hon 1" 12 13 14 15 16 7 18 19 20 21 22 23 24 25 BEFORE THE ARIZONA MEDICAL BOARD In the Matter of Case No. MD-16-0992A GREGORY J. PORTER, M.D. Holder of License No. 14879 NOTICE OF ERRATA For the Practice of Allopathic Medicine In the State of Arizona. At its public meeting on May 4, 2017, the Arizona Medical Board (‘Board’) voted to issue Gregory J. Porter, M.D. (‘Respondent’), an Interim Findings of Fact, Conclusions of Law and Order for Summary Restriction of License, for violations of A.R.S. §§ 32-1401(27)(e) and (q). The Board, pursuant to A.R.S. § 32-1451(D), ordered Respondent to immediately cease prescribing controlled substances, pending the outcome of a Formal Hearing on the matter. Paragraph 7, line 24 of the Findings of Fact inaccurately indicates that Respondent ordered that a patient take Methadone in combination of morphine sulfate and oxycodone. The Board issues this Notice of Errata to strike “and ‘“- MS or oxy.” from paragraph 7, line 24 of the Order and replace it with “and indicated that the patient should discontinue morphine and oxycodone.” +n DATED this__ © day of (20 9 2017 ARIZONA MEDICAL BOARD By. Teds C17, Sieg, Patricia E. McSorley Executive Director EXECUTED COPY of the foregoing mailed this" day of ao 2017 to: Gregory J. Porter, M.D. Address of Record ORIGINAL of the foregoing filed this day of Nos, 2017 with17 18 19 20 21 22 23 24 25 Arizona Medical Board 9545 E, Doubletree Ranch Road Scottsdale, AZ 85258 Board staffBEFORE THE ARIZONA MEDICAL BOARD. In the Matter of Case No. MD-16-0992A GREGORY J. PORTER, M.D. INTERIM FINDINGS OF FACT, Holder of License No. 14879 CONCLUSIONS OF LAW AND ORDER For the Practice of Allopathic Medicine FOR SUMMARY RESTRICTION OF In the State of Arizona. LICENSE INTRODUCTION The above-captioned matter came for discussion before the Arizona Medical Board (‘Board’) at its May 4, 2017 telephonic Board meeting, where it had been placed on the agenda to consider possible summary action against Gregory J. Porter, M.D. (‘Respondent’). Having considered the information in the matter and being fully advised, the Board enters the following Interim Findings of Fact, Conclusions of Law and Order for ‘Summary Restriction of License, pending a formal hearing or other Board action. A.R.S. § 32-1451(D). INTERIM FINDINGS OF FACT 1. The Board is the duly constituted authority for the regulation and control off the practice of allopathic medicine in the State of Arizona, 2. Respondent is the holder of license number 14879 for the practice of allopathic medicine in the State of Arizona. 3. The Board initiated case number MD-16-0992A after receiving a complaint regarding Respondent's care and treatment of a 60 year-old female patient ("VC") alleging failure to properly prescribe medications, resulting in the patient's death 4, VC established care with Respondent on March 2, 2016. VC had a prior history of chronic pain managed on a stable opiate regimen of Morphine Sulfate ExtendedSeemrnNoanroen "4 12 13 14 15 16 7 18 19 20 24 22 23 24 25 Release 30mg at bedtime and oxycodone 15mg as needed for breakthrough pain (2-3 daily with #75 dispensed for a one-month supply). 5. On VC's first visit with Respondent, he identified her chief complaint as. “Chronic Pain,” secondary to fibromyalgia and lumbar stenosis with “all over" pain and occasional sciatica in absence of a history of prior surgery. In addition, Respondent documented “severe stress" as a subjective complaint. VC's medication list at that time included Morphine 30mg at bedtime, oxycodone 15mg twice daily, tizanidine 4mg twice daily and Ibuprofen 800mg three times daily for her pain, in addition to prescriptions for Xanax (for anxiety) and amlodipine. VC was noted to have a history of hypothyroidism, and was non-compliant with her medication for that condition. 6. Respondent performed a physical examination of VC and documented tendemess over the lumbar spine (at L3/4) with normal reflexes and no focal neurologic deficits. Respondent's plan was to add amitriptyline, recommend water exercise, and to “consider methadone." For her non-pain complaints, Respondent ordered lab studies and adjusted VC's blood pressure medications. VC's last prescription for morphine and oxycodone would have been due for refill on or about March 4, 2016: two days after this visit. 7. Respondent saw VC again on March 7, 2016. At that visit, VC reported improved pain, sleep and that she was more relaxed with amitriptyline. The documented history of present illness noted that VC stated "I need morphine.” Her medication list was recorded as unchanged from the prior visit. Respondent performed another physical examination and noted tendemess at L3/4. Respondent's assessment included fibromyalgia and lumbar radiculopathy. Respondent documented a plan for VC's pain including the addition of methadone 10mg three times daily as needed and “- MS or oxy.”8. On March 12, 2016, VC was found non-responsive by her daughter. According to the autopsy report, the bottle of methadone had 73 tablets remaining of the 90 dispensed for VC. The pathologist who performed the autopsy opined that the cause of death was a “mixed drug toxicity: methadone and amitriptyline” with a contributory cause of death including arteriosclerotic cardiovascular disease. 9. The standard of care required Respondent to utilize diagnostic studies, outside records and the pharmacy board report information when determining whether to initiate treatment with opiate therapy. Respondent deviated from this standard of care by {ailing to utilize diagnostic studies, outside records or pharmacy board report information at the time the decision was made to treat VC with opiate therapy. 10. The standard of care requires an accurate calculation of starting dosage when converting the patient's regimen from morphine/oxycodone to methadone, to start the patient at a recommended dose, and to obtain a baseline EKG to assess for QT prolongation prior to starting the patient on methadone. Respondent deviated from this standard of care by converting VC's regimen from morphine/oxycodone to methadone without an accurate calculation of starting dose, by starting VC at a dose that was well above what would have been recommended, and by failing to obtain a baseline EKG to assess for QT prolongation prior to starting methadone. 11. Actual harm occurred to the patient in that VC died with a cause of death related to her use of methadone and amitriptyline. 12. During the Board's consideration of the above captioned matter on May 4, 2017, Respondent stated that he did not believe that methadone was a factor in the patient’s death. Board members commented that after hearing from Respondent, they ‘were concerned that the Respondent did not eppear to understand the ramifications of his prescribing and the drug-to-drug interactions of the medications at issue in the case. OneBoard member was particularly concemed that Respondent did not address the findings on the autopsy for VC. 13, Based on the evidence presented, the Board voted unanimously to summarily restrict Respondent's license, prohibiting him from prescribing controlled ‘substances. INTERIM CONCLUSIONS OF LAW 1, The Board possesses jurisdiction over the subject matter hereof and over Respondent. 2. The conduct and circumstances described above constitute unprofessional conduct pursuant to A.R.S. § 32-1401(27)(e) ("Failing or refusing to maintain adequate records on a patient”). 3. The conduct and circumstances described above constitute unprofessional conduct: pursuant to A.R.S. § 32-1401(27)(q) ("Any conduct or practice that is or might be harmful or dangerous to the health of the patient or the public.”). 4, Based on the foregoing Interim Findings of Fact and Conclusions of Law, the public health, safety or welfare imperatively requires emergency action. A.R.S. § 32-1451(D). ORDER Based on the foregoing Interim Findings of Fact and Conclusions of Law, set forth above, IT IS HEREBY ORDERED THAT: 4. Respondent's license to practice allopathic medicine in the State of Arizona, License No. 14879, is summarily restricted. Respondent is prohibited from prescribing controlled substances in the State of Arizona.2. The Interim Findings of Fact and Conclusions of Law constitute written notice to Respondent of the charges of unprofessional conduct made by the Board against him. Respondent is entitled to a formal hearing to defend these charges within 60 days after the issuance of this order pursuant to A.R.S. § 32-1451(D). 3. The Board's Executive Director is instructed to refer this matter to the Office of Administrative Hearings for scheduling of an administrative hearing on all issues in this matter to be commenced within sixty days from the date of the issuance of this order, unless stipulated and agreed otherwise by Respondent. In DATED AND EFFECTIVE this__©) day of Tea , 2017. ARIZONA MEDICAL BOARD 7p By tithe io WW SNe Patricia E, MeSorley G Executive Director EXECUTED COPY of the foregoing mailed this S“Sday of cs , 2017 to: Gregory J. Porter, MD | Address of Record ORIGINAL of the foregoing filed this S*® day of (\s. aaa 2017 with: Arizona Medical Board 9545 E. Doubletree Ranch Road Scottsdale, AZ 85258 x Board staff