State officials have summarily suspended the medical license of a Baltimore psychiatrist on charges of improperly prescribing addictive pain killers, tranquilizers and sleeping pills in treating drug addicts.
In a separate case, a psychiatrist from Catonsville was placed on three years' probation for prescribing narcotics in a manner "clearly outside the accepted standard of care."
The state Board of Physician Quality Assurance found that Dr. Else M. Hillgard, 65, of the 100 block of W. Read St., Baltimore, posed "a grave risk and an imminent danger to the public health, safety and welfare." The board said that she improperly prescribed addictive pain killers, tranquilizers, sleeping pills and other drugs in her treatment of drug addicts.
Hillgard's license was suspended last week pending a hearing Nov. 20 at which her license could be revoked or restricted. She was ordered to surrender the license, prescription pads and the state and federal certificates that allow her to prescribe controlled drugs in Maryland.
In the other case, the state board last week stayed a suspension order and placed Dr. Bruce L. Regan of Catonsville on three years of probation.
In one example, the board said, Regan was found to have prescribed narcotic analgesics, including injectable drugs, "outside the area of his expertise" over a 10-year period ending in 1990. For another patient, who was described as profoundly disturbed and a borderline substance abuser, Regan prescribed benzodiazepines, or tranquilizers, the board said. Even though Regan noted the possibility of over medication in the patient's medical record, the practice seemed to continue, the board said.
The board warned Regan that if he fails to meet rigorous probation conditions, his license could be suspended.
Hillgard was first licensed in Maryland in 1971. She had medical privileges at the Liberty Medical Center.
Her attorney, Stuart H. Arnovits, said yesterday that her case "isn't what it seems to be" and that at the hearing "a lot of the charges will not be sustained, from what I can see."
He said "there were some forgeries of her prescriptions, and some thefts."
Hillgard had two days' warning before the suspension, Arnovits said. She sought to delay the action until she could mount a defense, but the board denied a continuance. He declined further comment.
J. Michael Compton, acting executive director for the board, called the Hillgard case an "extreme" case of prescription abuse and likened her suspension prior to a hearing to the denial of bail to a suspect accused of a serious crime.
In its suspension order, the board said that Hillgard's activities began as early as October 1987 and continued through September of this year despite investigations and intervention in 1990 by federal drug authorities and the state medical society.
In one case cited by the board, Hillgard in October 1988 began prescribing a variety of drugs to a known drug addict who was enrolled in a Methadone program.
Between Oct. 25, 1988, and May 16, 1989, and without consulting with the Methadone program physician, the board said, Hillgard wrote 31 prescriptions for this patient, a total of 1,310 tablets. The drugs included pain killers, tranquilizers and Phenergan, a cough suppressant often used by drug abusers to enhance the effects of other drugs.
Hillgard also failed to assess and monitor the effects of several of the drugs on the patient, the board said.
The board first got wind of the alleged abuses in December 1988, and an investigation by the U.S. Drug Enforcement Administration began in 1989.
In one case, the DEA found, Hillgard wrote 45 prescriptions for one patient in six months, a total of 2,074 tablets, all regulated pain killers, tranquilizers and sedatives.
Nine of the prescriptions -- 464 tablets -- were written in 19 days.
The DEA withdrew Hillgard's federal prescription permit in July 1989.
A year later, a peer review of her practice by the Medical and Chirurgical Society of Maryland concluded that Hillgard attempted to "treat addiction with more addictive, but legal medication. [There is] no evidence that this is an effective treatment."
The reviewer concluded that this was "not an accepted treatment in psychiatry."
Med Chi's Committee on Drugs found "evidence of substandard care" in Hillgard's management of seven other patients, most diagnosed with "addiction personalities." In at least one case, the committee found, Hillgard "may have addicted the patient."
Hillgard then signed an agreement with the DEA allowing her to prescribe only non-narcotic drugs. She also agreed to submit lists of all her prescriptions for two years.
Two months later, the state Department of Health and Mental Hygiene was tipped off by pharmacists that Hillgard was again writing Medicaid prescriptions for Phenergan. A five-month audit of her prescription practices found that more than 12 percent of all her prescriptions were for Phenergan.
Comptom said Hillgard's practice included a "high volume" of Medicaid patients.