The Rhode Island Department of Health has suspended the license of Thomas Paolino, M.D., to prescribe controlled substances after the death of a patient in July.
Paolino is a psychiatrist with an office at 4474 Post Road in East Greenwich.
According to the report released by the health department Monday (attached, right), Paolino saw a patient in October 2010 for major depression. That patient, an unidentified woman, had been taking oxycontin for several years and was on methadone. Paolino prescribed her three benzodiazepines. According to the report, benzodiazepines taken in combination with methadone can be highly dangerous if not prescribed and monitored carefully.
The patient died in a motor vehicle accident on July 3, 2012, and the toxicology report (dated Oct. 3) revealed the presence of four benzodiazepines (diazepam, oxazepam, temazepam, and alprazolam) in her system.
The reports said Paolino prescribed three of the four benzodiazepines on March 11 2011, but his medical note did not record the order for diazepam, one of the three he prescribed that day. In addition, the report said, the medical record did not include a problem summary list, a controlled substances log, prior medical history, social history, treatment goals, treatment plan, mental status exam, or ongoing assessment of the patient's substance abuse – all required as "minimum standards of care."
The report states prescription records were "indecipherable" and several diazepam prescriptions were not documented. In addition, there were no urine toxicology tests, pill counts, pharmacy control, and no indication the patient needed all of these controlled substances, especially since the patient was on methadone.
The patient's last visit to Paolino was June 11, but the health department's report concluded the unsigned note for the visit was written by someone other than Paolino because the handwriting was different.
The report noted a pattern of inadequate medical records with four other patients as well.
"Continuation of the controlled substances registration of Thomas Paolino, M.D., constitutes an immediate threat to the health, welfare, and safety of the public," the report said, resulting in suspension of that registration. The suspension will continue until after an administrative hearing or other resolution, according to the report.
Paolino may continue to see patients, although the report noted he apparently has not been in his office since May.