HELENA — The state Board of Medical Examiners has indefinitely suspended the license of a Helena physician after finding he prescribed excessive quantities of narcotics to five patients and failed to adequately chart his reasons for allowing some early refills of pain medications.
The board approved the sanctions for Dr. Mark Ibsen on Tuesday, in an order that said it was “unfortunate” there are too few doctors willing to treat chronic pain patients.
“Chronic pain is an extremely difficult disease to treat,” the board wrote. “It’s not a patient population that most physicians want to treat. That’s unfortunate, because there are millions more people affected by chronic pain than by virtually any other chronic diagnosis in the world.”
The board said Ibsen could apply for reinstatement after he completes a course on medical record keeping and a competency assessment in the evaluation and management of chronic pain patients.
“I think we can actually be allies and treat the patients in pain that have been in this state and have been abandoned by their doctors,” Ibsen told the board Tuesday. “This problem has mushroomed over three years and it didn’t have to.”
Ibsen’s attorney, John Doubek, said he plans to appeal the decision, which also would require Ibsen to work under the supervision of another physician for at least a year after his license was reinstated and face audits of his patient charts until the board decided that was no longer necessary.
The case against Ibsen began in July 2013 when a former employee filed a complaint. Before the case was heard, the Drug Enforcement Administration raided Dr. Chris Christensen’s pain clinic in Florence, forcing it to close in April 2014. The DEA also was taking a hard look at pharmacies that were filling prescriptions for pain medication.
Ibsen ended up seeing 21 former patients of Christensen, who faces 400 felony charges including two counts of negligent homicide in the drug overdose deaths of two patients.
Ibsen prescribed some of Christensen’s former patients the same high doses of narcotics that they had been taking and planned on tapering their doses. But he said he was not comfortable prescribing the methadone they had also been taking, the board found. Without the methadone, the patients sometimes needed early refills of the other pain medication, Ibsen said. The board found Ibsen did not adequately chart those reasons.
Meanwhile, a Helena pharmacist refused to fill prescriptions for 30 mg tablets of oxycodone, so Ibsen substituted 10 mg tablets, with more tablets, the board said. The pharmacist also recommended Ibsen have his patients sign pain contracts, that he prescribe decreasing doses and that he refer those patients to a pain specialist. The pharmacist eventually refused to fill prescriptions for the higher number of 10 mg tablets.
Ibsen was upset that the pharmacist would involve himself in how he planned to treat a patient, the board said, noting that the pharmacist is not an expert in pain medications or weaning patients off of them.
The board’s findings noted that Ibsen made reports to the DEA when two patients altered their prescriptions to receive more pain medication and that one appeared to be “doctor shopping.” Other pain patients raised ‘red flags’ with Ibsen and he reported some of them to the Missouri River Drug Task Force. Ibsen testified that when he asked DEA agents how to properly treat pain patients without getting in trouble one said: “I can’t tell you. We’re not physicians.”
The initial patients whose records were at issue in Ibsen’s case were selected by “a former employee with an interest in seeing Dr. Ibsen punished for terminating her employment,” which weighs against a significant sanction, the board noted. However, the board said it found he didn’t meet the standard of care for documenting regular assessments of patients, whether other methods of controlling pain were tried and for not having written controlled substance agreements with chronic pain patients. Some patient records were illegible, the board said.
A hearing officer had recommended that Ibsen’s medical license be placed on probation for 180 days, allowing him to work under a peer supervisor with peer review of patient records. He also would have to complete a course in medical record keeping.
Ibsen closed his clinic, Urgent Care Plus, in December.