Psychiatrist's license revoked

A report from The Desert Sun of Palm Springs, California

The California Medical Board has revoked a Coachella Valley psychiatrist's medical license, alleging gross negligence, prescribing drugs to addicts, lying to the board, failing to keep accurate medical records and having sexual relations with a former patient.

Richard Duboe Seigle, who was employed part-time by the county of Riverside from October 2002 to February 2007 and has had practices in Carlsbad and Monterey, can petition in three years for reinstatement, according to the medical board. His license, issued in 1981, was revoked May 30.

When contacted Friday, Seigle declined to comment.

An expert called to testify in May told the board that Seigle's care of one patient "was not the worst example of patient care she had ever seen provided by a psychiatrist, but it was close," according to a 49-page California Medical Board document outlining the case.

Lithium toxicity

Also according to that document, a female patient he began treating in April 2000 had a diagnosis of borderline personality, depression, and possible attention deficit disorder, and said she was taking Thorazine, Klonopin, Prozac and Seroquel as well as several other medications.

Seigle prescribed her Adderall, Ritalin, Depakote, Klonopin, Prozac, Xanax, Effexor XR and Thorazine.

In November 2000, Seigle started her on lithium , but did not get blood and other tests.

"In July 2001, Dr. Seigle noted (the patient) was having difficulty speaking and that her speech was slurred. Dr. Seigle was unfamiliar with the signs and symptoms of Lithium toxicity and despite the clear signs indicating possible Lithium toxicity, Dr. Seigle did not order a blood test to determine (the patient's) Lithium level. At the time, (the patient) was taking somewhere between 1,200 and 1,500 mg," the medical board document stated.

When blood tests were ordered by another physician, it became clear her lithium level was 2.2, well into the toxic range.

"Upon learning of the patient's elevated lithium level, Dr. Seigle did not order a further workup; instead he directed that (the patient) discontinue taking lithium for 24 hours and then resume lithium at a dose of 600 mg daily."

The patient stopped seeing Seigle, but the two continued to exchange e-mails. In January 2006, Seigle messaged her that he had been reported to the medical board by a patient who had been on pain medications.

"If you filed with the board, I would not be able to work with poor people anymore. If I lose my license, I would no longer be able to prescribe medications. I see about 15 people a day three times a week. That is a lot of people to help. They feel like you did at one time, that I was the best psychiatrist they have ever seen."

The Desert Sun contacted several psychiatrists outside the case for their take on this incident.

Dr. Donna Mehrejany, who specializes in adult, child and adolescent psychiatry in La Jolla, said: "I don't ever start more than one medication at a time."

As for the lithium: "It's standard practice to obtain lab work when you prescribe a drug like lithium," said Dr. Andrew Elliott, of Palm Springs.

Possible relationship

Seigle is also alleged to have had a sexual relationship with a former female patient who had a history of alcoholism, depression, bipolar mood shifts, suicide attempts and obsessive-compulsive disorder. She was his patient from 1998 to 2002.

In 2004, the two stayed at a bed and breakfast in Idyllwild, attended a tennis match, and visited valley casinos. Seigle also invited her to a beach house in Rosarito, Mexico, where he ordered margaritas, knowing she was a recovering alcoholic.

A psychiatrist who testified about the ethical issues said the relationship "involved several extreme departures from the standards of care incumbent upon a psychiatrist."