“When treating friends, family members, or employees, physicans must treat them like any other patient by taking an adequate history and a proper medical assessment and maintaining complete medical records.”
people by a Dr. D. Jacoby,” according to the medical examiner’s report. The TMB disciplinary panel found
that between 2009 and 2010, Dr. Jacoby prescribed multiple controlled substanc- es to a family member and to several of his son’s friends for nonmedical purpos- es, with the understanding that he and his son would receive a portion of the pills prescribed. According to TMB, phar- macy records showed that after his son’s death, Dr. Jacoby continued to prescribe hydrocodone and carisoprodol to several of the same people. The suspension remains in effect un-
til further action by the medical board. TMB says it will schedule a temporary suspension hearing as soon as possible, unless Dr. Jacoby waives the hearing. At press time, there had been no criminal charges filed against Dr. Jacoby in his son’s accidental overdose.
treat them like any other patient by tak- ing an adequate history and a proper medical assessment and maintaining complete medical records,” she said. The Texas Medical Association Board
of Councilors provides similar advice: “One of the physician’s primary duties is to alleviate suffering. Thus, it is ethical to treat family and friends. As with all patients, in the course of treating friends and family, a medical record should be maintained; however, in urgent or epi- sodic situations, generating a medical record may not be practical or possible.” TMB prohibits physicians from pre- scribing controlled substances to them- selves, family members, or others with whom they have a close personal rela- tionship unless there is an “immediate need.” Ms. Robinson says physicians can prescribe controlled substances for up to 72 hours in emergencies. “It’s a violation of the Texas Medical
Practice Act to prescribe controlled sub- stances outside the immediate-need, 72- hour period,” she said.
34 TEXAS MEDICINE October 2011
Chapter 190 of TMB rules, http://bit .ly/r1WnuE, features applicable violation guidelines. The story of David James Jacoby, MD,
an emergency medicine physician at Westlake Medical Center in Austin, is an extreme and tragic example of what can happen when a physician crosses profes- sional margins and loses objectivity. TMB immediately suspended his medical license in May after a disciplin- ary panel determined he “posed a con- tinuing threat to the public welfare due to his lack of competence, impaired sta- tus, or failure to care adequately for his patients.”
On Dec. 19, 2010, Dr. Jacoby’s son,
Brandon, was found dead at home. An autopsy showed he died from multiple drug toxicity. The Travis County Medi- cal Examiner’s Office found evidence of antiseizure and antianxiety medications, a muscle relaxer, a pain killer, and other drugs in his body. Investigators discov- ered 49 pill bottles under the 24-year- old’s bed, “all prescribed to different
Follow the rules Ms. Robinson says many of the disciplin- ary orders the board levies pertaining to physician treatment of employees or family members involve nontherapeutic prescribing and medical records viola- tions. Recent TMB news releases are rife with examples.
In June, TMB disciplined Vernon F.
Williams, MD, for prescribing controlled substances to two employees and a close family member without indication of an immediate need and without main- taining adequate medical records. TMB requires the physician to pass within one year and within three attempts the Medical Jurisprudence Examination; to complete 10 hours of continuing medi- cal education in medical record-keeping and 20 hours in bariatric medicine and related pharmacology within one year; and to pay an administrative penalty of $2,000 within 60 days. In April, the board disciplined Mar-
garita A. Muniz, MD, for nontherapeutic prescribing, failure to meet the standard of care, inappropriately prescribing dan- gerous drugs to oneself and family mem- bers, failure to follow guidelines for the prescription of pain medications, and becoming financially or personally in- volved with a patient in an inappropriate manner. TMB requires her to complete
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