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Department of Health Controversies

In August of 2006, Dr. Alsager’s practice was caught up in a sweep by Washington State Department of Health & Social Services (DSHS) bureaucrats trolling prescription records at pharmacies. They were looking for DSHS (Medicaid) patients who were utilizing high doses of pain medications. Those responsible were part of The Interagency Group – an informal group of Washington State government agency directors (DSHS, Molina Health Care, Labor & Industries, and others) who have been enforcing new “guidelines” that will require patients receiving more than 120 mg of milli-equivalents of morphine per day to be seen by specialty pain clinics in large urban centers.

Dr. Alsager objects to Interagency directors’ access to patients’ private records for this purpose. Patient records are protected by HIPAA rules entrenched in federal legislation state government agents should not be exempted from confidentiality rules to protect patient confidentiality.

Dr. Alsager opposes the concept of dosing “guidelines” set by government agencies. Pain is an individual issue, varies considerably from one patient to the next, and dosing needs to be individualized as well. It is a private matter between each patient and their doctor.

Dr. Alsager’s practice was targeted and his pain management practice was “restricted” by an ex parte order (meaning Dr. Alsager was not invited to attend the hearing). The Department of Health focused on seven patients all of whom have well documented chronic pain conditions and who required daily doses of pain medications exceeding the Interagency Group proposed guidelines. The allegations against Dr. Alsager’s practice were publicized in August 2006 with considerable fanfare generated through press releases disseminated to all news media by the Department of Health. Dr. Alsager had no opportunity to defend himself in the public eye. Department of Health delayed a hearing regarding the restrictions they placed on his practice until May 2008 – almost two years later. The hearing of this issue was held on May 23, 2008. The issues are contained in the attached question and answer testimony presented by Dr. Alsager on each patient covering each allegation. Copies of that evidence presented at hearing are attached – Patient A through Patient G (the names are withheld to protect patient confidentiality at the hearing).

The Department of Health, in Dr. Alsager’s case, focused on one patient who is deceased, claiming that the patient’s death resulted from a prescription of Duragesic and other pain medications that Dr. Alsager had provided to the patient prior to his death. That statement by the Department of Health is false. There is no evidence supporting that allegation. The evidence is (see Patient A):
The deceased patient’s postmortem blood levels contain subtherapeutic doses of drugs prescribed by Dr. Alsager.

Dr. Alsager obtained urine drug levels prior to his prescriptions provided to the patient within hours of the patient’s death. The levels postmortem prove that all pain medications declined between the time the patient picked up the prescriptions and the time the postmortem levels were obtained. This proves without a doubt that the pain medication concentrations in the deceased’s blood were declining, not increasing at the time of the death.

The evidence presented at the hearing proves that Patient A died of a seizure disorder and not from drug overdose. For months prior to the patient’s death, he was under the care of a neurologist, Dr. Song and was experiencing increased, uncontrolled seizures. The evidence is that he died of SUDEP (Sudden Unexplained Death in Epilepsy) - see research paper attached.

The medical examiner’s report is faulty due to “opiophobia” – the assumption that pain medications were responsible for a death only because they were found at the scene. The medical examiner’s report fails to interpret all of the toxicological data and is presented in a manner that leaves itself open to misinterpretation and error. It is noteworthy that the medical examiner’s report was signed off by the medical examiner within 48 hours of Patient A’s death – long before the toxicology samples were even submitted to the lab for analysis. See evidence Patient A.

The State’s only expert witness, Jon Hillyer, a physician of unlike practice and unlike profession to Dr. Alsager, lied and misled investigators not once, but twice when he gave evidence upon which the Department of Health relied for its initial allegations against Dr. Alsager. See specific allegations regarding dosage levels given to patients contained in evidence for Patient A through G. These lies and misleading statements by Dr. Hillyer are also summarized in the attached letter of complaint to the Washington State Medical Quality Assurance Commissioner’s office in a complaint involving unprofessional conduct and perjury (see attached). The true facts, as you will read in the evidence given at hearing, are quite different from those alleged by Dr. Hillyer.


Nevertheless, the Osteopathic Licensing Board members chose to ignore much of Dr. Alsager’s testimony at hearing, including that of his expert witnesses. The final order by the Department of Health, after 91 days of waiting, maintains the current restriction of “no Class 2 or 3 narcotics (these are powerful, long acting opioid medications) to be prescribed”. This final order will be appealed on the grounds that the evidence of fact and conclusions of law were faulty. Other than the opioids, Dr. Alsager’s prescriptions and other treatments he uses are unaffected Meanwhile, the Washington State Department of Health continues its campaign to lockdown many competent pain doctors and their practices through administrative delay tactics, restrictions, and suspensions. In doing so, many legitimate, ordinary citizens suffering in pain in our community continue to do so without the availability of alternate, professionally qualified pain doctors in the area, particularly in rural communities. Pain patients organize and plan action. See website painreliefnetwork.com.

The following is the summary of evidence presented by Dr. Alsager at hearing:

Patient A Patient B Patient C Patient D Patient E Patient F

Patient G



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