State officials recently reprimanded a Soldotna physician for inadequate record-keeping and for leaving blank, pre-signed prescription forms in his office where a physician assistant improperly used them.
"This is all sort of a record-keeping problem and it's all been corrected," said Dr. Lavern R. Davidhizar, an osteopathic physician. "There was no question about the medical care. The medical care was appropriate."
On Oct. 27, the Alaska State Medical Board reprimanded Davidhizar, fined him $5,000 and placed his medical license on probation for two years.
"Disciplinary action was taken against the physician assistant, action which might not have been necessary had you not made the pre-signed prescription forms available," the board wrote.
According to a memorandum of agreement between Davidhizar and the board, Davidhizar told a state investigator he ended a physician-patient relationship with a woman identified as G.M. in July 1999 "because she was creating difficulties in his office, but that about Sept. 5, 1999, he reestablished the relationship when G.M. called him at home requesting that he prescribe medications for her because she was having problems obtaining another physician."
The federal government classifies drugs such as narcotics, stimulants and tranquilizers according to how dangerous or addictive they are. Schedule I, the most restrictive class, includes drugs such as heroin that generally are not used medicinally. Schedule II includes drugs such as oxycodone and morphine, both narcotics. Schedule V is the least restrictive class.
Between Sept. 5 and Oct. 31, 1999, the memorandum said, Davidhizar issued G.M. at least 13 prescriptions, including seven for APAP/Hydrocodone, federal Schedule III controlled substance, one for Pentazocine, a federal Schedule IV controlled substance, and five for noncontrolled substances. However, it said, Davidhizar kept no medical records concerning those prescriptions. Hydrocodone and Pentazocine are narcotic pain relievers.
"Our law requires maintaining records," said Leslie Abel, executive administrator for the medical board. "You must document the diagnosis, tests to support the diagnosis, a treatment plan, and what drugs you prescribe, the dosage, side effects and how long."
Davidhizar said it was an oversight.
"The patient called late at night when I didn't have a chart available. Late at night, I called in some medications. Inadvertently it didn't get into the medical record," he said. "This was actually several times. The record says 13 times. It wasn't actually that many, but I didn't protest it because it didn't make a difference."
The memorandum said Davidhizar was the primary collaborative physician for Nancy M. Mackey, a physician assistant. Because he left pre-signed blank prescription forms in his office, it said, "Mackey was able to utilize some of the forms to prescribe medications, including on at least one occasion a Schedule II substance."
In Alaska, physician assistants are not authorized to prescribe Schedule II controlled medications, the board said in an April 27 memorandum of agreement with Mackey. Abel said it is against federal law for a physician to leave pre-signed blank prescription forms.
Davidhizar said he left the pre-signed forms for Mackey because he was leaving town and had a patient who might need treatment while he was gone.
"We were supposed to be in contact when this occurred so I would be in control of the situation. I wasn't," he said. "I was available, but I wasn't contacted."
He said he did not know why Mackey did not call him. He said it apparently was illegal for him to leave the blank, pre-signed prescription forms in his office, but he did not know that at the time. He said he did not know what Schedule II substance Mackey prescribed.
"That's not true," Mackey said. "He actually called me and instructed me to fill it out for a particular patient. I'm not going to give the patient's name or say what the Schedule II substance was, but he did call me from Idaho and instruct me to prescribe medications for a particular patient. I reported this myself, because I didn't want to do that. I didn't want to be instructed to do something I'm not allowed to do."
Abel said she could not resolve the contradiction between Mackey's and Davidhizar's stories. Davidhizar said he could not recall phoning Mackey to tell her to complete the pre-signed prescription form.
The April 27 memorandum also said Mackey was practicing under a collaborative plan with Davidhizar as her primary collaborative physician and Dr. Charles P. Essex as her alternate. Abel said state law requires at least one alternate physician on every collaborative plan.
"Mackey failed to report that Essex left Alaska in 1996, a fact which automatically terminated the alternate collaborative agreement, and thereby terminated her authority to practice as a physician assistant in Alaska," the memorandum said.
She continued to practice as a physician assistant until about Jan. 7, 1999, it said.
Mackey said she was not aware that her collaborative agreement required two physicians. After Essex left Davidhizar's office in 1990 and opened a separate practice, she said, she relied strictly on Davidhizar and never had any need to consult Essex.
"Also, Dr. Essex didn't inform me he was leaving town," she said.
The medical board reprimanded Mackey and fined her $5,000, with $2,000 stayed on the condition that she has no similar problems for a year.
Abel said Davidhizar terminated his collaborative agreement with Mackey with a Feb. 22, 1999, letter. On March 11, 1999, Abel received a new agreement listing Homer physician Paul Raymond as Mackey's primary collaborative physician. Mackey said Dr. Kenneth Hahn of Kenai is her alternate collaborative physician. She now practices at Redoubt Medical Clinic in Kenai and Kachemak Bay Medical Clinic in Homer.
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