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Arkansas pain panel asks PA David Holt to seek changes after chart review
Summary
At a Sept. 12, 2024 meeting, the Arkansas State Medical Board’s Pain Management Review Committee found physician assistant David Holt’s charting generally sound but urged lowering opioid pill counts for several younger patients and asked Holt to consult his supervising physician and provide a follow-up note.
The Arkansas State Medical Board’s Pain Management Review Committee reviewed charts for physician assistant David Holt on Sept. 12, 2024, and asked him to consult his supervising physician, Dr. Silver, and send a follow-up note outlining any changes to patient management.
Committee lead Dr. Tilly told Holt the panel’s “overall theme for the reviews was not overly concerning,” citing consistent urine drug screens and pill counts but noting that signed pain-treatment agreements sometimes were not included in the one-year chart packet the committee received. “On all of the charts…they all had urine drug screens,” she said, while adding that some charts showed relatively large pill supplies.
Panel members highlighted specific prescribing details that prompted review. Dr. Tilly and others noted several patients receiving “4 to 5 hydrocodone a day,” which the committee characterized as roughly 120 to 150 pills over a month; she said that level, though under 50 morphine milligram equivalents (MME), can draw attention. “If you could dial those back, I try to keep most patients in my practice on no more than 3 pills per day,” Dr. Tilly said.
Holt described his practice at Meridian Medical, saying he works under Dr. Silver and that the clinic is referral-only, accepts standard insurance and puts patients on regular monitoring: “We have them come in…monthly, every other month, every 3 months, do a urine drug screen, pill count every visit” and periodically renew controlled-substance agreements.
Several committee members praised Holt’s documentation and monitoring. Dr. Clayton said initial confusion about materials was resolved by Holt’s supplemental response and that calculated MMEs were “in line.” Dr. Cannon said documentation “was good,” while noting that MME and pill counts each tell part of the picture and that clinicians should continue careful monitoring.
Dr. Wright pressed on longer-term treatment for some younger patients, asking whether the practice had concrete long-term plans beyond maintenance prescribing. “I didn’t feel like there was really any…concrete long term treatment plan for these patients,” Wright said. Holt responded that the clinic refers patients for interventional procedures or surgery when appropriate but acknowledged limitations posed by insurance and patients’ prior care.
After discussion, the committee sought a conservative, practical follow-up rather than disciplinary action. Dr. Tilly moved that Holt consult with Dr. Silver and provide the committee a follow-up letter describing any planned changes to prescribing or care; the motion was seconded and approved by voice vote. The committee also approved the meeting minutes for March 14 and May 9 earlier in the session.
The committee concluded that Holt’s documentation, urine testing and pill counts met standards for review but recommended efforts to reduce pill quantities where clinically feasible, particularly for younger patients on long-term regimens. The committee adjourned after requesting the follow-up note from Holt.
