License Number 0101231157 Occupation Medicine & Surgery Name Gurpreet S Bajwa Address Fairfax, VA 22031 Initial License Date 11/01/2001 Expire Date 04/05/2018 License Status Suspended
ORDER OF SUMMARY SUSPENSION Pursuant to Virginia Code § 54.1-2408.1(A), a quorum of the Board of Medicine (“Board”) met by telephone conference call on April 5, 2019, after a good faith effort to convene a regular meeting of the Board had failed. The purpose of the meeting was to receive and act upon information indicating that Gurpreet Singh Bajwa, M.D., may have violated certain laws relating to the practice of medicine in the Commonwealth of Virginia, as more fully set forth in the “Notice of Formal Administrative Hearing and Statement of Allegations,” which is attached hereto and incorporated by reference herein. WHEREUPON, pursuant to its authority under Virginia Code § 54.1-2408.1(A), the Board concludes that a substantial danger to public health or safety warrants this action and ORDERS that the license of Gurpreet Singh Bajwa, M.D., to practice Medicine and Surgery in the Commonwealth of Virginia is SUSPENDED. It is further ORDERED that a hearing be convened within a reasonable time of the date of entry of this Order to receive and act upon evidence in this matter. Pursuant to Virginia Code § 54.1-2400.2, the signed original of this Order shall remain in the custody of the Department of Health Professions as a public record and shall be made available for public inspection or copying on request.
STATEMENT OF ALLEGATIONS The Board alleges that:
• In spite of Patient A’s approximate two-month absence from Dr. Bajwa’s practice prior to the patient's December 22, 2017, office visit (due to the patient’s attempt at another detox/rehab via the inpatient/outpatient CATS program), and although Dr. Bajwa checked Patient A’s PMP report on December 18, 2017, prior to the visit, and thus knew Patient A was prescribed Suboxone by another provider while absent from his practice, Dr. Bajwa failed to consult with the Suboxone prescriber to coordinate Patient A’s care, or document having done so, and did not request medical records connected to the patient’s Suboxone therapy. • In spite of the significant risk of central nervous system depression when Suboxone is taken with benzodiazepines, other sedative-hypnotics, and muscle relaxants. Dr. Bajwa nonetheless resumed prescribing alprazolam, eszopiclone, and carisoprodol at Patient A’s December 22,2017, office visit. • On April 4, 2018, Patient A was taken to Inova Fair Oaks Hospital via EMS with a suspected poly-substance overdose requiring ventilator support. EMS reported that Patient A was found with an empty bottle of alprazolam, and bottles of Suboxone, clonazepam, Phenergan, Lexapro, catapres, vistaril, gabapentin, and Lunesta (cszopiclone). After reviewing Patient A’s PMP report and noting the prescriptions from Dr. Bajwa, Patient A’s treating physician called Dr. Bajwa to discuss Patient A’s condition, and documented that Dr. Bajwa took her phone number but never called her back. In spite of actual notice of Patient A’s overdose. Dr. Bajwa nonetheless immediately resumed prescribing benzodiazepines, other sedative-hypnotics, a muscle relaxant, and a stimulant to Patient A as follows: Date Written Filled Medicadon/Dofe Quantity Days Supply 4/12/18 4/13/18 zolpidem lOmg 15 15 4/12/18 4/16/18 zolpidem lOmg 1 15 1 15 4/12/18 4/13/18 clonazepam 2mg 30 15 4/12/18 4/13/18 carisoprodol 350mg IKT rw~ 4/23/18 4/23/18 alprazolam 2mg 45 15 4/23/18 4/23/18 methylphenidate ER18 mg 30 30 4/23/18 4/23/18 eszopiclone 3 mg 5 5 4/23/18 4/27/18 eszopiclone 3 mg 4 4 4/23/18 4/28/18 eszopiclone 3 mg 21 21
• On April 28,2018, Patient A was admitted to Fairfax Hospital with another benzodiazepine overdose. The treating physician noted Patient A’s years’ long history of drug misuse and overdoses, particularly with benzodiazepines, her overdose risk score of 950/999, and the quantity of benzodiazepines Patient A had received in the prior month from Dr. Bajwa and others. Based on the provider’s assessment and “concern for death related to OD when she is released,” this physician notified Dr. Bajwa of Patient A's overdose on or about April 28,2018. In spite of notification of a second benzodiazepine overdose in less than a month, Dr. Bajwa promptly continued prescribing Patient A benzodiazepines and muscle relaxants as set forth below:
rDate Written Filled Medkation/Dose Quantity i Days Supply 5/3/18 5/4/18 carisoprodol 350mg 90 30 5/5/18 5/9/18“ gabapentin 600 mg 90 5/5/18 5/5/18 alprazolam 2mg z0~ l“7 5/5/18 5/7/18 alprazolam 2mg 45“ 15 5/5/18 5/8/18 alprazolam 2mg 25 9 5/9/18 5/9/18 temazepam (C-IV) 30mg 30 30 5/9/18 5/9/18 carisoprodol 250 mg 108 30 5/9/18 5/9/18 carisoprodol 250 mg 12 3 5/9/18 5/9/18 carisoprodol 250 mg 18 30 |
smeared make-up, and admitting that she had filled prescriptions written the day before by Dr. Bajwa for alprazolam 2mg #90, carisoprodol 350mg #3, zolpidem lOmg #15, and triazolam (C-IV) 0.25mg #10 prior to presenting to CATS. • On May 28, 2018, Patient A was admitted to Fair Oaks Hospital with her fourth poly-substance overdose in approximately a month, and again required ventilator support. She was discharged home on June 5,2018, with an alprazolam taper and information regarding community resources because no inpatient facility would accept her transfer. • In spite of Dr. Baj wa’s knowledge of Patient A*s abuse of the medications he prescribed, Dr. Bajwa continued prescribing Patient A multiple benzodiazepines, other sedative- hypnotics, and muscle relaxants through August 2018 as follows: Date Written Date Filled Medication/Dose Quantity Days Supply i 6/6/18 6/6/18 temazepam 30m g 15 30 I 6/13/18 6/27/18 eszopiclone 3 mg 30 30 1 6/13/18 6/18/18 alprazolam 2mg 30 10 6/13/18 6/22/18 alprazolam 2mg 60 20 6/14/18 6/14/18 r6/29/18 diazepam lOmg 14 14 6/29/18 diazepam lOmg 14 H 7/2/18 7/2/18 carisoprodol 250m g 20 20 1 7/13/18 7/19/18 alprazolam 2mg 33 n 7/13/18 7/18/18 alprazolam 2mg 6 2 1 7/13/18 7/16/18 | alprazolam 2mg e : 2 7/13/18 7/16/18 gabapentin 300mg 45 15 1 7/19/18 7/19/18 eszopiclone 3 mg 16 15 7/27/18 7/27/18 alprazolam 2mg 45 Is 1 7/27/18 7/27/18 zolpidem 10 mg 15 15 . 8/18/18 8/10/18 8/18/18 temazepam 30mg 7 7 8/13/18 alprazolam 2rog 60 20 1 8/10/18 8/13/18 zolpidem lOmg 30 30 1 8/10/18 8/13/18 gabapentin 300mg 90 30 ,
b. Regarding Dr. Bajwa’s treatment of Patient B, a then 22-year-old male, for complaints of anxiety from approximately January 2017 until his death due to fentanyl, morphine, and alprazolam intoxication on January 21,2018:
i. Absent any assessment or documentation of symptoms or a substance use history and risk assessment. Dr. Bajwa prescribed Patient B alprazolam lmg #90 (30-day supply) at his second office visit on February 4,2017 visit, based on only the patient’s report of "moderate" anxiety and his claim that he had taken alprazolam in the past. Only four days later, on February 8,2017, Dr. Bajwa
authorized a telephone prescription for alprazolam 2mg TID #45 (15-day supply), a substantial dosage increase, without documenting any therapeutic purpose for doing so in the medical record
ii. Also at his February 4,2017 visit. Patient B complained of “muscle spasms, esp. lower back. ’ Although Patient B disclosed his previous back surgery, Dr. Bajwa foiled to obtain or document a detailed history related to such surgery, including prior treatments and therapies, before prescribing carisoprodol 350mg #30 (30-day supply).
iii. During a February 24, 2017 visit, Dr. Bajwa prescribed
hydrocodone/acetaminophen (C-H) 10/325mg #30 (15-day supply) at Patient B’s specific request due to an “exacerbation of back pain,’ without conducting an examination, ordering diagnostic testing, obtaining prior treatment records, or referring the patient for an appropriate woik-up and further treatment.
iv. On March 27, 2017 and November 17, 2017, Dr. Bajwa respectively prescribed Patient B oxycodone/acetaminophen (C-II) 10/325mg #60, a 30-day supply, and oxycodone/acetaminophen 10/325mg #14, a 7-day supply, at Patient B’s specific request, while foiling to satisfy provisions of the Board’s Prescribing Regulations. Specifically, Dr. Bajwa foiled to do the following:
• Document having considered nonpharmacologic and non-opioid treatment for Patient B’s complaints of pain, as required by 18 VAC 85-21-30(A).
• Perform a history and physical examination appropriate to the complaint, query the patient’s PMP report, and conduct an assessment of the patient’s history and risk of substance misuse prior to initiating treatment with an opioid, as required by 18 VAC 85- 21-30(B).
• Document the extenuating circumstances justifying more than a seven-day supply, as required by 18 VAC 85-21-40(A)(1).
• Prescribe Naloxone when co-prescribing opioids and benzodiazepines or carisoprodol, as required by 18 VAC 85-21-40(B)(3).
by 18 VAC 85-21-40(C).
• Document a description of the pain, a presumptive diagnosis for the origin of the pain, an examination appropriate to the complaint, and a treatment plan, as required by 18 VAC 85- 21-50.
v. Dr. Bajwa failed to monitor and manage Patient B’s use of the controlled substances he was prescribing. Specifically:
• Dr. Bajwa continued to prescribe opioids, several different benzodiazepines, and carisoprodol to Patient B without taking responsive action even though his check of the patient’s October 18, 2017 PMP report revealed that Patient B received Suboxone on October 4,2017.
• Although Dr. Bajwa admitted in his statement to the Board that he learned from the patient’s mother that Patient B had a significant substance abuse and addiction history, including approximately two-years of intravenous heroin addiction and daily use, as well as opioid and benzodiazepine addiction and misuse, Dr. Bajwa failed to obtain or document a comprehensive mental health and substance misuse history, and did not take any steps to obtain the patient’s prior treatment records or coordinate with the patient’s other treating providers.
• Even after learning of Patient B’s addiction and drug misuse history, Dr. Bajwa continued to prescribe controlled substances to the patient without monitoring or managing the elevated risk as follows:
o Dr. Bajwa continued to prescribe Patient B alprazolam 2mg #90 and carisoprodol 350mg #90 approximately monthly from October 2017 through Patient B’s death in January 2018 without conducting a single urine drug screen (UDS) or pill count
o Although Dr. Bajwa claimed in his statement to foe Board that he checked Patient B’s PMP report “with every visit,” his PMP Access Audit records show that Dr. Bajwa prescribed controlled substances at office visits without checking the patient’s PMP report on February 4,2017; March 22,2017; March 27,2017; April 13,2017; August 14, 2017; and September 9, 2017; and authorized telephonic prescriptions without checking foe patient’s PMP report on February 8,2017; June 9,2017; and January 15, 2018, approximately a week before Patient B’s fatal overdose.
o On November 7,2017, Dr. Bajwa added lorazepam lmg #14 (7-day supply) to Patient B’s medication regimen for foe first time absent any documentation in foe medical records supporting a therapeutic purpose for foe medication.
vi. Patient B voluntarily entered foe Farley Center on January 6,2018, for drug detox and substance abuse treatment. On January 15,2018, although he had not seen Patient B in a month.
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Dr. Bajwa authorized telephonic prescriptions for alprazolam 2mg #90 and carisoprodol 350mg #90. Patient B was administratively discharged from drug treatment on January 17,2018, after he was found with the drugs Dr. Bajwa prescribed. Patient B died on January 21,2018, as a result offentanyl, morphine, and alprazolam intoxication.
c. Regarding Patient C, a then 29-year-old male, to whom Dr. Bajwa prescribed controlled substances from approximately January through August 2018:
i. At Patient C’s first visit on January 30, 2018, Dr. Bajwa prescribed oxycodone/acetaminophen 7.5/325mg #14 (7-day supply) in response to Patient C’s specific request and on May 25, 2018, again prescribed that medication for vague complaints of “moderate” back pain; prescribed oxycodone 15mg #60 (20-day supply) on June 4,2018, when Patient C presented after a hip fracture and surgical repair requesting pain medication; prescribed oxycodone 15mg #30 (10-day supply) on August 13,2018, for further complaints of pain related to the patient’s May 2018 hip fracture; and co-prescribed alprazolam, while foiling to satisfy provisions of the Board’s Prescribing Regulations. Specifically, Dr. Bajwa foiled to do the following:
• Consider or document having considered nonpharmacologic and non-opioid treatment for Patient C’s complaints of pain prior to treatment with an opioid, as required by 18 VAC 85-21-30(A).
• Perform a history and physical examination appropriate to the complaint, query the patient’s PMP report, and conduct an assessment of the patient’s history and risk of substance misuse prior to initiating treatment with an opioid, as required by 18 VAC 85- 21-30(B).
• Document the extenuating circumstances justifying prescribing greater than a seven-day supply of opioids on June 4, 2018 and August 13, 2018, as required by 18 VAC 85-21- 40(A)(1).
on June 4, 2018, in addition to the May 29, 2018, prescriptions for oxycodone Smg #84 and morphine ER 15mg #40 that Patient C received from Fairfax Hospital on discharge after hip surgery, resulting in a total MME/day of 160.5, as required by 18 VAC 85-21- 40(B)(2). • Prescribe Naloxone when prescribing opioids in doses exceeding 120 MME/day and/or when co-prescribing opioids and benzodiazepines, as required by 18 VAC 85-21-40(B)(3). • Document die extenuating circumstances justifying co-prescribing alprazolam with opioids and a tapering plan to achieve the lowest possible effective medication doses, as required by 18 VAC 85-21-40(C). • Document a description of the pain, a presumptive diagnosis for the origin of the pain, an examination appropriate to the complaint, and a treatment plan, as required by 18 VAC 85- 21-50. ii. Based on Patient C’s complaint of Attention Deficit Hyperactivity Disorder (ADHD) and request for medication “refills” at his first office visit on January 30, 2018, Dr. Bajwa had Patient C complete half of the 18-question Adult ADHD-Rating-Scale-IV, a self-assessment tool used as one part of a comprehensive ADHD work-up. Had Dr. Bajwa checked the patient's PMP report, he would have seen that Patient C was not in need of “refills,” in that Patient C had not been prescribed Adderall or any other stimulant in file prior two years. Nonetheless, without conducting a comprehensive work-up or documenting any assessment as to whether Patient C’s symptoms were clinically consistent with a diagnosis of ADHD, Dr. Bajwa prescribed Patient C Adderall (C-II) 15mg #60 (30-day supply). iii. Dr. Bajwa failed to monitor and manage Patient C’s use of controlled substances, and continued to prescribe multiple controlled substances to Patient C when he knew or should have known that Patient C was exhibiting signs and symptoms of addiction or medication overuse, abuse, or misuse. Specifically: • AthisMarch 14,2018 visit. Patient C complained that his Adderall 15mg prescription (#30 filled March 5, 2018) was “not strong enough & wants dose adjusted.” Patient C also reported that he was using the previously prescribed alprazolam lmg more frequently than as prescribed. Notwithstanding this overuse of prescribed medication and medication seeking behavior, and absent a PMP report check, Dr. Bajwa prescribed alprazolam lmg TID #90, and Adderall 20mg BID #60, thus significantly increasing the daily dosage of JUUUUilU both medications without a valid therapeutic reason for doing so. • At an April 19,2018 office visit, Dr. Bajwa provided new prescriptions for Adderall 20mg #60 and alprazolam lmg #90 (both filled April 19,2018) when Patient C stated that “he lost his meds & needs early refill.” • At his May 21, 2018 visit. Patient C complained that alprazolam “lmg not strong enough & needs dose adjusted." Absent any documentation supporting a therapeutic purpose or need for increasing the dose above the manufacturer recommended dose of 4mg/day, Dr. Bajwa doubled the strength and prescribed alprazolam 2mg #90 (30-day supply). Four days later, on May 25,2018, Patient C stated his alprazolam was “taken from him & needs refill,” and Dr. Bajwa prescribed alprazolam 2mg #90 (30-day supply). • Dr. Bajwa admitted in his statement to the Board that he recommended Patient C see a psychiatrist However, when Patient C declined, and stated that he wanted only Dr. Bajwa to “treat his psychiatric conditions,” Dr. Bajwa took no action and continued to prescribe benzodiazepines and amphetamines. • Although Dr. Bajwa noted that Patient C was treated at Fairfax Hospital after being hit by a car, he failed to review or request those medical records or speak with any of those providers. Had he done so, he would have learned the fallowing: o Patient C suffered a fracture to his right acetabulum during a fight outside a bar, rather than a car accident, which necessitated surgical repair. o During his admission, he admitted to recreational drug use including marijuana. o While hospitalized, he was found taking controlled substances from home, not taking the pain medication given to him in the hospital and instead, “saving it for later.” o The patient’s wife and friend were noted to have slurred speech and unsteady gaits while visiting Patient C.
vi. Dr. Bajwa began prescribing Patient D clonazepam 0.5mg #60 (30-day supply) on January 20, 2016, absent any documentation in the medical record supporting a therapeutic need, and without documenting any psychiatric or substance use history. On February 24,2017, Dr. Bajwa significantly increased the daily dosage of clonazepam prescribed to 2mg #60 (30-day supply) absent any documentation supporting a therapeutic need for doing so. b. Regarding Patient E, a then 29-year-old male, and spouse of Patient D: i. Patient E presented to Dr. Bajwa on June 5,2014, to establish care, with a chief complaint of “hip pain” for which the patient was prescribed OxyContm, oxycodone, and tramadol by a physician at an orthopedic and spine care practice in the recent past. Although Dr. Bajwa told Patient E that he “would not write any narcotics for him,” Dr. Bajwa nonetheless prescribed Patient E tramadol 50mg 1-2 tabs TID pm #150 on that date without performing a physical exam, formulating a diagnosis, obtaining a detailed history including substance use, checking the patient’s PMP report, conducting a UDS, developing a treatment plan, or coordinating his care with other treating providers. ii. In spite of telling Patient E he would not prescribe narcotics, on July 1, 2015, Dr. Bajwa prescribed oxycodone/acetaminophen 10/325mg #30 (30-day supply) for a diagnosis of hip pain without having checked the patient's PMP report, verifying with Patient E's other treating providers that they were not also concurrently prescribing controlled substances, conducting a UDS, or documenting a treatment plan. iii. Dr. Bajwa continued prescribing Patient E opioids through May 2017 when he knew or should have known that the patient was exhibiting signs of addiction and misuse. Specifically: • Dr. Bajwa steadily increased the strength and/or quantity of oxycodone he prescribed Patient E based on the patient’s specific requests on July 24, 2015; August 19, 2015; October 10, 2015; November 23, 2015; December 17, 2015; February 2, 2016; June 21, 2016; and August 5,2016. , • Dr. Bajwa prescribed Patient E fentanyl lOOmcg #15 on September 3, 2016 because the patient “has friend on fentanyl & wants to see if this will be more effective.” Moreover, Dr. Bajwa prescribed hydromorphone 8mg #30 to Patient E on January 18,2017 when the patient complained that the cold weather made his pain worse, and because “He tried Dilaudid in past and requests one/day as needed.” • Dr. Bajwa failed to take any steps to monitor Patient E’s drug use by performing UDS’ or regularly checking, or documenting having checked, the patient’s PMP report. • Dr. Bajwa prescribed opioids prior to the time the prescriptions should have needed to be refilled if the medications were taken as prescribed and failed to take any appropriate responsive action in spite of the patient’s demonstrated overuse of opioids, as set forth below: Date Written Medication Dose/ Quantity Days Supply Per PMP Report/MME Date of Previous Rx Days Supply for Prior Rx Per PMP Report 7/24/15 oxycodone lOmg #60 '30/30 7/1/15 30 day supply 10/29/15 oxycodone 15mg #60 30/45 r 10/5/15 30 day supply 11/23/15 tramadol 50mg #120 30/20 10/29/15 j 30 day supply 11/23/15 oxycodone 30mg #60 30/90 10/29/15 30 day supply 12/17/15 oxycodone 30mg #90 30/135 11/23/15 1 30 day supply
12/17/15 tramadol 50mg #90 30/15 11/23/15 30 day supply 1/11/16 oxycodone 30mg #90 30/135 12/17/15 30 day supply 1/11/16 tramadol 50mg #90 30/15 12/17/15 30 day supply 2/5/16 oxycodone 30mg #90 30/135 1/11/16 30 dav supply 2/5/16 tramadol 50mg #90 30/15 1/11/16 30 day supply 2/29/16 tramadol 50mg #60 '30/10 2/5/16 30 dav supply 2/29/16 oxycodone 30mg #120 30/180 2/5/16 30 day supply 5/6/16 tramadol 50mg #60 30/10 14/15/16 30 day supply 5/6/16 oxycodone 30mg #120 30/180 14/15/16 30 dav supply 5/31/16 tramadol 50mg #60 130/10 5/6/16 [30 dav supply 6/21/16 oxycodone 30mg #150 25/270 5/31/16 [30 day supply 8/5/16 oxycodone 30mg #180 30/270 7/15/16 30 day supply 8/26/16 oxycodone 30mg #180 30/270 8/5/16 30 dav supplv 9/19/16 oxycodone 30mg #180 30/270 8/26/16 30 dav supph 10/10/16 oxycodone 30mg #180 30/270 9/19/16 30 dav supph 2/9/17 hydromorphone 8mg #30 30/32 1/18/17 30 day supply 2/9/17 oxycodone 30mg #150 25/270 1/18/17 25 dav supply 3/2/17 oxycodone 30mg #180 30270 2/9/17 25 day supply 3/21/17 oxycodone 30mg #180 30/270 3/2/17 30 day supply 4/12/17 oxycodone 30mg #180 30/270 3/21/17 30 day supply 5/6/17" oxycodone 30mg #180 30/270 4/12/17 30 day supply
c. Regarding Patient F, a then 48-year-old female: i. Dr. Bajwa began prescribing alprazolam lmg #90 (30-day supply) on July 6, 2015 for a diagnosis of anxiety, absent any assessment or description of the patient’s symptoms or substance use history. ii. At Patient F's next visit on August 8, 2015, Dr. Bajwa began prescribing carisoprodol 350mg #60 (30-day supply) for a diagnosis of muscle spasms, absent any documented physical examination, description of symptoms, or associated information relating to the spasms. iii. Dr. Bajwa began prescribing opioids regularly to Patient F on December 8, 2015 for complaints of back pain at the request of another physician. Although a November 6,2012 MRI report included in Dr. Bajwa’s records showed only mild encroachment of the left neural foramen at L4- 5, Dr. Bajwa nonetheless continued regularly prescribing hydromorphone 4mg #120 (30-day supply) and methadone lOmg #120 (two tabs BID, 30-day supply) (total 384 MME/day) through October 2016. iv. Dr. Bajwa failed to monitor and manage Patient F’s use of controlled substances, in that he did not conduct any UDS* or pill counts during the treatment period. Moreover, Dr. Bajwa failed to respond to the patient’s overuse of the controlled substances he was prescribing, and regularly provided prescriptions prior to the time the medications should have needed to be refilled had Patient F taken them as prescribed, as set forth below: Date Written Medication Doie/Quantity Days Supply PerPMP Report/MME Date of Previous Rx i Days Supply for Prior Rx PerPMP Report 2/24/16 alprazolam lmg #90 30 2/1/16 30 1 2/24/16 carisoprodol 350rag #90 30 2/1/16 30 1 2/24/16 methadone lOmg #120 30/320 2/1/16 30 1 2/25/16 hydromorphone 4mg #120 30/64 r2/1/16 30 1 3/22/16 hydromorphone 4mg #120 30/64 2/25/16 30 3/22/16 methadone lOmg #120 30/320 2/24/16 30 6/6/16 alprazolam lmg #90 30 5/16/16 30 6/6/16 carisoprodol 350mg #90 30 5/16/16 J0 1 6/6/16 hydromorphone 4mg #120 30/64 5/16/16 30 6/6/16 methadone lOmg #120 30/320 5/16/16 30 6/27/16 alprazolam lmg #90 30 6/6/16 30 6/27/16 carisoprodol 350mg #90 30 6/6/16 30 6/27/16 hydromorphone 4mg #120 30/64 6/6/16 30 6/27/16 methadone lOmg #120 30/320 6/6/16 30 7/8/16 methadone lOmg #120 30/320 6/27/16 30 7/18/16 hydromorphone 4mg #120 30/64 6/27/16 30 8/12/16 hydromorphone 4mg #120 30/64 7/18/16 3° r 9/6/16 hydromorphone 4mg #120 30/64 8/12/16 30 9/6/16 methadone lOxng #120 30/320 8/12/16 30 10/27/16 1 alprazolam lmg #90 30 10/4/16 30 10/27/16 1 hydromorphone 4mg #120 30/64 10/4/16 30 10/27/16 methadone lOmg #120 30/320 10/4/16 30
d. Regarding Patient O, a then 48-year-old female: i. Dr. Bajwa prescribed Patient G oxycodone/acetaminophen 5/325mg #30 (15-day supply) at her first visit on February 9, 2016, for her complaint of shoulder pain without performing or documenting an appropriate physical examination, obtaining a detailed medical and substance use history, or obtaining or reviewing prior medical records. Three days later, Dr. Bajwa now increased the oxycodone/acetaminophen to 10/325mg BID #30 at the patient's request absent documentation of any therapeutic support for that change in the medical record. ii. Dr. Bajwa continued prescribing Patient G oxycodone through 2017 and took no action in spite of the patient's signs of addiction and misuse. Specifically: • When Patient G reported at her March 8, 2016 visit that she had been taking the oxycodone/acetaminophen more frequently than prescribed. Dr. Bajwa increased the prescription to TID, and then increased it to QID at the patient's request during her next visit on March 21,2016, without any documentation supporting a therapeutic need for the increased dose at either visit. • In spite of a June 2016 MRI and orthopedic consult diagnosing shoulder tendinosis, and recommending a steroid injection, physical therapy, and anti-inflammatories, Dr. Bajwa continued prescribing oxycodone/acetaminophen through April 2017, did not prescribe anti-inflammatory medication, and did not require Patient G to follow through with physical therapy and steroid injections as conditions of treatment. In addition to prescribing oxycodone/acetaminophen in spite of the orthopedist’s recommendation, Dr. Bajwa added hydromorphone 4mg #60 (15-day supply) to Patient G’s drug regimen on March 22,2017 due to “increased pain at night” • Dr. Bajwa failed to take any action in spite of the patient’s overuse of oxycodone/acetaminophen, and regularly prescribed opioids prior to the time the prescriptions should have needed to be refilled if taken as prescribed, as follows: Date Written Medlcation/Qnantlty Days Supply per PMP Report/MME Date Previou* Rx Days Supply for Prior Rx Per PMP Report 3/8/16 oxycodone/acetaminophen 10/325mg #63 21/45 2/25/16 15 3/21/16 oxycodone/acetaminophen 10/325mg #120 30/60 3/8/16 21 5/2/16 oxycodone/acetaminophen 10/325mg
5/18/16 oxycodone/acetaminophen 10/325mg #120 30/60 5/2/16 30 7/26/16 oxycodone/acetaminophen 10/325mg
9/14/16 oxycodone/acetaminophen 10/325mg
9/19/16 oxycodone/acetaminophen 10/325mg #90 23/58.5 9/14/16 7 1/4/17 oxycodone/acetaminophen 7.5/325mg #120 30/45 12/30/16 30 1/25/17 oxycodone/acetaminophen 10/325mg 30/60 1/4/17 30 J
| 2/7/17 oxycodone lOmg #120 30/60 i 1/30/17 30
e. Regarding Patient H, a then 43-year-old male: i. Dr. Bajwa assumed the care, treatment, and regular controlled substance prescribing for Patient H from his prior physician, a psychiatrist and pain management specialist, in approximately November 2015. Dr. Bajwa failed to perform or document an appropriate physical examination; document appropriate information regarding the patient’s complaints of abdominal pain, including a diagnosis; document a substance use history; or develop or document a comprehensive treatment plan prior to prescribing hydromoiphone 4mg #60 (20-day supply), tramadol 50mg #120 (30- day supply), and diazepam lOmg #90 (30-day supply) at the first visit. ii. Although Dr. Bajwa’s records from the prior physician indicate that she was concerned the patient possibly had track/injection marks on his arms, Dr. Bajwa failed to follow up on this information by, for example, monitoring Patient H for the appearance of track marks or using UDS’ to ensure the patient’s compliance with his medication regimen. In spite of these concerns, Dr. Bajwa prescribed hydromoiphone and diazepam on December 7, 2015, December 19, 2015, and May 9, 2016, dates when those medications should not have needed to be refilled had Patient H taken them as prescribed, and failed to take any action in response to the patient’s overuse of hydromoiphone and diazepam.
Iiiuuun> r Report/MM! Rx PMP Report J 3/1/17 hydromorphone 8mg #120 30/128 2/20/17 30 J 3/30/17 alprazolam 2mg #90 30 3/4/17 30 J 4/24/17 morphine sulfote ER 60mg #60 30/120 4/1/17 30 J 4/24/17 hydromorphone 8mg #54 14/124.8 3/30/17 30 J 5/22/17 hydromorphone 8mg #60 15/128 5/12/17 T5 J 5/30/17 hydromorphone 8mg #60 15/128 5/22/17 17 J 7/11/17 morphine sulfote ER 60mg #30 30/60 6/19/17 3d- J 7/11/17 hydromorphone 8mg #60 30/96 6/19/17 30 J 8/18/17 alprazolam 2mg #66 22 8/9/17 30 J 8/18/17 morphine sulfote ER 15mg #30 30/15 8/12/17 30 J 8/18/17 hydromorphone 8mg #60 30/64 8/9/17 ^0~ J 8/30/17 carisoprodol 350mg #60 30 8/9/17 30 J 9/12/17 hydromorphone 4m g #90 30/48 8/18/17 30 J 10/6/17 hydromorphone 4mg #75 30/10 9/12/17 30 J 10/16/17 alprazolam 2m g #90 30 9/20/17 30 J 10/25/17 hydromorphone 8mg #65 16/128 10/6/07 30 I 5/30/17 hydromorphone 8 mg #120 30/128 5/19/17 30 I 7/11/17 morphine sulfote ER 60mg #30 30/60 6/19/17 30 I 7/25/17 amphetamine 20mg #30 30 7/3/17 30 I 8/18/17 hydromorphone 4mg #90 30/48 8/4/17 30 I 12/11/17 amphetamine 20mg #30 30 11/17/17 i 30
iv. Dr. Bajwa increased the strength and/or quantity of alprazolam and Adderall he prescribed Patient P on March 16,2018, March 19,2018, April 17,2018, and April 19,2018, at the patient's request, without any therapeutic indication for doing so documented in the medical record. Patient P told the Department of Health Professions Investigator (Investigator) that because she was a Medicaid recipient, her monthly Adderall 30mg was limited to #60 (60mg/day), the maximum recommended daily dose. In order to avoid the Medicaid limit and obtain Adderall 30mg #90 (9Qmg/day) monthly, Patient P stated that she paid Dr. Bajwa cash for a “third” prescription at each visit and then paid out of pocket for the extra medication at the pharmacy.
v. Had Dr. Bajwa responded to Patient P’s obvious drug seeking behavior, he might have learned that Patient P was admitted to several hospitals with various combinations of suicidal
ideation, psychoses, and hallucinations on May 21,2018, June 17,2018, September 15,2018 (pursuant to a Temporary Detention Order (TDO)), and October 13, 2018 (pursuant to a TDO), related to her consumption of benzodiazepines and Adderall.
b. Regarding Patient Q, a then 21-year-old male, who Dr. Bajwa treated from approximately June 2017 through August 2018:
i. Absent a comprehensive psychiatric evaluation including a substance use history and risk assessment or documentation of symptoms or findings supporting a therapeutic purpose, Dr. Bajwa prescribed alprazolam lmg #30 (30-day supply) at the patient’s first office visit on June 1, 2017, based solely on the patient’s report of anxiety with panic attacks. At the same visit, Dr. Bajwa prescribed hydrocodone-chlorpheniramine ER #120 (12-day supply) based on the patient’s complaint of a cough that kept him “up at night,” without documenting a comprehensive physical exam or any explanation supporting an opioid as the appropriate treatment for a cough.
ii. Although Dr. Bajwa stated in his written response to the Board that he prescribed to Patient Q based on the patient’s response to the medication, Dr. Bajwa doubled the alprazolam to 2mgon June 21,2017, without any documentation of the patient’s response, i.e., symptoms, triggers, or presentation, etc., and simply documented that the patient reported “lmg not effective.” Dr. Bajwa steadily increased Patient Q’s alprazolam to 2mg #90 (30-day supply) on August 28,2017, without any documentation explaining his decision to exceed the manufacturer’s recommended daily dose (4mg/day).
iii. Although Patient Q was absent from Dr. Bajwa’s practice for approximately three months. Dr. Bajwa resumed prescribing alprazolam 2mg #90 (30-day supply) on February 2,2018, noting that the patient was stable with medications, without any documentation regarding the patient’s absence or the performance of any physical or mental examination.
c. Regarding Patient R, a then 20-year-old female, who Dr. Bajwa treated from approximately December 2017 through August 2018:
i. At Patient R’s first visit on December 8, 2017, Dr. Bajwa prescribed alprazolam 2mg #90 (30-day supply), a dose exceeding the manufacturer recommended maximum daily dose (4mg/day), based on the patient’s self-report of anxiety and claim that "She needs it 3x per day." Dr. Bajwa failed to obtain or document a detailed substance use or medical history or description of symptoms. Further, Dr. Bajwa failed to verify that the patient had taken alprazolam previously and if so, at what dose. Although Dr. Bajwa claimed in his statement to the Board that he checked the patient’s PMP report at each visit, the PMP Access Audit records show that he did not access Patient R's PMP report at any time while treating her.
ii. At Patient R’s January 9,2018 visit, Dr. Bajwa documented that the patient “wants med for ADHD,” and had the patient complete an Adult ADHD-Rating-Scale-IV tool used as one part of a comprehensive ADHD work-up. Without conducting a comprehensive physical or mental examination or documenting any assessment as to whether the patient's symptoms were clinically consistent with a diagnosis of ADHD, Dr. Bajwa prescribed Adderall 20mg #60 (30-day supply) to the patient for ADHD on that date.
d. Regarding Patient S, a then 19-year-old female, who Dr. Bajwa treated from June 2018 through July 2018:
i. Absent a comprehensive psychiatric evaluation, including a substance use history and risk assessment, or documentation of symptoms or findings supporting a therapeutic purpose, Dr. Bajwa prescribed alprazolam 2mg #60 (30-day supply) at the patient’s first office visit on June 18, 2018, based solely on the patient’s report of anxiety with panic attacks.
ii. At Patient S’s next visit on July 5,2018, Dr. Bajwa increased the patient’s
alprazolam to TID based on the patient's claim that she needed an extra pill to control the anxiety, absent any documentation in the medical record supporting his decision to exceed the manufacturer's recommended daily dose (4mg/day). Moreover, Dr. Bajwa admitted to the Investigator that he discussed the patient seeing a psychiatrist, but the patient only wanted Dr. Bajwa to treat her anxiety, and he did not recommend any other alternative or concomitant treatments. e. Regarding Patient T, a then 24-year-old male, who Dr. Bajwa treated from approximately February 2017 to March 2017: i. Dr. Bajwa prescribed alprazolam lmg #60 (30-day supply) at Patient T’s first visit on February 17,2017 based on the patient’s self-report of anxiety and having taken alprazolam lmg in the past, without documenting a comprehensive examination or obtaining a detailed substance use history. ii. At Patient T's second and final visit with Dr. Bajwa on March 9,2017, in addition to increasing the alprazolam to 2mg based only on the patient's report that lmg “was not effective,” Dr. Bajwa prescribed promethazine with codeine syrup for the patient's complaints of congestion and mild wheezing keeping him “up at night,” without documenting a comprehensive physical exam or any explanation supporting an opioid as the appropriate treatment for a cough*