Opinion ID: 4470347
Heading Depth: 2
Heading Rank: 3

Heading: Michael’s Treatment at GNS

Text: The record shows that Dr. Brajer and Dr. Steven Grossinger, but not Dr. Grossinger, met with Michael to treat his pain several times between his initial 30 A17. 31 A293. 32 A18–20; A294–295 33 A22; A295. 34 A22; A295 8 presentation and his death on December 12, 2014. 35 Initially, Michael presented for treatment about once per month and was prescribed oral medications including opiates, such as Hydrocodone and Morphine Sulfate, during that time.36 Notably, however, a June 18, 2014 appointment with Dr. Brajer, at which a urine drug screen was to be conducted—the first such screen scheduled during the five months Michael had been, at that point, under GNS’s care—was cancelled due to a “lapse in insurance.”37 After this missed urine drug screen, Dr. Grossinger, who had never previously met Michael, refilled Michael’s prescriptions for Hydrocodone and Morphine Sulfate on three separate occasions.38 A follow-up visit was scheduled for July 30, 2014. Michael showed up for this visit, during which Dr. Brajer increased Michael’s Hydrocodone dosage, but his scheduled injection was cancelled because his insurance carrier denied coverage. 39 The missed urine drug screen from June 18 was not performed at this follow-up visit.40 35 A171–A222; A271; A325–326. Although Dr. Grossinger never met with Michael, the hearing officer noted that Dr. Grossinger’s “involvement with Michael’s treatment consisted in writing . . . and . . . refill[ing] prescriptions for Michael.” A326. 36 A33, A325. Hydrocodone is also an opiate-based medication. A33. 37 A43–44; A325. 38 A107–08; A326. 39 A287. 40 A43–45; A326. 9 Michael then cancelled his next appointment, scheduled for September 3, claiming illness.41 Despite the outstanding urine drug screen and the recently missed appointment, Dr. Grossinger refilled Michael’s Hydrocodone and Morphine Sulfate prescriptions again. 42 Michael then canceled another appointment, which was scheduled for October 27.43 On November 12, Dr. Grossinger again refilled Michael’s prescriptions, even though Michael’s treatment record as of that date showed that the June urine screen had not been rescheduled and that Michael had recently missed or cancelled two appointments. The doctor noted, however, that any further refills were contingent upon making—and keeping—an appointment at the GNS offices.44 Michael showed up to his next appointment on December 8, when he was seen by Dr. Steven Grossinger, and provided a urine sample for screening. 45 On December 12, 2014, Michael passed away from a heroin overdose.46 GNS, unaware of his death, discharged Michael as a patient on December 14, 2014, because the urine sample “was abnormal which is indicative of Heroin metabolite.” 47 41 A326. 42 A326. 43 A326. 44 A87; A326. 45 A326. 46 A271; A327. 47 A50–51; A327. 10