Order - Maryland Board of Physicians

IN THE MATTER
OF
NEAL 1. ARONSON, H.D.
*
BEFORE
THE
*
STATE
BOARD
*
QUALITY
*
Case Number:
Respondent
License Number: DOO150
*
*
*
*
*
*
*
*
CONSENT
PROCEDURAL
The State
on June
26,
"Respondent")
Maryland
Occ.
Board
1996,
§14-404
Practice
Act
*
96-0089
*
*
*
*
*
ORDER
Quality
to charge
(D.O.B. 7/22/26),
Medical
ASSURANCE
BACKGROUND
of Physician
voted
OF PHYSICIAN
Assurance
Neal
License
(the "Board"),
M.D.
1. Aronson,
Number
(the "Act"),
DOO150,
Md.
Code
under
Ann.,
(the
the
Health
(a) (22) .
Specifically,
the Board
charged
that
the Respondent:
(22) Fails
to
meet
appropriate
standards
as
determined
by appropriate
peer review for the
delivery of quality medical and surgical care
performed
in an outpatient
surgical facility,
office,
hospital,
or any other
location
in
this State;
The Respondent
by representatives
Prior
to the
entered
Pursuant
into
to
was
subsequently
of the Office
issuance
with
negotiations,
of the Board's
of the Attorney
of a Statement
negotiations
these
notified
the OAG
of
General
Charges,
the
to resolve
the Respondent
before a Board Case Resolution Conference
vote
("OAG").
Respondent
these
charges.
agreed to appear
("CRC"), which was held
£,
on November
before
1997.
the Respondent
the CRC,
Order,
of
consisting
Conclusions
As a result
agreed
Procedural
and
to enter
entered
into
this
into
Consent
of
Findings
Background,
FactI
of Law and Order.
FINDINGS
At
1.
of negotiations
all
times
relevant
is a physician
licensed
He was
initially
Maryland.
OF FACT
to these
to practice
licensed
charges
Respondent
I
medicine
in the State
in Maryland
on February
was
of
151
1957.
At the time of the acts described
2.
was and is engaged
The
3.
Neurology
in Baltimorel
Baltimorel
5.
Medical
Association
review
Control
6.
I
has
Hopkins
privileges
I
the
following
to a patient
11, 1995,
survey
23
a referral
(MDDC) to the Board
on the drug
Surgery.
for
the practice
of
at
Sinai
Hospital
of
Hospital.
February
received
prescribing
On July
an office
the Respondent
Maryland.
On or about
questionable
based
Johns
I
of Neurological
maintains
Respondent
BCGI
incident
Drug
Respondent
The
4.
in the practice
herein
the
19941
from Patient
County
from the BPQA to conduct
reporting
of
requested
A's
Quality
Division
of
Control.
a practice
incident
an
Respondentls
by the Maryland
of Physician
the Board
Baltimore
review.
review
7.
On
conduct
August
drug
a
16,
1995,
survey
the
Board
requested
the
Respondent's
regarding
that
the
MDDC
prescribing
practices.
8.
On or about August/September
findings
of the drug
On September
9.
Review
survey
Management
Facul ty
of
Respondent's
10.
PRC
requested
conduct
that
the Peer
and Chirurgical
a practice
review
of the
practice.
the
a practice
the
the Board
(PRMC) of the Medical
(Med-Chi)
Thereafter,
conducted
review,
Committee
medical
the
to the Board.
22, 1995,
Maryland
1995, the MDDC submitted
review
medical
records
a drug
survey
provided
Review
of the Respondent's
evaluated
office
Peer
Med-Chi
a
series
identified
by
the
of
through
Board
for
and
January
the
schedule
Additionally,
the Board
provided
requested
be
included.
Two
conducted
a review of a total of nineteen
five
peer
Respondent
(5) patient
reviewers
I
s patient
selection
Respondent's
through
appointment
In its
practice.
a random
the
(PRC)
Committee
office
August
names
1995.
that
designated
(19 )
from
patient
by
they
PRC
medical
records.
11.
Board
On April
regarding
26,
1996, the PRC submitted
the nineteen
(19) patient
3
records
a report
reviewed
to the
by both
peer
reviewers.
The
the
Respondent
PRC report
failed
to
concluded
that
appropriate
meet
the care
standards
given
by
for
the
delivery of quality medical care.
12.
Of
reviewers
the
agreed
nineteen
that
the standard
patient
records.
The
medical
practice
failed
seven (7) patient
13.
Respondent
the
peer
of care was met in eleven
(11)
patients
concur
reviewers
to meet
reviewed,
that
appropriate
the
Respondent's
standards
of care
in
records.
General
were
(19)
in
deficiencies
found
the
care
provided
by
the
as follows1:
a.
Over prescriptions
of, or inappropriate
prescriptions
of
controlled drug substances
(CDS), including CDS narcotic
medications
and other non-CDS medications;
b.
Inappropriate
and
frequent
prescription
of
CDS
medications
and
other
habituating
and
abusable
medications to known or suspected drug abusers;
c.
Inappropriate
prescription
pain patients;
d.
Failure to implement treatment modalities
for pain other
than the prescription
of CDS pain medications;
e.
Continued
prescriptions
for medication
the last recorded office visit;
of pain medications
years
The general deficiencies
are based upon
deficiencies
noted in the review of Patients
1-7.
4
to chronic
after
the collective
g.
Failure
h.
Failure
to
prescriptions
1.
Failure
recordi
j.
Failure to indicate the amount of medication
dispensed, especially after it had been prescribed
once.
14.
In addition
to monitor
to record
and
PATIENT
In
levelsi
and
with violations
patient-specific
refilled
in the patient
information
of H.O.
the Board
§14-404(a)
further
(22) based
information.
SPECIFIC
ALLEGATIONS
12
Patient
1, a thirty-six
year
and was
initially
and treated
May
drug
all prescriptions
to the above
the Respondent
the following
therapeutic
document
renewed
appropriatelYi
PATIENT
1987
long
Continued prescriptions for medication
periods with no follow-up care providedi
charges
upon
for
f.
1990,
Correspondence
1 continued
seen
Patient
1
was
concerned
Patient
According
to Patient
1
left
lis records
To ensure confidentiality,
in this Consent Order.
neck
somewhat
to
and
5
the
arm
names
Respondent.
noted
pain
addicted
in July
neurosurgeon.
surgeon
the Respondent
patient
injured
by another
orthopaedic
sided
"may be
was
referred
from the referring
to have
old female,
to
and he was
narcotics."
prescribed
are not
Patient
Vicodin
set forth
(50) , a
Hydrocet
(*3), a Schedule
Since
varlous
Patient
through
psychiatric
or poorly
The
prescribing
physician
evaluation
Patient
use and drugs
However,
the
a plan
non-steroidal
Respondent
10/01/90,
prescribed Hydrocet
Patient
open
that
(*)
on
be developed
04/05/91.
her
subjective
that
cervical
II,
The
discontinue
drugs
1 be
(NSAIDS)
Vicodin
(* )
(50) .
.
on
He
and 03/11/91.
discectomy
On April
the limit
that Patient
and, 3/25/91
02/26/91,
her
schedule.
to
prescribing
on 02/04/91,
1 had an anterior
discometry
on a fixed
1
for vague
with her and define
12/14/90,
an
Patient
recommended
anti-inflammatory
11/01/90,
that
by
and recommended
continued
for
procedures
solely
be given
for
A comprehensive
recommended
evaluation
for pain
psychiatrist
or therapeutic
make a contract
l's use of narcotics
with
1990
a
and
on 07/26/90.
surgeries
workers.
diagnosed
psychiatric
suggested
treated
09/12/90,
in August
conditions
complaints.
to
case
6/21/90,
analgesic,
multiple
referred
any diagnostic
defined
of her narcotic
was
on
analgesic,
III CDS narcotic
rehabilitation
evaluation
not have
narcotic
1 had undergone
she
maladies,
evaluation
should
III CDS
Schedule
1991
and fusion
the
after
Respondent
The asterisk (*) signifies there was a refill but the
quantity of medication
dispensed
was not indicated
in the
Respondent's medical record.
6
noted
that
doing
his best
(*)
(* )
Patient
to confront
on OS/24/91,
on
1 may have a moderate
Extra
her.
The Respondent
Strength
Tylenol
(*) and
Vicodin
06/0 7 / 91,
drug dependency
prescribed
Vicodin
(50) on OS/28/91,
Vicodin
Soma
substance,
on 06/21/91
and Vicodin
07/29/91,
08/09/91,
08/20/91.
On
prescribed
Vicodin
Soma
on
(* )
12/06/91,
12/20/91,
Additionally,
10/14/91
09/1 7/91,
and Hydrocet
On February
she was using
Soma
(*)
01/03/92,
17, 1992
on
(*)
March
"admonished"
Patient
continued
refill
to
the Vicodin
the Respondent
too much medication
and Vicodin
Again,
with
(*)
25,
1992,
1 regarding
the
for
11/25/91,
02/05/92.
Strength
Tylenol
on
informed
Patient
1 that
her prescriptions
for
and 03/09/92.
Respondent
her abuse
prescriptions
(*) and
and Soma on 02/05/92.
but renewed
on 02/17/92
07/15/91,
Vicodin
01/31/92,
Extra
non-
Respondent
11/11/91,
01/17/92,
prescribed
on
the
08/28/91
10/28/91,
abusable
(* )
(*) and refilled
10/01/91,
the Respondent
an
(*) ,
controlled
(50) and Soma
and he is
noted
that
but
of her medications
Vicodin
(*
)
and
Soma
he
( *)
on
04/23/92,
05/14/92,
06/04/92,
06/25/92,
07/16/92,
08/06/92,
08/27/92,
09/17/92,
10/08/92,
07/09/93,
07/30/93,
08/20/93,
09/10/93,
10/01/93,
10/22/93,
11/12/93,
12/03/93,
12/23/93,
01/14/94,
02/04/94,
02/25/94,
03/18/94,
04/08/94,
04/29/94,
7
OS/20/94,
06/10/94,
07/01/94,
07/22/94/
08/12/94/
09/02/94/
09/23/94/
10/14/94/
11/04/94/
11/25/94/
12/16/94/
01/06/95/
01/27/95,
02/17/95/
03/10/95/
03/31/95/
04/21/95/
05/12/95/
06/02/95/
07/14/95/
06/23/95/
On September
her that
the
20, 1995 the Respondent
50 Soma
three weeks
and 50 Vicodin
Although
to
1 continued
prescribe
1 had
conceivable
future
to be
surgical
Patient
she was
and Soma
maintained
failed
1 and told
receiving
every
and
to an additional
that
of Patient
there was some concern
he first
Soma
not
need
noted
surgery
1 would
on
8
and Patient
and
1 was a very
10/17/94
that
at C3-4 and it is
stabilized
probably
and maintained
failed to meet the standard
1 as follows:
The
her.
that Patient
to be
saw her, he
on narcotics
and some sublaxation
would
to
followed
Respondent
Respondent
that Patient
unnecessary
The Respondent
by the
The
level
indicating
were
The
on 10/13/95.
(*)
when
to recognize
"hypermobility
that
that
to narcotics
narcotics
candidate.
pointll
treatment
(*)
of the psychiatrist
The Respondent
Patient
that
was aware
1 was addicted
recommendations
poor
Vicodin
the Respondent
that Patient
Soma.
called
09/15/95.
had to be cut down to 50 of each every month.
Respondent prescribed
continued
08/25/95/
08/03/95/
at some
be subject
on narcotics.
of care in his
a.
Over prescription
of, or inappropriate
prescription
of
Vicodin, a Schedule III CDS narcotic analgesic and Soma,
an abusable non-controlled
substance to Patient Ii
b.
Failure to attempt non-CDS
treatment of Patient Ii
c.
Failure to follow the recommendations
by continuing
to prescribe
Vicodin
contracti and
d.
Failure to document the amount
dispensed in the medical record.
PATIENT
modalities
for the
of the psychiatrist
and Soma without a
of
Vicodin
and
Soma
2
Patient
Patient
2, a seventy
had
2
on
performed
postoperatively,
a
right shoulder
around
posterior
2, 1992
neck was no better
According
Vicodin
December
(
*)
and
She
seemed
shoulder
continued
the Respondent
recorded
to
physician
than before
noted
surgery
that
fusion
do
well
to be a problem.
that
Patient
Patient
and continued
21S
of the muscles
but her neck was "doing beautifully."
However,
2 stated
to complain
her
of
pain.
to Patient
, a Schedule
20,
of neck pain.
decompression
was frozen and there was atrophy
I, 1992 another
shoulder
cervical
complained
1991.
20,
but her right
the shoulder
on July
year old female,
December
On February
right
treatment
1991
21s
records,
the Respondent
III CDS narcotic
surgery
on
06/09/92,
9
analgesic,
08/04/92,
prescribed
after
the
10/22/92,
12/28/92,
02/05/93,
03/22/93,
04/26/93,
OS/25/93,
09/13/93,
10/11/93,
11/18/93,
01/24/94,
03/21/94,
05/05/94,
06/20/94,
09/16/94,
10/31/94,
12/13/94,
02/09/95,
03/24/95,
05/03/95,
06/29/95,
09/07/95.
Patient
contact
had
2
with
the
Respondent
made no notations
prescriptions
repeated
regarding
after
July
the number
The
1, 1992.
of drugs
any
without
filled
Respondent
dispensed
each
time.
Although
severe carpal
There
Patient
2 had wasting
tunnel
in the hand and EMG evidence
it was never
was no indication
addressed
that the Respondent
2 with nonsteroidal..anti-inflammatories,
around
G.I. sYmptoms,
Patient
used
2 had chronic
other
a.
of Patient
by the Respondent.
tried
to treat
or attempted
to find ways
2 had them initially.
there
treatment
was no sign
that
Patient
Finally,
if
the Respondent
modalities.
failed to meet
the standard
of care
in his
2 as follows:
Over prescription
of, or inappropriate
prescription
Vicodin,
a Schedule
III CDS narcotic
analgesic,
Patient
b.
pain,
non-narcotic
The Respondent
treatment
if Patient
of
of
to
2;
Continued prescription of Vicodin for three
after the last recorded office visit;
10
(3 )
years
c.
Failure to implement treatment modalities
non-steroidal
anti-inflammatoriesi
and
d.
Failure
PATIENT
to record
the amount
3, a 65 year
old
The Respondent
first
saw Patient
complained
acute
pain
knee.
of
Patient
cervical
and lumbar
symptoms
the
were
Patient
was
According
two
(
*)
1989.
multiple
and
surgeries
3
right
on her
3 on July II, 1991 after a fall six
noted
A note
that
by
dated
none
of
Patient
3 IS
3's last documented
January
another
a Schedule
2, 1992
to
physician
II CDS narcotic
indicated
write
analgesic,
a
for
(2) weeks.
to Patient
1995 the Respondent
Valium
in June
II, 1990. ",Patient
22, 1991 was Patient
asked
for Tylox,
3 every
injured
arm, low back,
neck,
undergone
Respondent
August
new.
Respondent
was
3 on January
saw Patient
to the Respondent.
prescription
(with
dispensed.
spine.
The
earlier.
female,
in her
3 had previously
The Respondent
visit
of Vicodin
included
3
Patient
days
that
3's records,
prescribed
) ,
50 Tylox
from January
to Patient
1992 to April
3 on 01/02/92
01/30/92,
02/17/92,
03/02/92,
03/17/92,
04/02/92,
04/16/92,
05/04/92,
05/19/92,
06/08/92,
06/26/92,
07/15/92,
08/06/92,
08/25/92,
09/14/92,
09/29/92,
10/12/92,
10/26/92,
11/09/92,
11/23/92,
12/07/92,
12/21/92,
01/11/93,
11
03/01/93,
02/17/93,
02/01/93,
06/09/93,
OS/21/93,
05/04/93,
50
Feldene
(2 0
mg
and
s)
07/29/93,
07/08/93,
Xanax
(with
08/25/93
09/30/93,
(1. 0 mg)),
30
04/19/93,
03/29/93,
03/15/93,
10/25/93,
11/25/93,
12/20/93,
01/31/94,
03/02/94,
04/01/94,
04/04/94,
05/04/94,
09/12/94,
11/17/94,
12/21/94,
03/21/95,
03/28/95,
04/25/95.
The
Respondent
for years
after
There
Patient
was
3 on
Respondent
abusable
Patient
The 50 pills
a month.
that
initially
the necessary
with Patient
3 to maintain
since
Successful
of Patient
there
Patient
was
no attempt
was
to take 1 every
use of narcotics
be taken
by the
or other
a contradiction
3 was given
had to last 2 weeks
narcotics
3
had
There
Furthermore,
instructions
The Respondent
a.
to Patient
to use non.,.steroidal .anti-inflammatories
3's prescriptions
treatment
narcotics
the Respondent
narcotics.
medications.
requires
that
of a single physician
chronic
of 50 pills with
last
to dispense
3 was last seen by the Respondent.
no evidence
close relationship
Patient
continued
in
a prescription
four hours
as needed.
and subsequently
to treat
on a regular
less
had to
chronic
pain
basis.
failed to meet the standard
of care
in his
3 as follows:
Over prescription
Tylox, a Schedule
of, or inappropriate
prescription
II CDS, to Patient III;
12
of
after
Continued
to prescribe
Tylox for three
the last recorded office visit;
c.
Failure to establish the necessary close relationship
with his patient to maintain the patient on chronic
narcotics;
d.
Failure to implement
treatment modalities
non-steroidal
anti-inflammatories;
e.
Failure
to follow proper protocol
for management
of a
chronic pain patient by changing the intervals
between
prescription
from two (2) weeks to one (1) month for the
same number of pills; and
f.
Failure
PATIENT
to record
the amount
that
of medication
included
dispensed.
4
Patient
Respondent
pain
(3) years
b.
4, a 45 year
on June
resulting
reinj ured
indication
candidate
a Schedule
4' s
at that
for re-exploration
Soma,
was
in May
time
first
4 complained
1986.
The Respondent
back.
to Patient
female,
Patient
an accident
for surgery
According
Darvocet,
10, 1992.
from
Patient
old
although
seen
of back
A second
noted
Patient
by
the
and leg
accident
there was no
4 might
be a
in the future.
4's
an abusable
III CDS narcotic
Date
Drug(s)
06/24/92
Soma
Darvocet
records,
the Respondent
non-controlled
substance
analgesic:
Ouantity
unclear
50
13
(350 mg)
prescribed
and Vicodin,
07/08/92
Soma
Darvocet
*
*
07/28/92
Vicodin
Darvocet
50
08/12/92
Vicodin
Soma
*
*
08/26/92
Vicodin
Soma
*
*
09/09/92
Vicodin
Soma
*
*
09/23/92
Vicodin
Soma
*
*
10/18/92
Vicodin
Soma
*
*
10/22/92
Vicodin
Soma
*
*
11/05/92
Vicodin
Soma
*
*
11/19/92
Vicodin
Soma
*
*
12/03/92
Vicodin
Soma
*
*
12/17/92
Vicodin
Soma
*
*
12/31/92
Vicodin
*
01/14/93
Vicodin
Soma
*
*
*
14
January
On
Patient
100
On January
4.
50
(
mg s)
management
I
that
Didrex
was
cause
of
indicate
insomnia
The
Dalmane
Dalmane,
in this
caused
be
a side-effect
the
that
he
of her
considered
other
agent.
did not
Patient
use
4 IS
of Didrex.
III CDS,
Vicodin,
#3:
02/01/93
Percodan
50
02/17/93
Vicodin
Soma
*
*
02/24/93
Dalmane
Tylenol
Tylenol
hypnotic
the Respondent
a Schedule
Ouantity
four
IV CDS
prolonged
Drug(s)
the
The
for
prescriptions
Date
1993
The Respondent
It could be the
situation.
Percodan,
and Tylenol
/
on
Didrex
to forty pounds.
for sleep,
record
prescribed
2
prescribed
loss.
a schedule
was prescribed
might
for weight
lose thirty
Dalmane,
in the medical
On March
using
used
including
surgery
performed
the Respondent
obesity,
that
symptoms
Respondent
III CDS to be used for the short term
4 should
improperly
Respondent
Soma,
a Schedule
Patient
medications
the
23/ 1993/
of exogenous
noted
Although
1993
20/
30 (30 mgs)
not indicated
#3
Respondent
#3 a day,
Soma,
15
noted
that
and Dalmane
the
and
patient
she needed
was
to
lose 100 pounds.
Soma,
Didrex
The Respondent
continued
to prescribe
and Dalmane:
Date
Drug(s)
03/10/93
Tylenol
Soma
03/15/93
Didrex
not indicated
03/24/93
Dalmane
Tylenol
Soma
30
04/14/93
Didrex
04/21/93
Dalmane
Tylenol
Quantity
#3
*
*
#3
*
*
100
*
#3
*
05/05/93
Tylenol
Soma
#3
*
*
05/19/93
Tylenol
Soma
#3
*
*
OS/27/93
Dalmane
06/02/93
Tylenol
Soma
#3
*
*
06/15/93
Tylenol
Soma
#3
*
*
06/29/93
Didrex
06/30/93
Dalmane
Tylenol
Soma
*
*
*
*
*
#3
16
Tylenol
#3,
On July
and
ache
needed
to
1993,
13,
in her
legs.
lose
weight
reported
Respondent
Patient
Tylenol
and had
to get
under
he would
consider
200 pounds.
The
that
Druq(s)
Quantity
07/14/93
Didrex
Tylenol #3
Soma
100
*
*
07/28/93
Dalmane
Tylenol #3
Soma
*
*
*
08/11/93
Tylenol #3
Soma
*
*
08/13/93
Didrex
Dalmane
*
*
08/25/93
Tylenol #3
Soma
*
*
09/14/93
Didrex
Dalmane
Tylenol #3
Soma
*
*
*
*
09/30/93
Tylenol #3
Soma
*
*
Respondent
low back
pain
that she
200 pounds.
further
The
surgery
Respondent
if
prescribed
#3, Soma and Dalmane:
Date
Patient
to have
She was told by the Respondent
Patient 4 did get under
Didrex,
4 continued
4's
complaints
maintained
that
continued
Patient
17
4 needed
and
on
10/13/93
to lose weight
the
"under
medical
supervision,"
a posturepaedic
inflammatories
recommended
relaxants
not using
continued
restrict
mattress
and
activities,
and use non-addictive
muscle
relaxants.
the use of nonaddictive
it is indicated
NSAIDS
"aspirin
Didrex,
Dalmane,
(s)
Drug
Didrex
Dalmane
*
*
10/20/93
Tylenol #3
Soma
*
*
12/22/93
Tylenol #3
Soma
*
*
01/05/94
Tylenol #3
Soma
*
*
01/11/94
Didrex
Dalmane
*
*
13, 1994
use her medications
Although
the
Respondent
(NSAIDS)
record
allergy."
Tylenol
anti-
and muscle
that Patient
The
4 was
Respondent
#3 and
Soma:
Quantity
Date
10/13/93
On January
sleep on
analgesics,
analgesics
in the medical
due to an
to prescribe
wear a support,
the Respondent
sparingly.
"admonished"
A Functional
Capacity
Patient
Evaluation,
done on 1/13/94 and 1/14/94 revealed a lot of inconsistency
presumably
prescribe
non-organic
Tylenol
pain
#3, Soma,
symptoms.
Didrex
18
The Respondent
and Dalmane:
4 to
continued
and
to
(s)
Ouantity
Date
Drug
01/19/94
Tylenol
Soma
#3
02/02/94
Tylenol
Soma
#3
02/10/94
Didrex
Dalmane
02/16/94
Tylenol
Soma
#3
03/02/94
Tylenol
Soma
#3
03/10/94
Didrex
100
Dalmane
30
03/16/94
Tylenol #3
Soma
*
*
03/30/94
Tylenol #3
Soma
*
*
04/08/94
Didrex
Dalmane
100 (50 mgs)
30
On 5/4/94
on diet
started
and
that the Respondent
responsible
Asendin
Patient
her on Asendin,
Respondent
50
50
50
50
(
3 5 0
mg
s )
5 0
mg
s
*
*
noted
(
that
4 was
considered
4's depression.
The usual
was attempting
the chronic
therapeutic
to treat
19
)
Patient
depressed
an anti-depressant.
for Patient
100 mg.
(350 mgs)
*
*
the Respondent
Didrex.
30
30
4 was
and
There
the
continuing
Respondent
is no indication
use of amphetamine
The Respondent
prescribed
dose for depression,
Patient
drugs
4 for depression,
if the
is
200
-
3 00
mg.
Didrex(
At this time the Respondent
Tylenol
was dispensing
#3 and Soma:
Date
Drug
Ouantity
05/03/94
Asendin
30 (100 mgs)
05/06/94
Didrex
100 (50 mgs)
05/11/94
Tylenol #3
Soma
*
*
OS/25/94
Tylenol #3
Soma
*
*
06/06/94
Didrex
100 (50 mgs)
06/08/94
Tylenol #3
Soma
*
*
06/22/94
Tylenol #3
Soma
*
*
07/06/94
Asendin
Tylenol #3
Soma
Didrex
*
*
*
*
07/20/94
Tylenol #3
Soma
*
*
08/03/94
Tylenol #3
Soma
Didrex
Asendin
*
*
*
*
08/17/94
Tylenol #3
Soma
*
*
08/31/94
Tylenol #3
Soma
*
*
(s)
20
Asendin,
09/02/94
Didrex
Asendin
100
*
09/16/94
Tylenol
Soma
#3
*
*
09/30/94
Tylenol
Soma
#3
*
*
10/03/94
Didrex
Asendin
(
100
Soma
50
50
10/14/94
Tylenol #3
Soma
*
*
10/28/94
Tylenol #3
Soma
*
*
11/03/94
Asendin
Didrex
*
*
11/14/94
Tylenol #3
Soma
*
*
11/28/94
Tylenol #3
Asendin
Soma
*
*
*
12/2/94
Didrex
*
12/14/94
Tylenol #3
Soma
*
*
12/28/94
Tylenol #3
Soma
*
*
01/04/95
Didrex
*
01/11/95
Tylenol #3
Soma
*
*
21
(
50
1 0 0
(5 0
mg s
mg
mg
s
)
)
s )
(100
mgs)
(3 5 0
mg
s )
01/20/95
Asendin
*
01/25/95
Tylenol #3
Soma
*
*
02/06/95
Didrex
*
02/08/95
Tylenol #3
Soma
*
*
02/22/95
Tylenol #3
Soma
*
*
03/08/95
Didrex
Tylenol #3
Soma
*
*
*
03/10/95
Asendin
*
On 3/14/95
and
diet
leg
pain
to
4 and
not
wants
he can make
indicate
#3, Soma,
is noted
instructed.
The Respondent
to 175 so that
Tylenol
4's weight
The Respondent
persists.
Patient
sparingly.
does
Patient
what
Didrex
type
prescribed
her
Patient
a decision
of therapy
to use
Druq(s)
03/22/95
Tylenol
Soma
#3
*
*
04/06/95
Tylenol
Soma
#3
*
*
04/07/95
Didrex
22
her
as to further
and continues
Ouantity
*
a very
restricted
medications
4 to get her weight
and Asendin:
Date
to be 193 and her back
therapy.
down
He
to dispense
04/21/95
05/03/95
Tylenol
Soma
#3
*
*
Asendin
Didrex
*
*
05/04/95
Tylenol
Soma
#3
*
*
05/19/95
Tylenol
Soma
#3
*
*
06/02/95
Tylenol
Soma
Didrex
#3
*
*
*
06/23/95
Tylenol
Soma
#3
*
*
07/03/95
Didrex
Asendin
07/07/95
Tylenol
Soma
#3
*
07/21/95
Tylenol
Soma
#3
*
*
08/04/95
Tylenol
Soma
Didrex
#3
*
*
*
*
*
08/14/95
Zoloft
50
08/18/95
Tylenol
Soma
#3
*
*
09/01/95
Tylenol
Soma
#3
*
*
09/11/95
Didrex
*
23
(5 0
mg)
09/15/95
Tylenol #3
Soma
*
*
09/29/95
Tylenol #3
Soma
*
*
10/13/95
Tylenol #3
Soma
Didrex
*
*
*
Didrex,
for weight
Patient
the
an amphetamine,
Although
loss.
4 as a result
Respondent
responsible
Dalmane
prolonged
effective
the
the
for the depression.
that
and there
the insomnia
use of Didrex.
and
are
only
Respondent
of depression,
considered
for sleep
considered
is indicated
for short-term
prescribed
there
is no indication
use
chronic
Additionally,
was no indication
of
that
of narcotic
by
complicated
the
use
that
4 was given
the Respondent
of Patient
use are always
of
to
amphetamines
Patient
could be a side effect
Regimens
Asendin
use
hypnotics
41S
less
and
sedatives.
The Respondent
treatment
of Patient
failed to meet the standard
of care in his
4:
a.
Over prescription
of, or inappropriate
prescription
of
Soma, an abusable non-controlled
substance,
Vicodin,
a
Schedule
III CDS narcotic analgesic,
Didrex, a Schedule
III CDS, Dalmane, a Schedule IV hypnotic agent, Tylenol
#3, and Asendin, an anti-depressant
to Patient 4i
b.
Continued to prescribe Didrex for over two years although
it should only be used for short term weight lossi
24
c.
Failure to recognize
symptoms
resulting
medications;
d.
Failure to consider insomnia as a side-effect
prolonged use of Didrex and prescribed Dalmanei
e.
Failure to consider the chronic use of amphetamines
result in depression
and prescribed Asendini
f.
Failure to prescribe
the appropriate
treat depression;
and
g.
Failure
PATIENT
Respondent
Patient
5,
a
the amounts
14,
5 was taking
Rhizotomy"
04/07/93
year
74
on July
On March
3, 1993
on Patient
dose
of the
could
of Asendin
of medications
to
dispensed.
female,
old
1992.
She
Percocet,
was
complained
a Schedule
the Respondent
first
of right
II CDS,
performed
5 and prescribed
seen
by
leg
at this
pain.
time.
a "Surgical
30 Percocet
the
Facet
on 03/29/93
and
and 50 on 04/21/93.
After
the
sparingly.
surgery
Patient
Respondent
5 complained
He prescribed
Percocet
prescribe
and
50 Percocet
"may
50 Percocet
be
of some paln
Patient
admonished
On June 16, 1993 the Respondent
taking
Didrex could be the cause of
prescriptions
for
other
5
Patient
1993
to record
that
In
25
5 to use
on OS/26/93
her
and
to
08/26/93,
it. II
Percocet
06/10/93.
notes that Patient
addicted
on 07/08/93,
and by May 10,
5 was still
He continued
09/22/93
to
and 10/18/93.
Patient
5's
The
1993.
Percocet
last visit
Respondent
occasionally
to the Respondent
recorded
and that
Patient
that
lias long
basis."
He
12/16/93,
01/11/94,
50
dispensed
to
Percocet
02/11/94,
on November
5 still
as she does
I will allow her to continue
medication,
was
required
not abuse
the
taking it on a monthly
Patient
(5),
02/16/94
3,
5 on
02/22/94,
11/18/93,
03/23/94,
04/27/94,
05/31/94,
06/30/94,
08/01/94,
09/01/94,
10/03/94,
12/07/94,
01/06/95,
02/09/95,
03/21/95,
04/27/95,
06/16/95,
07/27/95,
08/31/95
Although
Respondent
through
5's
pain.
modalities
The Respondent
treatment
5
of Patient
was
last
to dispense
1995.-
medication
continual
treatment
Patient
continued
October
a narcotic
and 10/05/95.
seen
medication
The Respondent
without
Finally,
in November
was
investigating
there
was
and no involvement
on a monthly
excessively
the
basis
prescribing
cause
of Patient
no attempt
to try
of any pain
program.
failed to meet the standard
the
1993,
of care
other
in his
5 as follows:
a.
Over prescription
of, or inappropriate
Percocet,
a Schedule II CDS to Patient
b.
Continued to prescribe Percocet,
the last recorded office visit;
for two
c.
Continued
to prescribe
investigated
the cause
medication
and
narcotic
of pain;
26
prescription
5;
(2) years
rather
of
after
than
Failure to try other treatment modalities
non-steroidal
anti-inflammatories
rather
d.
PATIENT
6
6,
Patient
year
37
a
January
on
Respondent
9,
Patient
6 had a fifteen
January
9, 1992 revealed
In a letter
dated
did not believe
were
Patient
A letter
of severe
Myelogram
of
discs
17, 1992,
by
leg
the
pain.
An 'MRI done
and a bulging
the Respondent
in Patient
seen
left
of sciatica.
degenerative
(50),
6's discs
Sclerosis
for anything
dated
March
and CT scan
40 Tylox,
Vicodin
1/29/92
6 complained
left sciatic
prescribed
history
dispensed
of Multiple
was unremarkable
first
noted
seen
on
annulus.
that
he
on the MRI
for her problem.
6 on 1/20/92
question
year
was
complaining
1992
January
The Respondent
After
female,
old
the bulging
responsible
Patient
that included
than Percocet.
a Schedule
(*),
(50) , 02/12/92
of severe
(MS).
facial
However,
that
and pain medicines
negative.
a Schedule
and
pain
to
02/24/92.
there
was a
a MRI of the head
like MS.
5, 1992 noted
was
III CDS,
The
Patient
were
6 complained
of no help.
Respondent
II CDS, on 03/09/92
continued
A
to
and 50 Vicodin
on 03/11/92.
On March
been
asking
19, 1992 the Respondent
for pain
medication
recognized
too soon
27
that Patient
and brought
her
6 had
into the
office
to
had
"functional
a
"admonish
prescriptions
then
continued
to
refill
05/18/92
(50) ,
6's
renewed
Vicodin
told Patient
medication
to come
Vicodin
07/09/92
he
Patient
symptoms
(* )
and 04/20/92.
for her pain
an appointment
that
However,
20, 1992 the Respondent
physician
make
He believed
overlay."
on 04/06/92
On April
family
her."
(*
and "if you need
However,
back."
)
(50) ,
for
6 to go to her
Patient
the
surgery,
Respondent
6 on
05/01/92,
07/22/92,
08/06/92,
08/20/92,
09/03/92,
09/17/92,
10/01/92,
10/14/92,
11/12/92,
11/25/92,
12/21/92,
01/07/93,
01/21/93,
02/04/93,
03/04/93,
03/16/93,
04/01/93,
04/15/93,
04/27/93,
05/13/93,
OS/27/93,
06/07/93,
06/24/93,
07/07/93,
07/22/93,
08/05/93,
08/19/93,
09/01/93,
09/14/93,
10/05/93,
10/19/93,
11/02/93,
11/16/93,
11/29/93,
12/14/93,
12/27/93,
01/11/94,
01/25/94,
02/07/94,
02/22/94,
03/07/94,
03/22/94,
04/04/94,
04/19/94.
The
Respondent
dispensed
50 Vicodin
sometimes
within
it had been
Patient
shown,
through
5 had no anatomical
Respondent
have
a period
continued
realized
of less
tests
to prescribe
that multiple,
than two
performed
reason
to Patient
(2) weeks.
Vicodin.
6,
Even
after
by the Respondent,
that
to be given pain medication,
subj ecti ve
28
at a time
The Respondent
complaints
of
the
should
pain
by
6,
Patient
indication
had
that
that Patient
no
reason,
anatomical
6 was seeking
drugs
were
to satisfy
obvious
an
an addiction
to narcotics.
The Respondent
of Patient
of in his treatment
6 as follows:
Over prescription
of, or inappropriate
Vicodin, a Schedule III CDS, to Patient
prescription
6i
b.
Continued
to prescribe
Vicodin
the last recorded office visiti
(2)
c.
Continued
to prescribe Vicodin
there was no anatomical
reason
d.
Failure to recognize that multiple, subjective complaints
of pain
without
anatomical
reason
were
an obvious
indication
of drug
seeking
behavior
to satisfy
an
addiction
to narcoticsi
and
e.
Failure
to record
the amount
for two
years
of
after
although tests indicated
to dispense narcoticsi
of Vicodin
dispensed.
7
Patient
Respondent
7, a 26 year
in 1982
On June
sustaining
A MRI
herniation
the
to meet the standard
a.
PATIENT
old.
failed
left."
29,
a work
after
revealed
The
being
1993 Patient
related
at L4-5
old male,
that
the disc
Respondent
initially
hit by a car when
treated
he was
by the
15 years
7 was seen by the Respondent
injury
there
was
on March
was
prescribed
29
18, 1993.
a "tiny
effacing
after
left
the adjacent
50 Tylenol
paramidline
epidural
disc
fat on
#3 on 07/06/93.
The
Respondent
trauma
believed
and an orthopedic
On July
Respondent
refilled
otherwise
Lortab
(*)
prescribed
,
10, 1994
and
was
related
to
that
counseling
7 complained
on
sym.
him
some more
was
a
Lortabs.1I
was
and 05/09/94.
The
and CT scan.
for
candidate
but would prefer
on the
analgesic,
03/16/94
7 had a Myelogram
7
The
program.
leg raising
narcotic
02/15/94,
Patient
note
of back and left leg
straight
"I gave
CDS
Patient
in an addendum
prescription.
(*)
positive
III
foraminotomy
Patient
lumbar
7 to lose
first..
On LTune 15,
dieting
1994
and prescribed
Lortab.
07/27/94
the Respondent
Tenuate(*),
Additionally,
and
On October
using
Schedule
noted
discectomy
#3
and noted
by the Respondent
Respondent
and
found
indicated
in a drug
15, 1994 Patient
normal
a
On May
weight
he was
the Tylenol
The Respondent
backache
was needed.
7 reported
On February
pain.
longstanding
27, 1993 the Respondent
that Patient
left,
the
"admonished" Patient 7 about
a Schedule
the Respondent
for sYmpathomimetic,
prescribed
Lortab
(*)
on
08/26/94.
4, 1994 the Respondent
"a lot of Alevell in addition
The Respondent refilled Lortab
(*)
30
recorded
that Patient
to one or two Lortab
on 10/04/94,
10/25/94,
each
7 was
day.
11/09/94,
prescribed
continued
05/10/95,
OS/24/95,
On June
prescribed
so
50
"
prescription
09/13/95
75
mg
Lortab
he
to 50 Lortab.
on 01/18/95,
(*)
7 stated
and
them.
instructed
Respondent
Patient
to
continued
07/19/95,
the
However,
renew
08/02/95,
Respondent
to
7
made him
the
08/16/95,
use
Lortab
them
(*)
08/30/95,
and 09/27/95.
Center.
2, 1995,
Patient
A note
in Patient
7 was referred
7's medical
Respondent prescribed Lortab
Patient
industrial
7 remained
accident
in a drug
prescribed
to the Physician's
temporarily
for more
counseling
Tylenol
to people
with
record
than
totally
two years.
program,
the
#3 and then Lortab.
histories
Weight Loss
indicates
that
the
since
the
on 10/11/95.
(*)
labeled that it is for short-term
given
04/26/95,
that the diet pills
Weight Loss Program for 16 weeks at the Physician's
was
The
02/01/95,
04/12/95,
03/29/95,
stopped
on 07/05/95,
On October
7
Respondent
06/07/95.
Lortab
The
the
01/03/95
in addition
)
03/15/95,
21, 1995 Patient
"weird"
"sparingly.
(
to prescribe
03/01/95,
02/15/95,
On
12/21/94.
100 Tenuate
Respondent
feel
and
12/07/94
11/23/94,
Even
though
Respondent
Lortab
Patient
initially
is specifically
use and that it should not be
of drug
31
disabled
abuse.
The Respondent
treatment
failed to meet the standard
of Patient
of care in his
7 as follows:
a.
Over prescription
of, or inappropriate
prescription
Lortab,
a Schedule
III CDS sym. narcotic
analgesic
Patient 7;
b.
Continued to prescribe Lortab for over one
although it is labeled for short-term use;
c.
Continued to prescribe Lortab to a patient in a drug
counseling program although the label indicated that it
should not be given to people with histories of drug
abuse; and
d.
Failure
to record
the amount
CONCLUSIONS
Based
on the foregoing
that the Respondent
§14-404
law that the Respondent
determined
medical
facility,
surgical
office,
dispensed.
the Board
the Board
acts under
concludes
peer
care
hospital,
review
performed
concludes
the Act,
standards
for the delivery
location
of
as
of quality
in an outpatient
or any other
H.O.
as a matter
failed to meet appropriate
by appropriate
and
of Fact,
prohibited.
Accordingly,
(a) (22).
year
OF LAW
Findings
committed
of medication
(1)
of
to
in this
surgical
State.
ORDER
Based on the foregoing
Law, it is this
L.11~
I
Findings
of Fact and Conclusions
day of --11{J)!eAflLk
32
,1997,
of
by a majority
of
the
full
authorized
meIT~ership
of
the
Board
considering
this
REPRIMANDED;
and
case:
ORDERED that
the Respondent
be and is hereby
be it further
ORDERED
complete
that
the Respondent
a Board
Respondent
shall
approved
enroll
the effective
date
course
nine
within
verification
course
within
to the Board
ORDERED
that
thirty
Controlled
record
(30) days
division;
course
Substances
verification
caused
to be submitted
said course from the Medical
course,
Director
33
submit
said
written
of said
prescribing
one
The
and
(1) year
Respondent
Compliance
assessment
further
complete
in and successfully
within
Order.
to the Board
a written
(60) days of
and be it further
("CDS")
prescribing
shall
in the proper
submit
CDS
sixty
and shall
enroll
date of this Consent
The
course.
of his completion
the Respondenbshall
in this
keeping
within
Order,
the effective
he enrolled
in and successfully
The Respondent
Compliance
Dangerous
written
enroll
course
Consent
months.
a Board-approved
complete
medical
in said
of this
(9)
shall
after
shall
division
shall
also
of his performance
of the course;
of
that
have
in
and be it
ORDERED
reviews
that
the Respondent
The initial
by the Board.
no later than eighteen
Consent
discretion
that
delivered
the peer review
in the peer
review
report
medical
indicates
record
Board
may,
forth
in this
appropriate
review.
below
not
Consent
limited
that
the
standard
modify
appropriate
standard
peer
of care
review,
by the Boardl
and
date of this
ordered
shall
in the
be limited
to
to the effective
shall
receive
a copy of
If the peer
that the Respondent/s
to prescribing
medical
practices
appropriate
the terms
made
standards
and
I
the
and conditions
set
within
the
and be it further
Respondent
of care
be conducted
by the Board.
fails «to meet
Order;
be
subsequent
shall
practice
as determined
In the event that the Respondent
the
approved
keeping,
shall
peer
follow any recommendations
to the Board
but
shall
reviews
and endorsed
in its discretionl
ORDERED
peer
and shall
report
including
practicel
reviews
The Respo~dent
Order.
report(s)
review
to periodic
after the effective
by the Respondent
date of this Consent
review
These
of the Board.
care
peer
be subject
peer
(18) months
Subsequent
Order.
shall
is found
as determined
if the peer
the Respondent's
34
by appropriate
to be practicing
by the Board
review
failure
peer
through
determination
to meet
is
appropriate
standards
shall
constitute
a violation
of this
Consent
Orderi
and
be it further
that if the Respondent
ORDERED
terms
or
deemed
conditions
set
a violation
that
Consent
Order,
sanctions
it
suspension
and COMAR
deems
and/or
ORDERED
revocationi
that pursuant
10.32.05/
health,
notice
impose
any of the
any
of
and a
disciplinary
probation,
and be it further
to Md. Code Ann.,
is subject
likelihood
or
other
reprimand,
State Gov't
§10-226(c)
to summary
suspension
or peer review indicates
safety
terms
and a hearing,
including
the Respondent
is a substantial
public
may
shall be
and be it further
violates
after
appropriate,
if an investigation
there
the Board,
with any of the
then his failure
Orderi
if the Respondent
of violationr
determination
above,
of this Consent
ORDERED
this
forth
fails to comply
welfare
to the Board
of a risk of serious
by
the
Respondent
i
that
harm to
and
be
it
further
ORDERED
incurred
that the Respondent
under
this
Consent
shall be responsible
Orderi
35
and be it further
for all costs
ORDERED
that
document pursuant
.
-!
i
l
~J'
this
Consent
Order
is
considered
a
public
to Md. Code Ann., State Gov't §10-611 et ~
C{ l
~JvwJ?
Date
~
-S)
.
Suresh C. Gupta, M.D.
Chair
Maryland
State
-'Board
Physician Quality Assurance
36
of
CONSENT
I, Neal
opportunity
to consult
document.
Fact
and Conclusions
consisting
the
before
I hereby
and
the validity
of
would have had the right
to call
substantive
consent,
of Law,
conclusion
testimony,
counsel
submit
that I have had the
entering
admit
to the
into
the
signing
Findings
foregoing
of
Consent
of 38 pages.
I acknowledge
after
with
By this
this
Order
M.D. , acknowledge
I. Aronson,
and
of this Consent
a formal
to counsel,
witnesses
procedural
the legal
to initiate
these proceedings
I also affirm
adverse
ruling
to confront
on my own behalf,
protections
acknowledge
Order.
evidentiary
authority
Order
as if entered
hearing
in which
witnesses,
and
provided
and the jurisdiction
and to issue and enforce
to give
to all
by
I
other
law.
I
of the Board
this Consent
that I am waiving my right to appeal any
of the Board
that might
have
followed
any such
hearing.
I sign
consult
with
this
Consent
counsel,
Order
without
after
having
reservation[
37
an opportunity
and I fully
to
understand
and
comprehend
the
language,
meaning
and terms of this Consent
Order.
11/5
/n
f~.
Date
Neal
~1!y1~,
I. Aronson,
M.D.
READ AND APPROVED:
"
1~...f7
Steven
F. Barley
Attorney
for Res
STATE
OF MARYLAND
/7
CITY/COUNTY
OF
I HEREBY
1997,
before
aforesaid,
!
Ii
lil./L/Ldc/
CERTIFY
me,
Notary
personally
j-JIJ
that on this
Public
appeared
of
Neal
in due form of law that the foregoing
and
the
day of
State
I. Aronson,
Consent
h
/ CCV-C-IJ~t/J
and
M.D.,
City/County
and made oath
was his voluntary
deed.
AS WITNESSETH my hand and notaria+ seal.
~
~uu~ G. (!i1,~'LbV
Notary
My Commission
Expires:
!3-/i/qf
I
I
C:\OFFICE\WPWIN\WPDOCS\KATE\ARONSON.CO
38
Public
,
act