http://www.philly.com/mld/philly/news/10966179.htm?1c

For pain doctor, a pointed dispute

N.J. may take Anna D. Lee's license, but patients defend her method
for relief.

By Virginia A. Smith

Inquirer Staff Writer


Nothing worked for Don Underwood - not surgery or painkillers,
muscle relaxants or physical therapy, steroid injections or massage.

Nothing stopped the debilitating back spasms he'd suffered for
almost four decades - until he met Anna D. Lee of Cherry Hill, a
physician who treated him with an automated needle gun invented by
her engineer husband. The needle was inserted into his throbbing
back, causing the muscles to twitch and then relax, a painful
procedure that over time brought sustained relief.

"It hurts," said Underwood, 56, "but it works."

Now, despite the apparent successful treatment of more than 1,400
chronic-pain patients such as Underwood, a radiologist at Hahnemann
University Hospital, Lee may be in danger of losing her license to
practice medicine. The New Jersey State Board of Medical Examiners
has accused her of malpractice, negligence, fraud, experimenting on
her patients with a potentially dangerous device, and other
wrongdoing.

Lee's patients are outraged. Many are victims of auto accidents with
herniated disks and shooting pains and migraines who say they have
endured years of frustration and disability trying treatments that
don't work. Hers is the only one that enabled them to throw away
their painkillers and live a halfway normal life, they say.

So which is she - visionary or quack?

The legal answer may come in June, when Lee's case is set to be
heard by New Jersey Administrative Law Judge Solomon A. Metzger.
Meanwhile, Lee said she has spent more than $200,000 in lawyers'
fees, her Cherry Hill Pain and Rehab Institute has been closed for
more than a year, and settlement talks are stalled.

"I cannot settle," she said. "I did not do these things."

The treatment

Lee, 54, is a native of South Korea who came to this country at age
23, received her medical degree from Hahnemann University School of
Medicine in 1989, and completed postgraduate training at Hahnemann
and the Hospital of the University of Pennsylvania. Board-certified
in physical medicine and rehabilitation, she opened her pain center
in 1996.

She describes her "intramuscular stimulation treatment" as a
variation of an acupuncture-like method developed in 1973 by pain
specialist C. Chan Gunn of the University of Washington in Seattle.
She said she also incorporates work on the twitch response done by
Chang-Zern Hong of the University of California, Irvine, and needle
techniques learned during a fellowship with Penn pain specialist
Jennifer Chu.

But Lee, whose so-called dry needling device was patented by the
U.S. Food and Drug Administration in 1998, says her technique
differs significantly from acupuncture, to which it is often
compared.

She inserts a Teflon-coated, flexible needle into muscle "trigger
points," where nerve fibers meet muscle fibers, not traditional
acupuncture meridians or channels. And the needle is neither twirled
nor twisted, as acupuncture needles can be.

Instead, it is plunged in and out of the damaged muscle until the
twitching stops. Lee then moves on to the next trigger point, a
process she said treats the irritated nerve roots and shortened
muscle fibers that cause pain - and ultimately breaks the pain cycle.

Lee administers morphine or Valium to her patients to help with the
pain of the needle treatments, which cost $200 to $400 and can last
more than 60 minutes. Patients get massage before the needling and
hot packs and water-bed rest afterward.

As healing sets in over time, she said, treatments taper off.
Patients talk of needing occasional "tune-ups" after they are
feeling better.

"It's like an iceberg in the ocean," said Lee, who has undergone the
treatment herself. "If the iceberg shows above the water, I can get
it to disappear so you are asymptomatic. But don't think you are
cured."

Battle with insurers

Lee's case has attracted the attention of a handful of national
consumer advocates, health-care activists and others, who believe
that bottom-line auto insurance companies are behind New Jersey's
efforts to shut her down. They believe that she is being punished
for using an innovative treatment - and for battling the insurance
companies in arbitrations and courtrooms when they refused to
reimburse for it.

"It boils down to this," said Andrew Schlafly, general counsel for
the Association of American Physicians and Surgeons, which supports
Lee. "The insurance companies look at their books each quarter and
say, 'How can we save dollars here?' Then they knock down things
that are innovative."

He accused them of "trying to get the medical board to do their
dirty work and get rid of the doctor. Legally, that allows them to
escape all their bills."

In November, Allstate New Jersey and several other insurance
companies sued Lee, 10 of her former nurses, and the office
receptionist in State Superior Court in Burlington County, alleging
fraud involving the same issues raised earlier by the New Jersey
medical board. The case was dismissed last month; Allstate may
appeal.

Allstate lawyer Douglas M. Alba declined comment. But company
spokesman James Griffin said that from an insurance perspective, the
Lee matter is "very simple."

"It's fraud," he said.

Griffin said she had submitted bills to Allstate totaling about $2.2
million since her clinic opened in 1996, of which about $1.2 million
was for services never rendered. He called Lee "an example,
unfortunately, of the unscrupulous people in the medical community
who prey upon the public and insurance companies."

Thirty former patients and nurses have told the company that Lee has
committed fraud, Griffin said. He confirmed that Allstate had
reported her to the New Jersey Office of Insurance Fraud in 2003.

Deputy Attorney General Joan D. Gelber, who is handling the state's
case, declined to comment. Paul R. Kenny, who oversees prosecutions
for New Jersey's 42 professional and occupational boards, said in an
interview that it was not unusual for doctors accused of fraud and
malpractice to blame insurance companies for their troubles.

Innovation is not the issue in Lee's case, he said.

"Members of the medical board are not horse-and-buggy people. There
is room for new technologies," Kenny said, adding that "we do
contend - and believe we can prove - that there is great potential
for harm to patients here."

Expert witnesses for the Attorney General's Office describe Lee's
technique as "a Dr. Mengele treatment" that is "unsubstantiated in
the medical literature" and poses a "significant risk" to patients.
The state cites "inadequate examinations, misinterpreted studies and
unsupported diagnoses."

Lee's defenders call her a compassionate champion and a pioneer in
pain management. Tough pain cases are frequently treated with
a "trigger point" technique, whether injections, dry needling (Lee's
method) or both, which do work, her experts say, while conceding
that most doctors may not understand these methods.

As each month passes, Lee's patients worry that she may never reopen
her office, although a 2003 New Jersey Law Journal survey found that
the state medical board rarely revokes doctors' licenses even when
they kill patients.

Revocation is but one option in the Lee case, Kenny said; others
include license suspension or public reprimand. "I don't necessarily
think... this is a revocation case," he said.

But Lee is fighting as if it is. She denies all the state's charges -
the work was proper and necessary, she said - and vows to fight to
her last penny.

"It is almost a curse that I know this treatment," she said.

Not for Underwood, president of Pain Patients United, Lee's patient
support group, who is having back spasms again. As a doctor, he also
misses her. "She was taking our difficult-to-treat patients, the
ones everyone has tried in vain to help," he said.

Pain is very subjective and people experience it in a bewildering
array of ways, according to Seattle pain researcher Dennis C. Turk,
president of the American Pain Society.

"There is no pain thermometer," he said, "so the only way we know
how much and the nature of the pain that someone has is by what they
tell us or show us by their behavior."

Given estimates that as many as half of all U.S. adults suffer some
form of chronic pain, and that traditional therapies often don't
work, it's no surprise that these patients are desperate - or that
the pain management field is fertile for both innovators and quacks,
he said.

Underwood, like Lee's other patients, was as desperate as they come.

Starting at age 19, he stressed his back working in construction and
on the railroad, playing ice hockey and chopping wood. Toss in a
fall, the strains of a busy medical career and middle age, and by
the time he landed in Lee's office five years ago, he was in agony.

For him, Lee was a godsend. "I think I am one of the most
successfully treated people she had," Underwood said.