The Medical Board of California has filed an accusation against the medical license of a Long Beach family medicine physician, who allegedly over-prescribed medications to four patients, three of whom were addicts.
One patient, a woman in her 50s who saw Melkumian for a variety of maladies from 2013-17, claimed she never smoked, drank only socially and denied illicit drug use, but her toxicology screens came up positive for opiates, marijuana and benzodiazepines, according to the accusation.
The state database that logs drugs and medications prescribed to patients indicates that over their history together, Melkumian prescribed the patient the muscle relaxant Soma, the anti-anxiety medication Valium and the opiate Norco. Yet the doctor’s own notes show she was concerned multiple times that the patient might be addicted to opiates. However, according to the accusation, she could produce no Controlled Substance Agreement or documentation to back up why she was prescribing medications that did not match up with the diagnoses for the patients, let alone opiates to a suspected abuser.
Soma was prescribed to the woman “on a regular basis for over two years without any medical justificaction,” according to the accusation, which feared that contributed to a “potentially deadly” combination because she was also taking opiates daily, regularly drank alcohol, tested positive for marijuana and had known sleep apnea and depression, therefore increasing “risk of respiratory depression while asleep.”
Another patient, a man in his 80s who was treated for various complaints from 2012-2017, was prescribed the benzodiazepines Lorazepam for anxiety and the tricyclic antidepressant Nortriptyline, but Melkumian’s notes are spotty regarding consultations and/or follow ups with a cardiologist, a pulmonologist, a pain management specialist and a psychiatrist, states the accusation. The patient’s charts make no notations about the former smoker’s alcohol and illicit drug use.
That’s important to know because the mixing of booze and benzos could be deadly, and according to the state prescription drug database the patient received enough benzos to take three tablets per day over three years. Melkumian claimed in her interview with medical board investigators that the patient rarely took the Lorazepam, but the state database showed he had the prescription filled monthly on a regular basis.
The same patient was diagnosed by Melkumian with hypothyroidism and given medications to treat it, but the levels showed in tests for the condition were “not indicative of hypothyroidism,” and the “erroneous diagnosis” represented “an extreme departure from the standard of care and lack of knowledge,” according to the accusation.
A third patient, a man in his 60s who saw Melkumian for various maladies from 2013-17, was known by the doctor to be an addict who was legally using cannabis, leading her to inform him that she would not prescribe him opiates while he used pot and having him sign an opioid contract dated Nov. 14, 2014. In September of the following year, the patient’s wife called Melkumian’s office with concern about medications her husband was taking. At his next visit, Melkumian diagnosed him with “opiod type dependence, gave him information about rehabilitation programs and a recommendation to a pain management specialist.
However, according to the accusation, Melkumian continued to dole out prescriptions for pain medications to the patient through May of 2017, when he tested positive for cannabis, which was the third time that happened during the course of his treatment. Over their time together, the patient received from Melkumian scripts for Xanax, Ambien, doxepin and hydrocodone, but nothing from the doctor’s notes indicate she discussed with him safer alternatives or recommendations to other mental and health-care specialists.
It’s not like Melkumian had not been alerted about the possibility she was feeding the habit of an addict. An Oct. 7, 2016, letter from the patient’s insurance company expressed concern about his use of Xanax and Vicodin, which the doctor nonetheless kept doling out. The mixture of drugs the patient was taking, an overall lack of documentation to back up Melkumian’s treatment plan for him and excessive and incorrect prescriptions for antibiotics “constituted an extreme departure from the standard of care and lack of knowledge,” according to the accusation.
The fourth patient, a woman in her 60s who saw Melkumian for various reasons from 2013-16, had prompted a 2014 chart notation indicating the doctor recommended weaning her off of medications and referring her to pain management, but while there is no documentation that she ever did see a pain specialist or mental health provider, she did continue receiving from Melkumian scripts for benzos, hydrocodone and muscle relaxants–monthly and at the same quanity as she had received before the physician made the note about weaning.
The patient also received scripts from Melkumian for opiates, muscle relaxants and the anti-anxiety medication Paxil. Having already prescribed what amounted to three tablets of benzos per day for more than two years along with “sleeping aids and opiates … constitutes an extreme depature from the standard of care and lack of knowledge,” according to accusation. It goes on, as it did with patient three, to further knock Melkumian for the excessive and incorrect prescribing of antibiotics to patient four.
Melkumian’s treatment of the four patients indicates gross negligence, repeated negligent acts, prescribing without exams/indications, excessive prescribing, inadequate record-keeping and incompetence, according to the accusation, which futher alleges prescribing to addicts in the treatment of three of those same patients.
Kimberly Kirchmeyer, executive director of the Medical Board of California, is seeking a hearing so discipline that could include license revocation or suspension can be considered.
OC Weekly Editor-in-Chief Matt Coker has been engaging, enraging and entertaining readers of newspapers, magazines and websites for decades. He spent the first 13 years of his career in journalism at daily newspapers before “graduating” to OC Weekly in 1995 as the alternative newsweekly’s first calendar editor.