Bangor physician fined for ordering excess pain meds

BANGOR – A settlement has been reached between a Bangor doctor and federal agencies investigating her prescribing practices. Attorneys on both sides agree family practitioner Jean Benson made an honest mistake in overprescribing pain medications for just one of her many patients, but the case is being held up as a warning to physicians everywhere to monitor carefully their use of prescription narcotics.

Benson, who has practiced in Bangor since 1995, has agreed to pay $101,241.16 in state and federal fines and to practice for the next five years under the terms of an “integrity agreement” with the federal Department of Health and Human Services. The settlement, which names Benson as well as her practice, Independent Medical Associates of Ridgewood Drive, was announced Monday by the Portland office of the U.S. attorney.

According to the U.S. Attorney’s Office, Benson overprescribed narcotic pain medication between Nov. 6, 1997, and June 28, 2000, to one unidentified patient who suffered from a number of complex ailments. Over time, Benson increased the patient’s allowable daily pain medication to about 100 5-milligram tablets of oxycodone, 22 80-mg tablets of OxyContin, and 285 15-mg doses of injectable morphine. The amount of the prescribed drugs the patient actually was taking daily is unclear.

Assistant U.S. Attorney Evan Roth acknowledged Monday that though the amount of opioid drugs prescribed was “shocking,” the medical case was very complex and the patient had built up a significant tolerance to narcotics. In such cases, he said, high doses are needed to control pain. But the amount of drugs prescribed to this one patient was beyond any accepted standard, he said – and enough that some of the drugs were diverted to street use.

“Dr. Benson lost control of this situation. She should have had a much better handle on the patient,” Roth said.

He emphasized that his agency’s investigation had revealed no pattern of overprescribing, and that Benson apparently had known nothing about the illegal trafficking she had enabled. “My sense is that she was completely flabbergasted,” he said.

Still, Roth said he hopes other practitioners will examine their prescribing habits in light of the investigation into Benson’s case. Physicians can best protect themselves and their patients by consulting with one another and with pain specialists, he noted.

Benson’s office referred all calls to Portland attorney Kenneth Lehman. Lehman said Monday that Benson had sought the advice of pain control specialists, including having her patient hospitalized for a pain evaluation. That evaluation determined that narcotics were the appropriate choice for controlling the pain with the least number of complications, including potential adverse interactions with the patient’s many other medications.

“Dr. Benson knew she had a very sick patient with intractable pain,” Lehman said. She was unaware that the patient’s supply of narcotics was so plentiful that the patient’s husband was able to “siphon off” and sell some of the medications.

“In this case, the doctored erred,” Lehman said. “It’s too bad the federal government chose to go after this physician for prescribing medications to one single patient, when there was no injury to the patient and no concern about the overall quality of the care she was receiving.”

According to Roth, Benson conceded to investigators that she had prescribed about twice as much pain medication as was appropriate, even given her patient’s level of pain and tolerance to narcotics. MaineCare, the state’s Medicaid program, paid out about $50,000 for the unneeded medications, so about half of the $101,241.16 award will be returned to state coffers, he said. The remainder constitutes a penalty that will be used for federal DHHS programs.

The second part of the settlement, the so-called integrity agreement, stipulates that for the next five years, Benson must submit to professional oversight by an independent pain management organization, send annual reports to federal DHHS, and submit to intermittent reviews of her patients’ charts.

Benson’s partner at Independent Medical Associates, longtime Bangor physician Dr. Toby Atkins, is not implicated in the investigation and is not affected by the integrity agreement.

Gordon Smith, executive director of the Maine Medical Association, said Monday afternoon that the federal investigation into Benson’s practice is indicative of the difficult balance physicians face in trying to adequately control their patients’ pain without getting into trouble with the law. While admitting the Bangor physician made a mistake, he said, it’s regrettable that she’s being held out as an example to other prescribers.

“This is tragic for Dr. Benson. She is a fine, compassionate physician,” Smith said. “I am really afraid that the publicity and the aggressive handling of this case by the U.S. Attorney’s Office will make other physicians afraid to prescribe appropriately for pain.”