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Pain clinic's patients are upset over closure; doctor suspended for 'improper prescribing'

Several days after patients got word that the Intractable Pain Clinic in Fallston had closed, those who received care there and from its primary doctor, Rakesh Mathur, are feeling abandoned and wondering who will prescribe their medication.

Chandra Mouli, deputy chief of the division of drug control, said she believes Mathur's suspension on Feb. 7 is what caused the clinic, at 2112 Belair Road, to close, "or else why would he voluntarily close his practice?" she wrote in an e-mail Wednesday.

As John Papavasiliou, deputy director for the Maryland State Board of Physicians, put it, "improper prescribing practices" is what caused Mathur to have his license suspended. He made it clear, though, that the board did not order the closure of the clinic, as it is "not something we do."

Denny, a Havre de Grace resident, said he was one of Mathur's patients until he received a call from the office Monday, two days before he had an appointment to obtain a refill prescription for his pain medication. Employees told the man, whose full name The Aegis is withholding, informed him they had closed and to come get his medical records.

"How can the State of Maryland cut his patients off without any warning at all?" he asked.

The man, who is in his 40s, said he is disabled and has several medical issues, including a heart condition that causes heart palpitations. He said he takes several medications and is worried that withdrawal could cause more problems than his body can take.

"The more stressed I get, the [sicker] I get," he said.

He said he had been prescribed 1 mg of Xanax three times a day, 10 mg of methadone four times a day and 20 mg of Percocet four times a day.

The Havre de Grace resident has been going to Mathur's practice for more than a year, at the recommendation of a friend, and commented that he has never been over-medicated. The man added that on occasions during a visit to the clinic, Mathur would "give people hell for not taking the meds the right way."

The man, who called The Aegis Wednesday and gave his full name and medical information, said he was unable to get medication from Harford Memorial Hospital and believed he would have the same result from his primary care physician later that day.

Chris, a patient who didn't want his last name used for fear of being rejected as a new patient at another clinic, is also concerned about not receiving his medication and the impending withdrawal he'll experience if he doesn't find a doctor who will prescribe them to him.

"[The board's] reason for suspending [Mathur's license] right away is because he was a danger to the public," Chris said. That public, he continued, includes the 400 to 500 patients Mathur saw who are scrambling to find another doctor before their medication runs out.

"The only people being affected are the patients," he said. "You're abandoned at this point."

The Board of Physicians has a responsibility, Chris went on to say, to "make proper efforts to make sure the ones who were there and were under the care of this 'bad physician,' or whatever they call it, aren't just sitting there not knowing what to do."

He also commented on the dangers of withdrawal, noting that people can die if not monitored.

He said he's not upset about the suspension itself, but that it was done without a plan on how to handle the affected patients who have nowhere to go.

"It was like, 'Here's your paperwork. Good luck,'" Chris said of how the situation was handled.

Like the Havre de Grace man and, undoubtedly, Mathur's other patients, Chris has been looking for another clinic to go to since news came Monday that the office had closed.

He said he was denied by one office on Wednesday because he doesn't have insurance and the medications he's been taking — oxycodone — that particular doctor doesn't prescribe.

Despite his anger and frustration with how things transpired, Chris still praised Mathur, saying he "received a lot of good care from there." He described a time in his life when he had trouble moving from the amount of pain he was in. When he went to see Mathur on his first visit, he was given cortisone injections and was back to work three days later.

"To me, that means a lot," he said.

Calls to Mathur were not returned.

Reason for suspension

According to investigative findings detailed in a report by the Maryland State Board of Physicians, the board received a correspondence from the Drug Enforcement Administration on July 28, 2010, which included a letter from a medical precuts provider regulatory specialist.

Mathur ran an in-office dispensary, which he was issued a permit for in February 2008, that he used to give his patients medication he prescribed.

That letter stated that Mathur's account for purchasing medications had been "pended" because of a large order for oxycodone. The medical provider also reported the orders to the DEA and referred to them as "suspicious."

In December 2010, the Board of Physicians received a complaint from a senior investigator from a national health care plan. The complaint included an on-site audit report that was conducted on Mathur's office.

In the complaint, "the investigator reported that the health care plan's investigative unit had detected that a large quantity of narcotic prescriptions were billed from [Mathur's] practice and that [he] prescribed an 'unusually high amount of narcotics for the majority of his patients,'" the report stated.

During the on-site audit, Mathur was interviewed and said local pharmacists "questioned his prescribing practices," according to the report.

"One pharmacist reported [Mathur] to the [Maryland] Board of Pharmacy whose inspectors inspected his office on two occasions," the report detailed. "As a result, [Mathur] decided to maintain a dispensary in his office to avoid issues with pharmacists and other physicians."

The report also stated that Mathur only carried generic narcotics "because the profit margin on them is higher than brand name narcotics."

Based upon a peer review of the records Mathur kept, several deficiencies were found, including prescribing "excessive quantities" of controlled dangerous substances disproportionate to a patient's symptoms, prescribing multiple types of narcotics without documentation of his treatment rationale, prescribing multiple long-acting controlled dangerous substances at the same time, failing to conduct and document "adequate physical examinations" and not advising patients of other treatments outside of medication.

A hearing on Mathur's summary suspension has been scheduled for Feb. 22 at the Maryland State Board of Physicians.

If the doctor isn't satisfied with the results after the hearing, he can request an evidentiary hearing.

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