What part of "no” doesn't psychiatrist Raymond Deicken understand?

January 25, 2012

On January 5, 2012, the Medical Board of California revoked the license of geriatric psychiatrist Raymond Deicken. However, the Board set aside the revocation, suspending him instead for 60 days. He was additionally placed on probation for five years with terms and conditions. This was the result of a stipulated decision which Deicken entered into with the Board to settle charges against him which included failure to maintain adequate and accurate patient records and numerous counts of dishonesty, gross negligence and incompetence.

The Board’s Accusation details Deicken’s treatment of four patients at the San Francisco Veterans Affairs Medical Center, primarily for pain symptoms. In each case, Deicken privately prescribed to the patients and kept personal records of their treatment. This secret treatment was not made known to any of the patients’ other health care providers.

Deicken, who at one time was a professor of psychiatry at University of California, San Francisco,  began working as a psychiatrist at the San Francisco VA in 1991. In October 2005, a committee at the hospital determined that he was inappropriately prescribing opiate drugs—these are drugs classified by the U.S. government to be dangerous and highly addictive—and Deicken agreed to no longer prescribe them to patients of the VA.

However, just a month later, Deicken visited a VA patient, identified in the Board’s documents by the initials “T.C.”, at her home. T.C. suffered with numerous complaints including back and abdominal pain, migraine headaches, fibromyalgia and depression and anxiety due to failed treatment of Hepatitus. T.C. reported to Deicken that the pain control treatments she was receiving from another VA physician were not satisfactory. In response, Deicken prescribed T.C. the highly addictive painkiller OxyContin, as well as another painkiller. He agreed to her T.C. at her home; agreed not to discuss his treatment of T.C. with opiate painkillers with any of her other physicians at the San Francisco VA and agreed not to document his opiate prescriptions in T.C.’s VA patient records or consult with any of her other health care providers.

Plainly speaking, this is bad medicine. A doctor who privately attends to a patient and does not make his treatments known to the patient’s other health care providers puts both the patient and the other health care providers at risk. For instance, T.C.’s primary care physician, unaware of Deicken and his opiate prescriptions, might have prescribed something which proved fatal if combined with opiates or might have attempted to treat side effects of opiate intoxication without knowing what the cause of the side effects was.

In December 2005 and January 2006, Deicken increased the dosages of the two painkillers on T.C.’s complaints of continuing pain. By April 2006, T.C. was suffering from lethargy, fatigue and cognitive dulling from the opiates. To counter this, Deicken prescribed her the stimulant drug Adderall, which is also classified as a dangerous and highly addictive drug.

In other words, Deicken prescribed an extremely habit-forming drug to combat the side effects of other habit-forming drugs he’d prescribed her.

In May 2006, he began see T.C. at the VA’s outpatient psychiatric services for depression and anxiety and lied in her medical records, stating that she was being treated for pain at another clinic, when the truth was that he was treating her for pain in secret.

The Board’s document contains similar secret treatment scenarios involving three other patients and habit forming drugs.

Should Deicken violate any of the terms of his medical board probation, the Board will have the right to revoke probation and carry out the revocation of his license.