A Point Reyes Station physician is seeking to dismiss an accusation of negligence made in June by the Medical Board of California. Dr. Colin Hamblin, who practices family medicine at West Marin Medical Center, called the accusation “unsubstantiated and specious,” and defended his practice as going above and beyond the standard of care.
According to an investigation by the medical board, Dr. Hamblin prescribed opioids and benzodiazepines irresponsibly over the last five years, dispensing them to his own family members, inadequately documenting or consulting with patients over them, and failing to consider non-addictive alternatives. Four patients are mentioned in the accusation.
The investigation stem-med from a review of a state drug database—the Controlled Substance Utilization Review and Evaluation System, or CURES—that found concurrent prescriptions of opioids and benzodiazepines. Investigators interviewed Dr. Hamblin, his employees, his patients and witnesses and forwarded the case to the state attorney general.
Speaking with the Light last week, Dr. Hamblin defended himself. He argued the medical board has lost touch with the needs of some patients as it attempts to remedy the overprescribing that led to the opioid epidemic. This has resulted in the misguided punishment of doctors who treat patients with long-term chronic pain. “The environment right now is terrifying and demoralizing and confusing and makes me want to give up,” he said.
In the census tract that includes Point Reyes Station, more than half the population is over 55, and in the neighboring tract including Inverness and Olema, that proportion is even higher.
As a specialist in gerontology and palliative care, Dr. Hamblin said relieving pain is a key element of his practice. He hasn’t taken any new chronic pain patients in more than a decade. But he is among the few in Marin and Sonoma Counties who continue to see chronic pain patients, many of whom reflect a legacy of overprescribing.
“Multiple colleagues stopped prescribing these meds, especially to these legacy patients,” he said. “Often if they couldn’t get pain relief from a physician’s office, they turned to illicit substances.”
Dr. Hamblin said he was caught off guard by the accusation. He believes his practice goes above and beyond the standard of care—work that can be challenging with some pain patients. “I think I should be getting commended for managing these patients and not escalating their dosages,” he said.
He called the accusation “incredibly distracting. Every free moment I have is devoted to this case.”
Dr. Hamblin’s attorney, Ronald Goldman, is seeking a dismissal of the accusation. If that fails, a hearing will be scheduled before an administrative law judge. Though it’s possible Dr. Hamblin’s license would be suspended or revoked, the outcome instead could be probation or a public letter of reprimand. “Revocation is but one of the forms of discipline that the board can take,” said Carlos Villatoro, a spokesman for the board.
In the past, the medical board based its investigations mainly on patient complaints. But in recent years, it has turned toward proactively examining death certificates and CURES, mining data to weed out physicians who may be prescribing opioids recklessly. Mr. Goldman characterized Dr. Hamblin as a victim of this trend.
Last year, the medical board changed the name of its Death Certificate Project, which some provider groups said unfairly punished doctors, to the Prescription Review Program. The board shifted the focus from strictly overdose-related death certificates to the entire “prescription profile” of doctors, monitored through the CURES database.
Mr. Goldman said the project is still unfairly and summarily punishing good doctors who provide compassionate care. Of the doctors disciplined in the Prescription Review Program so far, 11 surrendered their licenses, eight were subject to probation, and 25 were publicly reprimanded.
“The medical board has an agenda, and certain docs become targets,” Mr. Goldman said. “That’s what’s going on here.” He called Dr. Hamblin “a good guy that got in their crosshairs.”
Accusations of negligence
The medical board accused Dr. Hamblin of negligence in his care of a 44-year-old homeless man who sought help for chronic back pain in 2016. The patient was already on Adderall, Xanax, Valium, Dilaudid and oxycodone.
Xanax and Valium, the brand names for alprazolam and diazepam, are benzodiazepines used to treat anxiety. Dilaudid and oxycodone are opioids. In 2016, the Centers for Disease Control and Prevention recommended that doctors avoid mixing these two classes of medication together whenever possible.
Dr. Hamblin said the man had fallen 60 feet out of a tree at age 17; metal rods that were inserted in his back later became infected and had to be removed. The man has lived in a tent in a nearby state park for years.
In 2018, the man tested positive for marijuana and alcohol, along with his prescription drugs. A few months later, Dr. Hamblin allegedly renewed his prescriptions without consulting with him about his alcohol use. He also allegedly failed to document his conversations with the patient, ignored the patient’s positive drug and alcohol tests, did not warn him about the dangers of mixing alcohol with these drugs, and neglected to consult with or refer him to a pain specialist.
The man allegedly told Dr. Hamblin that he could not get a recommended epidural injection, but Dr. Hamblin did not follow up or document the missed treatment. Later, the man’s insurance denied some of his medications, leading to increased pain, but the board alleged that Dr. Hamblin failed to document which drugs were discontinued or reduced.
Dr. Hamblin said his clinic goes through complex and detailed procedures around prescribing controlled substances, reviewing charts, speaking with family members and friends, and conducting toxicology screens. He said there is no universal standard for documentation, but that his clinic goes above and beyond the common protocols.
“You’re in the room with the patient. You’re a physician with a license who’s been doing this for years and years,” he said. “The way I document is going to be different from the way the guy or gal next door documents.”
He added, “Outside of the documentation on the chart, the process is enormous. The entire staff is involved in this.”
Another complaint included in the accusation centers on a 54-year-old woman who saw Dr. Hamblin in 2014 for chronic pain stemming from her irritable bowel syndrome, arthritis and degenerative joint disease. Dr. Hamblin continued her prescriptions for Dilaudid, an opioid, as well as Ativan, a benzodiazepine. When the woman told Dr. Hamblin that her anxiety was worsening due to her efforts to quit smoking, he doubled her Ativan dosage while allegedly failing to document how her increased anxiety was manifesting itself or why such a dramatic increase in medication was in order.
In 2017, when the woman reported worse lower back pain, Dr. Hamblin allegedly put her on 20 milligrams of methadone a day alongside her renewed Dilaudid prescription, more than doubling her daily opioid dosage. He apparently failed to advise her of any non-addictive treatment options for her pain.
Addressing the allegation, Dr. Hamblin defended his use of opioids and argued that numeric thresholds are often insufficient guidelines. “The line for compassionate use versus excessive use is really physician-dependent,” he said. “I have a lot of experience managing complex chronic pain patients.”
Dr. Hamblin referenced a 1997 state law, called the Pain Patient’s Bill of Rights, which declared that for some patients, pain management is the single most important treatment a physician can provide, and that opioids can be safe.
“We’re not using those medications to kill the patient, we’re using them to extend their life and give them a quality of life,” he said. “I’d be killing these people left and right if I didn’t know what I was doing.”
But, he added, there are some clear boundaries. “I won’t prescribe methadone and Xanax together,” he said. “I know that that’s a combination to get high.”
According to the medical board, Dr. Hamblin also wrote prescriptions for opioids and benzodiazepine to members of his family, though he disputes one of those claims as a records error.
The board alleged that he wrote nine prescriptions for Xanax and Norco, an opioid also known as Vicodin, to a 78-year-old close female relative in 2019. He allegedly wrote five prescriptions for the same two drugs to a close male relative, also 78, the year before.
Dr. Hamblin told the board’s investigators he didn’t write many of these prescriptions, but they appeared in the CURES database. Prescribing controlled substances to family members is considered unprofessional conduct under California code.
Dr. Hamblin called the accusations about his family members “bogus.” He said another doctor at the West Marin Medical Center prescribed Xanax and Norco to the female relative, and pharmacists noted Dr. Hamblin’s name instead. Once CURES recorded the prescription, it couldn’t be adjusted.
He admitted prescribing the drugs to his male relative, but said it was while the man was an inpatient at Windsor Care Center in Petaluma, a nursing home where he serves as the medical director. The relative had his own primary care physicians for years before and after, Dr. Hamblin said, but when he was an inpatient, no other doctor could sign off on the prescriptions.
He cited the American Medical Association’s principles of medical ethics, which established that in emergencies or when no other physician is available, doctors “should not hesitate” to treat themselves or family members.
Alan Herber, the administrator at Windsor, was surprised by the accusation against Dr. Hamblin. “We have never had an issue with his ethical or medical decisions, or anything like that,” he said.
None of the patients mentioned in the accusation raised any complaints. “All four of these patients love Dr. Hamblin and will testify on his behalf” at any hearing, Mr. Goldman said.
Fellow doctors respond
University of Southern California health policy expert Jason Doctor said that if the board’s accusations are true, Dr. Hamblin did violate his professional duties.
“The type of prescribing described in this complaint is very far from the current standard of practice,” Dr. Doctor said. “The chance of fatal overdose from co-prescribing with benzodiazepines, prescribing to persons with substance abuse, and prescribing multiple opioids is high. If the allegations are true, then the D.O.J. and medical board are acting properly to protect the health of the public in this case.”
Yet some pain experts readily side with Dr. Hamblin. “The care of patients like this bedevils and frightens every doctor in America,” said Dr. Stefan Kertesz, an expert on opioid policy and professor at the University of Alabama at Birmingham. “What they normally do is to refuse to see them, or to stop all opioid prescriptions, because those physicians fear legal and licensure risk.”
Dr. Kertesz, who is a prominent opponent of forced drug tapering and stoppage, said many of these chronic pain patients should not have been prescribed such a high dosage of painkillers in the first place. But any doctor who continues to see chronic pain patients is bound to have “some situations that don’t feel good and don’t look good.”
“If a few doctors are willing to keep seeing those patients and keep them safe, we should probably be supporting those doctors,” he said.
A Marin native, Dr. Hamblin earned his medical degree from the University of Rochester School of Medicine in 2000, before completing his residency at U.C.L.A.’s Northridge Hospital and his fellowship in geriatrics at West Los Angeles V.A. Medical Center in Los Angeles. He began working at the Coastal Health Alliance in 2004.
In 2010, Dr. Hamblin moved across town to join Dr. Michael Whitt, a longtime West Marin physician, at his clinic, the West Marin Medical Center. Dr. Whitt retired five years later. He and others who worked with Dr. Hamblin were taken aback by the accusations.
Carrie Chase worked as a nurse practitioner alongside Dr. Hamblin at the health alliance before moving to the clinic in 2012. In 2017, she returned to the C.H.A. Because both she and Dr. Hamblin have many older, long-term patients with chronic pain, they try to balance compassionate care with protocols around prescription. Dr. Hamblin always did so professionally, Ms. Chase said.
“All of us are under a great deal of scrutiny, doing a radical shift in our prescribing practices,” Ms. Chase said. “He may be someone who’s targeted by having a lot of these legacy patients that have to be taken care of compassionately.”
She added, “I think he has safe practices, and you can tell that by the lack of adverse outcomes.”
While some physicians have accused California’s medical board of overzealously punishing doctors who prescribe opioids, the board has also been under fire in recent months for a failure to sufficiently discipline negligent doctors. In July, the Los Angeles Times reported that the board frequently gave doctors shorter probations than its guidelines recommend. An array of patient advocates and experts have accused the board of lacking transparency and protecting doctors over patient safety.
In May, a bill was introduced in the California state senate to add two more public member seats to the board and appoint an independent enforcement monitor, in an effort to make the disciplinary process more transparent.
If Dr. Hamblin’s case goes to a hearing and his license is placed on probation, he’ll face a dilemma when it comes to treating his chronic pain patients. “If any specific complaints come in during probation, I’d lose my license,” he said. “Why would I take the risk of prescribing a single pain pill?”