An appeal to combat overdoses
In an appeal for the public’s help in stemming the epidemic of prescription drug deaths, the Medical Board of California is asking people whose relatives died of overdoses to contact the board if they believe excessive prescribing or other physician misconduct contributed to the deaths.
Linda K. Whitney, the board’s executive director, urged those with information about improper treatment to contact the board without delay. By law, the agency has seven years from the time of the alleged misconduct to take disciplinary action against a physician.
“The sooner we get the information, the sooner we can move forward,” she said in an interview.
Whitney also said board investigators would review autopsies and other records on specific overdose deaths described in recent articles in the Los Angeles Times.
She said the board, which licenses and oversees California physicians, was acting in response to reports in The Times that documented the connection between doctors’ prescribing practices and fatal overdoses involving OxyContin, Vicodin and other narcotic painkillers.
Whitney said members of the public can report concerns about excessive prescribing by calling 1-800-633-2322 or filling out and mailing a complaint form, which can be downloaded from the agency’s website, www.mbc.ca.gov.
A revolution in treatment of chronic pain has caused a huge increase in prescriptions for pain and anxiety medications. There has been an accompanying sharp rise in prescription drug deaths over the last decade.
In response, authorities have focused on how addicts and drug dealers obtain such drugs illegally, such as by stealing from pharmacies or relatives’ medicine cabinets. The Times articles reported that many fatal overdoses stem from drugs prescribed for the deceased by a doctor.
In nearly half of the prescription drug deaths in four Southern California counties from 2006 through 2011, medications prescribed by doctors caused or contributed to the death, according to an analysis of coroners’ records.
Seventy-one doctors, a tiny fraction of all practicing physicians in the four counties, were associated with a disproportionate number of deaths, The Times found.
Sixteen patients of a Huntington Beach pain specialist died of overdoses from 2006 through 2011 after taking medications he prescribed. A San Diego County doctor lost 15 patients to overdoses, a Westminster physician 14, coroners’ records show.
All three doctors have clean records with the medical board, and there is no evidence that board officials knew about the deaths.
That medical regulators could be unaware of clusters of fatal overdoses underscores gaps in the state’s system of physician oversight.
Drugs fatalities are documented in great detail in county coroners’ files, which in many cases list medications found at the scene of death, along with the name of the prescribing doctor. But medical board investigators do not review those files to look for patterns of reckless prescribing or other inappropriate treatment.
Whitney said the board would like to receive reports from county coroners on all prescription overdose deaths. State Sen. Curren Price, (D-Los Angeles), responding to the Times coverage, has promised to introduce a bill that would require such reports.
A fatal overdose does not necessarily mean a doctor did anything wrong, Whitney said. Board investigators must review patient records to determine whether physician misconduct contributed to a death, she said.
Public participation will aid such investigations, she said, because investigators can gain access to a physician’s patient files more readily if a family member has granted consent.
In addition, family members may be able to contribute information about overdose deaths that is not in coroners’ files. Tips from relatives could also be valuable in calling attention to previously overlooked cases, Whitney said.
Julianne D'Angelo Fellmeth, a public interest lawyer who has monitored the medical board for the state Legislature, called Whitney’s announcement a “good first step,” adding: “They need this information.”
But Fellmeth said the board may be hindered in its investigative efforts by the effects of years of budget cuts.
The agency has fewer investigators than it did in 2001 and investigates about 40% fewer misconduct cases per year, according to board data. Over the same period, the number of licensed physicians in California has risen to more than 102,000.
“They should be actively seeking to restore the number of investigators’ positions that they had before and increase those to keep up with the increase in the physician population,” Fellmeth said. “It’s not acceptable to have the ranks of medical investigators decrease in the face of this kind of misconduct and abuse.”
From the time the board receives a complaint, it takes nearly a year on average for an investigation to be completed. In some cases, doctors under investigation for excessive prescribing have lost several patients to drug overdoses by the time the board took disciplinary action.