Following a complaint filed last year, Hermiston Dr. Bruce Carlson of the Urgent Care Clinic will no longer be able to treat patients with opioids for chronic pain unless they suffer from terminal illnesses. His clinic is still running, and he doesn’t plan to stop providing care anytime soon.
Carlson was placed on probation by the Oregon Medical Board in July, following a complaint that alleged he prescribed controlled substances without medical purpose or without following proper procedures.
“I love taking care of people, I’ve been taking care of people for 45 years,” Carlson said. “We’re short of help in this area.”
Carlson said he is complying with the stipulated order, which issued a stayed revocation of his license and includes a $5,000 penalty, a five-year probation period and compliance to an educational plan.
He will also have to taper his existing patients off higher dose levels of opioids, and completely off benzodiazepines or else direct them to other physicians. He won’t be able treat any new chronic pain patients with opioids.
If Carlson completes the probationary period successfully, his license will not be revoked.
He said that he felt the medical board’s language in the complaint to be heightened, and that it reads worse than it is.
“Anytime we get an education, it always makes us better,” he said.
According to the Oregon Medical Board, Carlson allowed a physician assistant— whom he hired in 2014 — to continue issuing prescriptions for Schedule II narcotics even though she failed her national recertification test. The complaint states that Carlson signed blank prescription forms, which the assistant then filled in his absence.
“I don’t want abnormal prescriptions with my name on them, going out,” he said. “Once we became aware that was a no-no, we stopped doing that.”
Carlson explained that when his physicians assistant failed recertification, he believed she was still eligible to prescribe Schedule III through V drugs, as mandated by the board. He thought Vicodin, which he said she was prescribing, was still a Schedule III drug at the time. It was later reclassified as a Schedule II drug.
The complaint also lists several incidents in which Carlson reportedly prescribed excessive amounts of opioids to patients without medical justification. Some patients were prescribed daily doses of pain medication that had a morphine equivalent dose of 120.
The Center for Disease Control stated that doctors should avoid increasing dosages past 90 without careful justification.
Carlson said he disagrees with the board’s findings that he prescribed without justification.
“Everybody that was prescribed pain medicine complained of pain,” he said. “I wasn’t handing out pain medicine like candy.”
The board also stated that some patient drug tests showed an absence of the prescribed medications. One patient tested positive for methamphetamine. Carlson allegedly didn’t take any action.
“I have to be trusting, and sometimes that gets me into trouble,” he said.
Carlson noted he’d heard new reports of people selling their medication for other pain medications, and that he felt that may have been the case in the past.
The board stated that with another patient, Carlson continued to prescribe oxycodone and gabapentin to a patient for six months without an office visit, and prescribed an additional medication which posed a risk to the patient’s health due to a higher body mass index.
Carlson insisted all of his pain patients have monthly appointments.
Carlson said he sees 2,000 Oregon Health Plan patients, and since pain was introduced as a fifth vital sign in 2001, opioid prescriptions have increased.
“I have more OHP patients than any other doctor in the county,” he said. “A lot of (patients) aren’t working and they have conditions where they can’t work. A high percentage are on pain medications.”