For nearly eight years, a Wilmington doctor treated a woman who sought his help for her lower back pain. But after years of being prescribed high doses of highly-addictive narcotics, the mother of four was involuntarily admitted for addiction detoxification.
The N.C. Medical Board reprimanded Dr. Mark Samuel Thomas Armitage, who practices at Pelican Family Medicine, on June 12 for lapses in the patient’s care.
According to a public Medical Board document, the woman – referred to as Patient A – first went to Armitage in August 2009 with complaints of pain. By November of that year, he had prescribed her Klonopin for anxiety and Vicoprofen, a combination of hydrocodone and ibuprofen, for lower back pain.
For the next eight years, Armitage maintained the patient on chronic narcotic and benzodiazepine therapy with minimal attempts at alternative treatments, the document states.
“During the eight years he treated Patient A, Dr. Armitage did not screen Patient A for risk of drug abuse or addiction, despite her known history of depression, anxiety, and panic attacks. Dr. Armitage did not document that he questioned Patient A about past drug and alcohol use. He did not have a pain contract with Patient A. He never counseled her on the potential risks and benefits of opioids.”
According to the document, Armitage prescribed multiple controlled substances simultaneously and, at times, prescribed doses of narcotics averaging over 700 milligrams of morphine equivalent.
“He never documented his treatment goals (with the patient), evaluated the efficiency of his treatments, or addressed aberrant behaviors,” the document says. “His physical examinations were cursory, and at times, non-existent.”
In January 2017, Armitage prescribed the patient with Adderall based solely on her complaint of having “focusing problems” and a scale of self-reported symptoms, according to the document.
In the months that followed, the woman began experiencing significant weight loss – 10 percent of her body weight in five weeks – and went into acute narcotic withdrawal during a February 2017 visit. However, there was no change in her medication plan or discussion of a need for detoxification or substance abuse counseling.
At a March 22, 2017 visit, Armitage wrote that the woman was “stable” and “not impaired,” and continued with her current medication regime, the document states.
“A week later, on March 29, 2017, Patient A was admitted to the hospital with multiple abscesses on her arms and legs, likely from intravenous drug abuse, and ‘skin popping,’” the document continues.
In her next visit, the patient reportedly asked Armitage to decrease her pain medication. However, Armitage continued “all current meds” and refilled her medications in the same doses and total number of pills, according to the document.
The woman was involuntarily admitted the following month with diagnoses of opioid use disorder, severe, and benzodiazepine use disorder.
Stipulations in the Medical Board’s order include, among other things, that Armitage cannot prescribe any controlled substances and must surrender his DEA privileges.
Armitage can, however, request the Board reinstate his ability to prescribe certain controlled substances, including opioids, after a certain amount of time has passed and he completes specific requirements detailed in the Board’s order (a full copy of which can be found at the bottom of this story).
"We have cooperated fully with the state Board and are committed to continuing to do so," Armitage said when reached for comment. "We are committed to the utmost safety and patient care."
All Pelican Medical Family locations will remain open during this process, and patients are being notified, Armitage added.
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