As Rural Doctor Surrenders License, Patients Wonder: "Where Am I Supposed to Go?"

Oct 12, 2017

Dr. Anna Konopka of New London uses only paper records and doesn't take insurance. She practices out of a small office adjacent to her house.
Credit Britta Greene / New Hampshire Public Radio

There’s a doctor in New London who’s ending her decades-long medical practice on Friday. She’s nearly 85, but her retirement is not voluntary. She says she’s being forced to shut down by a system that no longer values the type of patient-centered medicine that she practices. But the New Hampshire Board of Medicine has a different take. They’re challenging her medical decision making and other aspects of her work. 

Dr. Anna Konopka’s medical office sits just across the driveway from her house, tucked along the shore of Pleasant Lake in New London. There’s no cell service, no wifi. Her phone rings off the hook.

At 85, she’s set to close her practice Friday, but the move is not voluntary. She says she’s being forced to shut down by a system that no longer values the type of patient-centered medicine that she practices.  

The New Hampshire Board of Medicine has a different take. They’re challenging her medical decision-making and other fundamental aspects of her work.

Konopka's office sits adjacent to her house on the shore of Pleasant Lake in New London.
Credit Britta Greene / New Hampshire Public Radio

To talk with her patients is to hear story after story of medical turn-around, of admiration and gratitude. Unlike other doctors, Konopka listens and spends time with you, her patients say. She learns your family history, your physical and mental state. She doesn’t simply rush you out the door with a prescription.

One of her patients, Matt Runnells, drives from Claremont to see her about once a month. At 33 years old, he said he’s seen a world of pain. He was attacked about a decade ago on the street, stabbed 18 times, he said. He also has a serious spine disease and shattered his hand in a workplace accident a couple years ago.

“Honestly, if it wasn’t for Ms. Konopka and the things that she’s done to get me to where I am today, then I don’t think I’d be able to support my family,” he said.

Before he saw her, he visited every major hospital in the Upper Valley without success. “I’ve seen maybe 30 to 40 different professionals,” he said. “Their answers were all the same: ‘Well, short of surgery, there’s nothing we can do.’”

Konopka has instead worked with him intensely, he said, gotten to the root of his interconnected aches and pains, and helped him avoid surgery with different therapies, supplements and medications.

The doctor is short with a mop of white hair and a quick smile.  Last week, she wore a white polka-dot vest, white pants, white shoes. She’s originally from Poland, and was first licensed in New Hampshire in the 60s.

She doesn’t keep any electronic records, it’s all on paper. She said she finally caved and got a computer earlier this year, but it sits in her kitchen. She can’t figure out how to use it.

She knows she’s unique, that the medical system in the United States is changing and she’s refusing to change with it. “Even last year, the secretary of the Medical Society told me I’m a disappearing species,” she said, laughing. “I said, ‘I know that!’”

Konopka is fighting the medical board's allegations in court.
Credit Britta Greene / New Hampshire Public Radio

It may not come as a surprise, then, that she doesn’t trust the medical skills of most doctors nowadays. “They almost don't see the patients’ faces. They don’t remember the patient,” she said, adding that she thinks most doctors now spend too much time on their computers, too little time with patients. Plus, she said, they’re trained to make prescriptions based on one-size-fits-all guidelines.

“To me, it is not medicine,” she said.  “I’m not going to compromise patients’ life and health.”

She stopped accepting insurance several years ago because she felt pressured by the insurance companies to adopt electronic systems and sign complicated financial contracts. So, she charges a flat fee, $50, for an office visit.

But now, everything is changing. Last month, Konopka agreed to voluntarily surrender her license to settle allegations from the New Hampshire Board of Medicine. The board cites her recording keeping, prescribing practices and medical decision-making. These categories are quite broad, but the board said confidentiality rules limit the disclosure of more detail.

Regardless, these are serious allegations. But the doctor’s patients seem more upset with the board than her. Those I spoke with were not taking it lightly. 

“She’s changed my world and I’m terrified,” said Nancy Muskelly. “I’m absolutely terrified.”

Before she started seeing Konopka a couple years ago, Muskelly was using a walker or cane to get around. Now, with Konopka’s help, she can walk again freely. She said the doctor has cut her pill count to a quarter of what it was and allowed her to resume a normal life. “She listens to you,” Muskelly said. “She really does listen to you.”

She’s scared, if she has to go to other doctors, her health will again take a turn for the worse.

For her part, Konopka said she’s always been careful to follow the law and keep detailed records. She’s never been sued for malpractice in New Hampshire.  She agreed to surrender her license, but disputes the allegations and says she’s done nothing wrong.

Many of the doctor's patients, including Jeffrey Westover, say she's helped turn their lives around, managing complex conditions.
Credit Britta Greene / New Hampshire Public Radio

Talking with her patients, though, it’s hard to miss another trend. Many suffer from chronic pain, say they were referred to Konopka by friends or word of mouth, and say they see her about once a month.

It turns out many of the doctor’s patients, more than half she said, are on opioids to manage chronic pain. Those patients told me Konopka is a savior, not just because of her kindness and attention, but because it’s so difficult for them to find doctors nowadays who will keep them on the drugs.

“What do you think’s gonna happen to these 300 patients that she sees on a month,” Muskelly said. “I can guarantee you, half of them now, whatever they are on, if they can’t go to another doctor, they’re going to go to the streets.”

Konopka said this problem of people not knowing where to go -- it’s bad. She had decided this spring she wouldn’t take any new opioid patients but was overloaded with calls from people begging her to take them on. In some cases, when they told her they’d have to turn to the street, she let them in.

“Young people, you know, they are dying,” she said. “I wanted to save them.”

She insists she’s not overprescribing and, in fact, is often able to reduce a patient’s dosage.

And, while again, the medical board has disclosed only the broad strokes of its allegations, Konopka said her opioid prescribing practices are part of the complaints.

For one thing, in New Hampshire, physicians are required to look up patients in an online system when they’re prescribing opioids. It helps doctors know when a patient may be abusing the drugs. Konopka said she hasn’t been using it.

Given the extent of the opioid crisis across the country, physicians are under increasing pressure around their prescribing practice. Some doctors say it’s leading to unintended consequences, with some chronic pain patients being cut off from the drugs.

For many of Konopka’s patients, the system has become scary and exhausting.

“Other doctors won’t even see me,” said Jennifer Clark, who’s been seeing Konopka for about six years. “I’ve called 30 doctors, and they say no, we won’t take narcotics patients.”

In exasperation, she turned her back and lifted up her shirt, showing the scar running up and down her spine. She was in a bad car accident in the 90s.

She said she doesn’t abuse the drugs. In fact, she said, Konopka’s taken her down to half the dose that other doctors had prescribed.

“I have perfect records, nothing wrong in my records,” she said. “And they still say, no, we don’t take narcotics [patients]. So, where am I supposed to go?”

Konopka is now attempting to fight the medical board’s decision. She’s filed a complaint in Merrimack County Superior Court, and said she’s left information for Governor Chris Sununu, asking him to step in as well.