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MLB meeting: learn from others’ mistakes
e-Reports, April 20, 2015
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The recent session signaled a shift in attention, as well as continued scrutiny of controlled substance prescribing and medical record documentation Untitled document

The March 26 meeting of the Medical Licensing Board (MLB) of Indiana was one of the longest – from 8:30 am to 8:30 pm – but provided several lessons for physicians. Board members faced an agenda of administrative hearings, rules updates, personal appearances, presentations, and one petition for summary suspension. The ISMA Physician Assistance Program testified in support of one physician.

Members also heard testimony in a domestic violence case. A physician criminally charged with interference with reporting of a crime, domestic battery, strangulation and battery pled guilty to criminal confinement and battery resulting in bodily injury.

About the MLB
Indiana law specifies the MLB must have seven members: six physicians (5 MDs and 1 DO) and one consumer member (historically an attorney). Members are appointed by the governor and not more than four can be members of the same political party. MLB members receive $50 per day per diem, plus mileage. The MLB currently has two vacant seats.

Read more about the MLB on the ISMA website and in.gov.

The Office of the Indiana Attorney General asserted the physician’s medical license should be disciplined because he “had been convicted of a crime that is harmful to the public” and “continued to practice although he is unfit to practice due to professional incompetence by engaging in a pattern of conduct which demonstrates an inability to exercise reasonable care and diligence as is normally exercised by practitioners.”

The MLB agreed with the first assertion and placed the physician on probation. He may not petition for withdrawal of probation until he completes an anger management course within 90 days.

“This case may signal a new emphasis on professional discipline for personal, private conduct,” said Julie Reed, ISMA General Counsel. “Domestic violence by athletes has been receiving a great deal of attention lately; physicians may be the next group in the spotlight.”

Scrutiny on substance prescribing
The lengthiest case involved controlled substances. According to the state’s petition and evidence, the physician, a pulmonologist, began accepting patients of a primary care physician convicted of multiple narcotics-related crimes. These patients were self-identified gang members.

Around that time, a significant increase in hydrocodone prescriptions from the pulmonologist was noted. According to the state’s expert witness, these prescriptions significantly deviated from the standard of care and were not consistent with legitimate medical purposes. Testimony showed the prescriptions were not clinically supported by documentation in the medical records.

“Remember that to regulators, anything that is not documented does not exist,” Reed said. “Also, physicians who accept new patients are expected to perform and document a complete patient evaluation and make appropriate treatment decisions based on that evaluation.”

Additionally, while the physician was working at the hospital, his two office staff members were ordering large quantities of hydrocodone in his name and DEA number from wholesale distributors – and then selling them for $3,000 to $4,000 per shipment. In all, his staff admitted to diverting approximately 250,000 dosage units of hydrocodone. They were charged and pled guilty.

While there was no evidence the physician was aware of the drug-trafficking or financially benefitted from it, the physician testified he fired his staff only after receiving the state’s petition for emergency suspension of his license, approximately four months following the staff’s guilty plea. The physician was also accused of leaving blank, pre-signed prescriptions for office staff and having unsafe office conditions.

”Scripts must be dated and signed the day they are issued, not pre-signed,” Reed noted, “and staff that engage in drug crimes using the physician’s identity must be disciplined appropriately. In at least some cases, this will mean termination.”

The physician provided evidence he stopped prescribing controlled substances in 2014 and 2015. He also stated that he terminated his staff, was not pre-signing prescriptions, and presented photos showing his office had been cleaned.

MLB members were quick to opine that the physician should be disciplined for past conduct. However, the majority declined to grant the state’s petition to summarily suspend his license (the only petition pending) because the state did not meet its burden to prove the physician presently posed a clear and immediate danger to public health and safety.

State representatives indicated they will promptly file a new complaint seeking lesser discipline against the physician for past violations.

Watch future issues of ISMA Reports for regular columns on the MLB meetings and prescribing.

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