A Tucson physician cannot prescribe certain drugs for two years because of concerns over the amount of pain medication he was giving to patients, the state’s medical board has ruled.
Dr. David A. Ruben of Healthcare Southwest, 2016 S. Fourth Ave., must stop prescribing Schedule II controlled substances including Percocet, oxycodone, and fentanyl for a two-year period that began Feb. 14, according to the Arizona Medical Board ruling.
Ruben has been previously disciplined by the board and the Drug Enforcement Administration because of his prescribing practices. He must file a written request to the medical board after the two-year period if he wishes to have the prescribing censure lifted, according to the board’s order.
But the order is not relevant, Ruben said, because he has not prescribed any Schedule II drugs to patients at his Tucson practice in nearly two years and has no plans to do so.
He nonetheless plans on appealing the board’s order in Maricopa County Superior Court on principle, he said.
“Everybody is exhausted with this whole rigamarole,” Ruben said. “Overall the regulatory system is very dysfunctional and corrupt. ... I don’t want them in my hair at all.”
Complaints from pharmacies
The board’s order came after a yearlong process that began with accusations that Ruben had inappropriately prescribed painkillers to patients. Among other things, multiple pharmacies had complained about prescriptions for controlled substances Ruben wrote for seven patients, board documents show.
The board found that Ruben had violated the standards of professional conduct for doctors, citing several examples, among them:
- A male in his 30s, referred to as “GM,” had gout, osteoarthritis and chronic pain and saw Ruben between 2009 and 2013. The report cited one instance in 2012 when the man attempted suicide.
The medical board report says the last time Ruben saw the man in his office was Feb. 21, 2013. At that time, the report says Ruben prescribed 30 milligrams of oxycodone seven times per day and 50 millgrams of tramadol two to three times per day.
GM had suffered fractures from falls on two occasions, “as the risk for falls is increased with the medications that were prescribed,” the board’s report says.
The board ruled that Ruben “deviated from the standard of care by failing to attempt treatment of GM’s gout with safer modalities instead of immediately instituting opiate therapy.”
- A male in his 30s, referred to as “MB” in reports, established care with Ruben in July 2012 for complaints of lower back, bilateral elbow, wrist, knee, ankle and jaw pain.
A medication log shows Ruben prescribed the man 15 milligrams of oxycodone three to four times per day. A previous clinic had severed its relationship with MB, the report says.
Four months later, a medication log shows Ruben gave MB an early refill and increased his oxycodone dose to 15 milligrams five times per day. On Jan. 18, 2013, he again raised MB’s dosage.
The medical board said Ruben deviated from the standard of care by failing to review the treatment plan when MB had early refills and ran out of his medications and by doubling the oxycodone dose, “with little change in MB’s pain level.”
- A female in her 20s known as “PG” complained of back, neck and shoulder pain resulting from a motor vehicle accident. She reported also having carpal tunnel syndrome and migraines and getting about six hours of disrupted sleep per night.
In April, 2012, Ruben prescribed her 30 milligrams of oxycodone 10 times per day, the medical board’s review says. In October of that year, PG reported her boyfriend’s brother had stolen her medications, according to the report. A police report from the incident did not back up her claim that medications had been stolen, the medical board said.
Ruben’s office later had a report that PG’s husband was in jail and charged with murder and four of her five children were hyperactive. He prescribed 30 milligrams of oxycodone eight times per day and gave her an early refill. He also prescribed the muscle relaxant Soma. A medical board expert testified that Soma has a high street value because it increases the high or euphoria of oxycodone.
The medical board found that Ruben had prescribed pain medication to PG, “in the face of multiple aberrant behaviors without changing the treatment plan or increasing monitoring for abuse.”
The board also said the public was placed at risk due to an allegation that she was selling her medications.
Risk versus benefit
Ruben argued that his patients are low-income minorities and that the board is misunderstanding them.
“The problems associated with chronic pain and its treatment will not go away, but are representatives of the many issues to be faced in the promotion of safe and effective medical care,” he told the board. “They are the tip of an iceberg that has to do with risk versus benefit, the doctor-patient relationship versus obscure regulation.”
In 2010, Ruben was barred from prescribing certain medications after the state medical board found that he failed to show why several of his patients needed prescriptions.
Ruben, a 1974 graduate of the University of Arizona College of Medicine, says he agreed to the conditions only to end the matter, not because he did anything wrong.
Ruben said when the DEA raided his practice in 2014, it was scary enough to make him stop prescribing Schedule II drugs, though he’s still practicing as a psychiatrist.
He specializes in psychiatry for adults and adolescents, and in addiction and pain medicine, he said. He can still prescribe drugs classified as schedule III controlled substances, such as Tylenol with codeine and Suboxone.
But he’s not prescribing any opiates.
“I am going to do what all the other doctors have done and not prescribe. Doctors just want to keep their heads low and not confront this,” Ruben said. “It is a terrible situation for patients.”
