Do you need computer skills to be a competent doctor?

That's one of the central questions surrounding a difficult case unfolding in New Hampshire this month: Anna Konopka, an octogenarian doctor who eschews computers and has been practicing medicine for the better part of six decades, surrendered her license under a September agreement with the state's board of medicine — partly because of multiple complaints related to her record keeping, Merrimack Superior Court Judge John Kissinger said.

But Konopka challenged that agreement last month, saying she signed it under duress. She had sought an injunction on the agreement, but Kissinger upheld its legality and dismissed her case, noting that she is still free to ask the board itself to vacate their agreement.

"The problem now is that I am not doing certain things on computer," Konopka, who is in her mid-80s, told The Associated Press earlier this month.

In fact, she doesn't use electronic records at all in her office, which is nestled in a small rural community of roughly 4,500 in New London, N.H. Instead, the AP reports, "two file cabinets in a tiny waiting room inside a 160-year-old clapboard house hold most of her patient records. The only sign of technology in the waiting room is a landline telephone on her desk."

Nevertheless, Konopka has inspired the adoration of many of her patients, who she says will be hurt most of all by the end of her community practice. She charges just $50 for each visit, having ditched the insurance system partly because she shuns the electronic systems adopted by most insurance companies, New Hampshire Public Radio reports.

Doctors reliant on electronic records nowadays "almost don't see the patients' faces. They don't remember the patient," she told the member station. "To me, it is not medicine. I'm not going to compromise patients' life and health."

NHPR notes Konopka acknowledges that she is treating most of these patients with opioids for chronic pain, and that — as NHPR phrases it — "her opioid prescribing practices are part of the complaints" against her.

As a matter of fact, these opioid prescriptions make for a rather problematic mix with her avoidance of electronic records, at least in terms of state law. In New Hampshire, which has one of the country's highest rates of drug overdose deaths, lawmakers have sought to combat the opioid epidemic partly with a drug monitoring program — which is Web-based and which prescribers are required to register with in order to prevent opioid abuse.

By refusing to use electronic records, Konopka also essentially refused to participate in the program.

Beginning with an allegation of misconduct in 2014 and followed by several other complaints — the details of which are all sealed — Kissinger says the state's medical board investigated Konopka's "record keeping, prescribing practices and medical decision making." Ultimately, the board offered her the opportunity to settle these complaints and take a month to wrap up her practice if she voluntarily surrendered her license — an offer she took them up on.

Later, according to the judge, Konopka said she "acted under duress because she was told her license would be taken on September 13, 2017 if she did not sign."

The court did not agree, as Kissinger explained in his Nov. 15 decision:

"The Court has admiration for Dr. Konopka's devotion to her patients. Several of her patients were in attendance at the hearing. It is clear to the Court that Dr. Konopka has spent her career helping people in her medical practice and has a genuine commitment to address the needs of those not able to afford medical care elsewhere.

"Under the circumstances of this case, however, Dr. Konopka has failed to demonstrate that the extraordinary means of an injunction allowing her to continue to practice medicine is appropriate. To hold otherwise would be to ignore the process established by the legislature to regulate the practice of medicine in this state."

Still, the door remains open to Konopka, even if a little less than before: If the medical board "acts unreasonably in denying her relief," Kissinger added, "she is free to again seek injunctive relief from this court."

In the meantime, it remains unclear what will become of her patients in rural New London, several of whom have already had trouble finding other doctors willing to take on new patients who have been prescribed narcotics.

"What do you think's gonna happen to these 300 patients that she sees on a month," one patient, Nancy Muskelly, told NHPR. "I can guarantee you, half of [Konopka's patients] now, whatever they are on, if they can't go to another doctor, they're going to go to the streets."

"She's changed my world and I'm terrified," Muskelly added. "I'm absolutely terrified."

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