Utah Doc Loses License to Prescribe Narcotics by Telemedicine

Mark Crane

July 11, 2014

A Utah doctor who practices telemedicine from an island in the western Pacific Ocean was stripped earlier this month of his license to prescribe controlled substances for allegedly failing to properly evaluate 3 of his patients.

The Utah Division of Occupational Professional Licensing (DOPL) issued an emergency order, stating that Paul M. Gahlinger, MD, poses "an immediate threat to public health, safety and welfare."

Dr. Gahlinger doesn't have enough contact with his patients to "properly evaluate or take a medical record" before prescribing buprenorphine and naloxone (Suboxone), a medication used to wean people off more powerful painkillers or illicit drugs such as heroin.

The doctor lives on the island of Saipan and only sees patients at his Medicruiser Clinic, operated out of his assistant's home via online video conferencing, the division said. His assistant, Kelley Reyes, is not licensed under any profession in Utah.

Dr. Gahlinger's patients were identified only by their initials. One patient was an obese man with high blood pressure. The other 2 were pregnant women. All 3 received prescriptions for naloxone and dealt almost exclusively with Reyes.

When the 2 female patients gave birth at Ashley Regional Medical Center in late 2013, their infants had to be monitored for withdrawal from the drug, according to the emergency order.

Dr. Gahlinger doesn't have privileges and isn't affiliated with the hospital. In the case of one of the women, he did "little physical monitoring" of her condition and "did not communicate with [her] OBGYN," the order states.

Charges Called "Preposterous"

Dr. Gahlinger disputes the allegation. "In fact, we were in touch with the obstetrician and worked with him and the patient," he said in an interview with television station KSL News. "So this is just preposterous."

DOPL also said that Dr. Gahlinger prescribed naloxone to a man suffering from obesity, high blood pressure, and constant pain but didn't physically monitor the man prior to having his assistant call in the prescription. The man did not meet Dr. Gahlinger personally, but did see him over Skype, at times, the DOPL report adds.

Dr. Gahlinger told the Salt Lake Tribune that naloxone is "strongly supported by the medical standards during pregnancy," and is safer than the previously recommended treatment with methadone, and better than relapse.

"We counseled each of our pregnant patients on the use of Suboxone and the [effect] on the baby, and worked closely with them to reduce the dose to the minimal [dose]," Dr. Gahlinger said.

"The really preposterous thing is that Utah has a lot of doctors that prescribe opioids such as Oxycontin and other abused medications," he told the newspaper Deseret News. "That creates a problem and we are solving the problem.

"Telemedicine is a legal way to treat patients," he argued. "This is how you reach rural patients who otherwise would not be able to get care."

In his KSL News interview, Dr. Gahlinger said he may take legal action against the state for damage to his reputation and loss of income.

"Right now we have 65 patients who are dependent on us who are very distressed because they will no longer be able to get their medication," he said. "So this is causing great injury to the community."

The DOPL states that Dr. Gahlinger has 20 days to request a hearing on the emergency order.

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