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Hannan v. Delaware Board of Medical Licensure and Discipline

Superior Court of Delaware

February 23, 2018

PAUL J. HANNAN, M.D., Appellant,
v.
DELAWARE BOARD OF MEDICAL LICENSURE AND DISCIPLINE, Appellee.

          MEMORANDUM OPINION

          John A. Parkins, Jr. Superior Court Judge.

         Appellant is a physician whose license was revoked by the Board of Medical Practice and Licensure for, in the words of the Hearing Officer, "enabling a criminal drug gang in Pennsylvania by providing them with a regular source of controlled substance prescriptions to be sold on the street." The physician now seeks a stay of the revocation of his license pending the results of this appeal. It is manifest on the face of his application that he has not alleged any substantial issue to be raised on the appeal. Therefore, even though the State has stipulated to a stay, the court will deny it.

         A. Facts The Board summarized the evidence before the Hearing Officer in part as follows:

Based on the testimony of the State's expert, the hearing officer found as a matter of fact that Dr. Hannan's practice of prescribing opioids ignored a number of "red flags, " that indicate that his patients were seeking controlled substances for nontherapeutic purposes. Dr. Hannan requested MRI reports from his patients at the time of their initial presentation, but made little to no effort to secure any charting of prior pain management physicians. Dr. Hannan ignored point-of-care urine screens that indicated patients may be taking prescriptions, or other opioids, that he was not prescribing. Dr. Hannan required the execution of a pain management contract, but did little to enforce the terms of these agreements. Physical examinations were never performed, pursuant to the testimony of the patients highlighted in this hearing, and this is corroborated by the medical records that include no indication that physical examinations were performed. Dr. Hannan's medical records hardly ever included diagnoses, and medications were increased without documented rationale. Dr. Hannan's files did contain "short form" and "long form" disclosures about the risks and benefits of taking controlled substances, but the hearing officer found these were fill in the blank forms that weren't filled in, and referenced discussions of risks and benefits occurring elsewhere without documentation of any other discussion of the risks and benefits. The hearing officer found as a matter of fact the Dr. Hannan engaged in discussions with his patients including discussions of Dr. Hannan's Nurse Practitioner's family situation, as well as multiple conversations about Dr. Hannan being investigated by the DEA. Finally, the hearing officer found as a matter of fact that on April 22, 2015, Dr. Hannan was arrested and charged with knowingly and unlawfully carrying a concealed loaded handgun in his briefcase, a misdemeanor offense for which he pled guilty, but successfully completed probation before judgment.

         The State based its case against Dr. Hannan on his treatment of eight patients. The court need not detail the evidence relating to each patient at this point. Suffice it to say, the Board found that the "record of how these patients were treated is deplorable." The following are illustrative points:

• Dr. Hannan repeatedly prescribed opioid medications for patients without documenting any justification for doing so. He increased dosages even though there was no report of new symptoms or increase pain, and in at least one case ordered an increase in dosage even though he recorded that the patient reported she was doing well.
• Urine drug screens frequently were negative for the opioids he was prescribing, suggesting that the patient might be diverting the medication rather than taking it.
• On some occasions Dr. Hannan prescribed Oxymorphone (a drug with twice the potency of Oxycodone) without any justification being apparent from his records.
• The Pennsylvania Prescription Monitoring Program ("PMP) record shows that roughly 53 of Dr. Hannan's patients filled their prescriptions in Pennsylvania pharmacies. The PMP for one patient illustrates how quickly and freely he handed out prescriptions for pain killers:
o Initial prescription: 90 Oxycodone (30 mg.) and 56 Oxycodone (15 mg).
o Prescription changed to 84 30mg and 84 15mg. later.
o When patient reported this was "not enough" Dr. Hannan increased the Oxycodone 30mg tabs from 84 to 160.
o April 11, 2013: Appellant prescribed 160 Oxycodone 30mg tabs for the patient.
o Six days later (April 17) he prescribed 58 Oxycodone 5mg tabs for the same patient.
o May 10, 2013: Appellant prescribed 124 Oxycodone 30mg and 62 Oxymorphone 5mg tabs to the patient.
• Many of Dr. Hannan's patients came from out of state. According to one patient ostensibly living in Elkton, MD, Dr. Hannan knew that the patient actually resided in Kentucky and travelled by train to Elkton to obtain prescription. Another patient estimated that 35 to 40 of Dr. Hannan's patients resided in Shamokin, Pennsylvania, which is 115 miles (and roughly a three-hour drive) from appellant's office.
• One patient wore an audio recording/transmitting device to a visit with Dr. Hannan. The records prior to the recorded visit show that Dr. Hannan increased the patient's dosage of Oxycodone even though the patient advised of a "2" on a pain scale of 0 to 10. The recording shows that the patient told Dr. Hannan that he sold half of his prescribed drugs to support his family, and later told appellant he intended to sell half of the drugs. Dr. Hannan advised the patient that such activity was a criminal offense, whereupon the patient told Dr. Hannan he intended to continue selling the drugs. Nevertheless Dr. Hannan prescribed 150 tabs of Oxycodone 30mg and 60 tabs of Methadone 10mg "to prevent withdraw."

         The Hearing Officer observed that:

The evidence in this case establishes that Dr. Hannan was enabling a criminal drug gang in Pennsylvania by providing them with a regular source of controlled substance prescriptions to be sold on the street.

         The Board had a similar view of the evidence, concluding:

Dr. Hannan's practices show a clear priority on money-making at the expense of appropriate patient care. There is a real concern for public safety.

         B. The court will not agree to the stipulated stay

         The State and the appellant have stipulated that this court stay the Board's decision pending the outcome of this appeal. It is manifest from the papers that the sole purpose of the stay is to prevent (for the time being at least) Florida medical authorities from learning the Delaware Board's revocation of Dr. Hannan's license. Dr. Hannan is now treating patients for pain management in Florida, which apparently includes prescription of narcotic pain medications. The purpose of the motion is to prevent (for the time being at least) Florida authorities from learning that his license has been revoked in Delaware. According to his motion:

Appellant continues to practice in the area of pain management medicine in Tampa, Florida. Without a stay, and without being afforded his constitutional due process rights, the discipline will be made public and placed on the National Practitioner Database. * * * Appellant's patients, for the most part, suffer from chronic and life-altering pain and rely upon his practice for obtaining relief from that ...

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