when you read the document, the board seems actually reasonable. he was suspended. he could have had license revoked.
It seems like the state is trying to squeeze every last drop of potential wrongdoing out of these two patients, but I assume that's what they do once they decide to go after you. For example, the state suggests it was inappropriate not to refer to mental health after documenting, "
...due to long-term [use of] this combination and his personal stress level he is unable to cut down the dose and if he does he will end up in the emergency room or forced to do "something stupid." He does not appear to have any suicidal ideation or planning."
I suspect, and hope, the state decided to investigate this guy due to a pattern of malpractice rather than because someone had an axe to grind. However, as previous comments in this thread have shown, many of these allegations leave room for doubt with the potential to place blame on documentation omissions. I know that, "I forgot to document it" won't help you, but you'd think the state could come up with a stronger case since they presumably had full access to this guy's longstanding practice.
I bolded the only unambiguous allegations I see below.
#3 seems to be the only violation of the law since patient A was on >90 MME, so a 2018 California law requires naloxone be offered. So, he should've prescribed it to remove ambiguity about what "offer" means. This case would be a lot more convincing to me if the state could say something like, "In the last year alone, respondent violated assembly bill 2760 on X occasions."
#6 Patient B presumably was not on >90 MME, since they don't mention his MME in the next sentence.
#7 An opioid agreement seems to be a recommendation by the Medical Board of California. Note that they don't accuse him of not having one for patient A, implying that he used agreements for some patients.
#8 The Board recommends against opioids with benzos, but I can tell you it's not uncommon to see patients in California on this combination.
(1) failed to perform and document an adequate physical examination of Patient A while prescribing chronic opioid medications in excess of 90 morphine milligram equivalents (MME);
(2) failed to take and document an adequate medical history and medication history of Patient Awhile prescribing chronic opioid medication in excess of 90 MME;
(3) failed to prescribe naloxone to Patient A while prescribing chronic opioid medications;
(4) failed to recognize, document and address Patient A's aberrant urine drug test on or about January 1, 2018;
(5) failed to perform and document an adequate physical examination of Patient B while prescribing high doses of chronic opioid medications to a patient with multiple risk factors;
(6) failed to prescribe naloxone to Patient B while prescribing chronic opioid medications;
(7) failed to have a signed pain management agreement in place with Patient B while prescribing chronic opioid medications;
(8) prescribed high doses of opioid medications to Patient B, in conjunction with a benzodiazepine, in a patient with multiple risk factors and insufficient monitoring;
(9) failed to take and document an adequate medical history and medication history of Patient B while prescribing chronic opioid medications such as methadone, including failing to monitor the risk of QT prolongation with EKG testing.
If this guy is as sloppy as these two decade-old cases suggest, I'm surprised the state couldn't come up with a more convincing case.
norcalrecord.com
