Psychiatrist Anthony A. Frasca "Relied on Patients Knowledge" to Guide Ketamine Treatment; Patient Committed Suicide

June 9, 2026

On July 14, 2025, the North Carolina Medical Board issued a public Letter of Concern to psychiatrist Anthony Adolph Frasca, of Zen Psychiatric Services, following an investigation into his care of a patient to whom he provided ketamine treatment and who later died by suicide.

According to the Board’s letter, Patient A was a 49-year-old licensed mental health worker with training and extensive experience in the therapeutic use of ketamine. Frasca met Patient A in October 2021, when Patient A recruited him to participate in a ketamine-assisted psychotherapy program as a complement to Frasca’s existing clinic-based ketamine practice.

The Board said Patient A was first a colleague and peer, not a patient. Over time, Frasca developed both a professional relationship and a personal friendship with Patient A. That dual relationship later became one of the Board’s concerns.

Patient A requested ketamine treatment at Frasca’s clinic in December 2021. Frasca approved him for treatment, and Patient A received his first intramuscular ketamine injection later that month. He received additional ketamine injections in May and June 2022.

In August 2022, Patient A asked to receive ketamine at home. Frasca prescribed 20 medicated ketamine lozenges (troches) at 200 mg, and 90 ketamine tablets at 50 mg, to be used as needed. Patient A filled the prescriptions on September 1, 2022. He requested refills on September 13, 2022. Frasca prescribed both refills, and Patient A filled the prescription for 20 troches on September 15 and the prescription for 90 tablets on September 26.

Patient A died by suicide on September 27, 2022.

The Board reviewed Frasca’s care of Patient A using an independent medical expert. The reviewing expert found that the care of Patient A fell below the standard of care in North Carolina. 

Specifically, the independent medical expert cited the following in the Letter of Concern: 

• Frasca failed to maintain appropriate boundaries with Patient A, including Frasca’s reliance on Patient A’s experience and knowledge to guide his ketamine treatment. 

• Frasca failed to adequately document the evaluation and treatment provided. As to evaluation, there was no documentation of a detailed history, psychosocial assessment, or assessment of possible comorbidities or alternative diagnoses, and the documentation of presenting concerns was brief. As to treatment, there was no documentation of the rationale for prescribing ketamine for Patient A, alternative treatments, or discussion of the risks and benefits of ketamine. 

• Frasca’s decision to prescribe home-based ketamine treatment to Patient A without requiring an in-person visit, properly documenting the course of treatment, and communicating directly with Patient A’s other health care providers.

Citizens Commission on Human Rights investigates abuses in psychiatric and psychological treatment and is dedicated to cleaning up the mental health field.  This includes informing mental health care providers of disciplinary and/or criminal actions taken against colleagues in their vicinity.

Source: Public Letter of Concern to Anthony Adolph Frasca, M.D., July 14, 2025, North Carolina Medical Board.