Leigh Hopper, TMB public information officer, the remaining applicants had overdue renewals or had canceled their applica- tions, or the board canceled the application due to disciplinary action.
The board has been busy enforcing the law. At the medical board’s February meeting, 45-year-old Akili
Graham, MD, a Pearland family physician, agreed to a volun- tary revocation of his license for nontherapeutic prescribing practices and pill mill-related activities. In the DEA’s investi- gation of Dr. Graham, agents interviewed several employees — many of whom were unlicensed foreign medical graduates — who worked for the physician at four pain management clin- ics for which he held certificates. The employees admitted to giving prescriptions to patients Dr. Graham never evaluated. In addition to losing his medical license, Dr. Graham faces criminal charges in Harris County on four counts of unlawfully operating a pain clinic. The most severe penalty TMB can levy against a physician for violating pain management clinic rules is revoking his or her medical license. Ms. Hopper adds that to permanently re- move a physician from practice, TMB must file the case with the State Office of Administrative Hearings (SOAH) or the physician must agree to surrender his or her license. Ms. Hop- per was unable to say how many physicians’ medical licenses had been suspended or revoked for pain management clinic violations because the board doesn’t track that information.
In April 2011, TMB suspended
the medical license of Gerald Rati- nov, MD, 78, a Houston neurolo- gist, based on his “unprofessional conduct likely to deceive, injure, or defraud the public.” Dr. Ratinov was medical director of Hobby Medical Clinic, Abundant Life and Weight Loss Center, and Astro- dome Pain Clinic in Houston. He also faces criminal charges. DEA, which led the investiga- tion in conjunction with the Harris County District Attorney’s Office, DPS, and the Texas State Board of Pharmacy, says Dr. Ratinov used the clinics — along with some pharmacies — to fill fraudulent prescriptions without medical ne- cessity. Authorities shut down the clinics and related pharmacies. TMB documents show Dr. Rati-
nov had no contact with patients at the clinics. They say a foreign medical graduate not licensed to practice medicine in Texas filled out presigned prescriptions for pa- tients, a violation of board rules.
As of November, the board had suspended the certification of 20 pain management clinics for violating TMB rules. Ms. Hopper says disciplinary actions commonly pertain to viola- tions of board rules regarding operation of pain management clinics, failure to meet the standard of care, and prescribing controlled substances without a valid medical purpose or non- therapeutic prescribing.
Ms. Hopper says TMB doesn’t track the number of pain management clinics it discovers operating without required certification. She says the information may be reflected in dis- ciplinary actions the board takes against doctors. To view pain management clinic disciplinary actions, visit
www.tmb.state
.tx.us/professionals/physicians/licensed/pmClinicsDiciplinary Action.php. At press time, TMB averaged 115 days to process pain management clinic applications. Ms. Hopper says “the delay is mostly on the applicants’ side,” noting that applicants are often slow to submit lacking documentation. Physicians applying for pain management clinic certifica- tion must submit clinic ownership documents, which may in- clude the following:
• Filings with the Secretary of State; • Sales tax certificates with the Texas Workforce Commission;
TMA’S PAIN MANAGEMENT RESOURCES
TMA’s Physician Oncology Education Program (POEP) and the Texas Pain Society (TPS) offer a home-study course, Pain Medicine: Acciden- tal Lethal Overdoses. The course teaches physicians the principles of chronic opioid therapy, including appraising a patient’s risk for substance abuse, avoiding dangerous drug combinations, and assessing therapeu- tic benefit. The 13-page course costs $35 and offers continuing medical education
credit, including 1.5 hours of ethics. The course file is available through the TMA Education Center,
www.texmed.org/education. Physicians can request a hard copy in the mail by emailing Laura Wells at laura.wells@
texmed.org, or calling her at (800) 880-1300, ext. 1673, or (512) 370-1673. At TexMed 2012, the Texas Medical Association House of Delegates
passed a resolution developed by the Texas Pain Society and the Har- ris County Medical Society on responsible opioid prescribing for pain management. The policy states TMA “supports multidimensional strategies to opti-
mize the treatment of pain and works to educate Texas physicians about the latest evidence-based literature on responsible opioid analgesia management with the goal of reducing the risk to patients and enhanc- ing the public safety regarding opioid use, misuse, abuse, diversion, and nontherapeutic prescribing.”
April 2013 TEXAS MEDICINE 21
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