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Board revokes physician assistant's license over opiate prescriptions

New Hampshire Union Leader

December 15. 2016 12:59AM

CONCORD — The state Board of Medicine has revoked the license of a physician assistant, who previously was reprimanded for over-prescribing opiates.

Christopher Clough, who was once one of the largest prescribers of oxycodone in the state, in August 2014 agreed to abide by certain restrictions while his case was being investigated by the board. Those restrictions included the need for him to get pre-approval of a supervisory physician before performing pain procedures. It also required a “telephonic or face-to-face consultation” between him and the physician, along with other documentation.

Board investigators conducted an unannounced inspection of Clough’s workplace and obtained records of 20 patients seen by him from Sept. 8, 2014, to Nov. 13, 2014. A review of those records by the Medical Review Subcommittee revealed concerns that Clough had not abided by the agreement.

A hearing was held on Feb. 3 concerning the lack of documentation by Clough with regard to the physicians’ pre-approvals. Clough testified at the hearing, but the board said it found him to be less than forthcoming, according to its order dated Dec. 8.

The board said there is an absence of documentation that he and the physicians consulted.

The electronic signing off by a physician does not substantiate that communication, the board said, and it only demonstrates that the physician reviewed the record and approved the procedure.

One physician said when he signed the note electronically he was “documenting that upon consultation with Mr. Clough, he had approved the procedure.” That did not persuade the board that a face-to-face or telephonic exchange of information occurred between Clough and the physicians, according to the order.

More than 20 records were reviewed and, according to the board, not one record clearly indicated anything more than an after-the-fact signing of the electronic record, for the pre-procedure reviews, demonstrating that no “consultation” took place.

The board said members decided that Clough did not comply with requirements to engage in face-to-face or telephonic consultations with physicians prior to performing injections. “Whether the failure was ‘intentional’ or not is not of any significance in this case,” it said.

“The board placed the practice restrictions on Mr. Clough as a result of the allegations of improper prescribing in inappropriate injection procedures. His practice and the manner in which he continued to provide treatment without having a live-time dialogue with his RSP (Registered Supervisory Physician) or ARSP (Alternate Supervisory Physician) leaves the board concerned with his ability to follow requirements necessary to ensure patient safety,” the order said.

In October 2015, the board reprimanded Clough for over-prescribing opiates, using inappropriately high levels of local anesthetic and giving unnecessary injections to patients, including one who had a serious bacterial infection.

At the time of the over-prescribing allegations, Clough was a physician’s assistant with Pain Care of New Hampshire in Somersworth. His license was suspended for 90 days and he was permanently banned from the practice of chronic pain management and from prescribing all schedule II-IV controlled drugs, which have a high potential for abuse and may lead to severe psychological or physical dependence.

Clough has not worked for Pain Care since late 2015.

According to data available on the journalism website Pro Publica, Clough was the third-highest prescriber of oxycodone HDL in New Hampshire in 2013. Pro Publica used data from Medicare Part D to compile a list of frequent prescribers of many prescriptions, including the highly addictive painkiller oxycodone.

The website reported Clough’s patients filed 1,030 Medicare claims for oxycodone in 2013. The highest prescriber had 1,420 oxycodone claims.

Health General News Concord Somersworth

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