ALBUQUERQUE, N.M. — In 2011, Pawan Kumar Jain, a doctor who practices in Las Cruces, prescribed 3,028,939 doses of pain medication to 3,233 patients.
He was the top pain prescriber in the state; the second on the list was the entire staff of medical residents at the University of New Mexico Hospital, which prescribed about a half-million fewer doses for some 23,000 patients.
When I ran across those statistics last year in the course of writing about the explosion of deaths due to opiate overdose in New Mexico, I thought there must be something wrong in Dr. Jain’s office.
The people at the New Mexico Medical Board had the same suspicions. After a lengthy investigation into Jain’s prescribing practices and the deaths of 21 of Jain’s pain patients by overdose, they yanked Jain’s medical license last month.
The 23-page report by the board’s hearing officer is based on an investigative record he called “voluminous.”
It concludes that Jain, a neurologist, told patients he was giving them epidural nerve blocks and billing for them, even though he was not trained as an anesthesiologist and wasn’t actually giving epidurals.
It compared his travel records to the state’s computerized prescription monitoring program that requires pharmacies to report who is prescribing controlled substances, in what amounts and to whom and found hundreds of scripts dated when he was not in his office. Postdating of prescriptions for controlled substances is against the law.
And it found that Jain never once consulted the prescription monitoring database before February 2010 and failed to check it on a regular basis before prescribing to many of his patients.
The database exists to put curbs on excessive opiate use, either by identifying overprescribing physicians or catching drug-seeking patients who are seeing more than one doctor. Taking too many opiates or mixing them can lead to death, either through an accidental overdose or an intentional one.
The Medical Board’s prosecutor argued that deaths of the 21 patients who were included in the case against Jain were “directly related” to Jain’s practice of overprescribing and not monitoring their prescriptions through the state database.
Hearing officer David Thomson found that Jain improperly prescribed pain medication to those patients, but he also said that the patients had “various ailments and psychological trauma” and that he could not conclude Jain’s actions “without an intervening factor” caused their deaths.
Thomson said he “did not attempt to make a factual determination whether it was those events that caused either the death by overdose or suicide or whether it was the injudicious prescription practices.”
Nonetheless, Thomson detailed some of Jain’s treatment of the patients before they died.
♦ Jain gave one patient a three-month supply of the opiate oxycodone and alprazolam (Xanax) within two weeks of a suicide attempt and despite the patient’s dementia and history of overdose.
♦ For another patient, Jain prescribed a four-month supply of hydrocodone despite the man’s history of bipolar disorder, suicide attempts and sleep apnea.
♦ Jain prescribed a month’s supply of oxycodone to another patient after she tested positive for cocaine in a urine drug screen. She died four days later.
Although it stopped short of directly blaming Jain for their deaths, the report concluded Jain violated seven provisions of the Medical Practice Act and the Medical Board’s rules, including “injudicious prescribing or administering of drugs,” “excessive prescribing or administering of drugs,” “gross negligence,” “incompetence” and “conduct likely to deceive, defraud or harm the public.”
In the course of the Medical Board’s investigation and prosecution of Jain, the doctor’s lawyer argued that some of Jain’s responses to the allegations were “not what he meant” due to English not being his native language. An online biography says Jain received his medical training in India.
He has a right to appeal the decision to state District Court, although his attorney, José Coronado of Las Cruces, didn’t return my telephone message asking whether he planned to.
The phone number for Jain’s medical office has been disconnected.
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— This article appeared on page A1 of the Albuquerque Journal