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Some Providers Named in State’s Opana Suit Are Still Practicing

Between 2007-2014, Knoxville providers prescribed 916,513 more Opana Extended Release tablets than in all of New York City, Los Angeles and Chicago put together — cities with a combined population 82 times larger than Knoxville.

In 2015, Tennessee's rate of prescriptions for Opana ER and its generic equivalent were the nation's highest, nearly double that of the second-highest state, North Carolina.

Those are only two facts the state of Tennessee cites in its lawsuit against Opana maker Endo Pharmaceuticals Inc., unsealed June 7, to make the claim that Endo 'is substantially responsible for the opioid epidemic in Tennessee' — with East Tennessee hit especially hard.

And to reach those levels, Endo targeted high-volume providers, which they labeled 'Grade A' or 'loyalists.' They also targeted nurses, 'mid-level providers' — nurse practitioners and physician's assistants — and specialists in fields where they were unlikely to have as much knowledge of or experience with pain management.

Some of those providers voluntarily surrendered their licenses or had them revoked by the state — in some cases, not until after they faced criminal charges.

Others were put on probation with terms that included education about addiction and narcotics, or simply barred from pain management practices or prescribing controlled substances.

But some are still practicing.

Among those named in the suit are: Julie Bliss, nurse practitioner, Powell. Bliss, rated an 'A' prescriber by Endo, part of a group of providers that accounted for 50 percent of Opana ER prescriptions nationally, is on probation after a state board found her guilty of unprofessional prescribing practices. Bliss worked for American Anesthesiology on contract with Tennova Comprehensive Pain Treatment Center, which closed in 2016, and worked at Tennova's North Knoxvillee Medical Center and the now-closed Physicians Regional Medical Center, among other Tennova sites. She's required to complete educational courses on medical record keeping and prescribing controlled drugs, and she was assessed a $1,500 civil penalty, plus costs up to $12,000.

David Brickhouse, physician's assistant, Knoxville. Brickhouse was indicted in 2014 by a federal grand jury for conspiracy to distribute controlled substances and money laundering, along with seven other people who operated Breakthrough Pain Therapy Center in Maryville. Brickhouse died April 5, 2016, when his SUV left the ramp from Pellissippi Parkway to Interstate 40 east and struck a concrete bridge pier.

Brandy Burchell, nurse practitioner, Knoxville. Burchell had been a registered nurse in Tennessee since 2001. From 2011-2012, at two different pain clinics, a Department of Health investigation found Burchell prescribed at least 13 patients controlled substances, narcotics and other medications “in amounts and/or for durations not medically necessary, advisable or justified for a diagnosed condition” — sometimes giving them monthly prescriptions exceeding 1,000 morphine milligram equivalents a day that included “multiple” short-acting opioids combined with high amounts of benzodiazepines. She prescribed at least one patient 3,000 morphine milligram equivalents daily. When patients became addicted, the state said, she didn’t document, report or try to treat their addictions, and she also ignored signs they were selling their drugs to others. Her nurse practitioner certificate, valid since 2007, was revoked Nov. 20, 2017, and her registered nurse license was put on probation for two years.

Christina K. Collins, nurse practitioner, Knoxville. Collins’ nurse practitioner certificate, valid in Tennessee since 2007, was put on probation March 1, 2018, which barred her from practicing in a pain management clinic. The Department of Health said its investigation found Collins, who practiced in two pain clinics including one where she was supervised by Dr. Frank McNiel, overprescribed narcotics to 11 patients, in some cases a daily dose of more than 1,000 morphine milligram equivalents and a combination of multiple shortacting opioids and benzodiazepines.

But Collins’ witness, Dr. Christopher Vinsant, testified records showed each patient was being treated for a legitimate medical purpose, and the Board concurred. It cited her for not providing enough documentation, gave her two years of probation and let her keep her registered nurse license.

Dr. Robert Cochran, Nashville.

Cochran, an internist, retired voluntary in 2013 rather than admit to inappropriately prescribing controlled substances, of which the state accused him beginning in 2010. Though records show that 82 percent of Opana ER prescriptions Cochran wrote were for high-dose (20 mg or more) drugs, he denied inappropriately prescribing and was cited for failure to maintain adequate patient records. Endo acknowledged he was a high-volume provider, with reps visiting him 49 times in 2008 alone.

Dr. Allen R. Foster, Knoxville. Foster got a license to practice in Tennessee in 1999 and was an anesthesiologist but practiced pain management full-time from 2002-2007 at offices in Knoxville and Morristown. He closed the Morristown office in 2007 but continued to practice in Knoxville.

Foster’s license was temporarily restricted Dec. 24, 2010, after the Tennessee Board of Medical Examiners found he overprescribed narcotics “in amounts and for durations not medically necessary, advisable or justified for a diagnosed condition.” He didn’t order appropriate diagnostic tests and procedures, didn’t look at patients’ previous medical records, and prescribed to patients he knew were drug-seekers, the board said. The board also said Foster contributed to the death of a non-patient as a result of overprescribing narcotics to treat one of his patients’ for “back pain”; committed “gross malpractice” when performing a phenol block on a patient, leading to paralysis and nerve injury; and didn’t properly supervise two family nurse practitioners — Gwendolyn Noe and Eva Fields — who also were writing prescriptions for narcotics. Foster was one of the state’s top prescribers, especially in high doses. In 2008, Endo reps called on him at least 68 times.

Foster’s license was revoked by the board on Jan. 27, 2012, for “unprofessional, dishonorable or unethical conduct,” in addition to Foster’s being “guilty of a crime” — health-care fraud and failing to pay income tax, for which he was sentenced to 12 months and one day of prison and three years of supervised release. He was ordered to pay $736,905.07 to Medicare, TennCare and the IRS in restitution.

Brenda Friend, nurse practitioner, Bristol. Friend worked for a comprehensive pain clinic with patients referred from other doctors. The state found she didn't adequately examine or diagnosis patients, nor make a treatment plan for them, before prescribing high-dose painkillers. Her licensed was reprimanded in 2017; her practice will be monitored for five years, and the board ordered her to complete coursework on medical record-keeping and prescribing controlled substances as well as to pay $12,000 in civil penalties, plus costs up to $40,000. She moved to a practice that doesn't prescribe pain medication.

Dr. Yuchan Han, Chattanooga. The state reprimanded Han, a neurologist, in 2014 for leaving the country and leaving pre-signed blank prescription forms with his staff, though there's no evidence they were used. Han completed the terms of the discipline this year, which included attending a course on prescribing controlled drugs and five years of having the practice monitored and randomly audited. Han paid a $200 civil penalty, plus costs up to $1,000. Han was a high-volume 'A' provider for Endo and had at least 31 visits from Endo reps in 2008.

Buffy Rene Kirkland, nurse practitioner, Maryville. Kirkland became a registered nurse in 1998 and a nurse practitioner in 2004 and worked in several area pain clinics. She was reprimanded and her license suspended in 2015 after the Tennessee Board of Examiners found her guilty of “unprofessional conduct.” She voluntarily surrendered both her registered nurse license and nurse practitioner certificate on May 11, 2017, after she was found guilty of crimes related to dispensing controlled substances at Breakthrough Pain Therapy Center in Maryville. The clinic had no medical protocols, exam tables or supplies; patients weren’t given physical exams and paid cash for narcotics, and some used or sold drugs in the parking lot.

Jill Lorge, nurse practitioner, Lenior City. Like Julie Bliss, Lorge worked for American Anesthesiology on contract with Tennova Comprehensive Pain Treatment Center. The state put her license on probation in 2017 after finding she didn't have medical records to justify the amounts of controlled substances she prescribed and the length of time she prescribed them. She had to obtain continuing education on medical record- keeping and prescribing controlled drugs and pay a $2,000 civil penalty, plus costs up to $12,000.

Dr. Frank McNiel, Knoxville. The Board of Medical Examiners disciplined McNiel, licensed as a general practitioner in Tennessee since 1985, for inappropriately prescribing narcotics in 1994, but he and his wife — family practitioner Dr. Janet McNiel, also disciplined at the same time — appealed the action and, in 1997, both won. At the time, they co-owned the pain management clinic Bearden Healthcare Associates, where Frank McNiel supervised several nurse practitioners and where Janet McNiel still works. Endo called on McNiel and his associates 110 times in 2008. He was a sales target because he was such a high-volume prescriber, and 90% of his prescriptions were for Oxycontin. Between 2006-2016, he wrote 15,196 prescriptions for Oxycontin.

On March 20, 2018, Frank McNiel voluntarily surrendered his license. The board, after reviewing patient records back to 2002, had disciplined him for inappropriately prescribing controlled substances, including writing prescriptions for patients out of his East Knoxville home after retiring from Bearden Healthcare Associates in 2012. McNiel said in an interview with the News Sentinel that he did not believe he acted inappropriately but had decided not to fight.

Janet McNiel, according to state records, is supervising physician for four nurse practitioners and two physician assistants as part of her practice.

Dr. Abdelrahman Hassabu Mohamed, Knoxville and Morristown. Licensed to practice in Tennessee since 1999, a neurologist with a specialty in pediatrics, Mohamed treated multiple patients from Jan. 2, 2012 to Sept. 26, 2016, at his pain management practice, Hamblen Neuroscience Center in Morristown. From 2006-2011, he was one of Tennessee’s top prescribers of OxyContin.

On Sept. 11, 2017, he pleaded guilty in the United States District Court for the Eastern District of Tennessee at Greeneville for one count of conspiracy to commit health care fraud and 10 counts of aiding or abetting the commission of health care fraud — all felonies. On Jan. 24, 2018, Mohamed voluntarily and permanently surrendered his medical license, but state records show no formal Department of Health action against him before then.

Teodora Neagu, nurse practitioner, Knoxville. The Tennessee Board of Nursing found Neagu guilty of overprescribing narcotics and placed her nurse practitioner certificate, valid since 2007, on probation Nov. 11, 2017. From 2008-March 2013, Neagu practiced at pain management clinic Bearden Healthcare Associates, supervised by Dr. Frank McNiel, who state records show “informed (her) that higher doses of opioids generally led to a greater degree of functionality and quality of life. Thereafter, (Neagu) prescribed controlled substances in adherence to Dr. McNiel’s philosophy.” The board found the prescribing itself, though, wasn’t medically justified and was “nontherapeutic.” Neagu cooperated with the state department of health “in gathering facts regarding other practitioners” at Bearden Healthcare Associates and was given five years of probation.

Dr. Samson Orusa, Clarksville. The state has restricted internist Orusa's license, and last year the federal government indicted him for 22 counts of unlawful distribution of a controlled substance outside the boundaries of professional medical practice; 13 counts of health-care fraud; and nine counts of money laundering. An Endo 'Grade A' prescriber, the state's complaints allege he wrote prescriptions for 50-60 patients a day.

Marjorie Pickel, nurse practitioner, Lenoir City. Pickel also worked for American Anesthesiology contracting with Tennova Comprehensive Pain Treatment Center and, according to the state, failed to justify in writing the amounts of controlled substances she prescribed and the length of time she prescribed them. Pickel's license is on probation as she obtains continuing education on medical record-keeping and prescribing controlled drugs. She was assessed a $2,250 civil penalty, plus costs up to $10,000, and ordered to reduce the amount of controlled substances she prescribed.

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