Health Editor’s Note: In September I reported to VT readers that California was using death certificates to find individuals who have died from narcotic overdoses. This is called the Death Certificate Project. Evaluating causes of death on death certificates has lead to the names of doctors who have prescribed these narcotics. Initially the count was at 12. Now California has found 11 more doctors. So far California is the only state to use this procedure to find errant prescriptions of narcotics that have led to patient deaths. Various forms of discipline against these doctors are taking place. We have 50 states so that leaves 49 to step up to the plate and take action….Carol
California’s “Death Certificate Project” Nabs Eleven More Physicians
ByContributing Writer, MedPage Today
Another 11 physicians now face new “Death Certificate Project” accusations from the Medical Board of California, filed over the last month, because a patient for whom they had prescribed narcotics fatally overdosed years ago.
That brings the total to 23 physicians who face new disciplinary actions.
Their names and practice locations are as follows. The full accusations, made public by the medical board, may be viewed by clicking the links:
Ashmead Ali, MD, California City, Kern County
Michael S. Basch, MD, Temecula, Riverside County
Jose Rosendo Cesena, MD, El Cajon, San Diego County
Daniel George Clark, MD, Auburn, Placer Counter
John Courtney Dozier, MD, Susanville, Lassen County
Frank Gilman, MD, San Diego, San Diego County
William Lee Matzner, MD, Simi Valley, Ventura County
Mahyar Okhovat, MD, Agoura Hills, Los Angeles County
Ronald David Richmond, MD, Mission Viejo, Orange County
Bruce M. Stark, MD, Toluca Lake, Los Angeles County
Charles Yang, MD, Huntington Beach, Orange County
Among the many “causes for discipline” detailed in these 11 new accusations:
- Prescribing controlled substances for family members with whom he did not have a patient-physician relationship
- Prescribing dangerous medications to an alcoholic without referring patient for alcoholism treatment
- Prescribing hydrocodone for an undercover police officer after a “perfunctory medical examination”
- Failing to appropriately sever the doctor-patient relationship
- Writing “illegible” notes
- Failing to order drug tests to ensure patient was not abusing other substances
- Prescribing ultimately lethal doses of fentanyl patch to a patient known to be taking benzodiazepines
Details on the initial 12 physicians accused in the program were reported by MedPage Today in September.
Gilman’s case is especially notable: the medical board’s accusation runs to 63 pages, including nearly six pages listing controlled substance prescriptions for a single patient, most of them prescribed by him. The document notes that two of his patients died of drug overdoses. Gilman was said to have failed to screen one of his patients for aberrant drug behavior and did not check the prescription drug database or coordinate prescriptions he wrote with care given by other prescribers.
As MedPage Today initially reported, the controversial project was launched 3 years ago. It starts with the board’s review of death certificates from 2012 and 2013 listing overdose of a prescription drug as a cause. The state agency then cross-checks California’s prescription drug database to identify which physicians prescribed controlled substances to those patients up to 3 years before their death.
Investigations for those 2 years have so far targeted 450 allopathic physicians, 12 osteopathic physicians and another 60 nurse practitioners and physician assistants for more detailed probe. In roughly half, the board has determined not to pursue charges, with the rest either pending or resulting in formal accusations.
Many physician organizations expressed horror at the project’s methods. They said it is unfair for the board to reach that far back, to prescriptions written before a patient overdosed in 2012, because the extent of the opioid epidemic was far less well-known and state and federal guidelines had not yet been published. Providers have generally curtailed their prescribing practices since.
Many also objected that they shouldn’t be blamed for prescribing a legitimate analgesic for a patient in pain if that patient later overdosed on a different prescription or illegal drug.
The California Medical Association (CMA) was originally silent on the project’s worth, but it’s now pushing back — not just because of the Death Certificate Project, but because of other medical board requests for medical records and investigation subpoenas that the CMA suspects are unfairly targeting specific groups of doctors.
At its House of Delegates meeting in mid-October, it passed a resolution to push for an independent review to reveal what criteria the board uses in choosing which complaints to pursue.
“We have asked [the board] to look to using an outside agency to survey whether their techniques and investigations are improperly or irregularly focusing on specialties or geographic areas, and therefore skewing the investigations’ outcomes,” Theodore Mazer, MD, CMA’s immediate past president, told MedPage Today.
Mazer, a San Diego otolaryngologist, declined to say what specialties or specific regions the CMA is referring to. But he said that “in Northern California, there’s a specific area that feels they’re being focused on, improperly targeted, and it’s both a geographic and specialty concern.” He added that the CMA also has been hearing from doctors in southern parts of the state that they too are being unfairly scrutinized.
One concern was whether the board was targeting San Diego. Of the first 12 accusations filed in the Death Certificate Project, four physicians had San Diego County practice addresses, although the county has fewer than 10% of the physicians in the state, whereas none were from Los Angeles where 27% practice.
With the latest 11 accusations, six of the 23 are from San Diego versus two from Los Angeles.
One possible reason is that the San Diego County Medical Examiner has mounted an independent effort to perform toxicology tests in overdose cases and then inform physicians involved in those cases.
“It might be related… but we don’t know the answer and that’s why we’ve asked for an outside agency to look at it, to see if there’s a skew or is it being done without a focus on a geographic area,” Mazer said. “Or, another county may be supplying information directly or inadvertently that is focusing the MBC on those areas.”
One physician targeted in the new round of accusations said he had quit practicing as a result.
In an Oct. 31 decision, the board placed William Lee Matzner on seven years of probation and barred him from practicing medicine for 30 days and from prescribing or administering or possessing any controlled substances. It also ordered him to take several courses in ethics and prescribing.
Reached for comment, Matzner, a specialist in palliative and hospice medicine, told MedPage Today he was falsely accused. He was just practicing, and prescribing, the way he was trained, “but now that’s out of favor so they’re trying to criminalize doctors,” he said.
Matzner said he has not prescribed controlled substances since 2015, and now is no longer practicing at all. The accusations have resulted in him being “blacklisted from doing anything directly or indirectly with patients. It’s impossible to get a job as a physician.” He added that the medical board “is going after doctors to try and solve a problem they’re not solving very well.”
MedPage Today has sought comment from all the physicians named in the latest round of accusations. At time of publication, none besides Matzner had provided a substantive response. This story will continue to be updated if such comment is received.
The Medical Board of California is the largest physician licensing and disciplinary agency in the nation. As of its 2016-17 report, it oversaw 113,000 physicians practicing in the state and 24,867 out of state but who maintain California licenses.