Jarrott v. Louisiana Bd. of Med. Examiners
| Decision Date | 25 August 2009 |
| Docket Number | No. 2007-CA-0516.,No. 2004-CA-1714.,2004-CA-1714.,2007-CA-0516. |
| Citation | 19 So.3d 526 |
| Parties | David M. JARROTT, M.D. v. LOUISIANA STATE BOARD OF MEDICAL EXAMINERS. David M. Jarrott, M.D. v. Louisiana State Board of Medical Examiners. |
| Court | Court of Appeal of Louisiana — District of US |
Marie Riccio Wisner, Brett A. Bonin, New Orleans, LA, for Appellant David M. Jarrott, M.D.
Louis C. Lacour, Jr., Adams and Reese LLP, New Orleans, LA, for the Louisiana State Board of Medical Examiners.
(Court composed of Chief Judge JOAN BERNARD ARMSTRONG, Judge JAMES F. McKAY, III, and Judge MAX N. TOBIAS, JR.).
David M. Jarrott, M.D. (Dr. Jarrott) appeals from judgments of the trial court. In 2004-CA-1714, Dr. Jarrott appeals the trial court judgments of March 19, 2004 and May 12, 2004, denying Dr. Jarrott's request for declaratory judgment, preliminary and permanent injunctive relief from a disciplinary decision rendered by the defendant/appellee, Louisiana State Board of Medical Examiners (the Board).
In 2007-CA-0516, Dr. Jarrott appeals the trial court judgment of January 9, 2007, affirming the Board's ruling and rejecting Dr. Jarrott's challenge to the terms and conditions of probation ordered by the Board following an administrative hearing1.
The complaint alleged in Count One that Dr. Jarrott's clinical judgment, medical management, treatment and controlled substance prescription practices with respect to his patient, K.S., are demonstrative of medical practice that fails to satisfy the prevailing and usually accepted standard of practice in this state, are evidence of professional and medical incompetence, were without legitimate medical justification, and violated the Board's pain medication guidelines.
In Count Two, the Board charged Dr. Jarrott with having violated its Pain Management Rules (the Pain Rules) governing the prescription of controlled substances employed in the treatment of noncancer-related, chronic or intractable pain. Any violation or failure of compliance with a provision of the Pain Rules, as found in 46 La. Adm.Code §§ 6915-6923 (June 1997)2 is deemed to be a violation of La.R.S. 37:1285 A(6) and (14), providing cause for the Board to suspend, revoke, refuse to issue, or impose probationary or other restrictions on any license held or applied for by a physician to practice medicine in this state.
Dr. Jarrott was charged with violation of 46 La. Adm.Code § 6921 B requiring that, if the physician reasonably believes that his patient is suffering from addiction or drug abuse, he shall obtain a drug screen on the patient. It is within the physician's discretion to decide the nature of the screen and which type or types of drugs are to be screened. Evidence or behavioral indications of addiction, drug abuse or diversion of controlled substances by a patient being treated for chronic or intractable pain shall be followed by tapering and discontinuation of controlled substance therapy, and referral to an addiction medicine specialist, a pain management specialist, a psychiatrist, or other substance abuse specialist, or by an immediate referral to an addiction medicine or other substance abuse specialist for treatment. 46 La. Adm.Code § 6921 C provides that controlled substance therapy shall thereafter be reinitiated only upon the written concurrence of a pain management specialist based upon his physical examination of the patient and the review of the referring physician's medical records.
The Board charged that Dr. Jarrott's knowledge of K.S.'s drug addiction and abuse is undeniable, and that, despite that knowledge, between June and September of 1977, when the Pain Rules had been promulgated and were in effect, he did not order a drug screen, taper and discontinue controlled substance therapy or refer her to a pain management specialist for evaluation, all in violation of the Pain Rules.
On October 25, 1999, the Board served by certified mail, return receipt requested, notice of its complaint together with an opportunity for Dr. Jarrott to be heard and present evidence in his defense. Discovery was held in the administrative proceeding, and during the course of the extensive discovery process, the Complainant, Dr. John Bobear, filed a Motion to file a restated Supplemental and Amended Administrative Complaint, which was granted by the Presiding Officer on March 28, 2001.
The Supplemental and Amended Complaint restated the allegations of the Original complaint, and alleged the following additional facts:
— Dr. Jarrott did not create a treatment plan that properly included the use of non-addictive modalities, nor did he consult or refer K.S. to an appropriate specialist or specialists.
— Dr. Jarrott failed to follow up properly after an emergency physician referred K.S. to a psychiatrist at Charity Hospital, New Orleans (Medical Center of Louisiana), who refused to admit the patient for a work-up desired by Dr. Jarrott.
— Dr. Jarrott failed to take proper steps to ascertain that K.S. was in fact a drug-seeking patient and that she was in fact obtaining controlled substances illicitly and/or from other physicians.
— Dr. Jarrott did not follow through with toxicological studies (such as a drug screen) on K.S., nor did he take appropriate steps when she repeatedly refused the drug screen.
— Dr. Jarrott failed to give proper weight to the patient's mother's observations, requests and warnings.
— A medical review panel, consisting of three neurosurgeons, unanimously found that Dr. Jarrott breached the standard of care in his treatment of K.S.
In Count Two, the Board alleged the following additional violations3, providing lawful cause for the suspension of Dr. Jarrott's license to practice medicine in Louisiana pursuant to La.R.S. 37:1285 A(6)4, (12)5, and (14)6:
—Dr. Jarrott's clinical judgment and management of K.S., including his failure to pursue a diagnosis of the underlying cause of the patient's complaints, establish a plan of treatment, refer her to other consultants for evaluation and/or treatment, sufficiently employ therapy alternative to controlled substances, and his failure to obtain or heed the patient's known history of addiction and substance abuse, constitute continuing medical practice that fails to satisfy the prevailing and usually accepted standards of medical practice in this state, and evidences professional or medical incompetence.
—Dr. Jarrott was apparently indifferent to the contraindications, warnings, and dangers of continuing therapy to a patient with a history of drug addiction, abuse and repeated overdoses. By his personal knowledge, as well as the reports of his employees, patients and the patient's mother, he was aware of the extent of K.S.'s addiction, use and abuse of medication. In light of these facts, his prescription practices were in amount, frequency, and duration, without any legitimate medical justification and in contravention of the known warnings, dangers, and contraindications pertaining to such medications.
—Dr. Jarrott's failure to order or failure to follow through on a drug screen for the patient, failure to create a treatment plan properly including non-addictive modalities, failing to consult or refer to an appropriate specialist(s), failure to follow up on psychiatric care, failure to understand or control the patient's supply of controlled substances, and failure to address the family's warnings and observations, demonstrated ongoing breaches of medical standards and medical incompetence.
The record contains an undated Answer to the Supplemental and Amended Complaint signed and filed by prior counsel to Dr. Jarrott. The Answer admits the following:
1. The initial allegations concerning his status and areas of practice; that K.S. was his patient and died;
2. The facts as stated concerning K.S.'s initial visit and the results of her October, 1993, MRI;
3. That in October, 1996, he employed K.S. as alleged by the Board;
4. That he terminated K.S. as an employee in May, 1997, but continued to serve as her physician;
5. That he prescribed medications to K.S.;
6. K.S.'s 4/30/96 Overdose and its aftermath as alleged in the complaint;
7. K.S.'s 5/12/97 Overdose on Lorcet, her disorientation, shaking, and her collapse in Dr. Jarrott's office;
8. Dr. Jarrott gave a prescription on September 2, 1997; and
9. The medical review panel unanimously found that Dr. Jarrott breached standards of care in his treatment of K.S.
Dr. Jarrott either denied or denied for lack of sufficient information to justify belief the remaining allegations of the Supplemental and Amended Complaint.
Dr. Jarrott's answer also contended that:
1. He had no knowledge of the occurrences alleged in the complaint;
2. At the time of treatment, there was no standard of conduct such as was promulgated in the 1997 Pain Rules;
3. The Board is precluded from complaining about his prescriptive practices because it and its agents had reviewed those practices in 1992-1996 and did not file a complaint7;
4. There is a conscious and intentional effort on the part of the complainant, Dr. Cecelia Mouton, and the Board to sanction only those physicians who treat pain patients, and not those who under-treat pain patients, creating a denial of equal protection to physicians and their patients.
Dr. Jarrott also brought motions to recuse the members of the Board, Dr Mouton, Dr. Bobear, attorneys Byron Berry and Lawrence McNamara, the Board's trial counsel, and their law firm, Adams & Reese, which motions were denied.
The Board again amended its Complaint. According to the Board's Opinion and Ruling, this amendment added charges arising out of Dr. Jarrott's treatment of two other patients, T.D. and R.G.8 This Supplemental and Amended Complaint reurged violations of the Pain Management Rules, as applicable from the beginning of Dr. Jarrott's treatment of T.D. and R.G.
The Second Supplemental and Amended Complaint made the following allegations concerning Dr. Jarrott's treatment...
To continue reading
Request your trial
-
Harris v. La. State Contractors Licensing Bd.
...only when the Board files the petition for judicial review. See LSA-R.S. 49:964.1 and Jarrott v. Louisiana State Bd. of Medical Examiners 04-1714 (La.App. 4 Cir. 8/25/09), 19 So.3d 526, 556. Because Mr. Harris, rather than the Board, sought review, Mr. Harris is not entitled to recover his ......