About Amy Umble:
Amy Umble is health reporter for The Free Lance-Star
Local doctor disciplined for inadequate care and sexual contact with patient
A committee of the Virginia Board of Medicine has found that a Fredericksburg-area physician violated state law when he failed to properly manage the care of drug-dependent patients.
The committee also said that Dr. Russell Williams engaged in inappropriate conduct when he kissed a patient on the lips.
The committee heard evidence against Williams on Dec. 19 in Richmond and recommended that he be placed on indefinite probation. Williams has until Feb. 5 to appeal the verdict and request a full hearing. He said in a phone interview Monday that he probably will not appeal.
Asked about the committee’s findings, Williams said in a statement: “The board compared the selected patient records reviewed to what I would call a ‘gold standard’ of record keeping. Mine definitely fell short of that standard.”
As for the kissing incident, Williams said, “I maintain this was a situational anomaly. The affection expressed was like one would show to a family member.”
Williams is a family practitioner who has worked in the Fredericksburg area for 25 years. He practices now at Stafford Urgent Care and Stafford Primary Care Associates on Garrisonville Road and at the Colonial Beach Medical Center.
The committee said that Williams violated state law in his dealings with nine patients during the period 2006 through 2011.
Board documents indicate that he did not adequately respond to drug-seeking behavior or signs that his patients were abusing the narcotics he prescribed for them. The behavior of one patient in particular, referred to as Patient A, is described in detail.
Between March 7, 2008, and March 23, 2011, Patient A called Williams’ office 48 times, an average of once every three weeks, to get prescriptions for narcotics, according to board documents. Patient A admitted to Williams that she was dependent on drugs like OxyContin, Oxycodone, Dilaudid and Xanax. At different times, she asked for increased dosages or early renewals of her prescriptions.
Williams indicated in his notes that he was aware of her drug dependence. A urologist he referred her to also noted her dependency. Yet Williams continued to renew her prescriptions, according to board documents.
The board committee also found that Williams hugged and kissed on the lips a patient identified as Patient J. The incident occurred on Oct. 11, 2011, in his office. Williams, who represented himself at the hearing, said his style with patients was “informal and personal,” according to board documents.
He said he was treating Patient J for liver problems, and when a test indicated that she was going to be OK, he hugged her out of happiness. The kiss was not planned, he told the board.
“He doesn’t know why he kissed her on the lips, except that it was the closest area,” according to the board report.
The board committee also was critical of Williams’ record-keeping. For example, it found that he:
- Prescribed narcotics to Patient A and to other patients even though he did not obtain comprehensive patient histories, did not indicate why he was prescribing narcotics, and did not obtain records from prior treating doctors.
- Did not have pain management contracts with his patients, or if he did, did not monitor them. For example, one patient, described as Patient D, used seven pharmacies rather than a single pharmacy to hide his drug dependency. Another patient, described as Patient E, used three different pharmacies.
- Did not order random drug screens, conduct pill counts, or check the Virginia Prescription Monitoring Program, to see if his patients were taking their medicines as prescribed.
The Board of Medicine has adopted guidelines for the treatment of chronic pain, including the use of patients’ medical histories, physical exams, diagnostic tests, treatment plans, pain management contracts and period review.
“The Board of Medicine expects doctors treating chronic pain with narcotics to do things Dr. Williams failed to do,” said Jennifer Deschenes, deputy executive director of the board, in an email.
In his statement, Williams defended his care. He wrote:
“To rely on clinical judgment and a mutual patient/physician trust relationship is no longer adequate given the national focus on prescription opiate misuse, abuse, etc.
“The extent of documentation and monitoring now expected is, however, beyond what most primary care doctors will have time for.
“The misfortune for many of my patients with limited resources is that they will be either living with more pain or paying big bucks to someone who will maintain their treatment.”
As part of Williams’ probation, he is prohibited from prescribing narcotics “for more than 60 days for the treatment of acute pain.” Williams “does not have to stop seeing the patient at day 60, he just can’t prescribe any more drugs after 60 days,” Deschenes said.
Williams also must attend 53 hours of continuing education classes in four topics: the proper prescribing of controlled substances, pain management, medical record keeping and “maintaining professional boundaries.”
Williams graduated from Dartmouth Medical School in 1975. He did his residency training at VCU in Richmond and received his Virginia medical license in 1978.