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Major Pa. Opioids Prescriber Claims Judge Is Not Impartial, Wants New One Appointed

WILLIAMSPORT — The state's top prescriber of opioids in 2015 and 2016 wants a new judge to hear his latest appeal of his conviction and 15-year prison sentence.

Former Dr. Raymond K. Kraynak, 67, Wednesday filed a motion in the U.S. Middle District Court to have Judge Matthew W. Brann replaced claiming he is not impartial.

The Mount Carmel resident also accuses Brann's court reporter Collen V. Wentz of "criminally" redacting and altering part of his testimony from the August 2022 sentencing hearing at which he attempted to withdraw his guilty plea.

He contends based on the length of the hearing nearly 80 pages are missing from the transcript of his testimony on why he is innocent.

Kraynak, who currently is representing himself, says once an attorney is appointed to represent him he plans to file what is known as a 2255 motion to challenge the validity of his conviction.

He would ask the new attorney to seek an evidentiary hearing concerning the alleged missing transcript and if one was granted, he said he would call Brann and Wentz as witnesses.

Kraynak says he discovered the alleged altered transcript in February 2023 after he was transferred to his current location at the federal prison in Danbury, Connecticut.

His son was unable to contact Stephanie L. Cesare, the Carlisle lawyer appointed by Brann in 2002 after he allowed assistant public defenders Thomas Thornton and Gerald A. Lord to withdraw, he said.

With the aid of a prison counselor, Kraynak said he finally made phone contact with the lawyer on March 16, 2023.

When he described what he had found, he claims she was dismissive, stated she was hired only for his appeal and if he wanted to pursue the matter he would have to do it on his own.

Kraynak claims he has made criminal referrals to Attorney General Merrick Garland, FBI Director Christopher Wray, Inspector General Michael Horowitz, U.S. Sen. John Fetterman and House Judiciary Committee chairman Jim Jordan but has not gotten any responses.

He also filed a judicial misconduct complaint with the U.S. Third Circuit Court of Appeals, he said.

His motion seeks to have Brann recuse himself from appointing a new attorney for him and for the Third Circuit Court of Appeals to appoint a judge to oversee his case to avoid any appearance of bias or impropriety.

Kraynak pleaded guilty on Sept. 8, 2021, after the government had rested its case in the third week of the trial.

During the abbreviated trial, jurors were presented evidence the "pill doctor" as he was dubbed prescribed 1,452,767, 1,994,202, 1,880,223 and 1,433,306 oxycodone and hydrocodone pills in 2014 through 2017, respectively.

In February 2022, less than a month before his scheduled sentencing, Kraynak moved to withdraw his plea proclaiming: "I am absolutely innocent," which he maintains today.

He was sentenced that August and has been appealing since contending ineffective counsel caused him to plead guilty to 12 counts of prescribing drugs outside the course of standard medical practice. Those drugs included hydrocodone, oxycodone and fentanyl.

A Third Circuit panel when it denied Kryanak's appeal in October 2023 found he did not demonstrate his innocence and his claim of ineffective counsel was unpersuasive.

The record is clear he repeatedly failed to keep appropriate medical records, examine or diagnose his patients before prescribing opioids and failed to note signs of substance abuse all of which are compelled by the standard of medical practice, its opinion stated.

The U.S. Supreme Court in February declined to hear his appeal.

Kraynak practiced at Keystone Family Medicine Associates in Mount Carmel and Shamokin until his arrest in 2017 when the state Board of Osteopathic Medicine suspended his license.

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When Stopping A Dangerous Prescription Drug Is Dangerous

Source: James Coleman / Unsplash

We all know that opioid pain medications, such as oxycodone and hydrocodone, and anxiety-suppressing benzodiazepines like alprazolam (Xanax) and lorazepam (Ativan), can be addictive. Over time, higher doses are needed to produce the same effects, a phenomenon known as tolerance. Dovetailing with tolerance is dependence, whereby people experience an inability to function without the medications. Moreover, these drugs can cause euphoria. Opioids may numb emotional as well as physical pain, while benzodiazepines can work a little too well to eliminate anxiety. As a result, people become tempted to take more than prescribed. Misuse of either drug poses a risk of fatal overdose.

Twin Epidemics

Decades of overprescribing of opioids and benzodiazepines has led to twin epidemics of addiction and overdose. In the 1990s and 2000s, a nationwide campaign to treat pain as "the fifth vital sign" and aggressive marketing practices pharmaceutical companies brought a four-fold increase in opioid prescriptions as well as an alarming rise in nonmedical use of these drugs. Now, approximately 2.5 million adults in the U.S. Are living with opioid use disorder (OUD), while we are losing about 80,000 lives per year to opioid overdose.

A similar trend occurred with benzodiazepines: Between 1996 and 2013, prescriptions climbed 67%, while the overdose death rate more than quadrupled. The number of U.S. Adults with a prescription sedative or tranquilizer use disorder does not lag far behind that of OUD: 2.2 million. Taking opioids and benzodiazepines together (vs opioids alone) raises the overdose risk 10-fold, yet coprescribing of the two classes of drugs soared in the 2000s.

Overprescribing may have gotten us into these crises, but the path out is not as straightforward as deprescribing. In both the short- and long-term, cessation of opioids and benzodiazepines carries serious risks. Abrupt discontinuation of either class of drug can rapidly cause withdrawal. Even after a year or more, patients cut off from a long-term prescription face an increased chance of death.

Withdrawal

Imagine the worst flu of your life. That's what opioid withdrawal feels like: runny nose, vomiting, diarrhea. While rarely life-threatening, it is associated with increased emergency department utilization. Benzodiazepine withdrawal, which mirrors alcohol withdrawal, is a more serious syndrome that can include seizures and even death. With both classes of drug, withdrawal can set in within several hours of discontinuation.

Turning to More Dangerous Drugs

Even after withdrawal symptoms resolve, patients may suffer from underlying pain or anxiety and self-medicate with alcohol or illicit drugs. One study showed that discontinuing prescription opioid therapy doubled the risk of heroin use. Some experts have hypothesized that patients cut off benzodiazepines may drink to calm their nerves.

Use of non-prescribed drugs, including alcohol, can cause serious intoxication or overdose. Stopping prescription opioids is associated with a nearly threefold risk of fatal overdose. Benzodiazepine discontinuation has been linked with a small but statistically significant chance of overdose, both in patients who were also exposed to opioids and those who were not. This finding was noted in a study that followed patients for a year after they stopped their prescription, contrasting with previous observations of fewer adverse events over shorter follow-up intervals. The discrepancy suggests that after losing access to a prescription, people may engage in escalating use of non-prescribed substances over time, placing themselves in growing danger. Opioid overdose risk can persist up to two years beyond the start of tapering the prescription.

Suicidal Ideation

Another frightening potential consequence of stopping opioids or benzodiazepines is suicide. After opioid discontinuation, data points to a high-risk window for suicide (as well as overdose) of up to 100 days. For mental health crises, which include depression or anxiety as well as suicide attempts, that window expands to up to two years. Suicidal thoughts, attempts, and self-inflicted injury were all increased in patients taken off benzodiazepines at one-year follow-up.

Guidelines Offer Hope

Opioids and benzodiazepines have numerous parallels, both in the perils of using these drugs and the dangers associated with stopping them. Thankfully, organizations including the Centers for Disease Control (CDC), the American Academy of Family Physicians (AAFP), and the Veterans Administration (VA), have issued evidence-based recommendations to safely taper these medications.

Addiction Essential Reads

A patient-centered approach is key to tapering opioids and benzodiazepines. Clinician and patient should share in the process of deciding whether to taper off completely or reduce the dose to a safer level, as well as the speed of the taper. A rate of 10% per month may be appropriate for both classes of drugs. Should withdrawal or severe pain or anxiety occur, patients should have the option to slow down or even pause the taper. For patients who struggle to come off full opioids like oxycodone, switching to the safer partial opioid buprenorphine can be considered. Close follow-up allows for the plan to be adjusted and maintains the therapeutic alliance, which may be particularly strong if the clinician is the patient's primary care provider.

Adjunctive medications to alleviate pain, anxiety, and withdrawal should be offered during tapers. These include NSAIDs like ibuprofen for pain and SSRIs for anxiety. Opioid withdrawal can be managed with anti-nausea medications and antidiarrheals, while benzodiazepine withdrawal is more likely to require pausing the taper and/or switching to a different type of benzodiazepine or sedative. The opioid-overdose reversal agent naloxone should also be prescribed.

Nonpharmacologic supports play a key role as well. Exercise and physical therapy can mitigate pain, while talk therapy, and in particular cognitive behavioral therapy (CBT), addresses anxiety.

Freedom From Addictive Substances

Opioid and benzodiazepine discontinuation are fraught with similar hazards. Yet, the solutions are also similar. As an addiction medicine specialist, I have seen that utilizing an evidence-based, patient-centered taper strategy liberates people from relying on a dangerous substance to get through their day. To quote one of my patients, exhilarated after we completed a taper of the lorazepam she had been prescribed for 40 years: "I feel like I am finally free."

Road Dedication Held For Late Vicksburg Doctor; Endowment Established In His Honor

Published 11:57 am Wednesday, September 11, 2024

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The Dr. Bill Pierce Memorial Frontage Road sign was unveiled Wednesday at Medical Associates of Vicksburg, a medical complex founded by Pierce in 2008. Pictured are, from left, Transportation Commissioner Willie Simmons, Pat Pierce, Dr. Sam Pierce, Dr. Paul Pierce IV, Mayor George Flaggs Jr., Sen. Briggs Hopson and Warren County Board of Supervisor President Kelle Barfiled. (Terri Cowart Frazier/The Vicksburg Post)

Family members of the late Dr. Paul W. Pierce III pose in front of a memorial sign during a ceremony dedicating the intersection of Indiana Avenue and South Frontage Road in Pierce's honor Wednesday at Medical Associates of Vicksburg. Pictured are, from left, Sam, Clay, Pat, Kellie, Luke, Sam, Paul IV, Jill, Jake, Abby and Sarah Jane Pierce. (Terri Cowart Frazier/The Vicksburg Post)

The late Dr. Paul W. Pierce III, affectionately known as Bill, began his profession as an engineer. But after working for the U.S. Army Corps of Engineers for two years, he decided to change directions.

Pierce's wife, Pat, supported his decision.

"I can remember when Bill came home and said, 'I want to go to medical school,'" Pat said. "He told me he had become tired of sitting behind a desk."

Because of his engineering degree, Pat said her husband had had most of the math requirements needed for medical school, but he did have to take some science classes, which he did at Mississippi College.

Pat, who was a teacher at Warren Central High School, was already a student at MC. She was working towards a master's degree in counseling. She said she and Bill would ride to school together in the mornings.

"Bill came back as soon as his classes were over and went back to work at the Corps of Engineer," she said, adding the Corps allowed Bill to continue working there while also going to school.

Pierce ultimately graduated from the University of Mississippi Medical School in 1972. He spent three more years in Jackson for his internship and residency in internal medicine with UMMC before the couple returned to Vicksburg in 1975, where he began practicing at Vicksburg Medical Center. In 2008, Pierce founded Medical Associates of Vicksburg, a primary care practice, where he continued his 46-plus career as a physician.

In recognition of her husband's dedication and leadership in the field of internal medicine in Mississippi, in 2020 Pat established an endowment at UMMC — The Dr. Paul W. Pierce III Internal Medicine Endowment, which will honor in perpetuity his contributions  to the field of internal medicine and will provide ongoing financial support to the internal medicine department.

"Dr. Bill Pierce was an outstanding member of the medical community, and we are honored to have his name and reputation permanently tied to our institution," Dr. Michael Hall said. Hall serves as the Patrick H. Lehan Chair of Cardiovascular Medicine and Professor and Chairman of the Department of Medicine at the University of Mississippi Medical Center. "This endowed fund in the Department of Medicine will have an immense impact on those who come to train at UMMC, like Dr. Pierce. Funding for this endowment will ensure that the UMMC Department of Medicine can attract and retain the best academic leaders in the field of internal medicine and thus provide our patients with unmatched care. We are deeply grateful to Dr. Pierce and his wife Pat for creating this fund and to all of those individuals and organizations who have generously contributed their support."

In addition to the endowment, on Wednesday, Pierce was also recognized in Vicksburg with a ceremony dedicating the intersection of Indiana Avenue and South Frontage Road as the Dr. Bill Pierce Memorial Frontage Road.

"I thought the world of Dr. Bill Pierce and I am so glad to see him being remembered by establishing an endowment in his name at UMMC, and also honoring him in naming a road the Bill Pierce Road," Vicksburg resident Steve Golding said. "Dr. Pierce sincerely cared about each of his patients and he faithfully supported his local community."

Physician, mentor, father

With a career that spanned more than four decades, Pierce was a beloved physician by those he worked with and his patients.

Baleigh Ford, who worked as a PA-C with Pierce said, "He went the extra mile. He took time to know his patients on a more personal basis and his patients loved him as much as he loved them."

Ford said she was fortunate to have had the opportunity to "learn and grow by the best and most experienced physician" who was truly a blessing to those around him.

"For a physician to be loved by their patients isn't surprising. But for a doctor to be truly loved by his staff is rare and speaks volumes of the person he was," she said. "I was blessed with one of the greatest opportunities of my life when I was hired to work with Dr. Pierce III. Dr. Pierce left a legacy on this town and in my heart."

Melanie Furr, also a PA-C  with Pierce, concurred with Ford on both the influence Pierce had on her career and his dedication to his patients.

"It was clear to see that he cared about his patients very deeply," Furr said. "He took the importance of practicing medicine personal and helped more people than could ever be counted. I often recount the lessons I learned during my time with him as my supervising physician at Medical Associates and consider it a blessing that the foundation of my own medical career was influenced by Dr. Paul Pierce III."

Perhaps the greatest legacy Pierce bestowed on the community were his two sons, Paul IV and Sam, both of whom chose to practice medicine in Vicksburg. Paul is an interventional cardiologist at Merit Health River Region and Sam is an internal medicine doctor at Medical Associates.

"I can't remember ever wanting to be anything other than a physician, and that is due in large part to my father," Paul said. "Having said that, he could not have done any of what he did without the love and support of my mother."

Sam said he too always wanted to be a doctor, even though he did change his mind a few times along the way.

"But I always seemed to come back to medicine," Sam said. "My dad never tried to sway me in any certain direction. He always just wanted me to be the best at whatever profession I chose."

Pierce, also by example, taught his sons to have empathy and be dedicated to patients.

"He loved his patients. He considered all of them family, and he cared for them as such. He would take time with each and every one of them. He would even sometimes give them birthday presents," Sam said. "And once becoming a doctor, he certainly influenced the way I practice medicine. I modeled my professional career after his, including following my patients both in the hospital and clinic, which is a rarity these days. I asked his advice on every aspect of our practice. I was blessed with one of the greatest opportunities of my life when I was hired to work with him."

Paul also recalled how he saw first-hand how his father cared for his patients.

"I saw how he was able to take care of people and the positive effect he had in the community, and how his patients loved him," Paul said. "And when it came to diagnosing patients, he really didn't have much of an ego. He would readily refer patients to other specialists or other institutions to help them get a diagnosis, and I think they realized that and had more of an appreciation for him because of it. Also, he wasn't afraid to sit down in the exam room and have a real, honest conversation with people at length, even if it meant getting an hour or two… behind in clinic. He knew about their lives, their personal problems, their children, their work, and what they did for fun, and people responded to that."

Pierce was a beloved physician, something both Paul and Sam witnessed, but, to them, he was also just dad.

"I probably shouldn't say this, but when I was 13, he used to let me drive home from the golf course every Sunday," Sam said. "Which was 30 miles from home. We would take back roads home and he would instruct me on driving the whole way."

Paul also shard fond memories of growing up with Dr. Pierce as a father.

"He would take me to the hospital with him sometimes when he had to go back in and see someone at night," Paul said. "When I was eight or nine, it was Christmas Eve, and he got called in. He asked me if I wanted to go and I was reluctant to go with him because, well, Santa. He talked me into it, and we were up there for a while. It was close to midnight when we got back home, and Santa had come early. We stayed up very late playing with the toys and putting things together. He knew I was worried about it and worked it out with my mother. That's just the kind of person he was."

But, Paul joked, there are two sides to every coin.

But on the flip side, I remember breaking my brother's arm when he was little, and he (Dad) basically told him to tape two twigs to it and get back outside. Doctor's kids get the worst medical care," Paul laughed.

For more information on the Dr. Paul W. Pierce III Internal Medicine Endowment and how to support it, contact Dr. Melissa Robinson at mrobinson6@umc.Edu or 601-984-1106.

About Terri Cowart Frazier

Terri Frazier was born in Cleveland. Shortly afterward, the family moved to Vicksburg. She is a part-time reporter at The Vicksburg Post and is the editor of the Vicksburg Living Magazine, which has been awarded First Place by the Mississippi Press Association. She has also been the recipient of a First Place award in the MPA's Better Newspaper Contest's editorial division for the "Best Feature Story."

Terri graduated from Warren Central High School and Mississippi State University where she received a bachelor's degree in communications with an emphasis in public relations.

Prior to coming to work at The Post a little more than 10 years ago, she did some freelancing at the Jackson Free Press. But for most of her life, she enjoyed being a full-time stay at home mom.

Terri is a member of the Crawford Street United Methodist Church. She is a lifetime member of the Vicksburg Junior Auxiliary and is a past member of the Sampler Antique Club and Town and Country Garden Club. She is married to Dr. Walter Frazier.

"From staying informed with local governmental issues to hearing the stories of its people, a hometown newspaper is vital to a community. I have felt privileged to be part of a dedicated team at The Post throughout my tenure and hope that with theirs and with local support, I will be able to continue to grow and hone in on my skills as I help share the stories in Vicksburg. When asked what I like most about my job, my answer is always 'the people.'

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