NEW: East Greenwich MD Suspended For Dangerous Prescriptions
Monday, October 15, 2012
An East Greenwich psychiatrist has been suspended from prescribing controlled substances after it was discovered that he had prescribed benzodiazepine to a methadone user, a potentially dangerous combination, according to documents released by the Rhode Island Department of Health (HEALTH).
Thomas Paolino, MD, a psychiatrist whose primary business address is 4474 Post Road in East Greenwich, was treating a patient for major depression who had been taking oxycontin for several years, according to HEALTH. This patient was receiving methadone, and Dr. Paolino prescribed her 3 benzodiazepnes in October 2010. "Benzodiazepines taken in combination with methadone can be highly dangerous if not prescribed and monitored carefully and frequently," according to HEALTH. This patient died in a motor vehicle accident on July 3, 2012, and her autopsy toxicology report received on October 3, 2012, "revealed the presence of the four benzodiazepines (diazepam, oxazepam, temazepam, and alprazolam) in her system."
Paolino had prescribed diazepam, temazepam, and alprazolam for this patient on March 11, 2011, but his medical note did not record the order for diazepam. Further, "the medical record did not include a problem summary list, a controlled substances log, prior medical history, social history, treatment goals, treatment plan, mental status examination, nor ongoing assessments of co-morbidities of substance abuse, all of which are required as minimum standards of care with Patient's presenting medical issues," according to HEALTH.
While Paolino's records included prescriptions for controlled substances, "they were indecipherable as to the date of the last prescription, and multiple diazepam prescriptions were not documented," according to documents, adding that there were no urine toxicology screens, pill counts, pharmacy control, no diagnostic indication that this number of controlled substances was necessary, "especially in light of [the patient's] methadone regimen."
HEALTH also found a pattern of "inadequate medical records" for four other patients, revealing "no evidence of diagnoses; undocumented controlled substance prescriptions; inadequate monitoring of controlled substance prescribing, prescription of controlled substances in a pattern that lack coordinated care with methadone clinics, especially regarding patient benzodiazepine usage; inadequate safeguards to prevent controlled substance diversion; lack of recorded indications for controlled substance use; prescribing other controlled substances such as amphetamine salts without documentation in medical record; frequent failure to document vital signs, examinations or meaningful notes."
Paolino's suspension is in effect until further notice.
