BOARD OF PHYSICIAN QUALITY ASSURANCE NEWSLETTER
Volume 5, Number 4
DECEMBER 1997
Governor Parris N. Glendening has appointed two new physician members and one new consumer member to the Board of Physician Quality Assurance. The physician members, who were selected from a list of candidates provided by Med-Chi after a statewide election, are Zorayda M. Lee-Lacer, M.D. and Ronald J. Orleans, M.D.
Dr. Lee-Lacer, a graduate of the University of Santo Tomas in Manila, Philippines, is an anesthesiologist at Doctor’s Community Hospital in Lanham, Maryland, where she is the Medical Director of the Medical Surgical Intensive Care Unit, a member of the Credentials Committee, and the Director of Respiratory Therapy and Pulmonary Lab.
Dr. Orleans is in the private practice of obstretics and gynecology in Bethesda Maryland. He received his M.D. from the George Washington School of Medicine. Dr. Orleans has served as chair of the OB/GYN Peer Review Committee at Shady Grove Hospital, Chair of the Montgomery County Medical Society Peer Review Committee, a member of the Peer Review Management Committee of the Medical and Chirurgical Faculty of Maryland, and as the physician advisor for the Delmarva Foundation for Medical Care, Inc.
Samuel K. Himmelrich, Sr. was appointed as the consumer member of the Board representing the Maryland Hospital Association. Mr. Himmelrich is the Chairman of Inland Leidy, Inc., and is currently a member of the Executive Committee and the Chair of the Performance Improvement Committee for the University of Maryland Medical System. He has been a long-time member of numerous community and service organizations including the Walters Art Gallery, Baltimore County Industrial Committee, and the Associated Jewish Charities.
Mr. Himmelrich replaces Mrs. Sheila K. Riggs, charter member of the Board, who chaired the Psychiatrist Assistant Advisory Committee and was a member of the Respiratory Care Advisory Committee. The two physician members whose terms as BPQA members have expired are Lawrence A. Jones, M.D., of Hagerstown and Ira N. Brecher, M.D., of Montgomery County. Dr. Jones served as a Board member for eight years and was the Chair of the Practice of Medicine Committee for the last six years. Dr. Brecher, a Board member for eight years, served as the Chair of the Physician Assistant Advisory Committee. The Board thanks these three dedicated volunteer Board members for their efforts on behalf of the citizens of Maryland.
BOARD DISCIPLINARY ACTIONS July - September 1997
WILLIAM R. BRADLEY, M.D. License #D33173, Specialty: Anesthesiology (Baltimore, MD) Surrender of License. The physician’s decision to surrender his license was to avoid a summary suspension of his license to avoid further prosecution on charges related to the summary suspension and to begin rehabilitative treatment because of his relapse and lack of abstinence from mood altering chemicals. Effective 7/2/97
PRABHAKER J. KHAROD, M.D. License# D22212, Specialty: Orthopaedic Surgery (Pasadena, MD) Revocation for a period of four (4) years. The Board found that the physician was professionally incompetent and failed to meet standards of care in his practice of orthopedic medicine. The Board also found that the physician violated terms and conditions of the consent orders of August 26, 1992, and November 29, 1994. Effective 7/2/97
NEIL O. ROBY, CRT Certification# E31603, Specialty: Cardiac Rescue Technician (Clarksville, MD) Revocation. Care and treatment of three (3) patients did not follow MIEMSS protocols; abandoned a patient. Effective 7/2/97
HENRY S. GERING, M.D. License# D04303, Specialty: OB/GYN (Fort Washington, MD) Reprimand; inactive license with conditions. The Board concluded that the physician violated standards of care based on a peer review of twenty (20) patient records involving gynecologic surgeries. Effective 7/9/97
RICHARD L. GOLD, M.D. License# D04276, Specialty: Psychiatry (Mahwah, NJ) Revocation. The Board based its action on an action by the New York State Medical Board which found the physician guilty of moral unfitness in the practice of medicine and professional misconduct in the practice of psychiatry for engaging in physical contact of a sexual nature with his patients. Effective 7/9/97
EDWARD L. MOSLEY, JR., M.D. License# D21954, Specialty: General Surgery (Fairmount Heights, MD) Reprimand; fine of $10,000; and conditions. The Board concluded that by instructing and allowing unlicensed persons to practice physical therapy, the physician is in violation of practicing medicine with an unauthorized person. Effective 7/23/97
LEON R. LEVITSKY, M.D. License# D09187, Specialty: Family Practice (Lanham, MD) Revocation. The Board concluded as a matter of law that the physician violated the following provisions of the Maryland Medical Practice Act: abandons a patient and fails to meet appropriate standards of care. Effective 7/30/97
RICHARD NATHANIEL SCOTT, M.D. License# D11439, Specialty: None (Ellicott City, MD) Suspension for three (3) months; suspension stayed; fine of $3,500; physician prohibited from engaging in or performing any and all vascular surgical operations, procedures, or techniques, and any and all invasive vascular testing or diagnostic procedures; probation for a period of three (3) years subject to terms and conditions. The physician failed to meet standards of care in his practice of vascular surgery. Effective 8/27/97
LEE G. DANTE, M.D. License# D29330, Specialty: Psychiatry (Merion Station, PA) Reprimand; three (3) years probation subject to terms and conditions. The Board found the physician guilty of unprofessional conduct in the practice of medicine when he entered into business relationships with two (2) former patients and when he treated and/or prescribed medication for three (3) patients/employees. Effective 8/27/97
STANLEY Z. FELSENBERG, M.D. License# D01085, Specialty: General Practice-Forensic Pathology (Baltimore, MD) In accordance with the order of the Circuit Court for Baltimore County, the May 22, 1996 order of suspension is reversed. Effective 8/27/97
RALPH P. MERCHANT, M.D. License# D07773, Specialty: None (Shippinsburg, PA) Reinstatement of licensure denied. The Board concluded as a matter of law that the applicant was disciplined by a licensing or disciplinary authority in that his reinstatement of licensure in Pennsylvania was denied. In a prior Pennsylvania order the physician's license had been suspended and he had agreed not to contest an Order to Show Cause of the Pennsylvania Board which charged the physician with inappropriate prescribing of controlled drugs to a series of patients, having sexual intercourse with a patient in return for drugs, inadequate medical record keeping and inappropriate touching of female patients. Effective 8/27/97
WILLIAM J. DELAPAZ, M.D. License# D35373, Specialty: OB/GYN (LaPlata, MD) Suspension for three (3) years; all but one (1) year stayed; probation for three (3) years subject to terms and conditions. The physician failed to meet the standards of care in his practice of obstetrics and gynecology. Effective 9/10/97
EDDIE S. SAW, M.D. License# D17113, Specialty: Urology (Elkton, MD) Stay of suspension imposed by the order of June 25, 1997; probation for three (3) years subject to conditions. The physician has served the terms of suspension. Effective 9/23/97
EMAD R. AL-BANNA, M.D. License# D12705, Specialty: None (Prince Frederick, MD) Reprimand; fine of $5,000; and a condition of community service. The physician practiced medicine with an unauthorized person or aided an unauthorized person in the practice of medicine when he allowed a nurse employee to cover his office practice for approximately two weeks while he was out of the country. Effective 9/24/97
CHARLES T. GERBER, M.D. License# D08601, Specialty: OB/GYN (Chevy Chase, MD) Reprimand; terms and conditions. The Board concluded that the physician failed to meet standards of care for ten (10) patients in his practice of obstetrics and gynecology. Effective 9/24/97
MANOUCHEHR SADRI, M.D. License# D30549, Specialty: Psychiatry (Washington, DC) Revocation. The physician pled guilty to one (1) count of felony Medicaid Fraud in Violation of Article 27, Section 230 B and C of the Annotated Code of Maryland and, therefore, comes under the purview of State statute which mandates revocation of the license. Effective 9/24/97
TERMINATION OF PROBATION
FARHAD SATERI, M.D. License# D26855, Specialty: Urology (Westminster, MD) Termination of probation and the Consent Order of October 23, 1996. Effective 7/2/97
DONATO A. VARGAS, JR., M.D. License# D17148, Specialty: Internal Medicine (Phoenix, MD) Termination of probation and the Consent Order dated December 30, 1994. Effective 7/2/97
ROSITA H. DEE, M.D. License# D21691, Specialty: None (Silver Spring, MD) Termination of probation and the Consent Order of December 29, 1995. Effective 7/13/97
RONALD P. HAIRSTON, M.D. License# D07816, Specialty: None (Annapolis, MD) Termination of probation imposed by the Order for Reinstatement of July 27, 1994. Effective 8/27/97
J. JON C. MARIANO, JR., M.D. a/k/a JOSE C. MARIANO, JR., M.D. License# D04827, Specialty: None (Laurel, MD) Termination of conditions of the Consent Order of December 20, 1995. Effective 8/27/97
STEPHEN C. PAPASTEPHANOU, M.D. License# D09245, Specialty: General Surgery-Colon & Rectal Surgery (Lutherville, MD) Termination of the Consent Order of April 23, 1997. Effective 9/10/97
ZIA ZAKAI, M.D. License# D26485, Specialty: Orthopaedic Surgery (Baldwin, MD) Termination of probation and the Consent Order of June 28, 1995. Effective 9/10/97
GEORGE PIRPIRIS, M.D. License# D26170, Specialty: Orthopaedic Surgery (Towson, MD) Termination of probation and the Consent Order of February 25, 1995. Effective 9/18/97
MEHRDAD AALAI, M.D. License# D26712, Specialty: OB/GYN (Upper Marlboro, MD) Termination of probation imposed on May 31, 1996 Effective 9/24/97
ADMINISTRATIVE FINES
JAMES H. FRENCH, M.D. License# D26643, Specialty: Plastic Surgery (Annandale, VA) Administrative fine of $1,000 for practicing medicine with a lapsed license. Effective 7/16/97
DARRYL J. HODGKINSON, M.D. License# D38826, Specialty: Plastic Surgery (Darling Point, Sydney, Austria) Administrative fine of $100 for failure to notify the Board of a change of address as required by statute. Effective 8/13/97
JOSEPH. KLIGMAN, M.D. License# D29601, Specialty: Internal Medicine (Baltimore, MD) Administrative fine of $1,000 for practicing medicine with a lapsed license. Effective 9/25/97
THE BOARD’S DISCIPLINARY ACTIONS ARE A MATTER OF PUBLIC RECORD. A COMPLETE COPY OF ANY FINAL ORDER MAY BE OBTAINED BY CALLING 410-764-2475 . THERE IS A SMALL FEE TO COVER THE COST OF COPYING THE DOCUMENT.
On October 1, 1997, the Board of Physician Quality Assurance joined eight other states participating in the "Docfinder" web site at www.docboard.org. This site is a "look-up" service providing information about physicians. The site lists the physician’s name, address of record, medical school, year of graduation, area of concentration, status of license, expiration of license, and whether or not the BPQA has issued any sanctions against the physician’s license. Information on malpractice claims and other unadjudicated information is not included. Persons who wish to know more about an individual physician may contact the Board via an internet e-mail connection by simply clicking on the hypertext e-mail address on the look up system or by e-mailing a request to BPQA @ erols.com.
In addition to physician information, the home page contains the BPQA mission statement, information on choosing a physician, the roster of Board members, directions to BPQA offices, and selected information from the BPQA Newsletter. When BPQA demonstrated the "Docfinder" system to the members of the House Environmental Matters Committee and the Senate Finance Committee in the fall, there was a positive response to this service to consumers. The "Docfinder" system utilizes information already in the Board’s computer data base and thereby preserves Board resources for its primary function of protecting the public.
DO YOU WANT YOUR HOME ADDRESS LISTED ON THE BPQA WEB SITE?
That may happen to you on January 8, 1998, when the street addresses are added back to the information provided on the "Docfinder" system. To find out what BPQA has as your address of record, just check the label on this newsletter. You may request a change in your address of record by writing to the Board or by completing the form below. Physicians who have concerns about personal information being made available to the public on internet sources should check other web sites such as those maintained by the American Medical Association and the American Board of Medical Specialties.
CHANGE OF ADDRESS FORM
Mail to: BPQA
4201 Patterson Avenue
Baltimore, Maryland 21215-0095
Please Print!
Name: _________________________________________________________
License #: ______________________________________________________
Address of Record: _______________________________________________
_______________________________________________
_______________________________________________
Signature: ______________________________________________________
INVESTIGATING PHYSICIANS - a message from Suresh C. Gupta, M.D.,Chair, BPQA
The members of the Board of Physician Quality Assurance, twelve of whom are practicing physicians, realize that a Board investigation is one of the most disconcerting, in fact, disheartening events that a physician may experience. However, the Board is required to investigate all complaints that are filed and to respond to the complainants. The Board receives over 2,200 complaints each year from patients and entities required to report adverse actions against physicians. The Board does not select physicians to investigate nor does it set up traps for physicians. In the last year, Board members and staff have made presentations to over 2,000 individuals explaining the Board's function and investigative process. But let me take this opportunity to provide further insights into how the Board conducts its investigations.
Most often, a physician will learn that a complaint has been filed with the Board by receiving a letter. The letter often includes a copy of the complaint or a summary of the information and requests a response to allegations from the physician. Sometimes, the first notice of an investigation is a subpoena for records. Admittedly, a subpoena is not a friendly document, but when records are needed to investigate a complaint, the Board must obtain them in this manner to maintain patient confidentiality and to comply with the Maryland Medical Records Act. The Board may also subpoena hospital quality assurance files to look for a trend in similar complaints or deficiencies identified in the hospital setting. These subpoenas may arrive at the hospital before any other letters or subpoenas reach the physician. The physician should not panic, but realize that this is part of the Board's process of investigating a complaint or report.
The Board receives the majority of complaints from patients. However, the Board also receives copies of all malpractice claims filed with the Health Claims Arbitration Office. Claims which have a certificate of merit are assigned to be reviewed by a Board medical consultant in the same specialty as the physician being sued. This evaluation is presented at the Weekly Review Panel (WRP) of the Board for a decision whether the claim should be referred to the Medical and Chirurgical Faculty of Maryland (Med-Chi) for an incident review. Most of the time, the WRP closes the inquiry without referral. About 20% may be referred on to Med-Chi. I should emphasize that the Board understands that a poor outcome which results in a malpractice action is not, in itself, a reason for a peer review.
When the Board refers a case on to Med-Chi for a peer review, Med-Chi then assigns two physicians in the same specialty as the physician under review to evaluate the care. When their report is received, Board members review the report thoroughly to decide if further action should be taken.
Some of you may want to participate in the peer review process conducted by Med-Chi. The Board recognizes these peer review activities toward partial fulfillment of the continuing education credits required for relicensure.
The Board may conduct an extensive investigation prior to notifying the physician of a complaint when the allegation involves sexual misconduct, fraudulent billing, or unprofessional conduct. The investigation may involve subpoena of medical and billing records as well as interviews with prospective witnesses. In these cases, the physician may be aware of the ongoing investigation for some time prior to being asked to respond to the complaint. As you should be aware from articles that have appeared in the Board's newsletter, the Board takes findings of sexual misconduct, illicit drug use, and fraud very seriously and almost always exacts a sanction. However, I want to emphasize that we do not have a set quota of disciplinary actions. We investigate complaints thoroughly and review the investigations at every step of our process.
What should physicians do when they receive a request for a response to a complaint? The best thing to do is to respond promptly and completely with sufficient detail that the WRP can understand your version of the events leading to the complaint. How does a physician best show that he or she had provided quality care? The best way is to maintain thorough, complete, legible, and well organized records. Maintaining good records helps to insure the continuity of care for our patients and is itself a quality of care issue.
The Board was created with the mission of protecting the public. The Board members take their mission and tasks very seriously, but they do not look to discipline physicians just because a complaint is filed. The Board issues about 120 orders each year. The majority of sanctions on standard of care cases involve a plan for remediation of deficiencies with a goal to return the physician to safe and productive practice. I believe that the Board has a fine record and that if any of you sat on the Board, you would agree with the actions that the Board has taken.
Thus, you need not fear the Board. Fewer than one-half of one percent of practicing physicians are the subject of public orders each year. The Board is actively working to educate physicians how to avoid being the subject of a complaint and how to provide excellent care. The Board is mindful of giving due process to the physician at every step of the process which may result in a sanction.
BOARD POLICY ON USE OF CONTROLLED DANGEROUS SUBSTANCES
There is a general misperception among physicians that prescribing large quantities of opiates or providing prolonged treatment with opiates for relief of chronic pain will automatically result in the Board sanctioning the physician involved. It is true that drug surveys and practice reviews of physicians often deal with the question of the appropriateness of physician prescribing. Peer review evaluates both controlled dangerous substances (CDS) and non-habituating medication prescribing to ascertain whether or not the physician has met the standard of care. The Board hopes that by clarifying our policy on the prescribing of CDS that physicians will feel confident that they can meet their patients’ needs for pain relief without fearing Board sanction. The members of the BPQA expect physicians to use the following guidelines when prescribing CDS for their patients:
HISTORY AND PHYSICAL
Generally speaking, it is improper to prescribe any medication for any patient without first taking the steps essential to evaluation. This is particularly true of the chronic pain patients because other treatment modalities may be beneficial and because it is important to recognize the addict who may complain of pain as a means to maintain a habit. Prescribing narcotics without documented evaluation always represents substandard care.
TREATMENT PLAN
Just as treatment for diabetes or hypertension has a specific objective, so should treatment for chronic pain. Frequently, the pain cannot be completely relieved but the use of analgesic drugs may lead to an improved sense of well-being, better sleep, or even a return to work. The goal of analgesic therapy should be documented and the patient’s progress measured against this goal.
RECORDS
Adequate documentation is the key to management of these difficult patients and is the key to protecting the physician from legal or Board action. Documentation of the steps noted above should be recorded in a fashion that would allow another physician to understand and follow through with treatment.
INFORMED CONSENT
Since long-term narcotic use will usually result in habituation or tolerance, these risks should be discussed with the patient. Alternatives should be offered if they exist and the clinical report should refer to this discussion.
PERIODIC REVIEW
The course of treatment and the meeting of therapeutic goals should be periodically reviewed as is the case with any patient suffering from chronic disease. Modification of treatment or its continuation should be considered depending upon how well goals are being met. New information about the etiology of the pain or its treatment should be evaluated.
CONSULTATION
The complexity of chronic pain frequently requires evaluation by consultants who may suggest alternatives or additions to therapy. This may be particularly true in the patient who is at risk for drug misuse. The patient with a history of substance abuse requires special care in documentation, evaluation and consultation before long-term opiate treatment can be safely prescribed. Some pain management specialists recommend a written agreement with these and other patients before such therapy.
Finally, the physician who uses scheduled drugs should be familiar with federal and local laws regulating their use. The U.S. Drug Enforcement Administration publishes a manual for physicians and Maryland laws are available through the Board. The Board hopes that physicians will use these guidelines to help them manage patients with chronic pain without fear of regulatory scrutiny. At the same time, the Board maintains its commitment to prevent the diversion and abuse of controlled substances.