ALJDEC decisions subject to certification as final

05A-22064-MDX · Arizona Medical Board · 2005-05-09

IN THE OFFICE OF ADMINISTRATIVE HEARINGS

HEARING: Hearing held on August 15, 2005 did not conclude. A further hearing was held and completed on August 18, 2005. APPEARANCES: The Arizona Medical Board (“Board”) was represented by Assistant Attorney General Stephen Wolfe. Gary S. Blass, M.D., appeared on his own behalf. ADMINISTRATIVE LAW JUDGE: Michael L. Barth _____________________________________________________________________ findings of Fact 1. The above-captioned matter came on for hearing to determine whether Dr. Blass engaged in unprofessional conduct in violation of A.R.S. § 32-1401(27)(q), (r) and (nn). 2. The Arizona State Medical Board (“Board’) is the duly constituted authority for licensing and regulating the practice of allopathic medicine in the State of Arizona. 3. Gary S. Blass, M.D., is the holder of License No. 22064 for the practice of allopathic medicine in the State of Arizona. 4. The Board presented evidence that: a. Between 1975 and the issuance of his Arizona license in 1994, Dr. Blass had undergone treatment for substance abuse on several occasions. b. After graduation from medical school in Pennsylvania in March 1989, Dr. Blass enrolled in the Pennsylvania Physician’s Health Program for impaired physicians with a self disclosed history of alcoholism and drug abuse. c. In 1990, Dr. Blass was issued a training license for the practice of medicine by the Commonwealth of Pennsylvania but as a result of relapse was involuntarily terminated from his training program art Episcopal Hospital, thereby voiding his training license. d. After inpatient treatment of his relapse for 30 days, Dr. Blass, via recommendation of the Pennsylvania Physician’s Health Program, underwent out- patient continuing care treatment from November 13, 1990 through January 26, 1993 as well as voluntarily monitoring by the New Jersey Physician’s Health Program for abuse of alcohol and other mood altering drugs from March 1991 to January, 1994. e. After completing the 3 year monitoring program with the Pennsylvania Physician’s Health Program and his Family Practice Residency in 1993, Dr Blass was issued an unrestricted medical license by the Commonwealth of Pennsylvania. f. Dr. Blass applied for a medical license in Arizona and in January, 1994 entered into a Consent Agreement with the Board which resulted in the issuance of a medical license to Dr. Blass subject to an Order of Probation. g. Per the Order of Probation, Dr. Blass was required among other things to participate in a Board approved and sponsored aftercare treatment program and a 12-step recovery program, to refrain from use of any drugs or medications in absence of a prescription by his Board approved sole treating physician, to submit to witnessed random fluid collection the results to be provided to the Board and to maintain a log of medications prescribed to him by said sole treating physician. h. On April 24, 1996, the Order of Probation was terminated and in May, 1996, Dr. Blass entered into a Rehabilitation Stipulation with the Board subject to requirements similar to those in the Order of Probation. i. The Board’s Rehabilitation Stipulation and Order was terminated on January 31, 1997. j. On or about September 27, 2004, the Board was notified by the Vice President of Health Choice Arizona, Inc. (“Health Choice”) that Dr. Blass had sent numerous e-mails as well as made telephone calls to Health Choice of a threatening, vulgar and profane nature. k. The Board was further notified that Health Choice had reported Dr. Blass’ aforementioned conduct to the Tempe Police Department but decided against pursuing a restraining order against Dr. Blass. l. On or about October 19, 2004, Dr. Jacqueline Pynn, M.D., as required by statute, notified the Board that Dr. Blass, having been determined to be a danger to self and others as well as acutely psychiatrically impaired, had been involuntarily admitted to Maricopa Medical Center on September 24, 2004. m. At or about the time of his admission to Maricopa Medical Center: 1. Dr. Blass had been delusional, reporting that he came from another planet as well as being one of God’s chosen ones.

2. Dr. Blass had threatened to put LSD in Lake Pleasant and to blow up the insurance company (presumably Health Choice as he contended that it owed him monies). 3. Dr. Blass had requested his son to obtain drugs for him. 4. Dr. Blass reported that he suffered from depression for which he had been self prescribing Effexor. 5. Dr. Blass reported that he had recently tapered off Methodone (used to treat heroine addiction), although he denied having a relapse. 6. Dr. Blass had relapsed on drugs and alcohol. n. On admission to Maricopa Medical Center, Dr. Blass was diagnosed with psychiatric disorder not otherwise specified; and rule out major depressive disorder, with psychosis and bipolar, manic, with psychosis. o. Dr. Blass’ history and physical findings on admission to Maricopa Medical Center were consistent with poly substance abuse, including opiate dependence with no signs of opiate withdrawal. p. On discharge from inpatient treatment on October 22, 2004, Dr. Blass was diagnosed with bipolar disorder, not otherwise specified, and released to the care of Dr. Sweeney. q. On discharge from Maricopa Medical Center, Dr. Blass’ insight was only partial and his judgment was still impaired, although mildly. r. Dr. Blass presented to Thunderbird Treatment Center for treatment for drug dependency in July, 2001. s. At the time of his presentation at Thunderbird Treatment Center, Dr. Blass had been strung out on heroin or heroin like opiates for 1/2 years. t. Dr. Blass received methodone treatment, periodically, at the Thunderbird Treatment Center from July, 2001 to 2004. u. Dr. Blass also presented to Dr. Lisa Sparks, M.D., for treatment of suicidal ideation and depression in March, 2001. v. On his presentation to Dr. Sparks’ office, Dr. Blass reported that in February 2001 he had been severely depressed and had been asked to leave work. w. Dr. Sparks’ diagnoses of Dr. Blass included major depression and opiate dependency. x. In March, 2001, Dr. Blass underwent intensive psychotherapeutic intervention. y. As part of the Board’s investigation relative to the Health Choice incident and Dr. Blass’ involuntary admission to Maricopa Medical Center, the Board’s investigative staff along with its contracted addiction medicine specialist, Dr. Michael Sucher, M.D., interviewed Dr. Blass on January 31, 2005. z. In response to questioning during said interview regarding the Health Choice situation and the court ordered admission to Maricopa Medical Center for psychiatric evaluation and treatment, Dr. Blass was for the most part uncooperative and terminated the interview before the Board had completed its questioning of him. aa. In response to questioning about his October 2004 court ordered treatment during the interview, Dr. Blass did provide the following pertinent information: 1. He had been taking Effexor for depression but at or about the time of his involuntary admission, he had stopped taking Effexor because it was no longer affordable. 2. As a result of his discontinued use of Effexor, he decompensated and it was while in this state of decompensation, the events which led to leading to his involuntary admission had occurred. 3. He had been stabilized as a result of the court ordered treatment, was continuing outpatient treatment and his psychiatric condition appeared to be controlled. bb. During the interview with the Board, Dr. Blass refused to answer any questions regarding specific issues raised by his court ordered treatment. cc. Dr. Blass also denied having received treatment for substance abuse relapse including methodone treatment since the termination of the Stipulated Rehabilitation Order in 1997. dd. Although Dr. Blass had briefly stated in the interview that since his discharge from Maricopa Medical Center he had been practicing medicine, as a result of his premature termination of the interview, the Board was denied an opportunity to question Dr. Blass regarding the nature of said practice. ee. On February 10, 2005, the Board, on the recommendation of Dr. Sucher, issued a Confidential Interim Order for psychiatric, psychological, and psychometric evaluation and random biological fluid tests. ff. Dr. Blass’ denial during the Board’s interview of a substance abuse relapse and substance abuse treatment including methodone treatment since 1997 was, as reflected in the medical records, untruthful. gg. In the opinion of David Greenburg, M.D., a Board contracted addictive medicine specialist who formerly supervised the Board’s Monitoring Aftercare Program, Dr. Blass’ failure to report the drug relapse constituted unprofessional conduct. hh. In the opinion of Dr. Greenburg, the February 10, 2005 Confidential Interim Order was warranted as the Health Choice incident and the Maricopa Medical Center records, Value Options records (2004 out patient psychiatric treatment records) and the records of Dr. Sparks raised serious concerns that Dr. Blass had experienced a substance abuse relapse and as a result of his psychiatric and/or psychological condition, was not able to practice medicine safely. ii. The Confidential Interim Order along with paper work describing the “color of the day program” (a drug screen program in which participants are required to phone a specified number on a daily basis and if the color assigned to them has been called, then report within a specified period of time for a drug urine screen) in which Dr. Blass was required to participate via the Order was hand delivered to Dr. Blass on February 11, 2005. jj. Dr. Sucher contacted Dr. Blass on February 12, 2005 and informed him to present for a urine drug screen that day. kk. During the random urine drug screen on February 12, 2005, Dr. Blass was observed by Concentra Medical Center staff attempting to conceal two vials containing a yellow fluid. ll. The urine specimen presented by Dr. Blass was unusual in that it was cold to the touch and failed to register a temperature reading. mm. Dr. Blass refused to sign a form identifying the specimen as unusual as well as refused to present another urine sample under direct observation. nn. When his assigned color was called February 14, 2005 as part of the “color of the day” program, Dr. Blass failed to present for the urine drug screen as required. oo. Upon discovering that Dr. Blass had failed to present on February 14, 2005 for his required urine drug screen, Dr. Sucher contacted Dr. Blass and was informed by Dr. Blass that he was unaware of the “color of the day” program, not having read the paper work hand delivered by the Board on February 11, 2005. pp. On February 16, 2005, Dr. Sucher left a message for Dr. Blass to present for an observed urine drug screen and hair drug test within 4 hours but Dr. Blass failed to comply and later that day Dr. Blass informed Dr. Sucher he had no intention of ever presenting for either a urine drug screen or hair drug test. qq. In the opinion of Dr. Greenburg, the circumstances surrounding Dr. Blass’ presentation on February 12, 2005 for the mandatory urine drug screen were consistent with one attempting to substitute the urine specimen of a clean person for their own in order to avoid detection of their substance abuse. rr. On February 17, 2005, the Board issued an Order summarily suspending Dr. Blass’ medical license and amending the previous Confidential Interim Order’s requirements to include inpatient evaluation for chemical dependency at a Board approved facility within 14 days of Dr. Blass’ receipt of the Order as well as medical, neurological and neuro- psychiatric evaluation. ss. In the opinion of Dr. Greenburg, medical, neurological and neuro-psychiatric evaluation was called for in order to determine if there was a physical cause for Dr. Blass’ abnormal behavior so that Dr. Blass could be appropriately treated. tt. It was also the opinion of Dr. Greenburg that summary suspension of Dr. Blass’ medical license was proper and necessary inasmuch Dr. Blass’ refusal to be monitored by the Board, given the seriousness of his psychological/psychiatric illness coupled with his probable chemical dependency, made him an imminent risk to the safety of the public. uu. Dr. Blass had no intention of ever complying with any orders issued by the Board requiring him to undergo psychological, medical or chemical dependency evaluation. vv. Having failed to date to finish continuing medical education in specified subjects ordered by the Board to be completed by April 10, 2003, Dr. Blass violated the April 10, 2002 Order in Board Case No. MD-01-0018. 5. In defending the charges made against him, Dr. Blass did not controvert the foregoing evidence presented by the Board; instead, Dr. Blass asserted that his non-compliance with the Board’s interim Orders was justified for the reason that medical information obtained from such evaluations by the Board on him and other physicians in the past had been illegally disclosed by the Board to the public on its internet website and he was concerned that the Board would again make such illegal disclosures of his confidential medical information. Dr. Blass failed to support his assertion with any specific example of an alleged illegal disclosure of confidential medical information with citation to appropriate legal authority prohibiting such disclosure. 6. In any event, this tribunal finds that even if the Board was guilty of having made illegal disclosures of confidential medical information in the past, such past conduct by the Board did not constitute legal excuse for Dr. Blass’ non-compliance with the Board’s interim Orders.

7. Based on the foregoing credible and uncontroverted evidence presented by the Board, this tribunal finds the following: a. The Health Choice incident and the Maricopa Medical Center records, Value Options records (2004 out patient psychiatric treatment records) and the records of Dr. Sparks demonstrated that Dr. Blass may have been suffering from conditions (psychological/psychiatric disorders and chemical dependency) prior to his admission to Maricopa Medical Center and thereafter rendering him unable to safely practice medicine b. Dr. Blass violated formal orders (April 10, 2002 Order in Board Case No. MD-01-0018, February 10, 2005 Confidential Interim Order and February 17, 2005 Interim Order of Summary Suspension) issued by the Board. c. More intensive evaluation in the form of inpatient evaluation for chemical dependency was a reasonable response to Dr. Blass’ denial of substance abuse and attempt to avoid detection of substance abuse during the February 12, 2005 drug urine screen. d. Because there was a possibility that the cause of Dr. Blass’ condition was physical in nature, medical, neurological and neuropsychological examinations to rule out a physical cause were reasonable. e. As a result of his refusal to undergo Board mandated evaluation and monitoring of both psychological/psychiatric condition and his probable chemical dependency, Dr. Blass posed an imminent risk to the safety of the public. f. Dr. Blass engaged in conduct that is or might be harmful or dangerous to the health of a patient or the public (chemical dependency, failure to report same to the Board and request deactivation of his medical license, untruthfulness during his interview with the Board, refusal to undergo Board mandated evaluations and monitoring and violation of formal Board orders). h. Given his refusal to undergo current and future Board mandated evaluation and monitoring, if any, as well as his disdain for the regulatory authority of the Board, Dr. Blass is not a candidate for rehabilitation. 8. The Board requested that Dr. Blass’ license be revoked without stay.

CONCLUSIONS OF LAW 1. The Arizona Medical Board possesses jurisdiction over the subject matter and over the Respondent pursuant to A.R.S. § 32-1401 et seq. 2. The Board is authorized to order a physician to undergo any combination of mental, physical examination including biological fluid testing where there is evidence that appears to show that said physician is or may be unable to safely practice medicine. A.R.S. 32-1141(C). 3. Having been presented with evidence demonstrating that Dr. Blass was suffering from conditions possibly rendering him unable to safely engage in the practice of medicine (serious psychological/psychiatric illness and possible chemical dependency), the Board’s issuance of the Confidential Interim Order and subsequent amendment of the Confidential Interim Order were proper. 4. If on investigation of a physician, the Board finds that public health, safety or welfare imperatively requires emergency action, said physician’s medical license may be summarily suspended pending proceedings for revocation or other action. A.R.S. § 32-1451(D). 5. Because Dr. Balss posed an imminent threat to the public health, safety and welfare as a result of refusal to undergo previously mandated evaluation and monitoring for serious psychological/psychiatric illness and possible chemical dependency, the Board’s issuance of Interim Order for Summary Suspension of License was proper. 6. The Board is authorized to discipline licensees for unprofessional conduct. A.R.S. § 32-1451. 7. Having engaged in conduct which is or might be harmful or dangerous to the health of the patient or the public, Dr. Blass engaged in unprofessional conduct in violation of A.R.S. § 32-1401(27)(q). 8. Having violated formal Board orders, Dr. Blass engaged in unprofessional conduct in violation of A.R.S. § 32-1401(27)(r). 9. Having refused to submit to a body fluid examination and hair drug test per order of the Board, Dr. Blass engaged in unprofessional conduct in violation of A.R.S. § 32-1401(27)(nn). 10. When determining appropriate disciplinary action against a licensee, “the board shall consider all previous non-disciplinary and disciplinary actions against a licensee.” A.R.S. § 32-1451(U). 11. Pursuant to the provisions of A.R.S. § 32-1451(M), Dr. Blass should be assessed the costs of the formal hearing in this matter. Recommended Order In view of the foregoing, it is recommended that License No. 22064 for the practice of allopathic medicine in the State of Arizona, held by Dr. Blass, be revoked.

Done this day, May 9, 2005.

______________________________________ Michael L. Barth Administrative Law Judge

Original transmitted by mail this ____ day of ____________, 2005, to:

Arizona Medical Board Timothy C. Miller ATTN: Susan Ahn, Legal Coordinator 9545 East Doubletree Ranch Road Scottsdale, AZ 85258

By ___________________________

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Office of Administrative Hearings 1400 West Washington, Suite 101 Phoenix, Arizona 85007 (602) 542-9826