Due to what everyone involved hopes is past drug and alcohol abuse, an Irvine doctor will have his medical practice monitored, according to the Medical Board of California.
The board recently imposed an Interim Suspension Order on the medical license of Dr. Brent Edward Silvers, who specializes in podiatry and internal medicine.
Silvers, whose physician's certificate was first issued in March 1991 and is not set to expire until Nov. 30, 2018, came to the attention of the board in March of last year, when "complaints" about his "fitness to practice medicine" spurred an investigation, according to state documents.
A former clerical worker told board investigators that she heard Silvers say while at work he was hung over, and on another occasion he came to work at 9:30 a.m. with bloodshot eyes and the smell of alcohol on his breath.
A physician assistant told investigators Silvers reported to work "on multiple occasions ... under the apparent influence of alcohol," prompting her once to suggest that he go home. "She has observed erratic behavior, like screaming in the hallway," investigators wrote in their report, which added he mentioned during several staff meetings that he was an alcoholic but that he'd beat his addiction. The physician assistant says she noticed that after Silvers had a hip replacement and was prescribed medication (some by her), he suffered memory lapses.
Another medical assistant told of Silvers displaying "mood swings" and engaging in "odd behavior, such as randomly scraping paint off the wall." She smelled alcohol on his breath before a surgical procedure, investigators were told, and Silvers supposedly remarked that was a good idea when she once suggested he go home. She added Silvers often instructed her to give wine to liposuction patients to assist with sedation.
Silvers told board investigators that he consumed up to a half bottle of wine with every dinner, hoping it would help him sleep as he battled insomnia. The doctor also claimed to have suffered a fall that required an emergency room visit and left him with a subdural hematoma or serious head injury, although he submitted no documents proving he was injured nor that a treatment plan to deal with it had been devised, according to state documents.
The investigation discovered that Silvers told mental health professionals that he stopped consuming alcohol in November 2016, something that was supported in several blood tests through the following year.
Silvers denied ever reporting to work under the influence or telling anyone he was an addict, although he did admit to having in the past offered patients wine to help them relax.
The investigation's initial findings led to a board recommendation that Silvers get a psychological examination, which he agreed to. The board's contracted doctor found his mental status normal, although she did note mild cognitive impairment. She diagnosed moderate to severe alcohol use disorder and mild cognitive disorder that may have been due to a fall. Concerned that self medication through alcohol or sedatives may make the disorders worse, she recommended evaluations by an internist, a neurologist and a neuropsychologist.
The internist's report found Silvers' condition to be normal. So did the neurologist's survey, although he did recommend monitoring. The neuropsychologist found that Silvers was "impaired" when it came to cognitive skills and in the low range for someone his age in memory and mental processing speed. In three other memory tests, the doctor's results were low, borderline and "severely impaired." Silvers scored in the low range for someone his age when it came to "executive functioning" or performing higher order cognitive processes like planning, decision making and putting performance feedback to positive use.
Based on the findings of the three doctors, the board's contractor issued a new report that highlighted the doctor's cognitive deficits, citing particular concern with the memory and executive function results. She diagnosed him with "alcohol use disorder, opiate use disorder and sedative use disorder," adding that mild but persistent cognitive disorder was "probably due from brain trauma and substance use." She concluded he "has a mental illness or condition that impacts his ability to safely practice medicine."
But Silvers hired his own neuropsychiatric expert to conduct tests that found the memory problems were "relatively mild," that his "thought process was goal directed and he had a full range of affect," that he registered no problems in anxiety and depression tests, and that drug and alcohol tests were negative. Silvers' expert was "somewhat equivocal" about his "ability to practice medicine," adding that view would change if the doctor started drinking again, according to state documents that indicate the neuropsychiatric evaluator also recommended continued monitoring of Silvers' practice by the board.
The doctor also submitted six declarations of support, three of which were by health-care professionals who are also his patients, two of which were former employees and one of whom shared a medical office with Silvers. All said they never smelled alcohol on his breath, saw him intoxicated or heard him slur his speech, and they agreed he had always been steady on his feet while on the job.
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The board noted that all who evaluated Silvers, including the expert the doctor hired, had found cognitive deficits. But no evidence was presented of substandard care or patient harm by Silvers. That could show his impairment is not so severe as to effect his job, or that no one had noticed any problems. Either way, without any evidence, there is no justification for a full hearing on whether Silvers' license should be suspended or revoked, according to the board.
However, based on all the recommendations, there is justification that Silvers have his medical practice monitored "to protect the public," found the board, which also agreed patient safety would be an issue if he started consuming booze again.
Silvers, and not taxpayers, will pay for the monitoring of his practice done by a board-approved medical professional. He cannot practice medicine in California until that monitor is approved by the board, and there can be no lapses in the scheduled submissions of regular progress reports to the board.
Failure to abide by the board's conditions could cause license revocation proceedings to begin.