Thursday, April 26, 2018

Pain doctor's troubles prompt new policy at USF

TAMPA — In 2008, Dr. Gerard Dileo got in trouble with the Louisiana Board of Medical Examiners. Investigators said he was prescribing pain pills without fully examining his patients. In some cases, he used scripts created before patients even turned up in the office.

Yet, he still kept working as an obstetrician/gynecologist and assistant professor at the University of South Florida.

The next year, medical boards in California and Florida disciplined Dileo for those Louisiana violations.

Still, he remained at USF, where top leaders had no idea of the trouble he was in.

They got the word in September 2010, when Dileo was indicted on federal prescription drug and money-laundering charges. But he stayed on the job another five months until the university could get rid of him.

Dileo, 60, was convicted in November, and he lost his Florida medical license last month.

State medical boards long have been notorious for dragging their feet and failing to communicate across state lines. Many doctors have been able to practice while facing serious charges in another part of the country.

But Dileo's case reveals that even within the state of Florida, officials aren't talking to each other.

He worked for the state university system. Yet the state Health Department did not tell Dileo's bosses that they might have a problem on their hands.

Interviews and a review of more than 1,000 pages of USF documents reveal that:

• Leaders were slow to find out about medical board actions against Dileo — yet some of his colleagues knew about them.

• USF doesn't track whether any of its health faculty have been similarly disciplined.

• Job applicants are required to disclose whether they have been disciplined, but current faculty aren't.

John Curran, senior executive associate dean for faculty and academic affairs, called USF's experience with Dileo "a very embarrassing incident."

Dileo's case "gave us a lot of impetus to get on top of things," Curran said. "We handled it well once we knew about it."

Dileo did not respond to messages seeking comment. His New Orleans-based attorney, Joseph Bartels, said his client would not comment while awaiting sentencing. He could face up to 40 years in prison, plus fines of at least $1 million.

• • •

Dileo came to USF as an ob/gyn in 2006, and became an assistant clinical professor a year later. He eventually led the ob/gyn department's division of chronic pelvic pain.

When he applied, Dileo noted he had never been disciplined by a professional organization, which was true at the time.

But in March 2008, the Louisiana medical board put his license on probation for five years, prohibiting him from practicing pain management. An investigation into his work with Global Pain Management between 2004 and January 2007 found he "did not fully investigate patients' complaints of chronic pain prior to beginning chronic narcotic therapy," according to an agreement signed by Dileo and the president of the Louisiana board.

In some cases, Dileo used computer-generated clinic notes and prescriptions that were created two weeks in advance of seeing the patient, the order noted.

By signing the order, Dileo did not admit guilt, but acknowledged that the findings would constitute probable cause for actions to be taken against his medical license.

Medical boards in Florida and California — where Dileo was also licensed — were notified. But no one told USF leaders.

More than a year later, the Florida board placed Dileo's license on probation for one year, but allowed him to keep practicing under the supervision of another doctor. It also fined him $5,000 and ordered him to take courses in prescribing drugs and medical recordkeeping.

A colleague of Dileo's was asked to supervise his prescription writing. The board approved this appointment, but Curran was not told. Curran said had he known, USF could have placed further restrictions on Dileo's practice. He said he found out about the action just two or three months before Dileo's probation ended in April 2010.

Curran doesn't recall exactly what tipped them off, but he said USF officials visited the state Department of Health website and learned of the conditions on Dileo's license. He sent Dileo a letter in February 2010 requiring proof that he had met the terms of his probation.

Florida Board of Medicine actions are posted online where anybody who looks can find them, said spokeswoman Jessica Hammonds.

Some state and federal agencies do receive notice when the board disciplines doctors, she said. But a doctor's employer is told only when the Board of Medicine specifically orders it done.

• • •

USF leaders may have been in the dark, but federal law enforcement was all over the case.

In September 2010, Dileo was indicted on charges of illegally dispensing controlled substances — including oxycodone and hydrocodone — and money laundering at pain clinics in Louisiana and Pensacola between 2004 and 2007.

In material Dileo submitted to the Florida Board of Medicine this year, he wrote that the government's case was built on a "rogue's gallery of previous patients, all of whom had been arrested and then granted immunity for testimony against us."

He said all of his patients had legitimate pain medication needs and were appropriately treated.

USF leaders, who learned of Dileo's arrest through media reports, told Dileo in November 2010 he would not be reappointed to his faculty position, and they gave him 30 days' notice. But his colleagues came to his defense, with more than 20 on the ob/gyn faculty signing a letter to Dr. Stephen Klasko, dean of the medical school, suggesting Dileo "be retained in some capacity until his trial is concluded."

"He was an exemplary physician," said Dr. Anna Parsons in an interview. "Dr. Dileo was very interested in helping women with chronic pelvic pain, a problem we aren't really trained to deal with. … He was very effective."

Parsons said she was "mystified" when she learned of the medical boards' actions against Dileo. "And I still am."

State records indicate no patient complaints against Dileo or Florida malpractice lawsuits.

Dileo remained on the job as he filed a grievance challenging his dismissal date. His last day at USF was Feb. 3, 2011.

• • •

Dileo's lawyer says he is at home in Bradenton, taking care of his son, who has cerebral palsy.

Because of Dileo, the university has toughened its professional-conduct policy so faculty members who violate it can more quickly be disciplined or dismissed, Curran said.

And now, when a USF physician's contract is renewed, the university checks with the state Board of Medicine to make sure his or her license is clean.

"Once burned, you don't get burned again," he said.

Editor's note: This story has been amended to reflect the following clarification: In a May 20 article about a USF physician who lost his medical license over prescribing practices, the USF Health faculty dean criticized a supervising physician for failing to keep him informed of the situation. USF now says the reporting procedure was unclear at the time.Times researcher Caryn Baird contributed to this story. Richard Martin can be reached at [email protected] or (813) 226-3322.

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