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& Charles B. Anderson, MD 729 N. Ewing St. Helena, MT 59601 Fellow, American Academy of Newology Certified, American Board of Psychietry and Neurology 24 Feb 2014 ‘Mr Solan Doubek Helena, MT Mr. Doubek: T have spent 16 hours reviewing the medical records of Dr. Ibsen, as well as pharmacy records, spreadsheets, and current documents from the Montana prescription drug registry. As the result of this review, | have concluded that Dr. Ibsen has practiced medicine within the appropriate boundaries and guidelines of the license be bolds from the State of Montana, and I ‘see no reason to censure Dr. Ibsen's practice style or penalize him in any way. 1 will go further ‘and state that his methods of treating often-difficult patients with chronic pain should be applauded, rather than challenged, as they actually resulted in an overall decrease in narcotic use by his patients ‘As an emmergency physician, Dr. Tbsen is keenly aware that narcotic overuse can be problem in our profession, and is, unfortunately, epidemic in our society. Thus, he is appropriately wary about providing narcotics to patients who present requesting pain medications. TTaoted that each of the patients I reviewed came to Dr. Ibsen already having been prescribed narcotic pain medication by some other physician. Several of these patients were, in essence, ropped by their other providers, but Dr. Ibsen correctly found them in genuine need of contiowing care. His documentation reflects the considerable time he spends with his petients, and be does seem to offer alternatives to narcotics to each of them, which I applaud. Two patients were throughly investigated for diversion and were cleared of such activities. Some of the patients Dr. Tbsen saw did indeed suffer from chronic pain, but also had acute pain flare-ups; he seems to have been very thoughtful and thorough in the evaluation of these challenging paticals, |k’s interesting to me how many of Dr. Ibsea’s patients are now entirely off narcotics! If the concem of the Board is the over-prescription of narcotics, it was not present when I considered the pharmacy spreadshects. Certainly some patients were receiving narcotic medications in dosages approaching (but not exceeding) recognized upper limits, but they were closely monitored and were subsequently carefully tapered off narcotis, | would also add that having practiced neurology in Helena for many years and having treated a number of patients on pain medications, I can state that patients requiring narcotics have somewhat limited treatment options. It certainly seems to me that Dr. Ibsen was a tremendous lhelp for such pationts in his care and, in fact, while conducting this review, it occurred to me that instead of facing Board action, such as sanctions, Dr. Ibsen should be queried as to just how he ts able ‘such remarkable results! any farther questions or address other concems, please let me know.