Lags Pain Management Clinics (3 in Ventura County) Closure Friday, May 14, 2021
These clinics treat upward of about 1000 patients in Ventura County for pain management and opiate prescriptions. It was mentioned that Lags attempted to contact their patients to provide a month’s supply of prescriptions and that further care should be sought through their primary care physicians. This is a public health issue and we’ve had meetings at CMHS on how to manage this sudden change in care for our patients that used the Lags Clinics services. I’m including two articles on the topic to help our physicians and advanced practice providers in caring for our patients.
Lags Pain Management Clinics Closed – CFH Memo
We have recently learned that LAGS Pain management will be closing this week and wanted to notify you as soon as we confirmed the closing.
We anticipate that CFH and the County clinics will be seeing an influx of patients requesting Pain Management services, especially if you are the Primary Care Provider. We ask for your help in evaluating and treating those patients for whom you are their PMD.
To assist with this transition period, I have attached:
1. CFH Guidelines for treating pain – Opioid Prescribing Guidelines
2. Opioid taper guidelines – Pocket Guide_ Tapering Opioids for Chronic Pain
3. Prescribing Guidelines Video https://web.microsoftstream.com/video/d356083b-40e4-4cfd-81a4-4034e73b4487
Please remember that all treatment starts with proper evaluation and diagnosis of the pathology leading to pain. An honest discussion of treatment options rarely includes long term full agonist opioids as evidence-based treatment. Moreover, patients struggling to wean off opiates should be assessed for some level of an Opioid Use Disorder and may benefit from a conversion Buprenorphine treatment to treat both pain and the underlying use disorder.
We continue to receive referrals to Addiction Medicine for “opiate weaning” and “pain management”, or with the expectation of continued prescribing of full agonist opioid therapy (Oxycodone, Norco, etc.). Referrals to Addiction Medicine should be for Substance Use Disorder and a documented conversation about risks, benefits and options should be in the chart.
However, there are cases of patients who are Dependent on Benzodiazepines or Opioids who do not meet criteria for a Moderate or Severe Use Disorder. Patients who are opioid dependent and would like to transition to Buprenorphine (Suboxone) for treatment of their dependence and chronic pain may be referred to Dr. Kerrigan. Patients struggling to taper off of benzodiazepines may be referred to Dr. Kerrigan to Transition to a long acting benzodiazepine (Valium/Librium) in order to ease the taper while starting safer non-addictive alternatives. It should be expressed clearly to the patient that Dr. Kerrigan will not be providing full agonist opioids.
In addition, Dr. Wang is ready to receive patients where procedural interventions to relieve pain may be indicated. As with Addiction Medicine, “opiate weaning” is not an appropriate referral.
Please remember patients who are physically dependent on opioid pain medicines and suddenly have these medicines discontinued, or the dose rapidly decreased, can experience serious withdrawal symptoms, uncontrolled pain, psychological distress and suicide.
Although no standard opioid tapering schedule exists that is suitable for all patients, I have attached The Pocket guide CDC Guidelines on tapering Opioids to assist with a tapering schedule.
We are very appreciative to those of you who are M.A.T. certified. Providing Suboxone is going to be a valuable resource during this time. As you are aware, the first year of the waiver providers are limited to treating up to 30 patients. Please review your status as to the total number of patients you are eligible to treat. If you are interested in training, please inform administration and we will walk you through the process including the recent updates in federal guidelines making it easier to prescribe Suboxone.
A. Jaime Lara, MD
Ambulatory Medicine – North Region
Abrupt closure of Lags Medical Clinics leaves patients without care or referrals – Sacramento Bee
Stephanie Bjorge needs a fentanyl patch to manage her chronic pain. But she and hundreds of other patients are scrambling after the medical clinic that treats them abruptly closed its doors.
Lags Medical Clinics, which operates about 23 clinics throughout California – including two in Modesto – are shutting down, leaving patients without referrals, records or treatment plans.
No explanation for the closures was provided. The Bee reached out to the founder and CEO, Dr. Francis Lagattuta, but he did not respond. Lagattuta holds a license to practice medicine in California.
Doctors who do not provide notice to their patients before terminating their medical care could receive disciplinary action from the California Medical Board for patient abandonment.
The medical board states that to reduce the liability of patient abandonment and minimize disruption of care, “the physician terminating the physician-patient relationship should notify patients sufficiently in advance.”
Although the time required isn’t specified, the California Medical Association recommends that physicians provide patients with enough written notice to allow them time to find alternative care and to obtain their medical records.
Lags Medical Clinics provided a range of services but their primary focus was treatment of chronic pain. They have locations in California, Nevada, Florida and Delaware.
A former medical staff member in Modesto, who did not want her name published, was tearful when she described the surprise about the clinic’s closure and her heartbreak for her patients being left without a care plan.
She said, “Patients should contact their health plans,” so there are no interruption in their treatments.
Phone calls to several of the Northern California locations were answered by a recording stating the office was closed, without any additional information.
A staff member at the Lompoc location answered the phone and said that all the sites would be closed by Friday. She said she didn’t know the reasons but thought it was related to Medicare.
The Centers for Medicare & Medicaid Services is the federal agency responsible for the administration of Medicare and Medicaid federal insurance programs, including the billing and financial aspects of providing medical care under those programs.
In 2018, CMS terminated the Medicare provider status to the Lags Surgery Center in Oxnard, stating the site was not in compliance with regulatory requirements for an ambulatory surgery center with Medicare. The clinic continued to provide pain management services, according to their website.
Dr. Ed Balbas, one of the physicians listed at the Modesto site, has a previous felony conviction for insurance fraud. He also has a 2017 limitation on his California medical license, including that he cannot practice solo and requires oversight for patient billing.
IMPACT ON PATIENTS
Bjorge, a chronic pain patient at the Lags Stockton location, said she received a text on Thursday morning from her nurse practitioner notifying her about the closure. The text said she would receive a one month’s supply of her pain medications and that she should contact her other doctors for ongoing care.
Bjorge said she has chronic pancreatitis, which has required four surgeries in the past year, use of a feeding tube for nutrition and causes her debilitating pain.
“This is unbearable pain. I need heavy medications, including a fentanyl patch,” said Bjorge.
She said she was a Lags Clinic patient years ago for chronic back pain, but reported them to the authorities for unhygienic conditions, verbally abusive staff and lack of attention from medical staff. She said she didn’t want to return to Lags Clinics with her current illness and that the clinic staff did not want her back, but it was the only nearby location that accepted her insurance.
“The next closest option for me is in San Francisco,” said Bjorge, “There are no options. There’s nothing for us in the valley. This is catastrophic for us.”
For help with ongoing care, Lags Clinic patients can reach out to their primary care doctor or health insurance plan to find an alternative source of care.
ChrisAnna Mink, M.D.
May 15, 2021
Link to full article