The state has barred practitioners at a Derby pain clinic, including a high-prescribing nurse, from participating in the Medicaid program because of improprieties in treatment and oversight.
Documents from the Department of Social Services (DSS) show the physician heading the clinic, Dr. Mark Thimineur, and four nurses and assistants were notified in July that their participation in the Connecticut Medical Assistance Program, which includes Medicaid, is being terminated on Aug. 30.
Those terminations came after Heather Alfonso, an advanced practice registered nurse (APRN) at the privately run Comprehensive Pain & Headache Treatment Centers, was removed from the Medicaid program in May, DSS officials said.
Alfonso was identified in a February story by C-HIT as among the top 10 prescribers nationally of the most potent controlled substances in Medicare’s drug program in 2012 — Schedule II drugs, which have a high potential for addiction and abuse. She has since surrendered her state and federal licenses to prescribe controlled substances and is no longer at the clinic. Her nursing license is under investigation by the state Department of Public Health.
In June, Alfonso pleaded guilty to federal charges that she took kickbacks from a drug company in exchange for prescribing a cancer pain medication to Medicare patients. The charge of receipt of kickbacks in relation to a federal healthcare program carries a maximum term of imprisonment of five years and a fine of up to $250,000.
DSS spokesman David Dearborn said the termination of Thimineur and the other four clinicians “results from information in the public domain involving treatment and oversight issues.”
The clinic, located in Griffin Hospital, remains open. The clinic’s practice manager, who asked that her name be withheld, said Monday that Medicaid clients represent “a low percentage of our patient practice,” and that the pain center would continue to operate. She said the state DSS had begun notifying Medicaid clients of the termination and directing them to other practices that she said lacked the necessary expertise in pain management.
“Patients are getting phone calls and they’re upset and they have no place to go,” she said.
One such patient, Cynthia Russell, 57, of New Haven, said Thimineur was the only doctor who had helped her with chronic pain from fibromyalgia and spinal stenosis. She was not sure where she would go for treatment after Aug. 30.
“I’m upset,” she said Monday. “I went through 13 or 14 doctors before I found Dr. Thimineur – nobody else knew what to do . . . He gave me back my quality of life” by prescribing medications, injections and a stimulation implant.
“Why should we be punished? Why is he being punished?” she added. “This situation (with Alfonso) is something he had no control over.”
Thimineur has not been implicated in the federal kickback case, which involves a powerful painkiller called Subsys, manufactured by Insys Therapeutics. In June, he was reprimanded and fined by the state Medical Examining Board for writing prescriptions for patients based on assessments of their appearance or behavior that were conducted by unlicensed medical assistants. The consent order in the case says that from 2011 to the present, Thimineur failed to meet the standard of care when treating one or more patients for chronic pain.
DPH records show the agency launched its investigation of Thimineur in 2013, when it was investigating a separate complaint against Alfonso. Alfonso received a reprimand and fine last summer from the Board of Examiners for Nursing for improper prescribing practices related to a patient, but was allowed to continue practicing without restrictions, records show.
Alfonso and the pain center are being sued by the family of a former patient, Joseph Torchia of Meriden, in a complaint alleging that rampant overprescribing and poor oversight contributed to his death in 2013. Attorney James Biondo of Stamford, who is representing Alfonso, said his client denies the allegations of improper medical care.
A message left Monday for the pain center’s attorney was not returned.