A family physician in Townshend has been fined and told to attend medical training courses for overprescribing Adderall without properly documenting the treatment or monitoring the patient’s medication use. The Vermont Board of Medical Practice issued the decision in late August.
The patient, who is unnamed in a final stipulation agreement from the board, died in 2016 at 37, seven years after Dr. Maurice Geurts first began an intermittent regimen of 160 mg of Adderall a day. The highest recommended daily dosage for Adderall in an adult patient is 60 mg.
The stipulation says Geurts’ treatment of the patient “was not in conformance with the applicable standards of care for the provision of general primary care, prescribing medications, monitoring the patient’s medication use, and medical recordkeeping.”
Geurts was fined $2,500 and is allowed to continue practicing medicine with some restrictions.
The links between serious adverse cardiovascular events, such as heart attacks, and medicine used to treat attention deficit hyperactivity disorder, such as Adderall, are “limited and inconsistent,” according to the U.S. Food and Drug Administration.
However, the FDA advises caution for patients for whom high blood pressure or heart rate would be problematic. And it says “patients treated with ADHD medications should be periodically monitored for changes in heart rate or blood pressure.”
The patient in Vermont had been prescribed 120 mg of Adderall a day for seven years, before Geurts upped the dosage in 2009. Both prescriptions, the stipulation says, “were extremely high and well above the standard dosing.”
“During the time period that (Geurts) prescribed Adderall for this patient, he failed to include a documented rationale for prescribing Adderall in such an excess of the standard dosing,” the Vermont Board of Medical Practice wrote.
Geurts was the patient’s primary care provider from 2007 to May 2016, when he died. The patient was prescribed Adderall to treat adult ADHD from 2007 through October 2011, for one month in 2013 and five months in 2015. During the time he was not on the medication, he was seeking psychiatric care for the disorder.
The patient was also prescribed lisinopril in 2008 to treat hypertension, or high blood pressure. In March 2014, an electrocardiogram (EKG) was performed on the patient, which showed a QTc interval of 497 milliseconds, which is “borderline high.” An elongated QT interval — the time it takes for the heart to contract and relax between heart beats — can be an indication of a heart disorder that may cause fainting, seizures or sudden death.
A second EKG performed on the patient in February 2016 showed a QT interval of 468 ms, lower than the previous test but still higher than normal, which is 440 ms for an adult male.
“Despite these findings, Respondent (Geurts) did not pursue further evaluation of the patient with cardiology,” the stipulation says.
The patient died of “myocardial infarction,” the medical name for a heart attack, on May 28, 2016.
The committee of professionals and members of the public found that Geurts “demonstrated a failure to practice competently on multiple occasions, the performance of unsafe and unacceptable patient care, and failed to conform to the essential standard of acceptable and prevailing practice.”
Based on these findings, Vermont’s Board of Medical Practice decided to reprimand Geurts and place conditions on his medical license. He was required to pay $2,500 to the board and complete medical education courses on medical recordkeeping, treating and managing adult ADHD and proper EKG use and reading.
Geurts agreed to the findings and punishment. “Respondent enters no further admission here, but to resolve this matter without further time, expense and uncertainty; he has concluded that this Stipulation is acceptable and in the best interest of the parties,” it said.
If the board fails to reach a settlement with a physician resulting from a complaint, it then asks the Attorney General’s Office to file charges of unprofessional conduct.
Geurts was represented in the case by Shireen Hart, an attorney with Burlington law firm Primmer Piper Eggleston & Cramer. Attorney General TJ Donovan signed off on the order on behalf of the state.
Both Hart and the Attorney General’s Office declined requests Friday for an interview about the case. David Herlihy, chair of the medical practice board, did not respond to a request for an interview made through the Department of Health.
Geurts’ practice in Townshend is affiliated with Grace Cottage Hospital and Brattleboro Memorial Hospital. Attempts to reach Geurts through executives at Grace Cottage were unsuccessful.
Geurts has a medical degree from the University of Amsterdam Medical School and completed a residency in family medicine at the University of Vermont in 2003, according to his bio page on the Grace Cottage website.
