Physician’s license suspended

By NATE HUBBARD/Staff

A failure to mind her (patient) p’s and q’s when prescribing narcotic painkillers has landed Bland County’s “Dr. Pam” an indefinite suspension of her license to practice medicine from the Virginia Board of Medicine.
Dr. Padmaja “Pam” Polavarapu, 46, founder and head physician of Mountain Medical Clinic in Bland, signed a consent order with the board on Oct. 25 agreeing to the suspension.
Although the Board of Medicine cited violations in connection with nearly 20 patients, Polavarapu’s treatment of “Patient P” and “Patient Q” were highlighted as particularly egregious offenses.
In the consent order, which by signing Polavarapu neither admitted nor denied the expressed charges but waived the right to challenge them in any future board proceedings, Patient P was described as a 63-year-old female treated by Polavarapu from 1997-2005.
The order states that Polavarapu “failed to recognize and respond adequately to signs of Patient P’s drug abuse and dependence, including three hospitalizations following alleged suicide attempts by overdose of prescribed medications.”
After the three incidents, the commonwealth’s evidence found that Polavarapu continued prescribing the same abused medications to the woman.
During testimony before the board, the order also says that “Dr. Polavarapu admitted that she was treating the patient’s anxiety and depression by listing the medication as prescribed for other conditions.”
Patient Q, described only as a female patient, was only cited in generalities in the signed consent order, but in other detailed accusations brought by the board Polavarapu was said to have continued to prescribe painkillers up to the patient’s death of an apparent overdose in 2004.
“She failed to recognize and adequately respond to signs that Patient Q was abusing or diverting her prescribed medications or that her continued access to numerous prescribed medications to treat complaints of chronic pain and headaches presented a danger to the patient,” the documents state.
Multiple phone calls to Polavarapu’s residence went unanswered Monday and Tuesday. A person who answered the phone at Mountain Medical Clinic said Polavarapu was not in the office and that there was no one who could comment at this time about the future of the clinic.
Polavarapu’s attorney, Monica Monday, also declined comment when reached by phone Monday afternoon.
The consent order did note that Polavarapu provided numerous letters from patients that attested to her “skill, compassion, dedication and charity” and from physicians that called her “an ethical and competent physician who practices in a medically underserved area.”
At this time, there appear to be no criminal investigations into Polavarapu’s conduct. A state police spokesman and a person who answered the phone at the federal Drug Enforcement Administration’s Bristol office said they were unaware of any pending action.
Polavarapu was notified in May by the Board of Medicine regarding the need for a hearing on her conduct.
The hearing began on Oct. 24 in Richmond and continued the next day before the two parties agreed to the settlement.
Jennifer Deschenes, deputy executive director for discipline with the Board of Medicine, said the suspension of Polavarapu’s license is a complete ban on her right to practice “all medicine.”
Any attempt by Polavarapu to treat patients would be an “unlicensed practice issue” that “would be criminal,” Deschenes said.
Although Polavarapu’s suspension is indefinite, she can be reinstated after six months.
Deschenes said she couldn’t comment on the specifics of Polavarapu’s case, but said it’s up to each doctor to convince the board that they deserve to be reinstated.
“It’s the practitioner’s burden,” Deschenes said. “They need to assure the board they’re safe to return to practice.”
The consent order states that Polavarapu plans to “remedy the deficiencies noted in this order.”
Beyond the specific cases of Patient P and Patient Q, the consent order claims that Polavarapu displayed a long pattern of inappropriately prescribing medication to patients who complained of chronic pain.
“Specifically, she initiated treatment without consistently obtaining a medical and substance abuse history, performing comprehensive examinations or diagnostic tests, documenting her rationale for prescribing narcotics, or exploring non-narcotic treatment of pain control,” the order states.
A litany of improperly prescribed drugs such as Percocet, Vicodin, Lortab, OxyContin and Vioxx are cited in documents detailing the commonwealth’s evidence against Polavarapu.
Many of the narcotics were prescribed for ambiguous conditions such as “headaches,” “back pain” or “fatigue.”
In other incidences, patients were referred to specialists who found Polavarapu’s diagnosis of conditions like systemic lupus to be “somewhat questionable” and lacking clinical evidence of the disease.
“On several occasions, Dr. Polavarapu documented prescribing controlled substances for conditions other than those for which they are medically indicated,” the commonwealth’s evidence additionally claims.
The documents also show that Polavarapu refilled prescriptions in many cases when patients simply left telephone messages asking for more drugs.
A chart cited in the evidence shows Patient P leaving at least 301 prescription-related telephone messages for Polavarapu between 1997 and 2005.
Deschenes said she couldn’t comment on when or how the investigation into Polavarapu’s actions began.
She said, though, that investigations for the Board of Medicine are complaint driven – either from patients, community members or other physicians who are required to make a report if they suspect a violation.
Although the allegations against Polavarapu go back more than a decade, Deschenes said the time period doesn’t necessarily reflect the length of the investigation.
In many cases, she said, the board’s investigators will look through old records and find violations that date back years from the time of the complaint.
Deschenes also said she couldn’t offer additional insight into what motivations Polavarapu might have had in acting unethically. She emphasized, though, that any theoretical kickbacks or favors would have been noted in Polavarapu’s consent order – and they were not.
But the consent order did say that Polavarapu herself may have been an abuser of her medications.
“She prescribed controlled substances to Individual A, a family member, which she diverted for her personal and unauthorized use,” the order states, going on to say that “based on her self prescribing, there is concern that there could be underlying potential for addiction.”
In other evidence that was to be debated at a late November hearing subsequently dropped when the consent order was signed, the Board of Medicine also cited an admission from Polavarapu to a Department of Health Professions investigator that she consumes alcohol on a “daily basis.”
In July 2007, the evidence also claims that Polavarapu arrived at a hospital emergency room “exhibiting signs of intoxication” and that she also refused a drug screen. Based on blood work, Polavarapu was diagnosed with “acute alcohol intoxication.”
Polavarapu is the second Bland County doctor in the last decade to be accused of wrongly prescribing painkillers.
Dr. Freeman Lowell Clark, who ran a clinic in Bland in 1999 and 2000, additionally found himself in criminal trouble for his unauthorized medical practices.
Clark was convicted in July 2001 in U.S. District Court in Abingdon of 266 counts of illegally prescribing narcotic painkillers. He was sentenced in early 2002 to five years and 10 months in federal prison.
According to a physician profile posted on the University of Virginia-Wise’s Web site, Polavarapu came to Bland County in 1993 and began practicing medicine at the Bland County Medical Clinic in Bastian.
A Canadian native, Polavarapu received her medical degree from Nagarjuna University in India before completing her medical training in Pennsylvania.
She opened Mountain Medical Clinic in Sept. 1995, saying in a Bland County Messenger article that she wanted to create a “patient-friendly” environment at the office.
Polavarapu also was Bland County’s medical examiner at the time of her suspension.
As part of the order, Polavarapu is required to notify all her patients by certified mail of the suspension of her license.
In addition to her recently suspended Virginia license, Polavarapu also holds an active medical license in West Virginia and had a license in Pennsylvania that expired in 1993.
Deschenes said the Virginia Board of Medicine enters Polavarapu’s suspension into various federal databases, but licensure decisions are made on a state-by-state basis. She added that certain states require physicians to notify their medical agency if the physician’s license is suspended or revoked in another state.
Polavarapu’s West Virginia license is not set to expire until June 2009.
Nate Hubbard can be reached at 1-800-655-1406 or .