Arkansas medical board limits telemedicine weight‑loss practice after investigation finds staff made medication changes without physician documentation

The Arkansas State Medical Board voted to revoke‑and‑stay the license of Dr. Joseph Zitterman and placed disciplinary restrictions on his ability to prescribe weight‑loss medications after investigators found repeated instances where clinic staff adjusted dosages or switched GLP‑1 therapies without documented physician authorization.

The board’s action follows a multi‑week investigation described at Tuesday’s meeting, during which Arkansas Department of Health investigator Nick Scholl summarized his review of clinic operations and medical records for ten patients. Scholl said clinic records showed repeated dose increases and medication switches—often recorded by medical assistants—without corresponding, dated physician notes. ‘‘The charting suggested medical assistants were making medication changes that require professional medical judgment,’’ Scholl told the board.

Independent board expert Dr. Daniel Pace, a family physician who reviewed the same charts, said the changes involved complex judgment and that several patient records lacked an H&P or a clear physician–patient relationship before treatment began. ‘‘Even when doses were within manufacturer recommendations, dose adjustments and medication changes require documented physician evaluation and judgment,’’ Pace said.

Zitterman, who testified he worked remotely because of a medical disability, said he followed written dosing protocols for titration and that staff were instructed to contact him with any side effects or departures from the plan. He acknowledged gaps in paper charting and said some follow‑up notes the clinic later produced were incomplete. ‘‘I relied on the clinic owner and staff to supply the documentation I requested,’’ Zitterman said. ‘‘I never intended to practice outside the law or put patients at risk.’’

After deliberation the board voted unanimously to adopt findings that the clinic’s recordkeeping and delegation practices violated board rules on delegation and the medical practice act. The board imposed a revoke‑and‑stay penalty (two‑year stayed revocation), ordered no weight‑loss prescribing for one year, required board‑approved continuing medical education in recordkeeping, telemedicine regulation and weight‑loss pharmacotherapy, and directed that any future worksite be approved by the board before practice resumes. The board also assessed a $1,000 civil penalty, payable within two years, and referred pharmacy matters to the Arkansas State Board of Pharmacy for follow‑up.

The board’s order said the primary concern was not the choice of GLP‑1 drugs but the clinic’s model, which allowed unlicensed or unsupervised staff to implement medication changes without contemporaneous physician documentation. The board repeatedly emphasized that telemedicine can be legal in Arkansas when an equivalent clinical assessment and appropriate documentation exist, but that procedures must be established and followed.

The board’s action leaves Dr. Zitterman eligible to reapply to practice if he meets the board‑imposed conditions and the board approves his next site. ‘‘I will comply with whatever the board requires,’’ Zitterman said at the hearing.

The board also asked state pharmacy investigators to review whether the clinic used out‑of‑state compounding pharmacies in ways that violated pharmacy rules; the board may pursue separate referrals if pharmacy regulators find violations. The board’s written order will set forth monitoring and reporting requirements required before any return to practice.

The board’s decision is subject to appeal in state administrative court; the board said it will publish the final order and the avenues for appeal to Dr. Zitterman.