Book Review: “Bad Medicine: Catching New York’s Deadliest Pill Pusher,” by Charlotte Bismuth

The author wrote about her investigation and prosecution of Dr. Stan Li, a pain management physician who was ultimately convicted of two counts of manslaughter in the second degree and related offenses.

The author was an Assistant District Attorney with the Special Narcotics Unit when she started this case. She worked for four years accumulating data to show a jury that this doctor was motivated by greed and not by concern for his patients. She proved he prescribed dangerously high doses of opioids, many times along with prescriptions for sedatives, causing harm to patients.

He was convicted and then sentenced to ten years in prison. He was incarcerated in but died in early 2020 at age 68 from COVID which he contracted while in prison.

It is a story that needed telling. It’s not an unusual story at this point, with many similar books about pill-pushing doctors, but this one was written by the prosecuting attorney, giving more insight into how the government viewed their case and how they presented their case in court.

I have mixed feelings about this book.

I didn’t care for the way the author told her story.

For some reason, starting ten or so years ago, it became cool and hip to tell a story out of order. Telling the beginning first, then the middle, then the end suddenly became old-fashioned in the publishing industry. This book told the story upside down and sideways, and this annoys me mightily. The author went from “Day 1023 before the trial,” to “Day 45 after the trial,” and it’s confusing.

I’d advise the author to ignore what the hipster publicists think is cool and just tell the damn story.

Also, the author included details of her personal problems scattered among the disjointed narrative of the trial. I didn’t care for that, feeling that if she wants to include those kinds of things, call it a memoir instead of a narrative nonfiction. I wanted to read about the prosecutor’s thoughts and feelings about the physician and the case, not about the prosecutor’s Botox decisions. However, some people do like such details in a book, so I might hold a minority opinion.

I also felt a little sorry for Dr. Li. He came of age when the so-called “experts,” bought and paid for by pharmaceutical companies, told doctors there was little risk of causing addiction in patients with pain. He must have bought into that farce whole-heartedly, though his later actions suggested he did realize he was running little more than a pill mill. What those paid experts said back in the early 2000’s always did appear to fly in the face of common sense, but they were well-funded by the pharmaceutical companies. And none of those experts went to jail.

I didn’t expect the author to say much about treatment, since that wasn’t the theme of the book (but neither was Botox and we got to read about that). At any rate, there was perhaps one mention of medications to treat opioid use disorder.

The inner thoughts of this prosecutor were well-expressed. She appeared relatively naïve about physicians and their prescribing practices, and it seemed to take her some time to understand the difference between a good pain management practice and a pill mill. I could have saved her time: it’s all about the amount of time the physician spends with the patient.

A pill mill doctor will spend only a few minutes with each patient because he’s seeing fifty to a hundred patients per day. Pain management providers see patients for ten to twenty minutes at a minimum, seeing around twenty to thirty patients per day.

I was dismayed at the slow pace of work of this prosecutor. The dangerous doctor came onto the ADA’s radar about three years after he started his practice. It took her four years to investigate, meaning he did most of his work while the prosecutor trudged along getting evidence.

I know real life doesn’t move as fast as on “Law and Order.” But taking four years to investigate a doctor she thought was so dangerous? Seems like she would speed her investigation to keep patient harm to a minimum.

But it’s a good book, other than the annoyance of being disjointed.

7 responses to this post.

  1. Posted by Charles Erickson on July 15, 2022 at 9:12 pm

    Yeah, that out-of-order stuff annoys me mightily also. And four years does seem like a long time. But I am not a legal professional so I don’t know the standards that they have to meet. It always seems to take a long time to build up a case. I think it might be because the DA won’t prosecute unless they have a slam-dunk. Or close to it.

    Reply

  2. Posted by Sparky on July 18, 2022 at 4:57 am

    The idiot cops,dea,legislators,and medical boards should have left this and countless other drs alone and we would not have the heroine,fentanyl drug overdose deaths we have today,I guarantee you that dr nor any other so called pill mill dr ever wrote a prescription telling patients to take 10-20 pills per day,it didn’t happen,it’s the patients fault for not following the drs prescribing orders and the patient is the one who sells their medications,no dr prescribed cooking pills down in a spoon and shooting it up your arm,these drs got a bad rap and raw end of the deal,things were much better like that than they are now I promise you this

    Reply

    • Posted by Christy Lynn on July 24, 2022 at 3:30 am

      My comment to “Sparky”: I would wager that you have not had a close family or friend develop an addiction and/or dependance on a opioids,
      As a nurse practitioner in recovery, and who has met many people in recovery, I promise you that the majority of those who people didn’t plan to become addicted. Also, sure, a prescribing provider most likely will not instruct a patient to “take 10-20 pills a day” –it doesn’t mean they are excused from a professional liability and a code of ethics. Most people who develop an addiction to pain medication will eventually show a few or even numerous “red flags” that will clue in the medical provider that their patient is slipping down a dangerous path. As Dr Burson explained perfectly — a pill mill provider spends less than 1 minute with a patient, often exchanging the prescription for a large cash fee for the “visit”. They are no better than a street dealer.

      That being said…I have mixed feelings on criminal prosecution of prescribing providers, many who simply made poor choices, fell into working with the wrong partners in practice. I think there is fair argument against law enforcement using the Control Substance Act to prosecute providers. However, Police officers and others in authority absolutely should hold those “Pill Mill” prescribing providers accountable, as they are the equivalent to a street level drug dealer who sells cocaine, heroin, etc. I believe the anger you note towards “idiot cops, medical boards” or “junkies” is misplaced. It comes across that you see yourself on a higher moral ground because you don’t believe yourself to be an addict. Those in active addiction who “shoot up fentanyl” or “take 20 pills a day more than prescribed” — I would argue you are as addicted to your beloved pain regimen, even if you “take your meds like my doctor tells me to”. I have a strong suspicion that you likely have more in common with those in active addiction than you believe. All of that to say, please try to be less critical and judge less. Most people in active addiction and recovery are good people, and never planned to be where they are. Trust that I speak from experience. I am a nurse practitioner who is now five years in recovery, I became addicted to Percocet as a result of a work related injury.

      Thank you Dr Burson for the review on this book. I will definitely put it on my list to pick up! I recommend your blog to colleagues and those in my recovery peer group.

      Reply

  3. Posted by Sparky on July 18, 2022 at 5:01 am

    Also now when a person truly does have pain that should require an opioid prescription no dr will even think about it,they say oh you can take Tylenol with a bone sticking out of your arm,these idiots ruined it for everybody,and idiots I mean cops,dea,legislators and medical boards

    Reply

    • Posted by Charles Erickson on July 18, 2022 at 12:05 pm

      It’s as though they go from one extreme to another. People do have a legitimate need for opioid scripts, and they don’t need the additional pain of some fool pharmacy tech treating them like criminals.

      Reply

  4. I have a tendency to write in the manner. I tend to jump around. Of course I’m not detailing an investigation and trial. That might confuse the hell out of most folks! I agree with you four years is absurd if you honestly suspected patients were becoming addicted at an alarming rate! Wouldn’t it be in the best interest of the actual PEOPLE to not drag feet?? I had decided to go ahead and write about a highly unusual doctor’s visit I had a few years ago. Hopefully you’ll receive an opportunity to read it. It’s awfully strange, interesting and funny. Plus it shows folks what it took for a former methadone maintenance patient to recieve adequate care.
    I’ll add that it’s gotta be the strangest doctor appointment in the history of the universe! Stay tuned. Thank you

    Reply

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