BEFORE THE NORTH CAROLINA MEDICAL BOARD In Re: ) ) NOTICE OF CHARGES Amir Ishak Kaldas, M.D., ) AND ALLEGATIONS; ) NOTICE OF HEARING Respondent. ) 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 it in Article 1 of Chapter 90 of the North Carolina General Statutes. 2. On June 30, 2010, the Board first issued Dr. Kaldas a license to practice medicine and surgery, license number 2010-01177. 3. During the times relevant herein, Dr. Kaldas practiced nephrology medicine in Charlotte, North Carolina. 4. In July 2012, the Board received information alleging that Dr. Kaldas was prescribing excessive amounts of controlled substances to his patients who were engaged in drug seeking behavior and may have been diverting their prescribed medications. As a result, the Board opened an investigation. 5. A North Carolina Controlled Substances Reporting System ( NCCSRS ) survey of prescriptions written by Dr. Kaldas Notice of Charges Amir Ishak Kaldas, M.D. Page 1 of 8
revealed high quantities of controlled substance narcotic being prescribed by Dr. Kaldas to Patients A through E. The prescription medications prescribed for Patients A through E included high dosages of Endocet, Fentanyl, Oxycodone, Alprazolam, Carisoprodol, Temazepam and Zolpidem. 6. The Board submitted the medical records generated by Dr. Kaldas of Patients A through E to an independent reviewing expert. 7. The independent reviewing expert concluded that Dr. Kaldas overall care provided to Patients A through G was below the standard of acceptable and prevailing medical practice in North Carolina. Specifically, the independent reviewing expert found that Dr. Kaldas: (1) failed to properly document patient histories and physical examinations; (2) failed to formulate working diagnoses to justify the use of high dosage narcotic medications; (3) failed to examine, or obtain laboratory tests for, a patient with urinary tract infection or sexually transmitted disease symptoms; and (4) prescribed triptans to a patient with angina in spite of the contraindications associated with this medicine. 8. Patient A is a sixty year old male who presented to Dr. Kaldas with low back pain. Dr. Kaldas treated Patient A with Ambien 10 mg daily, Fentanyl 100 mcg every three days, Soma 350 mg twice daily and Percocet 10 mg twice daily. One month later, Notice of Charges Amir Ishak Kaldas, M.D. Page 2 of 8
Dr. Kaldas increased Patient A s Fentanyl prescription to every other day, increased Percocet from 60 to 110 tablets monthly and added Oxycontin 80 mg three times daily. There was no support in the medical records for the large doses of controlled substances beyond Patient A s claims of pain. 9. Patient B is the fifty year old wife of Patient A who was also seen by Dr. Kaldas for complaints of back pain. Dr. Kaldas prescribed Ambien 10 mg daily, Soma 350 mg three times daily, Percocet 10 mg four times daily, OxyContin 40 mg three times daily and Ativan 0.5 mg three times daily. Dr. Kaldas later added prescriptions of MS Contin 60 mg twice daily and OxyContin 40 and 60 mg twice daily. 10. Patient C is a twenty-five year old male with an eleven year history of low back, right shoulder and neck pain. Records from another state show a normal MRI of the lumbar spine and mild tendinopathy on right shoulder MRI. Dr. Kaldas issued prescriptions to Patient C for Methadone, Soma 350 mg twice daily, Xanax 2 mg twice daily and Oxycodone. 11. In his care of Patient C, Dr. Kaldas utilized a Controlled Substance Agreement which stated that lost and/or stolen medications would not be replaced. During one office visit with Patient C, a police report was given to Dr. Kaldas showing that 224 Methadone tablets were stolen. During this visit, Dr. Kaldas gave Patient C a prescription for Methadone. Notice of Charges Amir Ishak Kaldas, M.D. Page 3 of 8
Also during this visit, a urinary tract infection was noted which Dr. Kaldas treated without further evaluation. 12. Patient D is a twenty-six year old male who complained of low back pain and saw Dr. Kaldas for refills. Dr. Kaldas prescribed Roxicodone 30 mg three times daily and Fentanyl 100 mcg patch to the area of pain every three days. 13. Patient E is a twenty-eight year old male with low back pain complaints. Dr. Kaldas prescribed Roxicodone 30 mg three times daily, Duragesic 100 mg every two days, OxyContin 30 mg twice daily and Xanax 2 mg twice daily for anxiety. 14. After the initiation of its investigation, the Board later became aware that a young man had died of an acute Fentanyl overdose and that the prescription for the fentanyl patch may have been issued been issued by Dr. Kaldas. This deceased young man was sold the Fentanyl patches from a man who, it is believed, obtained the patches from Patients F and G who were patients of Dr. Kaldas. 15. Patients F and G have since been arrested by law enforcement officials. Patient F was charged with, among other things, felonious possession with intent to sell and distribute opiates, felonious selling of a controlled substance, and felonious delivering of a controlled substance. Patient G was charged with, among other things, felonious conspiracy to sell or deliver opiates and felonious possession with intent to sell Notice of Charges Amir Ishak Kaldas, M.D. Page 4 of 8
and distribute opiates. The man to whom it is alleged that Patient F and G sold their fentanyl patches has since been arrested and charged with felonious involuntary manslaughter, felonious possession with intent to sell and distribute fentanyl patches, felonious sale of a controlled substance, and delivery of a controlled substance. 16. The Board obtained the medical records for Patients F and Patients G and sent them to the independent expert for review. The reviewing expert concluded that all aspects of Dr. Kaldas care of Patients F and G failed to conform to the standards of acceptable and prevailing medical practice in North Carolina. 17. Patient F is a thirty-three year old male who began seeing Dr. Kaldas for neck pain. The patient s physical examination was described as completely normal and his neck as being supple. Based on a superficial assessment, Patient F was prescribed a Duragesic patch 100 mcg/hr every 72 hours, Opana ER 20 mg twice a day, Percocet 10/325 twice a day prn, and a transdermal Fentanyl patch 100 mcg/hr applied every 72 hours. Oxycontin 40 mg twice daily was added without explanation. 18. Patient G is a twenty-six year old female and the wife of Patient F. Patient G was being treated by Dr. Kaldas from February 22, 2012 until December 28, 2012 for complaints of lower back pain. Patient G was being treated by an orthopedic Notice of Charges Amir Ishak Kaldas, M.D. Page 5 of 8
physician and had a history of scoliosis and lumbar disc herniation. Patient G was prescribed Percocet 10/325 twice daily prn, Opana ER 20 mg twice a day prn, Duragesic patch 100 mcg/hr every 72 hours, OxyContin 60 mg twice a day, and oxycodone 10 mg twice a day. 19. The NCCSRS survey that the Board obtained when it initially opened its investigation was also revealed that Dr. Kaldas had written prescriptions for controlled substances to two close family members and to his pet dog. 20. Dr. Kaldas management and treatment of Patients A through G and his prescribing to close family members and the his pet dog constitute unprofessional conduct, including, but not limited to, Dr. Kaldas departing from, and failing to conform to standards of acceptable and prevailing medical practice, or the ethics of the medical profession, irrespective of whether or not a patient is injured thereby, or the committing of any act contrary to honesty, justice, or good morals within the meaning of N.C. Gen. Stat. 90-14(a)(6), and grounds exist under that section of the North Carolina General Statutes for the Board to annul, suspend, revoke, condition, or limit Dr. Kaldas license to practice medicine or to deny any application he might make in the future for a license to practice medicine. Notice of Charges Amir Ishak Kaldas, M.D. Page 6 of 8
NOTICE TO DR. KALDAS Pursuant to N.C. Gen. Stat. 90-14.2, 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, April 10, 2014 at 8:00 a.m. or as soon thereafter, 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. 90-14.2, 14.3, 14.5, 14.6 and 14.7 as well as 21 NCAC 32N.0110 and 21 NCAC 32N.0111. You may appear personally and through counsel, may cross-examine witnesses and present evidence in your own behalf. The identities of Patients A through G are being withheld from public disclosure pursuant to N.C. Gen. Stat. 90-8. However, this information will be provided to you upon your 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.0110(c), it is further ordered that the parties shall arrange a prehearing conference at which they shall prepare and sign a Notice of Charges Amir Ishak Kaldas, M.D. Page 7 of 8
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 conference shall occur no later than seven (7) days prior to the hearing date. 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 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) or N.C. Gen. Stat. 90-14.2(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 15 th day of November, 2013. NORTH CAROLINA MEDICAL BOARD By: Paul S. Camnitz, M.D. President Notice of Charges Amir Ishak Kaldas, M.D. Page 8 of 8