A consultant who reviewed the prescribing practices of a physician at a Lexington pain clinic reported to the state medical board that the physician's alleged actions constituted "unethical and criminal behavior."
Jeffrey W. Berg, a pain management physician in Louisville, reviewed records of patients treated by Dr. Najam Azmat, who prescribed drugs at Lexington Algiatry on Alexandria Drive. On Wednesday, Drug Enforcement Administration agents raided the clinic, which once conducted business on North Broadway.
Berg said in a Feb. 1 report to the Kentucky Board of Medical Licensure that after meeting with specific patients, Azmat knew or should have known that the medications "would likely be used illegally."
The report, in which Berg details his review of 21 cases, provides more insight into the board's emergency suspension of Azmat's license on Thursday.
"The people of Kentucky are safer today without him handing out pain medicine without regard to ... how they were being used," Berg said in an interview Friday. "This is what Gov. Beshear and the citizens of Kentucky need to be concerned about."
Gov. Steve Beshear has pledged to crack down on what police call "pill mills" — offices where doctors give people prescriptions for powerful painkillers with cursory examinations.
The medical board has been investigating Azmat since at least May 2011 after receiving reports about suspected inappropriate prescriptions of controlled substances, according to its order of suspension.
Azmat's attorney, Fox DeMoisey, said Thursday that Azmat "intends to defend the matter vigorously."
Berg said in his report that a significant number of patients at the clinic were unemployed. The fee for an office visit was $250.
"In order for a patient to be able to pay hundreds of dollars each month for expensive office visits and medications, the majority of the patients would have to be diverting their drugs to afford the cost," the report said.
Berg's report said Azmat's practice does not accept any health insurance and accepts only "cash or cash equivalents."
He said the $250 fee for an office visit was "outside the norm."
"A cash-only pain management clinic is a 'red flag' that the facility is not legitimate," the consultant's report said.
The report highlights other problems.
Berg said that all 21 patients whose records he reviewed had previously obtained medications "from out of state pill mills located in Florida, Georgia and Ohio."
Berg said a "pill mill," by definition, "implies that patients seeking services from those facilities intentionally do so for the purposes of obtaining controlled substances to use illegally."
"For Dr. Azmat to continue to prescribe to the same patients for the same purposes constitutes unethical and criminal behavior," the report said.
In one case in Berg's report, a 33-year-old man complaining of back, leg and pelvic pain had previously received pain medications at a clinic in Florida. The patient had been incarcerated. He refused surgery and other treatments. He said he was taking high doses of oxycodone. The report said Azmat continued to prescribe oxycodone, and the patient got monthly refills through October.
Berg's report said the prescription was unacceptable for that patient, that the patient's questionable behaviors were not explored and that no other treatment options were explored.
In another case, a 28-year-old woman with complaints of back and leg pain who had previously obtained pain medications in Miami went to Azmat in April. She tested positive for cocaine and other illegal drugs but was given 30 milligrams of oxycodone, the report said.
The report said Azmat prescribed amounts of medications that were excessive under accepted medical practices, and he prescribed all 21 patients oxycodone in its most abusable form in either 30 mg or 15 mg doses "or at times both."
The report, which did not identify the patients by name, said that well-trained and qualified physicians have policies that help identify and prevent fraud and abuse.
But Berg said, "Dr. Azmat's standard operating procedures, including the advertising, maximize the opportunity for fraud, abuse and diversion" of controlled substances."
Azmat had no training in the specialty of pain management or primary care, Berg said. Berg also found that Azmat's "procedures for validating MRI reports and other medical records lack the credibility necessary to make real medical decisions."
Urine drug screens are intended to be random and are part of the proper management for patients requiring opioid medications, the report said. Azmat's clinic notified patients they were going to have a urine drug screen, and if they failed were allowed to come back later for a retest.
The report said Azmat made no attempt to diagnose the patients source of pain.
In addition to Berg's findings, the board's order said an official with the Cabinet for Health and Family Services' Office of Inspector General found in the charts examples of young patients on high doses of narcotic analgesics, patients traveling long distances to obtain medications and members of the same family receiving the same or similar prescriptions.
The order said that Azmat's license is suspended until a complaint filed by the board is resolved. A hearing on the complaint is set for June 26.