When Colin Hamblin, a geriatric and palliative care physician from Inverness who has a practice in Point Reyes Station, received notice in June that the Medical Board of California had again accused him of misconduct, he wasn’t surprised. He knew treating patients with chronic pain comes with the risk of extra scrutiny and, he felt, his duty of care was at odds with the oversight function of the board.
Allegations by the medical board of negligence in 2021 resulted in a settlement the following year; Dr. Hamblin took a record-keeping course and paid the board’s investigation and enforcement fees.
The first investigation accused him of irresponsibly prescribing opioids and benzodiazepines over five years, including to his own family members, while inadequately documenting patient interactions and neglecting to explore non-addictive alternatives. Four patients were mentioned in that accusation.
Dr. Hamblin believes the past and present allegations reflect the medical board’s draconian practices. “The medical board is creating a climate of fear where physicians don’t want to prescribe,” he said. “And it’s leaving patients stranded.”
In the latest investigation, the board alleges that Dr. Hamblin improperly prescribed opioids and other controlled substances to a single patient, referred to as “patient 1.” The board’s report paints a detailed picture of the patient, whom it describes as a morbidly obese 43-year-old man with a history of opioid and stimulant abuse. He has endured constant pain since the amputation of one leg following a staph infection in a chronic ulcer.
The Light visited the patient last week at the rehabilitation center in Petaluma where he resides. He was unaware that his case was central to allegations against Dr. Hamblin.
Dr. Hamblin began treating the patient after his admission to Windsor Care Center following the amputation—a procedure the man referred to as his “leg departure”—in 2020.
By the time he came under Dr. Hamblin’s care, he was already following a regime prescribed under Kaiser’s Pain Management and Chemical Dependence and Rehabilitation Program, which included methadone, morphine and oxycodone, alongside a standing order for naloxone, for reversing opioid overdoses.
A few months after the patient’s admission, Dr. Hamblin started the man on paroxetine to treat his depressive disorder. But the board alleges that Dr. Hamblin failed to reassess his patient’s mood or to conduct a formal psychiatric evaluation. Despite the apparent ineffectiveness of the treatment plan, Dr. Hamblin allegedly continued the regimen unchanged for close to a year.
The board also claimed that he continued to prescribe high opioid doses without adequate reassessment or consultation with specialists, even as the patient hoarded oxycodone.
“The easy blanket answer is, every single accusation is factually incorrect,” Dr. Hamblin told the Light in a phone call last week.
Dr. Hamblin’s attorney, Ronald Goldman, believes the medical board has a weak case, with just one patient, who did not even initiate the complaint. The doctor and his lawyer are waiting to receive discovery from the board.
“I can see that everything that they have is factually incorrect, but until I get discovery, it’s impossible to fight,” Dr. Hamblin said. The Medical Board of California declined the Light’s request for comment.
Mr. Goldman is seeking to have the accusation dismissed. If it isn’t, the case will proceed to a hearing before an administrative law judge. In such cases, the board must demonstrate “clear and convincing proof to a reasonable certainty” to justify disciplinary action, which ranges from probation to the revocation of a medical license. The burden of proof is less stringent than the requirement in criminal cases, but it demands more than the “preponderance of evidence” required in civil litigation.
Dr. Hamblin’s patient has resided at the Windsor Care Center for nearly five years. (“There are worse places to live,” the man told the Light.) Sixty percent of the facility’s patients are long-term residents, but a stay as long as his is rare.
The man is at home in the facility’s florescent-lit halls, wheeling himself through them with relative ease, greeting by name every fellow patient, nurse, physician assistant, social worker and administrator he passes.
When informed of the allegations, he expressed surprise: “I really don’t think he did any of that. I remember him checking in on me and my dosage, asking how I was feeling,” he said. Though he admitted that the visits were not as frequent as he would have liked, he said Dr. Hamblin monitored his condition.
When patients are admitted to similar care facilities, a doctor is required to visit them within the first 30 days and then once every 30 days for an initial period. If the patient transitions to custodial or long-term care, the doctor is only required to see them every 60 days.
Dr. Hamblin said he treats around 140 hospice patients and another 400 patients in nursing homes, all while working as the sole physician at West Marin Medical Center.
Windsor Care Center, now under new ownership as Ridgeway Post Acute, parted ways with Dr. Hamblin this year, citing differences in approach. Kevin Amezquita, the facility’s administrator, explained that “Dr. Hamblin preferred old-school methods, like pen and paper, while we want to make sure we get things done as timely as possible.” Dr. Hamblin states that he chose to leave the center due to disagreements with the new management’s approach to patient care.
According to Dan Ciccarone, a professor of family and community medicine at the University of California, San Francisco and a leading expert on the opioid epidemic, earlier prescribing guidelines from the Centers for Disease Control and Prevention stringently instructed doctors to taper off dosage at specific rates. In the new C.D.C. dictum, however, “everything’s about doctor-patient collaboration,” he said.
Though the medical board typically investigates doctors in response to patient complaints, both of Dr. Hamblin’s investigations were triggered by a review of a state drug database—the Controlled Substance Utilization Review and Evaluation System, or CURES—that found red flags in patient charts.
Prescription drug monitoring programs use opaque proprietary algorithms to assess a patient’s risk of addiction and overdose from opioid painkillers. Studies suggest these algorithms often produce artificially inflated risk scores for marginalized patients—those who are poor, uninsured and have co-morbid conditions, including substance use disorder and mental health conditions.
The patient at the center of Dr. Hamblin’s latest allegations is Black, homeless and has a history of mental health issues and drug addiction.
In 1936, California implemented the first prescription drug monitoring program to stem a growing opium problem. The current opioid crisis has led every state in the union to establish such a program. Law enforcement agencies also conduct sweeps of their data to target providers labeled as “overprescribers” and patients deemed at high risk for drug diversion, misuse or overdose. Mr. Goldman sees Dr. Hamblin as a victim of this trend.
“Dr. Hamblin’s practice is based on hospice care and nursing, where patients are routinely given narcotics and benzodiazepines,” Mr. Goldman said. “These are patients who suffer from chronic pain and require these medications. So, if the medical board asks, ‘Who are the top doctors prescribing narcotics?,’ of course his name comes up.”
Opioids, first derived from poppies by ancient civilizations and now made synthetically, are among the most potent pain relievers available. They are also highly addictive, and their widespread use and misuse spiraled out of control in the late 1990s and early 2000s, fueled by aggressive pharmaceutical marketing and increased prescribing by doctors.
This ignited a crisis of addiction and overdose deaths.
In recent years, the United States has tightened regulations on opioid prescriptions. The result, according to patients, physicians and advocates, is a new crisis in which doctors have increasingly grown leery of prescribing these medications, leaving many chronic pain patients feeling abandoned.
“There’s a few brave individuals who are willing to stick their necks out to treat chronic pain patients now,” Dr. Ciccarone said. “Are they treating them appropriately? Are they over prescribed? That’s a matter for the medical board.”
While speaking with the Light, Dr. Hamblin reflected on this culture of fear, saying he is the only doctor still willing to care for the vulnerable patients who end up as unintended victims of the crackdown on opioid prescribing. “Every time I write a prescription, I wonder, is this the one that’s going to get me?”
If Dr. Hamblin were to lose his license, he would no longer be able to treat these patients. “I’d have to stop helping marginalized people with pain issues. So, elderly gone. Homeless people gone. People of color gone. Those with chronic pain gone.”
He has already seen colleagues leave the profession or refuse new patients due to the increasing pressures.
“We’re never going to get rid of opioids,” Dr. Ciccarone said. “Nor are we going back to the aught years of over prescribing. We’re now stuck in this middle zone, like it or not.” He said the medical board should prioritize supporting and incentivizing the development of a sufficient number of pain medicine specialists and addiction medicine experts to address the growing gap in care.
“We must hold two contradicting truths in our head at the same time,” he added. “One is that a lot of studies don’t support the use of opioids for people with chronic pain. And at the same time a lot of people know that’s the only thing that works for them.”
Bob Johnston, a retired professor who lives in Inverness, came to Dr. Hamblin as a patient on a legacy opioid prescription many years ago. Suffering from lifelong pain due to a football injury, Mr. Johnston has been on a consistent dose of morphine for nearly two decades. After a discectomy in 2005, he was put on his current dose of painkiller. Dr. Hamblin has put him on a slow taper off morphine, and he’s started to notice he was “hurting a little more than I used to.”
“They’re on this kick against pain control meds,” Mr. Johnston said. “But I can easily see why you’d kill yourself if you couldn’t get pain meds. I can see why people would go for street drugs, because pain just wrecks your life.”
Mr. Johnston vouches for Dr. Hamblin’s care, which he called “informal but thoughtful.”
Opioid prescriptions have fallen sharply, but opioid overdoses and deaths hit a record high last year. Most were not from prescribed opioids, but from illegal ones.
The medical board’s case against Dr. Hamblin confronts an uneasy relationship between law and medicine. In an era when drug addiction and overdose deaths are soaring, how should the law balance letting physicians exercise their best judgment with stopping egregious outliers? In a country where over a fifth of the population suffers from chronic pain, how can the board protect these patients while ensuring they are not left without proper care?
“We should be equally concerned about monitoring for patient abandonment as we are about monitoring opioid overuse,” Dr. Ciccarone said. “And I don’t know if [the medical board is] doing that, but they should be monitoring patient abandonment because it’s an ethical principle of medicine. We’re just going to have to find a wise path through the middle.”