Not so lucky in Kentucky

[Agast]

Pain Management Physician and Former Member of Kentucky’s Medical Board Convicted of Unlawfully Prescribing Opioids

In his role at the KBML (Kentucky Board of Medical Licensure), Fletcher oversaw disciplinary proceedings against physicians, including those who improperly prescribed controlled substances. However, Fletcher was also illegally prescribing opioids to IPS patients, including some who had tested positive for hard street drugs like cocaine and heroin, in part so he could perform and bill for lucrative and often medically unnecessary procedures on the same patients. Trial evidence showed that seven IPS patients died of drug-related complications shortly after being prescribed opioids by Fletcher.

If he was a peer reviewer for the Kentucky medical board I’m surprised his practice wasn’t cleaner. Anyone know this guy?

This is also a reminder that anyone who tests positive for illicts needs to be discharged from your practice. It doesn’t matter how much of a good doctor you’re trying to be, it *will* be held against you later.

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[TheLoneWolf]

Pain Management Physician and Former Member of Kentucky’s Medical Board Convicted of Unlawfully Prescribing Opioids


If he was a peer reviewer for the Kentucky medical board I’m surprised his practice wasn’t cleaner. Anyone know this guy?

This is also a reminder that anyone who tests positive for illicts needs to be discharged from your practice. It doesn’t matter how much of a good doctor you’re trying to be, it *will* be held against you later.

Reminds me of a podcasr lecture from a couple of years ago. They said 2 former presidents of a state pain society were arrested by the DEA and looking at serious jail time. I wanna say Alabama, but not sure.

 

[lobelsteve]

Pain Management Physician and Former Member of Kentucky’s Medical Board Convicted of Unlawfully Prescribing Opioids


If he was a peer reviewer for the Kentucky medical board I’m surprised his practice wasn’t cleaner. Anyone know this guy?

This is also a reminder that anyone who tests positive for illicts needs to be discharged from your practice. It doesn’t matter how much of a good doctor you’re trying to be, it *will* be held against you later.

Fire the meds, not the patient. They will not come back.

 

[au bon pain]

Fire the meds, not the patient. They will not come back.

Kinda amazing how some docs fail to do this.
Creating a scenario that could be viewed as patient abandonment doesn’t help anybody.
Minimum of 30 days to assist/offer as indicated with non-opioid pain options, withdrawal symptom management, list of other pain clinic contact info, and list of SUD resources with contact information.

 

[SSdoc33]

Kinda amazing how some docs fail to do this.
Creating a scenario that could be viewed as patient abandonment doesn’t help anybody.
Minimum of 30 days to assist/offer as indicated with non-opioid pain options, withdrawal symptom management, list of other pain clinic contact info, and list of SUD resources with contact information.

All for a 99214.

Why do you guys torture yourselves?

 

[Laryngospasm]

Offer meds to help with withdrawal psych and addiction referral.. they will not return and you did everything reasonable. Just don’t give them more opioids.

 

[bedrock]

All for a 99214.

Why do you guys torture yourselves?

Agree. I’m so much happier since I stopped doing COT.

 

[Laryngospasm]

I’m done torturing myself lol

 

[au bon pain]

All for a 99214.

Why do you guys torture yourselves?

I’ve had to do this 0 times in the last several years but when I do it’s not for the sake of the 99214. It’s to sleep better knowing I did right by the patient and protected my livelihood. While it can suck, it’s often not that bad as patients often walk out or don’t show up in the first places--I’ve still had staff mail the patients lists of other pain clinics and SUD resources.

I’ve recommended COT for 0 non-palliative patients. Don’t actually prescribe unless it’s part of a very temporary plan with patient’s PCP to help rotate and taper them (usually 3-6 months). I probably have less than 5 of these at any time. And if patient refuses to taper further they go back to their PCP.

My market is saturated and the vast majority of pain docs and their midlevels would happily throw oxy at Uncle Joe’s hammer toe or Aunt Gina’s bursitis du jour. So unfortunately gigs without regular COT prescribing are very uncommon here. My job shields me from much of this crap and I do feel like I’m helping folks by making their regimens safer. That said, I’d like to get to a point where I don’t have to write for anything as shedding all the drama entirely for a molecule that doesn’t work would definitely make some days more enjoyable.

 

[PinchandBurn]

Fire the meds, not the patient. They will not come back.

So in the article it appeared he was in trouble because "hard drugs" were done concurrently by patients. These included coccaine and heroin.

What if the patients were doing Marijuana?

If he knowingly ignored things. That could be an issue.

 

[lobelsteve]

Document a plan for what you are doing with the test results.
For THC you better show increased frequency of testing, counseling, DC meds when appropriate.
Until the DEA deschedules or it becomes legal federally.

 

[BobBarker]

It is getting moved to schedule 3 in a few months.

 

[lobelsteve]

It is getting moved to schedule 3 in a few months.

This does not change anything for me.
Unscheduled and I would possibly stop testing.

 

[au bon pain]

This does not change anything for me.
Unscheduled and I would possibly stop testing.

Do you test for EtOH?

 

[lobelsteve]

Do you test for EtOH?

Nope.

 

[Ducttape]

i do when the situation is appropriate.

 

[smarterchild]

Nope.

We've always maintained a zero tolerance policy for alcohol use for patients on opioids. Usually will give them a warning if it happens once and we test 3x a year.

If a patient has a complication from using your prescribed opioids and alcohol, can you be held responsible for this if you were not testing for alcohol? I ask this because we do a lot of the alcohol testing through Quest and often do get pushback from patients. We do not have a lab so it is time consuming preparing all the samples to be picked up Quest. I am wondering if we are overtesting patients? We typically do not exceed 30MME in our practice.

If you have any articles to support this, I would appreciate it if you could share so I could bring to my partners.

Thanks

 

[lobelsteve]

We've always maintained a zero tolerance policy for alcohol use for patients on opioids. Usually will give them a warning if it happens once and we test 3x a year.

If a patient has a complication from using your prescribed opioids and alcohol, can you be held responsible for this if you were not testing for alcohol? I ask this because we do a lot of the alcohol testing through Quest and often do get pushback from patients. We do not have a lab so it is time consuming preparing all the samples to be picked up Quest. I am wondering if we are overtesting patients? We typically do not exceed 30MME in our practice.

If you have any articles to support this, I would appreciate it if you could share so I could bring to my partners.

Thanks

Alcohol is legal in 50 states. Recommend against drinking and warning regarding combined effects provided.
You can also do the same for any sedating med: benadryl, SMR, gabapentin.
You can also set up your practice to not see anyone with BMI > 30, tobacco use, psychiatric comorbidity- all increase risks.

 

[Ferrismonk]

Alcohol is not the same as other sedating drugs. Relevant black box warnings:

Alcohol - "Instruct patients not to consume alcoholic beverages or use alcohol-containing drug products while taking (opioid) due to risk of additive sedation and respiratory depression.

vs.

CNS depressants - "Reserve concomitant prescribing for use in patients for whom alternative treatment options are inadequate, limit dosages and durations to the minimum required; and follow patients for signs and symptoms of respiratory depression and sedation."

We test for alcohol and it's metabolites and will discharge (the opioid) if repeatedly positive. Same for THC.

 

[Ferrismonk]

All for a 99214.

Why do you guys torture yourselves?

It pays more than a CESI?