A¿nurse at the Manchester hospital called the medical board in December to report a trend of overdoses with Xanax and other drugs prescribed by Williams. In January, Johnson and Clay County Coroner Danny Finley called the board with similar concerns, according the suspension order.
A medical board investigator interviewed Dr. Bryan Wood and Dr. Stuart Larson of the Centex clinic in Danville, where Williams practiced for about a month in 2011 before being dismissed. Williams brought many of his patients from his private practice with him when he joined Centex, said Wood, who owns the clinic.
Larson, also a psychiatrist, said he became concerned when he noticed several cars with license plates from across Kentucky in the clinic’s parking lot and heard other patients complaining about “junkies” hanging around the clinic, the order states.
Wood said he reviewed Williams’ records and discovered that 97 percent of his patients were being prescribed high doses of Xanax and a cocktail of other drugs including Seroquel, Klonopin and Trazodone. Another review of the clinic’s records showed Williams saw an average of 41 patients a day at Centex, more that twice as many as Larson. The average visit between Williams and a patient lasted five to seven minutes, the suspension order states.
Woods, who works in the emergency room at Fort Logan Hospital and also is part owner of 11 SelfRefind addiction treatment clinics in Kentucky, including one in Danville, said in an interview Friday it didn’t take he and Larson long to conclude something was out of line with Williams’ practice at Centex.
“The problem raised its head very quickly, and we dealt with it with expediency,” Wood said.
The high rate of patients being prescribed high levels of Xanax and other drugs, the short time spent with patients and “people coming long distances — that just didn’t feel right,” Wood said.
Noting he is not a psychiatrist, Wood said the drug cocktail most often prescribed by Williams is potentially dangerous, especially if used in combination with other drugs. A mixture of Xanax, Seroquel (anti-psychotic), Klonopin (anti-anxiety) and Trazodone (anti-depressant commonly prescribed as a sleep aid) is a potent combination, he said.
“When you prescribe all this together ... wow, that’s really going to slow you down,” he said.
Wood said Williams, whom he had known and respected for several years, was recruited to Centex to see SelfRefind patients, mostly pain pill addicts, who needed psychiatric help along with other forms of treatment. Centex will close later this month, and SelfRefind patients will receive psychiatric treatment in the SelfRefind clinics, Wood said.
Wood himself is currently under an agreed order with the licensure board — entered last month — that restricts him from prescribing Suboxone, a controversial drug used to treat people addicted to painkillers. Wood has defended his use of Suboxone to treat addicts for years while the medical board alleges that Wood overprescribes the drug.
After leaving Centex, Williams opened a practice on Daniel Drive and later moved his office to Martin Luther King Boulevard. He previously had a private practice in Green Leaf Shopping Center. He also admitted and treated patients at the behavioral health unit at Ephraim McDowell for 13 years, and has been in practice for a total of 40 years.
As part of its investigation, the medical board hired Dr. George R. Schrodt to review Williams’ records. Schrodt, an associate professor of psychiatry and behavioral science at the University of Louisville, analyzed the records of 32 of Williams’ patients, including 10 of those who died in Clay County.
Among Schrodt’s findings:
n There was no documentation Williams discussed the potential risks of using controlled substances, especially in combination with other prescribed or illicit drugs, with his patients.
n There was little notation of patients’ past medical histories. “Most importantly, there was minimal, if any, documentation of concurrent medications or therapies prescribed by other physicians, even when those might have potentially serious interactions with Dr. Williams’ prescriptions.”
n Inadequate time to complete adequate evaluations and management of patients due to extremely high case load.
n Starting patients out with a high dose of Xanax and often increasing it when standard psychiatric care calls for starting with a low dose and adjusting as needed.
In conclusion, Schrodt wrote Williams prescribed medications in such amounts he knew or should have known were excessive and “failed to conform to the standard of acceptable and prevailing medical practice.”
“Based on the sampling of cases I reviewed, it is my opinion that Dr. Williams demonstrated a pattern of acts during the course of the physicians medical practice ... that would be deemed to be gross incompetence, gross ignorance, gross negligence or malpractice,” Schrodt wrote.