PORTSMOUTH — An American Pain Institute physician agreed with the state Board of Medicine to accept a reprimand, get additional medical education and pay a fine for medical misconduct related to his discontinuing treatment for a pain patient.
The physician, Joshua Greenspan, agreed to the discipline, according to an agreement published by the medical oversight board, which distributed a copy to the media. A message left for Greenspan was not returned Wednesday.
The settlement agreement states Greenspan was licensed in 2006 to practice medicine, is board certified in anesthesiology and pain management and practices at the American Pain Institute at 14 Manchester Square in Portsmouth. The board reported it received a June 2018 complaint from a former Greenspan patient who claimed his pain medications were reduced, after being the same for years, leading to pain, anxiety and suicidal ideations. The patient also reported Greenspan "failed to treat his new and/or worsening symptoms over a period of years."
According to the agreement, the board conducted an investigation and Greenspan agreed that if a disciplinary hearing were held, the board could find Greenspan "engaged in professional misconduct." It reports the investigation involved one patient who suffered chronic pain "for many years" due to a fall, a crash and surgeries.
The patient began treatment in 2014 with Greenspan who prescribed Ocycontin and Oxycodone at the same levels for years, during which there were monthly appointments. The patient was also taking Klonopin, prescribed by his primary doctor for anxiety, after the FDA in 2016 issued a "strong warning" against combining that type of drug with opioids, the Board of Medicine notes.
The agreement states there's little evidence in the doctor's records that there was ever a review as to the use and/or levels of opioids during the four years of treatment, until April 2018, when Greenspan began reducing the dosages. The agreement states Greenspan told the patient that Medicare had issued new guidelines, effective Jan. 1 2019, that only allow 90 mgs of morphine equivalents daily. Citing that guideline, Greenspan reduced the patient's dosage by 13%, the agreement with the state Board of Medicine states. However, the report notes, the Medicaid rule did not set an upper per-day dosage limit, but did require a pharmacist filling prescriptions above the threshold to "document a discussion with the prescribing doctor."
Twice the patient complained about pain due to the reduced dosage, on one occasion going to the hospital for emotional duress, the settlement agreement states. Greenspan, according to the agreement, "made no referrals or recommendations regarding these issues, but instead reduced the patient's dosage by another 20 mgs.
The patient later failed a random pill count and was admitted to a hospital after threatening suicide unless he was given a higher dosage of the opioids, the agreement reports. Greenspan in turn discharged the patient from his practice, ordered the person a prescription for withdrawal medication, reported the patient to the police and the primary care doctor, it reports.
According to the agreement, Greenspan violated nine laws and/or the American Medical Association Code of Ethics and agreed to disciplinary action. He endorsed the agreement which calls for 12 hours of continuing medical education, in the areas of pain management and record keeping, to pay a $1,000 fine and bear all costs associated with the settlement. He is also required, for a period of one year, to provide a copy of the agreement to any employer. The agreement states it halts any further disciplinary action but may be considered should further misconduct occur.