Case against California doctor jeopardizes drug-tracking system

In trying to discipline a physician, the California Medical Board has opened a door for the state’s influential doctors’ lobby to eliminate one of the board’s only weapons against reckless prescribing.

If you’re trying to catch a doctor with dangerous prescribing habits, you have a limited toolkit.

In most states, you rely mainly on people calling to complain. This works if you’re talking about surgeons taking out the wrong kidney or psychiatrists trying to convince you to jump off a window ledge. But many of the patients harmed by reckless prescribing have an addiction to painkillers or other drugs and don’t want to cut off their supply.

See Also: Part 2: California Medical Association challenges drug-tracking system in court

You could ask the U.S. Drug Enforcement Administration for help. They track prescriptions of narcotics and other drugs. But the DEA’s mission is not to discipline doctors, and its agents don’t have a stellar record of working with state medical boards.

So you can do what California did. You can set up your own system to monitor whether patients are doctor shopping to load up on drugs and to track doctors who prescribe in quantities that are far beyond therapeutic. In California, this tracker is called the Controlled Substance Utilization Review and Evaluation System (CURES).

CURES has been unpopular with the California Medical Association – one of the best funded and most influential lobbying organizations in Sacramento – and now it is under attack from the association again. The opportunity for this attack was created by the medical board itself when it brought a lackluster case against Dr. Alwin Lewis of Burbank, the creator of the “Five Bite Diet,” popularized on Dr. Oz, among other venues.

The medical board accused Lewis of prescribing drugs to patients without adequate examinations or documentation, failing to consider the way drugs might interact and cause dangerous side effects, failing to recommend adequate follow-up testing, and recommending an extreme weight loss program that was detrimental to patients’ health, according to medical board records.

After one patient was prescribed two drugs that interacted badly, the patient was hospitalized “for rhabdomyolosis, a condition in which skeletal muscle tissue breaks down rapidly due to muscle damage, stemming from an interaction between nefazodone and Zocor,” according to medical board records.

But the case against Lewis was weak. After a long hearing where two medical experts delivered conflicting testimony about Lewis’ practice, an administrative law judge, Samuel D. Reyes, tossed out many of the charges against Lewis.

He found that the board had failed to make its case that Lewis had “engaged in repeated acts of clearly excessive prescribing, furnishing, dispensing, or administering dangerous drugs to his patients.” According to medical board records, Reyes wrote:

While [Lewis] did in some instances prescribe medications above standard dosages without documenting a reason for such excess…these instances do not rise to the level of ‘repeated’ or ‘clearly excessive’ in light of the patients’ conditions, their long-term relationship with [Lewis], and the relatively small number of instances given the total number of patient contacts.

Reyes did find, according to medical board records, that Lewis had “engaged in repeated negligent acts,” “failed to maintain adequate medical records,” and “engaged in unprofessional conduct.” The judge wrote:

In brief, [Lewis] failed to maintain adequate records in multiple instances, prescribed more than the regular dose of medication in six instances to two patients, and failed to order tests with respect to one patient. However, with the exception of V.C., a new patient about whom he was starting to gather information, all other patients were long-term patients and [Lewis] was familiar with their conditions and course of treatment. … There is no evidence that any patient was harmed by [Lewis’] failure to provide additional details in the patients’ charts, by his prescription of medication, or by his failure to order more frequent liver function tests for one patient, accordingly, discipline in the lower range of the spectrum is appropriate.

During the course of the hearing before Reyes, records from CURES were submitted to the judge. The judge wrote that the records confirmed that Lewis had followed the law. According to medical board documents, Reyes wrote:

No contrary evidence was presented to establish that [Lewis] failed to comply with the requirements” of state health laws.

With CURES in the mix, though, Lewis and the CMA had a tactical tool to challenge the Medical Board of California in the courtroom. Now they could attack the board’s ability to even use CURES to track doctors. I’ll write more about this strategy in my next post.

Photo by Joel via Flickr.