If you operate or work in a pain management clinic in Arkansas, compassionate and high-quality patient care is not enough to keep regulators happy. Across the state, Medical Doctors (MDs), Doctors of Osteopathic Medicine (DOs), Advanced Practice Registered Nurses (APRNs), and Physician Assistants (PAs) are held to standards that are so idealistic and disconnected from actual practice that even the best in the medical profession occasionally run afoul of the guidelines. This is true whether you practice in an urban clinic in Little Rock, Fayetteville, Bentonville, and Fort Smith, or have a rural practice in the Ozarks or near the Ouachita National Forest.
The national focus on opioid distribution has caused the state’s regulatory bodies, such as the Arkansas State Medical Board (ASMB) and the Arkansas State Board of Nursing (ASBN), to aggressively monitor every single prescription for controlled substances. All it takes to come under formal investigation is a single patient who complains that you were too quick to prescribe pain medication, or for an algorithm in the Arkansas Prescription Drug Monitoring Program to flag you as a suspicious prescriber. Once the investigation begins, your license is at risk and can be sanctioned or taken away before you even realize what exactly is going on.
When your professional license and right to prescribe controlled substances are under threat, you cannot stand idly by. The process will not “just resolve itself.” You need immediate, aggressive legal representation to ensure your rights are protected and enforced from the very beginning. The LLF National Law Firm Professional License Defense Team has many years of experience defending Arkansas’s medical community, especially those working in pain management. Call our team today at 888-535-3686 or send us a confidential online message to start protecting your career and reputation.
The Complex Landscape of Pain Management in Arkansas
Under both the Arkansas Medical Practices (AMP) & Chronic Intractable Pain Treatment Act (CIPTA), Arkansas law explicitly recognizes that pain management medicine is necessary for treating the state’s population. These laws prohibit regulatory boards from disciplining medical professionals solely for prescribing “dangerous or controlled drugs for the relief of chronic intractable pain.” CIPTA even implores physicians to consider pain management to be a regular part of their medical practice when assisting patients with chronic pain.
Unfortunately, how the law is written is often far different than how the law is enforced. Pain management is no exception. ASMB and ASBN both view regular high-volume prescribing for pain medications with immediate suspicion. Pain medicine specialists are expected to maintain exhaustive documentation proving that each and every prescription is medically necessary. Before determining that a patient’s pain is “chronic and intractable”, all plausible alternative treatments are required to be exhausted before significant opioid drug therapy can begin.
As a result, the conflict between how the law is written and how the law is interpreted by the boards results in practitioners being caught in the middle. You are expected to simultaneously treat those with chronic pain as though they are any other patient, while also being required by the boards to scrupulously document every possibly relevant data point about them before you even consider opioid medications.
The Role of The Arkansas Prescription Drug Monitoring Program
The Arkansas Prescription Drug Monitoring Program (PDMP) is a central tool used by both regulators and law enforcement to monitor the distribution of controlled substances. Administered by the Arkansas Department of Health, the PDMP tracks all controlled substance prescriptions dispensed within the state.
Arkansas prescribers are required to check the PDMP every time they prescribe a Schedule II or Schedule III opioid, and the first time they prescribe a benzodiazepine for a patient. The system is designed to alert providers to potential misuse, diversion, or doctor shopping.
The PDMP actively flags patients who appear to be seeking prescriptions from multiple sources. In Arkansas, a primary threshold for flagging potential doctor shopping occurs when a patient fills prescriptions from five different providers at five different pharmacies within 90 days. When this threshold is met, the system sends a clinical alert to all associated users.
While the PDMP is intended to be a clinical tool, it is frequently used as an investigatory weapon. Licensing boards and the DEA regularly mine PDMP data to identify top prescribers in the state. If your prescribing volume places you in the upper percentile compared to your peers, you are highly likely to face an audit. The LLF National Law Firm Team has extensive experience analyzing PDMP data and defending practitioners against allegations based on statistical prescribing anomalies.
Common Triggers For Disciplinary Action In Arkansas
Investigations by the ASMB or ASBN are rarely random. They are typically triggered by specific events or patterns that draw regulatory scrutiny. Some of the most common triggers include:
- Patient Or Family Member Complaints. A complaint from a patient who was dismissed from your practice for violating a pain contract, or from a concerned family member regarding a patient’s perceived addiction, is a guaranteed catalyst for an investigation.
- Pharmacist Reports. Pharmacists have a corresponding responsibility to ensure prescriptions are legitimate. If a pharmacist notices a pattern of identical prescriptions, large quantities, or questionable drug combinations (such as an opioid, a benzodiazepine, and a muscle relaxant prescribed together), they will likely report the prescriber to the board.
- Law Enforcement Referrals. If a patient is arrested for selling their prescribed medication, law enforcement will trace the drugs back to the prescriber. Even if you were unaware of the diversion, the board will investigate whether your safeguards and screening processes were adequate.
- High-Volume Prescribing Data. Appearing at the top of the PDMP prescribing list or billing an unusually high volume of urine drug screens to insurance companies will trigger an automatic review.
- Inadequate Supervision. Physicians who own or direct pain management clinics can be held responsible for the actions of the APRNs or PAs they supervise. If a mid-level provider violates prescribing rules, the supervising physician’s license is also at risk.
When a licensing board receives an alert, investigators will issue a subpoena for patient records. It is imperative that you do not alter any records upon receiving a subpoena and that you contact our offices immediately.
The Investigation and Disciplinary Process in Arkansas
The Pain Management Review Committee
This committee consists of five full-time active physicians, including pain management specialists. A highly significant feature of Arkansas law is that any allegation of improper prescribing determined to require an ASMB hearing must first be referred to this committee.
The Pain Management Review Committee (PMRC) is tasked with reviewing complaints on an individual patient-needs basis and providing an objective critique to the medical board before a disciplinary hearing takes place. To ensure fairness, regular medical board members are prohibited from being present during the committee’s deliberations.
The initial PMRC review is a vital stage in your defense. A well-prepared and persuasive hearing before the Committee can pause the entire process in its tracks and end the ordeal for good. The LLF National Law Firm Team will work to present compelling evidence to the review committee, including independent expert testimony from full-time active practice physicians knowledgeable in pain management. By demonstrating to the committee that your prescribing habits align with accepted medical standards, we can often resolve the matter before it ever reaches a formal, public board hearing.
Board Hearings and Sanctions
If the PMRC rules against you, your case will be heard by your licensing board. The board has a range of sanctions at its disposal if it also rules against you. Under Arkansas law, instead of issuing a finding of gross malpractice, the board may directly impose penalties. These can include:
- Monitoring your prescribing habits for a period not to exceed six months.
- Requiring you to voluntarily surrender your DEA registration to the board for a specified period not to exceed three months.
- Mandating continuing medical education (CME) in proper prescribing habits.
- Suspending or revoking your license, with the option to stay the action pending successful completion of a probationary period.
Administrative hearings are formal legal proceedings. The board will present evidence, call witnesses, and attempt to prove that you violated the standard of care. You have the right to cross-examine their witnesses, present your own expert testimony, and challenge the board’s interpretation of your patient records.
However, unlike many other states, the Arkansas Medical Practice Act does not guarantee you the right to argue your case to a neutral judge. This means that the board gets to act as both prosecutor and judge. Since this may be the only chance you get to a full hearing on the merits of your case, you need the LLF National Law Firm Team by your side to help ensure that you make the strongest case possible to keep your license.
Collateral Consequences of a Board Investigation
A disciplinary action against your medical or nursing license in Arkansas is rarely an isolated event. The collateral consequences can rapidly destroy a practice.
If the ASMB or ASBN restricts your prescribing authority, the DEA will almost certainly issue an Order to Show Cause, seeking to revoke your federal DEA registration. Without a DEA registration, a pain management practice simply cannot function.
Most alarmingly, administrative findings of improper prescribing can be handed over to the state Attorney General or federal prosecutors. What starts as a dispute over medical record-keeping can transform into a federal indictment for drug trafficking or healthcare fraud.
How The LLF National Law Firm Team Can Protect Your Practice
To defend your medical license, you need a legal defense team that understands national and local medical standards, state regulations, federal drug laws, and the administrative process. If the regulators can prove that you violated just a single rule from any of these sources, your license could be suspended or revoked. For that reason, the LLF National Law Firm Professional License Defense Team leverages our years of experience to protect our clients.
From the very beginning, our team handles all communications with state and federal regulators. Just as medicine is like a language of its own, where terms have very precise meanings that differ from colloquial speech, the law also has its own vocabulary distinct from regular English. This means that when clients “just try to explain things”, they often use words and phrases that can later be twisted against them. Our team is familiar with these tactics and uses carefully drafted responses that avoid falling into these traps while also making it clear that you are not being dodgy or shirking your duty of care to the public’s safety.
Additionally, our team conducts an exhaustive review of your patient charts. This includes looking at your evaluations, patient notes, pain contracts, PDMP queries, and alternative therapy considerations. We then collect this information and have it reviewed by our network of independent medical experts who can examine your clinical decision-making and attest to your suitability to practice.
Our team is also prepared to negotiate and come to settlements with the investigators. In many cases, investigators are just doing their due diligence and want reassurance that you aren’t just handing out prescriptions like candy. Our team “speaks their language” and can show them exactly how you are following the rules and regulations surrounding pain medicine.
However, in many more cases, investigators are overzealous and hyperaggressive. If they will not agree to end the investigation or accept a mutually beneficial settlement, our team is prepared to enforce your due process rights throughout the entire administrative process, such as your right to a hearing and to pursue judicial review of any adverse rulings.
Protect Your Arkansas Pain Medicine Practice Today
If you believe you are or might soon be under investigation, the worst thing you can do is wait until you receive a formal accusation from the state or a DEA raid before getting professional and experienced legal advice. By then, the chances of resolving things “behind the scenes” so they can go away quietly drop dramatically. The earlier you call the LLF National Law Firm Team, the faster we can negotiate directly with state and federal regulators to end the investigation early and keep your professional standing intact.
The LLF National Law Firm Professional License Defense Team has many years of experience successfully representing medical professionals in pain management across Arkansas. That is why those in the pain medicine community call us as soon as they believe their practice might be under threat.
Protect your livelihood and your right to practice medicine. Call our offices today at 888-535-3686 or contact us online.