The May 28 meeting of the Medical Licensing Board (MLB) of Indiana included administrative hearings and personal appearances, as well as a petition for summary suspension. During the 2015 General Assembly, MLB members also were charged with promulgating two new rules: one incorporating abuse-deterrent controlled substances into current opioid prescribing rules and another regarding civil immunity for health care volunteers.
The recent meeting started with two stakeholder presentations. Representatives from the Office of the Indiana Attorney General’s Prescription Drug Task Force explained its efforts to expand access to Naloxone for first responders and family members of opiate users.
|Fred Frick, MD
ISMA PAP medical consultant
|Candace Backer, MSW, LCSW
ISMA PAP director
Next, the ISMA Physician Assistance Program (PAP) reminded members about the important role of its program. Fred Frick, MD, PAP medical consultant, and Candace Backer, MSW, LCSW, PAP director, explained the program’s three major functions: triaging, monitoring and advocating.
National studies confirm the high efficacy rates of physician treatment and monitoring initiatives, and our state is fortunate to have the ISMA program, funded by participant fees and ISMA membership dues. During the meeting, ISMA program staff testified on behalf of several physicians.
|MLB earns national recognition with Best of Boards Award
The Medical Licensing Board (MLB) of Indiana received the 2015 Best of Boards Award from the Administrators in Medicine (AIM) during a recent national conference.
Our MLB was recognized for adopting opioid prescribing rules requiring physicians to perform abuse-risk assessments and thorough evaluations, sign treatment agreements with patients, and provide counseling on the risks and benefits of opioid prescriptions – including counseling on neonatal abstinence syndrome.
SEA 246, signed into law in 2013, granted the MLB the authority to adopt emergency rules that had to be in place by Nov. 1, 2013, and have those rules finalized by Nov. 1,
2014. The board completed the rulemaking process in October 2014.
“AIM values the Medical Licensing Board of Indiana’s work to curb opioid abuse, and we were excited to present them with this year’s AIM Best of Boards Award,” said AIM President Margaret Hansen.
For more about the MLB and opioid prescribing rules, see in.gov. For details about opioid prescribing, please visit the cdc website.
Complaints against physicians
The day was marked by hearings that centered on physicians who had previously surrendered their Drug Enforcement Administration (DEA) registrations.
In one case, the physician’s rheumatology practice had evolved increasingly into pain management. In 2012, state officials asserted he was prescribing extremely high amounts of controlled substances with inefficient clinical diagnoses and insufficient documentation. One of his patients was arrested for dealing controlled substances, and several patients died of accidental overdoses. The physician lost/surrendered his DEA registration that year and had his medical license suspended for 90 days – before being placed on indefinite probation.
Three years later, the rheumatologist is still working to fully restore his Controlled Substance Registration (CSR) and DEA to regain hospital privileges. The Office of the Indiana Attorney General recognized improvements and did not oppose his request to withdraw probation.
A second case involved a physician arrested last fall for controlled substance violations and additional charges filed in May. In all, 30 of 32 criminal charges alleged improper prescribing and dispensing – plus charges for voyeurism and trading sex for drugs.
In a third case, a physician had faced DEA action for improper prescribing of controlled substances for weight loss treatment. Specifically, no other methods of losing weight had been attempted, and no patient lost more than five pounds. But prescriptions continued. State officials noted he was concurrently prescribing patients opiates, benzos and soma – collectively “the holy trinity.”
In addition, this physician did not keep proper controlled substance logs and took controlled substances back from patients for destruction, testifying he was unaware of state laws on this issue. He surrendered his DEA in 2010 and was advised to reapply in three years. His application to reinstate his CSR was tabled until he completes approximately 30 hours of relevant continuing medical education (CME).
Actions from another state
A fourth physician voluntarily surrendered his DEA registration while practicing in Georgia. He worked at several clinics under DEA investigation for prescribing issues, including employing individuals with criminal drug histories and seeing patients from great distances and from across state lines.
A DEA investigator testified that the DEA in Georgia warned the doctor about improper prescribing practices and becoming a “pill mill.” The physician claimed he had no knowledge of any issues at the clinics in Georgia and offered completed CMEs in pain management as evidence of his ability to properly prescribe controlled substances for pain.
The MLB found the physician failed to “fully and appropriately assess, investigate or document causes, sources, or legitimacy of patients’ complaints when prescribing controlled substances for pain while working as a physician [in Georgia] seeing approximately forty (40) patients per day.” They found he failed to “follow appropriate and accepted standards of practice for pain management…”
His license was placed on indefinite probation for a minimum of six months, during which time he is not permitted to diagnose and treat patients, but he can perform histories and physicals. He is also required to complete a course in appropriate prescribing.
Watch future issues of ISMA Reports for lessons on how to react when the DEA visits your office.