Dr. Corrine Basch, who
runs the Full Circle Center for Integrative Medicine in Arcata, could
soon be stripped of her license to practice medicine, after a state
regulatory agency charged her with unprofessional conduct in regard
to prescription of pain medication, among other things.
But Basch is challenging the state’s accusations, saying that she is caring for people who come to her with preexisting excessive use of opioids – some of them in chronic pain. Meanwhile, some of her patients have come to her defense, saying that Basch has provided excellent care when other doctors have been unwilling.
Kimberly Kirchmeyer, the executive director of the Medical Board of California, filed a formal complaint against Dr. Basch alleging multiple charges of “unprofessional conduct” on May 8.
Details of the “unprofessional conduct” range from prescribing “excessive amounts of opioid medications and benzodiazepines”; a failure to lower “pain medications to a safe level in a timely manner”; a lack of discussion about the risks involved in taking narcotic medications; failing to develop to a clear plan about the reason behind taking a combination of opioids, benzodiazepines and other sedatives; failing to follow plans to taper patients off pain medications within an appropriate timeframe; and more. The most severe accusation states Dr. Basch “prescribed excessive amounts of opioid medications and benzodiazepines for [one patient], placing him at risk of overdose and death.”
If found guilty, Dr. Basch may have her license revoked, or she may be suspended for no longer than one year, or she may be placed on probation. Dr. Basch has denounced the accusations against her on the website of her practice, calling the state Medical Board’s accusations a public shaming, and has asked her patients and other community members to write letters in support. She denies that she has been negligent in the care of her patients.
“Currently I think many physicians are intimidated into doing things that they would have found unthinkable five years ago,” Basch told the Outpost. “For instance, one of the patients I inherited had been on the equivalent of 340 milligrams of morphine a day and was cut overnight to 90 milligrams with no warnings. I find that appalling.”
Basch specializes in pain management and has been practicing on the North Coast since 1996, with a five-year stint in Washington from 2008 to 2013. Basch said the Medical Board’s approach to the dealing with the opioid crisis is problematic and doesn’t take into consideration the quality of the patient’s life. Rapidly cutting a patient’s opioid prescription can lead them to seek pain relief from illegal sales on the streets, something Basch said some of her patients have admitted to.
“Once people are on huge doses, they are very tolerant and dependent,” Basch said. “I find it works better to persuade them that it is a good idea to come off [opioids]. If you threaten them that everything is going to go away, they freak out and do irrational and potentially dangerous things.”
According to the California Department of Public Health, physicians should proceed with caution when patients are taking over 80 milligrams of morphine per day.
The Medical Board of California’s guidelines for opioid prescriptions are somewhat vague. The state says that there is no “safe ceiling” dose of opioids, but physicians should “proceed cautiously” before prescribing more than 80 milligrams a day, and that doctors should refer to specialists before prescribing more. The five patients listed in the complaint against Dr. Basch were significantly over that mark. The first patient listed in the complaint (“P-1”) began treatment from Basch in Feb. 2014 and was on the equivalent of 980 milligrams of morphine a day when Basch assumed care. On July 12, 2018, the last day of recorded information in the state’s complaint, P-1 was on an equivalent of 612.5 milligrams of morphine.
Another patient, identified as P-4, was on the equivalent of 960 milligrams of morphine a day when Dr. Basch started care in July 2014. An outside pain specialist recommended P-4’s morphine doses be tapered by 10% a month until P-4 was down to 420 milligrams a day, but Basch failed to reach this goal. “Four and a half months after starting the taper, the total opioid dose had been reduced by only 15.6% instead of the nearly 40% reduction that would have resulted from the pain specialist recommendations,” the state’s complaint reads.
Basch told the Outpost that while she understands the state has a role to play in addressing the opioid crisis, she believes that her care of the patients in these cases is medically justified.
“I appreciate that the medical board has an agenda to help prevent more opioid-related deaths in our state, but I feel like they are amputating the wrong leg,” Basch said. “Pain patients who have been on high doses of meds for a long time and who are actually taking their meds are not the ones causing heroin and fentanyl on the streets. If we taper them rapidly and they go to the streets, we’ve actually contributed to that problem.”
Basch said she currently serves around 1,400 patients and about 60 of them are classified as chronic pain patients. One of them is Karen Bertenthal, who lives in Bayside and has been seeing Dr. Basch for the past five years. Bertenthal said her appreciation for Dr. Basch ranges from the attention Basch gives to her patients to the holistic approach she takes in treating them.
“She has helped me in ways that no other physician has,” Bertenthal told the Outpost. “I am grateful to go to a physician that looks at me and my issues and doesn’t compare me to her other patients, because everyone is different. She’s offered me ways to help my body on my own without prescriptions.”
Bertenthal suffers from chronic pain due to a broken humeral head, a broken wrist and the removal of her gallbladder. To help deal with her pain, Bertenthal attends pain management classes with Dr. Basch. During these classes, patients share stories about how they deal with pain and what has and has not worked for them. There are talks about the role of nutrition and what foods help with inflammation. When it comes to the Medical Board’s decision to go after Dr. Basch, Bertenthal felt that it was a “witch hunt.”
“Her office isn’t just going in and getting a prescription, if you walk in you will see that you are in a different place. Her office staff is so supportive of implementing what she prescribes. We are so lucky to have her here.”
Dr. Basch said she has been praised by colleagues for her multifaceted approach to dealing with pain – an approach that includes meditation, a focus on the relationship between the mind and body, and the need to address social isolation. (An essay on her approach to pain management can be found at this link.)
“I think having a relationship with a care provider that is trying to solve the underlying problems and finding the support for them to get better and get off meds is a good thing,” Basch said.
Lynn Robbins is also a patient of Dr. Basch, and has relied on her care since 2005. She said she has hypoglycemia, adrenal exhaustion, muscle spasms, stenosis and osteopenia – a mild form of osteoporosis.
“She is crucial to my functioning,” Robbins told the Outpost. “My health concerns are very complicated and have been for 40 years. Most doctors won’t touch me and medical costs have ate up most of my retirement money. Dr. Basch is the only doctor with a greater scope that is willing to take on Medicare patients. She is really a lifeline for me.”
Robbins praised Basch’s care for her patients – she treats them as individuals, she said, instead of using a “one size fits all” approach.
“[The Medical Board] found five people that should have been treated in a different way when she treats hundreds of patients,” Robbins said. “The medical board wants there to be one policy that is uniformly applied to everyone. Are the people that are legitimately using opioids correctly supposed to be penalized?”
If Basch is placed on probation, she will have to close her practice due to regulations from the Medical Board, she said. This would mean that the 1,400 patients currently under Basch’s care would have to go elsewhere for services in a county that is already in need of medical providers. Basch said a hearing date has yet to be set for her to contest the state’s accusations, but losing another doctor could have detrimental effects on the community.
“With these [pain] patients, the only way to manage them in a way that the state would not criticize, would be to fire them,” Basch said. “To say ‘I won’t care for you’ and that would protect my license, but it would not protect those individuals. There’s a good chance that the other 1,300 patients of mine are going to have no provider at all because of my management of these few. I never claimed to be the perfect doctor. Nobody is.”