The Arizona Medical Board has suspended the medical license of a Tucson doctor, saying he inappropriately prescribed opioids to patients.
Dr. David A. Ruben, who has a history of discipline problems with the board over prescribing practices, “is currently on a summary restriction status and is prohibited from practicing medicine at this time,” Arizona Medical Board executive director Patricia McSorley wrote in an email last week.
Ruben is still entitled to a hearing to defend himself against the suspension and a hearing has not yet occurred, she said.
The board, which licenses Arizona physicians, has in the past found that Ruben prescribed opioid painkillers to people who may not have needed them, that he prescribed inappropriate dosages, and that he put patients at risk for addiction.
Ruben, who is a 1974 graduate of the University of Arizona College of Medicine, says his patients are in pain and need his help, and that the board’s actions are unwarranted.
“All the patients I prescribed for were on low doses and helped by their treatment,” he told the Star. “None of them complained or were in any danger of harm.”
Ruben, who specializes in psychiatry for adults and adolescents, and in addiction and pain medicine, works out of Healthcare Southwest at 2016 S. Fourth Ave., in South Tucson.
The U.S. Centers for Disease Control and Prevention last year issued guidelines telling physicians to avoid prescribing opioids to patients for chronic pain because of the high risk for harmful addiction. The exception is for patients in active cancer treatment, palliative care and end-of-life care, CDC officials say.
PERCOCET AND NORCO
The board’s April 6 report, recently made public, says that Ruben wrote 25 prescriptions for Schedule II controlled substances to 11 different patients between Sept. 19, 2016, and March 16, 2017. The prescriptions included Percocet, Norco and one prescription for Oxycodone, board records show.
During that time, Ruben was under a two-year prescribing censure that began Feb. 14, 2016. The censure prohibited Ruben from prescribing Schedule II controlled substances, records say.
Schedule II substances have a high potential for abuse, which may lead to severe psychological or physical dependence, the U.S. Drug Enforcement Administration (DEA) says.
Examples of Schedule II substances include Dilaudid, Demerol, OxyContin Percocet, and fentanyl. Other Schedule II drugs include morphine, opium, codeine, and hydrocodone.
Ruben self-reported the Oxycodone prescription on March 1, and said it was prescribed in error.
During a March 24 interview, board investigators say Ruben told them he was unaware Percocet and Norco (acetaminophen and hydrocodone) were classified as Schedule II drugs, the records say.
The medical board decided that lacking awareness about the schedule on drugs as defined by the United States Controlled Substances Act, “points to a significant gap in knowledge.” Their vote to suspend him was unanimous.
“The board member noted that these medications are highly controlled by the DEA and that these are dangerous medications that need to be prescribed by a physician with current knowledge,” the board’s order says.
Arizona Medical Board records show Ruben had been previously disciplined for his prescribing practices, dating back to 2009 when he received a letter of reprimand and a period of probation after the board found he could have perpetuated a female patient’s drug addiction.
In that case, Ruben completed continuing medical education in pain management.
Then in 2010, Ruben was barred from prescribing certain medications after the state medical board found that he failed to show why several of his patients needed prescriptions.
The board’s censure in 2016 came after a yearlong process that included an eight-day hearing before the Office of Administrative Hearings, an independent state agency.
The censure stemmed from accusations that Ruben had inappropriately prescribed painkillers to patients.
Among other things, multiple pharmacies had complained about prescriptions for controlled substances Ruben wrote for seven patients, board documents show.
Ruben has appealed the board’s censure with Maricopa County Superior Court and says he hopes a court decision will void the board’s disciplinary action against him.
Arizona Gov. Doug Ducey on June 5 declared a statewide health emergency due to opioids. At least two Arizonans per day died of an opioid overdose in 2016.
McSorley said the board’s investigations department places a high priority on complaints related to inappropriate prescribing, though it does not keep statistics on disciplinary actions against physicians related to prescribing.
Of the 52 medical board disciplinary actions against Arizona doctors that have taken effect this year, 16 — including the action against Ruben — included allegations of inappropriate prescribing, a Star records review found. Of those 16 actions, nine included issues with opioid prescriptions.
The board is about to commence rulemaking to require physicians renewing their medical license have at least one hour of continuing medical education in safe and effective prescribing of opioids.
Members of the board are also actively participating in meetings with Ducey’s office to identify ways to address the opioid epidemic, McSorley said.
Ruben says he is disappointed in the Arizona Medical Board and in the Arizona Legislature for being, “baffled about the issues of opiate prescribing and little concerned about the millions of patients who cannot get pain care.”