacation then too. I am. We are booked out a month for new patients and I talk to chronic pain ones on the phone. I don't give any prescription at the first visit. I send out a urine drug screen first....

I can't take 25,000 patients.

Of the 25,000 patients "only" 6000 are medicaid. But many doctors won't take medicaid, or will take one new patient a week or their clinic has decided not to prescribe for chronic pain...60 medical providers are under investigation, meaning the prescriptions for all 25,000 are in jeopardy.

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