The state medical board has placed a Falmouth psychiatrist on six months of probation for the way he practiced medicine leading up to the 2015 drug overdose death of one of his patients, a punishment that the patient’s mother says isn’t nearly severe enough.
Elizabeth Marquis of Seabrook, New Hampshire, said Dr. Reinaldo de los Heros, who has a history of disciplinary actions in other states, should have lost his Maine medical license for over-prescribing medications for her daughter, Kelly Deyo of Westbrook.
WHAT KELLY DEYO WAS PRESCRIBED
These are the medications prescribed for Kelly Deyo by Dr. Reinaldo de los Heros:
n Gabapentin – 800 mg Anticonvulsant, anti-epileptic. For treatment of seizures. Prescription from previous provider: 300 mg
n Quetiapine – 200 mg Antipsychotic. For treatment of schizophrenia or bipolar disorder. Prescription from previous provider: 100 mg
n Latuda – 40 mg Antipsychotic. For treatment of schizophrenia or bipolar disorder. No previous prescription.
n Topiramate – 100 mg Anticonvulsant, anti-epileptic. For treatment of seizures. Prescription from previous provider: 100 mg
n Alprazolam – 1 mg Benzodiazepine. For treatment of anxiety or panic disorders. No previous prescription.
n Mirtazapine – 15 mg Antidepressant. For treatment of depression. No previous prescription.
n Clomipramine – 50 mg Tricyclic antidepressant. For treatment of obsessive compulsive disorder. No previous prescription.
Pharmacy records provided by Elizabeth Marquis.
De los Heros had been sanctioned by the Massachusetts licensing board in the 1990s and 2000s for Medicaid fraud, and for fraudulently trying to regain his medical license.
“They’re not really looking out for me, are they?” Marquis said Tuesday of the Maine Board of Licensure in Medicine. “The board has tried to protect him. It’s ridiculous.”
De los Heros, 64, did not respond to requests for comment Tuesday from the Portland Press Herald, nor did his attorney, Elizabeth Olivier. But in a July 13, 2015, letter to the licensing board, the doctor defended his actions as appropriate.
Deyo, 39, committed suicide on April 19, 2015, with 19 mostly empty prescription pill bottles and a suicide note found by her side at her apartment in Westbrook. The bottles, including refills, had contained nine prescriptions written by de los Heros.
“He was reckless and he’s a ‘pill mill,’ ” Marquis said.
De los Heros was placed on probation in a Feb. 24 consent agreement with the Maine licensing board for failing to coordinate Deyo’s care with her primary care physicians and poor documentation of her visits, including a lack of or incomplete treatment notes or treatment notes that were illegible, according to the agreement, which was released Monday.
Deyo struggled with mental illness. When she was under the care of a nurse practitioner immediately before she started seeing de los Heros in March 2015, she was taking one anti-psychotic drug, one anti-anxiety prescription and two anti-convulsants.
Deyo also was a recovering heroin addict and was taking methadone at the Westbrook methadone clinic, according to state records. De los Heros did not prescribe her 100-milligram doses of methadone, but was aware that she was taking the drug, state records show.
De los Heros nearly tripled Deyo’s dose of an anti-convulsant, gabapentin, from 300 milligrams to 800 milligrams, according to pharmacy records that Marquis provided to the Press Herald. The records from February 2015 show that Deyo was prescribed far fewer medications by the nurse practitioner she was seeing in New Hampshire immediately before moving to Maine and transferring to de los Heros’ care.
De los Heros doubled the dosage for an anti-psychotic that Deyo was taking, quetiapine, from 100 milligrams to 200 milligrams. He also added four additional anti-psychotic, anti-depressant and anxiety drugs, including clomipramine, mirtazapine, alprazolam and Latuda – to Deyo’s previous mix of medications. He maintained the dosage for topiramate, an anti-convulsant, and dropped an anti-anxiety drug, lorazepam. He also prescribed her medications unrelated to her mental illness, including an anti-viral for influenza and an acid-inhibiting drug for heartburn.
DOCTOR DEFENSE, SUPPORT, DISCIPLINE
Tim Terranova, assistant executive director of the Maine medical licensing board, said Tuesday that the board could not conclude that de los Heros over-prescribed for the patient. A doctor hired by de los Heros told the board that the treatment was appropriate. Terranova said the board chose not to hire an independent doctor to evaluate prescribing practices related to Deyo’s case.
“The board made its decision on what it could prove,” Terranova said.
He said by being on probation, de los Heros will be under the close supervision of another doctor for at least six months.
“This is difficult for the physician, being on probation. It will be expensive for the doctor,” Terranova said, noting that the board could keep de los Heros under supervision for longer than six months. “He very well could be under the watchful eye of another physician indefinitely,” Terranova said.
In the July letter defending his practices, de los Heros said Deyo was responding well to his treatment after complaining of numerous mental health conditions, including paranoia, insomnia, agitation, hyperactivity, mood swings, panic attacks and obsessive compulsive behaviors.
“During Mrs. Deyo’s treatment, she showed clinical improvement in several of her anxiety conditions, panic, generalized and post-traumatic,” de los Heros wrote. “She had never showed evidence of any signs of relapse into substance abuse of any type confirmed by the frequency of all her toxicology results. She was closely and frequently monitored.”
De los Heros was testing weekly urine samples from Deyo to make sure she didn’t have a heroin relapse, according to state records. However, at her death, morphine was found in her system, an indication she had taken heroin, according to the consent agreement.
De los Heros also noted in his letter that he was tapering off some of her medications, and that Deyo never indicated she was suicidal.
Dr. Harrison Pope, a psychiatry professor at Harvard Medical School, was hired by de los Heros to provide expert opinions to the medical board, Terranova said. “Dr. Pope reviewed the seven psychiatric medications that Dr. de los Heros prescribed to (Deyo) and concluded that none of (Deyo’s) doses exceeded the normal daily maximum, and that the medications have scientific evidence of efficacy for the psychiatric disorders that Dr. de los Heros diagnosed,” the consent order states.
Dr. Pope also noted that taken together, the drugs are not known to be a toxic mix.
When asked why the medical board didn’t consult an independent expert, Terranova said the board declined to do so based on a confidential meeting with de los Heros and Marquis. After that November meeting the board decided to pursue a consent agreement with de los Heros and not have a formal hearing.
MOTHER’S COMPLAINTS, LOST LICENSES
At a formal hearing, independent experts could have been called in. The person filing the complaint – in this case, Marquis – has no power to force the board to host a formal hearing.
Marquis said the system was rigged against her from the start, and she wants to know why her daughter was given numerous prescriptions by de los Heros, while other doctors gave her far fewer.
Marquis said that when Deyo was in her 20s and 30s she would typically be on one anti-depressant or anti-psychotic at a time. When one was not working, it was removed before another medication was introduced, she said.
Marquis said it was irresponsible for de los Heros to prescribe so many medications without consulting with Deyo’s previous doctors.
Deyo grew up and lived most of her life in the Seabrook area, but moved to Maine about a year before her death to get away from people who were bad influences, Marquis said. She had struggled with heroin addiction since her early 20s. She died leaving two children – one a teen and another an adult – who didn’t live with her, Marquis said.
Jenna Mehnert, executive director of the Maine chapter of the National Alliance on Mental Illness, said she couldn’t comment specifically on Deyo’s case, but that medication must be prescribed responsibly.
“Medication can be a part of the approach to addressing a mental health problem, but it most certainly cannot be the whole equation and it also needs to be an area that has a lot of caution and consideration,” Mehnert said.
She also said the organization is “especially concerned that someone who had lost his license in another state could practice in Maine.”
De los Heros’ license to practice in Massachusetts was revoked in 1997 for Medicaid billing fraud, according to Massachusetts medical board records.
De los Heros failed to disclose his disciplinary history on forms in Massachusetts when trying to regain his license in 2007, the records show, including that his license was revoked in other states, that he had a 2006 consent agreement in Maine and that his medical malpractice insurance company had imposed a surcharge on his policy.
QUESTIONS ON medical BOARD DISCIPLINE
In 2006, Maine granted him a conditional license to practice medicine, despite his previous troubles in Massachusetts and license revocations in New Hampshire in 1997 and North Carolina in 1999.
Under the 2006 conditions in Maine, which had been removed before the current discipline, de los Heros had to work under the supervision of another physician.
“We need more mental health providers in Maine, but we need the best and brightest, not the ones other states don’t want,” Mehnert said.
But Terranova said the licensing board, when considering a consent agreement, can’t look at past actions by Maine or other states.
“Each case has to be able to stand on its own merits,” he said.
Terranova said the board investigates every complaint it receives, no matter how minor. He said there were 136 complaints in 2015 and 16 disciplinary actions against doctors, including suspensions and surrendering of licenses. The 16 disciplinary actions were typical for the past several years.
Dr. Michael Carome, director of the health research group for Public Citizen, a nonprofit watchdog group that has researched medical boards, said it was “troubling” to hear that in the Maine case, the only expert considered was hired by the defendant.
But Carome said it’s common for medical boards to not vigilantly pursue cases, and the group has conducted research that shows state boards in many cases fail to police doctors who do wrong.
“We have been concerned about the performance of state medical boards for many years. Many times, state medical boards perform inadequately when disciplining their physicians,” Carome said.
Marquis said people she knew warned her that the medical board would not properly punish de los Heros, but the decision still hurts.
“He should have lost his license a long time ago,” Marquis said. “They were very easy on him.”
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