Local doctor's license suspended
The Montana Board of Medical Examiners has indefinitely suspended the medical license of Dr. Clyde Knecht, a physician who practices in Libby, for a number of practice violations including excessive prescribing of narcotics, failing to provide proper care for patients and failing to properly document the care he provided.
The Dec. 21 ruling immediately suspended Knecht’s license to practice under an emergency declaration pending further investigative and disciplinary proceedings.
“Due to the nature of the factual assertions set forth below, the Screening Panel finds that public health, safety or welfare imperatively requires emergency action,” Screening Panel chair Dr. Anna Earl wrote in the notice of proposed action for the case. “It is ordered that the Medical Doctor license of Clyde Knecht to practice in Montana be immediately and summarily suspended for an indefinite period pending further investigative and disciplinary proceedings or other resolution of this matter.
“The board was acting on a complaint filed by another medical provider, an addiction specialist, who had taken over the care of one of Knecht’s patients. According to the board documents, the complaining physician researched the patient’s prescription history and documented numerous hydrodocode-acetaminophen prescriptions written to the patient under both the patient’s name and a nickname, and were filled at five different pharmacies. The complainant categorized the prescription activity as “egregious over-prescribing of opioids.”
The use of the multiple pharmacies and different names, the complaining doctor alleged, helped hide the over-prescribing and cover the patient’s addiction issues.
The board concurred.
“Patients attempting to avoid pharmacists’ attention to unusually large quantities of pain medications often fill those prescriptions at more than one pharmacy,” Special Assistant Attorney General Michael Fanning wrote in the notice. “Patients attempting to avoid an MPDR (Montana Prescription Drug Registry) record of their prescription pain medication use will fill those prescriptions under different names so a review of use in the MPDR will not reveal their full history.”
According to the document, Knecht defended his decision to prescribe the narcotics in such volume.
“Dr. Knecht defended that his prescription writing was not greatly out of the norm,” Fanning wrote. “Dr. Knecht understood that 120 morphine mg equivalents (MME) per day is considered an acceptable level of prescribing and his prescriptions were in the range of 150 MME per day until the last two months of care when they increased to 170 MME per day. Dr. Knecht averred that many chronic pain patients take levels of medication greatly in excess of 120 MME and his prescribing was in keeping with formerly accepted practices.”
The board ruled against Knecht, issuing several findings of fact as a result of the investigation and proceedings, ruling on issues ranging from documentation to standard of care and the over-prescribing of medication.
“Dr. Knecht’s volume of narcotics for this patient in terms of MME were greatly in excess of responsible prescribing practices,” Fanning wrote.
“Dr. Knecht ignored facts in his charts regarding worrisome ‘red flags’ suggesting possible misuse or diversion. For instance, the patient claimed she lost her medications and demanded early refills, a practice commonly associated with cases of abuse or diversion. The records also contain instances in which another picked up the patient’s prescription medications.
“Dr. Knecht’s documentation of his care is indefensibly substandard.
“Dr. Knecht charted other medical issues such as elevated blood pressure, but took no steps to address that serious health concern.”
The board also found Knecht to be in violation of practice standards for prescribing narcotics to manage addiction as well as for pain care.
“Dr. Knecht acknowledged that his patient was addicted to pain medications and was prescribing narcotics to manage her addiction as much as for pain care,” Fanning wrote.
Knecht has 20 days from the date of the notice, Dec. 21, to request a hearing. If he requests a hearing, a special hearings examiner will be appointed by the Commissioner of Labor and Industry.
Should he not request a hearing on the matter, the board can enter a final order of discipline based upon the facts presented to date. The board has the authority to impose a number of sanctions, from fines of up to $1,000 per instance of violation to temporary or indefinite suspension or license revocation.