A Tustin family physician's medical license has been placed on probation for nearly three years due to the mistreatment of a patient who later died of methadone intoxication.
The Medical Board of California's action on the license of Dr. Anthony Francis Naples was effective as of 5 p.m. Friday.
Naples, his attorney and California Deputy Attorney General Chris Leong signed a settlement agreement that agreed to the following facts:
A 31-year-old man with a history of anxiety and shoulder pain from an injury began seeing Naples on March 7, 2009. Without performing a mental or physical exam, the doctor prescribed Xanax for daily and as-needed use.
At a follow up appointment three months later, when the patient reported continued anxiety episodes, he was given samples of Lexapro and told to check back in in a month.
On July 20, 2009, when the patient still complained of shoulder pain, he was prescribed Percoset without having been examined.
Ten days later, after still complaining of pain—and undergoing no exam—he was told to increase his Percoset intake and prescribed more Xanax.
On Aug. 14, 2009, after an arthroscopy of the shoulder by another doctor, the patient told Naples the Xanax seemed to be helping. So he got two more Xanax scripts, one for 40 mg pills twice a day and another for 80 mg. twice a day.
The patient returned Sept. 3, 2009, for a refill, not because he was experiencing pain but because he was leaving town. Without an exam, he was given two scripts for 80 mg. Xanax pills.
The next visit was Sept. 14 of that year, when the patient apparently reported he had lost one of his Xanax prescriptions, so he was given two more, one dated that day and the other Sept. 29, 2009.
On Oct. 8, 2009, the patient told Naples that he was still in pain—and addicted to drugs—so he had done some research and thought methadone would do the trick. The doctor prescribed him methadone and, to help with the transition, Valium.
No exam was done then nor before Naples doled out another methadone prescription dated Oct. 28, 2009.
The patient returned Dec. 15, 2009, complaining of having thrown out his back and neck and of having seen a chiropractor. He also said he’d lost his job and was experiencing anxiety again. Without an exam, he was prescribed two sets of methadone pills.
On Jan. 11, 2010, the patient still did not get an exam but he did get new prescriptions for methadone, Lexapro and Valium.
The patient’s last visit was on Nov. 11, 2010, when he again got no exam but did get new prescriptions for methadone and Valium.
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Shortly after that, Naples decided to stop seeing the patient due to a state Department of Justice Controlled Substance Utilization Review and Evaluation System (CURES) report that found the man had been receiving meds from multiple prescribers. But the doctor did not document anywhere that he'd decided to decline seeing the patient.
At 5:11 a.m. on Nov. 14, 2010, the patient died in the emergency room of Western Medical Center in Santa Ana. After receiving a toxicology report, the county corner determined "methadone intoxication" was the cause of death.
The state medical board found Naples negligent for failing to document a complete history and physical examination of the patient before first prescribing him dangerous drugs, for neglecting to do any follow-up exams during the patient’s return visits and for not recognizing the patient was a substance abuser.
The terms of the 35-month probation, agreed to by Naples, are that the doctor: maintain records and inventory of any drugs he prescribes; take a 40-hour continuing medical education course for each year of his probation; take courses in ethics, prescribing practices and medical-record keeping; have his practice continually monitored by a board designee; notify every hospital or clinic where he has privileges of his status with the board; refrain from supervising physician assistants; and obey all laws.