Defrocked Docs

What happens to doctors who break bad? And how can you know if your physician is already in the crosshairs of the Arizona Medical Board?

Simmons, describing himself as a war vet who fought in Iraq, denied charges of conspiracy to commit healthcare fraud that led to the indictments. After a hung jury, he wound up serving 96 days in a minimum security federal prison near Tucson in early 2022 after reaching a plea agreement for a lesser HIPAA infraction. He’s appearing via Zoom with the Arizona Medical Board on August 3, 2022, to explain his side of the matter and challenge the Board’s initial recommendation for Decree of Censure, a formal action against the doctor’s license.

“I’d like to be practicing,” he tells the board. “I have two children, a 9-year-old and a 12-year-old, and I’d like to be able to practice medicine again. That’s my love, it’s my passion.”

“Do you have any employment opportunities at this time?” asks AMB chair Gary Figge, M.D. “What do you have as offers right now, or are you waiting?”

“I can work at a medical spa,” Simmons, 53, shrugs. “But I would need my license to do so.”

Figge asks Simmons if he’s still living in Gilbert, where he had worked as an EMS.

“No, I sold my house in Gilbert, pursuant to my divorce,” he says, head bowed to the screen. “And now I live in a condo, actually, down in Phoenix. Right now, I’m at my office in Chandler, which is, uh, a plumbing company. I’m helping sort of supervise that plumbing company as I’m, you know, awaiting the board to make their decision so I can resume my practice.”

Simmons’ fall from grace is a dramatic example of what can happen when a doctor runs afoul of the law or, as in other cases, commits malpractice – and how hard it can be sometimes to come back after being disciplined by a state medical board. He’ll have to undergo extensive grilling on this day before the board can arrive at its decision.

But there are also hundreds of doctors in Arizona who’ve been issued disciplinary actions and are still practicing. And finding out if your own physician is on the “bad” list can take more than a bit of digging.

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Often prompted by patient complaints, the AMB conducts a slew of investigations into physician wrongdoings each year – 1,221 in the past 12 months alone – and publishes an annual list of disciplinary actions on its website. On a typical year, around 70 doctors appear on the list.

The actions range from, in order of severity: Probation, Letter of Reprimand, Decree of Censure to, finally, Surrender or Revocation of License. Patient advocates have demanded that the board should also make public the “Advisory Letters” it issues to doctors, the most common and least penalizing action doled out. At last count, more than 600 active doctors had the written reprimands – many of which are officially deemed “Non-Disciplinary” – on their records, according to a December 2022 investigation by The Arizona Republic, but those do not appear on the AMB’s website. (Every medical and osteopathic doctor ever licensed by the state of Arizona, represented by the acronyms M.D. and D.O., respectively, has a personal information page available to the public on the site.)

Nevertheless, the AMB’s “Recent Board Actions” page, showing the past 24 months of orders issued against Arizona doctors, links to enough tales of bungled treatments, on-the-job substance abuse and improper sexual behavior to script several seasons of a twisty TV medical drama.

In 2022 alone, there was the Sun City neurologist who began treating a patient complaining of intractable migraines with Botox injections instead of ordering the customary X-rays, missing a diagnosis of a brain tumor that subsequently ruptured, resulting in the patient’s death. There was also the Virginia doctor who treated Arizona patients via telemedicine site TeleSpecialists, and used his newfound videoconferencing skills to allegedly share “videos depicting pre-pubescent girls engaged in sexually exploitive positions.” Then there was the Goodyear OB/GYN who was suspended from a hospital job after a police report indicated him to be a heroin user who regularly filled large prescriptions of oxycodone to a woman he never saw as a patient. Other tales of medical misbehavior include an oncologist in Scottsdale who was accused by two female patients of touching them in inappropriate places during an examination, and a radiologist licensed in Minnesota and Arizona who admitted to practicing medicine while under the influence of improperly obtained Xanax.

Each of those doctors was either ordered to surrender their license or have it revoked. “A doctor is always given the opportunity to surrender their license if the disciplinary recommendation is revocation,” says Raquel Rivera, the AMB’s investigations manager who oversees a team of 12 investigators and assistants. “Many doctors who choose to surrender their license while under investigation do so because they recognize that they are experiencing a health condition that impacts their ability to safely practice medicine.”

Often, the “health condition” in question is a chemical dependency or mental crisis. Less frequently – just three times in 2022, in fact – the Board will move to decertify physicians with physical infirmities or older doctors who simply lose their capacity to understand and treat illnesses. AMB records tell the story of a 69-year-old family medicine specialist in Scottsdale who closed her doors in late 2021 without telling her patients or giving them access to their medical records. She finally conceded to having a health condition that impaired her ability to practice medicine.

But such cases are the exception – usually, malpractice and/or misbehavior trigger an investigation, and often the physicians in question will opt for an abrupt career change to avoid facing further scrutiny. In the case of the Xanax-abusing radiologist, who also admitted to hiring an “escort” to visit him in his office and tested positive for marijuana use, he responded to the board’s order that he complete a drug rehabilitation program with the emailed message, “Thanks for your help but I am done with medicine.”

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Despite the many disciplinary actions the Board issues, Rivera admits it takes a lot of major screw-ups for a doctor to have his or her license revoked. In 2022, only 13 out of a pool of roughly 13,000 active MDs and DOs in Arizona reached that stage. Over the past 7 years, the average was 17 – with 2020, a year rife with physician burnout, breaking the curve at 28.

“Revocation is not a penalty frequently imposed by the board,” she says, stressing that the board takes disciplinary recommendations seriously, but that it also considers a doctor’s past disciplinary history as well as the egregiousness of the violations under review. “Revocations commonly occur when a licensee who has committed a serious act of unprofessional conduct also fails to cooperate with the board’s investigation and demonstrates they cannot be regulated.”

Thus, even a doctor who commits a tragically grievous error can sometimes continue practicing, as long as they follow the board’s corrective orders. In 2018, Globe pediatrician Fernando Cruzado treated a 2-year-old girl whose parents had brought her into his medical center with complaints of wheezing, coughing and congestion one day after attending a carnival. The board determined that Cruzado had deviated from the standard of care for pediatric patients experiencing respiratory distress by prescribing Ativan, a strong benzodiazepine commonly used to treat anxiety, instead of first trying esophageal intubation. The toddler suffered an anoxic brain injury and, after being heliported to another medical facility, died six days later.

Nevertheless, Cruzado complied with the board’s order to complete three hours of pre-approved Continuing Medical Education, or CME, in the evaluation and treatment of pediatric respiratory conditions. Following six months of probation, he was allowed to continue practicing – this despite having previously been issued two Letters of Reprimand, a Decree of Censure with Practice Restriction, an Advisory Letter and another earlier probation.

It’s significant to note that Cruzado now serves smaller burghs like Globe and Peridot after starting his career working for Banner Urgent Care units in Goodyear and Gilbert. Doctors with spotty performance records often gravitate to the hinterlands, where there’s less scrutiny, according to experts. Although the AMB continues to monitor doctors under probation, a recent study by the Federation of State Medical Boards, which operates as a national clearinghouse of state medical board actions, found that in smaller towns and rural areas, physician and nurse shortages make it less likely that patients or professional peers will report improper conduct or competence issues.

“There is a perception that underserved areas cannot afford to lose health care workers – fostering a higher level of tolerance for improper behavior or adverse events,” wrote the report’s authors. “In addition, in smaller communities, health care workers may be reluctant to report the actions of their peers for fear of losing patient referrals or professional ostracization.”

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The company’s website notes only that “Dr. Fitzmaurice has retired from surgery and is now focused on research, development and quality control within the practice.” The loss of his medical license appears not to have hurt business; marketing intelligence firm ZoomInfo currently lists the company’s annual revenue at $4 million.

Fitzmaurice benefitted by building enough positive brand recognition for his practice prior to the surrender that it can now continue to prosper with other surgeons at the helm. But if a doctor who loses his or her license wants to get it back, there are paths open to vindication.

“Revoked or surrendered physicians are prohibited from reapplying for licensure for five years from the effective date of the revocation or surrender,” Rivera says, adding that the burden of proof is on them to demonstrate that they have remediated and resolved the issues that led to the adverse action against their license.

If the doctor has not practiced medicine while revoked, “the board would evaluate the applicant’s fund of medical knowledge and evaluations aimed to determine medical competency may be warranted to ensure that the licensee is competent according to current medical standards,” she says. As for those who have only been placed on probation, “They may be able to practice while on probation or after receiving disciplinary action, depending on the confines of their probationary order.”

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“How many people have died under your care?” asks Arizona Republic investigative reporter Andrew Ford to Scott Brannan, chief of endovascular surgery at Modern Vascular, a Glendale-based chain of outpatient clinics that specialize in the treatment of peripheral artery disease, or PAD.

“Like, died on the table?” Brannan replies, in a videotaped interview posted on the publication’s website.

 “Or, you know, shortly thereafter,” Ford qualifies.

Brannan sighs. “I think just one.”

Physicians issued disciplinary actions by the AMB are unsurprisingly reticent about talking with the press. PHOENIX tried repeatedly to contact each of the doctors mentioned in this article, but interview requests were summarily turned down or ignored.

But professional self-confidence will sometimes compel a doctor to freely admit to their transgressions, confident that the good work they do saving lives and healing illnesses will outweigh the bad. In his lengthy sit-down interview with Ford, Brannan was bracingly forthcoming about his checkered record – which includes arrests in his youth for assault (pleaded down to criminal damage), possession of 1,000 pounds of marijuana with intent to sell, improper self-medication with Ambien and anabolic steroids, and, most seriously, the death of a patient that the AMB ruled may have been partially due to Brannan’s failure to transfer her to a hospital in time.

Why did he cop to all that on camera? Simple, Ford says. “He hoped his better qualities would redeem him.” (Unfortunately, following the Republic’s story that unearthed troubling claims of harm to patients by Modern Vascular, Brannan has since clammed up. Recent requests for interviews have gone ignored.)

The AMB placed him on a one-year probation.

To some degree, the board appears to accept a certain amount of problematic behavior as an occupational hazard of working in a high-stress, high-stakes medical career. The case files of doctors with disciplinary actions that stop short of surrender or revocation can read like a rogues’ gallery of troubled healers who manage to stay in the game through the grace of peer review.

Drug and alcohol abuse charges pepper the paperwork. Anger management is frequently ordered. Volatile relationship issues abound, with scorned ex-spouses often the plaintiffs submitting evidence to the board. A recent case involved a doctor who was charged with abusing ketamine, cocaine and methamphetamine, but the board decided his accuser – a “jilted ex-girlfriend,” according to his lawyer, who had run her car into a palm tree on his property after a drunken quarrel – was an unreliable source. “It would be nice if we had a complainant who was pure in her intent,” said one board member. “But we don’t.”

Legislation lobbied by Arizona Medical Association that took effect last fall, House Bill 2429, created a confidential peer-support physician wellness program to counsel doctors facing their own issues. “Anyone who has any interaction with the health care system understands what physicians go through and understands the long, long hours and the pressures that health care professionals are under,” said AzMA director of government relations Amanda Rusing upon the bill’s passage.

Multiple studies on the risk factors for alcohol and other drug use by healthcare professionals have found that easy access to controlled substances, coupled with a sense of “professional invincibility” to misuse them, drives a disproportionate percentage of doctors to do just that.

The AMB’s decisions take all of this into account. “The board does have a ‘three-strike’ process for substance use disorder monitoring,” Rivera says. “A doctor who had previously completed monitoring for a substance misuse or dependency and who relapses is required to enter into an agreement to inactivate their license with cause, and complete treatment before requesting reactivation of their license. The reactivated license would then include a requirement for probationary substance-use monitoring. In the event the doctor violates that second probationary monitoring agreement by misusing substances, or relapses after completing the second agreement, the physician would be required to surrender their license or be revoked.”

• • •

The office manager at Rainwater Industries is courteous in accepting repeated calls to contact her supervisor, whom she still calls “Dr. Simmons.” But despite her attempts to relay requests to Simmons, who she confirms comes “in and out” of the plumbing company on a weekly basis, she ultimately has to relate that he’s “not available to take an interview at this time.”

Doctors captured in prescription kickback cases have a bit of history in the Valley, where federal prosecutors over the past five years have brought charges against multiple doctors, including three in Arizona, accused of taking payments from Chandler-based Insys Therapeutics in exchange for wrongly prescribing the company’s highly addictive fentanyl-based cancer pain medication.

Simmons’ case had been a relatively high-profile one, too. In October 2016, he was indicted in U.S. District Court in Dallas, Texas, for conspiracy to commit health-care fraud. Federal prosecutors alleged that a marketing company called CMG Rx hired recruiters who contacted TRICARE beneficiaries and induced them to sign up for experimental compounded topical pain cream or vitamins, then sent the pre-filled prescription forms to various doctors, including Simmons, for signing. CMG Rx would pay the doctors for each prescription signed. The pharmacies would fill them, bill TRICARE and send a portion of the proceeds they received from TRICARE back to CMG Rx.

Simmons claimed he was unaware of how the prescriptions were being used – in fact, federal officials first learned of the scheme when Simmons anonymously blew the whistle on the perps. Prosecutors insisted that he benefitted from his involvement, however. He struck a plea agreement before his retrial after the first ended in a hung jury, agreeing to pay back more than $527,000 in restitution – the amount of a loan extended to Simmons’ company from CMG Rx, which his attorney says was returned to the fraudsters after Simmons learned of the scheme – and serve 96 days in federal prison for violating HIPAA rules by sending the confidential prescription information to an unvetted source.

In the end, the AMB showed sympathy for Simmons in his Zoom meeting, with board member Dr. David Beyer saying, “I do understand the physician’s desire to try and clear his name as best as possible, and I think we are unlikely to see a repeat of these events.”

Downgrading its initial recommendation of a Degree of Censure after the Zoom call, the board issued a Letter of Reprimand and voted to place him on a two-year probation. He remains barred from federal health care programs and hospitals.

Editor’s Note: PHOENIX magazine wishes to clarify and correct portions of an earlier version of this article, published online and in the March-April 2023 issue, as they pertain to Valley physician Dr. Walter N. Simmons. Contrary to the original article, Simmons was not formally suspended by the Arizona Medical Board for his role in the TRICARE medical fraud scandal, though his license was inactivated or suspended in other states during his subsequent 96-day incarceration in federal prison. As stated in that article, his sentence resulted from a plea agreement to less-severe HIPAA violations following a hung jury in a federal trial for conspiracy to commit health care fraud. The plea agreement states, in part, that “the prescriptions Simmons wrote … were used by … other individuals (not Simmons) to commit health care fraud and violations of the federal Anti-Kickback Statute.” Simmons is currently eligible to practice medicine in Arizona during a two-year probation, but is excluded from participating in federal Medicare, Medicaid, and “all federal health care programs” for six years. Additionally, he did not lose his medical license in Texas, but was publicly reprimanded and placed on probation there. Also due to a reporter misunderstanding, the article misstated Simmons’ involvement with the compound pain drug at the center of the scandal: He did not personally develop or market the drug, though he did prescribe it on eight occasions. Finally, the article may have implied that Simmons was the sole prescribing doctor in the scandal. He was not.  Although the U.S. Department of Health and Human Services found “TRICARE, a government health care program, incurred an enormous financial loss due to the fraud scheme to which [Simmons’] criminal conviction relates,” several other parties were involved and Simmons was not the central figure. We regret the errors.