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
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Fibromyalgia
http://www.painfoundation.org/learn/programs/fibromyalgia/5-things-fibro-awareness.html
Maybe this will enlighten some of youse.
correction
The problem with the armchair narcs posting here is that they fail to differentiate between legal and illegal drugs, thereby stigmatizing the truly bona fide patients.
Dr. Plotnik...Drug Dealer..............I think not!!!!!!!!!!!!
My Wife was a patient of Dr. Plotnik for about 2 years. Yes her recovery was rocky, but not because Dr. Plotnik did anything wrong. As far as the prescriptions for try out, he very carefully managed new medications, narcotic or otherwise. He did not just hand out all sorts of meds. He did however, give smaller ammounts of new meds to ensure that they were right for her. We traveled to Arizona last summer. While there my wife needed a prescription for lasix, to combat swelling for the flight. Did we end up leaving a dozen messages and waiting for days, Hell No!! I made 1 call to his personal cell phone, which he made available to his patients, and within thehour her prescription was filled. On many other occasions I was able to get him, first try on his cell phone and if I had to leave a message I don't think I ever waited more that 15 min for a return call.
If drug seekers and patients who abuse drugs end up dying as a result of thier irresponsibility, I say good. Obviously Darwin's theory of natural selection is well at work. The treatment of Fibro and other chronic pain syndromes lost one hell of a great physician. He always included in in her care, always sent us home with educ
Judging Is Easy
It's easy to judge others from the outside. It's an entirely different thing from the inside. We all react and respond differently to the same things. Cold or flu symptoms can vary widely and react differently to the same treatments, and even be life-threatening. Many FMA sufferers achieve satisfactory results from diet, exercise, acupuncture, massage, etc. It doesn't work for all of us, and we don't froth at the mouth craving controlled medications. We crave a human existence.
I could write pages on the merits of Dr. P., but will sum it up with he is the most conscientious, caring, and determined Dr. I have ever seen. His practice provided the clearest, most extensive level of understanding of treatment options and instructions for EACH patient. Healthcare would be greatly improved to mimic his efforts. Society seems to look for scapegoats when something does not go its way. Look elsewhere.
patient deaths
These deaths are the only ones being looked at currently because of the direct complaints to the board. We will never know unless all of his dead patients records and family follow up is conducted to determine cause of death in each of them. These are not deaths attributable to natural causes, i.e., they would have died no matter who their physician happened to be. True, it may be that some of the deceased patients took more than prescribed, but when he tells them all to experiment to see what works best, that's a loose cannon, not a direct prescription. Then, when only prescriptions are taken and as prescribed, most of these deceased still had overdose levels in their toxicology. That is a direct result of the prescriber overdoing it and allowing it to continue unchecked because he did not monitor them medically. Get it now? CRIMINAL!!!
Incredible
I'm not a patient of Dr. Plotkin's, nor would I be if I could. That being said, I find it astonishing the people who claim to have fibro and beaten it but when asked how, say things such as "self-massage", or exercise, or something equally ridiculous. There are days when my fibro is so virulent I literally can't move because the simple act of fabric brushing across my skin brings tears to my eyes. Then there are the days that the only way I manage to get out of bed is because I'd rather deal with the pain than WET THE BED. Those are the days that I start out crawling. Literally. If I could safely take opiates I would do so in a heartbeat. I say good for Dr. Plotkin. I hope he beats the charges and continues to help those folk who actually suffer from Fibro.
With any doctor, there lies
With any doctor, there lies a risk of death in patients. The article mentions Dr. Plotnick treated over a thousand. At one thousand patients and 5 deaths, 0.005% of his patients died. At three thousand patients, that number becomes 0.001666666666. Compared to how many lives he saved, that number becomes almost negligible (with no offense to the deceased). Dr. Plotnick didn't dole out narcotics, he allowed the patients to decide what worked best with strict instructions. Additionally, it shouldn't be a doctor's responsibility to read a patient the dosing instructions. Dr. Plotnick is an incredibly kind man, one who is incapable of malice or such negligence. My prayers go out to him and his family, and wish the best for him as well as the deceased.
Standard of care.....
This article clearly states that Dr. plotnick did not even see one of the patients for the last 15 months of their treatment. And I know for a fact that he didn't always see his patients. I was a patient for 5 years and for the last three years of my treatment I rarely saw Dr. Plotnick! Yes in the begining of my treatment he did spend time with me and made sure I was clear on everything, but as his practice grew I felt that he cared more on seeing as many patients as possible than giving the care that was necessary to me. Everytime I went to his office I waited for at least two hours, and after he add two LPNs I still waited and there was never a guarentee that I would be able to see Dr. Plotnick! So this goes to show you that not every patient recieved the GREAT CARE you so passionately express!!!
Taking responsibility for your own actions
I have been a patient of Dr. Plotnick’s for 13 years. I will say that he took me from merely existing to living life again. Yes, I took prescribed narcotics and still need to. However, I was able to reduce the amount needed significantly because of Dr. Plotnick’s diligence in figuring out what was wrong with me. But, not only did he prescribe medicine, he also encouraged me to exercise, diet and to use alternatives to medication. This included use of the alpha-stim electrotherapy machine, reading books by Eckhart Tolle concerning helping your body heal through positive thoughts and journaling. He used computer printed prescriptions with complete and concise instructions which included the name and address of the pharmacy in which it had to be filled. He also gave printed instructions concerning your care that you needed to follow until your next visit with him and a printed medication list on which it was listed what you needed to take, how much and when.. You also signed a medication contract stating that you would take your medication as prescribed. When you arrived for your appointment, you never knew if you would be required to submit a urine sample for urinalysis. D
Marsha Coogan
This is a perfect example of people in our society that take no accountability for their actions and decisions. I find it hard to believe that anyone with more than one brain cell could be 'surprised' that they had any side effects and/or a possible physical addiction to some of these medications, when there are pages of warnings that the pharmacy gives you when you pick up the medication, not to mention the ones on the bottle in big red letters, even many non-narcotics have a fair amount of 'warnings' and contraindications.Thousands of people died from Vioxx. I think the majority of us are fully aware of the potential side effects we could have, and consent to this type of treatment. No doctor twisted our arm to take anything. I know for a fact if you wanted to come off of any of the medication, Dr. P took you off IMMEDIATELY. I know, because I had asked to stop before over a side effect. Take accountability, lady. Don't sue over your decisions, Marsha and the lawyer with 'brain damage'.. Gimme a break. No wonder our healthcare costs are sky high, people will do and say anything to file a lawsuit and get some money to move to a bigger trailer, why work for a living when you can s
You should not judge without ALL of the facts.
It always bother me to see people judging others when they have never even met them. You only need to meet Dr. Plotnick once to know that he genuinely CARES about this patients. I feel sorry for the families above and I know they want someone to blame, but I can assure you Dr. Plotnick is not the one to blame. The article indicates that this handful of patients were confused on taking their medications properly. What it doesn't tell you is that Dr. Plotnick spends about an hour with each patient counseling them on how to take their meds. He also types up the instructions for you to take home so that you and your family (if they care) can be sure that you take your medications properly. In addition to this, you have to watch a movie on medications and sign about a 15 page document stating that you will not take your medications in any way other than how they are prescribed and that you will report any change in moods, symptoms, etc to him immediately. He prints out your prescriptions on the computer with your picture on most of them to be sure that you are the only one who can get your medications. I have NEVER had a doctor that is as cautious and as caring as Dr. Plotnick. As for n
I myself was a patient of Dr
I myself was a patient of Dr Plotnick's until there was a change in Insurance policies. I was monitored very carefully by the Doc and when I was prescribed heavy meds my Insurance did not refuse. And I was never on the narcotics or heavy drugs for a long period, just long enough to do what was expected to be done and then I was off. When I had a visit with the Dr I always rec'd a written review of what was said and done, how to take meds, possible side effects to look for and a Rx for just a couple of pills to see if it was a proper med for me.(I always read and reread the information before I started taking the meds - yes I am a worry wart- I wanted to make sure I understood what the meds were being used for and what to look out for. There were times that I took the beginner samples and then refused to take them because I didn't like the way it made me feel or didn't want to take those particular drugs and the Dr would try soprescribe something else.) Dr Plotnick always encouraged me to exercize, always asked for a list of the drugs I was taking including OTC and vitamins. Yes, I saw his Nurse Practicianers (they were great!) who were very knowledgable on the illnesses which I hav
pain management
I am a nurse at a local family practice. Our pracice has encounterd not only some of Dr. Plotnick's former patients, but other pain management patients as well. I for one am a Major Patient Advocate. There really are people out there that need to be seen and heard in order to receive the appropriate care with their pain indications. Sometimes you have to be open minded in our profession . You must not only listen to what the patient is saying, you must hear it as well. Do the proper research into their previous treatment, no matter who it was with. All you have to do is use the appropriate channels to receive their previous records and follow up from there. The records generally give us professionals the information we need in order to help these patients who truley need to be helped. I believe in taking that extra step in order to make a difference in these patient's lives. This type of treatment does require the help and input of their families and loved ones. Think about it, those people are the ones that live with and see these patients after they leave our office. Please listen to what these people are saying and act accordingly. Not everyone is a "drug seeker". These patients
I was a patient of Dr. Plotnick's
I was a patient of Dr. Plotnick's for 8 years, from 2000 tilo 2008 and I have never, I repeat never had any problems with any treatment he has given me. He helped me through alot of pain, sickness and depression. If it wasn't for Dr. Plotnick I would not be here today or even in the state of remission that I'm in. I thank God for his guidance, treatment and advice through the years. Even my family appreciates all that he's done for my ilness through the years. My prayers are with him.
HLT
Who Dr. Plotnick really is
Dr. Plotnick is a very caring man as well as probably the most intelligent person and definitely the most knowledgeable about fibromyalgia I have ever known.He had multiple safeguards in place such as written as well as spoken instructions in addition to the ones on the bottles. We had to fill out 2 pages outlining how we were doing and how we actually took our meds. He did random drug tests to be sure we were compliant and were not overdosed. I have been his patient since he was at Portsmouth Naval Hospital. (diagnosed with fibro in 1981) Since his license was suspended my life has been miserable because no one will prescribe ANYTHING to help with the pain. I also have myofascial pain syndrome, spinal stenosis, degenerative vertebrae disease and severe arthritis. Pain meds were not "simply" for fibromyalgia as if that wouldn't be reason enough. I plan to return to Dr. Plotnick as soon as he regains his license. Then I'll be able to do more with my life than just suffer.
Glad to be here!!
I used to be a patient of Dr. Plotnick's alot of these stories sound alot like what I went through. I was addicted to the narcotics Dr. Plotnick prescribed me, luckily I found a doctor that was willing to help me get off the pills. I feel I've lost five years of my life, but I trusted Dr. Plotnick and kept with him hoping that I would get better. Finaly two years ago I left Dr. Plotnick's care,I found out that I had a different disease that he could have diagnosed, but overlooked. Now my new Dr. is having to play catch-up trying to undo the damage that has been done by going 5 years undiagnosed. It felt to me as if Dr. Plotnick pushed fibromyalgia, no matter what was bothering me it was "fibro" realated. I am glad his license has been taken away, now he can't do to other families what he has done to mine!
Where is the technology?
Where is the technology? Computer equipment is cheap. Why don't doctors write out scripts using a computer (touchscreen, etc). This way the script is always legible, and the doctor can confirm it by sight. Following this, the patient (before leaving the office) could be required to watch a short CBT (computer based training) type of video / animation that warns of dangers and issues with dosage, combinations with other drugs, and gives directions based on what the doctor prescribed. I would never rely on technology 100%, but this is stuff that could be assisted with technology to help ensure process is followed. Confused patients? They could easily print out clear, concise directional for the patient to keep with the specific instructions. I'm pretty sure some pharmacies keep profiles on customers that do some of this. But it could be carried further.
Sleeping pills
I tore up a muscle around the time of Anna Nicole's over dose death. The doc prescribed me a muscle relaxer, an NSAID, and 3 days of a pain killer. He made a really big deal at the time about sleeping pills...He made sure I never used sleeping pills as he said it was a big deal in the medical community at that time, due to a narcotic taken with a sleeping pill cause some kind of respiratory slow down (shallow breathing) many people he said, die in their sleep due to that shallow breathing...Looks like some of that was going on in at least one instance here. My thoughts go out to the loved ones of the deceased.
The Struggle
I can't help but to feel some sort of empathy for Plotnick. I worked a very fast paced, professional/science career, where I had to make many decisions daily that immediately affected many people directly. It is very stressful! I couldn't imagine how much extra stress was added to his day dealing with and discerning the difference between a convincing junky, a drug seeker, or a person crying in your presence asking you to "Heal" them from their debilitating pain. Now all those decisions are directly affecting him...whether it's through all those lawsuits, loss of a career he worked his whole life for, or the haunting memories of how many of his decisions turned out. As my old mentor used tosay...life is tough.
Living with fibromyalgia
I was diagnosed at 25, I'm 40 and everyday is a challenge. I have pain in all 18 points, simple hugs HURT, the pain is not in your head. I work over 50 hours a week, have 2 active children and volunteer for several groups. If I had layed in bed, took narcotics and not moved I would be disabled, it is disabling if you LET it. Thank God I had a doctor who believed in exercise and non-narcotic medicine. This doctor makes you believe you need him and his drugs. Your FIGHT is all you have, take control, giving in means giving up and the narcotic meds ony make it worse by allowing you to lie down and become disabled. Most people I am in contact with don't know I have the disease because I don't allow it to consume me and I fight everyday.