Dr. Dee, for Drugs?
Silver Spring Neurologist's Patients Try To Save Her Medical License
Dirty clothes on the floor, wine in the open medicine closet, loose pills in a plastic jack-o'-lantern, and an unleashed dog. These are not things the Maryland Board of Physicians expects to find in a doctor's office.
Dr. Rosita Dee, a Silver Spring neurologist, acknowledges her office was a bit cluttered, her patient records a little sparse. But she says the board had no cause to suspend her license last August, and she is fighting to get it back.
Last week eight of Dee's patients--most with painful injuries--came to the Maryland Board of Physicians' offices in Baltimore to try to help her. On Feb. 28, Dee's patients made their way from their homes in Prince George's and Montgomery counties to the board's offices at 4201 Patterson Ave. The board summarily suspended Dee's license to practice medicine last August and appeared ready to revoke her license permanently, although that proceeding was postponed until March 28.
Dee's patients say their doctor is more caring than other doctors and takes the time to listen when others don't. Many of them also say that since Dee's suspension they've had difficulties either finding a doctor who will take their payments from Medicaid or workers' compensation, or that they've had trouble finding a doctor to refill their prescriptions.
"Most doctors are in and out [saying], `You'll be alright, take this,' and then they're gone," says Wanda Scott, a patient of Dee's since 1999 who says she rearranged her work schedule to be at the hearing. "When I came [to Dr. Dee] I really was in a lot of pain, just about to kill myself. I didn't know what to do. She got me going. She's a good doctor. She doesn't deserve to be railroaded just because other people are not happy."
The patients knew they would not be allowed to testify on their doctor's behalf--a situation they find galling. "It's a star chamber," says Thomas W. Nicholas, a patient since 2001 who began calling reporters about Dee's case in mid-February and helped circulate a petition in support of the doctor for patients to sign. "I feel she's being railroaded."
Nicholas, walking with a cane, says little at the Board of Physicians' office cafeteria, where the group met to commiserate, speak to a reporter, and hug their doctor. But in several telephone calls he rails against the state's system of physician discipline, saying it is unfair to doctors because it does not allow them to defend themselves and because the board's investigators allegedly do not check the statements, or credibility, of those who lodge complaints.
"The state has been relentless," says Nicholas, a former teacher who says he was hurt in 2001 when a metal-encased movie screen fell from the ceiling onto his head. "[Dee] has been wrongfully accused. The state's attorney for [the Department of] Health and Mental Hygiene maybe overstepped the bounds of his authority."
Karen Wulff, spokeswoman for the Board of Physicians, says the disciplinary system is governed by state law, with evidentiary hearings conducted by an administrative law judge. Although part of the case file is public information, she says, "no one can discuss this case with you."
The board's files on Dee show that she was put on probation in 1993, violated it, and was kept on probation until 1997. Both of those sanctions, and the recent suspension, involve her prescription habits involving controlled substances like OxyContin, Dilaudid, and Percocet. In the most recent case, allegations included having inappropriate personal and business relations with a patient, addicting patients to painkillers, and keeping an office that investigators described as being in "complete disarray."
Dee, a 25-year physician who has never been sued for malpractice, says her current troubles began with a patient she discharged after finding out he was obtaining prescriptions from another doctor. The patient--referred to as "Patient A" in the board's case file--retaliated by telling the board what Dee says are wildly exaggerated stories of drug addiction, forced sex, and business deals gone wrong.
"His complaint is I forced him to take drugs, and to have sex, and that I forced him into a hotel. How could I do that?" Dee asks. "I'm 5-2 . . . and he's 6 feet and 180. I barely left my office, how can I force him to a hotel?"
Dee claims that the patient later recanted his story to her and her lawyer. Dee's lawyer, Andrew Marter, did not return a reporter's phone call.
The patient, who has convictions for jury intimidation, assault, and reckless endangerment, could not be reached for comment.
In 2004, with the complaint from Patient A in hand, the board opened an investigation and soon received other allegations against Dee "that raised additional concerns about [her] prescribing practices and possible personal involvement with a patient for whom she prescribed controlled substances," according to the board's findings of fact.
Then one of Dee's patients died of an apparent drug overdose. In May 2005 that patient's sister alleged to the board that Dee had got the patient hooked on painkillers "that ultimately led to her death." The sister--who is not identified in the board's findings and who could not be reached by a reporter--said in her complaint to the board that Dee "should be stopped before she kills anyone else."
The board found that Dee did not perform or keep an adequate medical history for the woman, nor did she justify the large quantities of various pain drugs she prescribed.
Dee says the board's main problem is that she did not document telling the patient not to mix her pain pills with alcohol. "But I do that every visit," Dee says. "You tell them all these things. Whatever they do out of my office is out of my control."
A fourth complaint about Dee came in, according to the board's findings. All four alleged that Dee "prescribed excessive quantities of controlled substances."
Dee's patients, however, say she does not overprescribe.
Kim Chaney calls from Florida to defend her doctor. She was injured several years ago at Home Depot when several front doors fell on her. She moved to Florida recently, after having several operations. Chaney says she suffers a leak of cerebral-spinal fluid through her nose, and that she has struggled to find a Florida doctor who will take payment from the Maryland workers' compensation system. And she cannot find a doctor who will prescribe enough pain medication.
"These people have no idea what it is to be throwing up for three days because of the pain," Chaney says, speaking of the Maryland Board of Physicians.
Another patient, Barbetta Jones, calls a reporter while drugged after a procedure she says involved getting a needle stuck into her neck. "You've gotta excuse me; I took Valium before this [medical procedure], and I had to take Percocet after, so my brain is a little bit fuzzy," she says, in trying to recall the details of a car accident several years ago that she says left her with debilitating neck, back, and shoulder pain.
Like many of Dee's patients, Jones says she did all kinds of physical therapy and nondrug interventions. Dee, she stresses, does not reach for the narcotics first. "She did like trigger-point injections and stuff . . . like Novocaine . . . [which] kind of numbs out the muscle and relaxes it a bit, helps it chill itself out. She also gave me [medicines] like Topamax--that's supposed to help nerves repair themselves--so it's not like good stuff that makes you feel good."
The board's findings--based mainly on patient records kept by Dee--depict some eyebrow-raising case studies. Patient A supposedly had six car crashes in five years, each time receiving treatment, and drugs, from Dee. He also was injured on the job, according to the record, before Dee noted in her file that he "may have a psychological dependence" on Percocet. But she kept treating him, and prescribing narcotics "in increasing quantities," for four more years.
The board found that Dee "entered into a series of business transactions with Patient A," encouraging him to become involved in a business/marketing venture with which Dee was involved. The patient also sold land to Dee, and then provided $60,000 in construction services to Dee at her home.
Dee says the business venture, Quixtar, which she describes as an online version of Amway, cost him $25. She says that she bought the patient's land--10 acres in Pittsylvania County, Va.--for a fair-market price of $50,000. She says Patient A installed hardwood floors, painted, and did other work in her house, but did not finish a deck and then stole the materials from her backyard. "He did not finish my deck-that's why I sued him," she says. City Paper could not find a record of that suit.
Dee says she knows that, under ethics rules governing her profession, "you're not supposed to get involved with your clients." But she says a distinction should be made between herself and people who attempt to exploit their patients. "I'm spending money," she says. "They [the board] did not ask me about this distinction--they did not investigate."
On Aug. 2 the board sent investigators to Dee's Silver Spring office. "Board found that the Respondent's office was extremely dirty," the findings state. The investigators saw a dog dish next to the water cooler, a power strip duct-taped to the wall, patient records out in the open, and "numerous prescription bottles, drug vials, sample drugs and painting supplies were positioned throughout the examination room . . . and were accessible and in plain view." The room was "haphazardly strewn with papers . . . medical equipment, packaged syringes and other items," according to the board's findings, while the medical equipment was "covered in dust," and there was "a small black dog in the examination room and . . . the carpet in front of the Respondent's desk was soiled with the dog's vomit."
Dee says the dog, a lab/collie mix named Maya, helps calm patients and "doesn't come out unless she sees a current patient crying."
Dee's prescription pad was on her desk, unsecured, according to the board's findings. Syringes were improperly disposed, and the billing office was in "complete disarray," its floor covered in medical records, billing records, lab results, food products, and prescription pads. "The floor was littered with trash, dirty cups and soiled clothing," the board's findings state.
Dee says she should have supervised her billing worker better.
The investigators then looked in Dee's drug sample/storage room, which was left open, according to their findings. This room also was in "complete disarray," they found, with "piles of medical records, expired pill packs, loose pills, food, beverages, a bottle of wine," and other things. "Board staff observed that loose pills were stored in a plastic Halloween pumpkin on the floor," according to the finding. "When Board staff questioned the Respondent about the pumpkin, the Respondent responded by taking the pumpkin and dumping it into the mail bin with other loose pills and pill packs."
Dee says she had asked her secretary to clean out the loose and expired sample medicines just that day, and her employee was using the pumpkin and the mail bin to collect these things for disposal.
The board's finding say that Dee's staff told the investigators that Dee "would leave blank signed prescriptions in an envelope in her top desk drawer." Citing state law and Centers for Disease Control and Prevention guidelines for sanitary conditions in doctors' offices, the board concluded that Dee's practice was a danger to the health, safety, and welfare of the public. It ordered her office closed on August 14, 2006.
Dee fought board sanctions last time, and the time before, in 1993, when the Drug Enforcement Administration came to her office to get records regarding a patient to whom she had prescribed 40 Percocets a day. She vows to fight back this time, when she faces revocation of her medical license on March 28.
"They jump, they jump," Dee says of the board. "They jump on everything."
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