Florida Physician Accused of Overprescribing Pain Meds is Permanently Barred from Treating Pain Patients by Board of Medicine

Tuesday, January 26, 2016
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health

The Florida Department of Health (DOH) filed an administrative complaint against central Florida physician, Dr. Frances F. Cruz-Pacheco, M.D., on November 24, 2014.  The complaint alleged that Dr. Cruz-Pacheco provided care and treatment during a specified time period for a particular patient whose untimely death on April 28, 2012, was the result of multiple drug intoxication.  The DOH alleged that certain medications prescribed by Dr. Cruz-Pacheco including alprazolam, methadone and hydromorphone, contributed to the patient’s death.  
Dr. Cruz-Pacheco entered into a settlement agreement with the DOH on February 13, 2015, in order to resolve all allegations of wrongdoing.  As part of the settlement, the physician was fined $30,000.  She was further permanently restricted from practicing in pain management clinics and from treating any patients with “chronic, malignant pain” as defined by Florida law

The Florida Board of Medicine approved the settlement agreement and entered a Final Order on December 15, 2015.


The Extent of the Allegations.


The DOH claimed, in its complaint, that Dr. Cruz-Pacheco violated Section 458.331 (1), Florida Statutes, in part, by failing to do the following:

(a)    Obtain a full medical history, including consulting with prior physicians or other specialists who previously treated the patient;

(b)    Complete a full physical examination and other relevant testing prior to prescribing;

(c)    Refer patient for psychiatric evaluation and physical therapy;

(d)    Maintain accurate and comprehensive medical records on patient;

(e)    Attempt alternate treatment options; and

(f)    Implement a consistent treatment plan with regular monitoring of patient’s compliance and potential substance abuse.

To read the full administrative complaint, settlement agreement and Final Order by the Florida Board of Medicine, click here


The "Big Deal" With Overprescribing.


The Department of Health and Human Services (HHS) Office of Inspector General (OIG) published a report in June 2013, to address prescription drug abuse which it believed to be a serious and growing problem in the United States.  It reported that the Centers for Disease Control and Prevention (CDC) characterized prescription drug abuse as an epidemic.  In 2010, it was found that approximately seven million people in the United States, were misusing prescription drugs.  Furthermore, overdoses of prescription painkillers ranks as one of the leading causes of accidental death in the U.S.

To read one of my previous blogs related to the crackdown on “pill mills” in Florida, click here

The government noted that along with the rise in prescription drug abuse, concerns about Medicare fraud (particularly prescriber fraud) related to pain prescriptions have increased as well.  As a result, the Centers for Medicare & Medicaid Services (CMS) implemented four recommendations by the OIG to better detect and deter fraudulent prescribing practices including:

(1)    Instruct the Medicare Drug Integrity Contractor to expand its analysis of prescribers;

(2)    Provide sponsors with additional guidance on monitoring prescribing patterns;

(3)    Provide education and training for prescribers; and

(4)    Follow up on prescribers with questionable prescribing patterns.

To read the full report by the OIG entitled Prescribers With Questionable Patterns in Medicare Part D, click here


Tips for Safeguarding Your Medical License.


Fairly recent enacted legislation in Florida placed more stringent restrictions on physicians prescribing controlled substances and established reporting mandates for those practitioners treating patients with chronic pain.  Since the implementation of this new legislation, a rise in disciplinary actions has been seen before the Florida Board of Medicine.  In 2010, there were 215 administrative complaints filed or investigations opened in Florida related to overprescribing of pain medications.  In 2011, this number increased to 332 complaints or investigations opened relating to the same matter.  Whether the numbers will continue to increase or will taper off in the face of more aggressive regulatory action is yet to be determined.  

While most physicians may simply be pawns in patients’ “pill shopping” schemes to acquire drugs, their perceived innocence is not always a sufficient defense against a complaint or in the midst of an investigation.  Physicians can still be held responsible for negligent overprescribing even if they had no intention of actually committing the offense.  Since pain is not necessarily a measurable condition and physicians are at the mercy of patients’ testimony in assessing it, physicians need to be diligent enough to safeguard themselves against potential liability.  

Maintaining comprehensive patient charts are essential to justifying patient prescriptions should a medical board be inquisitive as to a physician’s prescribing practices.  Furthermore, remaining astute and attentive to red flags in patients seeking pain medications will save the physician an immense amount of grief later on down the road.  Thoroughly screening each patient, accessing patient database information and documenting detailed notes will better ensure compliance with physician responsibilities in prescribing controlled substances.  

For more ideas on how physicians might protect themselves from drug-seeking patients, click here to access our resources page for Legal Tips for Physicians to Manage Pain Patients


Comments?


Have you ever been accused or suspected of overprescribing controlled substances?  Are you currently a physician regularly treating pain patients and prescribing pain killers? 


Contact Health Law Attorneys Experienced in the Representation of Health Professionals and Providers.


The attorneys of The Health Law Firm provide legal representation to physicians, nurses, nurse practitioners, CRNAs, pain management doctors, dentists, pharmacists, psychologists and other health providers in different cases involving allegations of overprescribing narcotics and pain medications, in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare investigations, Medicaid investigations and other types of investigations of health professionals and providers.  These include criminal investigations by local police and law enforcement authorities, investigations by the U.S. Drug Enforcement Agency (DEA), complaints against professional licenses by the Florida Department of Health (DOH), investigations and prosecutions by the Medicaid Fraud Control Units (MFCU), and other types of cases.  We have represented professionals in administrative investigations and administrative hearings at both the state and federal level.

To contact The Health Law Firm, please call (407) 331-6620 and visit our website at www.TheHealthLawFirm.com.


Sources:


Administrative Complaint 2-10, Nov. 24, 2014.

Settlement Agreement 2 & 6, Feb. 13, 2015.

Jurkowitz, Nicholas D. and Mir, Farooq.  “Overprescribing and Medical Board Enforcement: How to Avoid Discipline.”  Becker’s Hospital Review: 22 Jan. 2013.  23 Jan. 2016.

Levinson, Daniel R.  "Prescribers With Questionable Patterns in Medicare Part D."  Office of Inspector General, Department of Health and Human Services: June 2013.  Web.  23 Jan. 2016.


About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida area.  www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.


Keywords:
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1/26/2016

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