Suspended doctor seeks legal help (Semi-auto Machine Gun)

WALHALLA — A Seneca physician who had his medical license suspended last month following a series of drunk and disorderly conduct arrests applied Monday for a public defender to represent him in General Sessions Court.

Although he made the application in person at the county courthouse, Antonio Felipe Amaya has yet to make available the medical records his patients need to continue their treatment elsewhere. And now the state board of medical examiners is saying it is powerless to seize those records or deliver them to patients.

Dr. Amaya had his medical license suspended last month, following a series of arrests, the last of which landed him in jail on charges of criminal domestic violence and discharging a firearm while under the influence. Oconee County sheriff’s deputies say he was shooting an AK-47 semi-automatic machine gun, drunk in the backyard of his Hartwell Lake area home.

His application for indigent defense was tendered Monday, according to clerk of court records. Foreclosure proceedings already are under way on his Stonehaven Way home.

Since his arrest June 25, Dr. Amaya’s practice — the New Hope Neurological Clinic — has been closed, although some patients report the office was open for about two days so they could get copies of their medical records.

No formal notice was issued that the office would be open those days, however, and now the Eagles Nest Drive professional building is locked.

"All we can do is try and encourage the physician and his staff to assist patients in gaining access to their records," said Jim Knight, a spokesman for the state board of medical examiners. "We have not had that assistance or cooperation in this case."

Research by the Anderson Independent-Mail found that Dr. Amaya had been reported to the state board of medical examiners at least three times in the past three years.

The state board of medical examiners does not discuss complaints against a doctor unless formal action is taken, Mr. Knight said, and only the letter to the clinic owner prompted action by the board. Dr. Amaya received a public reprimand, was fined and required to take anger management classes.

South Carolina has a history of lax oversight when it concerns its doctors, according to officials from Public Citizen, a national watchdog group that runs the Web site www.questionabledoctors.org .

The group annually ranks state medical boards’ serious disciplinary actions, and for the past three years South Carolina has hovered in the bottom 10 states, based on a three-year average. Last year, of the state’s 10,140 physicians, only 33 received serious disciplinary actions, the group reports.

Medical boards are supposed to track complaints against doctors so that the public is protected, said Sidney Wolfe, director of Public Citizen’s health research group.

"When medical boards aren’t carrying out orders, they are protecting doctors instead of protecting patients," Dr. Wolfe said. Although a national database of complaints against physicians exists, it is not available to the public nor to practicing physicians, he said.

"It’s a secret," Dr. Wolfe said, one that is perpetuated by a piece of federal legislation: the national Health Quality Improvement Act of 1986. "It robs patients of finding out about their doctors."

State legislation apparently is what’s preventing local patients from gaining access to records at Dr. Amaya’s office. The South Carolina Physicians Patient Records Act does not specifically address what to do when a physician abandons his office, Mr. Knight of the medical examiners board said.

Although the board, which is overseen by the state Department of Labor, Licensing and Regulation, has the authority to suspend and revoke a physician’s license, it has no such authority to deliver medical records to patients, Mr. Knight said.

Said Mr. Knight of Dr. Amaya’s patients: "They’re caught in the middle, here."

Pattern of erratic behavior

Dr. Amaya had his medical license suspended by the state last month. He was arrested four times between Jan. 1, 2003, and June 25, and the most recent arrest came after Oconee County sheriff?s deputies say Dr. Amaya was found shooting an AK-47 semi-automatic gun in the back yard of his Hartwell Lake-area home, heavily intoxicated.

According to the order, that erratic behavior is what led the state Board of Medical Examiners to suspend Dr. Amaya?s license on July 26. The South Carolina Bureau of Drug Control revoked his ability to prescribe medicines the next day, and the federal government followed.

Although a hearing still must be held to determine whether his medical license will be revoked permanently, it is the first time Dr. Amaya has been prevented from treating patients since he secured his state medical license in December 1999.

But records and information suggest the state Board of Medical Examiners ? the sanctioning body for all medical professionals in South Carolina ? had been made aware of other concerns about Dr. Amaya years before they took action against him last month, including:

In 2001, Dr. Amaya was reported to the state after administrators at Oconee Memorial Hospital reported their concerns about his practice of mixing drugs and a lack of support for his clinical findings.

In 2002, Oconee County?s coroner, after noticing a pattern of overdose deaths where Dr. Amaya was the prescribing physician, reported him to a state investigator.

In 2003, the state placed him on probation for an accusatory letter he wrote to the owner of several Louisiana clinics, accusing her of extortion.

Lots of drugs, little paperwork

Attempts to contact Dr. Amaya through his home, office and past legal counsel were unsuccessful last week. The Oconee County Sheriff?s Department also does not know where Dr. Amaya has gone.

His supporters, patients who defend his medical practice, are quick to say he is the only doctor who ever diagnosed their painful conditions. They say he was mild-mannered and professional.

They are reluctant be named, however, saying people perceive them as drug addicts, not chronic pain patients.

"He listens to us. He sees our pain, and he got us out of pain," said one Westminster woman who had been seeing Dr. Amaya for nearly three years. She was being treated for arthritis, degenerative disc disease and a herniated back.

"I have admiration for the man," a Walhalla man diagnosed with lyme disease said. "He figured out something that?s been wrong with me for 30 years."

But questions regarding his medical practices have lingered since 2001, when Dr. Amaya resigned from the staff of Oconee Memorial Hospital.

According to internal documents obtained by the Anderson Independent-Mail, Dr. Amaya had been placed on hospital probation for a variety of issues uncovered by a "quality improvement committee." According to a letter addressed to Dr. Amaya, that committee recommended he attend counseling based on:

- his "polypharmacy practices," or mixing drugs to treat a single condition

- failing to document and support clinical findings and treatment plans

- questionable management of chronic pain

- his diagnosis of movement disorders and lyme disease.

The hospital confirmed the validity of those documents late last week, saying the review was part of a process that all provisional doctors go through before determining whether they qualify for full, medical staff membership.

Dr. Amaya resigned April 25, 2001, but because of the probationary nature of his clinical privileges, hospital officials said their findings were turned over to the state board of medical examiners.

By law, the state board is not permitted to discuss complaints against a doctor, spokesman Jim Knight said last week, therefore it is unclear what, if any, measures the state was taking to monitor Dr. Amaya?s medical activity from that point on.

Dr. Amaya was again reported to the state in 2002 by Oconee County Coroner Karl Addis, after he noticed a pattern of patient overdoses linked to Dr. Amaya?s practice.

Between April 1, 2000, and June 6, 2004, Mr. Addis said he traced five overdose deaths to prescriptions written by Dr. Amaya.

All but one of the patients was being treated for neck pain, back pain or both. Combinations of muscle relaxers, anti-depressants and narcotics were contributing factors in each of the deaths, Mr. Addis said.

He said he was unable to determine what the one patient not being treated for neck or back pain was being treated for.
That patient?s first prescription from Dr. Amaya was for Oxycodene, and it was written June 4, two days before her death.

Searching for accountability

In February 2003, the state did take action against Dr. Amaya, reprimanding him and placing him on probation.
That sanction was not for his prescription writing or medical practices, however.

According to information on file with the state board of medical examiners, he was cited for failing to deal honestly with patients and colleagues and for failing to respect the rights of colleagues.

The complaint stemmed from a letter he wrote to the owner of several Louisiana clinics (he graduated from the Tulane University School of Medicine) in April 2000, accusing her of trying to extort money from him. He was required to complete anger management, professionalism and ethics courses and pay fines and administrative costs of nearly $8,000.

"Any time a physician is found to practice medicine in a manner that is considered outside the standard of care on a regular basis, without appropriate justification for doing that, at some point there is a reckoning, and the physician is held accountable," said Dr. Marshall Meadors, who represents Oconee, Anderson and Pickens counties on the South Carolina Medical Association?s board of trustees.

The state is required by law to investigate every complaint, he said, sometimes preventing cases from being addressed quickly.

Although he declined to speak directly to Dr. Amaya?s patient care, Dr. Meadors said the privilege of writing prescriptions, particularly those that alleviate pain, anxiety and depression, is an awesome one.

"It is one that needs to be guarded and honored and respected," he said. "And physicians need to be reminded on an ongoing basis the importance of nurturing therapeutic relationships with their patients, and be extremely careful not to develop and nurture pathologic relationships with their patients."

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