Medical board disciplines physician for over-prescribing drugs

Sept. 27--The Medical Board of California found that a Tracy physician who manages a Turlock urgent care clinic was grossly negligent in over-prescribing pain medications and other drugs for patients.

Dr. Enrique Zarate was ordered to take training classes and comply with monitoring during a five-year probation period. The order, which took effect Thursday, prohibits Zarate from supervising physician assistants other than Monica Gleason, Paul Anderson and Kevin Bixel at the Turlock Express Lane Urgent Care Center, at Hawkeye and North Olive avenues.

Zarate also sees patients at a medical office on West Eaton Avenue in Tracy. The board action does not name the patients involved or say where the violations occurred. The physician did not return messages from The Modesto Bee. His Bay Area attorneys said they were unavailable until next week because of preparations for a case.

In its August 2013 accusation, the medical board charged that Zarate prescribed an excessive amount of drugs for a man who also was being treated by a psychiatrist in 2008.

Zarate refilled the man's prescriptions for two antidepressant drugs, which had been prescribed by the psychiatrist, and also wrote prescriptions for a narcotic and muscle relaxant.

The physician provided 240 tablets of alprazolam, an addictive drug for treating anxiety, before the patient traveled outside California in August 2008. A month later, Zarate sent prescriptions to an out-of-state pharmacy for 240 more tablets of the same drug -- commonly known by the brand name Xanax -- plus other medications.

The patient also obtained pain medication and the muscle relaxant from Zarate in October 2008. An hour after getting the drugs, the patient was in an auto accident and appeared intoxicated at the scene, the accusation said. Tests showed he had marijuana, a psychoactive drug and opiates in his system.

The man's sister, who was dating Zarate, told the doctor not to furnish her brother with any more narcotics because of his drug problem.

Investigators found Zarate failed to consider the patient's substance abuse and psychiatric history and did not communicate with the patient's cardiologist and other specialists. Zarate admitted to the board he should not have written the prescriptions.

Even though the man stopped being his patient in late 2008, Zarate provided more drugs for him in 2010 and 2011. The sister found her brother unconscious in her home April 7, 2011, with a bottle of alprazolam prescribed by Zarate nearby. The man was hospitalized for a drug overdose and suffered permanent brain and kidney damage, the accusation said.

Zarate also prescribed excessive amounts of hydrocodone and a muscle relaxant to a 38-year-old woman in 2008 and 2009 without a clear diagnosis of her health condition. The board faulted Zarate for an extreme departure from care standards for prescribing pain medication without a treatment objective. From August 2008 through June 2009, Zarate prescribed 2,740 hydrocodone tablets for the woman, while other doctors provided almost 300 tablets of the painkiller, plus morphine, zolpidem and methadone.

Investigators found that Zarate checked a box on an insurance form, recognizing concerns about patients' use of controlled substances. The form claimed that measures had been taken to address those concerns.

According to the board, Zarate over-prescribed drugs for a third patient and poorly managed care for a woman with extremely high blood pressure.

Investigators with the state Department of Consumer Affairs looked into the complaint filed with the medical board. Zarate was allowed to contest the allegations and agreed to a settlement and terms of the disciplinary action May 30. The decision was released in a notification of board actions Thursday.

Board spokeswoman Cassandra Hockenson said she could not comment on why Zarate may continue his practices, other than saying the board tries to settle allegations without going to trial. "The probationary terms are strict and there is going to be monitoring," Hockenson said. "The moment there is any type of violation, the story is going to change. This is someone who will be monitored very closely."

Zarate agreed to take courses on prescribing practices, record keeping and clinical education. He earned his medical degree from the National Autonomous University of Mexico in 1968 and was first licensed to practice medicine in California in 1984.

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