INDIANAPOLIS – Lengthy testimony on seven patient deaths highlighted the disciplinary hearing of embattled Fort Wayne pain management Dr. William Hedrick Thursday before the Indiana Medical Licensing Board.
An expert witness for the state identified what he considered to be evidence of substandard care – from overprescribing powerful narcotics to not responding to obvious signs of abuse by patients.
But during cross-examination, Hedrick's attorney noted several factual inaccuracies in the witness' examination of the patient charts and indicated there are differing opinions on some of the treatment.
The board decided to adjourn the day-long hearing after it was clear another eight hours would be needed to conclude the testimony. The case will continue either at the board's regular March meeting or on another date agreed upon by all parties.
Hedrick's license to practice medicine remains temporarily suspended. The worst punishment he faces is a full revocation, which lasts for at least seven years and is relatively rare.
The state Attorney General's Office filed a complaint against Hedrick in December, accusing him of incompetence and recklessly prescribing pain medications.
Hedrick is founder and president of the Centers for Pain Relief, which is based in Fort Wayne but has more than a dozen other locations in northern Indiana. In the past few months, multiple lawsuits have been filed against him, and a number of patients have come forward saying he got them addicted to controlled substances. There also was a raid on the offices by local, state and federal authorities.
In opening statements, Deputy Attorney General Jessica Krug said Hedrick's practice involved a number of physicians and other employees who failed to concern themselves with patient safety and outcomes.
She alleged Hedrick and others ignored clear evidence of addiction to and diversion of controlled substances. The issues mainly center on opioid therapy, or the chronic use of strong painkillers to control pain.
"He contributed to and maintained addiction in patients," Krug said.
She said Hedrick says he can't be held accountable for actions of other physicians or employees in his practice, but "the evidence shows Dr. Hedrick failed to watch the store."
Hedrick's attorney, Stacy Cook, first asked the board not to consider the fact that Hedrick sought a settlement of the case last month that would have resulted in a two-year suspension of his medical license.
She said before Thursday the case has been all allegations and speculations, but facts and evidence from patient charts refute the state claims.
Cook described the evidence related to the seven deaths as weak – noting that two of the patients at the time of death had no controlled substances in their system. In two other deaths, Cook said a coroner ruled the death was because of multiple drug toxicity based only on a drug screen – not an autopsy.
She plans to call a number of experts, including a toxicologist, a pain medication specialist and a pathologist. Hedrick is also expected to testify.
The state's star witness, Dr. Timothy King, runs a pain management clinic in Crown Point. He reviewed the charts of the seven patients who later died. Krug led the doctor through individual chart notes for hours. King identified several patterns that he questioned as being proof of substandard care.
First, he didn't believe the patients were candidates for chronic opioid therapy because of other health problems, psychiatric diagnoses and previous abuse history. Next he found several notations of patients either not taking the medication or taking too much – yet the staff at Hedrick's practice continued the prescriptions.
Third, King said there was evidence in multiple cases that the patient was getting additional painkillers from other doctors, but the treatment was continued – and sometimes increased. Sometimes the patients reported no improvement, and yet medication and spinal injections continued.
Lastly, King said a few specific chart notes directed that opiates be stopped but prescriptions were still given.
On cross-examination, Cook used a number of peer-review articles and journals to dispute what King considered to be standards of care. Specifically, King criticized the use of spinal injections by Hedrick and Cook pointed to differing opinions on the matter.
In addition, she was able to point out several factual inaccuracies in King's summaries of the patient treatment.
For example, one patient was allegedly given an opiate prescription after the chart specifically said it should be discontinued. Cook forced King to examine an INSPECT report – a state database tracking controlled substances prescriptions – that showed no prescription from the same date of the office visit.
On another case, she forced King to note that he had left heroin off the list of drugs found in a drug screen of one of the deceased patients.