Doctor argues license suspension

FARGO, N.D. - The owner-physician of five area clinics whose medical license was temporarily suspended for poor tracking of narcotics and overbilling the state's Medicaid program says he is filling a need for people with chronic pain.

The North Dakota Board of Medical Examiners issued an emergency suspension of Dr. Rodney J. Lee's medical license on Friday and notified the public on Monday.

Lee operates independent RapidCare clinics in Fargo and Grand Forks, as well as in Moorhead and Detroit Lakes, Minn. The clinics specialize in offering quick care without appointments.

"The medical board has made it clear they don't have any concern over patients and patient rights," Lee said Monday. "Most of my patients have a choice between living with 24-hour-a-day pain or ending it all. There is nowhere else for these people to go."

Lee's medical license in Minnesota is still in good standing. It appears the clinics will remain open for the immediate future, although not under Lee's supervision.

The physician's practice violated accepted medical practice in several areas, according to a statement from the board that licenses North Dakota physicians. These include:

- Accepting returned controlled substances from patients and keeping the drugs in an unsecured desk drawer in his Fargo office. Proper records were not kept to track these narcotics.

- Insufficiently documenting and recording information related to pain management patients. For example, Lee did not put into patient reports urinalysis results that showed they didn't have the prescribed drug in their systems or they had illegal drugs in their systems.

- Routinely signing and post-dating blank prescription pads, which allowed physician assistants employed by Lee to complete them in his absence, specifically for controlled substances.

- Billing North Dakota's Medicaid program under Lee's name for services completed by physician assistants and nurse practitioners whose work receives lower reimbursement.

"The (board's investigative) panel found that he overextended his practice," said Duane Houdek, executive secretary for the licensing board. "The number of patients for whom he's trying to manage pain coupled with the lack of supervision demonstrates a continued pattern of inappropriate care on his part."

Lee's North Dakota medical license is suspended until an Aug. 13 hearing before the full board, Houdek said.

The physician said he often works 14-hour days, seeing about 70 people a day.

"I'm a dumping ground for patients other doctors don't want to see," he said. "That's become too much of a burden for me."

Patients notified

On Monday, the RapidCare clinic on 32nd Avenue South in Fargo handed patients a letter saying the state licensing board removed Lee's license "without regard to your immediate medical needs. Their decision is related to your chronic pain. You have a right to pain management, but we do not know who can help you right now."

The physician assistant who worked with Lee in North Dakota was told that she can't practice without a new supervisory physician, Houdek said.

By Monday afternoon, six advanced practice nurses had told the state Board of Nursing that they were entering into a new agreement with a Long Prairie, Minn., physician whose supervision would allow them to continue to practice, said Connie Kalanek, executive director of that licensing unit.

Lee called the Board of Medical Examiner's allegations "nitpicky."

"There's a lot of hostility toward doctors who help patients," Lee said. "The medical community prejudges patients based on their appearance and social status. For some reason, patients like to see me. Probably because I respect them."

Patient Heather Morast of West Fargo arrived at the clinic on 32nd Avenue South in Fargo on Monday only to be turned away.

In the parking lot, she said that patients were "cut off cold turkey." She called the suspension of Lee's license "crazy."

She visited the clinic monthly to receive her pain medication and voiced concern about what she would do now.

"I feel horrible for him (Lee)," Morast said. "There's a lot of good people here. I just don't understand."

More details

According to the Medical Examiners board, on June 26 Lee ordered a staff member to destroy drugs stored in his desk by tossing them into a Dumpster.

He said he used to record narcotics returned by patients, but when the clinic got busy, staff would just throw drugs in a drawer.

On the June date in question, he said he asked his office manager to toss the drugs as part of general housekeeping chores. Members of the state licensing board and the Drug Enforcement Agency arrived that day, Lee said.

"They were thinking there was criminal activity, but obviously there isn't," he said.

Houdek declined to comment on any potential criminal activity, saying that the licensing board only looks into whether the state's Medical Practice Act has been violated. A spokesman from the Fargo Police Department referred questions to the North Dakota Criminal Bureau of Investigation. A spokeswoman from that office said that agency doesn't confirm criminal investigations.

Lee said he only post-dates prescription pads when he works late in the evening and his physician assistant opens the clinic early the next morning.

He called the Medicaid billing issue a "technicality." He said he didn't realize that the state program doesn't reimburse mid-level practitioners at the same level as physicians.

Maggie Anderson, medical services director for the state Department of Human Services, said the agency was notified by a federal group of irregularities in RapidCare's billing for Medicare, the national insurance program.

The state agency then reviewed bills from RapidCare and found the improper billing practices. Anderson said the state is still researching how much money was overpaid.

Lee said he has discussed the sale or partial sale of his clinics to undisclosed parties. Those talks have been expedited.