The Alaska State Medical Board has suspended the license of an Arkansas anesthesiologist investigators say was prescribing vast quantities of painkillers in exchange for cash at his one-man Anchorage clinic, which he visited just a few days per month.
Dr. Mahmood Ahmad "poses a clear and immediate danger to the public health and safety if he continues to practice medicine," the board said in suspending the doctor's medical license on May 6.
On Monday the office of Ahmad's United Pain Care, in a medical building on Lake Otis Parkway, was shuttered and locked.
Kash Siddique, who described himself as the CEO of the clinic, said it would be premature for Ahmad to discuss the allegations against him because he'd be appealing the board's decision at a hearing this week.
"These are just allegations made by an outside independent physician about how Alaska runs its medical practice," Siddique said.
The state's investigation into Ahmad began last year, when pharmacists began complaining about the volume of controlled substances the doctor was prescribing: More than 700 prescriptions in five months, according to the license accusation. Methadone. Xanax. Oxycodone. Fentanyl. All issued by one doctor who flew up from his home in Arkansas to see patients just a few days each month.
"Not only did every patient receive a prescription for controlled substances, they received high doses of opioids and frequently in combination with benzodiazepines, which increase the risk of overdose death and abuse," the accusation against Ahmad says.
In Alaska, far more people die of overdoses of opioid pain relievers than heroin. But public health officials have said the state lacks an effective system to monitor doctor prescribing behavior, which could warn of "pill mills" where patients may be over-prescribed narcotic painkillers.
The action against Ahmad is unusual. The state revokes the medical licenses of doctors every year for violating standards, but only a few cases in recent years have involved allegations of over-prescribing controlled medications.
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Trouble in Arkansas
Before he set up shop in Alaska, Ahmad faced similar trouble in Arkansas.
When Ahmad first applied to practice medicine in Alaska in 2013 he failed to disclose that he was under investigation by the Arkansas State Medical Board. United Pain Care also has a location in Sherwood, Arkansas.
In Arkansas, Ahmad was found to have "prescribed an excessive amount of controlled substances" and failed to keep proper records to justify such prescriptions. One woman complained to the board that her 59-year-old husband was over-medicated by Ahmad. She blamed the medicine for his 2012 suicide.
Ahmad fought the decision, and ultimately the medical board in Arkansas agreed to drop the findings in exchange for Ahmad reimbursing the cost of the $20,000 investigation, and completing new training, according to an Arkansas Democrat-Gazette article. Records show Ahmad currently is licensed to practice medicine in Arkansas.
Ahmad is also the defendant in a pending federal lawsuit that alleges his Arkansas pain clinic committed 121 violations of the Controlled Substances Act in 2012-2013. The allegations center on poor record keeping of controlled substances at a pharmacy, now closed, that United Pain Care also operated.
In July, Ahmad completed the conditions of the sanctions imposed on him in Arkansas — and was released from monitoring by the Alaska medical board.
In November, local pharmacists alerted the board that Ahmad had been "prescribing large amounts of high strength controlled substances to Alaska patients with little or no history of pain management prescriptions," according to the accusation. "The prescriptions included vague diagnoses, were primarily written for cash customers, and it was difficult to verify the prescriptions because Ahmad was only in Alaska for a few days a month."
State Division of Corporations, Business and Professional Licensing investigator Angela Birt hired Dr. Brett Stacey, the medical director of the University of Washington Center for Pain Relief, as an outside reviewer of Ahmad's practice.
Stacey concluded that Ahmad "engages in a quid pro quo with his patients — he received cash in exchange for prescriptions of controlled substances."
'Dangerous … and potentially lethal'
Stacey detailed instances in which he said Ahmad's medical examination didn't warrant the drugs prescribed. Ahmad didn't review outside records, imaging or lab results to confirm what patients reported to him, the allegations say.
In one instance, Ahmad prescribed doses of methadone and oxycodone that were "at least ten times a reasonable starting dose." In another, he prescribed oxycodone and Xanax for a patient who tested positive for cocaine.
For one patient, he prescribed five different sedating medications at once.
"A patient taking all these medications as prescribed would run the risk of life threatening respiratory depression," the investigator found.
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For a patient with back pain, he prescribed a cocktail of drugs — including fentanyl, lidocaine, oxycodone and valium — that could be "dangerous when prescribed individually and potentially lethal in the prescribed combination."
The report does not say whether any of Ahmad's patients died while under his care.
Ahmad is appealing the license suspension.
If the board ultimately rules against Ahmad and revokes his license, he can appeal through the Alaska Court System, said Janey Hovenden, the director of the Division of Corporations, Business and Professional Licensing, which oversees the medical board.
Ahmad's hearing is scheduled for 8 a.m. on May 26 on the 19th floor of the Atwood Building in downtown Anchorage.