LITTLE ROCK, Ark. (AP) - The state Medical Board, following the advice of its own pain specialist, has reduced the number of cases it will consider when deciding if a Russellville doctor engaged in "grossly negligent or ignorant malpractice."
Dr. Randeep Mann's patient care is the subject of a three-day hearing before the board as it prepares to decide whether to revoke Mann's license to practice medicine in Arkansas. The hearing began Thursday and was to continue Friday and Monday.
Officials say 10 of his patients have died from a lethal mix of drugs or an overdose of prescription medicines. Mann's license was suspended after the state accused him of prescribing excessive amounts of controlled substances to patients he knew or should have known had histories of drug abuse.
Meanwhile, outside the hearing room, an Oklahoma doctor once fined by the board over similar allegations was arrested Thursday in a confrontation with a state trooper after the physician showed up at the board's office with a crowd of supporters.
Arkansas State Police arrested Robert Kale, 53, and charged the Muldrow, Okla., doctor with disorderly conduct.
A patient of Kale's, Gene Mentink of Van Buren, said Kale had asked him and other patients to attend Mann's hearing. Mentink said state police and Medical Board officials kept the crowd from attending the hearing.
"He said he thought it would be a good idea to support the doctor," Mentink said. "They're trying to do the same thing (to Mann) that they did to him."
A state police news release said Kale and his supporters were asked to move away from the building's entrance after Medical Board representatives and employees complained of intimidation.
The release said Kale approached a state trooper in a "threatening manner," then refused to move from the building's entrance. He was handcuffed and taken to a patrol car, then ticketed and released, police said.
Kale told a somewhat different story. He said that he had agreed to leave and was walking away from the trooper when he called the officer an idiot.
"He said, 'That's it, you're not going to call me an idiot,"' according to Kale. He said the officer then grabbed his arm and told him he was under arrest.
In 2003, the board found that Kale had violated a regulation by promoting his services as a comprehensive pain-management program. Kale called his practice the Physician Acupuncture and Medical Pain Management Clinic, but he did not provide services from a team of interdisciplinary specialists as regulations require, the board ruled.
Kale was fined $14,634 for the cost of the board's investigation. The board's decision was upheld when Kale appealed to Sebastian County Circuit Court. Kale has since closed his Arkansas office and now practices in Oklahoma.
Earlier this year, the state Supreme Court upheld the lower court ruling and ordered Kale to pay more than $17,000 to the state.
In Mann's case, the board heard testimony Thursday from Dr. Carlos Roman, a Little Rock pain specialist who reviewed Mann's patient records at the board's request, and testified on the board's behalf. He said five of the 20 cases the board had cited did not clearly violate the Medical Practices Act.
Along with the 10 patients who died - one of those cases was among the five that Roman said met medical-care standards - several patients survived overdoses, including one who suffered brain injury. The board's investigation found that Mann prescribed excessive amounts - 15 to 26 bottles per month - of the pain reliever butorphanol for one patient.
Roman also questioned Mann's prescription of large amounts of acetaminophen for a patient with cirrhosis of the liver.
Mann testified about his care in the 15 cases still at issue. He said that, in some cases, he didn't know patients had overdosed - and continued to prescribe narcotic pain relievers - because he hadn't received records from a hospital's emergency room that would have reflected the overdoses.
"I've done everything in my power when I've known about a problem to address the problem," Mann said.
In other cases, he said, patients overdosed on medications prescribed by other doctors, or their cases were mischaracterized by the hospital as overdoses.
Mann said his procedures were accepted as appropriate techniques to manage chronic pain.
Roman disagreed.
"This isn't really an issue of pain management, right?" Roman said. "This is an issue of death and addiction ... They're not dying from back pain."
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