UPDATE, JAN. 22, 1:48 P.M.: We now know how the parents of the late Alex Smick feel about the “discipline” the Medical Board of California imposed on Dr. Daniel Joseph Headrick for the 22-year-old’s overdose death while in the physician’s care.
The Smicks hate it. They hate that it took four years for the board to come to a decision, and they hate the decision, which is that Headrick is receiving nothing more serious than a public reprimand.
You can watch the Smicks tell the board exactly how they feel here:
ORIGINAL POST, JAN. 15, 5:54 A.M.: In the recent documentary The Long Way Back: The Story of Todd “Z-Man” Zalkins, Dr. Daniel Joseph Headrick says on screen it is amazing the title character survived years of drug abuse, which only became worse after Z-Man’s close friend Bradley Nowell of Sublime died from an overdose.
Headrick, who operates Tres Vistas Recovery in San Juan Capistrano, has gone on to guest on Zalkins’ podcast, and both appeared together on a radio program dedicated to kicking substance abuse.
However, the same Dr. Headrick is being disciplined by the state medical board for the overdose death of a young man who was under the physician’s care. That is, finally being disciplined, and not nearly harshly enough, according to the family of 22-year-old Alex Smick, who died on Feb. 23, 2012. Tim and Tami Smick went on to become statewide activists for medical malpractice victims and their families.
A public reprimand over Headrick’s treatment of Alex Smick becomes effective Thursday, according to the Medical Board of California. Evidence shows the doctor’s medical license should be subject to probation or revocation proceedings, according to Eric Andrist, whose 4patientsafety.org website tracks medical malfeasance cases up and down the state.
“The medical board is not doing their job to protect us,” says Andrist, whose website includes the opinions of three medical experts highly critical of Headrick’s contributions to Smick’s death. Andrist says that case and others are prompting his group to soon expose numerous misdeeds by the Medical Board of California when it comes to disciplining doctors.
Click here for the medical board’s discipline of Headrick, who before operating Tres Vistas Recovery was the lone physician and CEO at Mission Pacific Coast Recovery Center at Mission Hospital in Laguna Beach. Based on the signatures Headrick and his Irvine attorney Raymond J. McMahon put on an acceptance letter from the medical board on Dec. 1 and Dec. 4 respectively, they agree with the findings of the public reprimand. That includes this of the doctor:
“You failed to write a comprehensible order for the level of overnight monitoring for a patient, failed to ensure that a nurse would provide that level of overnight monitoring and failed to ensure that the nurse documented the reasons for administering as needed (PRN) medications, that you ordered for the patient, as more fully described in the Accusation.”
According to Smick’s mother, Alex injured himself skateboarding at age 18, and his primary care physician suggested he go to a pain management specialist in Long Beach. That led to back injections and prescriptions of Vicodin, Oxycontin and even morphine. But he did not get better, Tami Smick says, he became an addict.
“He admitted to using opiates, benzodiazepines, sedatives, cannabis, cocaine, amphetamines, hallucinogens and tobacco,” say state medical board investigators, who add that CURES, California’s drug prescription monitoring system, shows that Alex Smick got scripts for Ativan, a sedative and anti-anxiety agent used to control seizures, and Dalmane, which treats insomnia, within a month of his Feb. 23, 2012, death.
“He just kept getting pain medications,” his mother said 11 months after her son’s death. “Alex knew he had a problem.”
According to medical board investigators, he was treated as an outpatient by a pain specialist on Feb. 15, 2012, when he received scripts for MS Contin, which is time-released morphine, and the highly addictive pain reliever hydrocodone. The following day, Smick overdosed on multiple medications, including MS Contin and the anti-anxiety drug Xanax, and was admitted to Downey Regional Medical Center near his parent’s home. He was then transferred to Pacific Hospital in Long Beach, where a new doctor prescribed more Xanax.
Somewhere along the way, Smick was diagnosed with major depression disorder with postpartum onset, which is actually a female condition, notes his mother, who partly blames that mistake for the additional problems and malpractice her son would face. She says that after his Feb. 22, 2012, discharge from the Long Beach hospital, he on his own arranged to have an ambulance take him to Mission Pacific Coast Recovery Center.
He was interviewed by the admitting nurse there at 5 p.m. and said, “I did not try to kill myself. I was in so much pain that I took too many pills,” according to the medical board. Smick went on to tell of having overdosed on 10 tablets of 2mg Xanax and 40 tablets of MS Contin. He said he used Xanax 3mg tabs for two years. The nurse logged the drugs he said he’d taken, noted his mood was neutral and filed out a checklist of his mental health status dimensions that showed they were unremarkable, according to medical board investigators, who add his vital signs were in normal ranges, and he was allowed to keep his regular clothes and luggage, with no notation from the nurse that either was searched.
Headrick diagnosed the patient as being dependent on opiates, cannabis and benzos with major depression and suicidal ideation. Smick was also diagnosed with Axis III disorders of lumbar disc disease, a T12 compression fracture and mild leukocytosis (slightly elevated white blood cell count). His EKG, urinalysis and metabolic panel all came back normal, and while he tested positive for opiates and cannabis, he surprisingly came up negative for benzos. His vital signs were taken at 9 p.m. and 11 p.m. on Feb. 22, according to the center’s records, which show he received medications to relieve his back pain.
However, according to medical board investigators, Headrick’s written notes from that day did not include any laboratory test results, and “leukocytosis” seemed to have been added later using a different pen. In a note dictated after Smick’s death early the following morning, Headrick said the patient had a positive toxicology screen for cannabinoids and opiates, and at 5:30 p.m.—hours after the young man’s death—the doctor wrote him orders for inpatient detoxification, inpatient rehabilitation and the taking of vital signs with a note that Headrick was to be notified about them, according to the probe.
“Detoxification medications” were also ordered—again, after the patient’s death—for moderate withdrawal symptoms, some to start “now,” report board investigators, who added there were also orders for “as needed” medications for nausea and vomiting and that scripts were written for the anti-convulsion medication Lyrica, the anti-depressants Elavil and Zoloft, a Lidoderm patch, the pain medication Toradol, the muscle relaxer Robaxin, Catapress for hypertension/high blood pressure and the anti-anxiety drug Librium. Another EKG and laboratory tests—including a complete blood count, metabolic panel, urine drug screen and breath test—were requested.
The record shows Smick got Lyrica at 5 and 10 p.m.; Librium at 5 p.m.; the anti-seizure Phenbarbital at 9 p.m., anti-anxiety Sertraline at 9 p.m.; and the pain reliever Buprenorphine at 11 p.m. It also shows Smick was able to go to sleep without distress.
The bottom of the page on his medical records has the time written as 3:30 (a.m., presumably) and hours slept as “8” and the notation “slept through the night,” according to investgiators, who tellingly add: “In light of the fact that A.S. was discovered dead at 6:20 a.m., it is difficult to see how the record could be accurate. Further troubling is the fact that Lyrica, Robaxin, Clonidine and Librium were noted as having been administered at 7 a.m. on Feb. 23, 2012, after A.S. was found dead.”
Nurses said they discovered Smick lying “supine” (face up) on his bed with rigor mortis at 6:20 that morning. However, the dictated record of a doctor, who came from the Emergency Department of Mission Hospital to assist in resuscitation efforts, observed the deceased had “obvious lividity with pooling of the blood in the anterior aspect of the body,” adding that, “The sheets were wet indicated [sic] that there was fluid there, which may have been either vomitus from which he aspirated and the fluid was noted on his face and eyes.”
This evidence indicates a Smick suffered a seizure, according to the state board, which also cites Orange County Sheriff-Coroner records that suggest there was evidence the patient had been turned over from the prone to the supine position. The coroner found no evidence of trauma or extra pills in the room, saying the cause of death was “[a]cute poly drug intoxication due to the combined effects of buprenorphine, sertraline, norsertraline, bupropion, amitriptyline, lidocaine, chlordiazepoxide, methocarbamol and tetrahydrocannabinol.” It was noted that none of the substances were at toxic levels. Furthermore, examination of Smick’s heart revealed left ventricular enlargement but no evidence of atherosclerosis.
Medical board investigators found notably absent from the coroner’s toxicology report any metabolites of Lorazapam, Flurazepam, Alprazolam and Phenobarbital, some of which center records show Smick received within the prior 24-36 hours.
Headrick’s public reprimand is for failure to maintain adequate and accurate records and unprofessional conduct/repeated negligent acts. His use of multiple medications “was unsupported by the medical records since withdrawal from opiates or benzodiazepines were not demonstrated, nor was insomnia or pain consistently proven,” states the medical board. “There was no indication for prescribing Zoloft since a diagnosis of major depression was excluded due to drug abuse. Elavil is an obsolete medication with many problematic adverse effects. Phenobarbital is similarly a medication belonging to an earlier generation of physicians due to its risks. The interacting side effects of these many medications are unpredictable.”
The “unpredictable consequence constitutes negligence,” according to the board, which also damned: the simultaneous administering of sedatives such as Phenbarbital, Lyrica and Librium with the opiate Buprenorphone; the simultaneous ordering of 10 medications without a record of symptoms supporting a diagnosis; and only ordering vital signs of a new patient when he was awake as opposed to every two hours.
The state nursing board previously cited Mission Pacific Coast Recovery Center registered nurse George Gappmayer for “failure to exercise the degree of professional judgment expected of a vocational nurse.” He was fined $1,000.
The mistreatment of their son led Tim and Tami Smick all the way up to Sacramento, as demonstrated by their support for Prop. 46, the Medical Malpractice Lawsuits Cap and Drug Testing of Doctors Initiative that was on the Nov. 4, 2014, ballot.
[embed-1]At the press conference that May 2, 2013, day, Tami Smick, with her husband by her side, accused Headrick of prescribing “a toxic combination of medications” that led to the death of her son. His blood pressure started to drop, yet he was unmonitored and unchecked for more than six hours, charged the Downey teacher.
“When a nurse checked him in the morning, he was dead. He’d been gone so long that he was already in rigor mortis. … Our beautiful son was left to die in his bed. No one checked on him. They left him alone and he went to this place for help and they left him for dead.”
Tim Smick, a home-building contractor, said he could not understand why, when there is a serious injury or death on one of his jobs sites, the police and the California Occupational Safety and Health Administration (Cal OSHA) show up, but no one did at the hospital where his son died. (Except for the coroner, who merely carted the victim away.)
But learning the cause of death from that coroner led the Smicks to fight for justice for others. That’s when the Smicks learned the Medical Injury Compensation Reform Act (MICRA), which Gov. Jerry Brown signed in 1975, capped non-economic damages at $250,000 in medical negligence lawsuits brought in California. Supporters of Prop. 46 argued that, with inflation, the cap should have been raised to $1 million.
“We can’t fight this,” Tim Smick said that day. “This system is so jacked up. There is no defense. In our case, we are up against the Goliath of insurance companies and doctors. The doctor actually had an insurance adjuster call our attorney to call us and say to watch what we say, really, or he is going to sue us. So I’m the victim now for causing our son’s death? This system is broken.”
Proposition 46 went on to be soundly defeated at the polls, thanks mostly to the tons of money poured into the no campaign by the health insurance industry.
The Smicks settled a malpractice lawsuit against Headrick, the terms of which weren’t disclosed.
Headrick is listed as the owner and medical director of Tres Vistas Recovery.
MATT COKER Matt Coker has been engaging, enraging and entertaining readers of newspapers, magazines and websites for decades. He spent the first 13 years of his career in journalism at daily newspapers before “graduating” to OC Weekly in 1995 as the paper’s first calendar editor. He went on to be managing editor, executive editor and is now senior staff writer.