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

Heading: Michael presents to GNS

Text: Two weeks later, on January 29, 2014, Michael presented to GNS, a medical practice located in Wilmington that specializes in pain treatment.18 GNS has three principals: Dr. Steven Grossinger, Dr. Grossinger (the Appellee), and Dr. Jason Brajer.19 Dr. Allen Silberman also works with GNS, and his name appears on GNS’s letterhead, but he is considered an “independent psychologist.” 20 Dr. Silberman performs psychosocial studies and evaluates pain status for GNS patients—a service he also provides to Dr. Lifrak. 21 When Michael presented to GNS, he signed a pain-management agreement, which provided that: (a) he would comply with “any random drug test” that GNS physicians felt was necessary, and (b) if he broke the agreement, GNS “will stop prescribing” pain-control medicines and “will discharge [him] from the practice.”22 naloxone-narcan-evzio; Suboxone, DRUGS.COM (Nov. 4, 2019), https://www.drugs.com/suboxone.html. 16 Suboxone, DRUGS.COM (Nov. 4, 2019), https://www.drugs.com/suboxone.html. 17 A270; A321. 18 A12; A157–158; A322. 19 A322. 20 A322 21 A322. 22 A170 (emphasis added); A324. 6 That same day, two doctors, Dr. Steven Grossinger and Dr. Silberman, evaluated him and produced written reports regarding their evaluation.23 Dr. Silberman’s report provided details about Michael’s recent care. Among other things, it noted that Michael “suffers an opiate addiction that started five years ago as the result of Oxycodone and Morphine prescriptions from his physician” and that Michael was treating with Dr. Lifrak, “who also manages his Suboxone[,] which is used for opiate dependence.”24 Dr. Steven Grossinger’s report took the form of a letter to Michael’s primary care doctor and described the results of Michael’s examination, which consisted of an MRI,25 an EMG,26 and nerve-conduction studies.27 In this report, Dr. Steven Grossinger noted that Michael had “not had treatment of his pain over the last year” but “had gotten Suboxone last month though it was not refilled.” 28 The report did not, however, mention why Michael was taking Suboxone.29 When questioned 23 A157–158 (emphasis added); A165–166 (emphasis added); A322. 24 A165. 25 MRI stands for “magnetic resonance imaging,” which “is a medical imaging technique that uses a magnetic field and computer-generated radio waves to create detailed images of the organs and tissues in [the] body.” MRI, Mayo Clinic, https://www.mayoclinic.org/testsprocedures/mri/about/pac-20384768 (last visited Dec. 3, 2019). 26 A326; A110. EMG stands for “electromyography,” which “is a diagnostic procedure to assess the health of muscles and the nerve cells that control them (motor neurons). EMG results can reveal nerve dysfunction, muscle dysfunction or problems with nerve-to-muscle signal transmission.” Electromyography (EMG), https://www.mayoclinic.org/testsprocedures/emg/about/pac-20393913 (last visited Dec. 3, 2019). 27 A22; A157. 28 A158; A324. 29 A15; A157–58. 7 about Michael’s Suboxone treatment, Dr. Steven Grossinger testified that he only found out about Michael’s heroin addiction a few days prior to testifying.30 Accordingly, the hearing officer found that Dr. Steven Grossinger “did not know why Michael was treating with Dr. Lifrak with Suboxone,” which strongly suggests that Dr. Steven Grossinger did not read Dr. Silberman’s report.31 Dr. Steven Grossinger also testified, and the hearing officer found, that he did not obtain Michael’s medical records from either Dr. Lifrak or Dr. Cary; therefore, he was ignorant of whether Michael had been compliant with Dr. Lifrak or Dr. Cary’s treatment.32 Nor did Dr. Steven Grossinger obtain Michael’s medical records from Michael’s primary care physician, Dr. Yezdani, who had referred Michael to GNS.33 Dr. Yezdani’s records indicated that he had been prescribing Alprazolam and Xanax for Michael—prescriptions that Dr. Steven Grossinger conceded he would consider in treating Michael due to the “potential ill effects of multiple medications.”34