The state medical board has placed a San Rafael psychiatrist on probation and ordered her to study ethics and prescribing practices after she allegedly prescribed more than 100 tablets a day of addictive painkillers to a woman later found disoriented in the middle of the street.
Pacific Sun (Mill Valley, California)
Bitter pills for San Rafael shrink – Psychiatrist gets painful lesson about prescribing painkillers
By Ronnie Cohen
July 30, 2010 – August 5, 2010
Dr. Patricia Stamm faced losing her license to practice medicine in connection with her treatment of the 54-year-old woman who wound up overmedicated, agitated and bewildered in Marin General Hospital’s emergency room in 2006. On July 15, after the medical board and Stamm agreed to settle the matter without a hearing, the board disciplined the 61-year-old psychiatrist by putting her on five years probation.
Stamm, who has a private psychiatry practice in San Rafael and also serves as an interfaith minister, defended herself in a telephone interview last week. She described herself as a bighearted, service-oriented doctor and the former patient as a sociopath who conned her. “I was empathetic and naive enough to think I could help her,” Stamm said. “If Fm guilty of anything, I should have sent her to a pain specialist from the beginning.”
Lawmakers in the state of Washington are considering mandating that physicians refer patients to pain specialists when their painkiller doses increase to specified levels. Last week, a federal panel rejected a proposal to curb narcotic drug misuse, saying it failed to go far enough because it did not require doctors to be trained in appropriate prescription practices for opiate painkillers.
During the summer of 2006, Stamm prescribed 7,912 doses of the narcotic oxycodone over 77 days to the patient who had admitted months before that she was addicted to opiates, according to a medical board accusatioa The accusation says that in September 2006, the patient, identified only as CJ., was found wandering in the street dazed.
When C. J. arrived in the emergency room, hospital staff found a bottle with the remains of a prescription Stamm wrote for 960 oxycodone pills, the accusation says. It says C. J., who suffered chronic ankle pain, admitted taking 700 of the 5 milligram pills in the preceding four days.
The board accused Stamm of gross negligence and incompetence in her treatment of C.J. The accusation alleges Stamm inappropriately terminated her care of CJ. by writing her a letter saying she believed the patient had an escalating drug-abuse problem and then presaibing a month’s supply of the drug – oxycodone – she had been abusing.
Similar to morphine, oxycodone is one of the drugs that killed 28-year-old actor Heath Ledger. A time-release version of oxycodone, OxyContin, also known as “hillbilly heroin,” has become a popular and deadly recreational drug among teenagers and young adults.
After treating CJ. with a variety of painkillers and other drugs from January through August 2006, the accusation says that on Sept. 1, 2006, Stamm hand delivered a letter to CJ. saying she could no longer work with her. In the letter, Stamm recommended that CJ. enter a detoxification program. Instead of going into rehab, CJ. took more than three-quarters of the pills intended to last a month in four days and wound up in the emergency room, according to the accusation.
“What I didn’t know because I’m not a pain specialist,” Stamm said during the telephone interview, “was that in addiction medicine you should only give the patient no more than a week’s supply.”
Although C.J. informed Stamm during her initial January 2006 appointment that she was addicted to opiates and entertained suicidal thoughts, the accusation says Stamm overprescribed oxycodone as well as other painkillers, antidepressants, stimulants and anti-anxiety drugs without taking a proper history or performing an appropriate physical examination.
Had she physically examined the patient, Stamm said she could have been sued for boundary violations. Stamm also denied prescribing close to 8,000 oxycodone pills in 77 days. The discrepancy appears to stem from a series of apparent ruses the patient used to get more medicatioa She reported spilling one-fourth of a bottle of oxycodone, which Stamm replaced with another prescription. Then the patient reported that her dog got into her medication bag.
Though Stamm knew that CJ. had an ongoing relationship with another psychiatrist, who continued to see and prescribe medications to CJ., Stamm failed to coordinate care. In the telephone interview, Stamm said she tried unsuccessfully to communicate three times with Kaiser, where CJ. was a patient, about her other care.
Stamm, who earned her medical degree from Columbia University in 1977 and was board certified in psychiatry in 1982, also failed to obtain a report from a state database to see what other controlled substances had been prescribed to CJ., the accusation says. In the interview, Stamm said she did not know about the database, the Controlled Substance Utilization Review and Evaluation System, or CURES. By law, since 2004, healthcare providers who dispense controlled substances like oxycodone must report dispensing information to the Department of Justice monthly.
In the telephone interview, Stamm said CJ., a heavyset woman who explained that only large doses of narcotics muffled her pain, told her she had been a prominent Marin County lawyer but chronic pain following a car accident, a fractured ankle and subsequent surgeries had left her unable to function in her job and homeless. CJ. told Stamm that her Kaiser physician had refused to give her the pain medication she felt she needed to get back on her feet.
“I felt sorry for her,” Stamm said. “I felt I wanted to help her. So I put her back on the opiate, and she got back to work.
“It turned out that unbeknownst to me she was a sociopath in addition to a borderline personality disorder. So she lied to me and didn’t tell me she was getting opiates from other sources. I wanted to give her the benefit of the doubt, and it has really been a mistake, and I realize that now.”
Stamm said CJ. paid her for the first few sessions but then said she had no money, and the psychiatrist agreed to wait for payment until CJ. returned to work. Stamm said CJ. owes her thousands of dollars.
“This whole thing has been so painful to me because I meant so well,” Stamm said.
Physicians began treating chronic pain with opiates in the 199Os. As a result of the movement toward more aggressive pain management, the federal Centers for Disease Control and Prevention estimates at least a 10-fold increase in the medical use of opiate painkillers during the past 15 years. At the same time, US. drug overdose rates have risen steadily, with most of the increase due to prescription drugs, according to the CDC.
Stamm said her father suffered a painful death three years ago because he was undermedicated. “I hope we don’t go back to the old days where people were left to die and where children had surgery with no painkiller,” she said.
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