The medical director of a pain clinic in Derby was reprimanded and fined $7,500 on Tuesday by the state Medical Examining Board for writing prescriptions for patients based on assessments of their appearance or behavior conducted by unlicensed medical assistants.
Dr. Mark Thimineur, medical director of the privately run Comprehensive Pain & Headache Treatment Centers, LLC, housed at Griffin Hospital, signed a consent order on June 1 agreeing to the punishment. In the order, he did not contest the findings by the board and the state Department of Public Health.
The consent order states that from 2011 to the present, Thimineur failed to meet the standard of care when treating one or more patients for chronic pain. It said he wrote prescriptions for patients based on assessments by unlicensed medical assistants of the patients’ physical appearance, behavior, pain levels or lab test results.
David Tilles, a DPH staff attorney, told the board that the health department is satisfied that Thimineur has made changes at the clinic and halted such use of the medical assistants.
Last week, C-HIT reported that Thimineur and Heather Alfonso, a nurse practitioner at the center, were among the top high-volume Medicare prescribers of Schedule II narcotic drugs in Connecticut in 2013, accounting for $9 million of the $40 million spent by Medicare on such drugs. The controlled substances, including opioids such as OxyContin, have a high potential for addiction and abuse.
Alfonso’s prescribing habits attracted scrutiny earlier this year, when a probe by the Drug Control Division of the Department of Consumer Protection led her to surrender her state and federal licenses to prescribe controlled substances.
William Gerrish, DPH’s spokesman, said Tuesday that the health department has an ongoing investigation into Alfonso’s advanced practice registered nurse (APRN) license. A person who answered the phone at the clinic last week said Alfonso no longer worked there.
In a related case in June 2014, Alfonso was fined $2,000 by the Board of Examiners of Nursing for failing to personally examine patients and relying on the assessments of an unlicensed medical assistant while authorizing renewals of opioids.
DPH records show the agency launched its investigation of Thimineur in April 2013 when it was investigating a separate complaint against the center’s APRN, who Gerrish confirmed was Alfonso.
Thimineur was the third-highest Medicare Schedule II drug prescriber among pain medicine specialists in the state in 2012, a February story by C-HIT disclosed, based on Medicare data. The recently released 2013 data shows he was the 10th highest prescriber statewide, with the sixth-highest billing to Medicare for the potent narcotic drugs.
In an unrelated case Tuesday, the board reprimanded and fined a Norwalk sports medicine doctor $3,000 for grabbing the face of a patient at Milford Hospital and telling the patient to “snap out of it,” records show.
The board also placed the medical license of Dr. Stuart Steinman, who is employed by WestSports Medicine in Norwalk, on probation for six months so that he can complete coursework in professional ethics and the management of patients with behavioral health problems. Steinman has already completed a course in anger management, medical board records show.
DPH began an investigation in October when it received a report from Milford Hospital about Steinman’s inappropriate conduct while treating a patient in August who was in police custody in the emergency department, board records show.
The patient was requesting medication for withdrawal symptoms when Steinman grabbed the patient’s face, said the patient would only receive Tylenol and told the person to “snap out of it,’’ records show.
The hospital said Steinman was asked to leave the hospital and not return to work pending an investigation. Steinman voluntarily resigned and the hospital submitted a corrective action plan, which was approved by DPH.
By signing a consent order with the medical board on April 25, Steinman agreed to the punishment and did not dispute DPH’s findings.
In other business Tuesday, the board reprimanded and fined Dr. Kenneth Abriola of Darien $2,500 for permitting unlicensed medical assistants to provide medication injections to patients in 2013 and 2014, medical board records show.
DPH launched its investigation into Abriola, whose internal medicine practice is in Glastonbury, when two former medical assistants contacted DPH to say that Abriola had permitted or directed medical assistants to give the injections, records show.
On May 6, Abriola signed a consent order agreeing to the fine and reprimand and agreeing not to contest the findings.
His attorney, David Haught, said Abriola was not aware of the regulation that barred medical assistants from giving injections. He changed his practice as soon as he found out about it, Haught said.
“He had no knowledge that medical assistants could not do that,’’ Haught said. “It wasn’t clandestine at all. He’s one of the good guys.”
