RICHMOND--A Virginia Board of Medicine committee said yesterday that an Orange doctor violated state law when he continued to prescribe narcotics to two patients who abused them.
Both patients were hospitalized for drug overdoses and one of them later died of drug poisoning, according to her autopsy.
The committee reprimanded Dr. Randolph V. Merrick, 50, of Madison. Its action was the least severe of three possible penalties and does not affect his license or his ability to practice.
Merrick declined to comment after the hearing. He has 30 days to appeal the decision to the full board.
The committee concluded that Merrick prescribed narcotics for the patients even though he did not definitively diagnose them, and did not monitor their use of the drugs.
Both patients signed nonbinding contracts with Merrick, meant to guide their use of the narcotics. Both patients violated their contracts several times, according to the testimony.
Merrick told the physicians who heard his case that he held on to the patients too long and should have dismissed them from his practice.
"There are lessons I have learned along the way," he said.
Merrick is a native of Orange and a fixture in the town. He graduated from Orange's Grymes Memorial School and Woodberry Forest High Schoo,l and today serves as medical director for both schools. He is also the medical director for the county rescue squad and the medical examiner for Orange, Madison and Louisa counties.
Merrick's problems with the medical board stem from the way he treated two patients at his office in Orange. He is a family practitioner, employed by the University of Virginia Health Services Foundation at its clinic in the town.
The two women--identified as Patient A and Patient B during the hearing--sought help for chronic back pain. One had fallen from a ladder, and the other had unsuccessful back surgery.
Merrick supplied one of the patients with narcotic pain killers, including fentanyl, methadone and oxycodone, and with stimulants, such as Adderall and Dexedrine, according to board records. The other patient received Percocet and MS Contin.
Merrick treated one of the patients for four years, and the other from 2000 until her death from an overdose in 2002.
Patient A was a 30-year-old who first visited Merrick in 1999. He prescribed pain killers, and when the pain medications made her sleepy, he prescribed stimulants.
The committee concluded that Merrick continued to treat Patient A when he knew, or should have known, that she was abusing the drugs.
She had requested early refills, had positive drug screens for alcohol and sedatives that Merrick had not prescribed, repeatedly canceled required evaluations and had two overdoses.
The overdoses occurred in 2002. In January the patient's husband took her to the emergency room at Fauquier Hospital after finding her confused and slow to respond.
Three months later, the patient was again taken to Fauquier Hospital's emergency room. This time she was unconscious and unresponsive at her home. She suffered a brain injury during the second incident. The cause was determined to be an overdose of narcotics.
Patient B had a long history of mental illness that included multiple hospital admissions and treatment, according to testimony.
She, too, was abusing the drugs that Merrick gave her, according to testimony. She requested early refills, had positive drug screens for cocaine and barbiturates, was convicted of distributing cocaine, and had two overdoses, the second of which was fatal.
In September 2002, the patient was unconscious and in cardiac arrest when she was taken to the emergency room at Culpeper Regional Hospital. She was suffering from an intentional, multiple drug overdose.
She survived the incident and continued to receive narcotics from Merrick through November of that year.
In December, she was found dead at her residence. An autopsy concluded that she died of oxycodone poisoning.
Merrick disagreed with that finding.
"I honestly do not feel that she died of oxycodone poisoning as much as she did of sepsis and pneumonia," he testified.
Merrick recorded in her charts that she died of pneumonia.
To reach JIM HALL: 540/374-5433 jhall@freelancestar.com