By Cheryl Clark

In addition to publicly calling out 64 physicians for overprescribing dangerous drugs, the California's Death Certificate Project has now threatened the licenses of four nurse practitioners for negligence after an investigation linked their prescribing to patients' fatal overdoses.

One of the accused, Sharon Anne Whittemore of San Bruno, was prompted to surrender her license after the board found she was grossly negligent and incompetent in her prescribing. In particular, she prescribed large quantities of oxycodone to a patient who was found dead in his home from an overdose one day after he filled her prescription.

The 50-year-old male, named "KP" in the California Board of Registered Nursing's accusation, had been admitted for spinal fusion therapy to the University of California San Francisco's Spine Clinic, where Whittemore worked. At discharge on May 11, 2012, he was given prescriptions for 200 oxycodone/acetaminophen tablets for pain and an undetermined amount of clonazepam for anxiety. On June 13, a few days before KP's scheduled follow-up appointment, he called and spoke to Whittemore, who wrote him another prescription for 360 oxycodone/acetaminophen tablets, an amount the board called an "excessive amount of oxycodone."

KP filled the prescription on June 16 and overdosed the next day. "A toxicology report showed that he had overdose levels of oxycodone and other drugs in his blood," the nursing board's decision and order stated.

Three other accusations are pending a decision, which could range from public reprimand to probation or surrender. They were filed against Linda Marie Scroggy, a.k.a. Linda Marie Ettensohn, of Turlock; Nalinee Pimphan of Fresno; and Sharon A. Hunter of Mendocino.

Scroggy, who worked at St. Mary's Urgent Care in Stockton, had prescribed numerous dangerous drugs to a patient two months before the latter's death in April 2013. That death was attributed to an accidental overdose of clonazepam, diphenhydramine, hydroxyzine, methadone, and naloxone. Scroggy's prescription for clonazepam, 270 2-mg tablets, "highly exceeds the recommended therapeutic dosing," according to the board's accusation.

Board documents also allege that Scroggy prescribed temazepam and other drugs to herself against recommended guidelines, overprescribed unsafe combinations of medications to patients, failed to keep the board updated on her contact information, incorrectly advertised herself as a pain management practitioner, and appeared at times "wobbly" and "drugged" and "arrived to work under the influence."

She is said by the board's accusation to have "sold fake recommendation letters" for friends with the practice office manager, and that she "prescribed medications to her friends and boyfriend," constituting gross negligence, incompetence, and unprofessional conduct.

Under the supervision of a Fresno physician, Pimphan prescribed the narcotic hydrocodone on numerous occasions in 2012 for a psychiatric patient under her care, but failed to conduct and document an adequate assessment justifying the prescription. The accusation said her activity constituted unprofessional conduct.

Hunter, who worked at the North Coast Family Health Center in Fort Bragg, is accused of overprescribing lorazepam to a 70-year-old patient with a history of pain, narcotic dependence, and alcohol abuse, among other medical issues.

The patient's death in January 2013 was attributed to acute toxicity from fentanyl, a drug Hunter had also prescribed. Hunter had also prescribed morphine sulfate, oxycodone/acetaminophen, and alprazolam in the six months prior to the patient's death.

At one point, the patient's lab results indicated levels of fentanyl more than seven times greater than therapeutic levels, but Hunter "did not make any notation that she reviewed these lab results," and subsequently "refilled the increased dosage of fentanyl."

Hunter "continued to prescribe opioid and controlled substances without consultation from a physician, referral to a pain-management specialist, or substance abuse treatment facility for alcohol and prescription drug abuse," the board document states.

Launched in 2015 by the Medical Board of California, which licenses and disciplines 140,000 medical doctors, the Death Certificate Project utilizes death certificates that have lab confirmation that a death was caused by a drug overdose, and then links those drugs back to any doctor who prescribed controlled substances to that patient up to three years before their death.

More than 2,000 such fatal overdoses in 2012 and 2013 were earmarked for expert scrutiny, and prompted board investigations that were launched for more than 500. Elimination of duplicates and doctors who were surrendered or deceased brought the number of investigations down to 469.

When the prescription database showed the prescribers to be nurse practitioners, physician assistants, or osteopathic physicians, who are licensed by other agencies, those cases were turned over to those agencies. The California Board of Registered Nursing oversees licenses of about 23,000 nurse practitioners in California who are authorized to prescribe drugs with physician oversight.

Physicians and nurse practitioners are not the only healthcare professionals under investigation in California for involvement in patients' overdoses. The Osteopathic Medical Board of California is investigating two cases but has not yet filed any accusations. The Medical Board of California has also overseen investigations of 31 physician assistants; all but one of those cases are now closed.