ORLANDO — As a new law cracking down on pain clinics took effect Friday, a parade of doctors came before the Florida Board of Medicine for wrongly prescribing the powerful painkillers that kill an average of seven residents a day.
A half-dozen doctors received penalties ranging from a $5,000 fine to the loss of medical licenses, which some gave up voluntarily rather than face further discipline.
The cases highlighted the fact that the problem is not confined to the "pill mills" widely blamed for today's crisis by making it easy for drug seekers to get huge volumes of controlled substances with little medical scrutiny.
"Just because they are pain cases, they are not all the same," said Dr. Onelia Lage, a Miami pediatrician who chairs the board. "It's more complicated than it appears. It's a multifaceted problem. It's like in medicine, there isn't a quick fix."
Consider the case of Tampa physician Shaukat Chowdhari, a pain management specialist with the expertise regulators endorse for the proper treatment of chronic pain. Yet Chowdhari didn't recognize the signs of addiction in a patient whom he saw at least monthly over seven years.
Chowdhari, who practices at University Pain Management Center, prescribed to the patient increasingly heavy doses of narcotics, including fentanyl, a drug more potent than morphine. He also tried procedures such as steroid injections and nerve blockers, which health officials cited in his favor. And even the psychiatrist to whom Chowdhari referred the patient didn't pick up on the addiction.
"I have done everything possible with all my patients, not only this patient, and this is the first time I am facing the board," Chowdhari told its members, asking for leniency.
"Dr. Chowdhari strongly opposes the operation of pain management pill mills and he actively advocates this in the community," said his attorney, Bryan Rotella, in a statement. "He is (in) support of measures to encourage the conservative use of pain medication in pain management."
Chowdhari was fined $5,000, the lightest penalty among the day's pain cases.
Board members, who have been criticized for going too easy on doctors, sought to balance their concern over pill mills with the legal rights of patients and doctors. It's a struggle for many physicians in Florida; some neurologists and pain physicians attacked the new law Friday as onerous even as they professed their support for cracking down on illicit clinics.
The law requires pain clinics to be owned by doctors. It imposes strict regulations on clinics that advertise pain treatment, or employ a doctor who mostly treats pain by prescribing narcotics. Already, pain doctors have filed a legal challenge.
The state's medical regulatory boards also are working on their own rules for pain clinics even as they hear cases of doctors accused of wrongful prescribing. Here are highlights of those heard Friday:
• Dr. Mary Stegman of Fort Myers was fined $20,000 and required to practice under supervision for a year after excessively prescribing narcotics to many patients starting in 2002. Despite warnings that one man was scoring drugs from other doctors, she approved increasing doses of painkillers, at one point prescribing for the 76-year-old man the equivalent of 48 oxycodone pills per day.
But health officials said Stegman technically followed the rules for prescribing controlled drugs. Now practicing at a hospice, Stegman said she treated patients at a time when the pain standards weren't clear, and only because other doctors refused to prescribe narcotics for patients with noncancer pain.
"The only reason I opened a pain practice was because I got sucked into it, no one else was willing to do it," Stegman said.
• Also fined was Norman Moskowitz, a Boca Raton orthopedic surgeon, who was slapped with a $50,000 penalty after the board rejected an earlier proposal by Health Department officials for a $30,000 fine.
Health investigators say in one visit to Moskowitz at the Chronic Pain Management Center, a 32-year-old man received two different prescriptions for the powerful narcotic Roxicodone — totaling 240 pills — without any medical evidence that he needed them.
"I made a mistake," Moskowitz told board members in April, explaining that he got into pain practice after falling on hard financial times. "This is not the industry I want to be in. It's not for me. It's not for anybody really."
• The board also accepted three doctors' offers to relinquish their licenses voluntarily after charges of misprescribing.
One of them, Thomas Weed of Boca Raton, prescribed over 31/2 years, 81,730 pain pills to two patients who were husband and wife. Weed's behavior came to light in October 2009 after law enforcement got a tip that the couple was selling oxycodone pills out of their home.
• Finally, board members rejected a Clearwater physician's request for an early end to the restrictions imposed for a drug-related offense. In 2008, Philip Bagenski was fined $10,000 and required to practice under another physician's supervision for two years after pleading no contest to possessing cocaine, which he was accused of obtaining in exchange for a prescription for Roxicodone.