Q&A with Dr. Scott Bickman: An insider's view of a painkiller mill and a dangerous clinic
The characters in Antidote's Shadow Practice series have mostly lived, as the title implies, in the shadows.
These are doctors who have operated on the fringe. Disciplined by medical boards or investigated by federal agencies, they found their niche in the cash-only world of immigrant clinics and cheap plastic surgery.
Dr. Scott Bickman came out of the shadows recently to provide Antidote with an insider's view of one of the most troubled clinics in California: the Anaheim Hills Surgery Center. The clinic has gone by a number of names over the years, and it has seen a revolving roster of surgeons who have run afoul of state and federal laws. Most recently, it was part of a massive painkiller mill, and it was the site of the completely avoidable death of Maria Garcia, who was allowed to bleed to death during back-to-back plastic surgery operations.
Bickman got caught up in the clinic's web when he agreed to let Dr. Harrell Robinson use his U.S. Drug Enforcement Administration (DEA) registration number to order drugs. That move cost him his registration and has sidelined him from his chosen profession: anesthesia.
His story takes him from some of the most prestigious medical institutions in California to some of the most disparaged. He was candid throughout my conversations with him and never declined to answer a question. If anything, he tended to repeat himself because, as he told me in an email, he wants:
to make certain that you clearly understand some of my feelings about the DEA, Harvard, and The System which clearly failed and allowed my Civil Rights to clearly be violated most probably intentionally. I think the Public needs to be informed of how this happened and is the DEA truly fighting The War on Drugs or is it a facade.
To believe his version of events, one has to take a few leaps of faith. One also has to believe that Bickman is nothing but a victim. I leave that up to the Antidote audience to decide.
Regardless of whether you believe everything he says, Bickman provides some valuable insights into how California's unregulated surgery centers are allowed to operate with little scrutiny. He also raises some important questions about whether we are getting much bang for our buck from federal efforts to crack down on painkiller mills like the one where he worked.
I reached him at his home in Southern California. The first part of our interview has been edited for space and clarity. The subsequent parts will run next week.
Q: You trained as an anesthesiologist, right? Where did you start your medical practice?
A: I went to medical school at USC and did my residency at the former Wadsworth Hospital, which was affiliated with UCLA. I finished in 1991, took the boards and then started my own practice in 1995. I was at Cedars Sinai for about three years and then worked at Sherman Oaks fulltime. That ended when I had a patient pass away. The patient died several days postoperatively from what the autopsy determined was a myocardial infarct suffered intra-operatively.
Q: This was the patient that resulted in charges from the Medical Board of California, and you were ultimately put on probation, right?
A: Yes. But the probation was for a record-keeping issue. Everything was fine with the surgery. There were no issues. She was just being sedated, and then the surgery happened. Then she was brought out of the surgery. But something had to have happened to her surgically, whether it was the cement the surgeon was using or I'm not sure what, but she ended up going into cardiac arrest. She was revived through CPR, but then she didn't make it. The etiology was probably due to extreme hypotension secondary to a surgical problem or an anaphylactic reaction to cement the surgeon used just prior to the patient arresting.
Q: The surgeon was never accused of anything by the medical board, though, right?
A: No. They just got me for a record -keeping issue. That's it. The records didn't reflect accurately her blood pressure, her pulse and what was done during the surgery. I needed to make the record more accurate. I spoke with the nursing supervisor and the head of anesthesia, and they said that I should do a second record just for that portion of the surgery. That was when all hell broke loose. People saw the creation of a second record as my being dishonest. But the record did not accurately reflect her blood pressure and pulse during the CPR portion of the operation because my attention was focused on direct patient care.
Q: What were you trying to accomplish by creating a second record?
A: The blood pressure and pulse that I had written down were too high. I knew they were too high, and I knew that this might become a legal case. I knew that people would question it. What I had written down wasn't reflective of the fact that she actually had no pulse and she had no blood pressure. Since the record was so disastrous in terms of how it was looking, I thought I needed to correct the portion of the record where she had coded so that the record accurately reflected what happened to her during that time.
Q: By "coded," you mean when "code blue" was declared and efforts were made to resuscitate her, right?
A: Right.
Q: I'm still not really understanding you. Why were the notes that you took during the surgery itself not accurate to begin with?
A: We were so busy taking care of her that the things I jotted down were not accurate.
Q: Are your notes during your surgeries usually not accurate?
A: No. They are. But this was a difficult case.
Q: So how did you know whether your notes were correct or incorrect?
A: Because the machine was still on, taking her readings, and I could go back and take a peek and see what the numbers really were. The nurse was going to write down whatever I had, but I said, "I don't want you to do that" because I knew that wouldn't be good.
Q: So because of this case you were let go from Sherman Oaks?
A: No. But the surgeon was such a jerk and let me hang out to dry on that case that I quit.
Q: Were you sued in that case?
A: Of course. They settled it under the California malpractice limit of $250,000. My insurance company paid it. It didn't even go to court. The surgeon went out to the family and said, "The anesthesiologist killed your mother." The fact that he did that really put me behind the eight ball. And that was not what happened at all. The medical board found that the record-keeping was an issue. Nobody seemed to care that I had asked the nursing supervisor and the chief of anesthesia how to handle it. They advised me to construct a second anesthesia record to make the appropriate corrections just for the portion involving CPR to supplement the original and in fact be exactly representative of the moment-to-moment care and vital signs.
Q: Was it your impression that changing the medical records in this way was done with some frequency?
A: No. They clearly hadn't done this very often. Clearly this was a situation which was unique for everyone concerned. And if they had been doing things this way, they probably wouldn't have put all the blame on me and left the impression that I was concealing something. The fact that a second record was created to supplement the first, even though it revealed much lower vital signs, was a problem for the medical board.
Q: Where did you work after that?
A: I went to work for a plastic surgeon who was a good friend of mine in medical school who opened a surgical center. I never went back to a hospital-based practice. I was making good money at surgery centers, and I didn't need the politics and the aggravation of hospitals. That's where I met Harrell Robinson.
Q: Where exactly?
A: At an outpatient center in Beverly Hills.
Q: Do you remember the name?
A: I don't, but it was on Roxbury Drive. I didn't even get to know him. The nurse from the center acted as a coordinator and hired the doctors independently. We worked together on two or three cases, and that was it. Then by chance we worked together at this other place in the valley called South Pacific Surgery Center in Encino.
Q: What did you think of Robinson as a surgeon?
A: I thought he seemed OK. He was a very friendly guy, which was the problem.
Q: Why was that a problem?
A: Because I didn't suspect that he would do anything wrong. He presented himself as a church-going family man. He took control of Chaparral. I don't know what happened there, but he took over the surgical center.
Q: You mean 145 S. Chaparral Court?
A: Right. He took it over, and he said, "Do you mind coming down to help me out at the surgical center?" I didn't suspect anything. I just thought he needed some help, so that's what I did. I gave them copies of my DEA registration information, my malpractice information, my license information, everything. I worked there in 2007, and, as far as I knew, there were no problems going on there at the time I was there.
In 2007, retrospectively, I learned there were three pharmaceutical companies where Dr. Robinson had opened accounts using my DEA registration. He was ordering so much hydrocodone that the ARCOS report the DEA uses to track physician prescriptions of controlled substances placed me at number 47 and Dr. Robinson as the sixth largest prescriber for California in 2007.
Yet, not one of those drug companies ever tried to contact me or came to my office and did anything to verify that it was OK for me to be prescribing that many drugs. Because if they had, they would have found out that someone else was using my DEA number.
Next: Did the DEA let painkiller mill fester while it fried bigger fish?