The Medical Board of California has accused a Mariposa doctor of repeatedly prescribing excessive amounts of controlled drugs for patients.
The board said it began an investigation of Dr. Carolyn Joan Rose after the California Highway Patrol notified the medical board that one of the doctor’s patients had been arrested for driving while impaired. The driver had controlled substances that were prescribed by Rose, the board said.
A review by the Board of the Controlled Substances Utilization and Review System, known as CURES, raised concerns about Rose’s prescribing practices, the medical board said. CURES, maintained by the Department of Justice, tracks all Schedule II, III and IV controlled substances dispensed in California. A mandate for doctors to consult CURES prior to prescribing, ordering, administering or furnishing controlled substances becomes effective in October 2018.
Rose did not answer calls left for her at her workplace, the John C. Fremont Family Physicians clinic in Mariposa. But Cynthia McAfee, director of clinical operations, said she had spoken to Rose and that “she basically said ‘no comment.’” According to a notice filed by her lawyer, John L. Fleer of Walnut Creek, with the state, Rose denies the accusations and has requested a hearing with the medical board.
The 46-page accusation filed by the board on July 6 lists five causes for discipline — gross negligence, repeated negligent acts, excessive prescribing, incompetence and failure to maintain adequate and accurate medical records — involving a total of six patients the doctor began treating in 2015.
In the case of a 68-year-old woman identified only as “Patient C,” the board said Rose prescribed a combination of muscle relaxants, opiates, sedatives and benzodiazepines (anti-anxiety drugs).
The patient had a history of several complaints, including chronic pain with muscle spasm, anxiety, insomnia and peptic ulcer disease. Rose ignored red flags for opiate abuse and/or diversion, the board said. “Patient C reported that her medications were not working, requested higher doses and refused to decrease her use of opiate medications.”
Rose’s prescribing of opiates in high doses to Patient C concerned United Healthcare, an insurance company, which sent three separate letters to the doctor in 2015, the board said. The board said after receiving the letters from the insurance company, Rose did not document that she had reviewed them, considered the warnings or discussed the letters with the patient.
In the case of “Patient E,” who complained of back pain, the board said Rose prescribed the opioid oxycodone, the narcotic-like drug tramadol and Soma, a muscle relaxer, to the 54-year-old woman on the patient’s first visit. Patient E already was taking oxycodone for pain when she started seeing Rose, and was receiving benzodiazepines from a psychiatrist she was seeing, the board said. Rose routinely prescribed 120 pills per month of Soma to Patient E, and she prescribed Soma in combination with opiates, even though it is recommended that Soma not be used for more than three weeks, according to the accusation.
Rose did not discuss or try less-dangerous treatments for Patient E’s muscle spasms, including physical therapy, heat, stretching or other treatments prior to prescribing Soma, the board said. Patient E was receiving medications and treatment from a psychiatrist but Rose made no efforts to coordinate care to prevent dangerous drug interactions or duplication of therapy, the board said. And Rose did not review the patient’s CURES reports or pharmacy records to prevent the simultaneous use of multiple drugs to treat the same condition.
An insurance company sent a letter on May 20, 2015, inquiring about two different antidepressants that Patient E was being prescribed simultaneously (duloxetine and venlafaxine), the board said.
The doctor also gave Patient E nonsteroidal anti-inflammatory shots despite documentation in the medical record that the patient had a history of ulcers and a known allergy to the anti-inflammatory drugs, the board said.
The board said Rose did not offer safer alternatives to narcotics or use CURES reports for “Patient B,” a 62-year-old woman with a history of chronic neck pain, migraines, muscle spasms and a family history of colon cancer. Rose prescribed excessive quantities of benzodiazepines to Patient B for an unnecessarily prolonged duration, according to the accusation.
In the case of Patient D, the board said in 2015 Rose failed to provide the 54-year-old man with the proper consent regarding the possible risks of taking tramadol for diabetic neuropathy. And she did not document any effort to use less-dangerous treatment options. Rose also was aware that Patient D had schizophrenia, but did not include that information in his medical records until 2017, the board said.
In the cases of two other patients, the board said Rose provided Patient A, a 64-year-old woman, with near-monthly prescriptions of morphine sulfate, methadone and Soma. And in the case of Patient F, she prescribed long-term narcotics without any attempt to consider less dangerous treatment options.
According to the medical board, Rose graduated from the Autonomous University of Cuidad Juarez School of Medicine in 1980.