A long-time Miami-area psychiatrist who prescribes heavy-duty drugs in abundance has not been doing it safely, the Florida Board of Medicine said Friday.
Dr. Francisco J. Pages, charged with mismanaging the care of nine patients, needs to be evaluated to see what his knowledge level is, the board decided at a meeting in Stuart. Pages needs training to make up the deficits and close supervision by another psychiatrist for at least two years, the board said.
“I’m not sure this physician understands the multiple medications he’s prescribing,” said board member Dr. Bernardo Fernandez of Coral Gables. “Some of these patients are on seven, even 10 medications. Sometimes he prescribes a medication that counteracts the medications (the patient is) already on.”
Dr. Zach Zachariah of Fort Lauderdale pulled no punches. “If you look at this case, it portrays a physician who is clueless, absolutely clueless,” he said.
Pages said very little, leaving that to his attorney.
“Uninsured, homeless citizens rely on Dr. Pages. He sees the patients no one else truly wants to see,” the lawyer, Philip Goss, said.
Goss said that while his client was “embarrassed” to be called before the Board of Medicine, he sees his problems not as lack of skill but as “improper record-keeping and lack of attention to detail.”
The Board of Medicine didn’t buy it. “It’s not inattention to detail,” said Dr. Sarvam TerKonda of Jacksonville. “It’s inappropriate prescribing.”
Regardless of their status, patients deserve the proper medicine, said Dr. Fernandez.
“I commend the physician for the fact that he is helping (the poor and homeless), but I think it is our duty to make sure he is practicing with skill and safety,” he said.
The board rejected a settlement negotiated between Pages and the Florida Department of Health as being insufficient. To the original terms -- a reprimand, $25,000 fine, some courses and two years’ probation – the board added an evaluation of Pages’ skills by a special team from University of Florida.
Technically, the psychiatrist could reject that offer and insist on a formal hearing, but attorney Goss said after the hearing that Pages would probably accept it.
The psychiatrist, who used to have an office, now practices only in hospitals, Goss said. He did not say which ones. The state DOH web site lists him as having privileges at six hospitals, but the list is clearly out of date since one of them has closed.
Pages was reported to DOH by the state Agency for Health Care Administration after his Medicaid prescribing patterns caused alarm, state records show. Pages lost the right to participate in the Medicaid program.
But not Medicare. Pages showed up as a fairly prolific prescriber for Medicare patients in ProPublica’s "Dollars for Docs” project, in which reporters analyzed the prescriptions filled for Medicare patients in 2012. ProPublica's searchable database shows Pages was responsible for about 15,000 claims for about 1,000 patients at a cost of $3 million. Among Florida psychiatrists, some wrote more prescriptions, but only one cost taxpayers more.
Pages is among the doctors who received money as a consultant for pharmaceutical companies, according to the ProPublica database. His two largest benefactors were Eli Lilly, which paid him about $20,000 for speaking in 2009-10, and Pfizer, from which he received about $16,000 in 2010 and smaller amounts in recent years, since the state investigation of his prescribing patterns began.
Pfizer has two patented anti-depressants, Effexor XR and Pristiq, and Lyrica, an anti-convulsant that is also used in neuralgia and fibromyalgia. Eli Lilly promotes Cymbalta for depression, anxiety, and several types of chronic pain.
Special correspondent Carol Gentry is part of in Tampa. receives support from the Corporation for Public Broadcasting.
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