STATE OF MAINE BOARD OF VETERINARY MEDICINE

IN RE: Margaret M. Linnell, D.V.M. ) CONSENT Complaint No. 2009-VET-6052 ) AGREEMENT

This document is a Consent Agreement concerning disciplinary action against

the license of Margaret M. Linnell, D.M.V to practice veterinary medicine in the State of

Maine. The parties to the Consent Agreement are: Margaret M. Linnell, D.V.M.

("Dr. Linnell"); the State of Maine Board of Veterinary Medicine ("Board"); and the Maine

Office of Attorney General rAttorney General"). The Consent Agreement is entered

into pursuant to 10 M.R.S.A. 8003(5-A)(A)(5) and (C).

FACTS

1. Dr. Linnell holds a license to practice veterinary medicine in the State of

Maine. She is the owner operator of South Berwick Veterinary Hospital, a veterinary

clinic located in South Berwick, ME.

2. On December 16,2009, the Board received a complaint ("Complaint")

against Dr. Linnell's license from Thomas E. Avery ("Mr. Avery'). the Board investigator.

The Complaint alleges, among other things, that Dr. Linnell admitted that she had

diverted and abused liquid Hydrocodone, Valium and Tramadol tablets, and Alprazolam

from her veterinary practice from late 2008 through July 2009 to both Mr. Avery and a

U.S. Drug Enforcement Administration ('"DEA") agent on November 17, 2009.

In addition, Dr. Linnell admitted that she also had diverted and abused liquid morphine

and replaced it with sterile water to conceal the diversion from her staff. The Complaint

further alleges that Dr. Linnell admitted to a history of abuse of prescription opiates and

alcohol and that she had undergone substance abuse rehabilitation eighteen (18) years

before.

3. Dr. Linnell voluntarily surrendered her DEA registration to the DEA agent

on November 17, 2009. As a result, Dr. Linnell is no longer permitted to store, order,

prescribe, dispense or administer controlled substances.

4. On March 1, 2010, the DEA seized all controlled substances from

Dr. Linnell's practice as a result of reports from Dr. Linnell's employees, including the

other licensed veterinarian, that Dr. Linnell had administered controlled substances to

animals on at least two (2) separate occasions since she surrendered her DEA

registration. In addition, the other licensed veterinarian employed at Dr. linnell's

practice voluntarily agreed to restrict her DEA registration rights with respect to

controlled substances to prescribing only in order to avoid any responsibility for

controlled substances at Dr. Linnell's practice. There is no evidence or allegation of any

illegal or unethical practice by the other licensed veterinarian.

5. In her response to the Complaint dated January 2, 2010, Dr. Linnell

admits that she suffered a substance abuse relapse in the late fall of 2008 through July

2009 spurred by a series of serious personal losses. In July 2009, Dr. Linnell voluntarily

admitted herself into an in-patient substance abuse rehabilitation treatment program.

Dr. Linnell also states that upon completion of the substance abuse rehabilitation

treatment program, she placed all controlled substances and Tramadol, which is not a

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controlled substance, in the offICe safe and had the lock changed so that she does not

have the combination but rather must rely on employees at the practice to open the

safe.

6. Pursuant to 32 M.R.S.A. 4864(4), the Board may impose discipline for

the "chronic or habitual use of drugs."

7. Pursuant to 10 M.R.S.A. 8003(5-A)(A){2), the commission of any gross

negligence, incompetence, and/or misconduct by a licensee while engaged in the

practice of veterinary medicine is subject to discipline by the Board.

8. The parties have agreed to resolve the Complaint through the Consent

Agreement.

COVENANTS

In order to resolve fully the Complaint against Or. Linnell's license to practice

veterinary medicine without further legal proceedings, it is agreed to by the parties that:

1. Dr. Linnell admits that she engaged in the chronic andlor habitual use of

drugs while licensed as a veterinarian;

2. Dr. Linnell admits that she committed misconduct by diverting and abusing

prescription medications and controlled substances from her veterinary practice;

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3. Dr. Linnell agrees that her license to practice veterinary medicine will be

subject to a period of probation for a minimum of five (5) years during which Dr. Linnell

agrees that:

A. Practice Management Plan

Dr. Linnell will develop a written plan ('"Practice Management Plan")

describing in detail how she intends to conduct a veterinary practice as both the

owner and a practicing veterinarian in the absence of a valid DEA registration.

Dr. Linnell must submit the Practice Management Plan to the Board for prior

approval by the Board Complaint Committee within thirty (30) days of the date

upon which Dr. Linnell signs the Consent Agreement.

At a minimum, the Practice Management Plan must address how:

1. Dr. Linnell intends to conduct a veterinary practice in the absence of a

valid DEA registration, which is required for her to store. order,

prescribe, dispense and/or administer the controlled substances

necessary for the care of patients in the normal course of a veterinary

medicine practice. Specifically, the Practice Management Plan must:

a. identify what, if any, surgelies Dr. Linnell intends to perform and

how she intends to perform them, including a detailed protocol for

the use of anesthesia; and

b. describe how Dr. Linnell intends to treat and manage patient pain.

both chronic and acute;

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2. Dr. Linnell intends to care for patients in need of controlled substances

in emergency situations, including how clients will be made aware of

any periods when emergency services for their animals are

unavailable; and

3. Dr. Linnell intends to track and account for the use of all other

prescription medications and substances stored, ordered I prescribed J

dispensed andlor administered in her practice, which are not controlled

substances but which have the potential for abuse, such as Tramadol

or its brand names and generic equivalents;

B. Client Notification

Dr. Linnell agrees that during the frve-year probationary period she will

notify her clients of the limitations on her veterinarian practice by, at a minimum:

1. Posting a written notice ("Notice") on the main entry door describing

what aspects of veterinary medicine she may practice. The Notice

must be submitted to the Board for prior approval by the Board

Complaint Committee no later than thirty (30) days from the date upon

which Dr. Linnell signs the Consent Agreement;

2. Providing a copy of the Notice to each client at the time of the first

appointment after the onset of the probationary period and upon the

clienfs request at any subsequent time; and

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3. Providing an oral explanation describing what aspects of veterinary

medicine Dr. Linnell may practice at the time an appointment is

requested for a service which Dr. Linnell is not permitted to perform;

C. Abstinence Maintenance and Monitoring

Dr. Linnell agrees to abstain completely from the use of Prohibited

Substances.1 In furtherance of which, Dr. Linnell agrees to:

1. Provide the name(s), addressees) and telephone number(s) of her

primary care physician(s), dentist(s), and any other physician(s) or

healthcare provider(s) from whom Dr. Linnell in receives healthcare

andlor treatment to the Board at the time she submits the signed

Consent Agreement. Dr. Linnell agrees that she will notify the Board in

writing of any change in her healthcare provider(s) within five (5)

business days.

1 Prohibited Substances" as used throughout the Consent Agreement shall be defined to mean: Fentanyl; Hydrocodone; Percocet; Vicodin; Vicoprofin; DameTOI; Pentobarbital; Valium; benzodiazepines; barbiturates; opiates; alcohol; cocaine; mood, consciousness or mind-altering substances, whether illicit or not; Tramadol and its brand name and generic equivalents; and all drugs which are dispensed to or prescribed for Dr. Linnen by anyone other than a treating physician knowledgeable of her history of substance abuse, unless the circumstances constitute a genuine medical emergency.

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Dr. Linnell shall execute any and all releases necessary for the Board

to have access to any medical and/or mental health treatment records

related to the prescription of or treatment for any of the Prohibited

Substances; and

2. Provide a written list of all medications currently prescribed for her,

identifying the prescribing healthcare provider, to the Board at the time

she submits the signed Consent Agreement. Dr. Linnell agrees to

notify the Board in writing of any change in her in prescribed

medications within five (5) business days. Dr. Linnell further agrees

that the prescribing healthcare provider will notify the Board both by

telephone and in writing within forty-eight (48) hours, or as soon

thereafter as possible, jf any controlled drug is dispensed to or

prescribed for Dr. linnell. This notice shall be followed by a written

summary of all pertinent circumstances to be submitted to the Board

no later than five (5) business days;

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3. Dr. Linnell agrees to provide a written substance abuse monitoring

plan ("Substance Abuse Monitoring Plan") from her primary healthcare

provider by which he, she or a qualified designee agrees to:

a. Administer observed random drug-screening tests to Dr. Linnell for

all of the above-listed Prohibited Substances not less than two (2)

times per month. The healthcare provider shall also agree to

forward copies of all test results to the Board within seventy-two

(72) hours and to notify the Board within twenty-four (24) hours, or

as soon thereafter as is reasonably feasible, of receipt of any

positive result for any Prohibited Substance for which Dr. Linnell

does not have a valid prescription from a licensed healthcare

provider;

b. Submit written reports on a quarterly basis to the Board

addressing: Dr. Linnell's current physical and mental conditions;

any medications prescribed to Dr. Linnell; Dr. Linnell's compliance

with abstinence and testing requirements; and whether there is any

evidence of a change in Dr. Linnell's affect or presentation

indicating the use of a Prohibited SUbstance;

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4. Dr. Linnell agrees to submit a structured substance abuse plan

("Substance Abuse Plan") to the Board within thirty (30) days of the date

upon which Dr. Linnell signs the Consent Agreement. The Substance

Abuse Plan shall be designed to reinforce Dr. Linnell's abstinence and

shall include at a minimum:

a. Participation in individual and/or group counseling with a licensed

mental health or substance abuse clinician. Dr. Linnell agrees to

submit the name(s), address(es). and telephone number(s) of any

individuals with whom she engages in substance abuse counseling.

Dr. Linnell also agrees that she will ensure that her mental health

and/or substance abuse clinician(s) submit written reports addressing

her current physical and mental conditions, compliance with

counseling, and any evidence of a change in Dr. Linnell's affect or

presentation indicating the use of a Prohibited Substance to the Board

on a quarterly basis. Dr. Linnell shall execute any and all releases

necessary for the Board or its designee to obtain access to her

substance abuse counseling treatment records;

b. Attendance at Alcoholics or Narcotics Anonymous or other such

substance abuse support groups. Dr. Linnell agrees to submit

evidence satisfactory to the Board verifying her attendance at and

participation in an established, recognized substance abuse support

group to the Board on a quarterly basis. The verifying documentation

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must be issued by an identified third-party, who is both satisfactory to

the Board and available for the Board to contact for independent

corroboration;

D. Restoration of DEA Registration

If Dr. Linnell's DEA registration is restored, in whole or in part, such that

she is permitted to store, order, prescribe, dispense and/or administer controlled

substances as part of her veterinary medicine practice, Dr. Linnell must submit a

detailed protocol by which the use of controlled substances rControlied

Substance Protocol") will be monitored and safeguarded from abuse and

diversion. The Controlled Substance Protocol must be submitted to and

approved by the Board before Dr. Linnell exercises any privileges pursuant to the

restored DEA registration.

E. Right of Inspection

Dr. Linnell's practice premises, drug inventory logs, patient records drug

purchase orders and inventory history records will be made available for

inspection by Mr. Avery, the Board Complaint Officer, or any Board designee at

any time during business operation hours without any advance notice;

F. Reporting Requirements

Dr. Linnell will appear in person before the Board at its September 2010

meeting and at subsequent meetings thereafter specified by the Board, not less

than twice per calendar year, to report to the Board as to her practice

performance and her compliance with the Consent Agreement;

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G. Change of Circumstances

If Dr. Linnell changes her profession, relocates her residence or her

practice, or changes her work or home telephone numbers, she shall provide

notice to the Board within ten (10) days of such occurrence(s); and

H. Termination of Probation

Termination of Dr. Linnell's probation status will rest solely in the

discretion of the Board and will be determined based upon Dr. Linnell's progress

and compliance with respect to aU of the terms of the Consent Agreement;

4. Dr. Linnell agrees that any reliable evidence of use of any Prohibited

Substance without a valid prescription at any time in the future, whether in Maine or

elsewhere, shall constitute a violation of the Consent Agreement, for which her license

may be immediately and indefinitely suspended until such time as an adjudicatory

hearing may be scheduled before the Board;

5. Dr. Linnell shall bear all costs incurred in performance of the Consent

Agreement If a violation(s) of the Consent Agreement is proven to have occurred, the

Board may reqUire Dr. Unnell to reimburse the Board for all costs and attorney's fees

incurred in proving such violation regardless of any sanctions imposed for the actual

violation{s);

6. The Attorney General and the Board agree that no further agency or iegal

action will be taken against Dr. Linnell's veterinarian medicine license based on the

facts described herein, except in the event that Dr. Linnell does not comply fully with the

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terms of the Consent Agreement Any violation of the Consent Agreement will be an

additional ground for discipline before the Board:

7. The Consent Agreement is not subject to appeal;

8. The Consent Agreement is not subject to amendment except by written

agreement of all parties;

9. The Consent Agreement is a public document within the meaning of

1 M.R.S.A. 402 et ~.;

10. Dr. Linnell understands that the execution of the Consent Agreement is

completely voluntary and that she has the right to consult with an attorney before

signing the Consent Agreement; and

11. Dr. Linnell understands that her signature indicates that she has read and

understands the Consent Agreement and that she enters into it of her own free will.

Dated: -7-t-1--'(s'-t-'