CLARKSVILLE, TN (CLARKSVILLE NOW) – A family medicine doctor’s clinic was raided by federal law enforcement last week, one month after he was placed on probation by the Tennessee Board of Medical Examiners.

On May 29, Dr. Ramon Aquino, owner and practitioner at North Clarksville Medical Clinic, was placed on probation by the Tennessee Board of Medical Examiners and restricted from prescribing opioids.

U.S. District Attorney spokesman Mark Wildasin confirmed to Clarksville Now that on June 25, agents from the Tennessee Bureau of Investigation, the Drug Enforcement Administration and other law enforcement agencies executed a search warrant on the clinic.

‘Matter of trust’ approach to opioids

According to documents from the Tennessee Department of Health, on May 28, the Tennessee Board of Medical Examiners approved a consent order taking disciplinary action against Aquino, which went into effect the following day.

Aquino prescribed controlled substances to 21 patients whose cases were reviewed by the board, but he didn’t keep patient records up to date with recent medical histories or physical exams, and he didn’t regularly check the Controlled Substance Monitoring Database, the order said. He also admitted he does not generally check the database when prescribing and that he does not perform pill counts, according to the order.

“(Aquino) admitted that he sometimes prescribes the ‘cocktail’ of benzodiazepine, opioid, and Soma (carisoprodol) even knowing this is not the right thing to do, but (Aquino) indicated that his patients want it,” the order states.

Additionally, he continued prescribing controlled substances to patients who had a history of positive urine drug screens for illegal substances or had a history of overdosing, stating that his method of monitoring his patients “is a matter of trust.”

He prescribed high doses that were “not medically necessary, advisable, or justified” for the diagnosed conditions, the order states. He often increased doses without clear medical reasons, especially without evidence of a chronic pain source to justify the ongoing and higher prescriptions. He also did not document a written treatment plan.

When Aquino prescribed these medications to patients, the order says he didn’t provide them with information about the risks and benefits and prescribed them in such a way that the patients would likely develop an addiction. In which case, he failed to make any effort to cure the habits or failed to document his efforts, and did not properly monitor, seek out or respond to signs of substance abuse.

Disciplinary action

Aquino was placed on a three-year probation, which will act as an encumbrance on his medical license. During this probation, Aquino can’t prescribe opioids or Soma for at least one year and can’t collaborate with any advanced practice registered nurse or physician assistant for issuing them either. Aquino also has to pay $9,250 in civil penalties and expenses related to prosecuting his case.

Clarksville Now has attempted to reach Aquino for comment.

This is not Aquino’s first time before the board. In March 2014, after reviewing 30 patient records, the board found he was prescribing opioids and benzodiazepines in amounts that weren’t “medically necessary.” He also did not utilize alternative treatment plans for his patients other than the continuation of controlled substances, the order said.

He was reprimanded, required to take educational courses and had to pay civil penalties and costs.

In February 2014, a Clarksville woman named Pamela Sheppard filed a suit on behalf of her late husband, Robert Sheppard, against Aquino and the clinic.

According to the court record obtained by Clarksville Now, during Mr. Sheppard’s routine office visits with Aquino, his urine tests consistently revealed traces of blood in his urine. From May of 2009 to November of 2012, in 13 visits, Aquino didn’t try to investigate the cause of blood in Sheppard’s urine or give him a referral.

In November 2012, Sheppard become aware of his condition when he saw the blood in his urine. The next month, Sheppard was seen by a urologist, and tests revealed he had bladder cancer that had spread to his spine, hips and legs. Despite treatment, the cancer was too advanced, and he died Sept. 22, 2013.

Mrs. Sheppard alleged that her husband’s death was the result of Aquino’s failure to recognize and diagnose his bladder cancer. The civil case was settled with undisclosed terms in 2015.

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