New Hampshire Physician Devoured by Weasels by Pat Conrad MD

When you went to medical school, did you look forward to joining a great shambling mass of collective thought that would turn out progressively homogenized, increasingly scrutinized, always more restricted actions?  Me neither.  But that’s what we’ve got now, and the medical profession has become The Blob with no Steve McQueen and no freezer big enough to hold it.

Say you’ve been practicing medicine for oh, I don’t know, 57 years.  Your patients love you (with multiple affidavits to prove it), your community needs you, and there are no complaints of negligence, malfeasance, fraud, or incompetence.  Sure, you’re in your mid-eighties, but you can still do your job well, which is fine so long as you do things just the same as everyone else.

But if you are Anna Konopka, MD, and you don’t like to use computers, then you are a danger to the community and need to be stopped by a beneficent state before you can non-conform again.  The New Hampshire Board of Medicine has pressured Dr. Konopka to surrender her license because she has not been participating in the state’s Prescription Drug Monitoring Program, because she chooses not to use a computer.

(A brief aside:  roll your eyes and call me a nut, but I’ve long been against the general notion that state medical boards should control licensure and the delivery of care.  Any good that they do can be accomplished by initial board certification and informed consumers.  I know that will never happen in a dumbed-down, fearful society, but this case makes my point)

“Last year, state medical officials enacted regulations that require physicians who prescribe opiates and other addictive medicine to register with the PDMP and check online to make sure patients are not receiving opioids or other addictive drugs from other doctors.”

Konopka “insists that her patients abide by pain contracts as required by regulations. And Konopka said she eventually finds out about abuse, either through pharmacists, other physicians or patients themselves.”  Oh sure, the state laws allow delegating PDMP data reporting to staff, but the physician is still left kowtowing to the almighty damn state.

But certainly Konopka’s colleagues in such a small state are there for her, right?  New Hampshire Medical Society executive vice president James Potter:  ” “Unfortunately, we tried to warn people, they (the Board of Medicine) will try to pick somebody out and make an example of them.”  At first, the Society voiced concerns over the PDMP requirements and laws, “but the organization now helps its physician members to comply with the regulations.”  Apparently, the AAFP and ABMS were busy, or they would’ve jumped on that “assistance” opportunity.

I haven’t been to a medical society meeting since I was in medical school. They are obviously worse than a waste of time, a rubber chicken meeting where attendees get to delude themselves and each other into thinking they are important.  They’re not.  Potter “stressed that the Medical Society will work with members, especially small practitioners, to meet the requirements. He does not fault the Board of Medicine for its actions against Konopka.  ‘That’s their job. Their job is to protect the safety of patients.’”

So they are toothless at best, sniveling collaborators at worst.  Meanwhile, a beloved community physician who they should have been defending surrendered her license to preempt the Board suspending it.  She is not presently allowed to see patients and has submitted an appropriately handwritten appeal.  Konopka has tried five different times to plead her case to establishment GOP Gov. Sununu; the weasel’s spokesman said: “This is a matter between Dr. Konopka and the New Hampshire Board of Medicine.”

Oh yeah, I left out a fairly pertinent point:  Konopka is not being accused of mis- or over-prescribing controlled substances.  Her only crime, the one that makes her such a danger to patients and to New Hampshire, is that she won’t use a computer to practice.  No, Dr. Konopka is proud to reduce pain medication use in some but mindful not to eliminate it in others, as is clinically warranted.  She says of the compassionate state:  “They practice medicine, and I practice medical art. They manage the patient, and I treat the patient.”

I am without qualification a supporter of Direct Primary Care, but the more it grows, the more government will use levers like mandatory PDMP participation to lever its way into the office and consume it.  I’m sorry for Dr. Konopka, but her day is prematurely, tragically past, and I am not optimistic for the rest of us.


Click here to get your free weekly newsletter. No Spam. Your email address is never shared. Promise.)

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  14 comments for “New Hampshire Physician Devoured by Weasels by Pat Conrad MD

  1. chris
    November 7, 2017 at 6:52 pm

    Ok people. Before holding this physician up as a paragon of our profession you might want to investigate a little. With a computer its fairly easy.

    She didn’t lose her license for not checking the state PDMP. She was disciplined by the state board in April of this year because she prescribed theophylline and digoxin to young child (less than 7 years old) with a respiratory illness, also advising aspirin for fever in the same patient (everyone together now: “INSANE”). I suspect the further board action is due to other stuff like that that was revealed in the investigation that came from that incident. Because she voluntarily surrendered her license, the reason for that action is sealed. You can see the consent decree on the NH medical board website.

  2. Chris
    November 7, 2017 at 6:03 pm

    Until her death from cancer, we had an elderly physician in our area who was obviously easily manipulated by drug seekers. I frequently saw her name in PDMP reports on drug seekers who would test the waters in my office. Most of these report had evidence that her patients were violating any possible treatment agreement that could have had with them.

  3. Chris
    November 7, 2017 at 5:55 pm

    I am all for people refusing to go along with advances in technology of they feel that the technology doesn’t advance your vocation. On the other hand it seems a little ridiculous that her best option is to surrender her license. She could agree not to prescribe controlled substances. Or she could do what I do. My staff runs a PDMP report on every patient who I prescribe controlled meds to prior to their visit. Voila…I’m in compliance.

  4. Kurt
    November 1, 2017 at 6:27 pm

    It’s too bad and a shame. I hope she has something to do with her enforced retirement
    and enjoys it. I know a lot of FP’s retiring as fast as they financially can and are going to
    spend their time doing something enjoyable and not missing the practice of
    molly-coddling primary care.

  5. Use2bFP
    October 31, 2017 at 1:45 am

    The Dr in question got off lightly , any physician that refuses to comply with their Board is obviously a danger to society and their patient population.
    She should have faced a firing squad of her peers at sunrise after one last hand written chart note . Since however, the majority of those herd animals would not have the intestinal fortitude for such action , she should at least be sentenced to 40 lashes at the mast .
    Surrender her license ? Piffle , that’s hardly a sufficient punishment for such egregious activity.
    In the famous words of Colonel Klink “ Ve must hav order “.

  6. October 28, 2017 at 9:02 am

    Pure unadulterated horseshit.

    Or in other words, a prime example for the disintermediation of the practice of medicine.

    The troika of the insurance cartel, government and regulatory/certification bodies is destroying this once proud and sacred profession.

  7. Randy
    October 28, 2017 at 8:52 am

    I have mixed feelings on this. I agree that a competent caring physician should be allowed to practice, especially if there is no evidence she actually mis-prescribed or over-prescribed.

    I think the reality is though that today if you are going to treat chronic pain with narcotics you have to have the capability to check a PMP. I would add treating adult ADD and probably some other diagnoses to that as well. It’s more than just the board coming down on somebody, it’s good medicine.

    As far as I can tell nobody is forcing her to use EMR’s, MIPS, meaningless abuse, etc. They just want her to follow what has become standard of care.

    • Steve O'
      October 28, 2017 at 11:54 am

      I disagree. I note the statement in the article: Konopka “insists that her patients abide by pain contracts as required by regulations. And Konopka said she eventually finds out about abuse, either through pharmacists, other physicians or patients themselves.” 
      The standard of care should be demonstration of a duly diligent effort to avoid manipulation by the dishonest, criminal patient who seeks to obtain pain medication for the purposes of diversion or abuse. Konopka’s actions, in my opinion, meet that diligent effort. There are fewer than 600 primary care physicians in practice. If one person hired by the board were to review the prescribing of about 5 New Hampshire physicians every day, that’s barely enough work to hire someone for a full-time FTE to do it. It is a matter of the STATE’S interest to police substance diversion and abuse. That’s a legitimate STATE duty. Why couldn’t the Board just check Dr. Konopka’s prescribing once a week to see if she is in compliance with the PMP?
      It’s not enough that they’re going to hang you, they’re making you buy the rope.

      • Randy
        October 28, 2017 at 5:24 pm

        To be clear, I don’t like the way the Board is handling it. They should be able to find some way for Konopka to check a PMP on her patients without a computer.

        But as far as pain agreements go, modern pain agreements specify that you will be checking a PMP periodically. And the thing is, it’s a good idea. Even the rebuttals of the ridiculous CDC narcotic policy I’ve read say that checking a PMP is a good thing. If docs are trying to treat chronic pain without using the PMP they are doing themselves and their patients a disservice.

        Finally, this should be a reminder that state medical boards are not your friend. Their mission is to protect the citizens of their state from bad doctors, and they are zealous in that mission. In this case, instead of finding some way for this doctor to meet guidelines they are threatening her license.

    • Alternate Theory
      November 2, 2017 at 10:15 am

      On the other hand, why aren’t the pharmacies responsible for checking the PMP? If the medications were checked at the point of dispensing it would catch a lot of other problems, such as fraudulent Rxs.

    • chris
      November 7, 2017 at 6:55 pm

      Shes not competent…see my post above. That’s the reason the board took the action they did. I commend them for actually taking decisive action; many state medical boards are wimpy. This women is a menace.

  8. Steve O'
    October 28, 2017 at 8:29 am

    “Psychopathy” is understood philosophically as those who cannot distinguish meat from machine. Both are manipulable objects to the psychopath. The prevalence of psychopathy as formally defined is about 0.25%-1% of the population at large.

    The social health of any society is readily measured by its “immune response” – for the society at large to naturally neutralize and wall off psychopaths. We do this by word of mouth – “Hey, don’t let your sister go out with that guy – he’s an animal!” We do it by building literal walls, those of prisons, for incarcerating those who genuinely need to be out of the society. It is curious that people point out how many Americans per capita are incarcerated. For incarcerated males, Cluster B personality disorders run about 15%-25% of the inmate population. Nobody who questions the number of incarcerated Americans, seems to consider the possibility that there is righteous incarceration of the dangerous, and instead to ask – “Why do we have so many psychopaths in America?”

    If one recognizes that technocracy also endorses psychopathic thought – the equation of meat to machine – then the actions of the New Hampshire Board do not surprise. The PDMP is a thing on a computer – and A. Konopka MD is a thing in New Hampshire. Same thing.

    Quality measures are unnervingly near psychopathy. The idea is that several arbitrary parameters defined by humans – and the regulators see themselves as a human influence over unthinking doctors – improve the operation of the workline. Charlie Chaplin skewered these thoughts a century ago; why have we returned to them?

    Sununu Sr. and Sununu Jr. have both held the job of Governor. Sununu Sr. was considered a fairly strict libertarian conservative, and worked under Ronald Reagan. Yet, when it comes to technocracy, Junior seems to think with assistance of the Borg. (See Star Trek, etc.) I fear he’s part of the Hive Mind.

    Technocracy tries to erase the distinction in common law between things that are malum in se infractions – those actions which are obviously wicked to any reasonable observer; and malum prohibitum, those which are declared impermissible simply because a legislative act for the public order has made them so. Examples of each would be pushing a child into the way of an oncoming train; and running a stop sign if one has clear visibility that there is no traffic within a mile of the intersection.

    Dr. Konopka wrongs the New Hampshire Board under the conclusion that their regulation is malum prohibitum – that it is a general good idea that ought not apply to her. Such opinions can be wrong, of course. But in her case, it is obviously right. The harm to society is nil. But she has resisted the common will. Such objects as Konopka which do so are not within standard requirements and should be crushed and melted.

    Resistance is futile.

    • Chris
      November 7, 2017 at 6:16 pm

      I disagree. If she negligently prescribes narcotics to someone who then goes on to sell their medications then she is little better than a drug dealer and she is causing harm to her community. To retain the privilege of prescribing such medications she must agree to take reasonable precautions to prevent doing just that. If she doesn’t wish to go to the trouble she needs to stop prescribing controlled substances.

      To use you own analogy, she drives through the red stoplights in town, well, because back in the day they didn’t have any stinking stoplights in town, and she’s never gotten in an accident doing this as other people stop their cars when they see her approaching the stoplight.

  9. Sir Lance-a-lot
    October 28, 2017 at 6:48 am

    “On ne saurait pas faire une omelette sans casser des oeufs.” — Robespierre (?) (also Stalin, by way of Walter Duranty)

    “You can’t make an omelette without breaking eggs.”

    The crushing of one doctor (and her patients) is nothing, considering the beautiful medical machine that is being created for all to use in the brave new world.

Comments are closed.