California’s “Death Certificate Project” Should Terrify All Doctors Across the Country

Why?  Because the next one attacked could be YOU!!

Any doctor in California treating pain could be the recipient of a letter from the Medical Board of California. In the letter, the medical board states that a “complaint was filed against you” regarding a patient who died of a prescription overdose. The death could have happened years before the letter, and might not every have been caused by a drug prescribed by the doctor. But in stern bold type, the letter’s second paragraph would say that the patient “died from an overdose of drugs X, W or Z.” The state’s prescription drug database, CURES (California Controlled Substance Utilization Review and Evaluation System), showed that the doctor targeted had been prescribing “long-term excessive amounts of these” and that “it is unknown what conditions the patient suffered from which required such medication.”

As a result of this letter, many physicians in California have stopped prescribing pain medicines. Physicians describe the situation as “terrifying”. A typical response is to immediately contact an attorney and the malpractice insurance carrier. Many doctors who received these letters say it has riddled their lives with stress and self-doubt, and then anger while they wait for the Board’s decision. Physicians are advising their colleagues to stop prescribing opioids. Many are considering getting out of medicine altogether.

“If they can’t see that this was me as a physician doing the best job that I could to help this patient with intractable pain, what am I supposed to do?” they ask.

This just shows how doctors are putting their own neck in the government noose by prescribing any controlled substance at all. Why? For starters, most physicians did not have easy access to prescription databases at the time of these deaths to see what other drugs their patients had been prescribed by other providers. And yet they are being held accountable. Second, at the time, there was no uniform standard on the total morphine equivalent dosage doctors should be prescribing, or how much is too much had been in dispute.

Ted Mazer, MD, California Medical Association president, and Kelly Pfeifer, director of the California Health Care Foundation’s High-Value Care staff have been approached pertaining to this. No one is standing up for the doctors. The California Medical Association’s associate director, Charlie Lawlor, said his group “remains committed to our continued work on effective policies that increase access to proven treatments for patients with addiction and dependency,” but is still reviewing the board’s program and wouldn’t comment on the merits of the project. The California Academy of Family Physicians declined to comment on the board’s project but its web page just advises doctors to retain an attorney immediately upon contact from the board.

Hundreds of California physicians are currently being targeted in the California Medical Board’s aggressive “Death Certificate Project,” in which the board takes death certificates in which prescription opioids are listed as a cause, then matches each with the provider — sometimes more than one — who prescribed any controlled substance to that patient within 3 years of death, regardless of whether the particular drug caused the death or whether that doctor prescribed the lethal dose.

The project was launched in late 2015 with 2,694 certificates being evaluated from years 2012 to 2013 and found 2,256 matches in CURES, showing each provider who wrote an opioid prescription filled by those deceased patients. Those reports went to medical peer reviewers who, after extensive review, selected 522 prescribers as warranting an investigation of the patients’ files. They included 450 allopathic physicians against whom the board has opened formal complaints along with 12 osteopathic physicians and 60 nurse practitioners or physician assistants, who were referred to their respective licensing boards. Of the 12 osteopath referrals, seven were closed for insufficient evidence; the other five remain open for investigation. Of the 450 allopaths, 216 cases were closed for insufficient evidence or no violation, or the license had already been revoked or surrendered, or the physician had died. As of last week, 38 still await further review of their cases before proceeding; the rest await completion of an investigation.

Of the nearly 450 MDs who received letters notifying them of a “complaint,” the state Attorney General has filed opioid-related prescribing accusations against ten who are:

1. David H. Betat, MD, of Lakeport;
2. Harold S. Budhram, MD, of Shasta Lake;
3. Bradley Howard Chesler, MD, of Escondido;
4. David James Smith, MD, of San Diego;
5. Tahir Yaqub, MD, of Atwater;
6. Emanuel Vincent Dozier, MD, of Bakersfield;
7. Jay Milton Beams, MD, of Susanville;
8. Moshe Miller Lewis, MD, of Susanville;
9. Raymond Paul Freitas, MD, of Santa Rosa;
10. John Winthrop Pierce, MD, of San Francisco

Go to any of the highlighted doctors’ names to see the setup that boards create against doctors. These doctors are being dinged for have repeated documentation for multiple patient visits in chart notes, not discussing a patient’s addiction risk before prescribing, not documenting discussions about non-opioid alternatives, and basic disagreement with method of treatment. Many of the accusations repeat these phrases: “gross negligence,” “furnishing dangerous drugs without examination,” “unprofessional conduct,” and “inadequate record keeping.” None of these physicians have had a hearing yet, nor have been found guilty of the charges against them. But keep in mind, this is only a paper trail.  Note that all of the complaints are headed with the State Attorney General’s officials as part of the complaint. You see, the State Boards of Medicine are simply an arm of the Departments of Justice.  They lay down the paper trail. Then the Attorneys General pick it up and run with it into the criminal courts. And those derogatory phrases are repeated to jurors as if they were fact.

Kimberly Kirchmeyer, the California Medical Board’s executive director, states that the board wants to “identify physicians who may be inappropriately prescribing to patients and to make sure that those individuals are educated (about opioid guidelines), and where there are violations of the Medical Practices Act, the board takes (disciplinary) action.” Kirchmeyer described the death certificate project as an “invaluable” and proactive way to prevent future opioid overdoses by revealing overprescribers.

So the board’s project is using death certificates and the CURES database to go beyond the individual fatality and examine a physician’s overall prescribing practices. In some cases, investigations triggered by a death certificate identified other, living patients for whom that provider had possibly inappropriately prescribed. That has resulted in a different letter sent directly to such patients saying that the board “is reviewing the quality of care provided to you by Dr. — ” and asking the patient to promptly authorize the doctor to turn over that patient’s medical records to the board. It also threatens to subpoena the records if the patient refuses. Addressing physicians’ concerns that these letters could erode patients’ confidence, Kirchmeyer said it only sends such letters to patients after a medical consultant “indicated that a physician may be inappropriately prescribing.”

Other states may be targeting their physicians as well through their Boards of Medicine. North Carolina has its Safe Opioid Prescribing Initiative, originating in 2016, which investigates clinicians with at least two opioid-related patient deaths in the preceding 12 months and who prescribed at least 30 tablets within 60 days of the patient’s death, or when licensees have large numbers of patients on 100 milligrams of morphine equivalents (MME) per patient per day.

What should doctors do?  No doctor in this country is safe from attack if they write a single controlled substance prescription. Doctors should agree as a body to stop prescribing at all until they are protected as intended by the Controlled Substance Act. Check out Doctors of Courage’s list of Concerns and Demands submitted to Congress April 25, 2018. Everyone should become a member of Doctors of Courage, to protect yourself and others from attack in the future. We need to be ONE BODY.  Go to Membership Levels to become a member.

Doctors need to come together as one so that our concerns and demands are acted upon. Go to DoC’s Concerns and Demands to read them and download your own copy to send to everyone, including the President, legislators and state officials.

Addendum

May, 2020, a Medpage Today article reports that deaths actually doubled as a result of these attacks on doctors. So California revamped their project of investigating physicians prescribing controlled drugs. It is now called the Prescription Review Program.