A Lexington doctor who got his Kentucky medical license back after giving it up when the state accused him of overprescribing pain medication has had his practice restricted after recent allegations of similar issues.
Dr. James Heaphy, who specializes in internal medicine, entered into an agreement with the Kentucky Board of Medical Licensure last month that prohibits him from prescribing controlled substances.
A board consultant issued an opinion that Heaphy's "pattern of narcotic and benzodiazepine prescribing deviates grossly from acceptable standard of care and poses a serious threat to the health of his patients and his community."
Under the agreement Heaphy reached with the board, he is prohibited from prescribing controlled substances and is to undergo an assessment of his clinical skills in pain management.
Heaphy could not be reached for comment. His attorney, Brian Good of Louisville, was out of the country and said in an email that he was "not in a position to comment at this time."
Heaphy practiced at CGG Internal Medicine and Fresh Look in the Eagle Creek Medical Plaza next to St. Joseph East. The practice's owner, Jane Winterton, said Heaphy no longer was working there because of the restrictions on his license.
"It's important to me that we keep a high standard of care. ... Your integrity as a practice cannot be questioned," she said.
Winterton said she couldn't say much about Heaphy's circumstances but said he was "well-liked by all the patients. He's a nice guy."
She thought the medical board's scrutiny of Heaphy was more a result of past problems than red flags in his current prescribing practices.
"There are so many physicians under scrutiny. His past does not help him at all," she said.
In 2008, the board temporarily suspended Heaphy's medical license. The next year, Heaphy agreed to surrender his license to practice in Kentucky after admitting he had falsified certificates he gave the board, claiming to have attended continuing medical education classes he did not attend.
While Heaphy denied "any unprofessional or illegal conduct," the 2009 board documents stated, he had been accused of falsifying patient records, providing early refills on painkillers, failing to adequately screen patients, allowing patients long-term use of drugs normally prescribed for short-term use and providing patients with dangerous combinations of drugs.
In January 2011, the state agreed to reinstate Heaphy's license, although he was subject to certain conditions, including requirements that he maintain a log of controlled substances he prescribed and that his practice be subject to periodic reviews by a consultant hired by the state.
In February, a board consultant reviewed 16 of Heaphy's patients' charts, as well as a KASPER report of his prescribing through October 26.
The consultant reported that the charts "paint a clear picture of reckless, medically irresponsible prescribing of controlled substances, both in dose, frequency and chronicity."
"A typical patient" received Valium or Xanax along with Lortab, according to the consultant. Most of the patients reported chronic back pain, the consultant reported.
"Some of them have little evidence of significant disease on their MRIs that would suggest a need for high dose chronic narcotics," the report stated. "... Virtually no effort is made by Dr. Heaphy in weaning these addictive pain medications."
The board documents say Heaphy argued in response that he had been managing the 16 patients' cases only since June 1, 2011, that he treated all except one of them for pain only and that he was not their primary care doctor.
Heaphy also had an independent consultant review three patient charts, which the board's consultant said were representative of all the charts that had been reviewed. That consultant said Heaphy's prescribing pattern "did not depart from the boundaries of acceptable practice and was consistent with the current Kentucky guidelines."
In April, a Board of Medical Licensure panel met and found "probable cause to believe" that Heaphy's "prescribing of controlled substances constitutes a danger to the health, welfare and safety of his patients or the general public."
Under the agreement Heaphy reached with the board, he is to undergo an assessment of his clinical skills in pain management with a Denver organization called CPEP, or Colorado Personalized Education for Physicians. The board panel won't consider a request to restore Heaphy's prescribing privileges until it gets a copy of CPEP's assessment report and an educational plan if it recommends one for Heaphy. He must repay the $1,500 it cost the board to investigate him.
Winterton said she thought the medical board was giving Heaphy a benefit by allowing him to take CPEP training rather than suspending his license again.
CGG Internal Medicine and Fresh Look provides anti-aging treatments as well as medical services. Winterton said Heaphy revealed little about how he chose to treat patients on the medical side. The clinic's clients include cancer and cardiac patients, and people with chronic diseases such as high-blood pressure.
"In consequence, you have people who have associated pain," she said.
Winterton is the daughter of longtime Lexington doctor Charles G. Grigsby, who was censured by the Board of Medical Licensure for overprescribing pain medication in 2008, a week before Heaphy's initial emergency suspension. When Grigsby died last year, he was on a probationary period after the board lifted restrictions on his license.
Winterton said her father got into trouble because he saw patients that other doctors turned away.
In a 2008 interview, Grigsby said he tried to verify patients' complaints of pain with MRIs or X-rays.
"What are you going to do?" he said at the time. "If a patient comes in suffering, are you going to run the risk that he really has the pain and make him walk out the door?"
He maintained that the medical board was being overly aggressive, making doctors afraid to prescribe narcotics for pain.
"What happened to my father is similar to what is happening to Dr. Heaphy now," Winterton said.
She said there is a disparity between how doctors are taught to prescribe pain medicines now versus decades ago, when her father and Heaphy studied medicine.
Prescribing "opioids at one point was accepted as a treatment," she said. "You have a population of patients and a population of doctors who are now trying to catch up to the new way of thinking."