Williamsburg doctor sanctioned for prescribing too many painkillers

A former Williamsburg physician, who moved back to Michigan two months ago, is no longer allowed to practice medicine in Kentucky unless he complies with the terms of an agreed order with the Kentucky Board of Medical Licensure, which was issued on July 19.

Investigators contend that Dr. Louis E. Wulfekuhler wrote prescriptions for controlled substances departing from "acceptable and prevailing medical practices" that endangered the public and placed them in imminent danger.

Wulfekuhler worked at Ho Physician Services in Williamsburg from Nov. 1, 2011, through May 30, 2012, when he resigned and moved back to Michigan, where he is also licensed to practice medicine, according to the agreed order.

The agreed order was issued in lieu of an emergency order of suspension and complaint against Wulfekuhler’s license, the order states.

The order calls for Wulfekuhler not to practice medicine in Kentucky unless the licensure board approves the practice location in writing ahead of time, and would require him to undergo periodic consultant reviews at intervals to be determined by the board if he wishes to return to Kentucky to practice medicine.

The board would consider no request until Wulfekuhler obtains a dual clinical skills assessment in the specialties of internal medicine and pain management 18 months prior to making a request for a practice location in Kentucky, the order states.
He would also have to complete the "Prescribing Controlled Drugs" course at "The Center for Professional Health," and pay a $5,000 fine.

Within six months, he is required to reimburse the board $900 to cover the cost of the investigation.

Complaint made

Williamsburg Police Chief Wayne Bird contacted the licensure board in January reporting that several of Wulfekuhler’s patients had suffered overdoses in the Whitley County area, including the 13-year-old daughter of two of his patients, the order stated.
Several concerned citizens also complained to the police department about his practice and several area pharmacies complained to Bird about the high number of controlled substance prescriptions written by the licensee, the order noted.

On Feb. 6, Stephen Johnson, a pharmacist consultant for the drug enforcement and professional practices branch of the Cabinet for Family Services, reviewed and analyzed the Wulfekuhler’s KASPER records from July 1, 2011 until Feb. 4, 2012, and noted several concerns based upon the age of the patients, the use of addictive drug combinations and similar last names among patients.

The Kentucky All Schedule Prescription Electronic Reporting (KASPER) system is the state’s prescription drug monitoring system.

Johnson identified several patients with prescribing patterns reflective of these concerns and recommended further investigation by the board, according to the order.

A board consultant reviewed 19 of his patient charts and found Wulfekuhler had departed from or failed to conform to acceptable and prevailing medical practices, such as using KASPER reports on initial visits to determine whether the patient should receive opioid medications.

"This leaves him open to patients who are doctor shopping and who have already obtained opioid prescriptions from other physicians. Secondly, this physician does not routinely use urine drug screens," the consultant stated.

The consultant also contends that Wulfekuhler stated he did not need to do this, which is a contention that his attorney disputes in a response to the consultant report.

The consultant also states that he believed Wulfekuhler failed to use spinal imaging prior to prescribing opioid medications to determine if the drugs were medically necessary.

Failure to utilize KASPER, urine drug screenings or spinal imaging to establish medical necessity departed from the standards of acceptable and prevailing medical practice in Kentucky, the consultant wrote.

"I feel that this physician demonstrates gross ignorance of how to treat patients with chronic pain and opioid medications," the consultant wrote. "This physician needs to understand that he is in a hot bed of prescription narcotic abuse, and not to use all of the tools at his disposal to check fraud and abuse represents ignorance, and subsequently, gross negligence in prescribing practices."

Wulfekuhler’s response

Wulfekuhler’s attorney, Robert W. Iwrey, wrote a response to the board dated June 29, 2012, that prior to coming to Kentucky, the majority of Wulfekuhler’s career was spent as an oncologist.

"As such, he did not face patients feigning pain for the purpose of obtaining narcotics under false pretenses. Rather, he primarily saw patients with various forms of cancer who he occasionally prescribed narcotics to address the associated pain," Iwrey wrote.

When Wulfekuhler took the position in Williamsburg, he expected to see patients with a wide range of complaints but after a few months he discovered that the majority of patients scheduled were for pain treatment, Iwrey wrote.

"He was not prepared for the volume and magnitude of drug seeking patients that he actually encountered," Iwrey contended.
Wulfekuhler was under the impression that the office staff would utilize KASPER to screen and filter patients until he received his own access to KASPER, which he applied for on Nov. 10, 2010, his response stated.

"During the first month at this position, Dr. Wulfekuhler was unaware that the office staff had not been screening and filtering patients as he was led to believe. Rather, Dr. Wulfekuhler found out only after the fact that patients who had previously been discharged for drug seeking or deceitful behaviors were allowed back in by order of the practice owner/manager, Ana Moreno," Iwrey wrote.

"Patients, who had not been to the clinic for years were allowed in and presented to Dr. Wulfekuhler as ‘established’ patients. Walk-ins outnumbered scheduled appointments by three to one."

Iwrey contends that after Wulfekuhler became aware of drug seeking behavior by patients, he insisted that KASPER be used on every new patient and any patient that he deemed "suspicious."

"However, Dr. Wulfekuhler’s efforts to limit new patients and discharge those who were deceptive were met with resistance from management," Iwrey wrote in the response.

Wulfekuhler resigned his position in early April 2012 but stayed on until May 30, 2012 in order to provide patient care continuity and to allow transition to a new provider.

Iwrey pointed out in the response that investigators found that the quantity of opioids prescribed were not excessive nor was there over billing or inaccurate statements or documentation.

"Even though he is no longer practicing in Whitley County, Dr. Wulfekuhler now recognizes the nature and magnitude of the drug problem in Whitley County and in the last several months of practicing there took numerous measures to guard against drug seeking behavior," Iwrey wrote.

"When he started his position in a new state, new area of the country and new culture, he was neither prepared for a poorly managed and possibly deceitful practice, nor for deception and manipulation by patients. In his prior 20 years of medical practice, he had no reason to distrust patients."

Wulfekuhler graduated from the Tulane University School of Medicine in New Orleans in 1989 with a specialty in internal medicine. He received his license to practice medicine in Kentucky on Sept. 15, 2011.

Past Michigan woes

When asked if Wulfekuhler’s response prompted any investigation into Ho Physician Services or its owners, Leanne Diakov, an assistant counsel with the Kentucky Medical Licensure Board, noted "We only have jurisdiction over licensed physicians. Chiropractors do not fall within our jurisdiction."

Diakov said she doesn’t know whether Kentucky’s agreed order regarding Wulfekuhler’s license would impact his Michigan medical license.

According to the Michigan Department of Licensing and Regulatory Affairs website, Wulfekuhler’s medical license was suspended on Sept. 7, 2006, and reinstated with sanction on Dec. 13, 2007. The website also indicated that on Dec. 14, 2010,

Wulfekuhler was in compliance and that his Michigan medical license expires on Jan. 31, 2014.
According to the Michigan Board of Medicine meeting minutes dated Nov. 14, 2007, the board voted to grant Wulfekuhler’s license reinstatement after he underwent an evaluation at his own expense by a Health Professional Recovery Program (HPRP) approved psychiatrist and that he be monitored for cognitive behavioral therapy and enter into a monitoring agreement.

He was then to be placed on probation for a three-year period with the following conditions, including: monitoring by a board-approved psychiatrist for cognitive behavioral therapy and any other treatment recommended by his evaluator; submitting quarterly psychiatrist reports; monitoring of his treatment of female patients by a board-approved work site monitor, who would provide quarterly reports on his practice and treatment of female patients; and completion of one course of continuing medical education in ethics and boundaries that wouldn’t count towards his license renewal.

The minutes called for Wulfekuhler to submit a letter from a board-approved addictionologist psychiatrist affirming his satisfactory completion of treatment and confirming that he no longer required monitoring and could be discharged from probation.

A message left on a recorder at Ho Physician’s Services Tuesday afternoon was not returned by press time.