Dr. Mark IbsenThis is an extremely long post. It records what happened over three years to Dr. Mark Ibsen of Helena, Montana. The main points to glean are the facts that State Medical Boards do not have patient needs as their priority. They are as much a part of government control as law enforcement, and are proponents of the government agenda against pain management doctors. Once you are tagged by your state medical board, your a__ is grass and they are the lawnmower.

The good points in this post is that there is actually good reporting of this case, with information in the doctor’s favor, instead of being all government hype and propaganda.  Good work, ladies and gentlemen. Here, reporters Terence Corrigan, Tom Kuglin, and Amanda Brandt from the Independent Record, have given us the best window into what happens to doctors being attacked by the government.

Terence Corrigan, author of “Physician’s license on the line: Patients say he’s the best” on Dec. 3, 2014, “Attorney questions doctor’s sanity in final day of hearing” on Dec. 4, 2014, and “How much is too much? Helena doctor’s drug prescriptions for pain challenged” on Dec. 8, 2014, covered Dr. Ibsen’s 4-day hearing.

Dr. Ibsen came under attack by the state medical board because of a complaint levied against him by a disgruntled clinic employee in 2013. The hearing took place in Dec., 2014. The major players during the board of medicine hearing covered in these articles were:

The hearing officer, David Scrimm.

The Board of Medical Examiners’ attorney, Mike Fanning, who is presenting the government’s side against the doctor

The doctor’s attorney, John Doubek.

The defendant’s evidence at the Board of Medical Examiners hearing was first forced to be reduced from 2,800 pages to 800 pages. However, through argument, Ibsen’s attorney got the full packet of documents admitted. However, this shows that these sessions are not really designed “for” the defendant. They want to minimize the defense. But they have no problem running hour after hour with government testimony.

The point of the hearing was to determine whether to impose sanctions on Ibsen and if so, what those sanctions should be. If Scrimm ruled that sanctions were needed, then a separate hearing panel would make the final decisions. The fact that a hearing was taking place at all means that the Board of Medicine planed on imposing sanctions. The hearing is just a way of white-washing the plan.

The complaints against Ibsen were that he over-prescribed opiate pain medications, failed to completely and properly keep patient records, did not properly examine or counsel his patients or suggest to them alternative pain treatments, such as chiropractic, physical therapy or naturopathic care, that he failed to properly treat patients with complex medical issues and lastly, vague allegations that he was mentally unstable.

Whether Ibsen was using proper procedures in evaluating patients and prescribing appropriately was disputed by witnesses. The crux of the problem was in his charting, per St. Peter’s Hospital Director of Pharmacy, Starla Blank. Dr. Camden Kneeland, the board’s expert witness and medical director of a pain clinic in Kalispell, said that without what he considered proper charting he couldn’t offer an opinion on the adequacy of care Ibsen provides. “If it’s not in the records how can I know?” he asked. . Kneeland provided testimony about the risks of narcotics and “standards of care.”

Both Kneeland and Blank referred over and over to the need for a pain management plan—a written agreement signed by the patient and the doctor. Blank described such a plan as critical for “responsible” use of opiates. But despite their increasing use such contracts are not legally required. Also, not everyone in the medical community thinks these agreements are useful and some even say they’re harmful to the doctor/patient relationship, akin to treating patients as suspects.

Kneeland reviewed the records of nine patients before the hearing and cited as problems, Ibsen’s failure to document safeguards of narcotic prescribing, failures to record patient exams and failure to refer (or to at least document referrals of) patients for other pain treatments besides narcotic painkillers. Kneeland also cited the absence of documentation in patient charts as methods used to try and prevent patients from getting too many painkillers. He also cited concerns that Ibsen’s patient records did not show whether Ibsen had done physical exams or taken patient histories.

Dr. Charles Anderson, a Helena neurologist who retired in 2012, testified on Ibsen’s behalf. In preparation for his testimony, he had reviewed the bulk of the patient records entered into evidence in the case. He also testified that he visited Ibsen’s clinic, spending a total of 50 hours or so reviewing the case.

When asked about Ibsen’s charting (patient records), Anderson said, “Most physicians tend to be independent minded.” Anderson described Ibsen’s charts as on the “lower half of the legibility scale.”  This shows that Dr. Ibsen did not use a computerized patient record, but did his charting longhand. This makes it harder to record all that transpires in an office visit. Just because it’s not there doesn’t mean it didn’t happen.

Anderson said that requiring signed controlled substances agreements was problematic. “Patients may lose their trust,” he said, “and there are bioethicists that agree. Patients must understand that you’re on their side.” Anderson said he did not use contracts in his four decades of practicing medicine, although he “saw some doctors that did.”

Anderson testified, in direct contradiction to other witnesses, that he saw clear evidence in Ibsens’ records that he had successfully weaned patients from narcotics. When asked about Anderson’s conclusions, Kneeland said, “My initial reaction was he couldn’t be reviewing the same things I was viewing.” The records were of the same patients.  This shows that government expert witnesses only report what the government wants them to report, in as negative a manner as possible. That’s what they get paid for, and their testimony in court should be scrutinized critically with the actual records. Kneeland testified that his success rate at weaning patients off opiates is 73 percent at reduced dosages and 10 percent off completely. No one testified in exact terms whether Ibsen was prescribing too many narcotic pain medications.

But when it came time for Ibsen’s patients, testifying on his behalf, to evaluate him the story was entirely different.

Ibsen’s first witness said “He really cared. He was beyond attentive. I’ve never met another doctor like him.” But on cross examination by Fanning, however, the patient got angry and at one point refused to answer questions when asked about his earlier testimony that he had been self-medicating.

“I can’t confirm or deny it,” he said. “You have an opinion of what I was doing but it’s all opinion. … What you’re trying to do is label me.”

It was reported that during the hearing when the government was examining one of Ibsen’s patients on the amount of pain medication Ibsen prescribed her, that Ibsen became visibly upset. Ibsen was moved to tears and became very angry at what he viewed as Fanning’s mistreatment of the patient.

Another patient testified for Ibsen that she’d been a patient for many years. She said Ibsen had conducted an extensive exam on her first visit and that he spent more time with her than any other doctor ever did. She also said Ibsen had taken a thorough history during every appointment and given her a physical exam pretty much every time she went in, describing Ibsen as “thorough” and “compassionate.” She also testified that he had referred her to many other treatment professionals, including a chiropractor, physical therapy and natural medicine, and had recommended she engage in swimming.

During testimony from Michael Ramirez, clinical coordinator of the Montana Professional Assistance Program, earlier issues with Ibsen’s behavior were discussed. According to Ramirez, Ibsen had a referral in 2006, and Ibsen was evaluated twice by two outside agencies. Ibsen complied with the program’s requirements, Ramirez said, and was released early. Ramirez did say, however, that Ibsen “was slow to comply” with the assistance program requirements. He was released from the program after about a year.

In the fourth and final day of the hearing, Fanning pushed Ibsen on allegations that Ibsen may have psychological problems that interfere with his ability to adequately perform his job. The tension between Ibsen and Fanning was immediately evident when Fanning began his questioning of Ibsen.

Shortly after Fanning started his line of questioning, hearing officer David Scrimm interrupted.

“I can see the tension,” he said. “I would ask that you (both) scale it back a little bit now before it gets any further down the road.”

“What kind of guidance would you give me?” Ibsen asked.

“Be cool,” Scrimm said.

Fanning’s line of questioning aimed at Ibsen’s behavior focused in large part on posts to Ibsen’s Facebook page. This shows how the government investigates every aspect of a doctor’s life to find something negative to use in court. Ibsen’s attorney, John Doubek, tried unsuccessfully several times to stop this line of questioning, objecting that it was irrelevant to the issues in the case. Fanning kept pressing Ibsen on his Facebook posts, asking what Ibsen’s intent was.

“Were you trying to threaten me?” Fanning asked. Fanning said. “He (Ibsen) has tried to undermine anybody who’s ever threatened him, and he sees me as a threat.”

Past actions with the Boards of Medicine are also brought up in these hearings, even if they are considered “No fault” decisions. Everything works against the doctor. In Dr. Ibsen’s case, in 2006, he entered into an agreement with the Montana Professional Assistance Program, a sort of diversion program, to avoid possible discipline through the more formal process with the state’s Board of Medical Examiners.

Ibsen signed a contract with the assistance program, but he said he was not happy with the terms. The 2006 issues, Ibsen said, were “driven by malice.” These kinds of programs are also driven by money. Spread the wealth, once a doctor is targeted. Ibsen went to the program because of his job as an emergency room physician due to pressure by the other doctors he worked with who thought he had a substance abuse problem. After a five-day evaluation at the Houston clinic, he was diagnosed with narcissistic personality disorder. Narcissistic personality disorder is a condition in which people have an excessive sense of self-importance, an extreme preoccupation with themselves and lack of empathy for others.

“I said, ‘Great, now let me go back to work with all the other narcissists,’” he said.

The five-day evaluation and diagnosis cost $10,000, Ibsen said, and the clinic’s recommendation was a 10-week in-patient treatment program that would cost $1,000 per day.

“I could hear ka-ching, ka-ching,” he said. “I thought the whole thing was driven by malice.”

Ibsen then got a second evaluation and complied with its treatment recommendations.

“I didn’t like it, but I wanted to keep my job. It turns out the job was gone anyway,” he said.

It took 6 months for the results of this hearing to finally be determined. Tom Kuglin wrote an article about it entitled “Examiner finds Ibsen met standards of patient care but kept insufficient records” on June 16, 2015. Usually the pro-doctor decisions aren’t reported by the press. This is a good article delineating the decisions that were in Dr. Ibsen’s favor. You would think, from the comments made here showing Dr. Ibsen was a good doctor, that that would be the end of the problem for him. But the government is unrelenting once they have you in their sights. You might win a battle, but they have the money to win the war.

The decision, a 49-page proposed order by David Scrimm, faces approval by the Montana Board of Medical Examiners, Scrimm found that Ibsen’s prescriptions were for legitimate medical reasons and that he employed and encouraged alternatives to medication for chronic pain.

The nearly 190 findings in Scrimm’s order include that Ibsen conducted regular assessments of his patients, and that he successfully reduced opioid use by nearly three-quarters of Christensen’s former patients, with 10 percent completely ceasing usage.

The findings go on to say that Ibsen often looked for alternatives to narcotics and that he took action against at least one patient that was “doctor shopping.”

Scrimm’s report surprisingly took issue with testimony from expert witnesses from the state, and what constituted “the” standard of care for chronic pain patients. “It was often not clear what was “a” standard of care versus “the” standard of care based on state provided testimony,” he wrote. The state further failed to prove that Ibsen suffered from any “psychological malady”. The allegations stem in part from interactions with Helena pharmacist Robert Gardipee, who refused to fill some of Ibsen’s prescriptions.  Ibsen was reportedly upset with Gardipee for interjecting in his treatment and,” did not hesitate to let Gardipee know that he thought Gardipee should fill the prescription as written,” Scrimm wrote. Scrimm found that Ibsen prescribed similar doses to Christensen’s former patients, and that without the narcotics their pain had returned.

Scrimm’s proposed order had to go back before another committee of the Board of Medical Examiners for a decision — a process that could take months. For failing to meet standards of care for record keeping, the order recommended that Ibsen’s medical license be placed on probation by the Board of Medical Examiners for 180 days. Ibsen would also need to complete a seminar on proper record keeping.

 “With the over prescriptions, Mark won on all those issues hands down,” said Ibsen’s attorney. “We think it’s a good order. We’re happy with it. The examiner spent a lot of time putting it together and we’re prepared to live with it. This is the recommendation by the guy appointed to hear the case, and in my experience, his word is it,” he said.

Fanning said “It is only a proposed decision so the board will decide how this will be concluded,” he said. “There are certain aspects of it that bear further study.”

An additional investigation ensued for a total of 30 or more patients after Ibsen treated a series of former patients of Bitterroot Valley Dr. Chris Christensen, who was raided by federal agents in April 2014 and had his license suspended relating to his prescribing of narcotics. Ibsen was reportedly told by a federal agent that he was “risking (his) freedom” by prescribing to those patients. When asked how he could treat the patients, the agent reportedly replied, “I can’t tell you. We’re not doctors.”

Ibsen subsequently reported to the federal agents when he found two of his patients had altered prescriptions to acquire more medication, Scrimm wrote.

But the damage had been done. Three months later this article by Perry Backus, “After Florence doctor’s arrest, Helena’s Ibsen drops chronic pain patients” appears on Sept 5, 2015.

In it, Mr. Backus states, “Dr. Mark Ibsen of Helena has been an outspoken advocate for providing chronic pain patients with the medications, including opiates, they need to carry on with their lives. Last week, in a short note, Ibsen told his patients he would no longer be able to do that. Ibsen’s decision follows the Ravalli County indictment of Dr. Chris Christensen of Florence on 400 felonies, including two counts of negligent homicide. Ibsen’s note read:

“To our patients: In solidarity with Dr. Christianson (sic), and in acknowledging the extreme hostility of the regulatory environment in which we are operating, Dr. Ibsen will no longer be prescribing any pain medications to chronic pain patients. Dr. Ibsen will be taking some time off to plan the next safe course of action. We wish you all the best.”

Ibsen’s announcement set off a panic for the hundreds of people who depend on him to treat their chronic pain, One of his patients suffering from fibromyalgia had been so impressed with Ibsen that she began volunteering at his Helena clinic to help other chronic pain patients fill out forms and find alternative resources. Now many of those patients are now contacting her, looking for answers that she can’t give.

“I get messages all day,” she said. “People are saying to me: ‘What am I going to do? No doctor will treat me. I’ve called all over.’ ” “They really don’t have any choices. They don’t have a doctor they can turn to. Every doctor that I called, especially after this Christensen thing, does not want to take anybody with a pain condition.”

She is quickly weaning herself off her medications while looking for alternative ways to treat her chronic pain.

“Withdrawal is not fun,” she said. Before she received treatment from Ibsen, her days were often spent curled up on her bed or her couch, crying out in pain, she said. “Right now, I’m afraid of going back to my couch,”

Ibsen said last week that his decision to stop prescribing pain medications to his patients with chronic pain was heartbreaking.

“I tried to figure out a way to cut down on the volume of chronic patients that I treat,” he said. “How do you make the decision on who gets thrown off the island?”

His decision had been a long time coming. Ibsen is certain that he’s still being investigated by the federal Drug Enforcement Administration. After hearing about the charges against Christensen and reading a story from Florida where authorities are seeking the death penalty against a physician in a similar case, Ibsen said it was “too dangerous” for him to continue in this regulatory climate.

“That was pretty much it for me,” he said. “These guys are not going to stop.” He recently learned of a new complaint filed against him with the Board of Medical Examiners. He said the stress has finally taken its toll.

 “I’ve done my best for my patients and I wish them well,” he said. “I’m on some kind of path and I’m not sure where it’s going to take me.”

The newspaper reporter continues with helpful information in this “War Against Doctors”.

Pain-patient advocate Terri Anderson of Hamilton said it’s time for chronic pain patients and their families to step forward and let regulators know about this growing health-care crisis. “Only then will we get their attention.”

“Pain patients are committing suicide,” Anderson said. Forty percent of all suicides in Montana are directly related to chronic pain and illness.

Anderson suffers from adhesive arachnoiditis caused by a failed medical procedure that misplaced steroids in her spine. She lost her civil engineering career with the U.S. Forest Service because of it. She will rely on opiates for the rest of her life.

“Spinal injections expose patients to many risks for temporary benefits,” Anderson said. “Patients are bullied, shamed, dismissed and abandoned if they do not submit to profitable procedures in Montana pain clinics.”

The inability of chronic pain patients to obtain medications will drive some to look to the black market,

“There will be a rise in the number of people using heroin and other street drugs,” said Ibsen’s patient helper. “This is a health-care crisis. Everyone is afraid. There’s only so much pain a person can endure before they give in. That’s just the reality of our lives. When you can’t eat, can’t get out of bed and you just lay there in a ball crying all day and all night, there’s only so much you can take.”

“If a doctor can give you a medication that allows you to work and be a productive member of your community and take care of your family, why would you take that away?” she said. “This is really inhumane. We’re backed into a corner without any treatment options. It’s just not right.”

 

And then the finally coup de gras to Dr. Ibsen’s traumatic fight: the examiner’s order was rejected by the state medical board and they asked the state attorneys to recommend sanctions for not meeting standards of care in his record-keeping. 

“I thought we won in June,” Ibsen said. “I’m completely stunned and mystified.”

An article by Angela Brandt on Nov. 19, 2015 goes into more detail.

The board voted unanimously to reject the order after voicing concern with the testimony of a witness deemed an expert in pain management and questioning the legality of some of the findings. The two physician members of the Board of Medical Examiners said they would like to suspend Ibsen’s medical license in the meantime. His license could have been suspended when this investigation began. However, in spite of the hostile intentions of the State Medical Board, a state judge intervened in the suspension of Dr. Ibsen’s medical license in March, 2016. The board had voted to strip Ibsen of his license indefinitely. Two days later, District Judge James Reynolds issued a temporary restraining order and injunction against the Montana State Board of Medical Examiners.

But there is only so much a doctor can take through this process. This had been ongoing for three years. The government knows that time is on their side. Finally, April, 2016 marks the last day of operation for Urgent Care Plus, Dr. Ibsen’s clinic. He can no longer sustain the business, saying it has been rendered worthless,

Ibsen says the more than two years of hearings followed by the arduous waiting for word from the Board of Medical Examiners regarding allegations of improper recordkeeping have rendered him emotionally and financially exhausted. His current practice cannot be revived, he said.

“This is a ghost town here,” Ibsen said, gazing around one of his patient rooms. 

When at full staff, Urgent Care Plus had upwards of 18 employees, he said. The clinic ran for about six years, averaging about 11,000 patients annually. 

As for Ibsen, he’s not sure what his next step will be.

“I’ve been anxious. I’ve been not able to make it through a whole day,” he said. “I have to get this stuff cleared up before I can go anywhere.”

And so, the government wins another attack on a good doctor following the Hippocratic Oath. But at least it would appear that in some states there are reporters that are telling all of the facts, not just the government propaganda. The reporting for Dr. Ibsen was a breath of fresh air.

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