Oldenberg's license revoked
The Arkansas State Medical Board has found Dr. Denise Oldenberg guilty of five violations including over-prescribing medications and gross negligence.
Following a 10 hour hearing in Little Rock on Sept. 8, the board took strong action, the following day, to penalize Oldenberg, including revoking her license to practice medicine in Arkansas.
"This has been a reoccurring issue," said Board Chairman Dr. Trent Pierce. "She has put us in this position. Our charge is to protect citizens of Arkansas."
Oldenberg, who has practiced in Fulton, Sharp and Izard counties for 22 years, is a family practitioner who specializes in treating patients with chronic pain problems. She has, six times, faced disciplinary action for over-prescribing narcotic pain medications and failing to properly monitor her patients.
In 2008, while facing disciplinary action, Oldenberg agreed to submit monthly reports on controlled substances she had prescribed as part of a program to monitor her practice.
In May of this year, an Emergency Order was filed suspending Oldenberg's license to practice after the medical board alleged that Oldenberg had violated the 2008 Agreed Order.
In June, Oldenberg's license was restored after an agreement that she would not prescribe any schedule 2 narcotic drugs until the new charges against her were heard by the board.
"As board's exhibit one, a listing of schedule 2 drug prescriptions prescribed by Dr. Oldenberg for patient B-H," said Attorney Bill Trice as he began presenting the case against Oldenberg.
Trice introduced the medical and prescription records of 33 of Dr. Oldenberg's patients.
Later, Dr. Gary Moffitt, a Springdale physician who reviewed the medical records board investigators collected, discussed findings he called "problematic."
According to Moffitt, Oldenberg repeatedly diagnosed patients with chronic pain syndrome and other pain related ailments, without medical tests or records to back up the diagnoses.
Then, according to Moffitt, Oldenberg began prescribing large amounts of narcotic medications and injections, while compiling few records to document that she was carefully managing the patients' cases.
"Do you view that Doctor Oldenberg prescribed excessive amounts of controlled substances for this patient?" Trice asked Moffitt.
"Yes, sir," Moffitt replied.
"Did you find that the doctor failed to maintain proper records in the treatment of the patient?" asked Trice.
"Yes, sir," Moffitt replied.
That was a typical exchange as Moffitt was questioned about his examination of Oldenberg's patient records.
Moffitt cited several instances of patients receiving prescriptions for thousands of doses of schedule 2 drugs over a period of months.
One patient received prescriptions for six narcotic drugs amounting to 9,000 doses over a year and a half, an average of 17 pills a day.
"Put this amount of medication together, taken for a year and a half, this is problematic," said Moffitt.
Another patient was prescribed 14,280 doses of four medications over a five month period while another patient was given prescriptions for amphetamine diet pills for 17 months, even though the patient was not overweight and the state places a six month limit on the dispensing of the pills.
Another expert witness, orthopedic surgeon, Dr. John Wilson, told the board that records indicate Oldenberg had been giving patients steroid injections into a lower spine joint without proper equipment and with a needle too short to reach the intended area.
Finally, Jim Myatt, a state pharmaceutical inspector, discussed his findings that Oldenberg had failed to list all of the drugs she had prescribed to patients in monthly reports required by the 2008 consent order.
Myatt also revealed he had found evidence that Oldenberg wrote two prescriptions for schedule 2 drugs in July, which were filled in Louisiana. The prescriptions were an apparent violation of the order that Oldenberg not dispense any schedule 2 medicines until charges pending against her were resolved.
"These are forms to patients," Dr. Oldenberg told the board. "In a sense, there is counseling. There is monitoring."
Oldenberg, who appeared before the board without an attorney, began her defense by passing out blank forms, eductional material on exercise and nutrition, and charts she uses to determine a patient's pain scale as she evaluates his or her progress.
Board members quickly asked why Oldenberg had not supplied medical forms that patients had actually filled out.
"The board wanted these records," said board member Dr. Joseph Beck. "They are important to your case. Why didn't we get them?"
"I didn't realize they were needed," Oldenberg replied. "I thought the hearing was to defend myself and my licence."
When told the records could help show she does monitor patients and manage their care, Oldenberg said the forms were in "an external drive" on her computer system.
Oldenberg later said the patient forms were in a box at her office but none had been scanned into her electronic record system since June.
Oldenberg repeatedly told the board it was wrong to issue an emergency order to suspend her license.
"There was no emergency," Oldenberg said. "No one died. No one was harmed."
Oldenberg reminded the board that the Arkansas Pain Management Act, which she helped pass, allows doctors to administer larger than normal doses of narcotics if they help with pain management.
She insisted she has helped hundreds of chronic pain sufferers lead more normal, active lives.
"My patients are happy. Doing well. They have quality of life. I haven't harmed anybody," Oldenberg told the board.
Rev. Ronald Meyers, M.D., an Oklahoma physician who also specializes in pain management, testified on behalf of Oldenberg.
Myers questioned how the board could charge Oldenberg with over-prescribing when it has not set guidelines to help physicians determine what constitutes over-prescribing.
He called Dr. Moffitt a "pill counter" who does not understand that many chronic pain sufferers must take large doses of medications. Instead of how many pills a patient takes, Myers said, "Are they improving?" is what a doctor should look at as patients are evaluated.
More than 40 of Oldenberg's patients attended the board hearing, although many had to wait outside after the hearing room was filled to capacity.
Oldenberg called 10 patients as witnesses. All praised Oldenberg as a caring physician who took them even if they did not have insurance and worked tirelessly to help them manage their pain, when other doctors had failed.
The patients also described being abandoned without needed pain medication since Oldenberg was ordered to stop dispensing schedule 2 narcotics.
"I take only one pain medication," said Tina Crenshaw of Salem. "I'm not a drug addict. I don't sell my pills. I am 48 years old. I don't have a quality of life since you took my doctor away from me."
As for testimony against her, Oldenberg talked of obtaining training in Florida to perform the disputed spinal injections, saying the procedure has greatly relieved pain for many patients.
After initially refusing to discuss the illegal schedule 2 prescriptions written in July, Oldenberg told the board, "The man came a long way. I felt very compassionate. I knew he would not find a doctor there for schedule twos."
Oldenberg complained that nothing happens to surgeons who make mistakes that result in death adding, "Why are doctors who treat pain so persecuted and other doctors are not?"
After board attorney Trice listed the charges against Oldenberg: improper steroid injections, over-prescribing medications, poor record keeping, improper use of amphetamine diet pills, and violating two consent orders issued by the board, Oldenberg was given one last chance to speak.
Rather than apologizing for mistakes and asking for leniency, Oldenberg said she didn't "like to complain" but she has gone through a "nasty divorce," her ex-husband and his friend, Salem Police Chief Albert Roork, have plotted to destroy her, and law enforcement has tried, unsuccessfully, to use confidential informants to catch her doing something illegal.
Her friend and former attorney, Ed Chandler, finally shouted to her, "Denise, you are getting off track."
Oldenberg ended her comments by saying, "I am not guilty as charged... I care about my patients."
As the medical board began discussions, board members expressed compassion for Oldenberg's patients who have had trouble finding new doctors to help them deal with pain and other medical issues.
They also expressed frustration that Oldenberg has continued to wind up before the board despite efforts to work with her and educate her about proper and improper methods of prescribing medications.
"She is not educable with prescription drugs and record keeping hasn't taken either," said chairman Trent Pierce. "This has become a reoccurring issue. With this history, does she have the right to practice in the state of Arkansas?"
After discussing the questionable spinal steroid injections, the board decided to offer Oldenberg a reprimand if she agreed to stop doing the injections.
Initially, Oldenberg was not receptive saying, "It helps people." But she quickly reversed herself and agreed to stop the injections. The board unanimously imposed the sanction.
After a short break, the board decided that, since they had been working for 11 hours, they would recess until Saturday, Oct. 9, to decide other punishment for Oldenberg.
On Saturday, with Oldenberg and 10 supporters on hand, two counts of over-prescribing of medication were the first orders of business.
Board members discussed whether to take Oldenberg's DEA permit, the permit that allows her to write prescriptions for schedule 2 narcotics, or revoke her license to practice.
After considerable debate, the board's decision was to permanently suspend Oldenberg's DEA permit.
A second count led to a vote to suspend her medical license for six months and require Oldenberg to repay the cost of the investigation of her practice, $10,300 to be paid over five years, as well as the DEA permit suspension.
For failing to record and document patient records, Oldenberg was, again, ordered to repay the cost of the investigation.
For violating diet therapy regulations, Oldenberg was given a one year medical license suspension, as well a the DEA revocation and investigation costs.
On the count of violating the 2008 consent order by failing to list all drugs she had prescribed, Oldenberg was given the toughest penalty possible, the permanent revocation of her license to practice.
As the day began, chairman Trent Pierce told the board the penalties it decides act as peer pressure on other doctors to follow the rules. He added, Oldenberg had challenged the board's authority by "flagrantly thumbing her nose at us."
On the count of violating the 2010 consent agreement not to write narcotic prescriptions, Oldenberg was given another license revocation.
The board issued separate penalties on each count because, in the case of a court appeal, a judge could dismiss some penalties while keeping others in place.
"I will send her the order," said board attorney Trice, after the penalties were decided.
Oldenberg has 30 days in which to file a notice of appeal to a court in Little Rock or Sharp County, since Oldenberg's current office is in Cherokee Village.
The hearing ended with the board using most of the punishment options available to it.
The board issued a reprimand, suspended Oldenberg's DEA license, issued a fine, suspended her license for 18 months and, finally, permanently revoked her medical license.
While Oldenberg has the right to, some day, seek a new license, the board indicated it hoped it had sent a strong message so that future boards would uphold its decision that Oldenberg should not practice medicine again in Arkansas.
At one point during the board's deliberations, Oldenberg asked to speak but was denied. After the meeting ended, she quietly left the hearing room without comment.