Fallout from a state crackdown on the medical director of a chain of Washington pain clinics has expanded with new sanctions against more providers — and a lawsuit filed by the family of a patient who died.

As many as 20 health-care providers who worked for Seattle Pain Centers have been suspended from the state Labor & Industries department network, which authorizes treatment for workers’ compensation claims.

“We did this to protect workers from harm,” Barbara Davis, an agency spokeswoman, said in an email Friday.

Help for pain patients

Seattle Pain Centers’ patients should seek advice from their primary-care providers and insurance plans about finding a new source of pain management, officials said Thursday.

Call the Washington Recovery Helpline at 1-866-789-1511, or visit warecoveryhelpline.org

Washington State Department of Health

State health officials this month suspended the medical license of Dr. Frank Li, the director of the eight pain clinics, amid allegations of billing fraud and possibly contributing to the deaths of at least 18 Medicaid patients. Li had run Seattle Pain Centers since 2008, serving an estimated 25,000 patients, including about 8,000 active users of opioids, pain experts said.

Li — who has not been charged with a crime — was barred from prescribing for L&I in 2013, when agency officials found evidence of two overdoses of patients under his care, one fatal, officials said.

But other providers who worked for Seattle Pain Centers had been allowed to treat injured workers. Most of them were concurrent-care providers, which means they provided pain management while another primary care doctor supervised the overall workers’ compensation claim, Davis said.

L&I did not immediately provide the names of the health-care providers suspended from the network.

On Friday, the family of Mallory Jean Rosas, one of the Medicaid patients cited in the state Medical Commission’s July 14 action against Li, sued him, Seattle Pain Centers and 10 other providers who worked for the clinics.

Rosas, a 28-year-old Maple Valley woman, died Jan. 12, 2011, of acute methadone toxicity within days of filling a prescription for the drug written by Li, state investigators said.

In the complaint filed in King County Superior Court, Joel Rosas, Mallory Rosas’ brother, alleges that Li and Seattle Pain Centers providers failed to properly assess and monitor the young woman’s care for knee pain.

She had injured one knee playing basketball in high school and, more recently, slipping on ice and water while working at a fast-food job, family members said.

Mallory Rosas was seen at Seattle Pain Centers 11 times in one year and provided prescriptions for oxycodone, Norco — the brand name for a narcotic combination of acetaminophen and hydrocodone — and methadone.

“Treating musculoskeletal knee pain with methadone is below the standard of care,” the complaint stated.

Because of the “failure to provide reasonably prudent medical care,” Mallory Rosas died, the complaint said.

She was among 18 Medicaid patients whose deaths were linked to poor oversight at Seattle Pain Centers between 2010 and 2015, according to the statement of charges filed against Li. Dozens more patients may also have been harmed, Medical Commission officials said.

Concerns about Li dated back to 2013, when L&I officials denied his application to care for workers’ compensation patients. A complaint filed in May 2015 by the state Attorney General’s office documented allegedly fraudulent billing of Medicaid for millions of dollars in unnecessary urine tests — and problems with drug monitoring that led to patient deaths.

The Medical Commission investigated the complaint and suspended Li’s license, citing “immediate danger” to the public. At the same time, the state Health Care Authority, which oversees Medicaid, terminated Li’s core provider agreement, which allows him to bill the agency for payment.

And the federal Drug Enforcement Administration took steps to revoke Li’s ability to prescribe powerful narcotics by pulling his DEA registration.

A Seattle lawyer representing Li, Mark Bartlett, has said the state’s decision was made in error and he was confident it would be reversed after a hearing.

State health officials and pain-management experts across Washington are scrambling to find care for patients of Seattle Pain Centers displaced by the action. All clinic sites except the Renton office are closed, according to a telephone message.