Allegations of poor record keeping, over prescribing medications without documenting valid needs and improper treatment of a patient with extremely high blood pressure have led to an amended accusation by the state against a Dana Point internal medicine specialist who has been affiliated with Orange County substance abuse recovery facilities.
The Medical Board of California filed an amended accusation against the license to Dr. Gregory John Van Dyke on Jan. 5, according to state documents.
A surgeon sent a patient with extremely elevated blood pressure to Van Dyke on April 17, 2013, when the man’s blood pressure was taken three times. Though each confirmed the fellow blood pressure was very high, Van Dyke did not ask him whether he was experiencing chest pain, other pain, shortness of breath, altered thinking, headache, difficulty speaking or whether he could move his arms and legs normally, according to board investigators.
Indeed, the investigators claim Van Dyke “conducted very little physical examination,” based on his own notes, which only state the patient was “awake/alert.” The state agents did say “illegible findings related to lung and heart findings were documented,” but “[t]here is no evaluation done to determine whether the patient was experiencing an emergency. A three-component combination blood pressure medication was listed under the plan. No instructions were given regarding when the patient should return, or what symptoms the patient or family should be aware of.”
They add that when blood pressure reaches systolic levels greater than 220, or diastolic levels are greater than 110-120, an assessment of the potential for immediate harm must be taken by a physician. Looking at blood pressure readings of 235/106, 247/103 and 229/92, Van Dyke should have evaluated whether the patient was dealing with “a hypersensitive urgency,” where the blood pressure could be managed over a day or two, or “a hypertensive emergency” that may require “immediate treatment, usually in an ICU setting.” Failing to determine this, and sending the patient home without a clear treatment plan or follow-up appointment in one to two days, constituted gross negligence, according to investigators.
They reached the same conclusion when it came to Van Dyke “improperly” prescribing Adderall to a patient with an anxiety disorder. At a follow-up appointment a couple weeks after an early August 2014 visit, the patient requested the stimulant Adderall for her ADHD. “No formal psychiatric or mental exam was performed,” according to investigators. Van Dyke did not perform a urine test nor did he “review the patient’s psychiatric records,” although investigators do note that the doctor requested them. He also prescribed her a month’s supply of Adderall and Xanax to deal with the patient’s complaints about ADHD and anxiety.
On Sept. 3, 2014, she saw Van Dyke again, saying her medications were stolen. He prescribed them again, as he did on Oct. 7, 2014, when she came back for refills. “Medication was prescribed without a detailed assessment of her conditions,” claim state investigators.
She came back the following Oct. 15, again to report her medications had been stolen, this time by her father. “Her medication was refilled,” investigators state. “Vyvanse was prescribed temporarily in place of Adderall, to minimize abuse. It was noted that Adderall would not be prescribed until psychiatric notes were received.”
The woman was back Oct. 27, 2014, for her monthly refills of Xanax and Adderall as well as to air a new complaint of chronic right knee pain she’d experienced over the past four years. She received scripts from Van Dyke for Xanax, Adderall and the painkiller Norco, although investigators add, “No psychiatric records were available.”
The patient returned Nov. 18, 2014, for Xanax and Adderall refills, then came back the following Nov. 21 complaining of an acute ankle injury from a mechanical fall and persistent right knee pain with swelling. She received no examinations of her ankles or knees, but she did get her pain medication changed to Tramadol.
At a Dec. 26, 2014, follow-up appointment concerning her ongoing medical issues, she was prescribed refills of Xanax, Adderall and Norco, according to investigators, who repeat that no urine test was done and no psychiatric records were available, although the patient’s chart did note that a psychiatry consultation was recommended.
On Jan. 22, 2015, which was a day after the patient went to an emergency room due to a sexual assault, she saw Van Dyke and complained of increased anxiety and insomnia. He prescribed more Xanax, Adderall and Norco. She also got scripts for Norco, Tramadol and Oxycodone for pain management on Feb. 23, 2015, when Van Dyke noted on her chart that her psychiatric records were still needed.
The patient authorized the release of her medical records on March 2, 2015, and the next day Van Dyke received confirmation of her DSM Axis Diagnoses of “chemical dependency, alcohol abuse, anxiolytic medication abuse and moderate generalized depression,” according to investigators, who add that recommendations were to “continue outpatient drug treatment programs and psychotherapy to maintain sobriety. The psychotropic medications recommended were Zoloft, Gabapentin and Trazodone.”
However, when the patient came back to Van Dyke that following March 11, he prescribed refilling the Xanax and Adderall. A urine test was also performed, and she was referred to a psychiatric follow-up. Two weeks later, after another urine test was completed, she tested positive for cocaine, amphetamine, marijuana, opiates and benzodiazepines, say investigators, who add she admitted to heroin use and was started on buprenorphine and naloxone to treat her opioid dependency.
The patient would go more than six months before seeing Van Dyke again. That changed in October and November of 2015, when he prescribed her Adderall and Xanax, according to investigators, who contend Van Dyke was “grossly negligent” in failing to properly manage her anxiety disorder and doling out Adderall without evaluations to justify it.
Board investigators also cited Van Dyke’s “grossly negligent” treatment of a patient who received escalating prescriptions for buprenorphine, which can be prescribed for pain and addiction to narcotics but is highly addictive itself, from July 2012 through September 2015.
“The patient had two clinic visits in 2012, five clinic visits in 2013, five clinic visits in 2014, and four clinic visits in 2015,” investigators note. “He was prescribed buprenorphine and/or alprazolam [a sedative used to treat panic or anxiety disorders] each visit. The reason for these two medications was opioid dependency and chronic anxiety, respectively. During these 36 months of visits, urine toxicology testing was done twice. No goals of care were discussed. No psychiatry counseling was offered. No laboratory blood testing was done.”
Failure to maintain adequate records is cited by investigators when it came to the three patients above as wells as a fourth, who saw Van Dyke 15 times between 2008 and 2014. Multiple times over that span, Van Dyke wrote the man scripts for opioid medications without noting why they were necessary, investigators allege.
They ask that the board also take into consideration Van Dyke’s license having received a public reprimand in 2009, when he was ordered to take medical record keeping and proper prescribing courses, and having been placed on probation for nearly three years in 2012 due to his failure to detect and treat a patient’s adult II diabetes. Van Dyke was again ordered to take a record keeping course as a term of his probation, investigators note.
An accusation can lead to medical license revocation or suspension proceedings.
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 paper’s first calendar editor. He went on to be managing editor, executive editor and is now senior staff writer.