TREATMENT CENTER, [HELPING PEOPLE TO CHANGE OPIOID TREATMENT PROGRAI Date: December 9, 2016, Re: Docket Number 16-415 Dear Ms. Hannon: |!am the Program Director at High Point OTP and | am writing to you on behalf of Dr. Khalid Mohammed, who brescribes medication for our patients here. | am writing in response to a complaint made by a patient last month, | began as Program Director here in January, 2016 so | have been working with Dr. Mohammed for about 1 year. During this time, have never received another complaint from a patient regarding Dr. Mohammed. It appears as ‘though this recent complaint was unfounded as the patient stated Dr. Mohammed didn't grant him his request for ' dose change, however, despite discussion with his therapist during their sessions, he hadn't requested an appointment with Dr. Mohammed until recently and, in fact, hadn’t even met with him since November, 2015 {they are required to meet once a year with the Dr. unless extenuating circumstances arise or the patient requests an appt). Please be aware that we work with a very complicated population. Most of our patients, all of whom suffer from 2 ‘severe Opioid Abuse Disorder, have co-morbid psychiatric issues, extreme psychosocial stressors, and other medical issues. While we always want to validate how a patient feels and try to understand them to the best of ‘ur ability, we also have to take into consideration these other factors. Many of our patients struggle with assertive communication, rather avoiding talking about their concerns directly with their source of discontent. | can't say for sure that was the case here as | haven't met this particular patient, but | do know that Dr. Mohammed 's fair with patients when they bring 2 concern to him and will talk over the pros and cons of a dose change. letter. f you have any further questions, you may reach me at the ‘Thank you for taking the time to,read thi ‘number or email address below. Program High Point OTP [email protected] 508-408-6126= SOUTHEAST REGIONAL NETWORK int Plymouth Camy Detoxification Unit Dual Diagnosis Uni Inpatin:Peyciare Unit (Oupatent Services Paiway CSS Recovery CSS, New Bedford Complex Administrative Ofises Nacotie Tentment Program ‘Transitional Support Services Women's Adistion Treatment Center wdowb on Brockton Addiction Treatment Center CCASTLE Adolescent Program Mee's Addiction Treatment Center ‘Outpatient Services Serenity C88 ‘Community Services Brockton, Manomet, New Bedford, Plymouth, Taunton, Wareham Adolescent & Adult Counseling Services Batters Intervention Progam Communities Mobilizing for Change Community Suppor Programm (CSP) Domestic Vielence Services Driver Alcohol Edusstion ‘Dual Diagnosis Treatment Family Services Opioid Overdose Prevention Coshiion Ppchiatrc Mediation Management ‘Second Offenders’ Aftercare Structured Outpatient Addiction Program Residential & Shelter Services Harmony House Men's Graduate House ‘Monarch House Reflections = CAP Unity House WRAP House Fall River Family Center arbour Howse Family Center Taunton Family Center Family Preservation Program 100 Now Froat St, 3* Floor Opioid Treatment Program 30 Meadowbrook Road Brockton, Ma 02301 December 12, 2016 To Paula Hannon Consumer Protection Coordinator Re: Docket Number: 16-415 RE: Dr. Khalid Mohamed, Thave been Mr. Robert Morano’ clinician since 2013 when he joined the clinic. Client was on a comfortable dose and even requested for dose decrease. He never went to see HP MD- Dr. Mohamed for dose increase and was denied the request or told he was drug seeking. Dr. Mohamed has always looked out for the best interest of the clients and performed his duties to the best of his abilities, He is well liked and Tespected by staff and clients. If you have any further questions, don’t hesitate to contact me at (508) 408-6190 ext. 4412 Thank You Yours Truly Oks Upeln-Frenceis Chika Njoku-Francois, MS, LADC 1 New Bedford MA 02740 Tel ($08)987-047 Fax: (508) 997.0765CHARLES 0. BAKER Governor KARYN E. POLITO Uautenant Governor MARYLOU SUDDERS Secretary Commonwealth of Massachusetts Board of Registration in Medicine 200 Harvard Mill Squaro, Suite 330 CANDACE LAPIDUS SLOANE, MD Wakefield, Massachusetts 01880 heir Prysican Member (781) 876-8200 KATHLEEN SULLIVAN MEYER, ESO Viee Chat, Buble heme? www.mass.govimassmedboard Enforcement Division Fax: (781) 876-8381 secret Prysictan Nema? Legal Division Fax: (781) 876-8380 Licensing Division Fax: (781) 876-8383 emealripcean wane WOODY GIESSMANN, LADC: CADC, CIP, CAI Pobic Menber ROBIN 5. RICHMAN, MD ‘nysiclan Momber MONICA BHAREL, MO, MPH GEORGE ABRAHAM, MD ‘commissioner Department of Puaic Heat Prysician Member GEORGE ZACHOS, Esa Executive Director March 16,2017 Robert F. Morano 239 Howard St Brockton, MA RE: treet 02302 Khalid Mohamed, M.D. Docket Number: 16-415 Dear Mr. Morano: Thank you for the information that you provided to the Board of Registration in Medicine. A copy of your complaint, referenced above, was sent to the physician, who was required to respond in writing. Enclosed please find a copy of the physician’s response After considering this matter on March 9, 2017, the Board’s Complaint Committee did not recommend disciplinary action and closed the complaint. However, your complaint and the physician's response will be placed in the physician's file at the Board. Thank you again for bringing this matter to the Board’s attention. Very truly yours, Tul aay a ia Hannon / ee Protection Coordinator PH/bmh,December 9, 2016 Khalid Mohamed, MD. . 8 Harvey Lane ‘North Easton, MA 02356 RE: Docket Number: 16-415 Dear Ms. Paula Hannon Consumer Protection Coordinator Board of Registration in Medicine The purpose of this letter is to provide a written response to a complaint tendered regarding my alleged conduct in the practice of medicine. ! understand the Health Insurance Portability and Accountability Act (HIPAA) provides that otherwise protected health information may be disclosed to a health oversight agency for activities that include disciplinary actions and the Board of Registration in Medicine meets the definition of a health oversight agency (see 45 CFR section 164.501), The patient reported requesting a dose increase but | have only met this patient once before this incident, back in November 2015. He had an appointment scheduled for October 2016 but canceled due to being hospitalized at the time. Enclosed is the appointment canceled of most recent medication consult Mr. Morano states | am discriminating against patients who are mentally ill, pregnant women and addicts in general that are trying to adjust their lives through medication assistant therapy by not increasing doses. ‘What Mr. Morano is not aware of is that | have the responsibility of obtaining an accurate and complete profile of my patients (i. drug screens, compliance with counseling, etc.) assessing for appropriateness and safety. The patient stated that | made him feel like a “criminal” and “not taking into consideration that my body converts and metabolizes methadone at a faster rate than some” but I never said this. ! would never accuse patients of criminal activity, dismiss their concerns or neglect them, | am following the standard of care for methadone patients. It is my primary concer to follow all regulations and procedures in overseeing safe practices and treatment for all of my patients regardless of legal involvement, pregnancies, mental iliness, etc. The written complaint received appears to be used on a broad spectrum, compiling other patients” reported complaints. It is my responsibility to address both Opioid Use Disorders and safety. Patients on medication assistant therapies face stigmatization in society, especially in the healthcare field. | sympathize with this dilemma and chose to dedicate my profession to helping those medically compromised by this disease. With the Opioid epidemic fatalities increasing at an alarming rate itis especially important to address medical and psychiatric needs to help eliminate cravings to use and provide healthy drug free coping skills to further reduce the likelihood for relapse which may lead to ‘overdose. I have been practicing Addiction Medicine for 32 years treating people suffering from this, terrible disease with respect, dignity and quality care. Kb 1G Q1kP- Khalid Mohamed, MDPatient's dose is 100 mg methadone daily with most recent drug screen on 11/02/16 negative for illicit substances; script on file for Alprazolam. Patient reported feeling much better evidenced by diminished withdrawals/cravings of opiates since dose increase. Patient met with Clinical Director and Dr. Mohamed to discuss treatment perspectives, the responsibility of professionals in the field of addiction, patient care, concept of “Do No Harm and advocacy for patients’ rights. Dr. Mohamed shared his philosophy of treatment, years of dedication and work in the field and intent to provide quality care to all patients regardless of diagnosis and behaviors. Clinical Director (this writer) discussed and encouraged patient to obtain the “whole picture” when advocating and finding truths before taking action and meet with management as 2 means to obtain a clear understanding of treatment being provided. Patient discussed his role in advocating for himself and others, feelings of justification at the time of written allegation to the Board and verbalized an understanding of mistake made in contacting officials before meeting with management. Patient expressed his feelings regarding action taken without meeting any management staff, recognizes he acted impulsively and will ask to meet with any member of management if further clarification or explanation needed. Patient inquired about status in treatment and was reassured patient's rights will be maintained and discharge/retaliation not an option atall Clinician discussed meeting with newly assigned clinician and it may be a better fit for treatment needs.High Point Treatment Center & Affiliated Organizations Inpatient Servi High Point Hospi. Dis Diagnosis Services Detoxification Services (ATS) (Clinical Stabilization Services (CSS) ‘Specialy Services Clean and Sober Tent Living Empowered (CASTLE) Men's Addition Trestent Center (MATC Sexton 35) ‘Women's Addition Testment Center (ATC Seton 33). ‘Adolescent & Adult Counseling Services ‘Batierers interven Program (IP) (Children’s Behavioral Heath Initiative (CBHD Comunity Suppor Program (CSP) Domestic Vielence Services ‘Diver Aleohal Education| Dual Diagnosis Treatment Family Services Mental Heath Tretment Opioid Overdose Prevention Coaon ‘Opin Treatment Program Plymouth Tri Boutique Primary Care Payshistri & Medication Management ‘Second Offenders Afercare Substance Abuse Prevention Collaborative ‘Transitionl Support Services (TSS) Graduate House Harmony House Monarch House New Chapters, Reflections CAP Unity House WRAP House Fall River Family Center Harbour House Family Center “Taunton Family Ceter Family Preservation Program (FPP) ‘Afrdsle Housing DECI 5 ang December 12, 2016 Ms. Paula Hannon Consumer Protection Coordinator Re: Docket Number 16-415 On 10/12/16 Mr. Robert Morano was scheduled to see Dr. Mohamed at 8:15 AM. Mr. Morano called in 5 AM and canceled his appointment as he was in the ER. Please see attached schedule with the canceled appointment. Mibiastep Hilda Delfino Office AssistantDate: 10/19/16 (Dr. Mohamed saw patient) Deseri Patient is a 49 year old male who is on methadone 70 mg daily. patient reports that last week has been very difficuit for him. he was seen in the Brockton Hospital on 10/2/16 around 11 am because of kidney stones and extreme pain and vomiting he was treated with toradol, V fluids and zofran. he was discharged around 4 hours later with a script for 6 , 5 mg percocets. Patient filled them untill 10/5/16 " i had 2 perocet left over from a pervious script” patient is also on xanax, 1 mg TID, neurontin 100 mg TIO, elavil 25 mg QHS. patient is upset that he complained against me to the DPH’ “iam very sorry, ii over reacted to the situation Assessment: Patient reports that he feels withdrawal aroud 4 to 5 pm daily "i was afraid if i ask for increase i might loose my take home privs.” Patient reports that he was not able to convince himself for dose increase. "part of me tells me why i need an increase. Plan: patient has take home privs his urine tox screen in house on 10/18 is pos for benzos, opioids, methadone, suboxone and methadone. patient education is done. his tx plan is discussed will give 5 mg stat and increase by 5 mg every 3 days to max of 100 mg daily for SS of withdrawals. patient agrees and will RTC if f he needs a dose increse or feels sedated .Progress Note Psychotherapy Page 3 off z La vots Bouck rest save fl concer | Fame 1] HTC | Peoe? Posed] Coopirea]| Gur Gkcwtan| Aierdim] brat Te ‘Add Goals from Treatment lon DECI 5 206 estan Vat [Ppad Desenaeie Roget on Teained Peapecive wa Rosy Caer Gers pat of popes tow palaces anc it sens: (eee tyme sah wh mes ew gsm RE ra i pre ool ots Apa Fan ape ay NDE RL SEE faharnaurnge of cpate ae dove rceoe Piet ev Clnca Drea a br Mahanesio aenne rene sepestves ne reparsbiy ol gessonas ied e6Scion pater inet 9 “Oo Ne Pam ard acces parts ts Dy Monaved Pech aoeopty obese yoow d cecnahon ox or ihe fe be ret fopoveaey cot pete 13 aga arc banavers Cri Drei Bn wr decade reaped gate aton he whos Scie wren savocurg aria ih berg ation ae ae wh br arneunsocian a iew uverang d tosirrt berg vies Peer cared hala" 2bvocing ts has ons thers lesinge ofthese ee 3 he gan Ss Soden denny 9 ane soe vier caste sory whrwupee Pee es ear pear aces Na oeerG Ma ‘Jeprach Und cade gale cf appach [Bison esnaec ota cra sesso loctnnd 9nd Benen BRUPT ITE OT DRS BTS ERIN TOCOTCD CODA ATT THOT ETDS ert Reaper to Herero f how cert mang pores on gos ert IMT?) [user ered alo, tered. enagedensiona a es evdencedby cyte amstne d RESTO. STs aug SORENTO WAG ND Pale WGI WOR RN aNaTAD [Shon commuavearnart jose Pan cet cortrsngntetnart cate evertons are nd delet) [Fat dove Gay ard wey Pav cncearg "an Shard Pom BS NaCea Bd Bo ROOT AN/ORE DICwE Certs Spree Oxted "cay ooo)Contact Note |e flatware Tine Stat [ETA Tne Ena [SAE AW ‘Sia Name [Rbraham, Bonzo 7 Progam [Opioid Tener Posen OTF) =I conta faitonte [et : | | prone [Sonar =] Naty [Fair catacteinin wt: long hin avi eter gpg Sepa We a dak rao Jcooy.f te letter and rtends to contact the Bond vin ohone Pater nota afer mesg wth the wrter | land Or. Mohamed * put things ric perspective | [This wrter thanked pair or econ fake to rectly the stun |Contact Note fase Tne Sat [O540AM Tene End [SABA | taf Name [abraham Bonzo | Contact Tyne [Cel Phone z Contact Relators Phone Note Progam [Opa Treatment Program OTF) erana. Rober ———SCSCS~SY [ce = [eoaearsas = [Peer contacted tis water rorang him of leaving alee regarcng legatons athe fort desk, maled = py of the ltr an rend o contact the Board vie phone. Part reported ater mesting wh ths wer land Dr. Mohamed“ putting into pespecve [This writer tnarked patie for actona taken to recy the stuston, al Page 1 of’Progress Note Psychotherapy Pago 3 of § 9) Ekeaion] Maendin] vate ‘Add Goals from Treetment Plan DECI 5 206 Corer Gers pat of popes tors ulltbacben anc at season Figs cre Td a methane cay wr not roars ug screen on T1/GD/Teepave lee beacon saan Avatclan, Pole pcted cdg nish Bale SaGady SARSE Iwevdonsscoyngsf opates ce done seme Fart mt wah clncal rec aa br Matanedio Sect ener sowerives re canoatay of sooo TS hae ooo fr. coment ‘o Ne Ham end cvacar ferpabeas ros Dr Mohamed sredhie rowan ovement yar of deston ve wor hie fed end stenioponds caky cowie doers feealertcldazncas ar bravo, rel Greta ths wit) casos ard ercourged pate obs ‘whae east woe sora ars ng Wetwbor ee ar ene eager a aearsto Gan 8 ca unsentasng of veamart bang povided Pet Gacused ea" scocaigier healer ches teen fates & he ee ween sepa [rs Goud an vetlzedanurdestning o make nace in crt eal ble ming wer anager Patert exresed ha ean ara acto ace hod resi ay marcato roach Und ld golf approach) [Bac ersanestere cng sewn Tnsledmeaingbareon pa and OTP VEC PS HSHIN FCOISE CET IREREA NOSE TCAD rt Retna to Htarvertere/n fol cert malrg pgs on goa dered IMTP) [ere eseried et. oertednl engaged enol a tnesevderced by yngne nner @ RparRan. S/His Haup aaraed ara aoe Fala a GIS WRN pico corece weer as Fn certs contra nteatnert nate teverton anred ad dee) Far wi due cy, send west nv cecesing tan aber ms sistance dado a Vener GeON/GPES POSH ote Gets Senatse Osten. oneal apse)Date: 10/19/16 (Dr. Mohamed saw patient) Description: patient is a 49 year old male who is on methadone 70 mg daily. patient reports that last week has been very difficult for him. he was seen in the Brockton Hospital on 10/2/16 around 11 am because of kidney stones and extreme pain and vomiting, he was treated with toradol, IV fluids and zofran. he was discharged around 4 hours later with a script for 6 , 5 mg percocets. patient filled them untill 10/5/16 ” i had 2 perocet left over from a pervious script” patient is also on xanax, 1 mg TID, neurontin 100 mg TID, elavil 25 mg QHS. Patient is upset that he complained against me to the DPH’ “iam very sorry, ii over reacted to the situation” Assessment: Patient reports that he feels withdrawal aroud 4 to 5 pm daily “i was afraid if i ask for increase i might loose my take home priv. patient reports that he was not able to convince himself for dose increase. ” part of me tells me why i need an increase.”* Plan: patient has take home privs his urine tox screen in house on 10/18 is pos for benzo’s, opioids, methadone, suboxone and methadone. patient education is done. his tx plan is discussed will give 5 mg stat and increase by 5 mg every 3 days to max of 100 mg daily for SS of withdrawals. patient agrees and will RTC if f he needs a dose increse or feels sedatedDAP Note Page 1 of 1 LL Fieseat a) tam Fast ‘Add Goals Treatment Plan DECI 5 2016 Deseaton fonts a yen odrae ow mmaheiane TES serps eto nec has ben vy gL fr Poe wee sen nthe BookenHoepalen 102/16 aun Ten becoute ney tones nd ene p avrg, wes teed nts fe on an. ches Gechrged bound doze wth ect fr§. Sng percocet, esaaner fuer pots rahe fee wthawel wed As Sp dy “ivas Sad anton nseane igh owe nye Foe pve fer oot ewanret eto carvmehnse#lor ote renee. pet eta a ry inend an nore Pn eho hone pe i ue tx ster hour on 1/1E poe bere’. pads, matador, sdbatone nd meade sien sieaion one ens cues