Report: Reckless Prescribing Common in California

December 11, 2012

California patients are at risk from reckless prescribing by doctors because of a lack of oversight at the state Medical Board, an investigation has found.

The board seldom tries to suspend the prescribing privileges of physicians under investigation, and even when it sanctions doctors for abusing their powers, in most cases it allows them to continue practicing and writing prescriptions, according to the Los Angeles Times.

At least 30 patients in Southern California have died of drug overdoses or related causes over a six year span while their doctors were under investigation. The board ultimately sanctioned all but one of those 12 doctors, and some were criminally charged.

One physician, Dr. Carlos Estiandan, wrote more prescriptions than the entire staffs of some hospitals and earned more than $1 million a year, the newspaper said.

Court records show Estiandan prescribed powerful painkillers to addicts who had no medical need for them, conducted phony examinations and appeared to be a supplier for drug dealers.

By the time the medical board stripped Estiandan of his prescription pad, more than four years after it began investigating, eight of his patients had died of overdoses or related causes, according to coroners’ records.

The Estiandan case was not an isolated example of the board’s failure to protect patients from reckless prescribing, the Times said. In 80 percent of the 190 cases of improper prescribing filed by the board since 2005, the offending physician was given a reprimand or placed on probation. In most of those cases, the doctor was allowed to continue writing prescriptions with few or no restrictions.

Eight doctors disciplined for excessive prescribing later had patients die of overdoses or related causes. Prescriptions those doctors wrote caused or were linked to 19 deaths.

In response to the Times’ findings, officials have asked the Legislature to require county coroners to report all prescription drug deaths to the board.

Previously investigators looking into reports of poor treatment usually did not search county coroners’ files to determine whether – as in Estiandan’s case – a doctor’s patients are dying of drug overdoses.

Dr. Rick Chavez, a pain management physician in Redondo Beach, serves as an expert for the board in cases of reckless prescribing. He told the Times overprescribing is a pervasive problem, and oversight is inadequate.

“We have doctors out there doing things that no one is monitoring,” he said. “It’s scary.”

The medical board’s president, Sharon Levine, a pediatrician who is an executive at Kaiser Permanente, declined to be interviewed by the newspaper, saying it would be “inappropriate” because disciplinary cases are ultimately decided by the board. Executive Director Linda Whitney declined to comment, and staff members said they are barred by policy from speaking with reporters.

Responding by email to written questions, board officials asserted that their “highest priority and primary mission is consumer protection.”

The Times examined board records and county coroners’ files from 2005 through 2011.

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