A Piedmont doctor was publicly reprimanded and accepted a two-year probation period last week for prescribing certain levels of controlled substances from the Alabama State Board of Medical Examiners.Dr. Russell D. Ulrich, D.O. of Piedmont Family Practice signed the negotiated consent order on March 26 after a two-year investigation by the Board of Medical Examiners found Ulrich in violation of a number of state regulations.
Two violations included failure to maintain medical records that meet the minimum standards stated in the Medical Licensure Commission Rule and practicing medicine in such a manner as to endanger the health of his patients, according to the board’s formal administrative complaint filed with the Medical Licensure Commission on Aug. 8, 2007.
The investigation included the review of some 4,000 pages of medical records provided by Ulrich to the Board of Medical Examiners, said Dr. Robert Coleman, Ulrich’s attorney and long-time colleague.
The administrative complaint states from 2000 through “at least” September 2006, Ulrich prescribed controlled substances to patients when they failed to make their appointments, prescribed them in amounts and for durations which documentation in their medical records did not support and “repeatedly” prescribed controlled substances to patients who “lost or ran out of their prescriptions early.”
The investigation also found Ulrich to have prescribed controlled substances to patients who tested negative for the substance in a drug screening after they had already been given a prescription for the substance.
Larry Dixon, executive director of the Board of Medical Examiners, said it was those findings that forced the board to recommend action against Ulrich.
“The board just felt like he was prescribing too many controlled substances,” Dixon said. “Alabama has a terrible reputation as a state with a lot of (prescription) drug diversion going on. They’re being sold on the street for a large profit, so we see which doctors are prescribing inordinate amounts and we do investigations.”
Dixon could not recall the exact complaint that sparked the board’s investigation, but said he thinks it was information from the state’s Prescription Monitoring Databank.
Coleman recalled the investigation beginning after a formal complaint from a patient in 2006. “In writing, we very carefully answered it and we thought that was the end of the matter,” he said.
But it wasn’t over.
The board sent in investigators who requested Ulrich’s medical records and then hired Montgomery attorney James R. Cooper.
Coleman said the board was uncooperative in its investigation, and did not allow him or Ulrich access to the evidence they used to base their findings. “We would ask for discovery, but the board’s view of discovery is very, very limited,” Coleman said. “We got almost nothing we asked for, so it was very difficult to respond to the board’s case.”
By the end of August, a hearing date was set for Ulrich and his attorney to respond to Board of Medical Examiners’ findings.
In the board’s affidavit to the Licensure Commission, it recommended Ulrich be revoked of his prescribing privileges for controlled substance schedules II and III, two of the higher levels of substances, and be monitored in his prescribing of schedule IV substances. It was also recommended that he pay a fine and be required to attend continuing medical education regarding proper prescribing.
In the stipulation and consent order negotiated by Ulrich and his attorney with the Board of Medical Examiners, Ulrich agreed to a $20,000 fine and the probation period of two years for prescribing schedules II, III and IV substances, with exception to his hospital and nursing home inpatients.
After the probation period, a hearing will be held for Ulrich to show reason for his prescribing abilities to be returned, Dixon said.
As of today, all signed narcotic agreements and future pain appointments have been cancelled, according to a letter sent from Ulrich to his patients dated March 26.
The only option left for Ulrich’s patients are to either find another physician to write the prescriptions for them or try a non-controlled medication to manage their pain, Coleman said.
Ulrich’s patients were the big concern for him and his attorney in the negotiation of the stipulation and consent order, Coleman said. Of the 3,500 to 4,000 active patients in his practice, many suffer from what Coleman called “acute, recurrent or chronic pain,” making them difficult to treat.
“Dr. Ulrich is one of the few doctors in his area that was brave enough to try and treat complicated, very sick people who have legitimate pain problems,” Coleman said.
The issue was not with whether the board agreed that these patients were legitimate in their conditions, it was with the documenting of their records, Coleman said.
But Dixon affirms the board saw Ulrich’s prescribing as “excessive.”
“This is a good man who is trying hard in a tough situation,” Dixon said of Ulrich. “The board doesn’t feel like this is a bad doctor, but the board thinks he over-prescribes and they are trying to get him to change his habits.”
What’s left are the patients who are still searching for another physician or a way to treat their pain.
The Journal spoke to two of these patients who said they are having trouble finding a physician that will take them in. Neither of the patients would go on record for fear of being rejected by other physicians for being one of Ulrich’s patients.
Dixon said the board knew Ulrich’s patients would have trouble finding another physician to treat them. “Some of these patients are going to be hard to pass on to another doctor,” he said. “Some of these patients are using way too many drugs. You don’t take someone into your practice that uses 60 controlled substances in three days. You just don’t do that.”
The board believes, Dixon said, that Ulrich’s “legitimate patients” can be treated with non-controlled substances for pain relief or can see an anesthesiologist through a pain management program.
Coleman said many of Ulrich’s patients will also have trouble finding another physician because they are on Medicaid, and many M.D.-licensed physicians do not accept Medicaid patients.
“Unfortunately what we’re running into is there are a number of physicians in this part of the state who won’t even touch a Medicaid patient,” he said, “much less someone who be unfortunate enough to have a failed back surgery or something like that.”
Ulrich is now searching for other physicians willing to take in such patients, Coleman said. “These are very difficult patients, ones who have acute, recurrent or chronic pain symptoms,” he said. “We’re going to do everything we can to ease the damage on them.”
Dixon said Ulrich’s practice can recover from this and hopefully, will not have the problem of patients seeking over-prescription of controlled substances any longer.
“You got a man here who is providing a vital service to a lot of people in a small town and he’s in a situation now where he’s going to have to send these patients that really need that kind of pain medication to someone else,” Dixon said. “But those people who are diverting drugs, they’ll find another doctor.”
During his probation period, Ulrich will attend a prescribing course at either Case Western University in Cincinatti or Vanderbilt University in Nashville. Dixon said the programs are highly effective and can hopefully teach Ulrich how to “protect himself in the future.”
You can access Dr. Ulrich’s licensee records and read the Board of Medical Examiners’ findings and the Medical Licensure Commission public documents by visiting www.ALBME.org and clicking on the “Licensee Search/Verification” link.
