Jailed doctor gets 2nd chance
A physician — who spent three months in federal prison last year for her part in a scheme with her husband to defraud Connecticut’s state employee prescription plan out of $877,882 — has been reprimanded by the Connecticut Medical Examining Board but will be allowed to resume practicing medicine.
Dr. Kakra Gyambibi, 39, did the time last summer and fall after pleading guilty in January 2019 to one count of conspiring to commit health care fraud in 2014 and 2015. She told prosecutors that, at her husband’s request, she prescribed expensive compound medicine skin creams — produced by a Mississippibased pharmacy — for patients she never saw or examined.
Paralleling the feds’ criminal action, the state Department of Public Health filed administrative charges in December
2018 that potentially could have revoked the Fairfield County resident’s credentials to practice medicine in Connecticut. But on April 21, the medical examining board concluded that case by voting to reprimand her, while letting her keep her state license as a physician and surgeon.
She will be on probation for two years, under the supervision of a physician approved by the health department and retained “at her own expense,” medical board Chairperson Kathryn Emmett said in an eight-page decision approved by 14 board members during a telephone conference meeting April 21. No one voted against it, and one member abstained because of a former work affiliation with Gyambibi.
The health department didn’t object.
The decision, effective Friday, listed several reasons for not taking harsher action, including:
■ Testimony at a two-day hearing in December, conducted by a panel of three board members, showed that Gyambibi “cooperated fully” with a state attorney general’s office investigation that preceded the federal probe that sent her to prison.
■ Gyambibi “has expressed sincere remorse for her actions … and completed numerous courses, including a course in Medical Ethics and Professionalism that included lessons in prescribing medications and maintaining medical records.”
■ “Her competency and character is supported by numerous letters from friends and colleagues in the medical field.”
“Based on the foregoing, the Board finds that [Gyambibi] is
capable of safely, effectively, honestly, and ethically practicing medicine under the terms of this Order, and … does not present a danger to the public in the practice of medicine,” the decision reads.
Requests from husband
A recurring theme in the character references cited by the board was the finding by federal prosecutors that although Gyambibi broke the law, it was at the instigation of her husband, Kwasi Gyambibi.
“It is important to note that, although a conscientious physician, when Kakra married in the African tradition, she also became an acquiescent, obedient and dutiful wife as expected of her culture. Kakra was a hardworking, respected physician, and a new mother with an infant and a preschool child at the time she was pressured to participate in the pharmaceutical cream business by her husband,” wrote James and Giesele Greene of Cleveland Heights, Ohio, a dentist and physician who said they’ve known her since she was a child in Cleveland.
“Despite misgivings and verbalized objection to the contrary, at a very vulnerable time in her life, Kakra obeyed her husband as her upbringing had taught her,” the Greenes wrote in
March 2019 to U.S. District Judge Jeffrey Meyer, before he sentenced Gyambibi. Their letter became one of several that the doctor’s Hartford-based attorney, Mary Alice Moore Leonhardt, used to fight the health department’s administrative charges.
Kwasi Gyambibi was sentenced in February to 12 months in federal prison as the result of his conviction by a trial jury on two counts of health care fraud. He was supposed to start serving his time on March 20 but, because of coronavirus problems in prisons, for now he’s been granted an additional 60 days before going in, court records show.
The Gyambibis’ cases have prolonged a story that dates to 2015, when state Comptroller Kevin Lembo reported a nearly 3,000% increase in costs to the state employees’ prescription benefits plan for very expensive pharmaceutical mixtures known as compound medications.
Produced by Mississippibased Advantage Pharmacy
LLC, and other such big compounding pharmacies in Southern states, the medications were mostly creams for pain and skin conditions such as stretch marks and scarring. And they weren’t approved by the U.S. Food and Drug Administration.
Lembo, who oversees the prescription benefits plan for state employees, retirees and their families, noticed costs for the compound medicines rose from $800,000 in 2012 to $24 million in 2015 when the plan was flooded with prescriptions for the creams.
Some of the creams cost more than $10,000 for a one-month supply, even though Lembo has said they’re often “essentially just combinations of affordable over-the-counter drugs like ibuprofen and Pepcid AC or Aleve and Nexium.”
The cost explosion became a national phenomenon, as other state and federal drug programs were hit hard, including TRICARE, which serves U.S. military members and their families.
The state has since adopted new prescription-approval procedures to contain costs — but that wasn’t the situation in 2014 and 2015, when Kwasi Gyambibi was a state employee at UConn’s Stamford campus, working as a coordinator in a program assisting low-income students.
He became a part-time sales representative for Advantage Pharmacy, and approached his campus coworkers to try prescriptions for the medicines that Kakra Gyambibi would sign without examining them, prosecutors said.
Blank prescriptions
Back then, Kakra Gyambibi was employed as a physician by a group that provided “hospitalist services” for hospital patients in Stamford. She admitted that she sometimes signed “blank prescriptions that did not contain the name of a patient or indicate a particular medication to be prescribed,” according to a federal “stipulation of offense” document she signed.
“The defendant felt uncomfortable signing prescriptions for patients she had not treated or examined, and expressed her concerns to Kwasi Gyambibi,” the document said. “Despite these concerns, at Kwasi Gyambibi’s request, the defendant continued to sign prescriptions for patients she had not treated or examined.”
All told, the Connecticut State Employee Pharmacy Benefit Plan was victimized for $877,882, more than half of the total $1.65 million lost in the scheme by government health programs that also included TRICARE, prosecutors said.
Each of the Gyambibis has been ordered by Meyer to pay about $825,000 in restitution over time to the federal court. That means each would pay half of the $1.65 million lost by the government health programs. Medical board members said April 21 that the federal restitution order is such a severe financial penalty that it was unnecessary for them to fine Kakra Gyambibi.
Kakra Gyambibi’s three-month sentence last year was far below federal guidelines. Meyer said he did not want to remove her from the lives of the couple’s two young children for too long — adding that she acted at her husband’s behest, and there was no evidence she personally profited from the scheme.
The board’s April 21 decision said the doctor “testified that at the time she signed the prescription forms, she was unaware of any scheme or fraud that other individuals involved intended to engage in regarding the State of Connecticut or any other health care payer source,” the decision said, adding: “The Board finds
this testimony … to be credible.”
Didn’t meet standards
The board said the doctor had admitted to the health department’s charges that she had not met professional standards for prescribing medications in “one or more” cases because she had failed to: “adequately establish a doctor-patient relationship,” “obtain an adequate medical history,” “perform an adequate physical examination,” “make an adequate medical diagnosis,” “create an adequate treatment plan” or “adequately monitor the patient for safety and efficacy of the prescribed medication.”
But the board also found that the department didn’t prove one of its charges — that “the cream did not actually treat keloid scars and/or stretch marks, and/or that she prescribed such compounding cream without a reasonable medical or scientific basis for doing so.”
Kakra Gyambibi “testified that before she wrote the prescriptions, she researched the components in the compound through UpToDate, a medical search engine, and recalls a few small studies that showed the effectiveness [of ] … some of the components used in the cream,” according to the board’s decision. “She also testified that her husband tried the cream on his own stretch marks, and it was effective.”
Under the terms of her probation, the board said that the physician retained to supervise Kakra Gyambibi will “conduct a quarterly random review” of 10% of her patients’ records, or 10 patients, whichever is less. She must meet with the doctor at least once every three months during the two years of probation.
Kakra Gyambibi will be “responsible for providing written supervisor reports directly to the [state health department] quarterly” and the reports will include when and how long she and the supervisor met, as well as the “number and general description of the patient records and patient medication orders and prescriptions reviewed … [and a] statement regarding whether [Gyambibi] is practicing with reasonable skill and safety,” according to the medical board’s decision.
She also must complete 10 credits of continuing medical education courses “in Ethics, Professionalism and Prescription Practices.”
Moore Leonhardt, Kakra Gyambibi’s attorney, said her client has not practiced medicine with patients since January 2016. This has been voluntary, and she never surrendered her license, Moore Leonhardt said.
“Dr. Gyambibi is extremely appreciative of the decision,” Moore Leonhardt said. “She’s passionate about her medical career and taking care of patients,” and the board “recognized that she is a good quality doctor” worthy of “an opportunity to get back on track with her professional career. … She assumes full responsibility for her actions.”
She said her client “also recognizes that it’s going to be difficult to find a position,” but has “already offered to work as a volunteer with a group that’s treating persons suffering from COVID-19 virus,” and to volunteer “helping people suffering from opioid addiction” as well as helping “inmates who are being brought back into the community setting.”
“This would be done as part of her community service that’s required under her probationary orders from the court,” Moore Leonhardt said. “But … she’d like to get back to work in a paid job so she can start paying the restitution ordered by the court.”
Moore Leonhardt said her client still faces a three-year-old civil lawsuit filed by the state attorney general’s office, seeking financial damages, and “we’re in the process of talking to the state to see if we can negotiate a resolution” that would avoid a trial.