Obituary: Harvey Rose, MD
by Forest Tennant, MD, DrPH
 HARVEY ROSE, MD
August 10, 1932 – January 1, 2008
Crusader for the Family Physician’s Right to Treat Pain
On New Year’s Day, 2008, we lost our “Gladiator Emeritus” in the fight
to allow American Family Practitioners to treat chronic and intractable pain. Without
question, Harvey Rose, was the MD who most believed that every physician—particularly
the family physician—had to have the right to prescribe opioids for the suffering
pain patient. No need for a specialty designation or blessing from an insurance company or
government agency; just carry out the primary tenet of the Hippocratic Oath—relieve
suffering. And there was no good or bad drug or dosage—simply prescribe what opioid
or other medication was needed to get the job done. Every American physician who is
prescribing opioids and every pain patient who is now obtaining some relief owes a prayer
to Harvey Rose. Yours truly, the writer of this memoria, wouldn’t be practicing pain
medicine if not for the pioneering, enduring, and Herculean efforts of Harvey Rose.
Harvey showed us you can beat City Hall. In this case Harvey’s City Hall was the
California Medical Board. In 1981, the California Medical Board brought charges accusing
him of excessively prescribing pain drugs. The Board naturally declared him guilty, but
the verdict was tossed out when Harvey appealed to the State’s Civil, Superior Court.
The Medical Board “conveniently lost” some of their records simply because they
didn’t want a twelve person jury to know that they were actually attempting to force
common, suffering patients to be deprived of humanitarian pain relief and de-license a
dedicated physician.
This case spurred Dr. Rose to push for legal protections for physicians and patients.
He helped State Senator Leroy Greene draft the 1990 Intractable Pain Treatment Act, which
shielded doctors from discipline for prescribing potentially abusable drugs for serious,
incurable, pain cases. It was a key early measure in several steps California has taken
toward greater pain management, including a 1997 Pain Patient’s Bill of Rights. With
the recent passage of a very futuristic law done with Harvey’s blessing and simply
known as AB198, California now protects and encourages MDs who treat pain as long as they
keep documenting records. Harvey lobbied for similar laws in Nevada and Oregon, and
appeared in a national news story on “48 hours.”
A shift in the attitude of the California State Medical Board in 1995 caused them to
acknowledge that pain is often under-treated, and relief sometimes requires large drug
doses. Harvey, however, didn’t believe they were truly sincere and continued to
crusade. The same year, Dr. Rose was recognized as one of ten “Heroes in Health
Care” in a program sponsored by the Health Communication Research Institute.
“I don’t think his contribution can be overstated,” said Dr. Lee Snook,
founder and president of Metropolitan Pain Management Consultants, Inc. “He embraced
the best tenets of being a physician—to listen to patients and do whatever they have
to do to alleviate their suffering. Harvey did that, even at his own risk”.
“When people couldn’t come to him, he’d go to them,” said Tom
Greenly, a longtime patient and friend. “He was absolutely committed to taking care
of patients with dignity and respect.”
Although Harvey believed and crusaded for a doctor’s right to prescribe, he
begrudgingly related to me in the mid-90s that few doctors would treat severe pain
patients for numerous reasons. He therefore advocated long-distance travel for patients to
obtain care if no local treatment was available. Patients nationwide traveled to Dr. Rose
for help.
Harvey Leon Rose was born in 1937 in Chicago, the only child of working-class,
Ukrainian Jewish immigrants who moved to Los Angeles when he was a boy. He earned a
bachelor’s degree with honors from UCLA in 1954 and graduated third in his class from
USC medical school in 1958. He completed his residency at Sacramento County Hospital and
joined the Air Force as a captain in the ROTC program.
He spent two years as a medical officer at a U.S. base in Crete, where he befriended
locals and made life-long connections to the Greek community in Sacramento.
“He’d leave the base and go out to the village and hang out,” said his
daughter Dianna Rose. “He became quite fluent in Greek and learned all the songs and
dances.”
Dr. Rose returned to Sacramento and joined a medical practice that moved to Carmichael
in the 1970’s. He also was an assistant clinical professor of family practice at UC
Davis School of Medicine. He raised two children with Alice Dow Rose, whom he met at a
folk dance and married in 1963. His wife died in 1997.
He spoke five languages and traveled widely in the United States and Europe. “He
was an outgoing and energetic man who loved folk dancing and singing and tried to attend
every ethnic food festival in town,” said his daughter Kari Ross Persell. He said it
was like traveling except he didn’t have to leave home and didn’t have to leave
his patients.
There are three accomplishments about which this author may singularly know and wishes
to be part of this memoria. First, in 1990 Dr. Rose helped draft, along with such notable
MDs as Otto Neubuerger and Lee Snook, a document entitled “The Painful Dilemma: The
Use of Narcotics for the Treatment of Chronic Pain.” Ostensibly, this was a report
prepared by an ad hoc committee of the Sacramento-El Dorado Medical Society and later
endorsed by the California Medical Association. Although listed as a
“consultant” on the report, some members of the drafting committee have informed
me that Harvey was the spirit and “bull dog” behind it. This report provided the
impetus for the California Intractable Pain Act and is the singular document that, two
decades later, allows millions of suffering patients in the Western United States to
obtain opioids and lead a quality life. The contents of this report are remarkable.
Considering its age, it lays out the merits, demerits, and scientific foundation for
today’s contemporary pain practice. It is a “must read” by any serious pain
practitioner today, and the author makes it available in honor of Harvey Rose.
In 1996, I received a short, hand-written note from Harvey, as was his usual style.
Short and to the point, “Hope you find this useful. We may have to go to battle with
the bureaucracy again.” Attached to the note was a paper entitled,
“Acetaminophen and Hydrocodone Levels in Pain Patients.” Harvey, unknown to me
at the time, had measured hydrocodone and acetaminophen blood levels in some of his
patients. His short conclusion of the study summarizes opioid therapeutics as succinctly
as anything that has since been written. A telephone call to Harvey clarified his intent.
He believed—and history has proved him correct—that many persons in government
bureaucracies hated the Intractable Pain Act, and were out to find a way around the Act to
prosecute all physicians who prescribed opioids. He believed that an opioid blood level on
pain patients would validate a high opioid dosage and show that the patient was compliant
and in dire need of pain medication. His belief about the obstreperous bureaucracy proved
correct as doctors were heavily prosecuted and disciplined in the 1990’s despite laws
that were supposedly protective. Only opioid blood levels on pain patients as documented
by Harvey kept some of our medical licenses intact. Harvey’s lobbying efforts in the
late 1990’s and early 2000’s brought about the additional physician safeguards
mentioned above. But an opioid blood level still remains a cornerstone of pain practice
and protection for the MD.
His third unappreciated accomplishment was his close relationship with his patients for
advocacy and advice purposes. In particular, his close friend, advocate, and patient, Tom
Greenly, helped Harvey win his battles to obtain physician rights to treat and prescribe
opioids. Fundamentally, Harvey believed that pain patients and doctors were “in this
together” and had to mutually take on bureaucratic adversaries—just as David
conquered Goliath.
Thanks and Godspeed to my friend Harvey Rose.
—Forest Tennant, MD, DrPH
— March 2008
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