One toke over the line . . . and Dr. Ufberg in the hot seat
Today’s case takes the concept of cavalier to a whole new height. How high is high? Think Proud Mary high. Think a cocktail of Oxy, Oxy, THC and more Oxy, with a little Gabapentin thrown in for good measure. Add to that a patient with COPD and cardiac arrthymia, and a doc who admits to a “don’t ask, don’t tell” policy when it comes to recreational drug use, one who testified in headwear that made him resemble the Mad Hatter. That is our case du jour. Robert Gibbons v. Heartland Industries, IAB Hr’g No. 1012995 (Jan. 4, 2021).
The outcome of this crazy recipe is an affirmance of a UR decision in the carrier’s favor on the issue of opioids, with the IAB ruling that not only was this prescription regimen non-compliant with the Health Care Practice Guidelines, but also blatantly unreasonable and unnecessary, as well as potentially life-threatening.
Some comments worth highlighting as to the Mad Hatter, I mean Dr. Ufberg:
“The Board is highly concerned by Dr. Ufberg’s lackadaisical approach to managing claimant’s medical care.”
“It is of great concern that claimant’s OxyContin MME dosage has essentially been reduced by at least half since the insurance denial of coverage without close monitoring by Dr. Ufberg. The Board is deeply concerned by Dr. Ufberg’s remark, ‘I don’t know if he’s alive, even’, which was in reply to defense counsel’s inquiry as to whether he had checked in with claimant following the carrier’s post-UR opioid denial.
Dr. Ufberg testified that he follows a ‘don’t ask, don’t tell’ policy regarding the combination of opioids and marijuana. He admitted that he purposely does not test for marijuana when ordering urine drugs screens despite having already having received a citation for that very practice….”
In addition to denying the claimant’s appeal, the Board demanded that this IAB decision be sent to the Board of Medical Licensure and Discipline “for it to consider appropriate disciplinary sanctions against Dr. Ufberg.”
The Board also endorsed the DME doc’s suggestion as to a 6 to 12 month titration period. Assuming, that is, that claimant is alive, even.
Irreverently Yours,
Casssandra Roberts
