Board of registration in medicine william a

BOARD OF REGISTRATION IN MEDICINE William A. Rohde, M.D./Parties' Stipulations of Fact & Law BOARD OF REGISTRATION IN MEDICINE William A. Rohde, M.D./Parties' Stipulations of Fact & Law Case No.:RM-93-535 (93-21-DALA) Parties:William A. Rohde, M.D./Parties' Stipulations of Fact & Law Appearing: Date:November 29, 1995 PARTIES' STIPULATIONS OF FACT & LAW The parties, the Respondent William A. Rohde, M D. ("Dr. Rohde") and the undersigned complaint counsels, agree that the Board of Registration in Medicine ("the Board") may make the following findings of fact and conclusions of law. FINDINGS OF FACT Biographical data regarding the Respondent 1. William A. Rohde, M.D. was born on October 30, 1945. He received his M.D. degree in 1972 from Johns Hopkins University School of Medicine. Doctor Rohde is a board-certified psychiatrist. Doctor Rohde obtained his license to practice medicine in Massachusetts on December 7, 1972 under certificate of registration number 35057. -2- 2. On June 9, 1993, at the outset of this adjudicatory proceeding, the Board summarily suspended Dr. Rohde's license and this suspension remains in effect. Respondent's practice patterns 3. Unless otherwise specified, the stipulations which follow describe Dr. Rohde's conduct during the period September, 1992 until June, 1993. 4. Dr. Rohde held himself out as a specialist in providing substance abuse diagnosis and treatment. 5. The majority of Dr. Rohde's patients had histories of substance abuse, including intravenous drug use. Many of his patients were concurrently enrolled in methadone maintenance programs and approximately half of his patients were HIV positive. EXHIBIT DPARTIES’ STIPULATION OF FACT & LAW
6. Doctor Rohde prescribed opiates and benzodiazepines to many of his substance abuse patients, including the fifteen patients whose treatment is the subject of the Board's Amended Statement of Allegations. To most of these specific patients, he prescribed the benzodiazepines Xanax and Klonopin concurrently, sometimes in high dosages (e.g., Xanax, 6-12 mg daily plus Klonopin, 10-16 mg daily). In some of these cases, he prescribed both Xanax and Klonopin together with one or more opiates. In addition to either benzodiazepines -3- alone, or benzodiazepines together with opiates. Dr Rohde also sometimes prescribed other drugs with central nervous system effects to these patients, including butalbital, Depakote, promethazine, clonidine and various anti-depressants 7. Doctor Rohde had reason to know: that his substance abuse patients might exceed his prescribing instructions; that they might also be receiving illicit drugs or additional controlled substances from sources unknown to him; and, that some of them were concurrently receiving methadone maintenance therapy. 8. Doctor Rohde continued prescribing addictive substances to some of his substance abuse patients despite evidence, in the form of urine screens, that they might have been taking other drugs, some of them illegal, in addition to the controlled substances he had prescribed, or, alternatively, that they were not taking the benzodiazepines he had prescribed to them. 9. Doctor Rohde routinely diagnosed his substance abuse patients as suffering from major depression, anxiety, agoraphobia and panic disorder. However, those diagnoses were inadequately documented in the medical records maintained by him. 10. In his treatment of Patients TB and TH, infra, and the thirteen other patients whose care is the subject of the Board's Amended Statement of -4- Allegations, Dr. Rohde failed to comply with accepted standards of psychiatric care. Patient TH 11. At all material times, Patient TH was a forty-three year old, HIV positive, male patient of Dr. Rohde's with a long history of substance abuse, including heroin addiction. In the late winter of 1992 Patient TH was receiving concurrent treatment from Dr. EXHIBIT DPARTIES’ STIPULATION OF FACT & LAW
Rohde and Bay Cove, a substance abuse treatment center in Boston, Massachusetts, where he was receiving methadone maintenance therapy. At all material times, Dr. Rohde knew that Patient TH was receiving methadone maintenance therapy. 12. On March 9, 1993, Patient TH was transferred from Bay Cove to Ad Care Hospital for purposes of detoxification, pursuant to Dr. Rohde's order. Upon arrival at Ad Care he collapsed due to a drug overdose and he was brought to the Saint Vincent Hospital emergency room for treatment. Patient TH was admitted to the Saint Vincent Hospital for management of his drug overdose. 13. During this admission, Patient TH reported to a medical student in the hospital that he had ingested multiple tablets of Xanax, Klonopin and Sinequan in an effort to amplify the effect of the methadone he had recently taken. Toxicology analysis confirmed the presence of Xanax, Klonopin and Sinequan in his system. 14. Doctor Rohde had prescribed the Xanax, Klonopin and Sinequan tablets to Patient TH. 15. On March 11, 1993, Patient TH was discharged from the Saint Vincent Hospital. 16. On March 13, 1993, Dr. Rohde prescribed to Patient TH Xanax, Klonopin, Depakote, Doxepin and clonidine. -5- 17. On April 8, 1993, Patient TH was admitted to the Boston City Hospital. He presented to the emergency room having had an episode of near syncope in which he was not sure whether he had lost consciousness 18. Upon admission, Patient TH reported that the previous day he had taken a combination of Xanax, Klonopin, and clonidine in an effort to get high and that two days earlier he had injected heroin. Toxicology analysis confirmed the presence of opiates, benzodiazepines and tricyclic antidepressants in his system. 19. Upon admission, Patient TH also complained of lower extremity symptoms apparently related to Rhabdomyolysis, his discharge diagnosis. One purpose of this admission was to permit evaluation and treatment of this problem. 20. On April 13, 1993, Patient TH signed himself out against medical advice when his Percocet prescription was withdrawn. 21 On April 21, 1993, Dr. Rohde prescribed to TH opium tincture, propoxyphene, Xanax, Klonopin and Doxepin, among other substances. Patient TB EXHIBIT DPARTIES’ STIPULATION OF FACT & LAW
22. At all material times, Patient TB was a thirty-nine year old, HIV positive, male patient of Dr. Rohde's with a long history of substance abuse, including heroin addiction and alcoholism. -6- 23. Between November, 1992 and February, 1993, Dr. Rohde was concurrently treating Patient TB with both Xanax (6 mg daily) and Klonopin (10 mg daily), together with either propoxyphene (520 mg daily) or Roxicet (4 tabs daily) 24. During this period, Dr. Rohde had reason to know that Patient TB might have been using heroin and alcohol. 25. On February 16, 1993, Dr. Rohde prescribed to Patient TB 40 cc of opium tincture, in addition to a week's supply of Roxicet (28 tabs), Xanax (21 2mg tabs) and Klonopin (35 2 mg tabs). 26. The next morning Patient TB sustained a drug overdose due to excess heroin and benzodiazepine ingestion, for which he was treated on an emergency basis at the Carney Hospital. 27: Although he knew of Patient TB's overdose a week earlier, Dr. Rohde prescribed propoxyphene, Xanax and Klonopin to him on February 23, 1993, albeit in smaller quantities than previously. Respondent's failure to cooperate with the Board 28. During both the preliminary investigation and adjudication of this case, the Respondent failed to provide information and documents to which the -7- Board was entitled, defying subpoenas and other lawful requests for information and violating agreements in which he agreed to produce such materials. CONCLUSIONS OF LAW A. Doctor Rohde has committed repeated acts of negligence, in violation of G.L. c. 112, s. 5(c) and 243 CMR 1.03(5)(a)(3). B. Doctor Rohde has failed to respond to subpoenas and otherwise furnish the Board, its investigators and representatives, with documents and information to which the Board was legally entitled, in violation of 243 CMR 1.03(5)(a)(16). Sanctions The parties leave the matter of sanctions to the Board's discretion. EXHIBIT DPARTIES’ STIPULATION OF FACT & LAW
Execution of this Order The parties agree that the approval of this stipulation is left to the discretion of the Board. The signatures of Dr. Rohde, his attorneys and the Board's complaint counsels are expressly conditioned on the Board accepting this consent order. If the Board rejects this stipulation in whole or in part, then the entire document shall be null and void; thereafter, neither the parties rely on nor refer to the consent order and no statement contained herein shall be considered an admission for any purpose. As to any matter this consent order leaves to the discretion of the Board, neither Dr. Rohde, his attorneys, nor anyone else acting on his behalf has received any promises or representations regarding the same. Doctor Rohde waives any right of appeal he may have resulting from the Board's acceptance of this stipulation. Doctor Rohde shall provide within ten (10) days of acceptance of this consent order by the Board, any employer or health care facility with which he has any appointment, privileges, or other association which requires a medical license, with a copy of this consent order by certified mail, return receipt requested, or by hand delivery, and Dr. Rohde is further directed to certify to the Board within that same time period that he has complied with this directive. /s/ William A. Rohde, M.D. July 19, 1995 /s/ Counsel for Dr. Rohde July 19, 1995 -9- /s/ Complaint Counsel July 20, 1995 Approved by the Board of Registration in Medicine this 29th day of November, 1995. EXHIBIT DPARTIES’ STIPULATION OF FACT & LAW
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Principles of Pulse Oximetry FIG. 1 Introduction Pulse oximeters provide a spectrophotometric assessment of functional arterial hemoglobin oxigenation (SpO2). Pulse Oximetry is based hemoglobin (Hb) and oxygenated hemoglobin (HbO2) differ in their absorption of red and infrared light. Second, the volume of arterial blood in tissue (and therefore light absorption by the hemoglo

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