Author: WorkCompAcademy

A West Hollywood doctor pleaded guilty to a federal drug trafficking charge for writing hundreds of prescriptions for various controlled substances after a federal order revoked his authority to prescribe drugs. James William Eisenberg, 72, who resides in the Venice district of Los Angeles, pleaded guilty to one count distribution of hydrocodone, a drug best known by the brand names Vicodin and Norco.Eisenberg wrote the prescriptions while he worked out of several medical offices in West Hollywood, including a Santa Monica Boulevard storefront he called Pacific Support Services. Eisenberg also issued “medical marijuana” recommendations from these West Hollywood locations. He has been prohibited from issuing such recommendations and from practicing medicine at medical marijuana clinics as a condition of his release on bail.

In order to legally prescribe controlled substances such as hydrocodone, physicians must be registered with the United States Attorney General and have a valid DEA registration number. On December 14, 2011, a DEA administrative judge determined that Eisenberg acted as a “drug dealer” and suspended his registration number. The DEA issued an order permanently revoking Eisenberg’s registration on July 24, 2012. The orders issued by the administrative judge were based on findings that Eisenberg, who at the time was working out of a “medical marijuana” club in Arizona, “lacked a legitimate medical purpose and acted outside of the usual course of professional practice” when he wrote prescriptions for oxycodone (the generic form of a drug often best known as the brand-name OxyContin) and Xanax in exchange for $150 cash payments. The DEA judge also found that Eisenberg wrote “medical marijuana” recommendations to undercover officers posing as patients, and that Eisenberg prescribed OxyContin to one of the undercover agents “before [Eisenberg] had even performed a physical examination.”

DEA investigators later learned that Eisenberg continued to prescribe controlled substances, including hydrocodone, in violation of the DEA’s orders. A review of a California Department of Justice database that can be used to track prescriptions showed that, following the suspension of Eisenberg’s registration number, patients filled more than 1,700 of his prescriptions for controlled substances, including more than 1,200 prescriptions for hydrocodone. As charged in the indictment, Eisenberg wrote one of those prescriptions on December 27, 2011, less than two weeks after his registration number was suspended.

DEA investigators executed a federal search warrant on one of Eisenberg’s West Hollywood offices on February 19, 2013. The affidavit in support of the search warrant outlines evidence, including surveillance and undercover operations, that Eisenberg continued to write prescriptions for controlled substances in violation of the DEA’s revocation order. The evidence included an operation in which an undercover agent, posing as a patient, obtained a prescription from Eisenberg for hydrocodone and alprazolam (the generic form of a drug best known as Xanax).

As a result of his guilty plea, Eisenberg faces a statutory maximum sentence of 10 years in federal prison when he is sentenced by United States District Judge Michael W. Fitzgerald on December 9, 2013.

The Division of Workers’ Compensation issued a notice of public hearing for the Predesignation of Personal Physicians and Reporting Duties of the Primary Treating Physician Rulemaking regulations. The public hearing on the proposed regulations has been scheduled for 10 a.m., October 7, in the auditorium of the San Francisco State Office Building at 455 Golden Gate Ave., San Francisco, CA 94102-3688. Members of the public may also submit written comment on the regulations until 5 p.m. that day.

The regulations implement provisions of Senate Bill (SB) 863 that limit the number of chiropractic visits an injured worker may have unless a specific exception applies. The regulations also revise the method for an employee to designate a personal physician. The changes include:

1) The optional form for an employee to use to predesignate a personal physician to provide them with medical treatment in case of a work related injury or illness is being revised to state that an employee may predesignate a personal physician if, in addition to the other required preconditions, the employee has health care coverage for nonoccupational injuries or illnesses on the date of injury.

2)The form is also being amended to provide space for the employer to provide the name of the insurer that covers them for nonoccupational injuries or illness.

3) The optional form for an employee to use to predesignate a personal chiropractor or personal acupuncturist form is being amended to advise the employee that for dates of injury on or after January 1, 2004, a chiropractor cannot be a treating physician after the employee has received 24 chiropractic visits unless the employer has authorized additional visits in writing. The form will also advise the injured worker that the term “chiropractic visit” means any chiropractic office visit, regardless of whether the services performed involve chiropractic manipulation or are limited to evaluation and management.

4) Once the employee has received 24 chiropractic visits, if the employee still requires medical treatment, the employee will have to select a new physician who cannot be a chiropractor. This prohibition shall not apply to the provision of postsurgical physical medicine prescribed by the surgeon or physician designated by the surgeon pursuant to the postsurgical component of the Division of Workers’ Compensation’s Medical Treatment Utilization Schedule.

The regulations concerning the reporting duties of primary and secondary treating physicians are being revised to include essentially the same information.

The notice, text of the regulations, and forms can be found on the proposed regulations page.

Elsie Martinez was employed by Southern California Edison until 2004, when she allegedly became unable to work. During her employment with SCE, Martinez was a systems computer programmer. Her work involved repetitive use of her upper extremities. The parties stipulated that she had suffered two industrial injuries which gave rise to two separate workers’ compensation claims: (1) a specific injury to her neck, right shoulder, right wrist, right hand and psyche, which occurred on June 15, 2001, giving rise to the specific injury claim; and (2) a cumulative trauma injury, which arose over the entire period of Martinez’s employment (February 1998 through May 21, 2004), and caused injury to her lumbar spine, cervical spine, both shoulders, both wrists, both hands and psyche, giving rise to the cumulative trauma or CT claim.

The WCJ found that orthopedic and psychiatric impairments in the 2001 specific injury case entitled Martinez to 29% permanent disability, after apportionment. The WCJ found that Martinez’s fibromyalgia entitled her to a 100% permanent disability rating in the CT case and did not apportion any of her permanent total disability to the specific injury or to nonindustrial causes. The WCJ purported to base his decision on the CT claim on the opinion of independent medical evaluator Seymour Levine, M.D., a rheumatologist, who erroneously believed that Martinez had not suffered a specific injury in 2001.

Dr. Levine did not apportion between the specific injury claim and the CT claim as he explained in his report: “The cover letter points out that this patient has filed a claim for a specific incident that was said to have occurred on June 15, 2001. I asked the patient about this specific incident. She told me that there was not a specific injury that occurred on that date. It was on that date that she reported her medical problems.” As a result of his belief that Martinez had suffered no specific injury in June 2001, Dr. Levine concluded that “[T]he injurious exposure in this patient’s case, in my opinion, is one period of cumulative trauma for the dates of February 1998 through May 21, 2004.”

The WCAB denied SCE’s petition for reconsideration of the CT claim and adopted the WCJ’s decision. The award was reversed by the Court of Appeal in the unpublished case of Southern California Edison v WCAB (Martinez).

The opinion noted that labor code section 4664, as amended in 2004, provides that “the employer shall only be liable for the percentage of permanent disability directly caused by the injury arising out of and occurring in the course of employment.” The 2004 legislation represented “a diametrical change in the law with respect to apportionment . . . .” “[T]he new approach to apportionment is to look at the current disability and parcel out its causative sources — nonindustrial, prior industrial, current industrial — and decide the amount directly caused by the current industrial source. This approach requires thorough consideration of past injuries . . . .” The evidence presented here strongly suggests that one or more of Martinez’s disabilities caused by the cumulative trauma overlap with those attributable to the specific injury. In sum, the WCJ’s decision to allow Martinez an unapportioned award for the CT claim rests on a misinterpretation of Dr. Levine’s opinion about the causes of Martinez’s 100% disability and a failure to acknowledge that Dr. Levine’s view that there was no specific injury was wrong, a circumstance that removed overlap and apportionment from his medical reporting.

The Court of Appeal also noted that the WCJ calculated a COLA at the fixed rate of 4.6%. “We find no justification for inflating the award at a flat, unvarying rate of 4.6%. Neither inflation nor the cost of living, nor average wages, increase from year to year at the unvarying rate of 4.6%. Moreover, all of these factors (COLA, inflation, average wages) are more properly the subject of expert testimony, and there was no testimony, expert or otherwise, to support the 4.6% figure.”

Accordingly, the findings of fact and the award on the CT claim must be annulled and the matter remanded for further proceedings. Upon remand, the WCJ must determine whether there is an overlap between the disabilities caused by the CT claim and the specific claim, and, if there is, to apportion the award on the CT claim between the cumulative trauma, the specific injury, and nonindustrial causes.

CVS Caremark Corp said on Wednesday that it has taken the unusual step of cutting off access to powerful pain-killers for more than 36 doctors and other healthcare providers found to prescribe the drugs at an alarmingly high rate. The drugstore chain, which was drawn into a government crackdown on prescription painkiller abuse last year, began revoking the dispensing privileges of certain providers in late 2012, said CVS Chief Medical Officer Troyen Brennan. “This isn’t a definitive solution to the problem,” Brennan told Reuters. “We wanted to share what it was that we did and have other people in healthcare, including other pharmacies, look at what we did and discuss what some more comprehensive solutions might be.”

CVS disclosed the suspensions in an article published on Wednesday on the website of the New England Journal of Medicine. “At CVS, we recently instituted a program of analysis and actions to limit inappropriate prescribing. Our program was intended to identify and take action against physicians and other prescribers who exhibited extreme patterns of use of ‘high-risk drugs’ relative to other prescribers.”

CVS identified high-risk prescribers by benchmarking them against others on several parameters. It used data from submitted prescriptions from March 2010 through January 2012 for hydrocodone, oxycodone, alprazolam, methadone, and carisoprodol. Prescribers were compared with others in the same geographic region who had the same listed specialty. The first parameters were the volume of prescriptions for high-risk drugs and the proportion of the prescriber’s prescriptions that were for such drugs, as compared with the volume and proportion for others in the same specialty and region; the thresholds for suspicion were set at the 98th percentile for volume and the 95th percentile for proportion.

Next, prescribers were evaluated with regard to the number of their patients who paid cash for high-risk-drug prescriptions and the percentage of their patients receiving high-risk drugs who were 18 to 35 years of age. In both cases, the thresholds for suspicion were set at the 90th percentile among clinicians in the same region and specialty.

Finally, CVS compared the prescriptions for noncontrolled substances with the prescriptions for controlled substances within the prescriber’s practice on the same parameters. CVS initially identified 42 outliers from the database of nearly 1 million prescribers. To minimize the possibility that CVS would suspend dispensing privileges for clinicians who were appropriately treating patients, it attempted to interview physicians who were identified as outliers to ascertain the nature of their practice and their use of controlled substances. After further screening, 36 met the criteria for suspension.

Pharmacists have an ethical duty, backed by both federal and state law, to ensure that a prescription for a controlled substance is appropriate. The DEA has now identified both pharmaceutical distributors and chain pharmacies as part of the problem, encouraging the industry to develop new programs to reduce inappropriate use.

The Los Angeles Times says that over the last decade, the maker of the potent painkiller OxyContin has compiled a database of hundreds of doctors suspected of recklessly prescribing its pills to addicts and drug dealers, but has done little to alert law enforcement or medical authorities.Despite its suspicions, Purdue Pharma continued to profit from prescriptions written by these physicians, many of whom were prolific prescribers of OxyContin. The company has sold more than $27 billion worth of the drug since its introduction in 1996.

Purdue has promoted the idea that the country’s epidemic of prescription drug deaths was fueled largely by pharmacy robberies, doctor-shopping patients and teens raiding home medicine cabinets. The database suggests that Purdue has long known that physicians also play a significant role in the crisis.

Purdue’s database, which contains the names of more than 1,800 doctors, could provide leads for investigators at a time when they are increasingly looking at how reckless prescribing of painkillers contributes to addiction and death. Purdue has said little about the list since it began identifying doctors in 2002. A company scientist offered a glimpse into the database at a June drug dependency conference in San Diego, noting it was the first time the program had been discussed in public.

In a series of interviews with The Times, Purdue attorney Robin Abrams said the company created the database to steer its sales representatives away from risky doctors. Policing physicians, she said, was not Purdue’s responsibility. “We don’t have the ability to take the prescription pad out of their hand,” she said.Abrams said the company had alerted law enforcement or medical regulators to 154 of the prescribers – about 8% of those in its database. The company’s tally could not be independently verified. Asked to provide cases reported to law enforcement, she identified three Southern California physicians implicated in major schemes to funnel OxyContin to addicts and dealers.

One of them, Masoud Bamdad of San Fernando, took in $1.5 million a year prescribing OxyContin and other painkillers to young addicts. He is serving a 25-year prison sentence on a drug dealing conviction. Bamdad was linked by prosecutors to six patient deaths. Another doctor, Eleanor Santiago, is awaiting sentencing on federal charges that she helped flood Los Angeles’ black market with more than 1 million illicit doses of OxyContin. Physician Kevin Gohar was linked to a suspected prescription mill in Reseda that authorities say sold OxyContin prescriptions to addicts across Southern California. Gohar died of a drug overdose in 2011 while a criminal investigation was pending.

Mitchell Katz, director of the Los Angeles County Department of Health Services, said Purdue has a duty to report all the doctors on the list, not just a select few. “There is an ethical obligation,” said Katz, a critic of what he says is the overuse of painkillers. “Any drug company that has information about physicians potentially engaged in illegal prescribing or prescribing that is endangering people’s lives has a responsibility to report it.”

Two state senators on Monday called on the maker of OxyContin to turn over the names of California physicians it suspects recklessly prescribed its pills to drug dealers and addicts.