Another doctor loses his right to prescribe

By Marshall Allen (contact)

Wednesday, Dec. 3, 2008 | 2 a.m.

The Nevada State Medical Examiners Board has stripped a Las Vegas psychiatrist of his license to prescribe controlled substances because the drugs he prescribed to a Kentucky woman may have contributed to her suicide.

The medical board took the action against Dr. Randall Foster at an emergency meeting Monday because he “presents an unacceptable risk to the citizens of Nevada,” documents show. Authorities are continuing to investigate other patient complaints about the doctor.

Foster, who is 81 years old and has been licensed in Nevada since 1978, was operating more as a pain specialist than a psychiatrist, according to a complaint filed against him with the medical board.

Foster declined to comment to the Sun.

In the case of the Kentucky patient, Foster allegedly performed only one “limited” examination during the six years he prescribed her opiates for her pain, the complaint said.

He is accused of continuing to prescribe her drugs after she wrote him a letter saying she was struggling with addiction and was taking the medications only to avoid withdrawal symptoms, the complaint said.

The woman later killed herself. The complaint does not say when or how she died.

“(The patient’s) addiction likely contributed to (her) overall dissatisfaction with her life and may have contributed to her committing suicide,” the complaint said.

Medical board officials said Foster did not keep regular office hours and patients had to call him at home to make an appointment. No more details can be discussed until the investigation is complete, officials said.

The medical board documents do not name the specific drugs Foster was prescribing. But the opiate family includes narcotic painkillers such as oxycodone, the main ingredient in OxyContin and hydrocodone, which goes by the brand names Vicodin and Lortab.

A Sun analysis this year found that Nevadans consume about twice the national average of several prescription painkillers, making us among the most narcotic-addled populations in the United States. The consequences are deadly. More people in Clark County die of prescription narcotics overdoses than of overdoses of illicit drugs or from vehicle accidents.

In 2006, Nevadans were the No. 1 users per capita of hydrocodone — better-known by the brand names Vicodin and Lortab. Nevada is ranked fourth in the nation for methadone, morphine and oxycodone use per person, the Sun analysis found.

Experts say the state is in the midst of a prescription drug crisis, and part of the problem is doctors and other providers who recklessly prescribe the drugs.

On Nov. 13, the medical board suspended Henderson family physician Dr. Kevin Buckwalter’s license to prescribe controlled substances after a review of his records found four cases of malpractice, including one in which “excessive” doses of narcotics contributed to a patient’s death.

The medical board’s action against Buckwalter came two months after the Sun published the first story in a months-long investigation of Buckwalter’s practice. The Sun found the doctor had been prescribing narcotics and the anti-anxiety drug Xanax in alarmingly large amounts.

Experts who reviewed Buckwalter’s medical records — with the permission of patients and their families — told the Sun his prescription habits contributed to three deaths and one overdose.

Louis Ling, executive director of the medical board, said the scope of the wrongful prescribing is unknown. State authorities generally investigate a doctor’s history of prescribing only if it is triggered by a patient’s complaint, he said.

He said the board’s recent actions against Buckwalter and Foster are indicative of how the state is investigating the overprescribing of narcotic medicines while respecting the legitimate care of patients who suffer from pain.

The medical board complaint against Foster includes four patients, but three cases are still being investigated, Ling said.

The complaint accuses Foster of three counts of wrongdoing: malpractice, failure to maintain adequate medical records and failure to follow the pain management guidelines set by the Federation of State Medical Boards. Those guidelines state that doctors must perform examinations, measure the success of their treatment and monitor them to ensure they’re not abusing the drugs.