- Voice of San Diego - https://www.voiceofsandiego.org -

Doctor at Center of Vaccine Scandal Accused of Overprescribing Opioids

Photo of Dr. Tara Zandvliet’s office in South Park
The exterior of Dr. Tara Zandvliet’s office in South Park / Photo by Megan Wood

Donald Turner thought it was weird that he and his son were circling a residential block in South Park trying to find parking for a doctor’s office. 

“I said, ‘Is this her office?’” Turner recalled. 

“He said, ‘Yeah, she works out of her garage.’”

Turner, who Voice of San Diego agreed to identify using a pseudonym because of ongoing legal proceedings involving his son, was at the practice of Dr. Tara Zandvliet, the South Park Doctor, as she calls herself on her website. Zandvliet works out of an outbuilding next to a residential home. She runs a cash-based practice, meaning she does not accept insurance, only direct payment. 

In this case, Turner’s son wanted to see her so he could refill his prescription for painkillers. 

“It only took about 10 minutes, it was fairly quick. No vitals check-up, no ‘How you doing?’” said Turner. “It was more like a drug deal than a doctor meeting with a patient. Like, ‘Here’s the prescription you want, give me the cash, see you next time.’ It wasn’t like, ‘How’s your knee? Do you have pain? Let’s get this leg feeling better.’”

New charges by the state Medical Board [1] against Zandvliet indicate Turner’s story is not an anomaly. The charges allege that Zandvliet over-prescribed addictive painkillers to at least four of her patients, failed to treat their addictions and did not make serious efforts to taper off their doses. She is charged with gross negligence, incompetence, repeated negligent acts and unprofessional conduct. 

In one case, she prescribed a woman 10 times the recommended maximum daily dose of opioids [2] for the better part of six years. 

Zandvliet became widely known in 2019 when Voice of San Diego reported she had written nearly one-third of all vaccine exemptions in San Diego Unified School District [3], the second largest district in the state. Many of those exemptions were written for reasons not accepted by mainstream medical science, including a family history of allergies. 

Ultimately, Zandvliet’s story led state lawmakers to pass a new law cracking down on vaccine exemptions [4]. She was placed on professional probation by the Medical Board for gross negligence [5] in a case involving vaccines and cannot write vaccine exemptions for three years. And she is also charged with another pending count of negligence related to vaccine exemptions. If found responsible, she could lose her medical license. 

According to her website [6], she attended Stanford University, New York Medical College and served as the chief resident at the University of Texas Medical Center in Houston.  

Zandvliet generated some good press [7] back in the early 2010s for opening a small practice, based on the idea of spending more time with patients and cutting free from the insurance system. The North Park News called it “a refreshing change from the assembly-line model [8] of larger medical practices.”

Zandvliet charges $120 and up [9] for a single visit, depending on the complexity, according to her website. 

When Turner was there with his son, he asked for a receipt for the payment. Zandvliet walked over to an older-looking printer and said it wasn’t working, Turner recalled. 

Zandvliet did not respond to a request for comment, but I viewed documents that confirmed she was prescribing Turner’s son oxycodone in 2017.

Turner and his wife passed information onto the U.S. Drug Enforcement Agency in 2018 in the hopes that agency might investigate Zandvliet. One agent responded to their query and at least briefly looked into Zandvliet’s history, according to an email obtained by Voice of San Diego. 

A DEA spokeswoman would not confirm whether any investigation is ongoing, nor whether the DEA referred the case to the Medical Board. 

A Medical Board spokesman did confirm that the DEA does pass information onto the Medical Board in some cases, but would not comment on the specific allegations against Zandvliet, per board policy. 

Investigators detail Zandvliet’s history with four patients, who are not identified, in the new opioid-related charges brought by the Medical Board. (It’s possible one of the patients mentioned in the Medical Board’s charges is Turner’s son, but the Medical Board does not release patient information, making it difficult to verify.) 

In the case of one patient – referred to as Patient B in the charges – Zandvliet more than doubled the dose of opioids the woman had been prescribed by her previous doctor. Zandvliet continued to prescribe the woman a similar dose for six more years, according to the charging document. 

Between oxycodone, oxycontin and other opioids, Zandvliet prescribed the woman more than 1,000 “morphine milligrams equivalent,” or MME, of opioids per day for the vast majority of time she was seeing the patient. 

The Centers for Disease Control and Prevention recommends a maximum dose of no more than 90 MME per day, said Dr. Kelly Bruno, a pain management specialist with VA San Diego Healthcare System, who also teaches at UC San Diego. 

Approaches to opioid prescription have changed greatly over the last five to 10 years, as awareness about the country’s ongoing epidemic has increased, Bruno said. Doctors now tend to realize that high doses of opioids are not only addictive and deadly, but also don’t always work. 

Taking high doses of opioids – like anything over 90 MME per day – can create a “feedback loop” that actually increases a patient’s pain, Bruno said. 

Zandvliet was prescribing anywhere between 73 MME and 1,360 MME per day to the four patients mentioned in the Medical Board’s charging document. In only one of the cases, she prescribed less than 90 MME per day for an extended period of time. 

Anything in the hundreds is “a high dose,” said Bruno. “If you’re in the hospital with post-surgical pain those are normal [doses.] But if you’re in a chronic pain setting, you have to start questioning whether that’s effective.”

Aside from prescribing excessive doses, Medical Board investigators also allege that Zandvliet failed to successfully taper down her patients’ doses – as is typically considered best practice for patients taking large doses of opioids. They also say she failed to refer some of her patients to pain management specialists, who would be more equipped to recognize their addiction and get them on the right kind of treatment plan. 

Among the alleged deficiencies in Zandvliet’s care, investigators also noted failure to recognize opioid tolerance, inadequate clinical assessments, fast escalation of narcotic doses, and inadequate clinical assessments. 

Turner and his wife said they have experienced indescribable pain trying to help their son deal with his addiction. They described him as a charming, athletic young boy whose entire life has been consumed by opioids. He has experienced homelessness, served jail time and lost custody of his child – all as a direct or indirect result of his addiction, his parents said. 

Turner’s wife said she regrets all the time she spent enabling her son’s addiction, by unknowingly giving him money for drugs and helping him in other ways. That, she believes, prolonged his addiction problems. But even more, she blames Zandvliet. 

For a medical professional to have helped fuel her son’s addiction, she believes, is inexcusable.