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LINCOLN â€“ â€śReckless,â€ť â€śdangerousâ€ť and â€śsubstantially below the standard of careâ€ť are some of the terms health officials are using to describe the prescribing practices of a local doctor whose medical license was suspended Thursday by the Board of Medical Licensure and Discipline.
A â€śpattern of fatal opiate overdoses in patientsâ€ť under the care of Dr. Fathalla Mashali prompted the board to conduct the investigation that led to his suspension, according to papers released by the board.
Mashali maintains an office at 6 Blackstone Valley Place and has staff privileges at Landmark Medical Center in Woonsocket. His specialty is anesthesiology.
Because the deaths involved painkilling opioid or other controlled substances, health officials hired an outside pain management physician to review the records in the deaths of six patients under Mashaliâ€™s care, referred to as Patients A through F in the suspension order. In more than one case, the reviewer said Mashali had overprescribed painkilling narcotics to his patients despite clear indications that they were abusing drugs, including cocaine.
One of the most glaring examples of the Mashaliâ€™s substandard care involved Patient A, the reviewer said. Despite evidence that the woman was suffering from cachexia, a type of physical wasting usually due to illness, he continued to prescribe her high doses of Valium, a tranquilizer, with Adderall, a stimulant often prescribed for attention deficit problems.
â€śOf all the questionable behaviors demonstrated by (Mashali) in the care of this patient, the most egregious is his continuing to prescribe huge doses of stimulants to a patient without a verified diagnosis, without monitoring her blood pressure or vital signs, apparently without even looking at her to see that she was cachectic,â€ť the reviewer said. â€śIn the course of forty days...a total of 312 Adderall 30 mg pills were prescribed.
â€śIn my opinion, it can be stated with a reasonable degree of medical certainty that the medical care provided by (Mashali) was substantially below the standard of care. His prescribing practices were dangerous.â€ť
Patient B, another female, had violated her narcotic contract with Mashali, which means she was using too much of a prescribed drug or that there was evidence of non-prescribed substances in her system. Nevertheless, Mashali prescribed her a monthâ€™s worth of opioid medication at a time.
Patient D, a male, died in the spring of 2011, about four months after Mashali accepted him as a patient, with three different kinds of opiates in his system, oxycodone, oxymorphone, morphine, plus alprazolam, a tranquilizer. Mashali was prescribing him drugs even though his initial toxicology screen came back positive for amphetamines and cocaine, the reviewer said.
â€śIt seems unlikely that any pain clinician (or any clinician of any specialty) would prescribe opioids for a patient on the same day that a tox screen came back positive for both amphetamine and cocaine,â€ť the reviewer concluded. â€śThe judgment here is quite poor, and despite (Mashaliâ€™s) assertion that he would monitor the patient at bi-weekly intervals, the patient was not seen again for four weeks.â€ť
Another of Mashaliâ€™s patients â€“ Patient E, a female â€“ initially came to him for Suboxone, a drug used to wean addicts off heroin. She died in the fall of 2012 with a cocktail of opioids and sedatives in her system, including methadone; diphenhydramine, a sedative; oxycodone; carisprodal, a muscle relaxer; bupropion, an antidepressant; and promethazine, a sedative.
The reviewer excoriated Mashali for giving the patient four times the supply of Suboxone than the normal protocol, and continuing the regimen despite positive screens for methadone, which hadnâ€™t been prescribed to her, as well as the street drug Ecstasy. The review said, â€śIn my opinion, this standard of care would place any patient at risk.â€ť
Patient F, also a female, died in 2011 with ethyl alcohol, the painkiller fentanyl and other drugs in her system. The reviewer said the case was â€śparticularly disturbingâ€ť because the woman had a long history of opioid, cocaine and alcohol abuse. Despite Mashaliâ€™s awareness of her history of abuse and repeated stints in rehab, â€śhe continued to give increased doses of opioids often for a monthâ€™s worth of pills at a time.â€ť
The disciplinary board, an arm of the state Department of Health, suspended both Mashaliâ€™s license to practice and his controlled substances registration, calling him â€śan immediate threat to the health, welfare and safety of the public.â€ť Mashali, who has retained a lawyer, according to health officials, is entitled to an administrative hearing within 10 days to seek the repeal or amendment of the order.
The disciplinary panel instructed Mashali to make arrangements for the continued care of his patients with a properly licensed physician.