Walker v. Louisiana State Board of Medical Examiners

638 So. 2d 350, 1994 La. App. LEXIS 1580, 1994 WL 220042
CourtLouisiana Court of Appeal
DecidedMay 26, 1994
DocketNo. 94-CA-0040
StatusPublished
Cited by2 cases

This text of 638 So. 2d 350 (Walker v. Louisiana State Board of Medical Examiners) is published on Counsel Stack Legal Research, covering Louisiana Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Walker v. Louisiana State Board of Medical Examiners, 638 So. 2d 350, 1994 La. App. LEXIS 1580, 1994 WL 220042 (La. Ct. App. 1994).

Opinion

JIJONES, Judge.

Dr. Herman E. Walker, Jr. (Dr. Walker) appeals the trial court’s judgment affirming the decision by the Louisiana State Board of Medical Examiners (the board) to suspend his medical license for a term of five years; or, in the alternative, Dr. Walker could be reinstated after six months, but he would remain on probation for the duration of the five year period and pay a fine of $5,000.00 to the Board, as well as other penalties not [351]*351pertinent to this appeal. We affirm the trial court’s judgment.

By Administrative Complaint filed January 19, 1989, Dr. Walker was charged with violations of the Louisiana Medical Malpractice Act. An administrative hearing was held before a panel of the Board in which attorneys from the law firm of Adams and Reese served as prosecutors and Dr. Walker was represented by counsel. In its decision written pursuant to the hearing the Board found:

... The evidence presented in this case relates to Dr. Walker’s treatment and prescription of controlled substances to some 53 patients, 52 of whom the physician ^purportedly treated for obesity, or weight control. In every one of such 52 cases, as appetite suppressants, Respondent prescribed one or more amphetamine or sym-pathomimetic amine controlled substances, including Biphetamine (amphetamine), Didrex (benzphetamine hydrochloride), Fas-tin (phentermine hydrochloride), Ionamin (phentermine resin), Melfiat (phendimetra-zine tartrate), and Tenuate Dospan (die-thylpropion hydrochloride).

The Board went on to find that when used as appetite suppressants these drugs are known as “anorectics”. In the management of obesity, drugs of this class are indicated and approved for short-term use only adjunc-tive with a weight reduction regimen based on caloric restriction. The Board also found that these drugs are “explicitly contraindicated for use in patients with advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism, known hypersensitivity or idiosyncrasy to such substances, and glaucoma, as well as for patients with a known history of drug abuse”.

Furthermore, the Board found the clinical efficacy of these drugs has been seriously questioned. “[I]t has long been the consensus of medical authority that such drugs should be used with extreme caution, weighing their limited usefulness against the substantial risks inherent in their use, and administered only to obesity patients who have proven refractory to other forms of therapy, and then at the lowest effect dosage for relatively short period”. Consistent with this thinking and many former cases treating promiscuous prescription of anorectics the Board promulgated a formal statement concerning the prescription of anorectics which was distributed to all physicians licensed to practice medicine in Louisiana.

Reviewing prescriptions filled by pharmacies between September 1987 and September 1988 and Dr. Walker-’s own records, the Board found that in a number of instances Dr. Walker initiated or continued the prescription of | ;¡anorectics “in the absence of documented consistent weight loss and, indeed in the face of erratic weight changes and even gains in weight”. The Board found that Dr. Walker prescribed anorectics “in the face of conditions in the presence of which anorectics are explicitly contraindicated and dangerous”. The Board went on to find that he “prescribed other controlled substances for extended periods without articulable medical justification and against authoritative medical advice to the contrary. And (sic) he has undertaken and maintained such drug therapies largely without recordation of patient medical histories and physical examination.” The Board concluded:

- Dr. Walker, substituting prolonged medication regiments and polypharmacolo-gy for sound medical treatment, repeatedly and consistently prescribed legally controlled, dependency-inducing substances without legitimate medical justification therefor. We further find that such practices clearly and convincingly demonstrate medical incompetency on the physician’s part and continuing and recurring medical practice which fails to satisfy the prevailing and usually accepted standards of medical practice in this state.

Dr. Walker appealed the Board’s decision to the trial court. The trial court ordered an evidentiary/contradictory hearing limited to the issue of whether the statutory and due process rights of Dr. Walker were violated. Pursuant to that hearing the trial court issued its judgment finding that:

... Dr. Walker was afforded a fair and impartial hearing before a panel of Board members who heard the evidence, including that presented by Dr. Walker, and reached detailed findings of fact and eon-[352]*352elusions of law, ultimately organized into a final document with the assistance of an independent attorney, who had no involvement whatsoever in the investigation or prosecution of the case.

Dr. Walker appeals the trial court’s judgment.

As part of its findings, the Board concluded that there .was no credible medical evidence indicating that anorectics could be useful or effective in the treatment of obesity beyond a period of twelve weeks administration. By his Ufirst assignment of error, Dr. Walker argues that the “twelve week rule” was not properly promulgated in the Louisiana Register in that it was publicized only on one occasion in the Louisiana State Medical Journal.

The Board argues that a suggestion that Dr. Walker did not know of the limitations on the proper and lawful use of a controlled substance is tantamount to a confession of medical incompetence. The Board introduced a formal statement concerning the prescription of anorectics which was distributed to all physicians licensed to practice medicine in Louisiana. Furthermore, the Board’s decision was not predicated on Dr. Walker’s having violated the Statement on Anorectics. In fact, specific rules advising physicians of the dangers of excessive use of drugs is not a prerequisite to the Board’s finding of incompetency.

Specifically, Dr. Walker was found to have prescribed amphetamines and related stimulants to patients not for twelve weeks, but in excess of two (2) years. Dr. Walker did not cite any authoritative source which indicated that amphetamines and anorectics could be used for periods greater than twelve weeks. He relied on an article by Dr. Friedman in Post-graduate Medicine (May 1988) which suggests that long-time use of appetite suppressants are less dangerous than antihyper-tensives or other medications commonly prescribed to the obese. Furthermore the long-term use of these drugs was but one finding of incompetency by the Board. Dr. Walker defended his prescription of these drugs when their use was contraindicated by reasoning that there are eases in which a patient with heart disease could use amphetamines if being overweight is a greater risk. The Board was adamant in its view that this was a breach of professional standards. The record contains comments which also support the Board’s findings of incompetency including a paucity of physical | .^examinations on the patient’s charts. We find that the Board’s decision is supported by the record.

By his second assignment of error, Dr. Walker argues that the Board’s discipline of him is arbitrary in that there is no evidence that any of his patients were harmed by his prescription of medication.

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638 So. 2d 350, 1994 La. App. LEXIS 1580, 1994 WL 220042, Counsel Stack Legal Research, https://law.counselstack.com/opinion/walker-v-louisiana-state-board-of-medical-examiners-lactapp-1994.