Former Bearden Doctor Surrenders License after State Review of Painkiller Prescriptions
To the state of Tennessee Board of Medical Examiners, Dr. Frank McNiel is a menace, part of the problem that's led to the state's widespread opioid epidemic.
To McNiel, practicing pain management medicine has become a battle he no longer thinks he can win.
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Earlier this year, the board voted to discipline McNiel's license after reviewing about 75 patient records back to 2002 and concluding he prescribed controlled substances too often and in amounts larger than "medically necessary, advisable or justified," sometimes "not for a legitimate medical purpose," and without seeking non-opioid alternative treatments for pain or monitoring his patients to make sure they didn't abuse or resell their prescriptions.
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In addition, the board found, McNiel was the supervising physician for "multiple" mid-level providers — advanced practice registered nurses and physician's assistants — who also prescribed opioids "excessively." Also, the board cited McNiel for not using the state's mandated Controlled Substance Monitoring Database, which tracks the amounts of controlled substances doctors are prescribing and patients are using, in an effort to stem abuse.
It's not the first time the board sought to discipline McNiel, who has practiced medicine for 55 years, 33 of them in Tennessee, for, in its judgment, too freely prescribing narcotics and failing to carefully monitor the patients he's given them to.
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In 1994, the board disciplined McNiel and his wife, Dr. Janet McNiel, who then both worked in pain management at Bearden Healthcare Associates, for similar reasons. The couple hired a lawyer, appealed the decision and, in 1997, won. McNiel said it cost them $100,000.
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This time, McNiel, 77, permanently surrendered his medical license. The lawyer who represented him before has died, and he has neither the funds nor the energy to fight, he said. Besides, in light of the skyrocketing number of overdose deaths, the political climate has changed.
"They have the power now, and they have the goodwill of the government," McNiel said. "I can't fight them."
Painkiller prescriptions raise concerns
The state's consent order, issued March 20, said McNiel left Bearden Healthcare Associates — where Dr. Janet McNiel still practices — in 2012 but then still saw patients out of his home, giving them "opioids, benzodiazepines and/or carisoprodol" for "chronic pain management."
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Though he was still licensed, and state regulations would have allowed this practice to qualify as a pain management clinic, McNiel "did not obtain certification of licensure of the clinic as required by Tennessee law," the consent order said, nor did he use the database to ensure the patients weren't "doctor-shopping," getting the drugs from multiple providers. And when investigated by the state, he couldn't produce complete medical records for some patients, or medical records at all for others.
These actions resulted in "unprofessional, dishonorable or unethical conduct," the consent order states.
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"I didn't challenge it," McNiel said. "I knew it was just a matter of time before they would come after me."
McNiel said he retired in 2012, when he left Bearden Healthcare Associates, but kept seeing 15 patients that he said he was trying to place with other providers. He said he charged them no fees to see them and write their prescriptions during that time. He said he "tried" to access the database but, having limited computer skills, couldn't figure out how.
The opioid epidemic "has become a problem — I'm not arguing that," said McNiel, who described himself as a "teetotaler" who doesn't even drink alcohol. "It's frightening how people are abusing this stuff."
But "I didn't prescribe these drugs for entertainment," he said. "Chronic pain patients have to have some kind of quality of life."
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Medico-legal death investigator Morgan Seymour uses a pill counter to count pills confiscated from cases in the evidence room in the Knox County Regional Forensics Center on Thursday July 13, 2017. The pills are turned over to Knoxville Police Department to be destroyed. (Photo: CAITIE MCMEKIN/NEWS SENTINEL)
A long career
After finishing his medical internship at California's Loma Linda University in 1965, McNiel was drafted for the Vietnam War but stationed for two years in Panama; having grown up in Latin America, he was fluent in Spanish.
After he met his wife, the two doctors served five years in a mission hospital in Nicaragua, then 10 years in a mission hospital in Honduras. After a year in Portland, Oregon, they settled in Greeneville, Tennessee, in a private family practice.
"Pain management was part of that, but it wasn't a pain management clinic — there wasn't such a thing back then," said McNiel, who said he also worked in a drug-and-alcohol rehab program at a nearby hospital.
But it was there the state first took notice of his pain medication prescribing habits and investigated him.
It wasn't only the state that was suspicious of McNiel's practice; there were also community complaints. In 2008, the McNiels and two other doctors with Bearden Healthcare Associates — then located in the Bearden area of West Knoxville — sued the Westwood Homeowners Association for "defaming" them in a newsletter that accused the clinic of “overprescribing narcotics” and being part of the “Narcotic Trade.” Also named in the same lawsuit was E.W. Scripps Co., then the parent company of the Knoxville News Sentinel and alternative weekly newspaper Metro Pulse, for reporting on the conflict.
Bearden Healthcare Associates moved further west on Kingston Pike and, according to state records, has no disciplinary actions against it and is renewing its license, which expired in January.
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Treating chronic pain
Janet McNiel said the practice of pain management has become "increasingly frustrating" with government and insurance restrictions.
"I'm not talking about 'pill mills' — those are dangerous," she said. But many of her long-term patients "have taken the same medications for years, and they need it for function and quality of life. ... A lot of them are asking, 'Why do I have to suffer because people are misusing and abusing their medications?'"
In 2016, Tennessee providers wrote 7.8 million opioid prescriptions — 118.3 opioid prescriptions per 100 persons, enough for every Tennessee man, woman and child to have at least one. The national average that year was 70 opioid prescriptions per 100 residents.
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One of the state's answers has been to more closely regulate doctors who prescribe the drugs for pain management, requiring a special license and continuing education. The state also demands meticulous record-keeping to ensure patients are getting full medical exams and not just prescriptions, have tried other methods of managing pain and aren't getting the pills to abuse or to sell or give away to others — as did a Kingsport woman who was convicted in 2012 of reselling pills prescribed to her by Frank McNiel. Frank McNiel did not meet that "standard of care," the consent order said.
Meanwhile, as overdose deaths continue to rise statewide, in some cases the state is experimenting with pursuing murder charges against those who provide the drugs — from drug dealers to doctors and pharmaceutical companies — even as the death rate from counterfeit and "street drugs" grows at an alarming rate.
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Insurance companies, too, have announced crackdowns on prescriptions, limiting the number of opioid pills that can be filled in a period of time. And some pain clinics, such as those affiliated with Knoxville's Tennova Healthcare, have ceased prescribing them entirely, relying instead on alternative treatments.
But Janet McNiel said insurance coverage and widespread availability of such "alternative methods" haven't caught up with this trend, leaving some patients unable to afford or access them. For others, she said, they don't work — at least, not as well as the pills do.
"It's very, very hard to study pain management with an open mind right now," Frank McNiel said.