(February 5, 2013): In late December 2012, the Texas Medical Board and the Texas Physician Assistant Board announced that they had suspended or restricted the licenses of seventeen physicians and four physician assistants as part of coordinated “Pain Clinic Takedown.” These licensing Boards met over a two-week period in back-to-back disciplinary hearings last December and took action against multiple licensed clinicians in connection with their pain clinic activities. Commenting on the massive enforcement action taken, Dr. Irvin Zeitler, Jr., the President of the Texas Medical Board said:
"This represents more than two years of hard and sometimes dangerous work by TMB staff. . . . . The doctors and physician assistants involved in these illegal operations have been fueling an epidemic of prescription drug abuse and fraud that is killing more people than heroin and cocaine combined. We hope this sends the message that pill mills aren't welcome in Texas."
According to the Texas Medical Board, when handling this investigation, their staff worked closely with officials of the Drug Enforcement Administration, the Texas Department of Public Safety, the Texas State Board of Pharmacy, the Texas Board of Nursing and local law enforcement authorities in and around Houston.
A review of the following pain clinic related disciplinary action examples can be quite instructive and can give a real sense of the specific concerns presented by the clinicians’ conduct. These risk areas can be incorporated into your practice’s Compliance Plan, and can be used to strengthen your efforts to ensure that subordinate licensed clinicians are properly supervised and that pain medications are appropriately handled.
Disciplinary Case -- Physician #1: A disciplinary panel of the Texas Medical Board temporarily suspended license of this licensed physician, ruling that he posed a “. . . continuing threat to the public welfare due to his failure to adequately supervise mid-level providers and due to inappropriate prescribing of controlled substances.” Physician #1 was responsible for supervising advanced practice nurses and physician assistants who prescribed controlled substances without a legitimate medical need.
Disciplinary Case -- Physician #2: As in the earlier case, a disciplinary panel of the Texas Medical Board temporarily suspended license of this licensed physician, ruling that he posed a “. . . continuing threat to the public welfare due to his failure to adequately supervise mid-level providers and due to inappropriate prescribing of controlled substances.” Physician #2 was responsible for supervising advanced practice nurses and physician assistants who prescribed controlled substances without a legitimate medical need.
Disciplinary Case -- Physician #3: A disciplinary panel of the Texas Medical Board temporarily suspended license of this licensed physician on the basis that he posed “. . . a continuing threat to the public welfare due to his failure to adequately supervise mid-level providers and due to inappropriate prescribing of controlled substances.”
Disciplinary Case -- Physician #4: A disciplinary panel of the Texas Medical Board temporarily suspended the license of a physician on the basis that he posed “. . . a continuing threat to the public welfare due to his improper and illegal operations of four pain clinics including two unregistered pain clinics and due to inappropriate prescribing of controlled substances.”
Disciplinary Case -- Physician #5: A disciplinary panel of the Texas Medical Board temporarily restricted the medical license of this physician and ordered him to immediately surrender his DEA/DPS controlled substance certificates. The physician was also “. . .prohibited from treating chronic pain patients and shall not supervise or delegate prescriptive authority to physician extenders”. The Board further found that the physician posed “. . . a continuing threat to the public welfare due to his improper and illegal operation of a pain management clinic based on his inappropriate ownership and unlawful method and manner of prescribing controlled substances.”
Disciplinary Case -- Physician #6: A disciplinary panel of the Texas Medical Board temporarily restricted the medical license of this physician, requiring that she immediately cease treating chronic pain patients and surrender her DEA/DPS controlled substance certificates. In addition, the physician was “. . . prohibited from supervising or delegating prescriptive authority to physician extenders, may not prescribe for herself or her family and must surrender any Pain Management Certificates issued to her by the Board” . The TMB further found that the physician’s “. . . continued practice of medicine [posed] a continuing threat to public welfare, and that she failed to adequately supervise advanced nurse practitioners and/or physician assistants at two pain clinics.”
Disciplinary Case -- Physician Assistant #1: A disciplinary panel of the Texas Physician Assistant Board temporarily restricted the license of this physician assistant, thereby “ . . . immediately prohibiting him from the practice of treating chronic pain patients and requiring him to surrender the DPS/DEA certificates that allow him to prescribe controlled substances.” The Board further found that the licensee posed “. . . a continuing threat to the public welfare because he inappropriately prescribed controlled substances and was not adequately supervised by a physician”.
Disciplinary Case -- Physician Assistant #2: A disciplinary panel of the Texas Physician Assistant Board temporarily the license of this physician assistant after determining that her continued practice of medicine posed “. . . a threat to public welfare”. The Board's order prohibits the physician assistant from “. . . treating chronic pain patients and requires her to surrender her DPS/DEA certificates that allow her to prescribe controlled substances”. The TPAB further found that the physician assistant poses “. . . a continuing threat to the public welfare because she participated in the illegal operation of a pain clinic and inappropriately prescribed controlled substances.”
As these examples reflect, both the Texas Medical Board and the Texas Physician Assistant Board take controlled substances quite seriously. Physicians responsible for supervising subordinate physician assistants and nurse practitioners with prescriptive authority have an affirmative obligation to properly oversee and manage these professional staff members and their pain management practices.
Should you receive notice that a complaint has been filed against you or your practice with the Texas Medical Board or the Texas Physician Assistant Board, it is essential that you take such a matter seriously. The informal and formal hearing processes are fairly complex. If at all possible, don’t try to handle this alone – retain experienced legal counsel to represent your interests.
Robert W. Liles and other Liles Parker attorneys are experienced in representing physicians and other licensed clinicians in front of the Texas Medical Board and its associated non-physician licensing Boards. Should you have any questions, call Robert for a free consultation. He can be reached at: 1 (800) 475-1906.
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