[M]ORRISVILLE — Caitlin Salem, a 31-year-old mother in recovery from opiate addiction, got a nasty surprise when she went to see her substance abuse counselor last week.
The counselor informed her that Dr. Paul Bertocci, who has treated her addiction for close to two years, surrendered his medical license following what appears to be an investigation by the Board of Medical Practice.
As a result, Salem was not able to get her buprenorphine that day. She was told Treatment Associates, Inc., where she is a patient, was working to find a solution. It was Wednesday. Salem spent the next day and a half experiencing the early stages of withdrawal before Dr. Fred Rossman, another doctor at the clinic, took her on as a patient.
Treatment Associates did not respond to a request for comment, but sources with knowledge of the situation say it’s temporary fix, and Bertocci’s roughly 70 opiate dependent patients will ultimately have to find a new provider.
Dr. Deborah Richter, a primary care and addiction medicine doctor with Family Practice Associates in the Cambridge, has already agreed to take on approximately a third of them.
“I’ve inherited 25 people because they were left hanging suddenly,” Richter said, “This fell in my lap and the patients are very upset.”
Richter was not able to say what forced Bertocci to surrender his license, but she defended his record in medicine.
“I’ve worked with this man for 10 years in primary care and subsequently in addiction medicine, and I can say without reservation that he is a competent, caring, wonderful physician,” Richter said.
Bertocci, 73, has been in practice for 47 years. Reached by phone on Friday, he declined comment.
Many of Bertocci’s patients whom Richter has seen in the last week have told her that he saved their lives, she said. Salem also had high praise for her former doctor.
“Dr. Bertocci helped me become a mom. When you’re using you’re not anything. Now I feel like I’m officially a parent,” Salem said.
Salem said that Bertocci is one of the few doctor’s in Vermont who is known to take patients with co-occurring mental health and addiction issues. Many doctor’s pass on such patients because treating them can be difficult.
When Salem hit a rough patch, stopped taking her buprenorphine and sank into a depression, Bertocci helped pull her out of what could have turned into a relapse, she said.
“He took me back, and he said the first thing we need to do is get your mental health on track,” Salem said.
Changing providers disrupts the already fragile lives of people in recovery, Richter said. Salem agrees. “It just interferes with everything. You have to build a new relationship with a doctor. It’s really hard to open up,” she said.
Making the trip to Morrisville once a week was already hard for Salem, who lives in Huntington and has had car trouble recently. Now it’s unclear where she’s going to be a patient for the long-term, and she’s concerned her commute could be even longer.
For many of Bertocci’s patients, this is the second disruption in their treatment in less than a year.
Bertocci previously worked at Maple Leaf Treatment Associates, Inc., at their Colchester outpatient facility. When that organization abruptly closed in February, many of his patients went days without medication.
“When they closed I got really sick. It was awful,” Salem said.
At the time, Bertocci called her on a Sunday to let her know that he had found a new home for his addiction medicine practice at Treatment Associates Morrisville clinic, she said. Salem said Bertocci had spent hours on the phone contacting all of his patients, who were largely in the dark about what was happening.
“If it wasn’t for Dr. Bertocci we would have been left in the cold. With the addiction crisis in Vermont, it’s impossible to get in anywhere,” Salem said.
Bertocci could have just retired when Maple Leaf closed, “but seeing all his patients with nowhere to go, he stepped up and helped us,” she said.
It’s unclear why Bertocci gave up his medical license. Board of Medical Practice Executive Director David Herlihy said: “He surrendered his license and that’s really all I can say.”
Herlihy said the board is bound by confidentiality rules that preclude it from confirming or denying the existence of an investigation until charges are brought against a license holder.
Salem said she was told that Bertocci lost his license because he continued to treat patients even after marijuana or cocaine showed up in their urine screens.
However, there is no set standard of care for medication assisted treatment, beyond complying with state and federal law, and while the Board of Medical Practice has a set of guidelines, it acknowledges that the best practices in the field continue to evolve.
Herlihy too said there is not hard-and-fast rules around what should happen when a patient’s urinalysis shows illicit drugs. When that occurs, the board’s expectation is that a doctor will record the incident and “address it with the patient,” he said.
“In some instances addressing it with patients, at a certain point after — depending on what aberrant behavior is present — it may be to no longer prescribe to that patient or dismiss them from the practice,” Herlihy said.
“Usually it would be some lesser means of addressing it,” he said, adding that doctors have some discretion.
Salem said that Bertocci did address such behavior with his patients. There were a few times when she slipped up and used cocaine. When that happened, Bertocci would drop her dose of buprenorphine and require additional counseling and group therapy sessions. Once she completed six or seven consecutive clean urine tests, they would up her dose again.
“Sometimes it was scary, but it wasn’t anything mean. If you were lying or manipulating, he called you right out,” Salem said.
Herlihy said the board is particularly sensitive to patients whose urinalysis comes back negative for their prescribed medications.
“That’s a pretty clear sign of diversion,” he said, meaning patients are selling or giving away a controlled substance — something that is not only illegal but dangerous as in rare instances people overdose on treatment medications.
Bertocci isn’t the first doctor to land in hot water because of issues related to treating patients for their opiate addiction. In a November, 2016, story, Seven Days highlighted the case of Dr. Robert Penney.
The board found in 2015 that Penney had continued to prescribe buprenorphine to an opiate-addicted patient even after urine screens showed the patient wasn’t taking it.
Penney also continued to prescribe buprenorphine to patients after they tested positive for other illicit drugs. In total, the board said he’d violated the standards for professional conduct treating six of his patients for addiction or chronic pain.
He was fined $2,000 and ordered to take educational courses on prescribing practices. Penney complied and was granted relief from conditions imposed on his license in September, 2016.
Both Penney and Bertocci’s cases show the pitfalls doctors face when wading into the difficult work of treating addiction. Richter said such cases are cause for concern in her profession.
“What worries me is it might give other doctors pause before they agree to take on patients with addiction,” she said, “It’s upsetting to me, especially in light of the opioid crisis and that we already have a shortage of physicians.”
