BEFORE THE NORTH CAROLINA MEDICAL BOARD ) ) ) ) ) The North Carolina Medical Board ( Board ) has preferred

Transcription

1 BEFORE THE NORTH CAROLINA MEDICAL BOARD In Re: James Stewart Campbell, M.D., Respondent. ) ) ) ) ) AMENDED NOTICE OF CHARGES AND ALLEGATIONS; NOTICE OF HEARING The North Carolina Medical Board ( Board ) has preferred 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 to it in Article 1 of Chapter 90 of the North Carolina General Statutes. 2. James Stewart Campbell, M.D. ( Dr. Campbell ) is a physician first licensed by the Board on or about October 18, 1975, license number During the times relevant herein, Dr. Campbell practiced integrative medicine in Pfafftown, North Carolina. 4. In May 2015, the Board received a complaint from a physician regarding Dr. Campbell s prescribing of controlled substances to Patient A. The complaining physician expressed her concern for what she characterized as a shocking amount of narcotics prescribed by Dr. Campbell to Patient A, who the complaining physician was also treating. Notice of Hearing James Stewart Campbell, M.D. Page 1 of 12

2 5. In June 2015, the Board received an additional complaint from a pharmacist with concerns that Dr. Campbell was prescribing excessive quantities of oxycodone and alprazolam. 6. In October 2015, the Board received a complaint that stated concerns regarding Dr. Campbell s prescribing excessive quantities of oxycodone and alprazolam, which may have resulted in Patient F s death. 7. In March of 2017, the Board was notified by the Department of Health and Human Services based on the Board s Safe Opioid Prescribing Initiative of the death of two additional patients treated by Dr. Campbell, Patients G and H. 8. The Board obtained the patient records of eight patients from Dr. Campbell, including Patients A, F, G, and H, and submitted the records to an independent reviewing expert. The reviewing expert found Dr. Campbell s diagnoses, treatment, and overall care of Patients A through H failed to conform to the standards of acceptable and prevailing medical practice. Specifically, the reviewer found the following with regard to Dr. Campbell s care of Patients A through H: Patient A 9. Dr. Campbell treated Patient A for chronic pain and anxiety as well as hypertension, hepatitis C, gout, muscle spasm, infected sacral ulcer-mrsa, and a femur fractured from a motor vehicle accident. Notice of Hearing James Stewart Campbell, M.D. Page 2 of 12

3 10. The reviewer expressed concern that Dr. Campbell s history and physical of Patient A lacked sufficient information and was difficult to read. 11. Dr. Campbell treated Patient A with two short-acting opiates but did not assess Patient A for personal or family history of substance use/abuse. Additionally, there were no urine drug screens performed and no medication use agreement was in place. Dr. Campbell also failed to explore any non-opiate intervention for pain control in the medical record. 12. A review of the North Carolina Controlled Substance Registry Service ( NCCSRS ) revealed that Patient A was being prescribed controlled substances by multiple prescribers. At one point, Patient A was admitted to the hospital, and his urine drug screen was positive for unexplained amphetamines. Dr. Campbell never addressed either of these issues with Patient A. 13. Dr. Campbell s interval visit notes for Patient A were insufficient to document proper pain assessment and the rationale for increases in dosing. 14. Dr. Campbell treated Patient A with benzodiazepines instead of recommended anxiety lowering agents. Patient B 15. Dr. Campbell treated Patient B for a history of low back pain, anxiety, hypertension, tobacco use, and obesity. Notice of Hearing James Stewart Campbell, M.D. Page 3 of 12

4 16. Dr. Campbell s initial history and physical examination of Patient B were incomplete and did not detail the cause of the pain. Specifically, there was no history of prior therapies that Patient B had tried and were unsuccessful. Dr. Campbell did not order any diagnostic imaging for evaluation. Dr. Campbell did not require Patient B to enter into a treatment agreement or pain contract or conduct an initial assessment with drug screening. 17. Dr. Campbell treated Patient B with a high dose oxycodone IR and alprazolam 1 mg three times per day ( TID ) for tension, increased to four times per day ( QID ) for extra stress. Patient B had initially been prescribed diazepam 10 mg two times per day ( BID ). This prescription was changed to alprazolam without any clear explanation regarding the rationale. Although Patient B was treated with high doses of benzodiazepines, there was no assessment of psychiatric symptoms or a specialist referral. Patient C 18. Dr. Campbell treated Patient C for bilateral arm pain, carpal tunnel release, high blood pressure, anxiety, bipolar illness, morbid obesity, hyperthyroidism, edema, and tobacco use. 19. At Patient C s initial appointment, she was prescribed oxycodone IR 30 mg QID from hydrocodone/apap 10/325. No Notice of Hearing James Stewart Campbell, M.D. Page 4 of 12

5 rationale for a significant increase in the opioid prescription was documented. 20. Dr. Campbell did not conduct an initial drug screen of Patient C or obtain a medication use agreement. 21. Patient C s history of chronic pain was inadequately documented by Dr. Campbell. The history and physical examination performed were inadequate. No information regarding personal or family history of substance use/abuse was documented. 22. At Patient C s appointment in January 2015, the cardiac assessment was inadequate as Patient C was treated for edema while on a beta blocker for hypertension. No assessment was done to ensure Patient C was not having heart failure. There was no documented cardiac examination, nor was there an EKG performed on this high-risk patient. Patient D 23. Dr. Campbell treated Patient D for chronic pain, depression, constipation, hypertension, menopause with hormone replacement therapy, reflux, hyperlipidemia, tobacco use, and hypertension. 24. At Patient D s initial appointment, Dr. Campbell failed to document Patient D s chronic pain and previous treatment history. Notice of Hearing James Stewart Campbell, M.D. Page 5 of 12

6 25. Dr. Campbell failed to screen for drug use or to document information regarding Patient D s personal or family history of substance use/abuse. 26. On at least five occasions, Dr. Campbell increased Patient D s opiate or benzodiazepine prescription without documenting a rationale for the increase. Patient E 27. Dr. Campbell treated Patient E for chronic pain due to arthritis and prior injuries related to accidental injury, tobacco use, anxiety disorder, low testosterone, and elevated blood sugar without mention of diabetes. 28. Dr. Campbell did not order or document an imaging study to clarify Patient E s diagnosis of arthritis. 29. Dr. Campbell did not test Patient E for sexually transmitted diseases despite the fact he was a young male with urethral discharge. 30. Dr. Campbell initiated a testosterone supplement for Patient E without a baseline PSA or documented lipid profile and failed to order a follow-up CBC for changes in Patient E s red blood cell count. 31. Dr. Campbell did not consult with Patient E about constipation prevention or a bowel program to deal with the issue of hemorrhoids in a patient taking opiates. Notice of Hearing James Stewart Campbell, M.D. Page 6 of 12

7 32. In October 2014, Dr. Campbell queried the NCCSRS and multiple providers for controlled substance prescriptions were identified. This discovery was not addressed or discussed with Patient E. 33. In June 2015, Dr. Campbell refers Patient E for posttraumatic stress disorder counseling; however no history was provided. In addition, Dr. Campbell did not document a psychiatric assessment or a screening for suicidal thoughts or plan. Patient F 34. Dr. Campbell treated Patient F for chronic upper back pain due to scoliosis and multiple injuries. Patient F had a history of arrests for drug use or possession and had been treated for drug addiction. 35. During the course of Patient F s treatment with Dr. Campbell from August 2014 through June 2015, Dr. Campbell s documentation was inadequate in its scope. 36. At Patient F s initial visit with Dr. Campbell, Dr. Campbell documented a minimal history that lacked important details of family or personal use or misuse of alcohol and substances. Dr. Campbell diagnosed Patients F with posttraumatic stress disorder, but no history of current mental status or state was documented. The description of Patient F s pain was minimal, and no evidence of other modalities of Notice of Hearing James Stewart Campbell, M.D. Page 7 of 12

8 treatment for pain was documented prior to Dr. Campbell initiating opioid therapy. 37. Although Dr. Campbell had Patient F sign a pain management contract, there was no evidence that urine or serum drug testing was performed during the course of Patient F s treatment with Dr. Campbell. 38. Dr. Campbell also prescribed large doses of alprazolam to Patient F for post-traumatic stress; however, Dr. Campbell provided little documentation regarding the rationale for this prescribing. Dr. Campbell did not document a psychiatric consultation, and no other psychiatric medications were listed. PATIENT G 39. Dr. Campbell treated Patient G after she transferred her care from a pain clinic. 40. During Patient G s treatment with Dr. Campbell from September 2014 through June 2015, Dr. Campbell s documentation was inadequate in its scope. No patient history was documented and Dr. Campbell failed to document his impression or a plan or goals for Patient G. 41. Although Patient G signed a pain contract, there was no evidence that urine drug testing was performed while Patient G was under Dr. Campbell s care. 42. Patient G suffered from respiratory disease. Despite this condition, Dr. Campbell prescribed high doses of opiates Notice of Hearing James Stewart Campbell, M.D. Page 8 of 12

9 and benzodiazepines together. These prescriptions were initiated on her first visit and the dosages were immediately increased before she had ever been physically examined by Dr. Campbell. 43. Patient G died less than four months after her last visit with Dr. Campbell. The cause of death was listed as multidrug toxicity. PATIENT H 44. Dr. Campbell treated Patient H for chronic knee and back pain and anxiety/panic disorder. Patient H had previously been arrested and placed on probation for drug possession. 45. During Patient H s treatment with Dr. Campbell from December 2014 through July 2015, Dr. Campbell s documentation was inadequate in its scope with a scant amount of detail regarding the patient history and physical examination. 46. Patient H did not sign a pain management contract with Dr. Campbell and there was no evidence that urine drug testing was performed during the course of Dr. Campbell s treatment of Patient H. 47. According to a NCCSRS report, Patient H had received a single prescription for a pain medication in the year preceding his initial visit with Dr. Campbell. Despite this fact, Dr. Campbell immediately prescribed Patient H high doses of Notice of Hearing James Stewart Campbell, M.D. Page 9 of 12

10 alprazolam and oxycodone. These doses were escalated rapidly during the course of Patient H s subsequent visits. 48. Patient H died approximately two months after his last visit with Dr. Campbell. The cause of death was listed as multidrug overdose. Oxycodone and benzodiazepines were among the drugs found in Patient H s system after he died. Dr. Campbell s diagnosis, treatment, and documentation of his care of Patients A through H, as described above, constitutes a failure to conform to the standards of acceptable and prevailing medical practice, within the meaning of N.C. Gen. Stat (a)(6) which is grounds under that section of the North Carolina General Statutes for the Board to annul, suspend, revoke, condition, or limit Dr. Campbell s license to practice medicine or to deny any application he may make in the future. NOTICE TO DR. CAMPBELL 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, at 8:00 a.m., Thursday, October 19, 2017, or as soon thereafter as the Board may hear it, at the offices of the Board at 1203 Front Street, 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 , 14.4, 14.5, and You may appear personally and through counsel, Notice of Hearing James Stewart Campbell, M.D. Page 10 of 12

11 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 30 days after the service of this notice. The identities of Patients A through H are being withheld from public disclosure pursuant to N.C. Gen. Stat However, this information will be provided to you upon your request. Pursuant to N.C. Gen. Stat. 150B-40(c)(5), it is further ordered that the parties shall arrange a pre-hearing conference at which they shall prepare and sign a stipulation on prehearing conference. The pre-hearing stipulation shall be submitted to the undersigned no later than seven 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. 150B-40(d), 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. Notice of Hearing James Stewart Campbell, M.D. Page 11 of 12

12 This the 25th day of August, NORTH CAROLINA MEDICAL BOARD By: Eleanor E. Greene, M.D. President Notice of Hearing James Stewart Campbell, M.D. Page 12 of 12