More than a dozen Houston-area physicians have lost three or more patients to accidental prescription overdoses in recent years — including doctors accused of running pill mills and some of the state’s top prescribers of pain pills and anti-anxiety drugs, according to a Houston Chronicle analysis.
Doctors previously targeted for disciplinary action by the state medical board for pill mill activity or prescription-related problems were often the sources of drugs found at multiple death sites, a review of medicines given to more than 200 people who accidentally overdosed in Harris County in 2008 and 2009 shows.
However, some local physicians with high volume practices — and no association with pill mills — who specialize in pain management or psychiatry also prescribed medicines found at multiple deaths.
Harris County is considered a national hub for prescription overdose deaths and for pill mills.
Many local deaths involve people who fatally ingested cocktails of medicines featuring opioid pain drugs combined with anti-anxiety medicines like alprazolam (Xanax), records show. Often they took more than prescribed or mixed drugs with alcohol.
The Chronicle’s findings on the source of prescriptions were based on inventories of medications found in homes of local overdose victims. In home deaths, Harris County medical examiner’s investigators recorded types, amounts and prescribers for drugs stored in bedside tables, closets or still clutched in the hands of the dead.
At least three doctors accused of operating pill mills wrote prescriptions found at three or more home deaths.
‘They leave happier’
Dr. Ruth Atlas, a Houston pediatric neurologist, prescribed medicines to four people who died in 2008 and 2009, records show. For years, Atlas has run a high-volume practice that attracted more than 700 patients a year to her clinics, medical board records show. She had her license temporarily restricted — barred from prescribing controlled substances — by the Texas Medical Board in December. A board attorney described her practice as exhibiting “hallmarks of a pill mill, the knowing scheme to distribute for profit narcotics and dangerous drugs through a known medical office facade.”
Atlas told the board her chronic pain patients came at least once a month for rechecks and prescriptions.
“I have patients who come in sad,” she testified. “They say they always look forward to coming into the office … and they leave happier.”
In a letter, her attorney Ace Pickens said “patient privilege” and “matters in litigation” made it inappropriate for Atlas to respond to the Chronicle.
Dr. Christina Clardy, who faces federal prosecution for fraud and conspiracy charges revealed after one of her alleged pill mills burned in a 2010 arson, was identified as treating physician or prescriber in three deaths. Chris Downey, her Houston criminal defense attorney, said Clardy, whose medical license was suspended in 2010, no longer has access to practice records and could not confirm whether she’d ever seen patients who overdosed.
“As you might imagine given the status of her criminal case, she can’t say much,” he said. “While we have been looking in these various clinics both on the state and federal side we have found multiple instances of her signature being forged. ”
Three others who died in accidental overdoses got prescriptions signed by Dr. Gerald Ratinov, a 76-year-old neurologist based in downtown Houston who formerly served as medical director at several so-called pill mills. He faces an on-going medical board disciplinary inquiry involving complaints about those clinics.
Ratinov has not been charged with any crime, but hired a Houston criminal defense attorney to represent him and is cooperating in an ongoing pain clinic probe. Lawyer Robert J. Fickman declined to comment on patients’ deaths but said Ratinov has disassociated himself from pain clinics.
1,751 Xanax prescriptions
The analysis also showed doctors not associated with pill mills prescribed drugs found at multiple overdose sites.
Two Houston doctors prescribed medicine to six patients who accidentally overdosed in 2008 and 2009, the analysis showed. Both practice in high-volume clinics and rank among the state’s top publicly paid prescribers of common pain or anti-anxiety drugs, Medicare and Medicaid data for 2008-2010 shows.
Public records show that one of them, psychiatrist Dr. Guruswami Ravichandran, is the state’s leading prescriber of the anti-anxiety drug Xanax, also called alprazolam. Last year Medicare and Medicaid was billed for 1,751 Xanax prescriptions for 10,142 of his patients for a total of $180,762.
By comparison, Texas’ second-ranked Xanax provider prescribed less than a third as much and billed for $29,167.
Ravichandran operates the Shamrock Clinic in southwest Houston — where his patients regularly wait hours and lines spill out into the halls. His office displays signs about Xanax and other medicines, including warnings not to resell or share prescription drugs. Ravichandran did not respond to phone calls, emails and a letter hand-delivered to his clinic. He was disciplined by the medical board in 2002 for “unprofessional or dishonorable conduct” and in 2007 for inadequate record keeping.
One with spotless record
Another doctor who had six patients overdose in 2008 and 2009, Dr. Patricia Salvato, has no disciplinary history. In fact, though Salvato has faced criticism for her prescribing practices, she emerged with a spotless record after a six-month review by the Texas Medical Board in response to a pharmacist’s complaint. Board investigators found Salvato “met or exceeded the standard of care in treatment of chronic pain” for the five patients whose case files were examined, according to records she showed the Chronicle.
Salvato annually treats 3,000 patients, including AIDS patients and about 600 chronic pain sufferers. She ranks in the state’s top 50 Medicare and Medicaid prescribers for the pain killer hydrocodone and the anti-anxiety drug Xanax.
Certified as a specialist in addiction medicine and in pain management, Salvato said in an interview she was troubled and saddened by the recent deaths of six patients, two of whom she’d treated for more than 20 years. Salvato said she takes many precautions to attempt to detect potentially dangerous addictions and prevent overdoses, including requiring patients to complete pain contracts and take random drug screenings.
She urged anyone concerned about loved ones’ medications or addictions to share information with doctors — providing information can help save lives.
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Source: Houston Chronicle(Olsen, 3/30)
Showing posts with label texas malpractice attorney. Show all posts
Showing posts with label texas malpractice attorney. Show all posts
Monday, February 4, 2013
Monday, November 28, 2011
Medical Malpractice Caps Hurt Patients
Much of the protection consumers have against irresponsible and negligent behavior on the part of health care providers hinges on oversight and incentives created by the medical professional liability insurance industry. A nationwide shift to caps could result in more cases of negligence and substandard care.
Support for caps comes from individuals who see the medical malpractice system as broken, largely based on anecdotal observations. Everyone seems to have heard a story of a high verdict to a plaintiff whose claim was not valid. Yet, careful studies suggest these cases are anomalies, and the court system generally works. While there are no statistics for the country as a whole, based on the existing evidence, we can say confidently that a good chunk of initial claims (likely more than three-quarters) do not move forward because no negligence was involved. The vast majority of cases that do move forward settle.
This means that court signals from earlier trials are clear. If court awards were random, one would expect many more cases to go to court as there would be an expectation of an award even where there was no negligence. Many cases go to court because plaintiffs think they have a case when they do not. We know this because plaintiffs rarely win; less than a quarter of all cases that go to court are resolved in favor of the plaintiff. At least one study found court findings of negligence lined up with assessments by impartial reviewing physicians.
Critics of the legal system point out that many cases of negligence are not reported or adjudicated. However, every review has found claims are concentrated among a very small subset of physicians; less than five percent of physicians are responsible for the overwhelming share of claims. Even if a large percentage of negligent actions are not reported, it would seem that the present system works in identifying physicians whose practice patterns put patients at risk.
For the system to work to reduce practice risk, malpractice premiums must be experience rated -- physicians who exhibit risky behaviors must face higher malpractice insurance premiums than their less-risky peers. The conventional wisdom among health policy experts has been that experience rating does not occur. But this is not true: high-risk physicians pay up to 500% more for insurance than their less-risky peers.
Insurance companies specialize. Some only insure physicians with spotless records. Others, the surplus lines carriers, specialize in underwriting the highest-risk physicians -- at any given time between two and ten percent of practicing physicians. As one broker put it, because it is so costly, being forced into the surplus lines market gets a physician's attention and motivates efforts to reduce practice risk.
New procedures are often left to surplus lines carriers to underwrite, adding a layer of oversight to the introduction of new procedures such as Lasik eye surgery and laparoscopic gallbladder surgery. On rare occasions, carriers deny coverage, which precludes affiliation with most hospitals and health maintenance organizations -- which effectively means these really risky physicians are forced out of practice, which is exactly the desired result.
Beyond individual underwriting to identify at-risk physicians, the medical professional liability insurance industry makes significant contributions to risk reduction in other ways. Companies offer premium discounts to physicians who take risk management seminars. The Physicians Insurers Association of America's Data Sharing Project identifies risky practice patterns. High insurance premiums motivated anesthesiologists to evaluate the risk associated with their practice patterns. As a result, anesthesiology is much safer than it used to be. Some insurers visit physician offices to evaluate safety and risk.
In 1992, when Congress tried to "help" community and migrant health centers by taking on their malpractice risk, many of the health centers resisted, lamenting the loss of the risk-management services the private carriers supplied.
Under the current system, liability motivates these efforts to reduce risk. Reducing liability, as caps do, is rarely a good idea in any situation. Placing caps would reduce malpractice insurers' incentives to oversee physician practice patterns and reduce incentives to manage risk in our health care system, and make health care that much riskier for all of us.
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source: Huffington Post (Svorny, 11/23)
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