'Pill mill' patient charts raise red flags, Little Rock doctor testifies

A Little Rock doctor who specializes in pain management testified Wednesday that patient charts from a suspected "pill mill" through which three medical professionals issued prescriptions in 2014 and 2015 revealed conduct "outside the bounds of acceptable medical practices."

Dr. J. Carlos R̶a̶m̶o̶n̶ Roman*, a board-certified anesthesiologist, was the third witness for the government in a federal jury trial for three health care professionals accused of conspiring with others to distribute controlled substances without a legitimate medical need.

The three are Dr. Felicie Wyatt, who was the supervising physician at the Artex Medical Clinic on Hermitage Road in 2014 and for its successor at the same location, the KJ Medical Clinic, until May 2015; Aaron Paul Borengasser, a physician assistant at the Artex clinic for three weeks in mid-2014; and nurse practitioner Kristin L. Raines, who worked at Artex and the KJ Clinic until federal agents raided the facility in May 2015.

Raines went home sick on Tuesday and remained absent from the courtroom on Wednesday.

R̶a̶m̶o̶n̶ Roman*, the prosecution's expert witness, acknowledged that the only charts he examined were those of nine patients. Attorneys say that's because Anthony King, an owner of Artex who pleaded guilty to a conspiracy charge last week, saw to it that the clinic's other medical records were destroyed.

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Out of 242 patients at the clinic, the charts of 233 of those patients couldn't be located.

Still, R̶a̶m̶o̶n̶ Roman* testified, his review of the nine available charts, in conjunction with his review of the other 233 patients' listings on the statewide Prescription Monitoring Program network, indicated "two peculiar trends" at the Hermitage Road clinics. The network, which was started up last year, is designed to monitor all controlled substances prescribed across the state. It tracks the filling of prescriptions for narcotics that tend to be abused, so doctors and pharmacists can check whether a patient might be "doctor shopping," and to aid law enforcement.

R̶a̶m̶o̶n̶ Roman* said one of the trends he observed was that prescriptions written by Borengasser and Raines, and approved by Wyatt, were routinely written for the strongest dose available of hydrocodone and Xanax, as well as a full month's supply of each.

"Usually, you see a lot more variability," he said, referring to the dosages and number of pills generally prescribed by doctors statewide, which indicates the varying needs of individual patients.

Plus, he said, "The first line of therapy for pain is non-narcotic treatment. You don't start with the maximum doses."

R̶a̶m̶o̶n̶ Roman* said the other trend he noticed was that the patients who got their prescriptions at Artex or KJ Medical were from a wide geographical area, while most subscriptions in the database are written for patients who live in the prescriber's immediate area.

Assistant U.S. Attorney Anne Gardner walked R̶a̶m̶o̶n̶ Roman* through each of the nine charts, referring to each patient by initials to protect their privacy. All the charts indicated the patient had been in a motor vehicle accident weeks, months or years earlier.

The chart for a 21-year-old Fordyce woman who went to the Little Rock clinic on June 19, 2014, complaining of upper back and neck pain, indicated that Borengasser never asked for the name of her regular physician or tried to access any of her medical records, nor did he perform any diagnostic tests. Yet he wrote her four prescriptions: for 120 10mg hydrocodone pills and 60 2mg Xanax tablets, in addition to prescriptions for a muscle relaxer and Zoloft, an antidepressant.

R̶a̶m̶o̶n̶ Roman* noted that the woman reported suffering from extreme anxiety, despite claiming to have already been taking Xanax, an anti-anxiety medication. He said that at the very least, that would indicate that Xanax wasn't working for her.

Another chart indicated that a 21-year-old El Dorado man complained of severe back pain and knee pain, as well as anxiety. Borengasser gave him a prescription for the maximum doses and quantities of hydrocodone, Xanax, a different muscle relaxer and Zoloft.

Charts for people seen by Raines reflected "the same pattern and assessment," R̶a̶m̶o̶n̶ Roman* said, referring to the medicines and dosages prescribed, and the lack of diagnostics.

R̶a̶m̶o̶n̶ Roman* testified that there were "way too many red flags" in the charts for most medical practitioners to overlook.

"This does not represent the basic practice of medicine," he said.

An audiotape made by a confidential informant who saw Raines as a new patient resulted in the same combination of drugs being prescribed despite a positive drug screen for marijuana, which R̶a̶m̶o̶n̶ Roman* said typically indicates a risk of drug abuse, thereby disqualifying the person from being prescribed certain narcotics.

Metro on 08/04/2016

*CORRECTION: Dr. J. Carlos Roman was a witness for the government Wednesday in a federal jury trial for three health care professionals accused of conspiring with others to distribute controlled substances without a legitimate medical need. Roman’s name was spelled incorrectly in this story.

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