Patients suffer with loss of pain doctor
Physician’s exit leaves many with no easy alternative.
CLEVELAND — In late October, Beachwood pain management doctor Jerome Yokiel checked himself into Glenbeigh treatment center in Ashtabula County for abuse of alcohol and sedatives. For his many patients taking opioid medications for chronic pain, they say there was little to no warning and no smooth transition plan.
Losing a trusted doctor can be difficult for any patient. But it is a particularly nightmarish scenario for those with chronic pain who rely on limited supplies of heavily scrutinized opioid medications for relief, face agonizing withdrawal when they run out, and must find new doctors in a climate that has become markedly anti-opioid.
More than a dozen of Yokiel’s patients who spoke with The Plain Dealer said they weren’t told for weeks what was happening. They say they feel “blacklisted” by many area doctors, who don’t want to treat Yokiel’s patients, many of whom have complex medical issues. Many patients are still fighting for full access to their years of medical records and have considered a lawsuit over their treatment.
Shock, anger over doctor’s drug use
Of the hundreds of chronic pain patients being treated at Yokiel’s Beachwood pain center when it shut down in October, John Tramsak probably should have been the least surprised by his doctor’s sudden departure from practice.
Tramsak, 61, of Bedford, has for decades seen pain management specialists for back pain caused by bulging and herniated disks, as well as nerve damage in his legs, that has left him disabled. He’d found some relief with a daily combination of opioid pain medication and periodic steroid injections.
But one by one, his pain management doctors have disappeared, usually with little warning. His first, Dr. Syed Jawad Akhtar-Zaidi, a neurophysiology and pain medicine specialist in Solon, lost his license to prescribe controlled substances in 2013 after he provided pain medication prescriptions without justification on 32 occasions to U.S. Drug Enforcement Agency (DEA) agents posing as patients. Zaidi, who fled to Pakistan soon after he was charged, remains a fugitive.
Dr. Mark Allen, an anesthesiologist who treated Tramsak and for a time was Yokiel’s partner, had his medical certificate suspended and subsequently reinstated three times from 2004 to 2017 due to his admitted abuse of alcohol and cocaine and a sexual relationship with a patient.
Yokiel’s sudden departure in October was precipitated by hospital staff at Cleveland Clinic Union Hospital in Tuscarawas County discovering the unusual presence of a used vial of the powerful sedative Propofol and multiple syringes in a procedure room the doctor had used, according to state medical and pharmacy board records. Yokiel admitted his drug abuse and checked himself into Glenbeigh a week later, on Oct. 22.
About 10 percent to 12 percent of doctors will develop a substance use disorder during their careers, a rate similar to or exceeding that of the general population, according to national research on the topic. Anesthesiologists and some other types of physicians, including emergency doctors, have been found to be overrepresented among those with addiction.
Patients knew nothing of the reason for Yokiel’s absence until weeks after his entry into treatment, they say, when records of the doctor’s interactions with state regulatory agencies became public. Many patients defended Yokiel and praised his bedside manner. Before they knew otherwise, many believed he had been unfairly targeted by the DEA.
“That guy seemed so professional,” Tramsak said. “If you needed to go out of town and you needed your pills early, it was hard to get them. They were strict. I didn’t think he was screwing around.”
“I thought he was a great doctor,” said Larry Harbert, 59, who was being treated for multiple back and leg issues after a serious car accident in his teens. “He cared about the patients. He documented everything...He wasn’t just writing prescriptions to random people.”
Harbert, of Sagamore Hills, learned of Yokiel’s departure when he called about a late October appointment and a nurse told him that Yokiel had a “medical emergency.” When he arrived for an Oct. 31 appointment, one during which he says he would have received medication refills for his opioid prescriptions, office staff had locked the doors and wouldn’t let anyone in because so many patients had been showing up demanding information, Harbert said.
A letter notifying patients of Yokiel’s departure, a requirement under Ohio law, arrived for most patients in early to mid-November. The law says that most doctors leaving practice must notify patients at least 30 days before the last date a patient will be seen. However, extensions up to 30 days after a doctor stops practicing are allowed for emergency circumstances, according to the law.
When pharmacy board representatives interviewed Yokiel at his home before he entered treatment, he had “glassy eyes and intermittent slurred speech,” according to records, and admitted to taking Propofol from the Clinic’s Union Hospital and his Beachwood center’s affiliated surgical offices for a year. He also in interviews with the pharmacy and medical boards said that he had used the potent painkiller Fentanyl “approximately five times,” used marijuana and took Ambien while drinking alcohol.
Yokiel first told pharmacy board representatives during the interview that he “would never” abuse drugs prior to performing procedures on patients, but later said he would “wait several hours before treating a patient after his personal drug use,” records state.
Yokiel’s medical certification was suspended indefinitely after he checked in for addiction treatment but has since been reinstated subject to probationary terms. He has not returned to practice and was terminated from employment at Northeast Ohio Surgery Center in Beachwood, where he performed treatments such as pain blocks and epidural steroid injections.
The majority of Ohio doctors subject to state medical board disciplinary action due to drug or alcohol abuse have their licenses reinstated after successfully completing probation, and only a very small percentage relapse during probation, according to the board. Last year, about 28 percent of board disciplinary actions were for impairment.
The Centers for Comprehensive Pain Care voluntarily surrendered its license to distribute dangerous drugs to the State of Ohio Board of Pharmacy on Oct. 20.
Release of medical records delayed, incomplete
One of the most frustrating pieces of fallout from Yokiel’s sudden departure, his patients say, has been trying to get copies of their medical records. They need these to document their illnesses, and to justify the pain medications they are taking when they find new doctors.
It took months for many of Yokiel’s patients to retrieve any part of their records. When they were successful, many only received notes from their most recent two patient visits.
When Tramsak complained, he said he was told by staff at Yokiel’s office that he’d have to appeal to the state medical board to gain access to his seven years of records. Attempts to reach office staff were unsuccessful; the office phone now plays a recorded message.
The medical board has no authority over medical records, says spokeswoman Tessie Pollock. Ohio law requires not just doctors, but all health care providers including dentists, nurses, optometrists, pharmacists, occupational therapists and others, to provide a complete copy of a patient’s medical records upon their request. A record can be denied only if the doctor believes the information in a file may endanger a patient’s life, and in Ohio it may then be released to another doctor.
The law allows 30 days for most health care providers to fulfill requests for records, and they can charge a fee ($2.74 for each of the first 10 pages, 57 cents for pages 11 through 50 and 23 cents for each page higher than 51) which can be substantial depending on the size of the file (about $75 for a 100-page file, for example).
Many of Yokiel’s patients say they have been asking the doctor’s former office staff for their files for eight months and would happily pay a fee to have their records.
An added stigma
The revelations about Yokiel’s drug abuse have been particularly galling to many of Yokiel’s patients as they have struggled to find other doctors to take on their care. Many feel their association with Yokiel is an added and unwarranted stigma they carry within an already hostile treatment environment for chronic pain patients.
“I went to see two doctors, and they refused to see his patients,” said a 55-yearold Willowick patient, who saw Yokiel for 20 years and asked to remain anonymous because she still hasn’t found a new doctor to treat her fibromyalgia, degenerative joint disease and arthritis. “They were under the impression that he was caught by the DEA.”
Many patients said they fear they’ve been “blacklisted” because doctors think that Yokiel inappropriately prescribed to them. There is no indication of this in medical or pharmacy board records.
Yokiel was ranked second of 88 Ohio pain doctors, however, in both the number of opioid prescriptions written in 2015 for Medicare patients and the total claims cost for these medications, according to data from ProPublica’s Prescriber Checkup. In 2016, the doctor wrote 6,024 prescriptions for opioids, including refills, which accounted for 73 percent of his overall Medicare prescriptions, according to data from the Centers for Medicare and Medicaid Services (CMS).
When Tramsak shared the trouble he was having finding a new doctor, he said that a nurse at a pain management clinic told him not to mention Yokiel’s name when trying to book an appointment.
“It does seem that when I mention his name, things change,” Tramsak said.
The Cleveland Clinic and University Hospitals said their pain specialists do not discriminate based on a patient’s former doctor. In an emailed statement, UH said that “many of the patients in question have been seen and continue to be seen by UH pain medicine specialists.”
A Clinic spokeswoman said the hospital system doesn’t know if Yokiel’s patients are being seen by its physicians because that information is private, but “to the extent any of (Yokiel’s) former patients came to our facilities, we would take care of them in the same manner any patient coming to us would receive.”
Harbert, who suffered withdrawal from morphine and oxycodone after Yokiel left and still has not found a doctor to care for him after calling about 60 area specialists, said he tried unsuccessfully to find a lawyer to sue Yokiel for malpractice. He believes there are grounds for a suit because Yokiel’s sudden departure left him and other patients with no alternatives but withdrawal from their medications, he says.
“The whole thing was wrong,” Harbert said. “It was totally wrong the way it was handled. Nobody should be forced to go through withdrawals. [Withdrawal] was horrible. Every bone in your body hurts. Every joint in your body hurts. My teeth hurt.”
Several of Yokiel’s patients who use, or had used marijuana to control their pain said they were disgusted to learn of the doctor’s admitted use of the drug. Required to sign opiate use contracts that prohibit the use of cannabis as a condition of treatment, a practice common in pain management, some were chastised or forced off pain medications when they tested positive for cannabis.
Yokiel told the state medical board he used the drugs to control back pain and to help with sleeplessness brought on by that pain, records state.
The majority of Ohio doctors subject to state medical board disciplinary action due to drug or alcohol abuse have their licenses reinstated after successfully completing probation, and only a very small percentage relapse during probation, according to the board.