By R Carter
The merits of this conviction are based on the fact that a Munster Indiana doctor prescribed opiates to an undercover officer posing as a patient without completing a full exam and verification of the patient’s medical records. Dr. Joshi admitted to using poor judgement in his prescribing practice but pleaded for leniency as he was not your typical street drug dealer. The sentence is base on treating one patient, prescribed four times over a five month period, a normal, not excessive number of pills.
Such harsh punishments are sending shockwaves through the healthcare community with more physicians, including pain specialist, choosing to abandon the practice of prescribing medication, placing a greater burden on those who do and in fact, raising the number of prescriptions issued by remaining practitioners.
Dr. Joshi was indicted Jan. 18 on allegations he prescribed 60 to 67 hydrocodone tablets to an undercover agent on four occasions between July 18, 2017, and Nov. 13, 2017, after only a cursory medical examination. In May 2017, Joshi allegedly had staff members at Prestige Clinic dispense prescriptions for controlled substances to patients while he was vacationing in Greece.
Dr. Jay K. Joshi, 34, a general practice physician at Prestige Clinic in Munster, was sentenced Monday by U.S. District Court Judge Philip Simon to serve 15 months followed by three years of supervised release, a $7,500 fine and a $100 special assessment after pleading guilty to dispensing hydrocodone, an opioid, for non-medical purposes, according to the U.S. attorney’s office for northern Indiana.
“Prescribing controlled substances that are not medically necessary intensify the opioid problem our nation faces,” U.S. Attorney Thomas Kirsch said. “We, working with our law enforcement partners, are focused on reducing opioid abuse in the Northern District of Indiana. Doctors who abuse their authority are just one of the areas on which our partners are focusing.”
Between September 2017 and December 2017, the Drug Enforcement Administration and Munster Police Department obtained information about Joshi’s history of prescribing controlled substances through Indiana’s prescription monitoring system, INSPECT, according to Kirsch.
INSPECT data obtained by investigators showed that from April 2017 to November 21, 2017, Joshi issued more than 6,000 prescriptions for controlled substances.
Joshi was ranked first in Lake County and ninth in the state among registered drug providers in 2017 for the number of prescriptions written for controlled substances, court records state.
Joshi’s medical license has been suspended since February 2018.
Without knowing what signs and symptoms were used by the undercover officer, it difficult to know whether or not the physician used poor judgement, his admission may be like most doctors who plead guilty in order to avoid harsher punishment.
6,000 prescriptions over 8 months amounts to 40 prescription per day on a 20 day work month. Depending on the providers practices setup, if employing a Physician’s Assistant or Advanced Nurse Practitioner as most clinics do, 40 patients a day is not excessive as each can see 2-3 patients every hour in a 10 hour day. Not having these facts from the published report makes it impossible to know if Dr. Joshi acted alone on in conjunction with an employee, but details hint at the fact that he had an employee qualified to act in his absence.
Logically though it would be impossible to prescribe for 40 patients a day as a single provider, without drawing such attention to your prescribing patterns, which may after all be the real cause behind a 15 month sentence.
Still, such actions by law enforcement raise serious questions about the rationality of such strict and literal interpretations of standards. Leaving no room for medical judgement, compassionate judgement, in a system so constrained by law enforcement actions, that physician shortages force patients execute and prioritize medical care above all other life issues, leaving no room for exception when the system breaks down or fails as it does at times. Failures in the system do occur and place prescribers and patients at risk for actions such as these. Yet the true nature of the violation is nothing more than a drop in the ocean of illegal drug abuse which is occurring on the streets, so why are going after such small infractions when clear and unmistakable criminal actions are occurring everyday?
I want to believe that law enforcement is acting rationally, but to date, no published indictments provide sufficient evidence to support drawing such a conclusion. Based on physicians I have spoken to; who have been charged with such crimes, charges have been excessive and poorly founded, often exaggerated to give the appearance of wrongdoing when in fact, doctors are acting well within the standards of care.
I would like to believe law enforcement is making the practice of medicine safer, but reports such as this and those I have investigated lead me to believe otherwise.