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Lebanon — A Dartmouth-Hitchcock Medical Center anesthesiologist accused of stealing powerful pain drugs for his personal use and falsifying medical records has voluntarily stopped practicing medicine and entered a program for doctors with addiction, alcohol and other behavioral problems.
Dr. Christopher Manfred’s agreement, on Jan. 31, to seek treatment came one day after the New Hampshire Board of Medicine invoked a law applicable “in cases involving imminent danger to life or health” and suspended the medical license he had been issued in 2010.
A day later Manfred agreed voluntarily to stop writing prescriptions or treating patients, but did not admit to violating state law. Messages left for Manfred and his attorney, Cinde Warmington of the Concord firm of Shaheen and Gordon, were not returned.
The agreement resolved a case that opened with allegations that Manfred had taken hydromorphone, a semi-synthetic opioid derived from morphine, from the hospital and altered patient records to hide his actions.
Those allegations came after a routine audit by managers of DHMC’s pharmacy found a “statistically higher utilization of hydromorphone” by a doctor who was later identified as Manfred, according to the board’s order. On Jan. 23, Manfred “admitted to diverting ‘a few vials’ for his personal use and falsifying records to hide his actions,” according to the order.
Pharmacy managers later determined that since September, Manfred had taken 166 vials from the hospital.
New Hampshire has about 4,000 professionally active doctors, according to the Kaiser Family Foundation, a nonprofit health issues analyst. In fiscal 2015, the state Board of Medicine, which oversees the state’s licensed physicians, closed 436 “matters,” including 17 in which it took disciplinary actions including nine settlement agreements, three practice restrictions and two license suspensions.
To settle his case, Manfred agreed to enter into a contract with the New Hampshire Professionals Health Program, a nonprofit organization in Amherst that oversees treatment and arranges drug testing for physicians, physicians’ assistants, dentists, pharmacists and veterinarians.
Manfred, who graduated from the University of New Jersey medical school in 2008 and completed a residency at D-H in 2010, won’t be alone.
The number of contracts overseen by the program generally ranges from 35 to 55, with the greatest number dealing with alcohol abuse issues, said Sally Garhart, the program’s medical director since 2002. The contracts normally last five years and the program had “a whole lot of graduates in 2016,” she said.
Physicians find, Garhart said, that “professional stress is high” in a job that demands a high level of attention to detail and perfectionism.
The disclosure of the allegations against Manfred came against the backdrop of a statewide opioid crisis. The total of drug overdose deaths in New Hampshire is now projected at 477, according to the Office of the Chief Medical Examiner. About 320 of those 434 overdose deaths confirmed so far involved fentanyl, a synthetic opioid that, according to the National Institute of Drug Abuse, “is similar to morphine but is 50 to 100 times more potent.”
But New Hampshire doctors have proven vulnerable to other perils. “We have not seen an increase in opioid use among health care professionals,” Garhart said. “Alcohol is still the number one problem.”
Manfred was accused of abusing hydromorphone, which is used “to relieve severe pain in people who are expected to need pain medication around the clock for a long time and who cannot be treated with other medications,” according to MedlinePlus, a website maintained by the National Library of Medicine. The drug is an opioid, comes as a liquid or as a regular or extended-release tablet and may be habit forming, according to the website.
Hydromorphone “may cause serious or life-threatening breathing problems, especially the first 24 to 72 hours of” treatment or after a dosage increase, according to MedlinePlus. In some states it is included in the drug cocktails used in executions.
More widely, hydromorphone use has grown at a faster rate than the use of morphine, according to a 2015 article in the journal, Pain Research and Treatment. Compared to morphine, hydromorphone has “a faster onset of action and greater euphoric effects,” the journal reported.
Manfred agreed not to resume practicing medicine without a green light from Garhart and the state Board of Medicine.