Washington patients scramble for care after Seattle Pain Centers close

The calls are coming, angry and anxious, from pain patients across Washington worried they can’t find care.

Three weeks after state officials suspended the medical license of Dr. Frank Li, medical director of Seattle Pain Centers, citing allegations of billing fraud and possibly contributing to patient deaths, other providers say they’ve been swamped with a new – and desperate – demand.

“We’ve had hundreds of patients who have been referred to us already,” said Dr. David Tauben, chief of pain medicine at the University of Washington.

It’s the same story at Seattle’s Swedish Medical Center, where Dr. Steven Stanos is the medical director for Pain Services. At the Washington Center for Pain Management, which has clinics in the Puget Sound area and in Oregon, staff have been fielding at least 200 calls a day.

“We’re absorbing quite a few of them,” said Jae Lee, chief executive of the operation.

But finding enough places to accept more than 8,000 Seattle Pain Centers patients prescribed opiates this year – and an estimated 25,000 who have received care overall – is a challenge.

“It puts us in a precarious situation when you have a huge prescriber of patients and they suddenly close up,” Stanos said. “A lot of these patients were very high-risk to start with.”

Li has not been charged with a crime. He has requested a hearing regarding the charges brought by the Washington state Medical Commission, but no date has been set. Julie Graham, a spokeswoman for the state Department of Health, said the hearing is likely to be held in the fall.

Particularly vulnerable are an estimated 400 patients who receive pain medications through implanted pumps. If they run out of drugs, they could suffer severe withdrawal or die, doctors said.

Seattle Pain Centers previously operated eight clinics across Washington, including one in the Spokane area. As of this month, only one, in Renton, is seeing patients, state officials said.

Other providers of pain care were taken by surprise when the Medical Commission suspended Li’s license July 14 and took action against more than 40 other providers who worked for his clinics since 2013. The state Health Care Authority, which oversees Medicaid, also revoked his ability to bill for services.

“We weren’t warned this was going to happen,” Stanos said. “Looking back, that would have been helpful. We could have done a better job to plan.”

It’s especially difficult now, in the middle of summer, when vacations mean staffing levels are lower and trauma incidents – boating and car accidents, among others – are high.

“I can’t think of a worse time than Seattle in August,” Tauben said, adding later: “We are indicating that we are not staffed for this . We are beyond our resource capacity to take this on.”

‘Kicked to the curb’

State records showed problems with Li’s practice dating to 2013. But health department officials say they acted quickly to coordinate efforts to offset the impact of the clinic closures.

“We are working with HCA to identify resources, gaps and potential short- and longer-term solutions for patients and health-care providers,” said Graham, of the health department.

More than 60 providers across Washington called in last week for a telephone conference organized by the health department. The session was closed to reporters.

“We reviewed the whole problem,” Stanos said. “We all had the goal of not keeping people out in the cold.”

That’s hopeful news for people like Joseph Tade, 54, of Olympia. He was hurt at age 20 in an industrial accident – a transmission fell out of a machine and he caught it, he said. It left him with degenerative disc disease and chronic back pain.

Tade has been a patient of Seattle Pain Centers for four years and found out July 27 his clinic was closed.

“I’ve never been kicked to the curb without a referral,” said Tade, explaining he takes opiates and other drugs to function. “I’ve got enough for two months to get by. I can’t be off of medication. I’m one of the people who actually need it.”

State health officials have set up a patient hotline and urged those who are without care to reach out to the primary-care providers who originally referred them to Li’s centers.

But other primary-care doctors may be reluctant to take on chronic-pain patients who are covered by strict state pain-management rules that took effect in 2012. It’s especially difficult to tackle patients who may be on high doses of painkillers, Tauben said.

“Many of them have not been trained and many of them have been terrified that they don’t know how to manage patients above the guidelines,” he said.

New guidelines from the Centers for Disease Control and Prevention say that doctors should avoid doses higher than 90 milligrams of morphine-equivalent drugs per day – or have a strong justification for their use. State rules require an expert consultation at doses of 120 milligrams of morphine equivalent or higher.

Complicating matters, many doctors don’t like to accept Medicaid patients because reimbursement for care is low.

“You can’t get a doctor. It’s real hard to get a doctor,” said Pam Rockwood, 67, of Woodinville, Washington, who said she was treated at Seattle Pain Centers after her back was injured in three car accidents between 2003 and 2006.

“I’m not a drug addict. I’m responsible with my medications,” she said. “You could have seizures. You could die.”

Helping doctors

In a letter last week to primary-care providers across the state, health officials again urged them to step up to help Seattle Pain Centers patients.

“Health practitioners who treat displaced patients should not fear disciplinary action from the state’s Medical Commission for ordering, prescribing, dispensing or administering controlled substances, including opioids, for legitimate medical purposes and in the course of professional practice,” said the letter.

It was signed by Dr. Kathy Lofy, state health officer; Dr. Dan Lesser, chief medical officer for HCA; and Melanie de Leon, executive director of the Medical Quality Assurance Commission.

Efforts are underway to increase help for primary-care doctors, including an expansion of UW’s TelePain service, which offers weekly consultations for community and veterans providers.

The situation is challenging, but health care providers across the region and the state are working together, Tauben said. Pain patients shouldn’t panic.

“It’s not just platitudes,” he said. “There are things happening and the system is doing its best to respond. The last thing to do is view this as the sky is falling, because it’s not.”