Physician's Opioid Prescribing Habits, Behavior Raise Doubt Over Standards For Arkansas Doctors
Bill Witty sits on his front porch on a large plot of land in Harrison, Ark. He lost his daughter Jill to an opioid overdose. She was 24 years old.
In the distance, over some rolling hills, is the cemetery where Jill is buried.
"You'd have to have field glasses to see it, but you can see her headstone from here," Witty points out.
Witty wanted to understand how Jill and the man she was with at the time of her death had access to such large amounts of powerful narcotics like fentanyl, morphine, and oxycodone. He started to look into the pain management physician in town, Dr. James Merlin Hawk, M.D.
Jill was not Dr. Hawk's patient but doing some investigating was his attempt to get more information on what might be happening in his community.
He'd seen statistics from the Centers for Disease Control and Prevention that Boone County, home to Harrison, was tied with Sebastian County in having the largest opioid prescribing rates in Arkansas, almost three times the rate per capita than the national average. The difference, however, is that prescribing rates have gone down noticeably in Sebastian County but have increased in his county.
He gets emotional thinking about his grandson, who was just three years old when Jill died. It's hard for him to think about one day having to explain to him what happened to his mother.
"I'm not the kind of person, and I wasn't the kind of dad that's going to have to look at my grandson and say, 'Gee we don't know. We never checked into it.' I'm not going dishonor my daughter by saying 'Gee, she was an addict. Those things happen'," Witty says.
Hawk's file with the medical board is more than 900 pages. It includes statements from medical experts who reviewed patient charts and warned that Hawk was prescribing excessive amounts of opioids and other controlled substances and that he wasn't keeping proper records to justify continuing to prescribe the medications.
In March of 2016, Dr. Daniel Pace of Searcy Medical Center, who reviewed five patient charts, said "there are irregularities which rise above the standard for malpractice. Dr. Hawk has displayed behavior and treatment which meets the criteria for 'grossly negligent.'"
In addition to serious concerns about prescribing habits, there are questions about whether mental illness could be affecting Hawk's ability to practice medicine safely. A psychiatrist in Little Rock who reviewed Hawk's mental state in September of 2016, Dr. Brian Hyatt, noted Hawk had just had a severe bipolar manic episode.
He said Hawk's wife told the University of Arkansas for Medical Sciences he'd tried to strangle her.
His wife also claimed Hawk had been abusing family pets and his step son wrote a letter to the medical board saying his father had threatened to hurt his dog and had said he wanted to look into the dog's eyes while he was beating it. He said his father would also aggressively kick his cat. He told the medical board Dr. Hawk was a great guy when he was on medication and attributed the disturbing behavior to his father refusing to take it.
It wasn't the first time questions arose about whether Hawk was mentally fit to practice medicine. While in California in 1998, he had a manic episode there and was hospitalized. He was told that if he wanted to keep his license, he would need to be on 15 years probation, take medication and be under the care of a psychiatrist.
Dr. Hawk moved to Arkansas shortly thereafter and Carlos Villatoro with the Medical Board of California explains that he surrendered his California license in 2000.
"He did not seek to reinstate his surrendered license, and that's the last that we heard of him," said Villatoro.
When Hawk came to Arkansas in 1999, he was told he must be under the care of a psychiatrist for a year before he could get a permanent license.
In the 2016 letter to the state Medical Board, the psychiatrist in Little Rock expressed concerns over whether Hawk would be taking his mood-stabilizing medication after the manic episode. He said Hawk's wife indicated that he'd told her he wouldn't be and that he felt like he had "fooled" the psychiatrist.
Dr. Hyatt wrote it was "suggestive of an utter indifference to the potential consequences his untreated mental illness could cause his patients and therefore represents gross negligence."
While Hawk was seeking treatment in an inpatient psychiatric facility in 2016, a doctor was recruited to fill in at his practice in Harrison. Soon after she started, she called the medical board to say she was aghast to see the amount of pain medications Dr. Hawk was prescribing. She described the clinic as a drug mill and left after two weeks.
But, despite it all, Dr. Hawk still practices medicine today.
"That's not someone who should be in the practice of medicine. So I'm not going to sit here and defend the medical board on this decision. There's just no way I'm going to," says Dr. Carlos Roman, an anesthesiologist in Little Rock.
Dr. Roman heads the Pain Management Review Committee of the Arkansas Medical Board. The Committee looks into physician prescribing habits when complaints are made and then makes recommendations.
He's reviewed Hawk several times over the past five years. Roman has said in his assessments that Hawk was repeatedly giving excessively large quantities of narcotics to patients with common medical problems and that there was high risk that patients were selling their medications.
He's told the Arkansas Medical Board that Hawk "shows an extreme departure from the standard of medical care."
Dr. Roman says he feels like he's fighting an uphill battle when it comes to speaking out about the risk surrounding opioids.
"There's a lot of crappy politics on this. One of the problems is there's a shipload of money that people are making on this, from the drug companies to the physicians. And a lot of these physicians have effective lobby with legislators," Roman says.
He also says he thinks a shortage of physicians in small communities in Arkansas leads to lower standards.
"The other thing with the medical board is there have been doctors that were bad prescribers in small communities," Roman says.
"And one of the fears and the apprehension of the board was, 'Well, if we take this doc out, he's got two thousand patients. Who's going to take care of them? They're going to flood the emergency rooms in opiate withdrawal. The community would be deprived.' So there have been times when the medical board has not wanted to make a disciplinary move because the effect it ripples through the community."
We spoke with the medical board's attorney, Kevin O'Dwyer, who did not want to be recorded for broadcast. He says no one disputes that Hawk had a manic episode in 2016 and that it wasn't safe for him to continue to see patients. But, he says that after undergoing treatment, a psychiatrist found him fit to practice medicine again.
A report from that psychiatrist isn't found in Hawk's file. O'Dwyer says that documentation is kept by the Arkansas Medical Foundation and isn't released to the public. We tried to contact the Foundation but its medical director would not speak with us.
As for overprescribing opioids, O'Dwyer says the board doesn't revoke a doctor's license for that. It instead imposes requirements on doctors, like additional education. In Hawk's case it meant taking two courses, one on setting boundaries with patients and one on proper prescribing.
We reached out to Dr. Hawk, who initially agreed to be interviewed. But a few hours later, that interview was canceled at the advice of his attorney, Bruce Tidwell in Little Rock.
Tidwell would not talk about Hawk's case specifically, but did say he has concerns about how over-prescribing of opioids is currently being defined.
He says fear seems to be resulting in rules that are too stringent, making it hard for doctors to do their jobs. Tidwell says he thinks physicians should be allowed to make decisions on a patient-by-patient basis.
"We're kind of in an over correction period, maybe. And we've had some bad cases out there about too many opioids."
He also seemed to echo the sentiment that physician shortages in parts of the state are a factor in decisions about removing physicians from communities. He says he thinks the medical board has a tough job because it gets conflicting information from different experts.
"[The medical board is] trying to balance keeping the public safe but at the same time not removing medical care where we don't have an overabundance of it in Arkansas. Especially when you get outside of the major metropolitan areas," Tidwell said.
As for doctors practicing medicine safely while battling mental illness, Tidwell explains that if a physician is admitted to inpatient treatment for mental health issues, they'll typically have their license suspended temporarily, as in Hawk's case, and then are cleared to return to practice.
"The Board has always been encouraging of physicians if they think they need help to get help," says Tidwell. "Usually that will be monitored maybe through the Medical Foundation where they just get reports every now and then to say 'This person's doing what they need to do. They're safe to continue practicing.' But in those cases usually they are allowed to continue practicing."
Bill Witty of Harrison continues to mourn the death of his daughter. He says investigating doctors can feel strange to him, since he grew up in a culture where it was ingrained that doctor always knows best.
"Whatever the doctor tells you to do, you don't say 'Why?' You don't say 'Are you sure?' You don't question them. You trust them," Witty says.
"And how much dependency is there on that trust? Because that trust also becomes complacency and it also becomes apathy. And that may be part of the reason we've got an opioid epidemic."