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Top Prescribers: Do Medical License Restrictions Have Unintended Consequences?

Top Prescribers: Do Medical License Restrictions Have Unintended Consequences?

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Dr. Steven Balt, editor-in-chief of the Carlat Psychiatry Report, recently found himself on the list of top prescribers for a psychiatric drug billed to California’s Medicaid program in 2009.

He says that he prescribed a lot of medications that year because at the Bay Area clinic where he worked. He says he disagreed with that culture, but then why did he work so long – 2008 to early 2012 – in a clinic where he felt the care was substandard?

One big factor was that in 2005 he had been placed on probation by the Medical Board of California because of two shoplifting charges and a driving under the influence charge. Balt about how a lifelong struggle with bulimia nervosa led him down a path of risky behaviors.He said at the time, the bulimia “proved to be my undoing.”

Balt says now that the effects of that Medical Board case were still being felt when he worked for the Bay Area clinic:

As an independent contractor myself with that clinic, I could have left at any time and probably should have, since their practices did not align with my professional ethics. But this was my first "real world" experience, and I told myself that my expectations may have been far too idealistic. More importantly, though, I could work nowhere else. As your readers may recall from , after I left Stanford [Hospital’s residency program] I was in no man's land. I was still licensed as a physician, but I was in the Medical Board’s diversion program [for doctors with substance abuse or mental health problems], until that program was ended.  I had not yet finished residency so my options were extraordinarily limited. Several California residency programs with openings between 2008 and 2011 were unwilling to hire me.  The only reason I worked at the clinic was because it was, literally, the only place I could find that would permit me to work as a psychiatrist.

And now here’s the scary part.

Balt says he thinks that he was just one of many doctors in duress who take jobs that other physicians don’t want, often dealing with vulnerable populations. I have written about this before, with doctors being funneled into treating or as part of their discipline by state medical boards.

And then there are the no-other-options doctors, like Balt describes. These are the doctors you may remember from series. In , he described how he ended up in trouble with the U.S. Drug Enforcement Agency for allowing another doctor to use his DEA privileges to order massive volumes of painkillers that then went unaccounted for. One of the only places he could find a job was in a 1-800-GET-THIN Lap-Band clinic that later was slapped by the FDA.

Balt now has a full and unrestricted medical license in California. But, his experience demonstrates that a Medical Board history can severely curtail a doctor’s employment prospects:

In my job searches over the past year, I have found that physicians with license restrictions have extreme difficulty finding regular work, regardless of their ethics or philosophy. As a result, they may be drawn to positions like the one in that clinic or crisis medication clinics, or performing quick disability evaluations or group home visits. As a result, many of our disciplined or reprimanded physicians are working in the highest-volume settings, which may severely compromise care. Of course, we also have fully licensed and "pristine" physicians practicing in these settings and overprescribing, too, but that's an entirely different matter.

So does Balt still prescribe antipsychotics and other drugs in high volumes? Not at all, he says.

In my own case, I recently completed my residency and passed my Boards, and I have opened my own private practice in the Bay Area. It has been slow thus far, but I fully believe I can succeed because I feel confident in my ability, and I get great feedback from my patients. The Medical Board’s action against my license had nothing to do with the quality of my patient care, and I have always been committed to treating each patient as a complete person, not just a collection of symptoms. On my own, I feel that I'm practicing a different type of medicine than in the high-volume medication clinics I've seen in the past. I'm treating the same sorts of people, but I am not restricted by documentation requirements, time demands, formulary restrictions, or an overflowing waiting room. I do prescribe antipsychotics, but not without a careful assessment of risks and benefits first. This is the psychiatry I was taught to practice.

Stephany at Soulful Sepulcher, one of my most vigilant readers when it comes to mental health issues – and the blogger who about Balt being on the list of top prescribers – suggested that I ask Balt about Medicaid. So I asked, “Because you and the clinic were billing Medicaid for Seroquel, a name brand drug, versus a cheaper drug, do you feel like this was abuse of the Medicaid system?” Here’s what he wrote:

Yes. But keep in mind, if billing for Seroquel is "abuse" of Medicaid, then I would also state that there were similar abuses of Medicare, Social Security Disability, State Disability, Workers Comp, In-Home Support Services (IHSS), etc., and that such abuses were not limited to this one clinic.

One final note. You may notice that Balt deleted some of the tweets I wrote about on Monday (and that Stephany has posted on her blog). The social media world tends to punish deletions as something akin to homicide. But is there room for error on Twitter? I’d love to hear your thoughts on when it is acceptable to remove a tweet and whether it is any different than deleting an email or throwing out an early draft of a document that you shared with people and then revised. Send me a note at [email protected], leave a comment below or find me on Twitter @wheisel.

Image by Joe Houghton via

Comments

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These clinics are involed in Medicaid fraud, big-time!
Jim Gottsein, Attorney in Alaska has a link that explains in detail -

These drugs are not FDA-approved for children, for a REASON... They are dangerous!

Some good links about their dangers, and how to safely taper off of the drugs -

U.S. Senator Charles Grassley has bee instremental in helping curtail their use... howeve,r more needs to be done. For all readers, please his office and ask for further investigations into Mediciad fraud, to include U.S. Dept of Justice action - fines and federal prison for those who contine to ignore the law, and target low-income families with these harmful drugs! -

Duane Sherry, M.S., CRC-R

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My license was restricted regarding solely chronic pain management. I have never had any complaint, even now, against me to any medical board by a patient/ex-patient and/or the domestic partner/spouse of a patient or ex-patient. I did nothing morally, legally, ethically or medical wrong. Yet now I cannot find work any where, even for positions whose task have no impact due to the restrictions on my license. These positions include administrative positions, general practice in remote regions with no health care provider and medical exams (doctor-claimant relationship only, no doctor-patient relationship). I am told that I have been rejected because of these restrictions on my license. My personal and professional life have been destroyed. I am now homeless, on food stamps, on Medicaid and am suicidal at least 2-3 times per month. I have no criminal record. I do not do recreational drugs. I do not abuse alcohol. I have always tried to be a good human being and a good physician. I did not deserve what has happened to me. Things like this should not be happening in the United States but they are. Licensing boards are a law unto themselves. No one elects them. No one can legally get rid of them. And they do not have to answer, beyond mere lip service, to the public or lawmakers. They write the rules which are vague and essentially allow them to do what they want to do with impunity. Totalitarianism lives, breathes and is growing in the U.S.

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I agree with Bobsmith. A license restriction is by far the worst sentence a board may give. It leaves a physician with false hope that he could find some employment, but no one ever wants to hire such a physician. My license was restricted to seeing male patients only after a single boundary violation with a female patient. It was a mutual communication with no physical . Since the restriction, I lost my job, and have not been able to find any work. I also have a son who just managed to survive cancer, thankfully before the restriction went into effect. With minimal savings, we are struggling to manage. I have applied for a different state license hoping that they would show some mercy. If not, I can definitely see the same doom befalling me. The medical board in Florida decided to place this restriction despite an extensive evaluation done by a renowned psychiatric facility that found I was completely fit to see patients of both genders, as long as I agree to a monitoring contract with Florida PRN for a 5 year period. My license restriction was indefinite as long as I practiced in Florida. Even shamefully begging for a job from friends led to no where. I am left with praying that I get an unrestricted license elsewhere, and to move out of Florida. It is down right disgusting to see how the Florida licensing board treated the physicians that came before them. Everyone was presumed guilty, and they have to provide no explanation as to why the chose a certain judgement contrary to expert advice. I agree with Bobsmith's quote: "Licensing boards are a law unto themselves. No one elects them. No one can legally get rid of them. And they do not have to answer, beyond mere lip service, to the public or lawmakers. They write the rules which are vague and essentially allow them to do what they want to do with impunity. Totalitarianism lives, breathes and is growing in the U.S."

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I was prescribed Oxycontin for chronic migraine, and I had trouble stopping it. My physician recommended I enter the AZ Medical Board's confidential Relapse Prevention program. Under my agreement, I was ordered to go to inpatient rehab ($45,000), submit 2 random urines a month ($130/mo) for 5 years, and attend counseling with a group of docs weekly ($900/mo) for 5 years. My license was never restricted, I continued working, I had no arrests, no patient complaints, no DUIs, nothing.

When my spouse and I decided to move to CA, the CA Medical Board in its wisdom granted me a probationary license, so now no one will hire me. Discrimination against addicts who have rehabilitated is illegal (Americans with Disabilities Act), so I intend to pursue a class action suit against the Board.

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I have a very twisted case where the medical board was used as a way to get revenge from ex-employees who were embezzling. There were many instances where I was not given due process and where the medical board violated a variety of laws. I would like to talk to a MD with similar problems and see if there is a way to network to
have the medical board have proper oversight. I am currently having to sell my practice from the fallout....

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I experienced exactly same situation, from a malicious lie told by a local sheriff who wanted me off main street in my town. The board in Kentucky is without any due process, as is the AAFP and ABFM. It is like the Antichrist, no buying or selling of goods or services anywhere on earth because they blackball you on the internet. I am not anti-board or anti-government, but if a doctor is suspect, put him on leave, but then let's have DUE PROCESS IN A COURT OF LAW. The Boards care zero about truth. Lies serve there purposes better and so that is all they do, and that with impunity, in some cases. REFORM REFORM REFORM. It is a human rights violation per Eleanor Roosevelt's human right commission in the 40's, to take a lie and destroy an individual's ability to earn a living, but that is exactly what was done in my case, and NO ONE ANYWHERE WILL LISTEN. This must change.

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My experience is the same, and they exercise the power of the Antichrist without any checks or balances and totally without due process. They are 100 percent unconcerned with the truth or reality since lies and deception serve their purposes better. Besides that, they are VERY unprofessional and unethical.

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I can totally relate to you Bob...the same was done to me in NY-and for no good reason.

The State Medical Boards are powers unto themselves with no over sight...they are set up separate from the government so there is no political influence imposed on them supposedly. We have no recourse.

I too got screwed over--by a former employer who has nothing better to do than put a lot of the community at risk by bogus complaints about my care of them. He has connections to the NYS DOH and I do not...guess who got screwed.

I am on probation for three years--I need a babysitter for three years to sign off on my charts--I cannot operate my own practice--I have to take CME in medical record keeping--I have mastered three EMR systems. I have to take CME to on opiate prescription and addiction--I have a suboxone waiver and completed the training to get it. So what gives?? I was in the 2014 Edition of the leading Physicians of the World and am a former "Healthcare Hero"...so seriously--what gives??

Power, ego, connections. I have painfully learned that it is not about doing what is right, it is about who you know. A doctor can do everything right, and still get seriously screwed over...that is what happened to me--no ethics or morals played a role in what my previously employer has done to me; it is a vendetta that he will do anything to fulfill.

What if all of us screwed over docs come together with our medical knowledge and talent and create some kind of on line business to help people?? We all seem to have internet and medical knowledge...we need a platform is all.

When God closes the door, he opens a window. We all feel the same about what was done to us. We should gather together and skype and come up with something and show these idiot boards that they were wrong in how they handled us. Feel free to me if interested--I am serious--I have nothing else going on at this point. Good luck to all of us.

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The next "door" for me will be a coffin lid. It is no longer bearable.

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I'm in. Let's collaborate and get something going!

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do you have any organization or agency who can get us a job

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I'm right there with you all. It's crazy what can happen.

I love the idea of pooling talents and creating something awesome!

Who's in?

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Please include me too.

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I got restricted license since I didn't have money for the trial for medicare fraud ($150000 ) while in the middle of horrible divorce, I got slapped with 3 year probation on MD license and 5 year exclusion from OIG.
I am looking for any options to make income since I have been also slapped with a $5000/mo alimony.
Please share any recommendations, thoughts, hints and experiences

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I have been set up in a sting operation and charged with medicare fraud since I did not have money for the trial ( north of $150000 cash) with no guarantees since I was in a middle of a horrific divorce, ended up with 3 years probation of my license and OIG exclusion for 5 years. I have been slapped with alimony of $5000/mo with no ability to pay. Does anyone know about any employment opportunities for physicians in similar situation?
Please share your experiences. Situation is very difficult
Thanks for any responses

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