Dr. Daniel Headrick
Medical Board Record—G 45144
Disciplinary Actions—License Renewed & Current; Accusation Filed; Decision
Dr. Headrick, a graduate of the UCLA School of Medicine, is currently under investigation by the California Medical Board and the Attorney General’s office over the death of Alex Smick. He currently works out of Tres Vistas Recovery in San Clemente.
Click here for Alex Smick’s Story
George Gappmayer was the nurse on duty the night that Alex died. He has been cited by the Nursing Board.
Dr. Headrick Reprimand | OC Weekly
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, 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 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,” 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 use 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,” the medical board quotes him as telling the nurse. 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 a checklist of his mental health status dimensions 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 indicate 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.
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. (LINK)—1/15/2018
From the Medical Board of California Accusation (in part):
FACTS*
10. [22 year old A.S.] admitted to using opiates, benzodiazepines, sedatives, cannabis, cocaine, amphetamines, and hallucinogens. CURES activity demonstrated prescriptions for Lorazepam (Ativan) 2mg and Flurazepam (Dalmane) 30 mg within a month of his death on February 23, 2012.
11. Prior to entering Respondent’s clinic, Mission Pacific Coast Recovery Center (MPCRC) at Mission Hospital, A.S. was treated as an outpatient by Dr. G.E., a pain specialist, on February 15, 2012, when he received prescriptions for MS Contin and hydrocodone. The following day, February 16, 2012, he overdosed on multiple medications including MS Contin and Xanax. Pursuant to the provisions of Welfare and Institutions Code section 5150, he was admitted into the Downey Regional Medical Center for involuntary treatment of a mental disorder, and then transferred to Pacific Hospital, Long Beach under the care of Dr. R.I. While under the care of Dr. R.I., he was prescribed Alprazolam (Xanax).
12. A.S. was discharged from Pacific Hospital on February 22, 2012, at about 2:00 p.m. and transported by ambulance to Respondent’s care at MPCRC, arriving at approximately 3:30 p.m.
13. Respondent is the only physician, as well as being the Chief Executive Officer of MPCRC. Respondent diagnosed A.S. as being dependent on Opiates, Cannabis and Benzodiazepines with Major Depression and suicidal ideation. A.S. was also diagnosed with Axis III disorders of lumbar disc disease, Tl2 compression fracture and leukocytosis, mild. Respondent’s written notes at 5:15 p.m., on February 22, 2012, did not record any laboratory tests and he seems to have added “leukocytosis” later with a different pen.
14. In his note dictated February 23, 2012 (subsequent to A.S’s death), Respondent noted that A.S. had a positive toxicology screen for Cannabinoids and Opiates.
15. Respondent wrote orders at 5:30 p.m. for A.S.’s inpatient detoxification and inpatient rehabilitation. Vital signs were ordered, and orders were left that Respondent was to be notified if there were alterations in A.S.’s vital signs. “Detoxification medications” were ordered including Phenobarbital 30 mg every 3 hours for moderate withdrawal symptoms and Buprenorphine 218 mg every 3 hours as needed for withdrawal symptoms to start “now”. In addition, “as needed” medications were ordered including Quetiapine (Seroquel) 25 mg every 3 hours as needed for agitation and Ondansetron (Zofran) 4 mg as needed for nausea and vomiting. Respondent also wrote medication orders for Lyrica 25 mg three-four times daily; Elavil 25 mg at bedtime; Zoloft 50 mg at bedtime; Lidoderm patch at 6 pm; Toradol 60 mg IM (“now”) then 30 mg IM four times daily; Robaxin 1,500 mg four times daily; Catapress 0.1 mg four times daily if his systolic pressure was above 100, and; Librium 10 mg twice a day.
16. Respondent also requested an EKG and laboratory tests, including a complete blood count, chemistry metabolic panel, urine drug screen and Breathalyzer.
17. A.S. was interviewed by the admitting nurse at 5:00 p.m., who documented his explanation of his earlier overdose. The nurse reported that A.S. stated: “I did not try to kill myself. I was in so much pain that I took too many pills.” He reported to the nurse that his overdose was 10 tablets of 2 mg Xanax and 40 tablets of MS Contin. He reported that he had used Xanax 3 tabs daily for two years.
18. The nurse listed A.S.’s many drugs of abuse at his initial evaluation. His mood was recorded as neutral and the nursing check-list of mental status dimensions were unremarkable. His vital signs were within normal ranges and he was allowed to keep his regular clothes and luggage. There is no notation of his clothes and luggage being searched.
19. The laboratory test ordered by Respondent showed a slightly elevated white blood cell count of 12.5 thousand. The metabolic panel was normal. The urinalysis was normal. The urine toxicology screen was positive fur Cannabis and Opiates, but surprisingly negative for benzodiazepines. The EKG was normal.
20. A.S.’s vital signs were taken at 9:00 p.m. and again at 11:00 p.m. on February 22, 2012. The record reflects that he received his evening medications and that he reported his back pain as improved.
21. A.S.’s ordered, night-time medications were recorded as given, included Lyrica at 5:00p.m., and 10:00 p.m., Librium at 5:00p.m., Elavil at 9:00p.m., Phenobarbital at 9:00p.m., Sertraline at 9:00p.m. and Buprenorphine at 11:00 p.m.
22. The records note that A.S. was able to go to sleep with no further distress. At the bottom of this page in the medical records the time is written as 3:30 (a.m. is presumed) and the hours slept is noted as “8” and “slept through the night.” In light of the fact that A.S. was discovered dead at 6:20 a.m., it is difficult to see how this record could be accurate.
23. Further troubling is the fact that Lyrica, Robaxin, Clonidine, and Librium were noted as having been administered at 7:00a.m. on February 23, 2012, after A.S. was found dead.
24. Nurses discovered A.S. lying “supine” in his bed with rigor mortis about 6:20 a.m., according to the records. However, the dictated record of Dr. G.M., who came from the Emergency Department of Mission Hospital to assist in resuscitation efforts, observed that A.S. had “obvious lividity with pooling of the blood in the anterior aspect of the body …. ” Dr. G.M. also noted 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 seizure.
25. The sheriff’s records indicate that A.S. was found in a supine position with evidence that he had been turned from the prone position. No evidence of extra pills was found in A.S. ’s room, nor signs of trauma. According to the Orange County Sheriff-Coroner the cause of death was “[a]cute poly drug intoxication due to combined effects of buprenorphine, sertraline, norsertraline, bupropion, anitriptyline, lidocaine chlordiazepoxide, methocarbamol and tetrahydrocannabinol.” It was noted that none of the substances were at toxic levels. Furthermore, examination of A.S.’s heart revealed left ventricular enlargement but no evidence of atherosclerosis.
26. Notably absent in the coroner’s toxicology report were metabolites of Lorazapam, Flurazepam, Alprazolam and Phenobarbital, some of which A.S. had reportedly received within the prior 24-36 hours.
FIRST CAUSE FOR DISCIPLINE
(Unprofessional conduct -repeated negligent acts)
27. By reason of the matters set forth above in paragraphs 14 through 26, incorporated herein by this reference, Respondent, Daniel Headrick, M.D., is subject to disciplinary action under section 2234, subdivision ©, in that he engaged in unprofessional conduct constituting repeated negligent acts. The circumstances are as follows:
28. Respondent’s use of multiple medications was unsupported by the medical records since withdrawal from Opiates or Benzodiazepines was not demonstrated, nor was insomnia or pain consistently proven. 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. Thus, Respondent’s use of multiple medications with unpredictable consequences constitutes negligence.
29. Respondent’s simultaneous administration of sedatives such as Phenobarbital, Lyrica and Librium with the opiate Buprenorphine is contraindicated due to the risk of respiratory arrest and constitutes negligence.
30. Respondent’s simultaneous ordering of 10 medications without a record of symptoms supporting a diagnosis, together with the high risk of adverse effects for these medications constitutes negligence.
31. Respondent ordered vital signs for A.S. only when he was awake, although he was a new patient. This failure to order vital signs every two hours constitutes negligence, and taken together with other negligent acts as set forth above, constitutes repeated negligent acts.
SECOND CAUSE FOR DISCIPLINE
(Failure to Maintain Adequate and Accurate Records)
32. By reason of the matters set forth above in paragraphs 14 through 31, incorporated herein by this reference, Respondent is subject to disciplinary action under section 2266 in that he failed to maintain adequate and accurate medical records for patient A.S. The circumstances are as follows:
33. Respondent is the Chief Operating Officer, owner and only physician at MPCRC and bears responsibility for system deficiencies and individual documentation errors of the nursing staff, as well as his own lack of appropriate documentation.
34. Respondent failed to maintain adequate and accurate medical records for A.S., which constitutes a violation of section 2266.
*Note: There were some inaccuracies about “A.S.” in the medical board accusation which have been verified and changed for this blog post.
THREE DOCTOR’S DECLARATIONS IN THE MEDICAL NEGLIGENCE DEATH CASE OF ALEX SMICK
DR. DAVID Y KAN, M.D. 1
1. “Dr. Headrick’s prescribing pattern is a deviation from the usual standard of care in that he mixes medications excessively and redundantly.”
2.”Dr. Headrick’s prescribing for benzodiazepine (Alprazolam) detoxification also demonstrates redundant medications. He prescribed and (Alex) received both Chlordiazepoxide and Phenobarbital. This is a well-known dangerous combination.”
3. “The initiation of multiple redundant medications with known sedative effects fell below the usual standard of care and directly lead to (Alex’s) death.”
Dr. Michael Rigas, Pharm.D. 2
Graduate USC School of Pharmacy
1. “It is my opinion that the performance of Dr. Headrick and Mission Hospital Recovery Center nursing staffs were a departure of the standard of care.”
2 “Based on Dr. Headrick’s orders the nursing and medical assistant staff at Mission Hospital Recovery Center should have been monitoring the decedent at least hourly…and throughout the night in order to access the level of withdrawal and subsequent medications that were ordered to treat the withdrawal. This level of monitoring did not occur.”
Dr. Timothy Fong, M.D. 3
“It is my opinion that Dr. Headrick’s care of Alexander Smick did not meet the standard of care. The combination of medications that Alexander Smick was prescribed and dispensed was unnecessary. This combination did not come from any clearly documented clinical rationale and it did not follow evidence-based treatment guidelines for inpatient detoxification. Dr. Headrick failed to recognize potentially lethal drug-to-drug interactions. He followed PCRC detoxification orders reflexively without taking into consideration the presenting clinical evidence and unique history of this case that would be necessary to create an individual detoxification plan. As a result of these failures to meet the standard of care, Alexander Smick was exposed to a combination of prescribed medications that directly lead to his death.”
Dr Headrick’s locations:
Tres Vistas Recovery Center
Headrick Medical Center
243 Avenida La Cuesta
San Clemente, CA 92672
Headrick Medical Center
34085 Pacific Coast Highway Suite 203
Dana Point, CA 92629
1. From “Declaration of David Y. Kan, M.D. In support of plaintiffs Timothy Smick and Tammy Smick’s opposition to defendant Daniel J. Headrick, M.D.’s motion for summary judgment.” (Public record available at the Orange County Superior Court)
2. From “Declaration of Michael Rigas, Pharm.D. In support of plaintiffs Timothy Smick and Tammy Smick’s opposition to defendant Daniel J. Headrick, M.D.’s motion for summary judgment.” (Public record available at the Orange County Superior Court)
3. From “Declaration of Timothy Fong, M.D. In support of plaintiffs Timothy Smick and Tammy Smick’s opposition to defendant Daniel J. Headrick, M.D.’s motion for summary judgment.” (Public record available at the Orange County Superior Court)
Dr. Daniel Headrick used as an “expert” in a Medical Board Case against another doctor.
It doesn’t appear that the Medical Board found his testimony very convincing. Makes one wonder about doctors sticking together and supporting one another when they’re in trouble. (LINK)
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