Questions swirl around doctor, clinic in DHEC inquiry

By Matt Tomsic
mtomsic@scbiznews.com
Published June 17, 2013

In September 2011, Tri-County Spinal Care Center began offering pain relief injections, and the facility’s owner, Cameron Wills, hired a physician to provide them.

Since then, three patients who received injections at Tri-County Spinal Care have tested positive for hepatitis B; the S.C. Department of Health and Environmental Control has found lapses in infection control and injection procedures; and hundreds of the clinic’s patients have been asked to undergo testing for hepatitis B, hepatitis C and HIV. The clinic isn’t regulated by DHEC, officials said.

DHEC “has confirmed three cases of hepatitis B involving patients treated by the contracted physician,” according to an order from the S.C. Department of Labor, Licensing and Regulation, which licenses chiropractic examiners and medical examiners. A separate order from the state medical board has temporarily barred Richard Kellett, the only medical doctor listed on Tri-County’s website, from practicing medicine. The board suspended Kellett the day after DHEC issued its first public health order for the clinic.

The orders and other public documents shed more light on DHEC’s investigation and the circumstances surrounding the infections, the clinic and Kellett, who was reprimanded in 2007 after he admitted to diverting narcotic painkillers for his personal use.

A DHEC spokesman hasn’t acknowledged further and repeated questions about the clinic and why it isn’t regulated by the state agency. Wills and Kellett also didn’t return messages seeking comment.

‘Several lapses’
O
n May 20, DHEC ordered the North Charleston clinic, located at 8626 Dorchester Road, to stop all invasive procedures after three patients treated there tested positive for hepatitis B.

“All three patients received spinal injections with common medications performed at Tri-County Spinal Care Center on the same dates in February 2013,” according to the DHEC order. “Until the source of this infection can be completely investigated and steps approved by the department to prevent the spread of the disease can be implemented, Tri-County Spinal Care Center must cease to perform all invasive procedures, including but not limited to injections.”

According to state law, chiropractors aren’t allowed to give or administer medication, said Norman Ouzts, a chiropractor in Greenwood. Ouzts is the president of the National Chiropractic Board of Examiners.

“There would be nothing that would preclude a chiropractor from owning the facility,” Ouzts said, adding he knows several facilities that have chiropractors as well as medical doctors who perform their licensed services. “He could not provide the services.”

Tri-County continues to provide noninvasive care and cooperate with the investigation, the company said in a news release.

“We are surprised and very concerned for our patients,” Wills said in a news release. “This is very shocking to us. Lab tests have not yet confirmed how these infections were contracted. We are working feverishly with DHEC to scrutinize every element of our procedures. This is perplexing because we use prepackaged sterile supplies.”

A week later, DHEC expanded its investigation, asking that patients of the clinic who received spinal, joint or other injections since 2011 be tested for hepatitis B, hepatitis C and HIV. The agency found 526 patients at risk of infection.

“The department’s investigation has found several lapses in infection control procedures and injection practices have occurred at Tri-County Spinal Care Center,” according to a public health order issued to the clinic May 29. “The department is informed that the clinic’s injection practices have not changed since these procedures were first offered in September 2011, and the department cannot ensure that patients who received injections at any time since then were not exposed to a bloodborne pathogen.”

Tri-County responded to the second announcement, saying it will continue to cooperate with investigators.

“We have always used sterile, single-use supplies for injections,” Wills said in that news release. “We do not reuse syringes or needles.”

DHEC’s authority
DHEC doesn’t regulate chiropractors or medical doctors, said Carl Roberts, an attorney with Haynesworth Sinkler Body in Columbia. Roberts is a former general counsel for DHEC.

“There may be some incidental regulation if a chiropractor has an X-ray machine,” Roberts said. “Then DHEC may regulate the X-ray machine. There’s nothing in state law that gives DHEC authority to regulate a doctor’s office or chiropractors’ offices or dentists or other medical professionals.”

DHEC does have authority over issues of public health, though, Roberts said.

“That can give DHEC authority in areas that they don’t otherwise specifically regulate,” he said.

The agency regulates controlled substances, Roberts said.

According to the agency’s website, DHEC’s Bureau of Drug Control enforces the S.C. Controlled Substances Act. The law requires physicians, pharmacies, dentists, veterinarians and other professionals who deal with controlled substances to register with the bureau. The bureau also conducts site inspections and audits of its registrants and investigates complaints. As of press time, DHEC was not able to answer whether TriCounty was registered with the bureau.

On May 21, an investigator with Labor, Licensing and Regulation examined the facility’s medications, according to an affidavit filed by the investigator. State law also requires the state Board of Pharmacy to issue facility permits to allow certain drugs to be administered and stored. Examples of those facilities include clinics, wholesalers, manufacturers and distributors.

The investigator noted: “There are medications stored at this facility without proper permit from the Board of Pharmacy.”

License suspended, stayed
In 2007, the S.C. State Board of Medical Examiners publicly reprimanded Kellett and suspended his medical license, though the board allowed him to continue to practice under certain conditions.

Kellett was working at St. Francis Hospital in Greenville, and in 2006, he diverted a host of prescription pain relievers to self-medicate chronic back pain, according to a final order from the Board of Medical Examiners. Later that year, investigators arrested Kellett for diverting controlled substances without a prescription.

Kellett checked into a treatment facility for opioid abuse in September 2006, according to the order, and the criminal charges were resolved through his participation in a pretrial program.

A year later, the state medical board provided its decision for Kellett, fining him $5,000 and allowing him to continue practicing. The board had to approve his practice setting in advance, and Kellett couldn’t prescribe drugs with a Schedule II
classification, the same class of drugs Kellett had diverted for his own use. Kellett also had to submit to random drug and alcohol testing and participate in the S.C. Recovering Professional Program, which provides substance abuse treatment for health care providers.

Representatives with the S.C. Department of Labor, Licensing and Regulation weren’t available to say whether Kellett was still being monitored by the board.

Reach Matt Tomsic at 843-849-3144.

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