Doctor who quit US post was warned by state

Two months before he resigned from a top federal family planning position, Marblehead gynecologist Eric Keroack received two formal warnings from the Massachusetts board of medicine ordering him to refrain from prescribing drugs to people who are not his patients and from providing mental health counseling without proper training.

Keroack resigned last week as head of the US Office of Population Affairs, which is responsible for providing low-income women with access to contraceptives, after he was notified that the state's Medicaid office had launched an investigation into his private practice. The office, whose investigations generally focus on Medicaid fraud, declined to provide specifics about what it is investigating but confirmed there was a pending case dating back a "few years."

The warnings from the Board of Registration in Medicine stem from a complaint filed in May 2005 by the daughter of one of Keroack's patients, who said he overmedicated her mother, prescribing several powerful psychotherapeutic drugs, and "brainwashed" her into thinking she was "severely depressed."

The daughter, whose name was withheld, also said Keroack gave her parents money and presents, and allegedly issued a fraudulent prescription for the anti depressant Zoloft to her sister -- who had insurance -- when their uninsured mother became unable to pay for the prescription herself.

In his response to the board, Keroack acknowledged that he had switched the prescription, saying that he had recently given the complainant's sister several free samples of Zoloft. With the prescription in hand, he said, the sister would then be able to pass the samples on to his patient. He said it was like "killing two birds with stone."

He also acknowledged giving the patient money and presents, but denied overstepping the patient-doctor boundary, as alleged in the complaint.

"I am guilty of being generous to a fault in the care of this couple and their family," said Keroack, who has a degree from the Tufts University School of Medicine.

"It seems that being aware of the dynamics in a family that I have taken care of for over 12 years has somehow been interpreted to be atypical, abnormal, and a violation of boundaries," he wrote the board. "This is a sad reflection on the state of what is considered normal within today's medical care system. In my opinion, it does not serve a patient's best interest to whisk them in and out of an office visit in 15-20 minutes, learning nothing about their actual every day life."

President Bush appointed Keroack -- a doctor known for his anti abortion work and advocacy for abstinence programs -- to lead the federal government's family planning efforts in November, triggering an immediate outcry from abortion-rights activists. He had been on the job less than five months when he announced his resignation last week.

In the 2005 complaint, the patient's daughter, who had once been Keroack's patient, alleged that the doctor gave her mother money for groceries, evenings out with her husband, and a Cape Cod getaway for the couple. "What MD does this???" the daughter wrote the board of medicine in writing.

But she seemed most upset by a letter he had recently sent urging her to make peace with her parents, who had both been diagnosed with cancer.

Using exclamation points, all-capitalized sentences, and quotes from country singer Randy Travis, Keroack urged his patient's daughter to make up with her mother "before it's too late to fix it." "If either of your parents were to die tomorrow . . . . YOU and ONLY you will be responsible for the losses that will surely follow," wrote the gynecologist, now 47.

In her complaint to the board, the daughter wrote: "I haven't been able to sleep; I am upset all of the time because I cannot get over the fact the he would have the audacity to send me such an invasive, unethical letter."

Keroack could not be reached yesterday for comment. But in a 13-page letter to the board, he called the charges -- of insurance fraud, distributing medication to nonpatients, and behaving unprofessionally or unethically -- "patently false."

In a separate letter to the board, Keroack's patient defended him, telling the board that her daughter's complaint was "filled with false statements, distortions, misrepresentations and lies . . . ."

"Without Dr. Keroack's help, we would have been unable to put food on the table because medications cost us a fortune to buy," the patient wrote the board. "Dr. Keroack never asked for anything in return for these generous gifts, he merely asked that we accept them as being from him personally because he felt that we deserved to be helped. I admit it is unusual for people to display such generosity in today's world . . . but it isn't improper. It is right."

On Jan. 10, the board of medicine sent Keroack two letters. One warned him against practicing psychotherapy with patients without adequate training and supervision. "Should you choose to pursue this practice, you should do so only after receiving education in the identification and management of boundary issues," the letter said.

Doctors are barred from doing anything that oversteps the clear boundary between doctor and patient. "That can be a lot of things," explained board spokesman Russell Aims, "anything from a psychiatrist having sessions at the patient's home or a doctor driving a patient someplace after an appointment to loans, personal gifts, favors."

The second letter warned Keroack to conform to the state's prescribing practices. "You should familiar[ize] yourself with the Board's policy and adhere to the guidelines to avoid problems in the future. You may not prescribe to individuals who are not your patients," the letter said.

A warning is not considered disciplinary action, which would be reported to federal authorities, Aims said. Keroack came under heavy criticism from abortion rights advocates for his connection to crisis-pregnancy centers that show ultrasound images of fetuses to pregnant women in an effort to dissuade them from having abortions.