Staff at the University of Missouri Hospital’s Missouri Psychiatric Center gave Jennifer Crouch an unusual discharge recommendation after her suicide attempt in 2015: File a complaint against your doctor with the state medical board.
The staff believed her doctor and employer, Justin LaMonda, had contributed to her suicidal thoughts by giving her drugs she didn’t need while engaging in an inappropriate sexual relationship with her.
Crouch made the complaint, then waited two years for the Missouri Board of Registration for the Healing Arts to determine LaMonda’s fate. The board’s investigators found that LaMonda had endangered Crouch by prescribing or directly giving her at least 39 different drugs, including tramadol (an opioid), Valium (an anti-anxiety medication) and oxytocin (a hormone sometimes used to increase sex drive).
Last month the board’s order finally came: LaMonda’s license to practice medicine was suspended for three years, but the suspension would be reduced to 30 days if he completed a class on professional boundaries.
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LaMonda can now return to his practice in Moberly, or anywhere in the state, as soon as he gives the board proof that he took the class.
“I don’t think it’s at all justifiable,” said Crouch, who contacted The Star after a story about LaMonda’s suspension. “As long as this case took for them to process and get this outcome and then basically slap his hand and say, ‘OK, you’re admitting to this and we’re going to do this.’”
LaMonda has not responded to messages left with employees at his office.
Crouch’s complaint comes amid other concerns that the medical board is not doing enough to protect the public from dangerous doctors.
Orders reinstating the licenses of two doctors, Michael Impey and Charles Sutherland, with felony convictions for illegally distributing drugs and forging prescriptions surprised a prosecutor, who said Sutherland had contributed to her community’s opioid crisis and should not be licensed to practice medicine again.
Randall Williams, the director of the Missouri Department of Health and Senior Services, called Impey and Sutherland “the tip of an iceberg.” Based on national rates of physician drug abuse and the Missouri medical board’s relatively small number of disciplinary actions last year, Williams said he thinks there’s more out there who are contributing to the state’s opioid epidemic.
He said the prescription drug monitoring program the state announced in July will root out doctors and pharmacists “who are misusing drugs illegally and deviating from best practices.”
“We anticipate we will be identifying more providers and dispensers that are part of the problem,” Williams said.
Meanwhile, Williams’ boss, Gov. Eric Greitens, has a chance to remake the nine-member board, with four vacancies awaiting his appointments. But he’ll be constrained by Missouri laws that give doctors more influence over the board than those in most states.
LaMonda’s case, which was potentially decided on the votes of just three board members, gives a sense of what’s at stake.
Psychiatrist’s report flags ‘considerable violations’
Crouch said she was an office manager for LaMonda when he started treating her for work-related stress with anti-anxiety medications and then antidepressants and other medicines.
She said the drugs altered her moods and her personality. According to the board’s order, she and LaMonda had sex at least four times and at least one of their encounters came “in an exam room immediately after administering treatment.” Crouch said that treatment was an injection of ketamine, a strong anesthetic that is sometimes abused as a “date rape” drug. It was one of the 39 drugs listed in the board’s order.
Crouch said she thought the sex was consensual, though out of character for her, at the time. But after a verbal confrontation with LaMonda’s wife, she was fired and, feeling guilty and despondent, tried to overdose on Valium and a muscle relaxant called Flexeril. She immediately regretted the decision and confessed the affair with LaMonda to her husband, who got her to the hospital.
The staff at the Missouri Psychiatric Center told her there was no reason for her to be on most of the medications LaMonda had given her and Crouch said a therapist urged her to report him.
Crouch’s discharge summary, written by MU psychiatrist Lauren Tran, faulted LaMonda.
“There were considerable violations of boundaries by the patient’s former employer that include treating a patient without appropriate documentation, dispensing controlled substances without a prescription, and having an intimate relationship with an employee/patient, which have resulted in significant distress and suicidality in the patient,” the report says.
Crouch said she now believes she was a victim of acquaintance rape. She and her family have since moved to the West Coast because she said life in Moberly became impossible after she reported the local doctor to the medical board.
“It’s small-town politics,” Crouch said. “Everybody knows everybody. ... I couldn’t even find employment.”
Few disciplinary actions
The Missouri medical board’s executive director, Connie Clarkston, said the board’s deliberations about how to discipline doctors like LaMonda, Sutherland and Impey are private. Only the board’s final decisions are released publicly.
Williams and the health department staff have been analyzing those decisions. They found that the board disciplined 58 doctors last year, a rate of about 2.23 per 1,000 doctors. The national average last year was 5.43 per 1,000 doctors. Kansas was 2.55 per 1,000.
Given that national drug rehabilitation stats estimate about 10 to 15 percent of doctors have abused drugs or alcohol, Williams believes there’s room for more discipline in Missouri as part of efforts to address the state’s opioid crisis.
“As we refer new cases to the Board of Healing Arts, we want to make sure we’ve raised awareness of the full scope of this problem, especially as we anticipate the increased ability to detect those who are abusing, misusing and diverting drugs,” Williams said.
Williams said he had talked to Clarkston about the state’s opioid problems and she “has been very helpful” in distributing information about proper prescribing practices to all 20,000 licensed physicians in Missouri.
Williams said physician burnout is a problem that can lead to drug abuse and some doctors may just need help. Studies show a high rate of recovery for doctors who get treatment, he said.
But for those putting patients at risk, stronger measures may be in order.
“As we identify those, the options are, if they are egregiously breaking the law, we work very closely with the Drug Enforcement Agency,” Williams said. “They will be turned over to law enforcement. But sometimes it’s not a law enforcement issue, but it’s more of a professional standards issue. Sometimes that calls for education. Sometimes that’s sanctions and the other issue is sometimes that’s getting physicians help.”
Jeff Howell, the general counsel for the Missouri State Medical Association, said it’s hard to make state-to-state comparisons about medical board actions because the laws that allow boards to discipline physicians differ from state to state. He also noted that Williams was comparing disciplinary actions for all offenses, not just those related to drugs.
The Missouri medical board is made up of nine members: eight doctors and one representing the general public. Under state law, the medical association, an advocacy group for the state’s doctors, forwards the governor five candidates for each open slot and the governor chooses one.
According to a study of state medical boards published by the U.S. Department of Health and Human Services in 2006, that’s traditionally how such boards have been set up: the doctor’s association has a strong say in picking the members and all or nearly all the members are doctors.
But most states started changing that decades ago, according to the study’s authors.
“Some medical society influence survives in some states, either by law (as in New York) or tradition,” they wrote. “But starting in the 1980s, the role of organized medicine has generally been reduced.”
The authors chose six state boards to study in-depth, based in part on their reputations as good models: California, Iowa, Ohio, Massachusetts, Virginia and Washington. The boards in those six states were made up of 21 to 37 percent non-physicians.
“Almost every state now requires some number of lay members, on the theory that they are more likely to hold errant physicians accountable,” the authors wrote.
Missouri’s board is 11 percent non-physicians. It’s one lay member is Sarah Martin-Anderson, the division manager for Community Engagement, Policy and Accountability for the Kansas City Health Department.
Howell said to his knowledge Greitens has not yet asked the medical association to provide him any candidates for the board’s four vacancies.
Greitens’ office didn’t respond to a request for comment, but Williams said his department has been advising the governor’s office on the coming appointments.
“As the governor fills those positions we are making sure the processes we have in place recognize how the opioid crisis is affecting the Missouri Healing Arts Board as it’s affecting the profession, as it’s affecting really every segment of society,” Williams said.