A Seattle doctor who heads a chain of eight Washington pain clinics has been barred from practicing medicine after state regulators charged that he failed to properly monitor prescription use of powerful opiates, possibly contributing to at least 18 deaths since 2010.

The Washington state Medical Commission on Thursday suspended the license of Dr. Frank D. Li, 48, medical director of Seattle Pain Centers, and revoked the agreement that allows five physician assistants to practice under his authority.

Officials also said they have either started investigations or filed complaints regarding more than 40 doctors and other health-care providers who have worked for Seattle Pain Centers since 2013. And the state agency that oversees Medicaid revoked Li’s ability to bill for services.

The moves could affect a clinic he operates in Beverly Hills, Calif., as well.

The crackdown in Washington will all but shutter clinics in eight cities — Seattle, Tacoma, Olympia, Poulsbo, Vancouver, Renton, Everett and Spokane — that serve at least 12,000 Medicaid and Medicare patients across the state, and perhaps as many as 25,000 people, including many with chronic pain.

The sites will stay open, at least for now, said Micah Matthews, deputy director of the Washington state Medical Quality Assurance Commission (MQAC).

“There shouldn’t be an immediate disruption,” Matthews said. “We’re planning for the worst possible scenario, but we don’t expect the clinics will be immediately shut down.”

Patients will be able to obtain prescriptions for now. Seattle Pain Centers employs at least three other medical doctors, according to the firm’s website, whose licenses remain active, and other providers, including advanced registered nurse practitioners, ARNPs, who can continue to prescribe medication. But because Medicaid payment won’t be honored, patients will have to pay for the drugs themselves.

State officials urge patients to check with their primary-care providers about finding another source for pain care.

The medical commission’s statement of charges, dated Wednesday but issued Thursday, alleges that Li committed unprofessional conduct in violation of state regulations for chronic, non-cancer pain management, including rules designed to prevent opiate abuse, overdose and death. It also states that he failed to conduct proper patient evaluation, to provide informed consent to patients or their families, and to conduct proper reviews and consultations for opiate therapy.

The actions may have contributed to the deaths of 18 Medicaid patients seen by Seattle Pain Centers between 2010 and 2015 — and possibly dozens more, Matthews said.

Seattle Pain Centers patients were given opiates inappropriately, with little supervision, in amounts that may have sent the powerful medications onto the street to be sold, officials said.

“I guess what I would call it is classic ‘pill mill’ behavior,” Matthews said.

Thirteen complaints targeting Li and Seattle Pain Centers have been filed with the medical commission since 2010, records show. Eleven were closed after no violations could be verified, officials said.

But two complaints filed in 2015 remain open: one from the Health Care Authority (HCA) and one from the state Attorney General’s Office.

Both the HCA complaint and a May 2015 complaint filed by the state Medicaid Fraud Control Unit, a division of the Attorney General’s Office, detailed problems with Li’s practice.

Issues included hiring minimally trained staff and allowing them to bill under the names of established providers at the clinic; excessive use of urine drug screens to maximize profit; and failure to properly monitor a high number of complex patients.

The new actions reflect only the latest concerns regarding Li.

In 2013, officials with the state Department of Labor and Industries (L&I) denied Li’s application to prescribe drugs for the workers’ compensation program. That decision, officials said, was based on “noncompliant” prescribing practices and substandard care of a patient who died of an overdose. Li withdrew his application before L&I officials could report the denial, the charging statement said.

In addition, Li has not been able to bill Apple Health, the state Medicaid program, for laboratory payments since February 2015, when HCA officials barred payments to Northwest Analytics, the lab he operated, amid suspicions of fraud related to unnecessary urine screens.

On Thursday, HCA also terminated Li’s core-provider agreement, which allows him to bill Medicaid for clinic services. That move prevents other providers who work for Li from billing Medicaid, too. They can reapply for participation, an HCA spokeswoman said.

Li’s status with Medicare had not changed Thursday.

Washington’s actions soon could be followed by California, where Li has been licensed in good standing since 1999.

“That would immediately trigger us, we would be notified and then we would take a look at him as well and take any appropriate action,” said Cassandra Hockenson, a spokeswoman for California’s medical board.

18 deaths

The Washington attorney general’s complaint documented the unexpected overdose deaths of 18 Medicaid patients seen by Seattle Pain Centers between January 2010 and April 2015, according to a copy obtained by The Seattle Times. Patients died within days or weeks of filling prescriptions from the clinics, the investigation found.

Those deaths were included in the medical commission’s statement of charges, which found that acute drug intoxication was a cause or likely contributing factor in 16 of the deaths. One patient died in a car accident and another died from a stroke, but both received opiates from Seattle Pain Centers and had “multiple, serious health conditions” that clinic providers disregarded during opiate therapy.

“(The) medical records reveal an egregious pattern of substandard medical care,” the charges said.

The state medical commission has been investigating Li and his clinics for more than a year, but only received confirming evidence, including a required outside expert’s opinion, in mid-June, Matthews said.

“It may have been available a year ago, but it wasn’t available to us,” he said.

The deaths included Becky Gene Rae Kruse, 58, of Everett, a grandmother of three who had fibromyalgia and struggled most of her life with chronic pain and addiction.

Kruse, who is listed as “Patient J” in the charges, died April 7, 2013, after an overdose of drugs including painkillers methadone, hydromorphone and tramadol, plus trazodone, an anti-anxiety medication, the charges state.

Her daughter, Megan Sargent-Everett, 33, of Spokane, found Kruse collapsed on the bathroom floor, with the sink faucet still running, a police report said.

Six days before her death, Kruse had filled a prescription for 90 4-milligram hydromorphone pills, also known as Dilaudid. It was written by an ARNP at the Everett Seattle Pain Centers clinic — which was within walking distance of Kruse’s apartment.

“We don’t think it was intentional,” said Nicole Ellis, 43, of Everett, Kruse’s sister. “She had her coffee mug half full. It really caught us off guard.”

The family was well aware of Kruse’s past problems, but Ellis, who saw Kruse at least once a week, said she seemed like she was doing better.

“Had it happened years ago, it wouldn’t have shocked us at all. But she was looking pretty good, gaining weight,” Ellis recalled. “I really don’t know for sure why she had so many drugs in her system.”

Patients like Kruse need careful monitoring by experienced pain-medication providers, Ellis said.

“They’re real people. Their lives are precious, and they’re not to be thrown away,” she said.

Infrastructure lacking

Li is a board-certified pain-management specialist licensed since 1999 in California and since 2008 in Washington state. He started the Seattle Pain Center Medical Corp. that year, just after a state panel approved new guidelines regarding treatment of non-cancer chronic pain. Strict new laws took effect in 2012.

The laws require doctors to incorporate safeguards into their practices, including close supervision, to minimize the potential for abuse and diversion of controlled substances, including opiate painkillers.

Li didn’t heed those safeguards, officials said, even as he expanded the number of centers across the state, growing to seven, then eight sites. Li sought out what he described as the “most difficult pain patients,” the attorney general’s complaint said.

“But he failed to ensure that SPC (Seattle Pain Centers) had the infrastructure and qualified pain management specialists necessary to serve the large numbers of complex patients referred to his practice,” it stated. “Instead, Dr. Li’s rapid expansion of SPC’s clinical practice placed the care of those ‘most difficult pain patients’ in the hands or providers who were not qualified or able to care for such patients.”