Disciplinary Action against Ashiq V. Patel, M.D.
Stephen Barrett, M.D.
In 2016, the Arizona Medical Board reprimanded Moneil M. Patel, M.D. for improperly prescribing hormonal medication to two patients who were seeking to lose weight. As noted below, the board placed him on probation for six months and ordered him to take courses in ethics and recordkeeping.
BEFORE THE ARIZONA MEDICAL BOARD
|In the Matter of
MONEIL M. PATEL, M.D.Holder of License No. 44593
For the Practice of Allopathic Medicine
In the State of Arizona.
FINDINGS OF FACT, CONCLUSIONS
The Arizona Medical Board ("Board") considered this matter at its public meeting on August 4, 2016. Moneil M. Patel, M.D. ("Respondent"), appeared with legal counsel Andrew Plattner, Esq., before the Board for a Formal Interview pursuant to the authority vested in the Board by A.R.S. § 32-1451 (H). The Board voted to issue Findings of Fact, Conclusions of Law and Order after due consideration of the facts and law applicable to this matter.
FINDINGS OF FACT
1 . The Board is the duly constituted authority for the regulation and control of the practice of allopathic medicine in the State of Arizona.
2. Respondent is the holder of license number 44593 for the practice of allopathic medicine in the State of Arizona.
3. The Board initiated case number MD-14-1082A after receiving a complaint regarding Respondent's care and treatment of two patients ("SN" and "MA") alleging that Respondent was inappropriately prescribing medications for weight loss for both patients.
4. In April of 2012, Respondent began working as an independent practitioner with LIFEXMD, a private practice offering hormone optimization and testosterone therapy.
5. In September of 2012, SN, a Washington resident, was seen at the LIFEXMD in Washington. SN continued to be treated by different providers at LIFEXMD throughout the year.
6. Respondent prescribed Phentermine, Sermorelin, and Omnitrope to SN on July 9, 2013. On July 23, 2013, Respondent conducted his first telemedicine encounter with SN, who provided a self-reported weight of 253. Respondent listed diagnoses of overweight and fatigue with the recommendation to continue therapy. There was no mention of testosterone or the medications previously prescribed by Respondent on July 9, 2013.
7. Respondent continued to prescribe SN medications throughout 2014, which included HCG, Oxandrolone, and Omnitrope. Additionally, Respondent began prescribing SN Adderall for weight loss in May 2014.
8. On July 21, 2014, Respondent listed diagnoses of hypogonadism and overweight with the recommendation for updated labs and a physical exam at the next visit. Respondent refilled SN's Adderall, but there was no documentation of lab orders for the next visit.
9. In October of 2014, Respondent began prescribing Testosterone cypionate and later added Liothyronine to SN's medications. Respondent's records did not identify a rationale for the additional prescriptions and Respondent did not record a TSH value.
10. MA was a patient of LIFEXMD who also held an officer position at the practice. MA also had the ability to phone in and fax prescriptions for himself and others.
11. MA began treatment with LIFEXMD in December of 2011 and Respondent's first involvement with MA's care occurred on June 25, 2012, when a prescription for Phentermine was provided by Respondent for MA. Respondent provided additional prescriptions for Liothyronine, Phentermine, Oxandrolone, Anastrozole, and Tamoxifen on July 24, 2012.
12. The first documentation of Respondent seeing MA as a patient occurred on August 8, 2012. During the August 8, 2012 visit there were no vital signs documented and it was noted that MA had been on therapy since January. Respondent diagnosed MA with overweight, fatigue, and andropause with no labs to support the diagnosis.
13. MA continued to be prescribed medications from Respondent and other LIFEXMD providers throughout 2013 and 2014, which included prescriptions MA ordered for tamoxifen and anastrozole on March 18, 2013. Respondent denied approving the prescriptions for MA on that date.
14. In July of 2014, Respondent noted MA's poor compliance with medications and diagnosed him with hypogonadism and overweight with the recommendation to obtain new labs, discontinue Adderall, and continue Armour thyroid medication for weight loss. Respondent last evaluated MA in November of 2014 over the telephone for a medication refill. Respondent diagnosed MA with hypogonadism and recommended current T3 therapy, noting that MA's weight was still elevated.
15. The standard of care for treatment of patients with exogenous obesity requires a physician to discuss the need for dietary changes, caloric reduction, regular exercise, and/or behavioral modification. Respondent deviated from the standard of care by failing to discuss the need for dietary changes, caloric reduction, regular exercise, and behavioral modification for patients SN and MA.
16. The standard of care when administering hCG requires a physician to clearly identify the rationale and indication for the treatment. Respondent deviated from the standard of care by administering hCG to patients SN and MA without an indication.
17. The standard of care when providing liothyronine requires a physician to monitor for thyroid status. Respondent deviated from the standard of care by providing liothyronine to patients SN and MA for weight loss but failing to monitor thyroid status.
18. The standard of care requires a physician to monitor vital signs during the course of treatment. Respondent deviated from the standard of care by failing to monitor vital signs for SN and MA during the course of treatment.
19. The standard of care requires a physician to explore secondary causes of obesity from findings based on history, physical exam and initial lab screening. Cardiovascular risk factors should be identified and treated, and comorbidities explored and documented. Respondent deviated from the standard of care by failing to adequately screen patients SN and MA for cardiovascular risk.
20. The standard of care for treatment with testosterone requires a physician to monitor hematocrit, testosterone levels, and PSA. Respondent deviated from the standard of care by failing to perform lab monitoring of SN and MA to whom Respondent prescribed testosterone, including hematocrit, testosterone levels, and PSA.
21. The standard of care requires a physician to avoid the use of anastrazole and oxandrolone in patients with obesity and without proper indications for the use of an anabolic steroid. Respondent deviated from the standard of care by inappropriately using anastrazole and oxandrolone for SN and MA, who were being treated for exogenous obesity and possible diminished libido, without indication for the use of an anabolic steroid.
22. The standard of care requires a physician to perform a physical examination prior to prescribing controlled substances and to clearly identify the indications for the prescribed medication. Respondent deviated from the standard of care by prescribing a variety of controlled substances to patients SN and MA that were not indicated and issued prior to anv patient examination.
23. The standard of care requires a physician to coordinate patient care with other providers involved in the patient's treatment. Respondent deviated from the standard of care by failing to coordinate care with other providers involved in the treatment of SN and MA.
24. Actual harm occurred in that SN and MA were subjected to unnecessary therapy.
25. There was the potential for patient harm in that the medications provided to SN and MA could cause increased risks for other serious health issues.
26. During a Formal Interview on this matter, Respondent testified that he worked with the medical practice at issue from 2012 through 2014, focusing on providing elective bioidentical hormone replacement therapy. Respondent testified that the majority of the patients at the practice are non-professional athletes and other individuals wishing to maintain an active lifestyle. Respondent stated that charting was difficult during his time at the practice because he only had a few hours of access to the charts per month. He stated that he now has implemented electronic medical records and has regular access to charts.
27. In response to questions from Board members, Respondent stated that he was not specifically aware of any black box warnings for the medications at issue in the case.
28. Board members expressed concern with the care provided to the patients in this case; specifically, whether Respondent's treatments were scientifically grounded and whether patients were adequately informed of the risks of the medications being prescribed by Respondent.
CONCLUSIONS OF LAW
1. The Board possesses jurisdiction over the subject matter hereof and over Respondent.
2. The conduct and circumstances described above constitute unprofessional conduct pursuant to A.RS. § 32-1401 (27)(e) ("Failing or refusing to maintain adequate records on a patient.").
3. The conduct and circumstances described above constitute unprofessional conduct pursuant to A.RS. § 32-1401 (27)(q) ("Any conduct or practice that is or might be harmful or dangerous to the health of the patient or the public.").
IT IS HEREBY ORDERED THAT:
1. Respondent is issued a Letter of Reprimand.
2. Respondent is placed on Probation for a period of 6 months with the following terms and conditions:
3. Continuing Medical Education
Respondent shall within 6 months of the effective date of this Order obtain no less than 5 hours of Board staff pre-approved Category I Continuing Medical Education ("CME") in an intensive, in-person course regarding ethics and a minimum of 15 hours of Board staff pre-approved Category I CME in an intensive, in-person course regarding medical recordkeeping. Respondent shall within thirty days of the effective date of this Order submit his request for CME to the Board for pre-approval. Upon completion of the CME, Respondent shall provide Board staff with satisfactory proof of attendance. The CME hours shall be in addition to the hours required for the biennial renewal of medical licensure. The Probation shall terminate upon Respondent's proof of successful completion of the CME.
4. The Board retains jurisdiction and may initiate new action based upon any violation of this Order.
RIGHT TO PETITION FOR REHEARING OR REVIEW
Respondent is hereby notified that he has the right to petition for a rehearing or review. The petition for rehearing or review must be filed with the Board's Executive Director within thirty (30) days after service of this Order. A.R.S. § 41-1092.09(8). The petition for rehearing or review must set forth legally sufficient reasons for granting a rehearing or review. A.AC. R4-16-103. Service of this order is effective five (5) days after date of mailing. A.R.S. § 41-1092.09(C). If a petition for rehearing or review is not filed, the Board's Order becomes effective thirty-five (35) days after it is mailed to Respondent.
Respondent is further notified that the filing of a motion for rehearing or review is required to preserve any rights of appeal to the Superior Court.
DATED AND EFFECTIVE this 5th day of October, 2016.
ARIZONA MEDICAL BOARD
Patricia E. McSorley
EX~TED COPY of the foregoing mailed
this 5th day of October, 2016 to:
Mcneil M. Patel, M.D.
Address of Record
ORIGINAL of the foregoing filed this 5day of October, 2016 with:
Arizona Medical Board
9545 E. Doubletree Ranch Road
Scottsdale, AZ 85258
This page was posted on October 16, 2016.