Letter to the American Academy of Pain Medicine

Content has been preserved in its original form and syntax. Modifications were made only to protect the interest of private citizens and to facilitate readability.

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Xiulu Ruan 66857019 E1

F.C.I. Oakdale 1

P.O. Box 5000

Oakdale, LA 71463

 

June 27, 2018

 

Re: The Persecution of Pain Management Physicians & the Intrusion on Pain Medicine Jianguo Cheng, MD, PhD

President, the American Academy of Pain Medicine Cleveland Clinic Main Campus

 

9500 Euclid Ave.

Cleveland, Ohio 44195

 

Dear Dr. Cheng:

 

I write to you from a federal prison in Oakdale, Louisiana. I am serving a twenty-one-year sentence that followed a seven­ week jury trial in the Southern District of Alabama, from January 4 to February 23, 2017.

 

I had dreamed of becoming a medical doctor in the United States since I was in medical school in China, some thirty years ago. In August, 1989, at age twenty six, I arrived at Baton Rouge as an international graduate student to pursue my post­ graduate studies at LSU.

 

Two and half decades later, after going through countless hardships, my ultimate dreams finally came true. I became an established pain specialist, achieved a record number of board certifications, published dozens of papers in many reputable medical journals, and became a co-owner of a sizable private interventional pain management center (employing close to 60 people). By May 2015, over twenty-five years after coming to the land of the free, I was indicted, arrested, and prosecuted for crimes I had never committed.

 

I was chosen as a scapegoat by the government for a variety of reasons, of which I will name a few. However, I am not the only physician scapegoat that has been targeted and sacrificed. There were many victims before me, and there will be many more after me.

 

Sadly, pain management doctors, among all physicians, are common and easy targets, chosen for prosecution by the government. Many pain management specialists often practice opioid analgesia to treat their patients suffering from debilitating chronic pain. This fact alone is “sufficient” for the government to find an excuse to charge these pain physicians with “prescribing controlled substances outside the usual course of professional practice,” and to subsequently prosecute them as street drug dealers. Once indicted, the clinic is raided; the physicians are portrayed as “drug pushers,” and their patients are labeled “addicts” or “drug seekers.” As a result, physicians’ assets or properties, either personal or from their business, become marked as illegally obtained from their “criminal proceeds,” thus are subject to forfeiture, regardless of how appropriately the pain management was practiced at the clinic. As a general rule, physicians can expect to see grossly exaggerated stories by the government’s media in an attempt to disgrace and prejudice them, often times by imputing physicians’ prescribing opioids for pain relief to their fueling of the opioid epidemic. This is deliberate pre-trial planning executed in order to prepare for the subsequent conviction of the physicians. This has been my personal experience.

 

In his book titled “Pain Control and Drug Policy,” (dedicated to the blameless victims of the War on Drugs policy), Guy B. Faguet, MD, a hematology and oncology specialist, writes:

 

“[Through the DEA, the U.S. government is conducting an aggressive and unjustifiable campaign against pain treating physicians. This is achieved by a multifaceted approach. It includes redefining the terms ‘addict,’ ‘drug dealer,’ and ‘drug distributor’; criminalizing opioid prescribing patterns coupled to a disinformation campaign to convince the public that, contrary to evidence, physicians are responsible for a ‘major prescription problem in the US’; and aggressively using the asset forfeiture law at the arrest rather than at the conviction stage of an investigation.” (97)

 

“By heavily publicizing physician arrests, indictments, and convictions usually accompanied by character assassination, the DEA ensures high visibility that fosters a public and congressional perception that is successfully addressing and protecting the public from a ‘major drug problem.'” (97-98)

 

“Shifting the focus from hard-to-penetrate black markets of illegal drugs controlled by unknown and ever changing players to a pool of easy-to-track, stable, registered, cooperative, record-keeping, tax-paying physicians with plenty of forfeitable assets would help stabilize their own prosecutions, appease Congress, and validate the DEA’s own existence.” (89)

 

Further, law enforcement agents are rewarded for the prosecution of physicians and other healthcare professionals. For instance, investigators and prosecutors receive promotions and pay raises while law enforcement agencies seize the properties of doctors and other healthcare professionals charged with various crimes. In his book “The Criminalization of Medicine: America’s War on Doctors,” Ronald T. Libby, a Professor in Political Science, writes:

 

“Indeed, doctors have been tried as drug kingpins and dealers for manslaughter in deaths of pain patients who miscued and overdosed on drugs they were prescribed. When convicted, physicians are subject to the same draconian mandatory drug sentencing guidelines that were designed to punish violent, illegal drug dealers.” (118)

 

“Seizing doctor’s assets was a recurring theme…Greg Aspinwall of the Miami Dade Drug Task Force stressed the importance of taking a task force approach to diversion investigations by using the theme ‘spreading the love.’ He said that as many law enforcement agencies as possible should be involved in investigations; it reduces the cost and guarantees that ‘everybody gets their fair cut from the forfeiture.’ He noted that even if there were no criminal charges, they can bring civil action to recover the cost of an investigation.” (136)

 

“Detective Dennis M. Lukens…explained the financial importance of targeting physicians for investigation. Luken, who worked on an asset forfeiture squad for three and a half years, said that in an ‘era of budget cuts, forfeiture are an important way to make up the losses.”‘ (136)

 

From these passages, it is clear the prosecution of physicians is also financially driven. It appears the government is running a gigantic lucrative business through the prosecution of physicians in the name of fighting crime. This also partially explains why I was targeted to be sacrificed as my assets and properties (fully listed In the Second Superseding Indictment) could be taken away and divided up among a host of the government agenci.es, to be used for pay raises and bonuses of the agents and the prosecutors, as well as for operational budget, etc. In other words, I am also the victim of the government’s “spreading of love” campaign. It is no wonder why the prosecutors would trump up any charges, regardless how absurd the charges are, in order to reach their ends-getting conviction(s).

 

For example, Physicians Pain Specialists of Alabama (PPSA) had been portrayed as a “pill mill.” In the First Superseding Indictment, it states: “Couch and Ruan ran what was, in essence, a pill mill. Through PPSA, Couch and Ruan did little more than prescribe…”(2). In the Second Superseding Indictment, it states: “Ruan and Couch ran what was, in essence, a pill mill. Their primary method of pain management was writing multiple prescriptions for…” (8)

 

According to the above allegations, PPSA is essentially a “pill mill”, and Dr. Couch and I did little besides prescribing controlled drugs. However, a consistent feature in all “pill mills” found in the legal literature is the use of cash payment for prescriptions of controlled drugs. As a matter of fact, the definition of “pill mill” in multiple convicted pill mill cases contains this feature: for example, in United v. Oti, 872 F3d 678,685 (2017): “…’a pill mill,’ a drug business exchanging controlled substances for cash under the guise of a doctor’s office…”; also in United States v. Sachs, U.S. APP. LEXIS 24078 (2017): “…Sachs ran a ‘pill mill’ in which patients were given large amounts of prescription drugs in exchange for cash’; and in United States v.

Crittenden, U.S. APP. LEXIS 24633 (2017): “…a pill mill where doctors, in exchange for cash, prescribed large dosages of controlled substances…”

 

In his article titled “When a Pill is Really a Pill Mill/ published online in 2012, Dr. Lynn Webster, a nationally and internationally renowned pain expert, opines that true pill mills have the following features:

 

non-physician owners who retained physicians for their federally-granted registrations to prescribe strong analgesics

 

a cash-only basis without any insurance billing

 

one form of treatment—pills

 

pill mills tend to open and close suddenly, as an attempt to evade law enforcement

 

 

The following features contrast sharply between the pain management provided at PPSA and “pill mill” practice:

 

PPSA had been in business at the same location at 2001 Springhill Ave. Mobile, AL, for seventeen years.

 

PPSA provided multidisciplinary pain management with special focus on fluoro-guided interventional therapies, equipped with four C-arm fluoroscopes (two at each location), used as guidance when performing interventional procedures.

 

The designation of PPSA under Medicare is 09-lnterventional Pain Management.

 

PPSA added new nerve testing equipment (Nerve Conduction Study & Electromyography machine) in 2005.

 

PPSA added new Hitachi Open MRI (machine alone cost $975,000) in 2007.

 

PPSA added new Stryker Radiofrequency Ablation machine in 2007.

 

PPSA added an immunoanalyser (Beckman AU 480) and a Beckman Coulter hormone testing machine in 2014.

 

PPSA added two Perkin-Elmer liquid chromatography/mass spectrometry (LC/MS) machines in 2015 (cost $455K).

 

PPSA provided multidisciplinary pain management including multidisciplinary evaluation (open MRI), electrodiagnostic testing, fluoro-guided interventional therapies, physical therapy, blood hormone testing, urine drug testing with immunoanalyser and GC/MS, and an onsite pharmacy staffed by certified Pharmacist and technicians.

 

PPSA offered in house physical therapy, initially at the Sringhill Ave. location, later changed to the Airport Blvd. location.

 

PPSA provided m1.1ltidisciplinary pain management including neuroimaging evaluation (Open MRI), eletrodiagnostic testing, fluoro-guided interventional therapy, physical therapy, blood hormone testing, urine drug testing with immunoanalyzer and LC/MS, and onsite pharmacy staffed by certified pharmacist and pharmacy technicians.

 

PPSA had kept its “No Cash Payments” policy since its establishment in 1998.

 

All PPSA patients were referred by their primary care or specialist physicians.

 

Based on this comparison, anyone, including the prosecutors and the judge, could only conclude that PPSA was not a “pill mill” as asserted by the government. The prosecutor, Mr. Chris Bodnar, realized this himself. However, in a cunning and deceitful way, he modified the allegation and argument to keep them in line with the First and Second Superseding Indictments by adding a new allegation: “atypical pill mill-money mill.”

 

In his opening statement, Mr. Chris Bodnar stated:

 

“PPSA was not cash only. In fact, they wouldn’t accept that. PPSA required patients to be referred by another doctor. They required patients to have insurance. And the insurance is the big key here. Because this wasn’t a pill mill in your traditional sense. What this was, was a money mill. And to have a money mm you needed two things, and they had it at PPSA. You needed patients with good insurance that would pay for these drugs and the doctors needed their own pharmacy so there was no checks and balances on what was dispensed based on what those doctors prescribed” (Tr. 1/5/17 p. 28}.

 

This was the very first time that the defense team ever heard the new allegation of “money pill” which had never been in any of the three versions of Indictments. The new allegation of ”running a money mill” made its way into the trial since the prosecutors realized the need to mingle “pill mill” with “money mill” simply because they knew that the “pill mill” prong would not stand. By cunningly mixing “pill mill” with “money pill,” the prosecutors could continue to advance their agenda, despite that “money mill” had never been formally charged previously.

 

The theme of “running a money mill” became the new thread of the trial, and the prosecutors made sure that the jury was largely confused and prejudiced. During the closing rebuttal argument, the prosecutor Ms. Deborah Griffin stated: “A pill mill is a money mill. A money mill is a pill mill. You don’t have to put a label on what these people are charged with” (Tr. 2/16/17 p. 6170}.

 

Clearly, Ms. Griffin was telling the jury and Judge Granade to simply forget about the “pill mill” charge in the First Superseding and the Second Superseding Indictments. There is no need for any type of reasoning or logic. No argument or evidence is needed. All it needs was the prosecutor’s assertion. Mere assertion. The statement “A money mill ls a pill mill” exemplifies the absurdity of my trial.

 

Ironically, during the sentencing hearing, the presiding judge, Senior District Judge Callie V. S. Granade, summarized her opinion this way: “This is not a typical pill mill. This is not a typical doctor overprescribing case. This is a very unusual case. I don’t think there is any question about it” (Tr. 5/25/17 p. 87).

 

Even though Judge Granade’s statement denigrates the allegation of “in essence, a pill mill” in the First and Second Superseding Indictments, the prejudicial effects of alleging PPSA as a ‘pill mill” is far reaching so that even today, this case is still widely referred to as a ‘pill mill’ case by the public/media.

 

The second lesson I have learned through my case is that there exists a huge gap between what we were taught toward being better pain management physicians and what is out there in the Real World, which can be extremely hostile and sinister. As pain physicians, we were taught that as long as we played by the book, followed related practice guidelines, strived to improve our knowledge and skills, and treated our patients with compassion and competence, the government would not deliberately find trouble with us, let alone criminalize us. Was I wrong!

 

One problem is that, during our training, we were never educated on how to deal with a hostile environment created by the government or how to avoid being ensnared by the government such as what I have been through. Unquestionably, such a course, more than anything else, should be added to the educational curriculum in medical school or during the residency training so that pain physicians are prepared. I think this is in dire need to bring medical graduates up to date to the harsh reality they will be facing in this country, especially for those who plan to go into pain management.

 

Specifically, in my case, I was charged with multiple counts for prescribing controlled substances outside the usual course of professional practice (OUCPP). Although it sounds benign, the phrase OUCPP used in prosecuting pain physicians carries the same weight, if convicted, as the federal laws used for penalizing street comer drug dealers and drug kingpins.

 

Unfortunately and alarmingly, many jurors could not understand the gravity of such charges, especially when the prosecutors deliberately misrepresented facts and confused the jury with that of medical malpractice (civil in nature).

 

At trial, defense medical expert Dr. Warfield (for Dr. Couch}, a world-renowned pain specialist and the Lowenstein Distinguished Professor of Anesthesia at Harvard Medical School, (also the first woman at Beth Israel Hospital of Harvard Medical School to have earned an endowed professorship at Harvard under whom the Pain Management Center of Beth Israel Hospital was named (Tr. 2/8/17 p. 4661, p. 4663}, gave her opinion on the difference between OUCPP and that of outside of standard of care in her testimony:

 

“Outside of the standard of care is often something that happens when the doctor makes a mistake, like a malpractice, negligence, the doctor makes a mistake. But they are still practicing medicine. I mean, if a surgeon leaves a sponge in somebody’s abdomen, they are still practicing medicine when they do that. It’s still within the usual course of medical practice, but they made a mistake or did something wrong. Or even if the doctor didn’t have the right knowledge and gave the wrong treatment or something, they’re still practicing medicine and acting like a doctor when they make that mistake. That’s malpractice” (Id. p. 4715).

 

“…outside …the usual course of medical practice, meaning a doctor isn’t even acting as a doctor any more. So, for example, you know, if somebody came up to me at a cocktail party and said: Oh, I hear you’re a pain doctor, can you give me a prescription for morphine, and I do it… (Id. p. 4715-16).

“Or if someone comes to me even in my office and says: Here, I’ll give you a thousand dollars if you give me a prescription for Oxycontin, and I give it to them-that’s outside the usual course of medical practice…” (Id. p. 4716).

 

“Or if I know, if my patient comes to me and says: You know, Doctor, I don’t have any pain but I just like this stuff because it makes me high. If I slip you a little extra money, will you give me that drug–that’s outside the usual course of medical practice” (Id. p. 4717).

 

Unquestionably, Professor Warfield tried to educate the jury what falls into OUCPP and what falls into standard of care category because it is a rather complex issue for the jury to comprehend as OUCPP (outside the usual course of professional practice) sounds so common and benign. On the contrary, It appeared that the prosecutors did understand the difference between that of OUCPP (criminal) and malpractice {civil). In his opening statement, the prosecutor Mr. Chris Bodnar made the following statement:

 

“So as we start here let’s talk first about what this trial is not about. This not about the United States telling doctors how to practice medicine. Doctors have a wide range of deciding how to prescribe, who to prescribe to, and what’s appropriate for a patient. If a doctor has a legitimate patient relationship and they decide I think in the best interest of my patient for the disease or the symptom of that patient that this particular drug is the proper drug for them, that is per se within the law. You have the right as a doctor. You could be absolutely wrong, you could have messed up completely, and It could turn out that, you know what, that drug I thought really good for that patient wasn’t good and maybe you have malpractice there. But you certainly don’t have a crime” (Tr. 2/5/17 p. 26).

 

Clearly, Mr. Bodnar knows how to distinguish criminal cases from civil cases. So, on the one hand, the government tells the physicians there is a great latitude in what they do for their patients just as Mr. Bodnar sugar-coated in his statement); however, this latitude is illusory, merely used to fool the media and further prejudice the jury. When it comes to the government prosecution of physicians, such a latitude becomes nonexistent; and the government gets to use any arbitrary standard, regardless how absurd and nonsensical, to viciously attack the physicians in order to reach its ends. My trial is replete with such evidence. I will give       couple of examples to show just how low the threshold was when the prosecutor labeled what I did for my patients being OUCPP, i.e. like a street drug pusher. The following dialogue occurred during the direct examination of the government medical expert witness Dr. Rahul Vohra by the prosecutor Ms. Deborah Griffin:

 

Q And what is the pre-G-A-8-A-pregabalin?

A Pregabalin is Lyrica, which is a medication that’s used commonly for nerve pain, and she was being prescribed that.

Q Would it be outside the usual course of professional practice not to counsel her on this and not to record what was done in the file?

A I would-again, I would talk to the patient: why are you taking these medications? Who are you getting these medications from?      (Tr. 1/23/17 p. 2214-15)

(Author Comment The patient received Lyrica from her neurologist. Lyrica is a schedule V drug, not an opioid}

 

Q As with a new patient coming in with a referral, do you have to start that patient on what they come in taking from their last doctor?

A No….

Q Would it be outside the usual course to just continue them or increase them on exactly what they come in with?

A Yes… (Id. p. 2266-67).

 

The following dialogue occurred during the direct examination of the government’s leading medical expert witness Dr. David G. Greenberg by Ms. Griffin, regarding the care rendered by me to patient OW:

 

Q: You didn’t notice any initialing on the lab report to show that Dr. Ruan had reviewed that lab report showing the inconsistencies?

A No, I didn’t see that.

Q And would that be outside the usual course of professional practice, rather than just a mistake to inquire about the inconsistent drug test?

A Yes… (Tr. 1/12/17 p. 640).

 

Further, the following exchanges occurred during the direct examination of Dr. Greenberg by Ms. Griffin, regarding the care rendered by me to patient KL:

 

Q Was there any warning that there were dangers with mixing powerful opioids with her prescribed sleeping pills and other sedative medications?

A Not that I saw in the chart.

Q Is that outside the usual course of professional practice?

A Yes, it was outside the usual course of professional practice (Tr. 1/12/17 p. 643).

 

Q Or any questioning about what she had attempted to do to help her pain for the past 20 years?

A No. There was really no history of present illness taken or recorded, that I can see, regarding this patient.

Q Did you determine there were any referrals to a psychiatrist or any kind of physical therapy? A No…l did not see any referrals to a psychiatrist or any kind of physical therapy…

Q Is that outside the usual course of professional practice for the pain clinic? A Yes, I would say so. Absolutely (Id. p. 641).

 

The truth is patient KL had been a patient of mine since September 2008. She had been seen roughly every month over six years. There was history of present illness on every progress note. Her medical record showed she already had physical therapy as well as psychological treatment from Dr. TB (a local clinical psychologist), prior to her being referred to PPSA to see me. All these were documented in her medical records. However, her records prior to 2011 were not allowed to be shown at trial, because it happened prior to the indictment period (2011 to 2015). Even her medical records were suppressed by the Court, insisted by the prosecutors. Where is the “latitude” after all when even her pertinent medical records were not allowed to be shown to the jury? Therefore, the notion of “a fair trial” is nothing but an illusion.

 

So, if my failure to refer KL to psychiatrist or physical therapy “absolutely” made my practice fall into OUCPP, i.e., I “absolutely” became a· street comer drug pusher, then how can we make sense with respect to Mr. Bodnar’s statement: “You could be absolutely wrong, you could have messed up completely…and maybe you have malpractice there. But you certainly don’t have a crime.” That tells us the so called latitude is nothing more than a kind of red herring used by the prosecutor to mislead the jury.

 

Indeed, it is carefully planned by the prosecutors to bombard the jury with countless statements containing OUCPPs, such as those from the above. The infusion of OUCPPs was clearly intended to inundate the minds of the jurors to the point that OUCPP became an inseparable part of the trial. For example, OUCPP was mentioned by Ms. Griffin and Dr. Greenberg SEVENTY times during Dr. Greenberg’s direct examination alone (Tr. 1/12/17 p. 576-93).

 

Adolf Hitler made infamous the “Big Lie” propaganda scheme about a century ago in his rise to power, which states: “If you tell a lie big enough and keep repeating it, people will eventually come to believe it” because of the use of a lie so “colossal” that no one would believe that someone “could have the impudence to distort the truth so infamously.” (Wikipedla) What Ms. Griffin and Dr. Greenberg did reminds me of this type of propaganda scheme.

 

The last issue I want to address to you and my fellow colleagues at MPM concerns government witnesses. The government pays physicians without or with only minimal pain management experience to obfuscate and get the jury to convict well trained, veritable pain specialists. This problem is prevalent, pervasive, and progressive.

 

Here, I will briefly touch on the pain management background of physicians at PPSA Both Dr. John Patrick Couch and I had been members of MPM for over a decade, only to be interrupted by the government’s raid of PPSA in May 2015, when we lost our means to pay MPM membership fees beyond 2016. At the time of the raid, Dr. Couch had three active specialty/subspecialty board certifications (adding one more in Addiction Medicine in 2016), and I had eight active specialty/subspecialty board certificates. Both of us were boarded by the American Board of Pain Medicine, which is closely affiliated with MPM. Both Dr. Couch and I had received formal pain management fellowship training under Anesthesiology, after completion of residency training in Anesthesiology and Physical Medicine, respectively. Both of us subsequently were boarded in our primary specialty and the subspecialty of Pain Management. My other board/subspecialty board certifications included interventional pain medicine, addiction medicine, electrodiagnostic medicine, neuromuscular medicine, and one by American Board of Independent Medical Examiners. Besides, I became recognized as a Fellow by the World Institute of Pain (WIP) in 2007 (Cert. No. 362) after passing the certification exams by the WIP. I took active roles in many professional societies and took leadership roles in some. For example, I was President of the Alabama Society of lnterventional Physicians for many years until I was arrested In May 2015. I had served as President of the Alabama Society of Addiction Medicine as well as National Director at Large of the American Society of lnterventional Pain Physicians. Besides, I actively participated in clinical research and have published over 100 papers in peer-reviewed, PubMed-indexed journals.

 

In contrast, the leading medical expert, Dr. David G. Greenberg, had virtually no formal training in pain management. All he ever completed was a one-year internship, devoid of any residency or fellowship training. His resume showed that he has been employed by the Greenberg & Sucher, P.C., since 1994. The official website of the company does not contain anything related to pain management, nor does it use any descriptive words such as “pain management,” “pain patient,” or “pain specialist.” (Tr.1/13/17 p. 792-93) Despite this, his “pain management experience” was blatantly vouched for by Ms. Griffin to be “3540 years” (1/12/17 p. 567).

 

Dr. Greenberg is a bombastic character more so than an expert for witnessing. Throughout his testimony, he made numerous inflammatory, groundless statements-he would say things irrespective of any factual basis. A good example would be his answer to the question asked by Ms. Griffin a few minutes after he took the stand as the government expert witness: “What is an internship?” (Recall that is his only formal medical training beyond medical school) Dr. Greenberg’s answer surprised everyone in court: “An internship is the first time that a newly-minted graduate in the field of medicine will get a chance to autonomously or to basically take care of patients on their own without supervision from an attending physician” (Id. p.558). Even a first-year medical student could tell that his definition of “internship” is wrong and inexcusable as an internship is a training program of fresh medical graduates entering a training program specifically under the supervision of attending physicians.

 

Early during the trial, Dr. Greenberg admitted twice that he had never done residency training (Id. p. 563-64). Yet, a day later, he became oblivious, claiming he did some interventional procedures during his “residency” when he was cross examined by the defense attorney Mr. Gordon Armstrong: [Q: Now you mentioned earlier that you have experience with interventional procedures in the past; correct? A: Yes, I did during residency. Q: During residency…we’re talking about 40 years ago is when you did that? A: Right (Tr. 1/13/17 p. 903)]. Nevertheless, he unequivocally admitted that he had received $320,000 from the U.S. government (DOJ or DEA) as expert witness/consultation in 17 criminal cases, with $250,000 made over the previous five years (Id. p. 801-02).

 

Dr. Greenberg’s credibility problem was further exposed when he downplayed the time when he abused and diverted fentanyl when he was in medical training; and he deliberately withheld this pertinent Information in 2012 at the state court of Arizona (Id. p. 847-50) Moreover, he also admitted that he was dishonest even during the current trial, evident in the following exchange between him and the defense attorney Mr. Sharman:

 

Q And when Ms. Griffin was asking you about fentanyl and your addiction problem and your seeking help, you didn’t volunteer any of the facts that we have just discussed in the last few minutes, did you?

A I did not.

Q Even though you were testifying under oath, you did not do that, did you? A I did not (Id. p. 858).

 

However, the true colors of Dr. Greenberg became fully exposed only following his testimony after he flew back to Arizona. The defense team found out the following (though the jury was never made aware):

 

The prosecutors filed a motion under seal over the weekend (Dr. Greenberg’s testimony finished Friday afternoon, 1/13/2017) pertaining to the “neurological condition” of Dr. Greenberg. (Tr. 1/17/17 p. 963) Obviously, the prosecutors were not happy with the performance of their bombastic speaker during his testimony.

 

The prosecutors were trying to disqualify Dr. Greenberg and his testimony-citing “ineffective mental capacity” because Dr. Greenberg told the prosecutors that “he is unreliable and the facts are unreliable” due to diagnosed “early onset dementia.” (Id. p. 964-65)

 

Dr. Greenberg offered to refund the money charged the government for his testimony and the government accepted the refund. (Id.) Mr. Bodnar told Judge Granade and the defense attorneys how disturbed he was by Dr. Greenberg’s lack of integrity:

 

“I think most prominently the fact that he talked throughout the week about flying possibly straight to Albuquerque to testify in that case in New Mexico supposedly today. And when I called today to say out there–let them know what happened on Friday, they told me: Our case has been postponed. He knows that. We told him that a couple weeks ago. He doesn’t have testimony-and that was very disturbing to me.” (Id.) Judge Granade, upon learning all of this, concluded: “I don’t think there is any question that he was competent to testify. I think the whole thing is a credibility issue…(ld.).

 

Despite all of the above, instead of telling the jury the truth and throwing away Dr. Greenberg’s testimony, the prosecutors continued to mislead the jury all the way to the end of the trial. At this time, we can see that Mr. Bodnar no longer found Dr. Greenberg’s dishonesty “disturbing” as he previously had admitted. In his closing argument, this is how Mr. Bodnar phrased it:

 

“Now, at times did Dr. Greenberg get confused about small matters? Yes. He was on the stand for two days, two full days, answering questions for the United States, meticulously going through those files and then being grilled on the small details from the files by defense counsel. Of course, he had some mistakes and he forgot some things. That does not mean that his opinions are not valid. Not only that, his opinions were hardly refuted” (Tr. 2/16/17 p. 6024).

 

As we have just seen, per Mr. Bodnar, dishonesty can be downplayed to “small matters.” So, nothing really could be disturbing to him after all. His statement tells us that as long as Mr. Bodnar could reach his ends, he really didn’t care about his means-thus Mr. Bodnar has indeed become a Machiavellian.

 

The second government medical expert, Dr. Rahul Vohra, certainly received more training than Dr. Greenberg. Dr. Vohra did complete a residency program in Physical Medicine and Rehabilitation, although he had never completed a pain management fellowship. Despite obtaining a subspecialty board certificate in pain management, he worked largely as a physical medicine doctor. The website of his place of employment, NewSouth Neurospine, Flowood, MS, lists Dr. Vohra as one of the three physical medicine doctors, whereas two other physicians, Dr. Jeff Summers and Dr. Jeff Laseter are listed as pain specialists. In my trial, Dr. Vohra rendered his opinion as a pain and addiction specialist, yet he had never published a single paper in any peer-reviewed, PubMed-indexed journals in pain management, addiction medicine, or pharmacology.

 

An interesting observation noted during the trial is that three government witnesses gave quite different answers when it came to explain how potent fentanyl is in comparison to morphi1ne:

 

The DEA agent Ms. Susannah Herkert told the jury: “This is Fentanyl…is considered to be 50 to 100 times as potent as morphine” (Tr. 1/6/17 p. 115-16).

 

Dr. Tricia Aultman told the jury: “It is, because fentanyl is more than twice as strong as morphine” (Tr. 2/6/17 p. 4303).

 

Dr. Rahul Vohra told the jury: “It is something that’s several hundred times more powerful than morphine” (Tr. 1/23/17 p. 2200).

 

Obviously, there is no way that all of them are correct. Ironically, believe it or not, only agent Herkert, who never had any training in medicine or pharmacology, provided the correct answer to this very basic question. This observation gives a rough idea what type of “pain management specialists” these government experts really are.

 

Although Dr. Tricia Aultman did complete her residency training, it was in Internal Medicine. She is a full-time hospitalist working for Memorial Hospital in Gulfport, MS. The fact that the government allowed her to testify in a federal court as “pain specialist” does not mean her opinion is valid as that of a pain specialist. The government cannot make her an actual pain specialist overnight by paying her to provide the specific type of testimony the prosecution needs. It is glaringly clear that Dr. Aultman lacks basic knowledge in pain management. For example, when she was asked by the prosecutor Mr. Bodnar: “Can you explain to the jury what is a Spurling test?” Her response was: “I’m going to be honest. I’m not exactly sure” (Tr. 2/6/17 p. 4291). When she was asked by Mr. Bodnar. ”What’s Gralise?” Her answer was: “I believe it’s also a fentanyl” (Id. p. 4292-93). Well, Dr. Aultman was not even close in her guessing game. Gralise is sustained-release gabapentin, an anti-convulsant, used for managing neuropathic pain; and it is not an opioid.

 

Pain physicians who practice opioid analgesia are familiar with the term “Pseudoaddiction” which simply means seemingly drug seeking behavior of patients due to poorly controlled pain. But when this question was asked by the defense attorney Mr. Jack Sharman, Dr. Aultman equivocated as follows:

 

Q You’re familiar with the term of “pseudoaddiction,” are not not?

 

A I’m not entirely sure what you mean by pseudoaddiction.

Q Have you ever hear that term?

A I am not sure I have (Tr. 2/6/17 p. 4367)

 

Dr. Aultman made over $300K working for the U.S. government as its medical expert witness in helping the government to prosecute other physicians. During my trial, when she was cross examined by defense attorney Mr. Gordon Armstrong in relation to her financial gain by giving such testimony, the prosecutor quickly raised an objection which was instantly sustained:

 

Q Isn’t it true that between the year of 2000 and 2014 you had signed government contracts totaling more than $325K?

Mr. Bodnar: Your Honor, we object to the relevance of any contracts unrelated to what she’s paid for her work in this case. The Court: Sustained (2/6/17 p. 4406).

 

Ostensibly, neither Mr. Bodnar nor Judge Granade wanted the jury to hear about the details about her receiving large sums of money from the government for her testifying against other physicians. Nevertheless, this issue is not only relevant but critical, because it all goes toward her credibility. It is clear that she has an incentive to misrepresent in order to support the government’s allegations. When she is hired to testify for the government, she has to deliver what the government wants to hear. To this end, Dr. Aultman seems to have well met the government’s expectations, and she pays special attention to her DEA achievement/record. For example, she has a designated section of “DEA Experience” in her resume (prior to my trial), which displays:

 

2004 Expert Witness Testimony given in Federal Court. Richard Mazur convicted.

 

2008-2010 Expert Witness Testimony given in Federal Court. Dr. True pied guilty. Pharmacist Nick Tran convicted.

 

 

I expect her current resume reads the same except that she may have added the following: 2017 Expert Witness Testimony given in Federal Court. Dr. Xiulu Ruan convicted.

2017 Expert Witness Testimony given in Federal Court. Dr. J. Patrick Couch convicted.

 

Have Dr. Couch and I become new “trophies” for her resume? Prior to my trial, I glanced through her resume provided by the government. The only thing conspicuous was her “DEA Experience.” There was not a single publication, nor was there any academic expertise or clinical research related to the field of medicine.

 

Clearly, with such mentality, anything Dr. Aultman said in court should be questioned, because she has financial motivation to distort facts and misrepresent truths, as she is to win her own “case” so that she could boost her conviction rate and get paid.

 

Tragically, the specialty or subspecialty of pain medicine is losing respect and due recognition as a medical subspecialty. This is aggravated by physicians without specialty training being allowed to testify against those who do. This problem is not limited to pain medicine alone; rather, the reputation and authority of all other medical specialties or subspecialtles are equally threatened so long as such absurdity Is allowed to go unchallenged. The art and science of medicine is being destroyed by the government and individuals like Drs. Greenberg and Aultman. The careers and lives of many innocent physicians have been ruined, and many more are at risk.

 

Recently, I sent a letter to the the President of the AMA, Dr. McAneny, relating to the escalating problem of the scapegoating of physicians in the U.S. I have taken the liberty of including that letter with this one, as I believe these issues–the scapegoating of physicians by the government and the paying of nonqualified physicians as “specialty/subspecialty experts”–are closely related. I further believe a concerted effort from the entire medical community is needed to effectively put a halt to these malevolent witch hunts of physicians in this country.

 

Thank you very much for your time and attention.

 

 

Sincerely,

 

Xiulu Ruan. MD