I can understand why a Medical Board investigates a practice for allegations related to patient safety. I get it when the Board responds to concerns a doctor may be taking advantage of patients sexually. The main purpose of the Medical Board is to protect the public.
What I don’t understand is when a Medical Board stretches its mandate in “protecting the public.”
Case in point, Donovan Dave Dixon, MD.
On February 16, 2016, Dr. Dixon received a public letter of concern from the North Carolina Medical Board. Such a letter is easily accessible on the Board’s website. And such a letter was reported to the National Practitioner Data Bank.
Before I get into the details of what Dr. Dixon allegedly did to earn his Letter of Concern, first a word about the NC Medical Board’s website. My browser accessed the Board’s website and it looked like this:
Observe the red “X” and the red line slashing through “https”. This means the site does not follow best practices for security. Nerd alert. (It uses SHA-1 as the algorithm to authenticate the site. SHA-1 is generally considered to offer weak security. An “attacker” can spoof the certificate and set up a rogue site. Among other things.) My point is that the Board’s website security is dated and vulnerable.
But, I digress.
On June 11, 2014, a Judgment was entered against Dr. Dixon’s professional medical services corporation, Dixon Medical Services, PC. The judgment was for $64,000. Dr. Dixon breached his lease agreement for his medical practice office space.
The Board’s reasoning:
While this does not directly involve patient care, it is possible that patient care could be adversely affected in such situations because the Judgment concerns a medical practice.
The Board urges you to ensure that the above-described conduct does not happen again. If repeated instances of similar conduct do occur, then this matter in addition to your prior history with the Board, which includes an April 28, 2014, Consent Order and an April 6, 2015, Consent Order, shall be taken into account in deciding what action to take against your North Carolina medical license.
To be fair, Dr. Dixon is no stranger to the NC Medical Board. One consent order allegedly involved “inappropriately prescribing excessive amounts of controlled substances for the treatment of pain in amounts that raise concerns for abuse and/or diversion of these drugs…”
Still it’s quite a stretch to discipline a doctor for violating a lease agreement, particularly if no patient was harmed, much less inconvenienced.
Where would this nonsense end?
Failure to immediately have snow removed from the parking lot? A patient could fall.
Running late? Patient could get stressed out and experience hypertensive crisis.
Collecting copays? Patient could get stressed out and experience hypertensive crisis.
Maybe the Board is just using a plausible excuse to target someone they otherwise believe is guilty of broader offenses. O.J. is in jail, not for murder, but for kidnapping.
But, in Dr. Dixon’s case, it just looks like piling on.
Just one more positive reinforcement of my decision to never return to direct patient care services in the future.
Could this be another way to railroad self-employed physicians out of business? Entrepreneurship is frowned upon by the new world order elites, after all.
Whether we like or not, we are held to higher standard than the public in many aspects of our lives. Basically, under the principle or moral turpitude or just general ethics, physicians can get in trouble for many things that really have nothing to do with the actual practice of medicine. One has to be extra careful these days. It is not just about protecting patients, but also for protecting the respectability of the medical profession from whomever’s perspective. It is just part and parcel with being in the profession.
These days it’s tough complying with everything and even tougher if you are not an employed physician. I recently discovered an organization that is trying to give a voice to those of us who remain in private practice: the Association of Independent Doctors. I’ve checked it out and may join…
Maybe he can’t afford rent because he’s more of a professional than a businessperson. Maybe he’s not aggressively billing and collecting, maybe he serves the underserved and unfunded and can’t afford rent. Maybe he pays his staff well and/or has expensive diagnostic and/or therapeutic equipment incorporated into direct patient care and his rent has lapsed. Maybe the landlord hasn’t fixed ventilation, plumbing, roofing, or other aspects of the office important in safety and comfort, and the doctor is holding off rent until they are fixed, so landlord reported him, and landlord supports local politician who initiated Medical Board Investigation and Enforcement.
No good deed goes unpunished, and being a physician is basically, lots of good deeds. We tolerate lots of punishment and abuse by patients, by attorneys, by corporate and government bureaucracies, by our suppliers and landlords, and by our employees. Our business is high risk, high level of customer service, high investment in training and expertise, and high cost.
The rewards are there, but don’t expect them to be tangible.
Unfortunately DrD was reprimanded by the NCBME for inappropriate narcotic prescribing in 2014. He is a FP doc who’s entire internet presence is currently defined by this order. And he’s listed as a Suboxone doctor on the substance abuse recovery network.
The moral of this story is DON’T get involved with pain management and high volume opioid prescribing if you’re not a pain management specialist. All of the states have controlled prescription databases, and if you become labeled as an opioid “dealer”, you will remain under scrutiny. This is piling on for certain, but 64k is more than a few late payments. Should this be a NCBME issue? No. But the landlord likely wrote a letter and brought more attention to a doc who is currently under observation after reprimand. Thank you.
Yes, where do we draw the line on invasiveness by regulatory boards. Are they going to discipline him for missing a car payment? Witch Hunt comes to mind. To James Summers, are doctors really held to a higher standard? Or are just SOME doctors held to a higher standard. I’ve seen incompetent doctors cruise through life without a hint of policing. They are usually in tight with someone or some organization who will protect them. Then there are doctors who are sanctioned by the hospital MEC because they didn’t meet the 24 hour rule on completing an H&P (patient seen, H&P in draft within the 24 hours, but not SIGNED!).
As in all other businesses and walks of life… it isn’t how good you are as a person, how well you do your job, how well you are liked by your patients, or any other reason, it all comes down to who you know or if you have secret pictures of someone doing something.
Corruption is everywhere, whether you see it or not.
One more group standing in line to take a bite off our butt!
We are all made as hell and shouldn’t take it anymore. Time to do something different.
There is another potential explanation for his inability to pay his office rent: He used to prescribe large amounts of narcotics. This undoubtedly “helped” increase his patient level as local users were quite willing to pay for or even stand in line to get his narcotic prescriptions.
Prescribed narcotics are not considered “street-produced” drugs and have an incredibly high street value, due to their predictable purity. Thus, having real narcotics for sale is one of the most profitable businesses anyone can get into.
He apparently was censured for over-prescribing. Here in CA, there is movement afoot to find ways to limit over-prescribers here. I don’t know what form it will take, but the legislature is looking into it.
If he stopped (or significantly cut back) prescribing, his clientele would “revert” back to ordinary patient volume levels. This could cause a precipitous drop in business, easily “bad” enough for his inability to cover his lease.
Family medicine providers must see large volumes of patients crammed into small time periods. Paper work and medical records’ requirements are huge. It takes very little time to write a narcotic prescription for a phantom diagnosis that has not been evaluated medically. For example, a “migraine headache” equals a prescription for 50 Oxycontin. The word gets around on the street very quickly. But that stopped.
This is a likely explanation of his inability to cover an expensive lease agreement. I would also look to the very real possibility that he also has a drug use habit. These situations seem to have a (familiar) pattern all their own.
Michael M. Rosenblatt, DPM
“Piling on” is what prosecutors and prosecutorial agencies do. This case only makes sense in the context of other concerns about this doctor. Interestingly, NC’s Board may hoist themselves on their own petard if they use this one in some later action against him/his license. They will have set up a tangential defense for him to use against Board action.
Generally, we want Boards policing our profession to 1. Protect the public, and 2. Protect our “brand.” They do look at non-medical issues, such as crimes of moral turpitude, and they often use shortcuts, e.g., felonies. In VA, driving over 80 mph is an automatic felony, even if your passenger is rapidly dying and you are hastening towards help. I suppose it could be argued that going that fast endangers others and is therefore justification for lifting a license. VA also has or had the Bumble Fund, which offered assistance against ridiculous technical prosecutions. It’s named for the Dickens character Mr.Bumble: “Then the law, sir, is an ass!”
Beside been fooled by the system, Boards, Law enforcement, and ANYBODY….as the God play role duties we have to be perfect all the time.There is no excuse in USA to be hardly and capital punished as the most vulnerable professional Medicine. I don’t see any solution but I see the worsening medical burnout as less and less doctors and some of them as me without board and/or for medical monitoring limitation and unable to work at he time in CA. We only learn medicine and do our best. Even with highest professional qualities and outcomes any stain in your career make it the worst Dr. The armery level of the system won’t go to the accused doctor, then plea guilty or accept shortcuts that won’t break your limited saving is an option of eternal process and suffering, etc. This system is going to worse if no appropriate medical support rather than only punishment, revocation, termination or voluntary resign for any reason. There is No mercy.
When fixing my car the mechanic ho is over 75 year old told me he’s still working as his pension is low, about 650 a month and need to keep working. He explained me in detail how a Single ? woman with 4 kids makes the equivalent of more than 70 K a years in benefit and he didn’t include the cost of full medicaid and medications benefit, neither than they could get some non reported earning etc. Add rent, etc etc and then add the taxes you would pay to get tat ammount etc and it may go above 90K/Year; No including that if we mistake on that population we get sue very bad and they continue to be the beneficiary of the society and never will work as this system promote that behavior that we never wanted to be part. What’s our future I ask. It’s UNCERTAIN, sorry for all of Us. God bless you. Urged FP opportunity with thousand of bills.
Once again, everybody seems to have an opinion without access to the facts of the case. I suspect there is far more to this issue than meets the eye and the NCBME is prohibited from comment leaving the practitioner to spin it anyone he/she wishes. Very likely, the physician’s found himself “locked out” of his office due to his failure to pay months of past due rent, effectively stranding numerous patients. Allowing this to happen could well be viewed as a form of patient abandonment, resulting in a complaint to the medical board. If in fact, these patients were chronic pain patients, their ability to secure other sources of care would be significantly limited.
In short, more facts are needed before you start throwing rocks!