5 patients died on his watch. Now his license is on the line.

VIRGINIA BEACH

A Virginia Beach doctor who has treated thousands of patients for chronic pain could have his medical license revoked after at least five patients died under his care.

Dr. Stephen Plotnick faces a hearing this week before the Virginia Board of Medicine, which suspended his license in August, citing “a substantial danger to the public health or safety.”

Plotnick specialized in treating fibromyalgia, a little-understood disorder characterized by widespread pain and heightened sensitivity to touch.

He was known for his aggressive treatment of the disorder, often prescribing powerful narcotics. In at least five cases, patients died of overdoses. In other cases, patients were hospitalized for severe depression and addictive symptoms.

Plotnick also has been named as a defendant in six malpractice lawsuits, one of which has been settled.

If the Board of Medicine revokes Plotnick’s medical license, he would join a tiny percentage of Virginia’s 25,000 doctors who have received the board’s severest penalty. Last year, the board revoked 56 licenses; only four were for prescription-related breaches of medical standards.

Plotnick’s record of fatal cases dates at least to December 2003, when he began prescribing narcotics for a woman identified only as Patient O in Board of Medicine records.

The board alleges that he continued prescribing the drugs despite noting in his records that the woman was unclear about how to take them properly. The combination of medications caused her to complain several times of nausea and vomiting.

Two months later, on Feb. 19, 2004, she died of an overdose of drugs that includ ed narcotics Plotnick had prescribed during her last visit on Feb. 11.

That same month, two other patients were admitted to a psychiatric center for treatment of severe depression and detoxification from the drugs Plotnick prescribed.

In May 2004, Plotnick began prescribing narcotics for another woman, Patient M. The board alleges that he continued the treatment despite being told by the patient, her family members and other doctors that she might be overmedicated and might not be following Plotnick’s dosing instructions.

On March 3, 2005, the board alleges, Plotnick doubled Patient M’s dosage of oxycodone, marketed under the trade name OxyContin , without giving her proper instructions, even though he knew she had previously had trouble understanding his dosing instructions. He also prescribed a combination of antidepressants, including sertraline and nortriptyline.

Two days later, on March 5, Patient M died. Two forensic toxicologists and a medical examiner concluded that her death was the result of “acute combined drug toxicity (of) oxycodone, sertraline, and nortriptyline.”

The same month, Plotnick began prescribing narcotics for Taryn Holland, a young Chesapeake mother of three. Again, the board alleges, he continued the therapy despite concerns about overmedication voiced by the patient, her husband and another physician. Plotnick is said to have advised her to manage her own medications and to adjust the dosages as she saw fit.

On March 30, 2008, Holland was found dead in the bathroom of her home of an overdose of methadone and other drugs, including drugs prescribed by Plotnick during her last visit March 19. She was 29.

According to a $1.9 million lawsuit filed by Holland’s widower in October, Plotnick did not examine Holland during the final 15 months of her life but instead delegat ed her care to his office personnel.

The case is set for trial in August.

A month after he began treating Holland, in April 2005, Plotnick began prescribing narcotics for Harold McDuffie II, a Virginia Beach father of two. He continued the treatment, the board alleges, despite noting in his records that McDuffie had shown “inappropriate or irresponsible behavior” in relation to his medications, including requesting early refills.

On Feb. 5, 2006, McDuffie was found dead sitting at his computer. He was 37. The cause of death was an overdose of drugs that included oxycodone and hydromorphone .

McDuffie’s widow filed a $1.8 million lawsuit in September 2007. Plotnick settled the case in June for an undisclosed amount .

In August 2005, Plotnick began prescribing narcotics for a Virginia Beach woman, Teresa Parker. On May 30, 2008, she was seen having an apparent seizure in her locked car in the parking lot of Janaf Shopping Center. Rescue workers broke in and took her to Sentara Leigh Hospital, where she was declared dead of “acute combined oxymorphone and amphetamine poisoning.” She was 48.

A $5 million lawsuit filed last week by her widower alleges that Plotnick’s “unabated negligence” compounded Parker’s psychiatric and pain management problems with overmedication, addiction and major depression.

Marsha Coogan went to Plotnick in 2003 after seeing a succession of doctors who seemed unable to deal with her fibromyalgia. She had been diagnosed with the disorder after severing her Achilles tendon in a kitchen accident in 1999.

Coogan, 48, a Chesapeake mother of two, suffered from migraine s and pain in her neck, back and knees that forced her to give up her job as a school bus driver. Once a five -mile-a-day jogger, she had quit running.

Plotnick “was very charismatic, very upbeat,” she said. “He would bounce around with a big grin on his face. He thought I was going to be an easy case. He said he’d get me back running in no time. He was so easy to trust.”

According to a $5 million lawsuit Coogan filed last week , Plotnick put her on a variety of powerful medications, including Actiq , which is approved only for managing severe cancer pain, and failed to monitor her intake.

One morning in October 2006, Coogan said, “I woke up and could not breathe.” As her husband drove her to Chesapeake Regional Medical Center , “I thought I was going to die before I got there.”

That was the first of three hospitalizations. Coogan’s lawsuit alleges that the cocktail of potent drugs prescribed by Plotnick led to a cascade of adverse drug interactions, overmedication and addiction.

Plotnick, 46, a rheumatologist, initially was licensed to practice medicine in Virginia in 1993. He has lectured widely on fibromyalgia and chronic pain management and was named a “physician of choice” for fibromyalgia care by a local support group.

He was selected by drugmaker Pfizer Inc. to help market Lyrica , the first drug approved by the U.S. Food and Drug Administration for treating fibromyalgia.

He did not respond to interview requests for this report.

In a 2003 interview with The Virginian-Pilot, Plotnick said he believed that most fibromyalgia patients weren’t treated aggressively enough:

“Many times, those with fibromyalgia feel helpless, but they shouldn’t give up hope. There is a combination treatment that works for every individual.”

Some of Plotnick’s patients defend him, saying he saved them from a life of intolerable, debilitating pain.

Christine Gauss, 53, of Chesapeake developed fibromyalgia after she was in a car accident in 2001. The pain she experienced in her neck and back afterward wouldn’t go away, and she developed flulike aches in muscles and joints throughout her body.

She went to an array of doctors, even an acupuncturist, but couldn’t find relief until she went to Plotnick in 2003.

“I was running into walls, and he understood,” she said. “He knew how to help me.”

Gauss said it took about a year to find the right combination of drugs, which included several narcotics.

“Without the meds, I can’t function,” she said. “I would not be able to work or do anything. I’d go insane because of the pain. I wish more doctors would realize it’s a disease, that it’s real and that people suffer from it.”

After Plotnick’s license was suspended, Gauss struggled to find a doctor who would prescribe the same medications. As soon as she told some doctors’ offices she had been seeing Plotnick, they wouldn’t accept her as a patient.

“They have their own opinion,” she said. “Some do not believe in it. They say: 'It’s all in your head.’”

If Plotnick gets his license back, Gauss said, she’ll be first in line to return.

“I have been going to him for years, and he was nothing but professional and helpful. He understands. He’d say, 'We will figure this out. We will make you feel better.’ He truly wanted to help people with fibro – that was his goal.”

Fibromyalgia is a mysterious ailment, even controversial in some quarters. Some critics regard it as psychosomatic. Its cause is unknown; there is no cure, nor is there any objective test to confirm it. There are no outward symptoms; to those around them, sufferers appear normal.

Its history as a medical diagnosis is brief: The term was coined in 1976, and it was recognized as an illness by the American Medical Association in 1987.

According to the National Fibromyalgia Association, the disorder affects an estimated 10 million people in the United States, mostly women. Symptoms include widespread body aches, stiffness, soft tissue tenderness, general fatigue and sleep disturbances. It often is associated with depression.

Most researchers agree that the trigger for the disorder lies not in the affected muscles and tissues themselves but in the central nervous system, which somehow misfires and sends the wrong sensory signals to the brain, amplifying the pain.

Recommended treatments include exercise, sleep-restoring therapy, antidepressants and non-narcotic pain relievers. The disorder is not life-threatening – sufferers face the prospect of living with it for decades – so narcotics generally are considered a last resort because of the potential for addiction.

Board of Medicine records document 19 cases in which Plotnick prescribed narcotics, sometimes as many as four at a time. Frequently, the board alleges, he allowed patients to manage their own medications – telling them to try first one, then another to find what worked best – and failed to monitor them adequately.

In an e-mail interview, Dr. William Harp, executive director of the state board, said he could not comment on the Plotnick case beyond what is available in the board’s public documents. Those don’t indicate how the case first gained the attention of the board.

In general, he said, board investigations are spurred by complaints and by malpractice lawsuits that result in paid claims.

Plotnick also is a defendant in two other pending lawsuits.

In May 2008, Albert Fary Jr., a longtime Portsmouth lawyer, sued for $2 million, alleging that drugs prescribed by Plotnick caused brain damage that forced Fary to give up his law practice.

In October, Courtney Guy of North, a small community near Gloucester, sued for $2.2 million, alleging that Plotnick inappropriately prescribed high doses of the cancer-pain drug Actiq for her chronic pain, fibromyalgia and headaches, causing permanent injuries and disability.

Marsha Coogan, the Chesapeake patient driven by her husband to Chesapeake Regional Medical Center , spent two weeks in the intensive-care unit hooked up to a ventilator with double pneumonia. According to her lawsuit, doctors there concluded that the multiple medications had depressed her respiratory system.

Over the next seven months Coogan was hospitalized twice more: at Virginia Beach Psychiatric Center, where doctors diagnosed her with possible “physician-aided” drug dependence, and Sentara Bayside Hospital, where Plotnick himself concluded that Coogan was overmedicated and addicted, according to the lawsuit.

Nevertheless, the lawsuit alleges, Plotnick kept putting her back on the narcotics.

“Marsha lost 4½ years with her husband and children because she was a complete zombie,” said her lawyer, John Heilig. “She was constantly in a state of overmedication and addiction.”

Finally, by July 2007, Coogan had had enough. She found another doctor in the Yellow Pages who gradually weaned her off most of the drugs. Her treatment now consists mainly of physical therapy, exercise, acupuncture, vitamins and a more-nutritious diet.

She still has pain, Coogan said, but it is manageable. Most important, she feels alive again.

“I’m awake. I have a new appreciation for life,” she said. “I still panic at times when I think about where I’ve been.

“To say I’ve been through hell is too simple.”

Pilot writer Elizabeth Simpson contributed to this report.

Bill Sizemore, (757) 446-2276, bill.sizemore@pilotonline.com