Md. doctor accused of mishandling 3 living wills

Morhaim signed papers falsely attesting to exam

February 15, 2005|By Jonathan Bor | Jonathan Bor,SUN STAFF

Maryland's medical disciplinary board has charged Del. Dan K. Morhaim with falsifying documents in the execution of living wills for three residents of a nursing home where he works as medical director.

Morhaim, an emergency physician who also supervises medical care at Ruxton Health and Rehabilitation in Pikesville, is alleged to have signed forms attesting to the patients' inability to make decisions for themselves, without examining them.

One of two practicing medical doctors in the General Assembly, the Baltimore County Democrat represents the 11th District, which includes Owings Mills, Reisterstown and much of the county's west side.

The cases, all stemming from forms signed in January 2003, involve an 82-year-old woman and two 90-year-old women who, Morhaim certified, were suffering from dementia. There was no evidence on the patients' medical charts that Morhaim had examined the patients on the dates he signed the papers, the board said.

The women had signed living wills stating that they wanted medical treatment withheld in the event they were in a terminal condition or had lapsed into a vegetative state. By state law, such advance directives can speak for patients once they are no longer mentally competent to make decisions.

Before such a directive can take effect, however, Maryland law requires that two doctors examine the resident and determine that she is indeed incompetent and nearing the end of life. By pre-signing the forms, Morhaim allegedly left it to a second physician to make a medical judgment based on the resident's current condition.

In its charging documents, the board said Morhaim acknowledged that pre-signing the form was improper.

"The respondent acknowledged to the surveyors that the use of the pre-signed form was not `good practice' and that it had been done for the `short term to accommodate the health needs of the social worker and the schedule of the physician.'"

The Maryland Board of Physicians issued the charges Dec. 3, more than a year after receiving a complaint from state health inspectors who had found 20 pre-signed forms in a social worker's desk. Morhaim allegedly made the forms available for a social worker to give to a second physician.

"The respondent's actions in pre-signing forms that indicated he had `examined' a nursing home resident on a date certain, when he had not, constitutes the making or filing of a false report in the practice of medicine," said a charging document signed by C. Irving Pinder, the board's executive director.

Specifically, the board charged him with "immoral or unprofessional conduct" and "willfully [making or filing] a false report in the practice of medicine."

In a statement, Morhaim said yesterday that the state attorney general's office had recommended dropping the word "immoral" from the charges. That office declined to comment.

"I have been a practicing physician for over 29 years with an unblemished record," Morhaim said. "Over two years ago I made a mistake with respect to completion of forms for three patients, for which I am truly sorry. I did this because I was asked by a social worker colleague who was in the third trimester of a difficult pregnancy to help her expedite paperwork. No patient was harmed, nor would I ever do anything to risk patient safety.

"I have never tried to conceal my actions or to deny responsibility for them," Morhaim said.

He is in his third four-year term and is a member of the House Health and Government Operations Committee.

"He's a very valuable member of the committee," said Del. John Adams Hurson, a Montgomery County Democrat and chairman of the panel. "When you are dealing with complex health issues, he is one of the members who understands it from the ground up."

Hurson said he had not heard about the complaint and could not comment on it.

A longtime supporter of advance directives, Morhaim was the lead sponsor of last year's Advance Directive Information Availability Act, a bill requiring the state Department of Health and Mental Hygiene to develop a fact sheet about the practice and to publicize it more widely. The bill was enacted into law.

Karen Black, a spokeswoman for the state Department of Health and Mental Hygiene, said the law Morhaim is accused of violating was intended to protect patient rights.

"The law considers this to be such an important decision that it requires two physicians to personally examine a patient before making this determination," she said. "To pre-sign a form without doing an examination or even knowing who the form is for is a misuse of authority."

The Health Department imposed a $13,000 fine on the nursing home, based on the living will problems and of other deficiencies. The home submitted a corrective plan, which the Health Department accepted.

"He continues to be and is a superb medical director, and we continue to give quality care to our residents and community," said Susan Stone, the home's administrator.

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