March 18, 2007 — A doctor sits in a federal jail in Puerto Rico. Hundreds of his patients and their families on St. Thomas suddenly find themselves without medical care. Many wonder what happened.
In a well-publicized trial, a jury convicted Dr. Paul Maynard on four counts — out of a possible 170 — of prescribing pain medication to patients without "a legitimate medical purpose." (See "St. Thomas Doctor Found Guilty of Illegally Prescribing Drugs.")
According to Siobhan Reynolds of the advocacy organization Pain Relief Network (PRN), Maynard is just one of thousands of doctors who have been arrested, prosecuted, convicted and sent to prison. Hundreds of them have been pain-management specialists like Maynard, she says, arrested by federal and state authorities for violating the Controlled Substances Act. Reynolds maintains that this is a concerted effort by the government designed to limit the dispensing of illegal prescription drugs by doctors and their use by patients.
Reynolds is an outspoken advocate for both doctors and patients. She pulls no punches in her characterization of the Maynard case, saying, "This was a set-up, a political prosecution. Very similar to many other cases we are following. Like all of them, this one is filled with discrepancies and questionable motives and actions."
Drug companies pressure doctors to prescribe their products, and then the government moves in and prosecutes them for doing so, Reynolds asserts.
"It is like the Inquisition," she says. "The government applies pressure on both patient and doctor until one of them breaks."
During Maynard's trial, prosecuting attorney Kim Chisholm accused the doctor of being "motivated by greed." Maynard prescribed drugs to people for a $60 to $80 fee without examining their medical records, conducting follow-up examinations or referring those patients to other medical professionals for further study, she said.
Chisholm also blamed one of Maynard's prescriptions for OxyContin, a powerful and addictive narcotic, as the cause of death of 26-year-old Aaron Houle in May 2001.
Sitting in Limbo
While he awaits sentencing on May 8, Maynard is being held in federal prison in Puerto Rico. According to his family, he suffers anxiety and diabetes problems, has no outdoor or exercise privileges and, as of yet, no access to his new attorney, former federal drug prosecutor, John P. Flannery, special counsel for PRN.
Visiting hours for the doctor are between 7 a.m. and 10 a.m., according to Maynard's sister, Milicent. In order for his family or supporters to visit him, they must pay for airfare, hotel and transportation costs.
Maynard must submit names to prison officials of those who are permitted to visit him. According to the family, that list is not available over the phone — visitors must go to the prison to find out if they are on the list.
The family feels that they are putting themselves at risk — not only financially, but also because they are questioning the motives of the government and the efficacy of their attorneys.
The case has many aspects and threads: local and national political and legal issues, issues of medical care in the territory, race and social standing.
One patient, Alston Harris, stands out by the side of the road, waiting to tell his story to a reporter and Reynolds, an advocate from New Mexico who specializes in cases involving doctors she feels have been wrongly convicted.
A 12-year patient of Maynard's, Harris has several medical conditions, including diabetes. "I am a mess over this," he says tearfully. "I can't sleep at night. Justice was not done." Milicent, Maynard's sister, consoles him. As he turns to go, Harris slips her money for the doctor's new defense fund.
Speaking on behalf of another of Maynard's patients are David and June Turner, who say the health of June's 90-year old mother has deteriorated dramatically since the doctor's incarceration: "We can't get any doctor to visit her in the house. We have been trying for weeks and she has only received one visit."
This is a major problem for the elderly on the island, they say. Doctors do not make house calls, and for patients who have problems walking, the transportation system is often inadequate or cost-prohibitive. "We can't get a taxi to even come to our home, and the driveway is too steep to walk down," June Turner says.
Since Maynard's conviction, the Turners say they have been forced to give June's mother unusual care, including injections, which they have never done before. They maintain that Maynard was always very careful in his care and, in particular, with his dispensing of prescriptions. Many times he did not charge for his services, they said.
Now they are unable to get any sort of prescription filled without taking their mother in, which is impossible. "If you can't walk in, no system will come out and see you," June Turner says. "We were lucky to have Dr. Maynard. This was a spiteful act to convict him. We are getting almost no help now."
Another 20-year patient of the doctor, Selena Murrell, spoke at the recent vigil in support of Maynard. (See "Hundreds Hold Vigil for Doctor Convicted of Prescribing Drugs Illegally.") Many more in the community failed to attend the vigil because the word was slow to get out. "Lots of people love Dr. Maynard and lots have questions about what happened," Murrell said.
A Question of Character
After staying in court "gavel to gavel," Murrell said she could not understand how the doctor could have been convicted on two counts, released, allowed to go to his office and then called back to court and convicted on two more counts. She also questioned why Maynard's lawyers called no character witnesses, indicating the Rev. George E. Philips of the St. Thomas Assembly of God church was in court to do just that.
Family, supporters and patients all question why the defense called no character witnesses in Maynard's trial. They also complain that the defense failed to call an expert witness it had hired.
The would-be character witnesses included some prominent community leaders, such as Whitman Browne, principal of Gladys Abraham Elementary School. He was at the courthouse and never got called to testify. "This man is my doctor," Browne said recently. "He is a good man."
Browne, an author and veteran educator, was master of ceremonies at the vigil held for Maynard. Browne has been recognized as one of 55 outstanding Caribbean citizens and is to be honored at the ICC World Cup for cricket.
A woman who worked with Maynard also speaks in his favor.
"This is a man who is passionate about his patients. He would do anything for them," said Ophelia Powell-Torres, retired assistant nursing professor from UVI, who has worked with Maynard for years. She has worked at Schneider Hospital and now runs a private nursing-care service. Powell-Torres serves as vice chair of the V.I. Board of Nurse Licensure, and the UVI Alumni Association honored her as one of the territory's nursing pioneers.
She has nothing but praise for Maynard: "Paul is a brilliant man. He was the man who made house calls and stayed with his patients. He would do anything for them. Now it is our turn."
In the trial's closing arguments, Chisholm painted a very different portrait of Maynard's character. She described his office as a "grocery store for controlled substances." Instead of referring addicted patients to other medical professionals, Chisholm said, he continued to "freely give out the medications," sometimes writing two or three prescriptions for one patient in a day.
During the trial, jurors watched vi
deo footage of an undercover agent asking Maynard to refill a prescription for Percodan and give him a new prescription for Valium because of pain in his leg. In the tape, Maynard wrote both prescriptions and told the patient to exercise caution when taking the medication.
The defense argued that a series of patients and undercover officers duped Maynard into prescribing medicine for false ailments. "These guys know how to act," Gordon Rhea told the jury during closing arguments. "And Dr. Maynard gave them the benefit of the doubt. He thought he could trust his patients."
Maynard's family has many questions about the doctor's defense. The cost was very high, they say, well over $60,000 so far. They maintain that Rhea did not raise objections during the trial and was not prepared for the possibility of conviction.
A Painkiller Crackdown?
According to Reynolds, there has been a crackdown on doctors prescribing pain medicine during the Bush Administration. This has resulted in system-wide cutbacks in the availability of legal pain relief for patients, she says, arguing that the crackdown forces patients legitimately in pain to explore other means, some less effective or illegal.
One of the drugs authorities accused Maynard of illegally prescribing was OxyContin. Reynolds argues that Purdue, maker of OxyContin, aggressively marketed the drug. In 2004, the FDA claimed that Purdue purchased ads in the Journal of the American Medical Association that "grossly overstate" the drug's safety. The fact that the drug was highly addictive and could be fatal was in the fine print at the bottom of the page.
Authorities are arresting and prosecuting not only doctors but patients as well, Reynolds says. She points to discrepancies in the way authorities in Florida have prosecuted two men in cases involving painkillers: conservative radio personality Rush Limbaugh and Richard Paey, one of PRN's primary cases still in the appeal process.
According to the February 8, 2006, edition of the Tampa Tribune, "Wheelchair-confined Richard Paey committed almost exactly the same violations of Florida prescription drug laws that radio personality Rush Limbaugh did, with a different result: Limbaugh's sentence, in May, was addiction treatment, and Paey's, in 2004, was 25 years in prison. Both illegally possessed large quantities of painkillers for personal use, which Paey defiantly argued was (and will be) necessary to relieve nearly constant pain from unsuccessful spinal surgeries after an auto accident, but which Limbaugh admitted was simply the result of addiction. (In fact, if Limbaugh complies with his plea bargain, his conviction will be erased.) Paey's sentence now rests with a state Court of Appeal."
The PRN website states," We are here to abolish the Controlled Substances Act so that society will have to rationally regulate these important medicines, ensuring that those who need them can get them without fear of prosecution. The criminalization of doctors and patients must stop. The doctor-patient relationship must be restored to the privileged position in society it once enjoyed.
"It is time to put the medical needs of the vulnerable ahead of the political aspirations of the powerful."
During closing arguments in Maynard's trial, Chisholm characterized the doctor as recklessly fueling drug addiction.
"If you want to help someone who's an addict, you don't keep prescribing …," she said. "That's just smoke and mirrors presented by the defense. Dr. Maynard is not a pharmaceutical company, but he is taking a chance with human life."
For her part, Reynolds likens the situation in St. Thomas to an old Caribbean tradition: piracy.
"The Maynard case is typical," she says. "This is a war on doctors. The government seizes property and assets. It is like piracy. These cases make other doctors very nervous and they stop dispensing pain medicines, and ultimately the patient suffers."
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