Ventura County Star (California)
Simi Valley psychiatrist fights license revocation;
Doctor says errors made during inquiry
By Tom Kisken
November 29, 2013
An administrative law judge ruled in October in a case brought by the Medical Board of California that Dr. David M. Gudeman wrongly prescribed opiates and other powerful medications. Two patients died of drug intoxication, according to board records.
But the decision to revoke Gudeman’s license — once scheduled to become official the day before Thanksgiving — has been put on hold at the doctor’s request until the case can be reviewed. Gudeman said he’s falsely accused, claiming mistakes were made in the investigation, including what he said are attempts to link him to a death involving drugs he did not prescribe.
Gudeman, who claims to be the only private psychiatrist in Simi Valley, said the Medical Board of California is overreacting to criticism its leaders have not done enough to stop doctors who operate so-called pill mills.
“I think there’s a witch hunt,” he said.
Gudeman is a UCLA Medical School graduate trained in psychiatry and internal medicine. Also an addiction specialist, he’s been in medical practice since 1989.
He has led inpatient psychiatry units and served three years as director of the Ventura County Behavioral Health Department. Gudeman was fired in 2002 after criticism for embroiling the department in governmental disputes about mental health treatment in juvenile hall. He started his private practice two years later and sees about 1,200 patients.
The Medical Board case, filed two years ago, involves seven patients named only by their initials in the ruling and accusations.
In his ruling, Judge Daniel Juarez said Gudeman treated patients with addictive drugs such as OxyContin and Norco knowing they were fighting drug dependency problems. He said Gudeman did not obtain lab tests, perform physical examinations, contact patients’ former doctors or ask for second opinions.
One patient died Jan. 12, 2009, of morphine, oxycodone and oxymorphone intoxication, according to Medical Board documents. Juarez said Gudeman prescribed addictive drugs including an opioid, or opiumlike drug, several months before the suicide and noted the patient’s suicidal nature but took no other therapeutic action.
In its accusation, the Medical Board alleged Gudeman did not question his continued prescription of opiates to the patient or act on the potentially lethal affects of providing multiple medications to what the accusation called a depressed, suicidal, alcohol-abusing patient.
But Gudeman said he never prescribed opiates or opioids to the patient, noting that another doctor dealt with the patient’s pain issues.
“I was being blamed for another doctor’s prescription,” he said in a letter to Gov. Jerry Brown, defending his care of all seven patients.
Another patient died of methadone intoxication on Aug. 3, 2010, according to Medical Board records. Juarez said Gudeman continued to prescribe addictive substances while acknowledging concern the patient was misusing them.
Gudeman said he prescribed a modest refill of methadone for the patient before he died out of concern that withholding the drug could send the patient into withdrawal that would strain his heart. He said the patient had suffered chest pain that had brought a recent hospitalization.
“He clearly had a heart attack,” Gudeman said of the patient’s death. He noted the patient was once homeless and that he treated him for free.
“I must be the world’s worst opiate mill if I’m not charging,” Gudeman said.
In his ruling, Juarez described Gudeman as inflexible. He said his prescriptions and increased dosages for patients he knew overused medication or other drugs represented “extreme departures” from the standard of care.”
Gudeman said he no longer accepts cases that involve addiction and that they always made up a small portion of his cases. He said he used painkillers carefully, and with monitoring, to deal with pain and push patients battling a combination of pain, addiction and psychiatric issues away from other drugs, including heroin.
Supporters include members of National Alliance on Mental Illness in Ventura County with which Gudeman serves on an advisory board. They say he’s thorough, focused on his patients and doesn’t fit the profile of a doctor who carelessly prescribes pills.
“I support him wholeheartedly,” said Duane Bentzen, president of the group.
Gudeman contends the Medical Board’s vigilance in pursuing cases involving painkillers stems from a Los Angeles Times series that said the board often failed to stop doctors who recklessly prescribed painkillers.
Cassandra Hockenson, a spokeswoman for the Medical Board, said she couldn’t respond to Gudeman’s accusations or comment on his case because the case against him is ongoing.
But she noted that Juarez, in his ruling, referenced Gudeman’s apparent unwillingness to change.
The judge wrote that there was little chance probation “would be fruitful in modifying (Gudeman’s) seemingly immovable mindset with regard to the proper care and treatment of patients in his practice. Revocation is, thus, the appropriate discipline.”
Juarez also ruled Gudeman kept incomplete records, failing to document when he started or increased powerful drugs. He didn’t note when he suspected patients were overusing medications or illegal drugs, the judge said.
The doctor said he will file an action in Ventura County Superior Court if his Medical Board challenge isn’t successful.
Others focus on the affects of a revocation that they said could leave Simi Valley without a private psychiatrist.
Gudeman’s patients write letters to politicians and praise the doctor for what they say is attentive and careful care.
They fear what could happen.
“I need my doctor,” said Fran Cohn, of Simi Valley. “This man has just been wonderful. … That I could lose that support is frightening, absolutely terrifying.”