Records request bothers physician

Dr. Ivan Goldsmith, owner of the TrimCare weight loss program, seemed stunned by the subpoena he held in his hand from the Nevada Board of Medical Examiners.

The board's investigative committee had ordered him to hand over a list of all his Nevada patients, past and present, on the TrimCare diet program, as well as a comprehensive accounting of all medications used in the program.

"We're talking five to six thousand patients here," Goldsmith said last month as he sat in a Starbucks off Rancho Drive. "I'm not sure my patients would like me just handing over their names for no apparent reason. It would take about 1,000 hours to go into their files to find out specifically what medications they were on. I honestly don't know why they are doing this."

That wide-ranging July 1 subpoena had followed an earlier Feb. 11 subpoena delivered by board investigator Monica Gustafson. In February, she asked to see the files of 12 patients.

"She never told us why she was here," Goldsmith said.

Goldsmith, 49, is also dealing with a lawsuit filed earlier this month by Las Vegas comedian Jeff Beacher, who alleges the physician negligently prescribed medications that caused him physical and psychological distress.

Beacher says he hasn't filed a complaint with the board.

"That's coming," he said.

Goldsmith is livid not only with what has happened, but the manner in which it has transpired, alleging that the board is not following procedure that gives physicians due process.

"Asking carte blanche for five or six thousand names with no evidence of wrongdoing is like living in Nazi Germany," said Goldsmith, who has three clinics in the Las Vegas Valley. "No judge is going to compel me to turn over five thousand names. If we have to go to court, we will."

His wife, Mona, who is the office's chief administrator, turned over some files after Gustafson's initial request, an action Goldsmith wishes wouldn't have happened. Mona Goldsmith had asked Gustafson at the time whether she was acting on a patient complaint, and Gustafson replied that was not the case, Ivan Goldsmith said.

Tony Clark, the medical board's executive director, said normal procedure is for an "allegation letter" to be sent to the physician under investigation.

"They're told what the complaint is about and asked for a response," Clark said Friday.

Not until Aug. 12, six months after issuing her first subpoena and after repeated inquiries about the case from the Review-Journal and Goldsmith's attorney John Cotton, did Gustafson write a letter to Goldsmith outlining the allegations. The letter contends the board had received information that Goldsmith:

•Illegally dispensed compounded medications.

•Dispensed medications without having a pharmacist on-site and allowed clerks to dispense medications.

•Altered documents to pass audits.

•Used human growth hormone, HGH, on patients without meeting FDA criteria.

•Prescribed pain medication without proper diagnosis.

That letter followed July 31 correspondence from Cotton to the board investigator, saying Goldsmith "must respectively protest and reject" the request for names of TrimCare patients past and present.

TrimCare patients, he wrote, include "doctors, lawyers, judges, politicians and numerous renowned citizens in the Las Vegas community. Many of these people will strongly protest production of their names in response to a presently unspecified board initiated inquiry. Your office's current refusal to share the nature of the complaint with me on informal inquiry causes great concern as to the actual motives behind the request for names."

Despite Gustafson's August allegation letter, Cotton has not turned over names asked for in the July subpoena.

Gustafson did not ask the Nevada State Board of Pharmacy for input on the case, according to an agency spokesman. That is normal practice, since the allegations center on the dispensing of medications.

Larry Pinson, executive secretary of the pharmacy board, said cases involving medications generally are joint efforts between the medical and pharmacy boards because of his board's expertise.

"We've heard nothing from the medical board regarding Ivan Goldsmith," Vinson said. "All I can tell you is that we have yearly inspections and he is in compliance. ... They (the medical board) really don't have the inspectors to look into that kind of stuff about a physician. They probably don't go into the detail we do."

In July, Doug Cooper, chief of the investigative division, said he knew nothing about the Goldsmith case. He did not return a phone call last week.

Dr. Charles Held, chairman of the investigative committee and the man whose name was on the subpoena, also said he knew nothing about the case. Board investigators just stamp his name on subpoenas, he said.

Lyn Beggs, the board's deputy general counsel, said she had never heard of the board possibly dealing with as many as 5,000 or 6,000 patients in an investigation.

"I don't know that it's humanly possible," Beggs said.

As to the allegation that Goldsmith was dispensing medication at his clinic without a pharmacist on site, Pinson said it's not a requirement of Nevada law.

And an inspection by the board of pharmacy at Goldsmith's clinic earlier this month showed Goldsmith had the proper license displayed to "prescribe/dispense drugs."

"All medications dispensed within our office are monitored and reviewed on a continual basis by the Nevada Board of Pharmacy," Goldsmith said. "I am not altering any documents for their audits."

Pinson said that there has been no indication that Goldsmith is altering documents.

The doctor wonders why Gustafson is dealing with matters regarding dispensing medications that has already been covered by the board of pharmacy.

"All dispensing guidelines are followed, including passing mandatory frequent inspections and audits by the inspecting pharmacist," Goldsmith said. "That is easy to see. Why are we having to do this again and again? It is just harassment."

Goldsmith said he always performs a complete medical work-up before prescribing drugs for pain, and that patients "are approved for a one-month supply only."

The board of pharmacy inspection earlier this month showed Goldsmith's clinics were in compliance when prescribing drugs for pain.

When it comes to HGH, Goldsmith said, "it has been prescribed only if an individual is deficient in it."

Goldsmith has another lawyer, Brent Bryson, defending him in the lawsuit filed by Beacher. Filed Aug. 15 in District Court, the lawsuit alleges Goldsmith illegally gave Beacher seven drugs, including HGH and testosterone.

Two nationally renowned physicians, Dr. Thomas Perls and Dr. Todd Schlifstein, both of whom testified on Capitol Hill about hormones and steroids, entered expert medical opinions in Beacher's case.

Both said the treatment afforded Beacher by Goldsmith was substandard.

Perls, of the Boston University School of Medicine, gave his permission for his opinion to be used if Beacher files a malpractice complaint with the state medical board.

Goldsmith says he only prescribed drugs to Beacher that were medically necessary.

Goldsmith says Beacher sued him because he was angry that the doctor wouldn't pay him $10,000 a month "to be the face of the diet program."

Beacher said he received assistance from an aide to Gov. Jim Gibbons in finding the two expert doctors who helped him cope with the "terrible effects" of the diet drugs.

Gibbons' press secretary, Ben Kieckhefer, said he does not know whether anyone in the governor's office filed a complaint with the medical board against Goldsmith.

Goldsmith's patients are not happy that he may have to turn over their names to any agency, let alone one that public officials have described as inept in handling the hepatitis outbreak investigation now going on in Southern Nevada.

"I wouldn't trust them to keep my name confidential," said one engineer who is a TrimCare patient.

A patient who is a lawyer said she also worries that her name will get into the public domain. "When I go to a doctor, I don't want my information shared," she said.

Goldsmith can't stop wondering how the board's investigation got started.

He says the practice of medicine in the Las Vegas Valley is very competitive and physicians have made unfounded complaints to the board in the past to hurt another doctor's practice.

Doctors aren't above cutting "each other's throat," he said.

He noted that several months ago he thought about selling his practice but took it off the market because there weren't serious offers.

Now, however, with the board investigation under way, Goldsmith noted that a business broker contacted him Thursday and said five to six physicians are interested in buying his practice.

Goldsmith shared an e-mail from the business broker. It reads in part: "These individuals would like to move forward and are even willing to take over despite the potential legal problems, as long as you are willing to indemnify them."

Goldsmith also wonders if his criticism of Dr. Dipak Desai, former chairman of the board's investigative committee and the man at the center of the hepatitis C investigation in Southern Nevada, could be a reason for the board's actions.

Goldsmith said he has seen first hand how the medical board works, charging that the board's power can be used to financially line a board member's pockets or those of his friends.

In a July 6 Review-Journal profile on Desai, Goldsmith described how Desai, when he headed the investigative committee, said he would allow wrongdoing by Goldsmith to go unnoticed if Goldsmith referred patients to him.

Goldsmith admitted he once allowed a physician's assistant to start work in his office before he received the necessary paperwork from the state.

But Desai is no longer on the board, and Cooper and Clark, two of the board's head administrators, say no such thing is happening now.

"I have seen no one on the board using their position to further themselves or against anybody that way," Clark said.

"I can guarantee you it's not happening," Cooper said in July.

Goldsmith believes he must take a stand. "I've been told by my lawyer to be quiet. But it's not right for power for to be abused. I think all people want is for the board to be fair. If I'm in the wrong, so be it."

Contact reporter Paul Harasim at pharasim@reviewjournal.com or 702-387-2908.