"It's craziness," said Wanda Abell Meade, a Marion County native who now manages nine nursing homes in eastern Kentucky, southern Ohio and West Virginia, "Just craziness!"
Meade was alerted to the existence of Lebanon's new pain clinic when a nurse who works for her showed her a quarter-page ad for Lebanon Medical Solutions in the July 28th edition of The Journal-Times, the newspaper for Grayson, Kentucky, which is 162 miles east of Lebanon; no ads have appeared in Lebanon's local newspaper. "Specializing in complete pain management," the ad said, "Walk-ins welcome. Now accepting new patients."
Alarmed by what she saw, Meade asked a member of her nursing staff to call the pain clinic. The nurse was told that all one had to bring was an MRI less than two years old, $200 in cash, and a fax number for your pharmacist. What normal person carries around copies of their MRI? To Meade and her medical staff, this was a red flag.
"Many long-term care facilities have had issues with drug diversion," Meade told MCL, meaning the theft and misuse of drugs like Percocet, Loritab and Oxycontin -- the three drugs Meade identified as being the greatest culprits from her experience. So given her role as a long-term care facility administrator in an area particularly hard-hit by the pain pill pipeline, the last thing Meade wanted to see was the problem moving into her hometown.
"I love Marion County. I'm from there," she said. "I love Lebanon, and I think there's enough people in Lebanon to keep that from happening there."
Meade is not alone in her concern. In the one month since it opened, Lebanon Medical Solutions has sent a shock wave throughout Lebanon's medical community, as its members try to piece together the clinic's suspicious activity. Although regular business hours and a phone number are painted on LMS's door, phone calls to that number often yield no answer and no voicemail during regular business hours, and the days and hours posted on the door are not reliable indicators as to which days it will actually be open.
Yet when it does open, cars spontaneously arrive from as far away as Leitchfield (80.8 miles away), Wolfe County (129 miles away), and Paducah (222 miles away), according to a Trade Center businessperson, and those cars are filled with four or five people per vehicle -- all seeking prescriptions from LMS, according to a local pharmacist, who will no longer fill prescriptions written there.
Who runs Lebanon Medical Solutions, LLC?
Members of the Lebanon medical and pharmacist community identify two doctors writing prescriptions at LMS: Najam Azmat, MD, license number 32661; and Michael Maynor, MD, license number 23140. According to the Kentucky Board of Medical Licensure, both doctors graduated from medical school in 1982, Maynor from the University of Louisville and Azmat from Khyber Medical College in Peshawar, Pakistan.
The two doctors have taken significantly different routes to the Lebanon Trade Center pain clinic.
Dr. Najam Azmat worked as a vascular surgeon at Hardin Memorial Hospital in Elizabethtown, Kentucky beginning in November 1996. After a year of work there, his supervisors informed him that he must submit to greater oversight since 23 percent of his procedures resulted in complications, according to court documents. After consenting to voluntary oversight, Azmat attempted to remove the Adverse Action Report against him from the National Practitioner Database, maintained by the Dept. of Health and Human Services. When HHS denied his claim, Azmat filed suit -- Azmat v. Shalala -- in July 1999, court documents show. Since the burden was upon Azmat to prove "the absence of a genuine issue of any material fact," Judge Charles Simpson ruled against Azmat in 2001.
While at Hardin Memorial Hospital, at least three civil suits were filed against Azmat in Hardin Circuit Court, all of which are public record.
In the summer of 2005, Dr. Azmat moved to Waycross, Georgia, to work at the Satilla Regional Medical Center's Heart Center cath lab, according to court documents. While at the Waycross hospital, the U.S. Department of Justice alleges that Azmat and hospital administrators engaged in a series of fraudulent activities, including submitting false Medicare and Medicaid claims "for totally worthless medical services;" for "upcoding" fees in order to "overcharge or double bill" for services; causing in at least six patients, "extremely serious and life-threatening complications as a result of open procedures negligently performed"; and most seriously, for allegedly perforating a patient's renal artery during a procedure that the DoJ claims was "not medically necessary" and which "caus[ed] the patient to die."
You can read the entire 31-page complaint against Azmat here:
The DoJ complaint against Azmat is on-going, and has made news within legal circles as recently as August 11, 2010 -- during the period when Azmat was actively writing prescriptions for dangerously addictive drugs in the Lebanon Trade Center on a cash-only basis. Dr. Michael Maynor, Azmat's partner at LMS, has led a less turbulent past than Azmat, but still appears to be somewhat of a vagabond. Maynor might have worked in Sumter, SC around 2006, according to an online doctor listing. In late 2007, he worked briefly at the Seven Rivers Regional Medical Center in Crystal River, Florida. According to a Seven Rivers spokesperson, Maynor worked fewer than 10 shifts in his time there as a contract employee.
In 2009, Dr. Maynor worked as a clinical assistant professor at the LSU Medical School, Department of Emergency/Hyperbaric Medicine, where he authored a paper on necrotizing faciitis, or rotting skin disease. In 1997, Maynor appears to have published a paper in Academic Emergency Medicine on Brown Recluse Spider Devenomization using hyperbaric oxygen therapy.
Given his apparent publishing history, Dr. Maynor seems as scholarly as Dr. Azmat seems litigious -- making an odd couple of doctors to end up as partners at a pain clinic in the Lebanon Trade Center: a seemingly incompetent vascular surgeon and an emergency room doctor with a background in hyperbaric medicine and a tendency not to stay in one place for very long.
Despite what MCL was able to determine about Drs. Maynor and Azmat in the past week, questions remain:
One online listing shows Dr. Maynor with a Louisville address but with a phone number from Charlotte, NC, area code 704.
On one online doctor profile, a phone number for Dr. Azmat -- area code 419 -- rings to Mercy Hospital in Toledo, Ohio, but a spokesperson for Mercy tells MCL via email, "we do not show Dr. Azmat as ever having privileges or practicing within our system." The Toledo phone number appears on many of Azmat's online doctor profiles, including this one, which also includes a fax number for Azmat with a 402 area code, which belongs to the University of Nebraska Medical Center in Omaha. A representative from UNMC tells MCL, "Dr. Azmat is not one of our physicians."
Calls to a 502 number for Dr. Maynor have not yet been returned. No active number could be found for Dr. Azmat. Of the five different listings for Azmat in the 270 area code, two ring to a different doctors' offices; two are disconnected; and one rings to, " the home of the Bio Burner," according to its outgoing voicemail message.
Inside the pain clinic:
MCL checked out Lebanon Medical Solutions on three consecutive days last week. Despite its posted hours on the door, LMS was closed on Tuesday and Wednesday, before lunch and after. On Thursday, the lights were on and the sign said, "OPEN," so MCL went in to check things out.
In front of the clinic, a car with Greenup County plates (185 miles away) sat idling while someone smoked a cigarette inside.
The interior of the pain clinic is divided by a wall about twenty feet inside the front door to make a waiting room. Beside the door that leads to the back of the clinic is a pay counter and a sliding-glass window into a nurse's office. Behind the window, an attractive young female nurse greeted her visitor with a smile.
"Do you take insurance here?"
"No," she said. "Not at this time."
In response to a second question, she replied, "You'll have to ask them," before disappearing into the back room, leaving the inquisitive walk-in alone in the waiting room with two women, one with a severe spinal deformity and aluminum crutches. To accommodate patients like these, how many handicapped parking spaces does Lebanon Medical Solution provide in front of the clinic? Exactly zero.
In fact, LMS instructs even its most handicapped patients to park far away from the front door, as this photo of the clinic's "RULES OF THIS OFFICE," illustrates clearly, despite its errors in grammar, spelling and punctuation:
NAI Isaac, a Lexington-based property management firm announced the Trade Center's new tenant on June 3, 2010, saying that clinic would open on August 1 in a 1,300 square foot business formerly occupied by an H-and-R Block. An NAI Isaac property manager declined to answer MCL's questions regarding the tenant at 110 Lebanon Trade Center.
According to the Secretary of State's office, LMS was incorporated on March 17 by a local attorney who serves as LMS's registered agent and organizer. The incorporation documents list LMS's mailing address not at 110 Lebanon Trade Center, but rather a vacant house on a dead-end street.
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