Health System Accused of Filling Fraudulent Stimulant Prescriptions for Staff

A current civil lawsuit claims that a health system inappropriately filled fraudulent prescriptions for stimulants for nurses, staff, and family members.

The health system is also accused of not keeping complete records of its controlled substances, according to the US Attorney’s Office for the Eastern District of Kentucky.

The fraudulent prescriptions, which were written by a physician working at Appalachian Regional Healthcare Inc (ARH) in Harlan, Kentucky, were filled without proper doctor-patient relationships.

The main medication named in the lawsuit was phentermine, which can produce a high and prevent an individual from falling asleep if used incorrectly.

In the civil lawsuit against the health system, the plaintiff claimed that some of the prescriptions were written for double the recommended dose of the medications and that thousands of pills were illegally given to ARH employees and family.

Through a contract with a third party called Mountain Medical Enterprises, physician Donald Ramsey, MD, started working in the emergency room at ARH’s hospital facility in 2004. From the get-go, there were some issues with getting him credentialed and obtaining a Drug Enforcement Administration (DEA) registration in order to prescribe controlled substances.

The lawsuit alleged that ARH allowed Dr. Ramsey to prescribe controlled substances without a DEA registration until 2013. According to the US government, this meant that ARH pharmacies filled hundreds of Dr. Ramsey’s prescriptions despite the fact that he wasn’t registered with the DEA.

In 2010, a staff pharmacist voiced concerns that Dr. Ramsey was writing multiple prescriptions for phentermine for employees and family members. The pharmacist highlighted several red flags, including the fact that it was inappropriate to prescribe phentermine in an emergency room setting, and that Dr. Ramsey’s prescriptions were written for double the recommended dose.

The pharmacist also saw several ARH hospital nurses who filled the prescriptions for phentermine at the Harland ARH Pharmacy but didn’t seem to have a medical need for the weight-loss drug.

Despite those red flags, ARH allegedly didn’t speak to Dr. Ramsey about the phentermine prescriptions and didn’t tell ARH pharmacies to stop filling the prescriptions.

“For the next 4 years (until 2014), ARH continued to fill double-dosed prescriptions of phentermine written by Dr. Ramsey, who continued to work in ARH’s emergency room, for ARH nurses, employees, and family members,” the lawsuit read.

ARH Harlan’s Risk Manager Phyllis Wilson learned in 2010 that a nurse admitted to receiving the weight-loss drugs and then giving half of the pills back to Dr. Ramsey.

Wilson said she spoke with Mountain Medical Enterprises owner Amir U. Ahmad about her concerns with Dr. Ramsey, but Ahmad said he didn’t remember speaking with any ARH Harlan employee about Dr. Ramsey’s prescribing.

Between January 17, 2012, and March 10, 2014, ARH filled about 83 prescriptions for phentermine for ARH nurses, staff, and family members. All of the prescriptions were for a 30-day supply of 60 phentermine pills, and all of the prescriptions were paid for with cash.

Dr. Ramsey’s medical license was suspended in 2014, after an anonymous tip said he was prescribing phentermine to employees so that they could stay awake during their night shifts.

Five registered nurses, a licensed professional nurse, a nurse’s aide, and a nursing services clerk admitted to receiving phentermine from Dr. Ramsey without any exams or testing.

“ARH nurses stated that ‘everyone does it’ and ‘it happens all the time’ at ARH as a professional courtesy,” the lawsuit stated.

Dr. Ramsey admitted to both writing the prescriptions and using the pills himself to stay alert during night shifts.

“It was determined that Dr. Ramsey had an ongoing substance use disorder involving stimulants, like phentermine, that prevented Dr. Ramsey from practicing medicine with reasonable skill and safety,” the lawsuit stated.

Hazard ARH Regional Medical Center Clinic Pharmacy and Middlesboro ARH Pharmacy were also accused of not keeping adequate records of controlled substances. The attorney’s office noted that this failure to keep and maintain records prevents the government from determining whether other controlled substances were diverted.

ARH, which operates at least 9 pharmacies, had records of at least 97 instances of pharmacies dispensing controlled substances for “office stock” to another registrant pursuant to a prescription.

The United States seeks civil penalties for the alleged violations of the Controlled Substances Act.