THOUSANDS SEARCH FOR NEW DOCTORS

When Dr. Alfredo Gonzalez of Falmouth gave up his license to practice
medicine after being arrested on marijuana charges earlier this month,
he wasn't alone.

Within the past year, the state Board of Registration in Medicine has
ruled that two other Cape primary care physicians had to give up the
privilege of practicing medicine because of criminal charges or
professional missteps, and a Sandwich internist was convicted of drug
and Medicaid fraud.

These turns of events have left thousands of patients searching for a
new doctor at a time when there is a nationwide shortage of primary
care physicians.

"I wouldn't say it's unusual," said Russell Aims, spokesman for the
Board of Registration in Medicine. "In a given year, we discipline
between 70 to 80 doctors out of the 30,000 that are out there."

But on the Cape, with its large population of senior citizens and
traditional shortage of primary care physicians, each discipline
affects hundreds of patients.

In July, Dr. Michael Brown, 53, was jailed after a jury found him
guilty of prescribing narcotics for no medical purpose. His license
had been suspended by the state Board of Registration in Medicine in
2005.

This spring, Dr. Ann Gryboski voluntarily suspended her license to
practice after shooting her abusive husband to death. Last month, a
grand jury declined to prosecute her and Gryboski said in an interview
she planned to practice again.

In late September of last year, Dr. Neena Chaturvedi voluntarily gave
up her license after patients complained to the state about lost
medical records and other issues.

In another case, the board put Dr. Richard Smayda, formerly of
Brewster Medical Associates, on probation late last year after he was
accused of inappropriate conduct toward several female patients.

Both Gonzalez and Gryboski are employees of Cape Cod Healthcare Inc.
and had a panel of about 2,000 patients each, said David Reilly,
spokesman for Cape Cod Healthcare.

Gonzalez practiced at Bourne Internal Medicine in Bourne and Gryboski
treated patients at Yarmouth Internists.

Dr. Neena Chaturvedi, and her husband, Dr. Rahul Chaturvedi, had a
bustling practice at Physician Medical Centers in Hyannis, reporting
up to 49,000 patient visits a year.

Although Rahul Chaturvedi has an active medical license, financial and
legal problems are taking a toll on the practice, which declared
bankruptcy last month. A PMC office worker said Rahul Chaturvedi would
be working a reduced schedule.

Cape Cod Healthcare is scrambling to fill in the gap in patient
services caused by Gryboski's and Gonzalez's arrests months apart,
Reilly said.

"Our doctors and other providers have done a good job of pitching in
and helping out with the patients," Reilly said. He said some of
Gonzalez' patients will be able to see the other two doctors at Bourne
Internal Medicine, while others will be matched up with other
practices on the Upper Cape.

It has helped that Cape Cod Healthcare has been able to recruit eight
new primary care physicians this year, with another two being expected
to start work this fall, Reilly said.

But finding a new doctor is only part of the problem when one's
medical provider is accused of criminal or non-professional conduct,
some say.

One former heroin addict who did not want to be named said he can't
find a physician to fill his prescription for the withdrawal
medication suboxone now that Gonzalez has been arrested.

"We're just stranded here. We're in active withdrawal," the man said.
"We feel betrayed."

Gonzalez was one of a handful of doctors on Cape Cod who prescribe
suboxone. He also was director of inpatient treatment services at High
Point, a treatment center in Plymouth for people with substance abuse
problems, from February until his arrest, said Julie Lizotte, director
of marketing and development at High Point.

Dr. Maryanne Bombaugh, president of the Barnstable Medical Society,
said people should remember these cases involved a small percentage of
the 449 physicians practicing on Cape Cod.

According to Reilly, 120 of them are primary care physicians.

"Most doctors are caring and competent," Bombaugh said. "They are
human beings."

The state Board of Registration in Medicine's role is to make sure
that physicians are able to fulfill their great responsibilities to
patients, said Dr. Dale Magee, president of the Massachusetts Medical
Society.

"It's a role in society as well as a job," Magee said.

June Allen Silvia of Wareham said she and her husband, Charles Silvia,
plan to remain with Dr. Gonzalez if his license is
re-instituted.

"He saved my husband's life" by diagnosing a "silent heart attack,"
she said. "I have nothing but good to say about Dr. Gonzalez. I feel
if he didn't have 'doctor' in front of his name, it wouldn't be such a
big deal."

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Troubled doctors

Dr. Michael Brown

The Massachusetts Board of Registration in Medicine summarily
suspended the Sandwich physician's license in 2005, saying the charges
against Brown posed an immediate threat to the public health, safety
and welfare, said board spokesman Russell Aims.

Brown was convicted by Barnstable Superior Court of drug and fraud
charges for writing bogus prescriptions in July.

Dr. Ann Gryboski

She voluntarily gave up her license to practice medicine after being
arrested for shooting her husband, Patrick Lancaster of Barnstable, to
death on Easter. Last month, a grand jury declined to indict her on
manslaughter charges. Gryboski said she was a victim of domestic abuse
and was badly bruised at the time of her arrest. An employee of Cape
Cod Healthcare Inc. at Yarmouth Internists, she has said she is eager
to get back to her practice. She must petition the Board of
Registration in Medicine to reinstate her license, says board
spokesman Russell Aims.

Dr. Alfredo Gonzalez

He voluntarily agreed not to practice medicine Sept. 14, Aims said.
Gonzalez was arrested earlier this month after police seized what they
said was $7,000 worth of marijuana plants and a large hydroponic
growing apparatus from his home in Falmouth. Gonzalez is an employee
of Cape Cod Healthcare Inc. at Bourne Internal Medicine in Bourne.
Asked if Gonzalez was still drawing a salary, David Reilly, spokesman
for Cape Cod Healthcare, said, "We do continue to support him." After
his arrest, Gonzalez was fired from his other job directing inpatient
services at High Point, a substance abuse treatment center in Plymouth.

Dr. Neena Chaturvedi

She voluntarily agreed not to practice medicine Sept. 27, 2006, after
the Board of Registration received 11 complaints about her practice,
at least five of which concerned patient access to their medical records.

Dr. Richard Smayda

Late last year, the state Board of Registration in Medicine put him on
probation after eight former female patients accused him of
inappropriate conduct, which ranged from allegedly grabbing one
patient's buttocks to straddling another while she was lying down.
Smayda, formerly of Brewster Medical Associates, was acquitted by an
Orleans District Court jury in 2005 on charges he assaulted an
84-year-old female patient. The probation included having a
board-approved chaperone present every time he saw a female patient.