Dead patients -- and missing records -- tell Vermont internist's pitiful tale

Here's what you shouldn't do if you get caught breaking the medical rules in Vermont: skip class.

Dr. William A. O'Rourke, Jr. of Rutland, Vermont, had been in practice for more than 40 years as an internist when the Vermont Board of Medical Practiced filed charges against him. The board said that the doc had prescribed addictive drugs to a fellow doctor's family member without examining her or learning her medical history.

Chances are good this patient ended up addicted, leading to a complaint that caught the medical board's attention. Prescribing without an exam is a big no-no for a doctor, but not something that generally costs a doctor his license.

O'Rourke was ordered in 2003 to keep detailed medical records and to take a course in controlled substance management and recordkeeping.

If O'Rourke had just taken that class, his career might have had a different trajectory. But he didn't. In fact, he petitioned one of the board's committees to be let out of the requirement. The board filed new charges against him in January 2005. Two years later – as with too many boards, speed is not one of the Vermont board's virtues – the board reprimanded O'Rourke and suspended his license for 20 days.

There's a great scene in "Barton Fink," where Fink, a struggling screenwriter, lights up upon being told that the studio boss, Mr. Lipnick, has taken an interest in his screenplay. But his excitement is quickly extinguished when Mr. Lipnick's assistant says, "Never make Lipnick like you."

The Vermont board started to take an interest in O'Rourke all because of this one skipped class. It sent investigators to his office to examine lists of prescriptions. When the investigators, Philip Ciotti and Paula Nenninger, asked for copies of 175 different prescriptions and charts for 13 patients, O'Rourke's staff could not find charts. They gave O'Rourke 20 days to track down the records. O'Rourke did not turn them all over. As for the prescription records, the board investigators found that 12 out of 63 patients had filled prescriptions for controlled substances that could not be documented in O'Rourke's files.

So Ciotti asked for more charts. O'Rourke said, according to board documents, that "it was nothing but more harassment and that Investigator Ciotti had nothing better to do."

O'Rourke's staff eventually turned over some records but, as the board said, they were "disorganized and difficult to understand."

Like prescribing to a patient without an exam, bad recordkeeping usually doesn't cost a doctor his license, but now, because the board had taken an interest, O'Rourke was in real trouble.

Lax recordkeeping when it comes to addictive drugs indicates a bigger problem. It didn't help that three of the patients with missing records were dead. These were patients who had been given repeated prescriptions for addictive drugs with no medical documentation to back up the prescriptions. A pattern like that starts to worry a board, or the Drug Enforcement Agency.

On August 2010, the board filed a motion against O'Rourke's license that could lead to his license being revoked.

So remember this, kids: stay in school. Especially if you are sent there by the Vermont medical board.

Final question: When a licensing board cracks down this hard on a doctor, can you count on the board also to make this information plainly available to the public? No.

The Vermont board on its "Physician Profile" for O'Rourke says only, "11/5/03-- License conditioned as a result of prescribing and recordkeeping practices undefined". If you can tell me what that means, perhaps you speak bureaucrat. There is nothing on the profile about the deceased patients about the pattern of addictive prescriptions or about the new charges against O'Rourke.

Patients going to his office today would never know that he has been under intense scrutiny and now may be in the process of losing his license. That's a shame for a board that is one of the few to actually follow up when a doctor is found to have strayed outside the guidelines. If it can send two investigators into a doctor's office to comb through his records, it ought to be able to hire an intern to put some of these public disciplinary documents online.

Jenn Harris contributed to this report.

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