BEFORE THE NORTH CAROLINA MEDICAL BOARD. The North Carolina Medical Board (hereafter "Board")

Transcription

1 BEFORE THE NORTH CAROLINA MEDICAL BOARD In re: Everette Bernard Thombs, M.D., Respondent. ) ) ) ) ) NOTICE OF CHARGES AND ALLEGATIONS; NOTICE OF HEARING The North Carolina Medical Board (hereafter "Board") has pref erred and does hereby prefer the following charges and allegations: 1. The Board is a body duly organized under the laws of North Carolina and is the proper party to bring this proceeding under the authority granted it in Article 1 of Chapter 90 of the North Carolina General Statutes and the rules and regulations promulgated thereto. 2. On June 16, 1981, the Board issued Dr. Thombs a license to practice medicine, license number During the times relevant herein, Dr. Thombs practiced in Kings Mountain, North Carolina. 4. Patients A through E presented to Dr. Thombs for care. In each instance, Dr. Thombs provided substandard care to Patients A through E. 5. Patient A presented to Dr. Thombs for left hip pain, low back pain, morbid obesity and dyslipidemia. Patient A monthly for a period of several years. Dr. Thombs saw During this Notice of Charges and Allegations - Everette Bernard Thombs, M.D. Page 1 of 13

2 time, Patient A was treated for chronic pain with fentanyl and oxycodone. There is no explanation as to why Patient A is being treated with fentanyl and oxycodone, other than it appears that Patient A received these medications from a prior treating physician. Patient A picked up his prescriptions from Dr. Thombs every month with minimal interaction with Dr. Thombs. 6. Dr. Thombs prescribed the maximum dose of Lipi tor (atorvastatin) to Patient A. At age 35, Patient A's ten year risk for cardiovascular disease, assuming total cholesterol of 300 and HDL cholesterol of 30 is about 4%. Even if Patient A did qualify for statin therapy, an 80 mg dose would be too high. There is no mention in the chart of any prior or intended interventions regarding Patient A's morbid obesity, a BMI (body mass index) of over Dr. Thombs' records for Patient A are below the standard of care. The records are chaotic. An example of the chaotic nature of the records is a note of a physical examination dated This exam documents every physical finding as abnormal, including meningismus, pleural rub, abdomen tenderness and guarding, etc. Although clearly an error, this error is never corrected in subsequent charting. Most of the documentation for Patient A's care is either absent or never created. For the documentation that is present, it is all identical template charting that sheds no light on the actual Notice of Charges and Allegations - Everette Bernard Thombs, M.D. Page 2 of 13

3 care the patient was receiving. For instance, although Patient A is being treated for hip pain and low back pain, there is no documentation of a spine or hip examination. 8. Patient B presents to Dr. Thombs for hypertension, degenerative disc disease, a history of panic attacks, and bipolar disorder. Dr. Thombs treats all of these conditions. He prescribes Xanax (alprazolam) for the panic attacks, Percocet (oxycodone) for pain, and lisinopril for hypertension. 9. The medical records for Patient B are also chaotic and do not follow a logical sequence. Between June 2010 and February 2012, there are nine print outs of vital signs for Patient B. None of these print outs correspond with any record of an office visit during that same time period. From May 2012 to May 2013, there are 11 documented office visits, approximately one a month. All of these notes are in template form, and except for the subjective portion and vital signs, the rest of the notes are nearly identical with a few slight variations in the assessment and plan. The Review of Symptoms (ROS) portions for the 11 notes are identical. 10. Dr. Thombs failed to treat Patient B's hypertension appropriately. Dr. Thombs never considered whether Patient B suffered from primary or essential hypertension or had secondary hypertension brought about by another condition. In addition, if a diagnosis of essential hypertension is made, then the Notice of Charges and Allegations - Everette Bernard Thombs, M.D. Page 3 of 13

4 physician should address those factors that can cause an increase in blood pressure, such as medications taken, salt intake, alcohol use, tobacco use and diet and exercise. Laboratory testing and electrocardiograms (EKG) should be performed and repeated. Dr. Thombs never specifically addressed Patient B's hypertension diagnosis and treatment in a systematic way and obtained no diagnostic information about Patient B's renal and electrolyte status while he was on lisinopril. 11. Dr. Thombs treats Patient B for anxiety. He does so by prescribing 100 pills of 2mg of Xanax monthly. This medication was initiated by a prior physician for Patient B and Dr. Thombs continues it without any explanation. He never seeks to determine if there are any psychosocial factors that may be contributing to Patient B's anxiety. Dr. Thombs never reassesses Patient B nor does he try alternative therapies for Patient B's anxiety or determine if past non-benzodiazepine therapies were attempted so that he may try to wean Patient B off benzodiazepines. This is important given the risk of addiction and accidental overdose when a patient is taking both a benzodiazepine and an opioid at the same time, as Patient B was doing. of Xanax Dr. Thombs simply continues Patient B on 100 pills per month without any mention of reassessment or alternative therapies. Notice of Charges and Allegations - Everette Bernard Thombs, M.O. Page 4 of 13

5 12. Dr. Thombs treats Patient B's pain in much the same manner as he does Patient B' s anxiety. Dr. Thombs prescribes Patient B five tablets of oxycodone, 10 mg, per day, and is seemingly doing so for the rest of Patient B's life. The oxycodone is ostensibly for a diagnosis of degenerative disc disease, yet there is no data to support the diagnosis and at no time does Dr. Thombs perform an examination of the spine. 13. Patient C presents to Dr. Thombs for anxiety, migraine headaches and low back pain. Dr. Thombs prescribes Xanax for anxiety, hydrocodone for pain and Ultram ER (tramadol) and Maxalt (rizatriptan) for the migraines. Dr. Thombs saw Patient C for approximately 12 visits. In or about April 2014, Patient c is discharged from Dr. Thombs' practice for obtaining duplicate refills. 14. Dr. Thombs treated Patient C for chronic pain. Dr. Thombs did not obtain Patient C's prior medical records to incorporate the patient's prior history and diagnostic information into his care. He did not document in the medical record an appropriate musculoskeletal and neurologic exam, nor did he attempt to resolve Patient C's pain with conservative therapies before initiating opioid therapy. Dr. Thombs did not refer Patient C for specialty assessment for unremitting pain and he failed to make an effort to determine the etiology of Patient C's pain to determine whether it was neuropathic, Notice of Charges and Allegations - Everette Bernard Thombs, M.D. Page 5 of 13

6 inflammatory or skeletal. The only spine and neurological examination he did document was normal. This examination does not justify why Dr. Thombs would prescribe 100 tablets of hydrocodone every month, seemingly indefinitely, to an otherwise apparently healthy 34 year old woman. Dr. Thombs continues Patient C on medications she was previously prescribed without any effort to determine the appropriateness of the prior diagnoses or treatment plans. Dr. Thombs fails to take a comprehensive, multi-modality approach to treating Patient C and simply refills medications on a monthly basis without any meaningful assessment and reassessment. 15. Patient D presented to Dr. Thombs for treatment of chronic pain and other co-morbidities, including Hepa ti tis C infection, gastroesophageal reflux disease (GERD), ongoing tobacco use, rheumatoid arthritis, chronic obstructive pulmonary disease (COPD), hypertension, hyperlipidemia, back pain, hip pain, and leg numbness. Patient D had a history of back surgery in Dr. Thombs prescribed several medications including oxycodone for pain. Print outs of vital signs do not correspond with any office visit. Urine screens that test positive for ketones, protein and urobilinogen are not addressed. 16. It is the standard of care for a physician to take a history and conduct a physical examination, to review old records, to obtain and assess appropriate diagnostic testing, to Notice of Charges and Allegations - Everette Bernard Thombs, M.D. Page 6 of 13

7 refer to specialty evaluation, and to incorporate all of these findings into a patient assessment, working diagnosis, and plan of care. Dr. Thombs does not perform a basic evaluation of chest pain, back pain, hip and leg pain, or complaint of headache. Dr. Thombs does not manage the monitoring of Patient D's hypertension and dyslipidemia properly. Dr. Thombs does not offer the patient smoking cessation counseling. He makes no mention in the notes of his plan of action for Patient D's diagnosis of rheumatoid arthritis. Patient D to avoid all alcohol as a Dr. Thombs does not caution result of his Hepatitis C infection. 17. Although possible that Patient D may have thwarted Dr. Thombs' plans of treatment - Patient D did refuse a flu shot - there is almost no documentation that Patient D refused treatment or acted contrary to medical advice. 18. There does not seem to be one single area in Patient D's record where Dr. Thombs properly assessed Patient D in a systematic testing. manner by history, examination and diagnostic It is the standard of care that office visits be documented in such a way to make internal sense and provide a resource for the physician to assess the patient appropriately and make working diagnoses. Coherent charting allows for the planning of care in a longitudinal manner including acute Notice of Charges and Allegations - Everette Bernard Thombs, M.D. Page 7 of 13

8 problems, chronic problem management and health maintenance efforts. Dr. Thombs' records do not meet this standard. 19. Patient E is a 59 year old woman who has been under Dr. Thombs' care since at least Patient E has a heavy burden of illness, including obesity, diabetes, hypercholesterolemia, leg pain, joint pain, abnormal gait, anxiety, panic disorder, abnormal gait, and breast cancer. Dr. Thombs prescribes several controlled substances for chronic pain, including tramadol, morphine, oxycodone and hydrocodoneacetaminophen Dr. Thombs does not approach Patient E' s care in a systematic manner, nor does he plan interventions for each condition based on a hierarchy of importance. Dr. Thombs does not manage Patient E's pain over time by periodically reassessing the goals of opioid therapy and the potential for ill effects due to polypharmacy and drug interactions. It is the standard of care when prescribing opioid therapy to be descriptive of the type of pain that is being treated, what the circumstances of the chronic pain are, what treatments and evaluations have been performed in the past, and what are the goals of therapy. It cannot be determined from Dr. Thombs' records whether he is treating hip, leg, shoulder, or breast pain. There is no clarity as to what Dr. Thombs is trying to achieve by prescribing multiple controlled substances and muscle Notice of Charges and Allegations - Everette Bernard Thombs, M.D. Page 8 of 13

9 relaxers. In some notes, Patient E describes adverse effects from taking Ultram ER (tramadol) but there is no indication or discussion of possible medication changes. Many of Dr. Thombs' notes for this patient have blank sections. 21. Dr. Thombs fails to provide appropriate care for Patient E's other conditions. There are no laboratory work ups other than point of care urinalysis. There are no imaging studies. There is no reference to colon cancer screening. There is no reference to diabetic eye care. There is no diabetic foot exam. exams or pap smears. There is no reference to breast or pelvic It is the standard of care for a patient with multiple medical problems for the physician to oversee the care of the patient and see that proper laboratory monitoring is being performed for diabetes, hypertension and dyslipidemia, and that the patient is being offered the opportunity for health maintenance examinations. Dr. Thombs falls below these standards with regard to Patient E. 22. As a result of the concerns raised by Dr. Thombs' management and care of Patients A through E, the Board ordered Dr. Thombs to be assessed by the Center for Personalized Education for Physicians, or CPEP. To date, Dr. Thombs has refused to undergo a CPEP examination Dr. Thomb' s treatment of Patients A through E, as described herein, constitutes unprofessional conduct including, Notice of Charges and Allegations - Everette Bernard Thombs, M.D. Page 9 of 13

10 but not limited to, departure from or the failure to conform to the standards of acceptable and prevailing medical practice, irrespective of whether or not a patient is injured thereby, within the meaning of N.C. Gen. Stat (a) (6), which is grounds for the Board to annul, suspend, revoke, condition, or limit Dr. Thombs's medical license to practice medicine and surgery issued by the Board or to deny any application he might make in the future. 24. Dr. Thomb' s failure to comply with the Board's Order for an Examination, as described herein, constitutes a failure to respond, within a reasonable period of time and in a reasonable manner as determined by the Board, to inquiries from the Board concerning any matter affecting the license to practice medicine, within the meaning of N.C. Gen. Stat (a) (14), which is grounds for the Board to annul, suspend, revoke, condition, or limit Dr. Thombs's medical license to practice medicine and surgery issued by the Board or to deny any application he might make in the future. NOTICE TO DR. THOMBS Pursuant to N.C. Gen. Stat , it is hereby ordered that a hearing on the foregoing Notice of Charges and Allegations will be held before the Board, or a panel thereof, on Thursday, February 18, 2016, at 8:00 a.m. or as soon thereafter, at the offices of the Board at 1203 Front Street, Notice of Charges and Allegations - Everette Bernard Thombs, M.D. Page 10 of 13

11 Raleigh, North Carolina, to continue until completed. The hearing will be held pursuant to N.C. Gen. Stat. 150B-40, 41, and 42, and N.C. Gen. Stat , 14.3, 14.5, 14.6 and 14.7 as well as 21 NCAC 32N.0110 and 21 NCAC 32N You may appear personally and through counsel, may cross-examine witnesses and present evidence in your own behalf. You may, if you desire, file written answers to the charges and complaints preferred against you within thirty (30) days after the service of this notice. The identities of Patients A through E are being withheld from public disclosure pursuant to N.C. Gen. Stat However, this information will be provided upon request. Unless otherwise permitted by the presiding officer, all exhibits shall be provided to the Board electronically. All preliminary motions, including motions for continuances, shall be received at the office of the Board no later than fourteen (14) days prior to the date of the hearing. Pursuant to N.C. Gen. Stat. 150B-40(c) (5) and 21 NCAC 32N.OllO(c), it is further ordered that the parties shall arrange a prehearing conference at which they shall prepare and sign a stipulation on prehearing conference. The proposed prehearing stipulation shall be submitted to the undersigned no later than ten (10) days prior to the hearing date. The prehearing Notice of Charges and Allegations - Everette Bernard Thombs, M.D. Page 11 of 13

12 conference shall occur no later than seven (7) days prior to the hearing date. The right to be present during the hearing of this case, including any such right conferred or implied by N.C. Gen. Stat. lsob-40 (d) or N. C. Gen. Stat (b), shall be deemed waived by a party or his counsel by voluntary absence from the Board's office at a time when it is known that proceedings, including deliberations, are being conducted, or are about to be conducted. In such event, the proceedings, including additional proceedings after the Board has retired to deliberate, may go forward without waiting for the arrival or return of counsel or a party. This, the 11th day of November, NORTH CAROLINA MEDICAL BOARD By: Pascal 0. Udekwu, M.D. President Notice of Charges and Allegations - Everette Bernard Thombs, M.D. Page 12 of 13

13 CERTIFICATE OF SERVICE I, the undersigned attorney for the North Carolina Medical Board, hereby certify that I have served a copy of the foregoing document on Counsel for Respondent by depositing a copy with the United States Postal Service, postage paid, to the following: Alan Schneider Cheshire, Parker, Schneider & Bryan, PLLC 133 Fayetteville St., #500 Raleigh, NC This, the day 11th of November, cus Jim' on oard Att rney Notice of Charges and Allegations - Everette Bernard Thombs, M.D. Page 13 of 13