A Laconia doctor and chairman of the Salisbury Board of Selectmen has been reprimanded by the state Board of Medicine for misconduct in three cases that involved prescribing painkillers to patients.

Michael Dipre has been licensed to practice in New Hampshire since February 1998 and has worked at the Laconia Clinic on North Main Street in Laconia since 2001.

Dipre was cited for failing to keep accurate records, "inappropriate prescribing practices," and a lack of follow-up with patients being treated for pain management. The allegations concerned three patients Dipre treated between 2003 and 2007. Two of the patients died.

Dipre was fined $3,000 and required to attend a course on controlled substance management as well as earn 20 hours of continuing medical education credits on record keeping and prescription practices. His license to prescribe certain narcotics was suspended.

In the settlement agreement, Dipre acknowledged that if the case had moved forward into a disciplinary hearing, the hearing's counsel would have proved several counts of professional misconduct. Dipre did not return messages left for him at work and at home.

Andy Patterson, executive director of the Laconia Clinic said Dipre "is complying with the requirements of the settlement agreement with the Board of Medicine and modifying his practice to ensure that that compliance is continued going forward."

Patterson declined to comment on whether any disciplinary actions were taken by the clinic.

The settlement refers to the patients by their initials only. In August 2003, according to the settlement, Dipre wrote in a treatment record that he was increasing patient J.S.'s dose of methadone, though there was no prior record of the woman being prescribed methadone. In January 2004, a court-ordered drug screen came up negative for J.S. But Dipre continued to prescribe her methadone and didn't document discussing the test result with her.

Between September 2004 and March 2005, while J.S. was incarcerated, Dipre issued six prescriptions for her, which were not recorded in the treatment record. He wrote three more while she was in a halfway house. The prescriptions were picked up from the clinic by a third party.

J.S. appeared for an office visit in December 2005, and the patient record said she would begin monthly appointments. Dipre did not see her for 10 months, though he continued prescribing methadone.

Dipre "failed to recognize or appropriately respond to signs of J.S.'s possible drug seeking behavior," the settlement said.

In another case, Dipre failed to maintain an up-to-date record of his treatment of a patient who died of a drug overdose. In November 2006, patient K.B. filled two prescriptions of painkiller Fiorinal for 30 pills each, both written by Dipre, though the treatment record only documented one prescription written.

Dipre began treating K.B. in December 2005 and last saw the patient on Oct. 30, 2007, according to the settlement. K.B., who was also prescribed psychotropic medications by a psychiatrist, died on Nov. 3, 2007. According to the settlement, Dipre dictated notes about his treatment of K.B. up to 21 days after an appointment.

The settlement also references a patient whose estate filed a civil suit against Dipre in Belknap County Superior Court. The woman, Helen Long, went to the emergency room at Lakes Region General Hospital on July 16, 2006, with abdominal pain, diarrhea, nausea and vomiting. The following day, a radiologist saw indications of a possible bowel obstruction and Long was told she should see her primary care physician, who was Dipre.

Long had a history of abdominal surgeries and hernias. According to the settlement, Dipre saw Long on July 17 and prescribed Demerol and promethazine, but he failed to document how much. According to court records, he diagnosed her with food poisoning and told her to call within 24 hours if she didn't feel better.

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