In a bid to avert a crisis, medical organizations and government agencies in Buffalo have pulled together a short-term plan to take care of the thousands of pain-management patients abandoned after the indictment of their physician and the closing of his practice.
BlueCross BlueShield played a key role by announcing Friday that it will allow Gosy & Associates in Amherst back into its network on Monday, the day the practice had communicated to patients on its website that it would reopen. The health insurer’s decision followed arrangements to staff the practice on an interim basis with physicians with the appropriate qualifications and credentials to supervise the nurse practitioners and physician assistant who work there.
Dr. Eugene Gosy’s practice was shut down April 27 following his indictment on federal charges of unlawfully distributing narcotics, leaving patients with few, if any, alternatives for care. Gosy & Associates, with about 9,500 active patients, was one of the busiest pain-management practices in New York State.
Efforts to aid the patients came together Friday with more evidence of an epidemic raging out of control.
Public health officials confirmed that the final total for fatal opioid-related overdoses in Erie County more than doubled from 2014 to 2015. A record number 256 deaths related to opioid overdoses occurred in 2015 compared to 127 in 2014 – a 102 percent increase, according to the Erie County Health Department. Officials project another doubling to more than 500 deaths from heroin and prescription opioids this year.
“This is a staggering total, especially when you consider the number of people in our community affected in addition to the deceased individual – family, friends and colleagues,” said Dr. Gale Burstein, county health commissioner.
BlueCross BlueShield announced May 9 that Gosy and his practice had been terminated from the company’s network of participating medical providers after his office was closed without a contingency plan or arrangements for members to continue pain management treatment or access their medical records. Network participation is important because the medical office’s nurse practitioners and physician assistant can’t work without a collaborating or supervising physician.
“There has been a very collaborative process to address the needs of our members in less than ideal circumstances,” said Julie Snyder, spokeswoman for BlueCross BlueShield.
The plan for staffing the practice calls for Dr. Nancy Nielsen, senior associate dean for health policy at the University at Buffalo’s Jacobs School of Medicine and Biomedical Science, to be on the site on Monday. Arrangements have been made to have two physicians from Hospice Buffalo be at the office in the days afterward, although they will not always have to be there to supervise nurse practitioners. They are Dr. Christopher Kerr, chief medical officer of the Center for Hospice & Palliative Care, and Dr. Robert Milch, a co-founder and former medical director.
“It became apparent that in the short term the best thing to do was to bring in doctors to help the people at the practice. These people know the patients. This is where their records are located,” said Nielsen, an internal medicine specialist who helped organize the relief effort.
After Gosy’s office closed, hospital emergency departments prepared for a deluge of patients, many of the them on addictive painkillers that require renewals and ongoing care. Public health officials advised patients to seek care from their primary care physicians, a pain-management specialist or one of the area’s federal qualified health centers.
However, many primary care physicians are reluctant to prescribe narcotic painkillers. To make matters worse, there is a limited number of pain-management specialists in the area, and many of those practices are full.
“We don’t have the capacity in the community for pain-management physicians to take in these patients,” Nielsen said.
She said turning to hospice physicians made sense because they use similar pain medications, although under different circumstances.
BlueCross BlueShield, Hospice Buffalo, the state Health Department, and Erie County Medical Society were among the organizations and agencies that worked through the bureaucratic credentialing process to staff the practice.
Independent Health had removed Gosy as a provider but not his practice. Univera Healthcare had suspended him from its network. Both insurers gave their blessing to the plan to staff the office by the hospice physicians, Nielsen said.
She described the effort as a “bridge” solution, lasting no more than 75 days. It remains unclear what will happen over the long term. Among other scenarios, the practice could continue under different ownership or it could close.
Meanwhile, the Erie County Medical Society in recent days reached out to physicians in the community. In a bulletin, the group said it had received assurance from the state Health Department that doctors who prescribe controlled substances for Gosy’s patients will not fall under increased scrutiny if their usual prescribing pattern shows a sudden change in number, dose or nature of prescriptions written.
The medical society, working with Dr. Paul Updike, a Catholic Medical Partners pain medicine and addictions specialist, also developed guidance to assist primary care physicians to evaluate and manage patients who come in for renewal of pain medications.
With Gosy & Associates back in the Blues network, it’s expected that practice will begin calling patients Saturday to schedule appointments.
“The termination of Dr. Gosy from our network was not the result of any criminal investigation. It was about protecting the safety of our members and quality of care they receive,” Dr. Thomas Schenk, senior vice president and chief medical officer at BlueCross BlueShield, said in a statement.