Tennessee doc accused of hooking pregnant woman on drugs stays in business

Pop quiz: Which scenario will cause a doctor to lose her license in Tennessee?

A. You go into business with a convicted murderer, who also happens to be your husband, and you get caught selling drugs illegally, resulting in a felony conviction.

B. You fall behind on your professional license fees.

If you answered "B" you are right.

Dr. Mireille Lalanne in Nashville kept her license and has been allowed to keep practicing medicine. The fee laggard, Dr. George H. Jackson, lost it.

Lalanne was married to Dr. Visuvalingam Vilvarajah, who, infamously, killed his first wife and mother-in-law in 1986. It took the Tennessee Board of Medical Examiners three years to take away his license.

Vilvarajah managed to serve just four years of a 24-year sentence, and he had barely returned to civilian life when he applied to have his license reinstated. The Tennessee board acted quickly this time, handing him his license back in 1993. The Nashville Tennessean read through the board's minutes and found no indication that the board had even discussed the matter. Here's one question the board might have asked: "Should we allow someone who murdered two people to make life-or-death decisions in caring for patients?"

Five years later, in 2008, Vilvarajah was in trouble again, this time with his new wife, Lalanne, as his partner in crime. They were indicted in Harlan County, Kentucky, on charges that they were part of a criminal drug syndicate. Debbie Caldwell in the Harlan Daily Enterprise wrote that Harlan County Sheriff Marvin Lipfird and state prosecutors decided they could charge the couple with second-degree assault and first-degree wanton endangerment because one of their patients, "Carolyn Middleton gave birth to a child who was addicted to narcotics." As Caldwell wrote:

Middleton was arrested recently on the same charges and entered a plea in Harlan Circuit Court on Wednesday. "(Middleton) was going to Dr. Vilvarajah and Dr. Lalanne - she'd been going to them for a while," Lipfird said. "She stated that they knew she was pregnant, and they still continued to prescribe large quantities of narcotics to her without any concern to the child. The child was born severely addicted to narcotics."

This did not amount to much with the Tennessee medical board. The board, surely embarrassed by its quick decision to give Vilvarajah his license back in 1993, revoked his license in March 2010. But, that same month, the board allowed Lalanne to keep practicing, albeit on probation, for five years.

Does the Tennessee Board of Medical Examiners at least provide the public with a clear history for doctors who consort with murderers and sell drugs to pregnant women? No. The board's site is confusing and often just plain wrong.

The main problem is that the board, like other boards that seem conflicted about their public safety mission, has separated its licensee database from its disciplinary action database. In Lalanne's case, if you click on Physician Profile, you are given the faint outlines of her disciplinary history but no indication that there are further details to be had.

You have to guess that searching for her name a second time might lead you to those details. Doing so will provide you a link that says "Adverse Licensure Actions." Here you will find Lalanne's initial suspension, which makes it sound as if the board took Lalanne's criminal offense seriously. It said that her misconduct was "so severe that it imperatively requires emergency action in order to protect the public health, safety and welfare" and that Lalanne "would be willing to violate other accepted standards of medical care and cause further harm."

That was in January 2010. Something must have happened between then and March because her final probation order strikes a much more conciliatory tone. Lalanne's misdeeds are limited to three paragraphs of a 10-page document. There is no mention of the actual patients who were harmed, including Middleton's child.

Final question: Did the board provide more information about the guy who didn't pay his licensing fees? George H.Jackson skipped a $400 payment. The board had a lot more to say about Jackson's history. Of its 11 reasons for revoking Jackson's license, 10 of them were connected to licensing fees. The only other point the board mentioned was an action taken against Jackson's license in Virginia related to a positive drug test for cocaine. The board seemed to think the late fees merited much stronger action than Lalanne's criminal conviction for patient care abuses. In September, Antidote posed a similar question about why boards focus more on finances than patient care.

The message to doctors seems to be: stray outside the boundaries of ethical medicine, if you must - but keep those checks coming.

Jenn Harris contributed to this report.

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