Medical board moves slowly against addicted doctors

BY DAVID WENNER – Of The Patriot-News.

Dr. Jennifer Zampogna showed many signs of having a drug addiction that could endanger patients.

Pharmacists noticed. Her staff noticed. So did the state attorney general’s office, local police and federal authorities.

Yet the Pennsylvania Board of Medicine, which is supposed to protect the public from addicted doctors, didn’t act decisively until after Zampogna had been investigated for seven months and arrested.

The board’s response raises many questions.

How can a doctor display so many red flags and come under such investigation, yet be allowed to continue treating patients and doing surgery?

Are patients adequately protected from addicted doctors who don’t get arrested?

The medical board eventually suspended Zampogna’s license to practice medicine. But only after the police investigation that led to her arrest.

From the beginning, there were signs Zampogna might be jeopardizing her career to obtain one of the most widely abused drugs. Yet no one stopped her from treating patients and performing surgery at her practice, Advanced Dermatology and Skin Care in Lower Allen Twp.

Near the end of the investigation, staff members were telling investigators she had been unreliable for months. They described two incidents in which surgeries that normally took four hours lasted 12 hours because Zampogna “had a hard time getting herself together to the point she could finish the surgery,” an investigator’s report stated.

They told of a patient who returned with part of her nose hanging free because Zampogna had missed a stitch.

Zampogna is among three local doctors recently arrested on charges that, according to police reports, stem from addiction to hydrocodone, a pain-killer with a growing reputation for abuse among white-collar professionals.

The others — Dr. Richard L. Davis, a family physician in Hampden Twp., and Dr. Adam C. Abram, an ear, nose and throat specialist in Hampden Twp. — also drew police attention but no action from the medical board prior to arrest.

State investigations

The medical board is one of 27 licensing boards within the Pennsylvania Department of State. Seventy-one investigators, working for the state department, look into complaints involving licensed professionals, including doctors who might be unfit or unsafe.

With doctors, the results are presented to the medical board, which is composed mostly of doctors, and who decide what to do about the situation.

Basil Merenda, who oversees Pennsylvania’s licensing boards, said the process is “complaint-driven,” meaning it depends on reports from people who know of an addicted doctor.

“I think the statistics bear out that it is working fairly well. I have no evidence the system is breaking down in any shape or form. Once we are aware of a situation, our prosecutors and investigators swing into action and they are effective,” he said.

State department staffers said the attorney general’s office didn’t provide sufficient information about Zampogna until right before her arrest.

But Kevin Harley, a spokesman for the attorney general’s office, said that’s not true. He said the attorney general’s office informed the state department in fall 2006 it was investigating Zampogna for matters including “diverting” drugs. It was an “informal call,” conveying that “we were concerned she was self-medicating and continuing to treat patients.”

Harley also said it’s the job of the state department and medical board — not the attorney general — to protect patients from doctors who might be unsafe.

Diverting drugs, which can involve using presciption drugs for recreational purposes, is often a sign of an addicted doctor, addiction experts said. When licensed medical professionals know of a doctor who is diverting drugs, they are supposed to notify the medical board.

However, Andrew Demarest, a prosecuting attorney for the state department, said that merely knowing a doctor is diverting drugs falls far short of the “clear and immediate threat to the public health” that must be proven before the medical board will temporarily suspend a doctor’s license in Pennsylvania.

When there is sufficient evidence, it must be presented to a medical board committee composed of three doctors. A written report is forwarded to the committee in advance. Then a committee meeting must be scheduled.

Often, the issue is put off until the medical board’s monthly meeting. As a result, days and weeks can pass before the license is suspended of a doctor who poses a threat, Demarest said.

The attorney general’s office began investigating Zampogna after it was contacted by a pharmacist about suspicious prescriptions.

Cliff Rieders, a personal-injury lawyer and member of Pennsylvania’s Patient Safety Authority, argued that the medical board falls far short of finding out about the majority of impaired doctors.

Depending on people who work around addicted doctors to report them isn’t enough, because most workers would be afraid, he said. Rieders said the medical board should be more aggressive in looking for signs of addicted doctors.

Admitting addiction

Jennifer Zampogna, 35, was not willing to be interviewed for this story. She has admitted being addicted to hydrocodone and completed three months of inpatient treatment, said her attorney, William Fetterhoff.

Zampogna faces felony charges of illegally obtaining prescription drugs. She would lose her Pennsylvania license for 10 years if convicted of a felony. But Fetterhoff, who views Zampogna’s addiction as a disease that is being treated, said it would be grossly unfair to interrupt her career that long.

He hopes she can plead guilty to a nonfelony and eventually convince the medical board she is fit to practice. Fetterhoff acknowledged he never visited Zampogna at work or spoke to her staff or patients. But he said he was unaware of any patients who were harmed and that Zampogna never showed signs of impairment at his office.

“She was a very good doctor, by all reports,” he said.

The attorney general’s office began investigating her in October 2006. By November 2006, the U.S. Drug Enforcement Administration was bearing down on Zampogna, and she surrendered her drug-prescribing credentials.

DEA spokesman Garrison Courtney said he cannot discuss details of the case. Generally, he said, the DEA often learns of violations from pharmacists. They have an incentive because they are subject to audits and can lose their licenses for dispensing drugs for illegal purposes, he said.

“A lot of times they’ll call us and say, ‘This doesn’t seem normal,’ and that typically will lead to an investigation,” Courtney said.

Doctors confronted by the DEA often “surrender” their license to prescribe drugs, as did Zampogna, to avoid having it suspended, he said. If a doctor voluntarily surrenders a license, it’s easier to get it back, Courtney said.

Courtney said the DEA typically notifies state medical boards after suspending a prescribing license, but he couldn’t confirm that the agency did so with Zampogna.

In February, Upper Allen Twp. police became involved after a pharmacist contacted them about suspicious prescriptions. It’s unclear if the township notified the board of medicine.

The state department, which does the investigations for the medical board, became involved on March 23, 2007. It had learned Zampogna allegedly was using the drug-prescribing credentials of her physician assistants, without their knowledge, to write prescriptions for hydrocodone.

State department prosecutors said that’s not evidence of a clear and immediate danger. They also said the state department investigator, at that point, found no signs patients were being affected.

A May 18 search warrant obtained by the attorney general’s office prompted a state department investigator to interview members of Zampogna’s staff. The interviews took place more than two weeks later, on June 5. Three staff members said Zampogna was unfit to practice.

Public Citizen, a consumer advocacy group, argued that state medical boards often do a poor job of identifying and disciplining doctors who pose safety threats. Pennsylvania has long been among the worst, it said.

In a ranking of state medical boards published last year, Public Citizen ranked Pennsylvania 36th out of 51 states and the District of Columbia. That’s up from 45th in the previous rankings.

The rankings are based on the number of serious disciplinary actions taken by each state board.

During her time in the House, state Sen. Pat Vance, R-Cumberland County, was on the committee that oversees the medical board. “I don’t think the medical board ever moves real quickly,” Vance said, adding she had the same complaint about many of the professional licensing boards.

However, Vance said it’s unreasonable to expect the board to know about a doctor’s substance abuse in the absence of an arrest or major incident. When told a state investigator had known March 23 of possible fraudulent prescriptions from Zampogna, she said that should “light up a bulb.”

Are patients protected?

Dr. Mark Piasio, the president of the Pennsylvania Medical Society, defends Pennsylvania’s track record for dealing with drug- and alcohol-impaired doctors.

The medical board can suspend or take away the license of a substance-abusing doctor. It can force the doctor into treatment, then require years of monitoring.

Also, an organization affiliated with the medical society runs a program for addicted doctors. It can reach out to doctors who have been referred by someone who thinks they might be addicted.

Doctors can enter voluntarily. It involves random drug testing and monitoring, including a workplace monitor.

“I think it’s worse than being on parole. You have an awful lot of meetings and monitoring and testing to be done once you are in that program,” Piasio said.

He said the system isn’t perfect and can’t detect every impaired doctor. But he doesn’t see how it could do better without infringing on doctors’ personal rights.

In interviews, many backers of the system touted its ability to help addicted doctors but offered little about the rights of patients.

They did say that enabling doctors to obtain help without destroying their careers makes it more likely doctors will address, not hide, an addiction. As a result, the public is safer.

A conservative estimate is that about 7 percent of doctors are addicted to drugs or alcohol. Pennsylvania, with about 35,800 licensed doctors, would have at least 2,500 addicted doctors.

In 2006, the medical board disciplined six doctors for situations involving addiction. It’s monitoring about 73 doctors dealing with substance abuse, with 24 more waiting to enter the program.

The treatment program affiliated with the medical society has a total case load of about 350 doctors, including those who entered voluntarily, without crossing paths with the medical board.

When people contact the state department about an addicted doctor, they must make a written report and give their name, although their identity is protected.

If a doctor denies the addiction, it can be hard for the board to take action, said Kevin Knipe, who oversees the state’s monitoring of addicted doctors.

Other legal obstacles can prevent the medical board from seeing all the red flags surrounding a doctor under investigation by criminal authorities, staffers said.

A law, the Criminal History Records Information Act, prevents law-enforcement agencies, such as the attorney general’s office, from sharing full details of investigations with agencies such as the medical board.

State department officials want the law amended to allow sharing of investigative files, said Peter Marks, the state department’s executive deputy chief counsel.

They also support a bill that would allow fines of up to $10,000 against licensed professionals, and licensed professionals close to a situation, who don’t cooperate with investigators.

11/10/07 10:23 PM EST, UPDATED: 11/12/07 2:38 PM EST