How Enforcement Agents Target Doctors

• In Event: Lightning Talk: New Directions in Health Criminology

Abstract

Today’s physicians are dancing on a shifting legal carpet. Providers in stigmatized specialties envision enforcement agents poised to investigate and prosecute them. But how closely do providers’ imaginaries map onto enforcement practices? This study uses the case of opioid enforcement to examine how enforcement workers pursue cases against physicians. Given the shift from medicalization to criminalization of opioids over the last twenty years, the opioid case offers insights into the micro-level dynamics of enforcement in administrative law and criminal law arenas. Drawing on 94 interviews with enforcement agents from 2009-2019, I ask: How do enforcement workers identify, investigate, and discipline physicians? To what extent do they collaborate and to what extent do they compete? These questions are critical because they illuminate an understudied aspect of legal mechanisms that shape professional work. I address these questions by: 1) mapping the enforcement environment to identify organizational variation; 2) offering preliminary findings about collaboration and competition based on pilot research; and 3) identifying next steps. Findings provide a window into dynamics of political and legal control of healthcare work and contribute to broader understandings of frontline work and inter-organizational processes in enforcement fields.

Author

• Elizabeth Chiarello, Saint Louis University