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THE IMPENDING REVOCATION OF DR. CARMEN PULIAFITO’S LICENSE
Spiga & Associates • January 17, 2019
THE IMPENDING REVOCATION OF DR. CARMEN PULIAFITO’S LICENSE.
PRACTICAL LESSONS FOR THE MEDICAL PRACTITIONER FACING CHARGES.
Few things are more riveting then the spectacular flame out. The end stage of the train-wrecked career arc is the subject of stage, screen and unfortunately, litigation. Such is the case with the sad story of Dr. Carmen Puliafito
Dr. Puliafito, former dean of USC’s Keck School of Medicine, was not immune to the vices of this world and at some point while leading USC’s prestigious medical school, he began using methamphetamine. His use became severe as it always does with that drug and his life quickly spun out of control. The carnage consists of a host of moral, administrative and criminal violations, including cavorting with prostitutes, drug fueled bacchanalias involving USC students, allegations of treating patients while under the influence and allegations of providing methamphetamine to others etc. . . . His defense is that he should be allowed to continue practicing as he is in recovery while still disputing some of the significant allegations against him. In short, his case is difficult; his prognosis, grim.
Some might think Dr. Puliafito’s case is too atypical to serve as a cautionary tale to the average practitioner. Some would be wrong. Dr Puliafito’s case demonstrates on a grand scale, a lawyer’s concern in every professional licensing case. For example:
LESSON 1: AVOID PUBLICITY
Little fish get thrown back. Big fish get fried. Dr. Puliafito is a big fish. Regardless of Dr. Puliafito’s demonstrated recovery, the bad publicity will most likely dictate the Board’s decision. The Board is a political body sensitive to public opinion. If a doctor wants to survive discipline, the most important thing is to avoid publicity. Avoid press conferences and attorneys who give them. Stay silent and age the case. Do not rush into a hearing. Take your time. Gather your evidence. Be yesterday’s news, not today’s lunch. Public opinion affects results. Let things blow over. The unfortunate Dr. Puliafito had no such leeway. His prominence made publicity unavoidable. In September of 2017, the Board sought and received an interim suspension order against Dr. Puliafito, the Dr. had little choice but to go to hearing on an accelerated schedule.
LESSON 2: OWN IT. . . .IF YOU CAN.
The Board does not need to be convinced of your guilt beyond a reasonable doubt. Preponderance of the evidence is the standard of proof. That means the slightest tipping of the evidentiary scales against you is enough to result in an accusation followed by a revocation. So if the evidence preponderates against you, do not deny it. Do not run from it. Own it and explain how you got there. Disputing facts in which the evidence preponderates against you will be seen by the Board as denial and failing to take responsibility. This is a deadly sin and usually results in revocation. That does not mean you should be afraid to dispute facts, but if you are righteous you must be right, because the consequences for being wrong could be revocation.
Dr. Puliafito is disputing the most salacious allegations. He has little choice. Several of the allegations, if admitted, would be fatal. For example, there is one allegation he provided methamphetamine to a minor. This is not something the Dr. Puliafito can own. This fact is so damaging that its admission would probably result in revocation by itself. Dr. Puliafito must dispute them or give his license to the Board. The lesson? Dispute falsity and admit error. Take ownership if you can.
LESSON 3: REHABILITATION AND MITGATION
No matter what offense you have committed the Board wants to see that you took the commission of your error seriously and have done your utmost to correct it. First, the Board will consider evidence of your rehabilitation. If you are suffering from a drug addiction then you better show that you have gone through a program and have done regular testing, preferably hair follicle testing. You need to show the Board that your rehabilitation is ongoing, and you are regularly attending group and or individual counseling. If you are in trouble for a management or a practice issue the board will want to see that you have taken continuing education courses in professional practices such as office management, medical recordkeeping, prescription writing etc…
The Board will want to see evidence of mitigation; evidence that you have lessened the impact of your error. There is restitution-based mitigation. If you over-billed, then they want to see that you have paid the amount back. If you have damaged a patient, they want to see the patient made whole. Other things may not lend itself to direct mitigation through restitution. Other forms of mitigation are encouraged. For instance, If you diverted drugs, they might want to see that you addressed the broader impact of your error such as sitting on a panel and counseling other doctors on the issue, or helping to sponsor others through recovery. Donating your medical skill to the needy is always an excellent way to mitigate an offense and can be a spiritual lesson in and of itself.
While Doctor Puliafito demonstrated to the Administrative Law Judge that he is in recovery, it is unclear what he has done or shown in mitigation of his offense. Given the claims against him and the little time he has had to remediate, Dr. Puliafito faces an uphill climb.
The Medical Board of California has broad discretion in granting and revoking licenses to practice medicine. They have criteria they must follow and due process they must satisfy, but if so followed and satisfied, the Administrative Law judge will uphold their decision. There are fatal career errors, that no lawyer can save you from. Dr. Puliafito’s case probably demonstrates that as well as anyone’s. But most career errors are survivable
if you do not make fatal errors in judgment. Whenever confronted by a law enforcement or Board inquiry, call a qualified attorney in Criminal, Medical and Nursing license defense. We at Spiga and Associates are here to serve and counsel you.
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You see him or her on your television, in your professional journals, and on your home page . . . the “Poster Child.” The Physician existing on the fringe of the profession, who gets arrested for overwriting prescriptions for Schedule II substances . Their example is easy to dismiss. The average M.D. engaged in legitimate practice seemingly has nothing to worry about. This fate befalls the slacker, the greedy, the foolhardy. Don't be so sure, any M.D. who prescribes Schedule II substances as a regular part of their practice is only one adverse patient outcome away from California Medical Board and possibly criminal investigation. For example, Surgeons and Physicians practicing in Emergency Medicine, Oncology, and Pain Management, routinely write hundreds, if not thousands of prescriptions for Schedule II substances. There is no way for a Physician to control the patient’s use of controlled substances, yet a dangerous and influential myth is being propagated that a physician is a fortune teller and can predict which patients will misuse the substances provided. Further complicating the issue is the difficult ethical landscape navigated by Physicians dealing with patients presenting legitimate symptoms demanding treatment with Schedule II and III substances, but who are nevertheless, drug dependent. Long term pain management patients are at particular risk of overdose due to their high tolerances leading to increasing dosages and the difficulty in weaning them off the substances they have become dependent upon. Should a patient die or suffer an adverse outcome that is somehow connected to a prescription for a schedule II substance, a criminal and California Medical Board investigation is sure to follow. Oftentimes the investigation will be spearheaded by investigators for the California Department of Consumer Affairs working in conjunction with local law enforcement but who also work on behalf of the Medical Board of California. These investigators are sworn peace officers and have the power to arrest and working with the Attorney General or local District Attorney also have the ability to bring criminal charges against a Physician. These investigations start out invisibly with scrutiny of CURES II reports detailing a Physician’s prescription history. All patients receiving scheduled substances will be given particular attention. Soon after, the physician will receive a request for patient records, followed by a letter of investigation from a California Department of Consumer Affairs Investigator indicating that a complaint has been made and requesting an interview. They do not inform the Physician of his or her right to counsel or whether the Physician even has the right to refuse the interview. Nor do they inform him or her of their right to review the complaint. Believe it or not, one of the common mistakes Physicians make in dealing with these investigations is not taking it seriously. They will delay responding or not respond at all. Often Physicians confident in their prescribing practices will have a false sense of confidence going in to such an interview and will wing it without consulting consul. Those Physicians learn the error of that approach through hard experience. If you are facing such an inquiry. Take it very seriously, Your medical license is your most important asset. If you have an adverse patient outcome that has come to the attention of your Hospital Administration, The Medical Board of California or local law enforcement, call Spiga and Associates immediately. Because of our 25 years of experience in both Criminal and Administrative defense we are uniquely qualified to defend you and your medical license.
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