1(a). On August 25, 2014, Kimberly Kirchmeyer (Complainant) filed the Second Amended Accusation while acting in her official capacity as the Executive Director of the Medical Board of California (Board), Department of Consumer Affairs.
1(b ). Prior to the filing of the Second Amended Accusation, the following pleadings were filed: the original Accusation in this case (filed June 20, 2013), and a First Amended Accusation (filed February 12, 2014).
2. On or about July 3, 2013, Respondent filed a Notice of Defense requesting a hearing on the Accusation, and this matter ensued.
3. On October 6, 1993, the Board issued Physician’s and Surgeon’s Certificate Number A 52415 to Respondent. That certificate is scheduled to expire on July 31, 2015. Interim Suspension Order
4(a). On May 7, 2013, a partial Interim Suspension Order (ISO) was issued against Respondent on an ex parte petition, which restricted Respondent’s Schedule II and III prescribing privileges. A noticed hearing on the petition (original scheduled for May 28, 2013, but continued by stipulation of the parties) took place on June 14, 2013, and the matter was submitted following briefing on July 2, 2013.
4(b). On July 8, 2013, the noticed petition was granted and an ISO was issued, which stated: (Exhibit 17.) Pending a final decision by the Board on the merits of the Accusation to be filed under the provisions of Government Code section 11529, Respondent’s physician’s and surgeon’s certificate number A 52415 is restricted in the following manner: Respondent shall issue no prescriptions for any substance listed on Schedules II, III, IV or V set forth in Health and Safety Code sections 11055 and 11056.
4( c). The ISO, which remains in effect, is based on facts and circumstances similar to those set forth in the Second Amended Accusation, except for the added allegations regarding Respondent’s violation of the ISO (discussed more fully below).
Background Facts
5. Respondent is a neurologist who, for the past several years, has traveled to numerous private clinics providing per diem services which included examination of patients and prescribing medications. Respondent has no hospital privileges.
6. Some of the clinics with which Respondent became associated were pain management clinics in the San Fernando Valley operated by a woman named Anush Davtyan (Anush). When he was introduced to Anush, Respondent was seeking to establish his own medical office, and Anush provided Respondent with office space at one of her clinics located at 8619 Reseda Boulevard, in Northridge (8619 clinic). She also facilitated Respondent’s application process for Medicare and Medi-Cal billing and ordered his prescription pads for that location.
7(a). In about September 2011, following an investigation by federal and state agencies, Anush’s clinics were closed by authorities, and an indictment was filed against her in federal court. The criminal charges were based Anush’s operation of several clinics (including the 8619 clinic) for the purpose of issuing and filling prescriptions for Oxycodone, which would then be sold to customers/addicts, regardless of whether the customers saw a physician at the clinic, or to dealers for resale on the streets. According to the indictment, the scheme included Anush’ s bribery of pharmacists to fill the prescriptions. On about September 1, 2011, Anush was found to be in possession of over 8700 Oxycodone pills.
7(b ). On May 2, 2013, Anush was sentenced to 135 months in federal prison following her guilty plea to a charge of Conspiracy to Possess a Controlled Substance with Intent to Distribute, in violation of Title 21, United States Code, Section 846.
7( c). No charges were filed against Respondent.
8. As part of its investigation, the Medical Board obtained reports from the California Controlled Substance Utilization Review and Evaluation System (CURES) (2) which showed the prescribing history under Respondent’s license at the 8619 clinic for the periods of April26, 2008, through April 26, 2011, and May 10, 2011, through May 10, 2012.
The CURES reports revealed that 11,174 prescriptions had been issued under Respondent’s license during that combined time frame, including hundreds of prescriptions for Oxycodone, Oxycontin, and varying combinations of acetaminophen and hydrocodone. Only a few prescriptions for Oxycodone were issued in Respondent’s name after September 1, 2011.
9. Respondent denies issuing all of the prescriptions listed in the CURES reports and asserts that, unbeknownst to him, Anush and her co-conspirators forged his signature on prescriptions.
Respondent’s Pre-signing of Prescriptions
10. On November 14, 2012, Respondent willingly submitted to an interview with Board investigator, Rashya Henderson, Board consultant, Shoaib Naqvi, M.D.; DAG Tran participated via telephone. During the interview, Respondent’s responses to questioning were often rambling and imprecise. Nevertheless, the interview elicited the following statements and admissions:3
(a). Respondent noted that Anush was helping him establish his practice, so she "printed everything" for him and “had all [his] prescriptions.” (Exhibit 9, p. 80; Exhibit 18.)
However, he denied authorizing Anush or anyone at the 8619 clinic to use his prescription pads. (Exhibit 9, p. 80; Exhibit 18.)
(2) CURES allows healthcare prescribers, pharmacists, law enforcement, and regulatory boards to access patients’ and providers’ controlled substance prescription histories. CURES is intended to assist in the reduction of prescription drug abuse in California.
3 The interview was recorded and transcribed. The CD (Exhibit 18) and transcript of the interview (Exhibit 9) were admitted into evidence and served as the basis for Factual Finding 9.5
(b). Respondent also noted that he had previously been the subject of an FBI investigation involving the issuance of prescriptions in his name for patients whom he had never seen. Respondent was arrested in 2000, but was released and no criminal charges were pursued. According to Respondent, he had shared an office with a chiropractor who forged prescriptions in his name by copying the signature on his medical license hanging on the office wall. (Exhibit 9, pp. 13 and 30-37; Exhibit 18.)
( c )(2). When asked if he left pre-signed prescriptions for use by others, including chiropractors or doctors, Respondent answered, “It would be a very, very few,” and "Sparingly, sparingly.“ (Exhibit 9, pp. 46, 76 and 117; Exhibit 18.)
( c )(3). Respondent explained that he worked in many places where either the chiropractors or the doctors could not prescribe Schedule II controlled substances. However, some of their patients required medications (such as Percocet, Vicodin, Norco, ibuprofen 800 mg., or naproxen 500 or 550 mg.), but would not be at the clinic on a day when Respondent was working there. Respondent recalled that the doctors would ask him to prescribe medications, and he "obliged them” and left pre-signed prescriptions after being told “what the patient was on.” (Exhibit 9, pp. 72-79, and 117; Exhibit 18.)
(d). When Respondent was asked “While you were working at the … 8619 clinic . . . did you ever pre-sign prescriptions for future use?” Respondent provided the following halting answer: “Urn, ah, ah if ah, the over there if I did it would be for the, for the urn for the urn, the family of ah because I’ve had sometimes they’d call me and say hey. I was just being because I thought they were helping me get my place. I remember somebody said they wanted an urn. Viagra.” When asked to clarify his answer, he stated, “No, no I don’t, I don’t see. Ifl have it’s very, very few.” (Exhibit 9, p.117; Exhibit 18.)
(e). Respondent sought to justify his use of pre-signed prescriptions, noting that "nobody ever abused it … in all this [sic] eight years.“ (Exhibit 9, pp. 72-76; Exhibit 18.)
Respondent stated, ’‘That’s how it’s always worked until … last year when I was at 8619 … ” (Exhibit 9, pp. 75-76; Exhibit 18.) Respondent maintained that he has stopped leaving pre-signed prescriptions “after last year.” (Exhibit 9, p. 74-76; Exhibit 18.) He also noted that this “has also cost me some business in terms of … they need doctors that can be more liberal with them … ” (Exhibit 9, pp. 75-76; Exhibit 18.)
11. Respondent testified at the administrative hearing. His testimony was self serving, often evasive and vague, and lacked credibility (as set forth more specifically below in Factual Findings 12, 26 and 27).
12(a). At the administrative hearing, Respondent’s testimony regarding his presigning of prescriptions differed sharply from the prior inconsistent statements he made during the November 2012 interview. Respondent testified that the majority of the presigned prescriptions he left for chiropractors were for non-steroidal anti-inflammatory drugs (NSAID’s), which he categorized as “over the counter [(OTC)] basically.” This characterization was misleading, since in the 2012 interview, he indicated that he would presign prescriptions for ibuprofen 800 mg. which is prescription strength, not OTC.
Furthermore, it differs from his indication in the 2012 interview that the patients needed notjust ibuprofen, but also naproxen, Percocet, Vicodin, and Norco.
12(b ). Additionally, in his testimony, Respondent maintained that on the occasions that he left pre-signed prescriptions, it was for patients with whom he had a doctor/patient relationship and that he did not leave pre-signed prescriptions for patients whom he did not diagnose as being appropriately prescribed those meds. He explained that they were patients whom he had seen before, but who were returning to get medications that he did prescribe earlier because “for whatever reason, [he] did not trust what told they told [him],” and they needed to “prove their need” for the medication. This explanation made no sense since Respondent’s patient’s history and physical and ensuing diagnosis should have given rise to a treatment plan which either did or did not call for the prescription of medications. Since Respondent’s examinations did not necessitate the immediate prescription of medications, it is unclear what the patients had to do to “prove” their need for the medication, or how, without further examination or documentation by Respondent, he determined the need to leave a pre-signed prescription for the patient. Furthermore, this explanation was quite different from that offered by Respondent in the November 2012 interview wherein he recalled that the chiropractors who could not prescribe controlled substances would ask him to prescribe medications, and he left pre-signed prescriptions after being told “what the patient was on.”
Ill
12( c). In his testimony, Respondent also explained that when he left blank pre-signed prescriptions at a chiropractor’s office it was because he wanted to have prescriptions available in a “crash cart” when he had to leave, like when he had to go to the restroom. He stated that he wanted the crash cart to have simple medications like epinephrine to naloxone, and if a patient was in severe pain, they could obtain pain medications right away. This explanation was illogical and not believable. A crash cart for use in emergency situations should contain the medications themselves, not a blank prescription on which a nonphysician would fill out the information and then somehow get the prescription filled by a pharmacy in time for the emergency administration of the drugs to the patient. Respondent further contended that he counted how many blank prescriptions he was leaving, and retrieved them, unused, when he got back. He asserted that none of them had ever been used. Given his lack of credibility in other portions of his testimony, this added explanation was also not believable.
12( d). Respondent testified that he never left blank prescriptions at the 8619 clinic.
However, this contradicted his prior statement in the 2012 interview that, “If l have it’s very, very few.” Given his lack of credibility in other portions of his testimony, his complete denial of leaving even a few pre-signed prescriptions at the 8619 clinic is also not believable.
12(e). Based on the totality of the evidence presented at the hearing, including Respondent’s 2012 admissions and his inability to deny the authenticity of his signatures on prescriptions for patients he did not see (see Factual Finding 13, below), Complainant established by clear and convicting evidence that Respondent previously left pre-signed prescriptions at clinics for later use by others (accessible to those with keys to his desk drawers), sometimes omitting the prescribed medication and/or patient name.
No Authentication of Respondent’s Signatures on Prescriptions for FM, RL, DL, WJ & JL (4)
13(a). During the 2012 interview, Respondent was shown the medical records (apart from written prescriptions), for Patients FM, RL, DL, WJ and JL and asked whether any of the handwriting in those files was his. Respondent reviewed all of those patient records and confirmed that none of the handwriting in patient files for Patients FM, RL, DL, WJ and JL was his. During the interview, Respondent was shown several prescriptions for oxycontin and oxycodone issued to Patients FM, RL, DL, WJ and JL, written on Respondent’s prescription pad with signatures which purported to be his. Respondent verified that he had never seen any of the patients from whom the prescriptions were written. When asked whether he had signed any of the prescriptions shown to him, Respondent stated that some of the signatures could be his, but could not confirm that they were actually his. He noted that there were differences between the prescription signatures and his typical signature, but also noted, “my signature varies.” (Exhibit 9, p. 83; Exhibit 18.)
(4) Patients’ initials are used in lieu of their full names in order to protect their privacy.
13(b ). Respondent’s admission of pre-signing of prescriptions was insufficient, in itself, to prove that Respondent was the person who signed the selected prescriptions presented at the 2012 interview. His uncertainty regarding his signature on those prescriptions is also insufficient to establish that he actually signed the prescriptions.
Moreover, Marva Purcell, a prior office manager at the 8619 clinic, testified credibly that she saw Anush and two other people at the 8619 clinic writing Respondent’s name on prescriptions. Consequently, absent other evidence authenticating his signature on the questioned prescriptions (see Factual Findings 14 through 19, below), Complainant failed to establish that Respondent issued the prescriptions to Patients FM, RL, DL, WJ and JL.
14(a). At the November 2012 interview, Respondent was asked to sign his name several times on a piece of paper; these signatures were later used as exemplars of his known signatures.
14(b). Forensic document examiners (i.e. handwriting experts) for both Complainant and Respondent were given the exemplar of known signatures and copies of the questioned prescriptions.(5) Complainant also provided as a known signature Respondent’s signature from a prior declaration, submitted in opposition to the ISO. Both experts conducted an examination of the questioned prescriptions and two known exemplars of Respondent’s signature.
14( c). Lynne Variano, submitted reports and testified on behalf of Complainant. A. Frank Hicks, submitted reports and testified on behalf of Respondent. Both experts were qualified to testify as forensic document examiners. Any additional weight given to one expert’s testimony over the other’s was based on the content of their testimonies and reports and bases for their opinions, as set forth more fully below.
15(a). In her initial report in May 2013, Ms. Variano concluded it was “highly probable” Respondent had signed nine of the prescriptions. For two other prescriptions, Ms. Variano determined that it was “probable” that Respondent signed them. However, Ms. Variano qualified her conclusions by stating:
(5) In both experts’ reports, they used evidence numbers to identify the questioned prescriptions which did not match the prescription numbers cited during the 2012 interview, so the ALJ was unable to cross-reference the prescriptions identified in the expert reports from those discussed in the 2012 interview. However, this made no difference in the analysis and conclusions set forth in this decision.
(Exhibit 5.)
These opinions are qualified to the extent that insufficient original known signatures were provided for this examination. Further, what signatures were provided were machine copies which do not reveal important identifying features within the writings. If the originals of the questioned signatures and acknowledged known exemplars are made available for examination, I wish to have the opportunity to confirm these findings in a supplemental report.
15(b ). In his original report in June 2013, Mr. Hicks echoed the concerns of Ms. Variano regarding examining copies of the prescriptions rather than the originals and having insufficient known exemplars ofRespondent’s signature. Mr. Hicks observed: (Exhibit A.)
1. There are intrinsic limits in the examination of copies rather than original documents. Copies are subject to manipulation that may not always be detectable and subtle details that are of significance in evaluating handwriting are obscured ….
2. The copy quality of the documents in this case is particularly poor. This prevents any examinations of the fine details in the signatures and limits the examination to the large movements.
4. The known writing … is a mixture of course-of business documents … and requested signatures… Requested signatures are those written specifically for comparison purposes. They frequently do not provide useful comparison signatures since they may be either intentionally or accidentally distorted. The manner in which [the requested signatures] were obtained is also not ideal. Signatures collected in the manner of those on this document tend to be much more uniform than they might normally be. Another limiting factor with these known signatures is that they all post-date the questioned documents by at least 1 V2 years. Thus, there is no evidence revealing this writer’s handwriting habits at the time of the questioned documents.
15( c). Mr. Hicks did find that the questioned signatures “all share similar gross shapes, indicative of a single writer.” (Exhibit A.) He also noted, “The gross characteristics of the questioned signatures are significantly different from those in the known signatures.
Unfortunately, because of the limitations described in paragraphs 2 and 4 above, it is not possible to form a conclusive opinion about these questioned signatures.” (Exhibit A.)
15( d). Mr. Hicks opined that the questioned signatures “may not have been prepared by the writer ofthe known signatures … but this opinion is far from conclusive.” (Exhibit A.) Mr. Hicks noted that, “In order to provide more definitive opinions, it would be necessary to examine the originals of the questioned documents … It is also suggested that at least 12 to 15 course-of-business signatures of this individual be submitted. These known signatures should be from the 2010-2011 time period.” (Exhibit A.)
15( e). Given the limitations presented by the quality of the provided documents, neither Ms. Variano’s nor Mr. Hicks’ initial reports provided a conclusive opinion regarding authenticity ofthe questioned signatures as Respondent’s.
16(a). In her initial report, Ms. Variano referred to the 2012 interview and noted that Respondent “admitted some of the … signatures [on the questioned prescriptions] ‘may have been his;’ these signatures were used for comparison to supplement the request[ed] signatures … and the [declaration] signature. They will be referred to herein as Known writing.”
(Exhibit 5.)
16(b ). In his initial report, Mr. Hicks pointed out that Ms. Variano “chose to switch the category for several questioned documents … in her report and use them as known signatures. She appears to base her decision to do this on a statement by [Respondent] that the signatures … "could be”, “may be”, “might be” his actual signatures. To unilaterally change these signatures from the questioned category to the known category on such flimsy evidence is something that no competent Forensic Document Examiner would ever do.“ This observation was well-reasoned and quite persuasive.
16( c). Given Ms. Variano’ s willingness to unilaterally change questioned signatures to known signatures, despite Respondent’s inability to confirm the signatures as his, calls into question the bases for Ms. Variano’s opinions and serves to reduce her credibility as an expert forensic document examiner.
17(a). After the issuance of their initial reports, the experts were provided additional known signatures. None of the additional known signatures consisted of prescriptions signed by Respondent. They included a lease agreement from 2009, an invoice for 2010, five checks from 2012 through 2014, and two deposit forms from 2012.
17(b ). Ms. Variano was provided with originals of all of the questioned prescriptions. Mr. Hicks was provided with the originals of only questioned prescriptions numbers 1 through 4, 9, 10, 11, 14 and 16 through 24.
18(a). Ms. Variano issued a supplemental report in January 2014. It was unclear if Ms. Veriano continued to use some of the questioned signatures as known signatures, as she had in her original report.
18(b ). In her supplemental report, Ms. Variano noted, "After careful comparison between all the features within the signatures, significant similarities between the questioned and known signatures were observed.” (Exhibit 6.) Ms. Variano concluded:
(Exhibit 6.)
Based on the evidence … it is my opinion that the same person who signed [questioned prescriptions numbers 17, 18, 19, 12b and 25) also signed the known exemplars …
Further it is my opinion that it is highly probable the same person signed all the prescriptions and all the known writing provided for examination. This portion of my opinion is qualified only to the extent that the questioned and known signatures demonstrated two different styles of signature; but the pen movement within the writing of both [questioned] and [known] is very similar. Also, the wide spacing between the first name, the initial “0” and the last name is a writing habit seen in all the signatures which adds to this high level of opinion. To reach a higher degree of certitude on the “highly probable" signatures would require receiving acknowledged exemplars of [Respondent’s] signatures on non-questioned prescriptions.
18( c). In his supplemental report in August 2014, Mr. Hicks noted: [T]he known writing … is a mixture of course-of-business documents . . . and requested signatures … These signatures both pre- and post-date the questioned signatures. All of this writing is consistent with that of one individual. This material is suitable in both quantity and quality to carry out the requested comparisons. These signatures are somewhat more complex and legible than the questioned signatures. [S)ignificant differences were noted between the questioned signatures on [questioned prescriptions numbers 1 through 4, 9, 10, 11, 14 and 16 through 24] and the known signatures …
(Exhibit B.)
18( d). Mr. Hicks opined:
(Exhibit B.)
It was determined that the writer of the [known] signatures did not prepare the questioned signatures on [numbers 1 through 4, 9, 10, 11, 14 and 16 through 24]. This is an elimination of this writing as being the writer of those questioned signatures.
This writer probably did not prepare the questioned signatures on the remaining prescriptions …
18( e). Ms. Variano testified at the administrative hearing and reiterated the opinions she stated in her supplemental report, wherein she focused on the similarities between the questioned and known signatures in determining the author of the questioned writings. She noted that "looking at differences [between questioned and known signatures] is not how it works,” and that “it is the similarities” that must be noted since there will always be differences.
18(f). Mr. Hicks also testified at the administrative hearing and reiterated the opinions he stated in his supplemental report, wherein he focused on the differences between the questioned and known signatures in determining the author of the questioned writings and noted very significant differences.
18(g). Mr. Hicks maintained that Ms. Variano’s focus on similarities rather than differences was “absolutely incorrect” and an incompetent methodology for a forensic document examiner. He credibly and persuasively agreed with the instruction from a treatise (submitted by Ms. Variano as evidence), which stated:
(Exhibit 23.)
Significant differences in class characteristics alone are generally sufficient to eliminate the person from whom … the samples are derived. Although there may be agreement in class characteristics, the presence of fundamental differences in individual features leads to an opinion of different origins. It is a basic axiom of identification that even a limited number of basic differences, in the face of numerous strong similarities, are controlling and accurately establish non-identity. (Kelly, et al., Scientific Examination of Questioned Documents, 2d. Ed. (2006), Ch. 2, p. 13.)
18(h). For the reasons set forth in Factual Findings 16 and 18(g), Mr. Hicks’ opinions were given greater weight than Ms. V ariano’ s.
19. Complainant did not establish, by clear and convincing evidence that Respondent was the author of the questioned prescriptions issued to Patients FM, RL, DL, WJ and JL.
20(a). In paragraph 16(1) of the Second Amended Accusation, Complainant alleged that Respondent:
(2) [failed] to provide even a modicum of essential information in Respondent’s records regarding the necessity/justification for the prescriptions to patients JL, DL, WJ, RL, FM, PM, SC, SL, RM and ST, as well as for other patients seen by the chiropractors and other clinics for whom Respondent worked, thus representing an extreme departure from the standard of care.
(3) [prescribed] addictive medications without performing appropriate prior examinations, or establishing a medical indication therefor; and failing to document same with respect to patients JL, DL, WJ, RL, FM, PM, SC, SL, RM and ST, as well as for other patients seen by the chiropractors and other clinics for whom Respondent worked, thus representing an extreme departure from the standard of care.
[~] … [~]
(5) [failed] to adequately supervise physician assistants.
(6) [failed] to use universal guidelines of pain management when prescribing controlled substances.
20(b ). Complainant did not establish any of these allegations by clear and convincing evidence.
Standard of Care Regarding Issuance of Pre-signed Prescriptions
21(a). Complainant offered the expert testimony of Rick Chavez, M.D., to establish the standard of care in this case. Dr. Chavez:’ s testimony often took on the tenor of an advocate, rather than an impartial expert. Several times on cross examination, he avoided answering hypothetical questions which required him to assume that Respondent did not author the questioned prescriptions. Instead, he made factual arguments in support of his belief that Respondent issued the prescriptions. Dr. Chavez refused to consider alternative hypothetical facts, even when advised by the ALJ that he would not be conceding facts in Respondent’s favor but would merely be indicating his opinion in the alternative scenario. Dr. Chavez’s tenacious defense of his position diminished his credibility. Nevertheless, many of his opinions were rendered unnecessary, given that Complaint failed to prove that Respondent issued the questioned prescriptions. Furthermore, the remaining opinions were uncontroverted and mirrored requirements set forth in regulation.
21(b ). Dr. Chavez’s qualified and uncontroverted testimony established the following: It is a departure from the standard of care to pre-sign prescriptions. No physician is allowed to issue a prescription without examining the patient, and the physician must only write the prescription on the date he/she sees the patient. The prescription must include the date, the name of the patient, and the prescribed medications. If a physician leaves even just one pre-signed prescription for later use, this constitutes an extreme departure from the standard of care. Violation of ISO
22. Following the issuance of the ISO in July 2013, Respondent continued working as an “independent contractor” (his words) for Metropolitan Health Medical Group (Metropolitan), at 3540 Wilshire Boulevard, in Los Angeles, and conducted neurological examinations of the following patients: PM, SC, SL, RM and ST.
23(a). Although the ISO prohibited Respondent from issuing prescriptions for any substance listed on Schedules II, Ill, IV or V, CURES reports showing Respondent’s prescribing history at the Metropolitan address for the period of June 6, 2012, through June 6, 2014, revealed that 28 prescriptions for Carisoprodol (generic for brand name Soma), had been issued under Respondent’s license and filled at Ronco Drugs between November 25, 2013, and May 15, 2014.
23(b ). Specifically, Carisoprodol/Soma had been prescribed and filled by patient PM on 3/19/14; by SC on 3/26/14; by SL on 3/26/14; by RM on 3/26/14; and by ST on 3/26/14.
23( c). Carisoprodol/Soma is a Schedule IV controlled substance. It has the potential for abuse.
24(a). Records obtained from Metropolitan for the time period in question included forms (Metropolitan medication forms) with Respondent’s name, Drug Enforcement Administration (DEA) number and medical license number at the top. At the bottom was a signature line entitled “Doctor’s Signature” and a line entitled “Date.”
24(b ). The Metropolitan medication forms contained typewritten medications listed under categories as follows:
(1). Under the category “Pain Medication:” was listed Tramadol/Ultram 25 mg. or 50 mg.;
(2). Under the category “Migraine Medication:” was listed Imitrex/ Sumatriptan 25 mg., 50 mg., or 100 mg.;
(3). Under the category “Anti-Inflammatory Medication:” was listed Diclofenac/Voltaren 100 mg., Nabumetone/Relafen 500 mg., Naproxen/Naprosyn 550 mg., Cidaflex 400 mg. or 500 mg.;
( 4). Under the category “Muscle Relaxant Medication:” nothing was listed, but a blank space was made available;
(5). Under the category “Ulcer Medication:” was listed Omeprazole/Prilosec 20 mg.;
(6). Under the catetory “Anti-Convulsants Medication:” was listed Gabpentin/Neurontin 600 mg.;
(7). Under the category “Constipation Medication:” was listed Docuprene 100 mg.;
(8). Under the category “Sleep Medication:” was listed Sinatralyne-PM; and
(9). Under the Category “Additional Requested Medications:” nothing was listed, but a blank was available to fill in. (Exhibit 20.)
24( c). The Metropolitan medication forms were filled out with handwriting and check marks to indicate selected medications for specified patients, including the five at issue in this matter. The selected medications on Metropolitan medication forms for virtually all of patients whose records were provided were almost identical.
24( d). For the patients at issue, the Metropolitan medication forms were filled out as follows:
(1 ). For patient PM, the Metropolitan medication form was dated “3/17 /14” and purportedly signed on “3/17/14” with what appears to be Respondent’s signature. Tramadol 50 mg. was circled, and X’s were written in next to Naproxen 550 mg. and Omeprazole. Also, handwritten under “Additional Requested Medications:” was “Soma.” (Exhibit 20, p. 26.)
(2). For patient SC, the Metropolitan medication form was dated “3/21/14” and purportedly signed on “3/21/14” with what appears to be Respondent’s signature. Handwritten check marks were made next to Tramadol 50 mg., Naproxen 550 mg., and Omeprazole. Also, handwritten under “Additional Requested Medications:” was “Soma." (Exhibit 20, p. 28.)
(3). For patient SL, the Metropolitan medication form was dated "3/21/14” and purportedly signed on “3/21/14” with what appears to be Respondent’s signature. Handwritten check marks were made next to Naproxen 550 mg., Cidaflex and Omeprazole. Also, handwritten under “Additional Requested Medications:” was “Soma.” (Exhibit 20, p. 34.)
(4). For patient RM, the Metropolitan medication form was dated “3/14/14” and purportedly signed on “3/14/14” with what appears to be Respondent’s signature.
Handwritten check marks were made next to Tramadol 50 mg., Naproxen 550 mg., Cidaflex and Omeprazole. Also, handwritten under “Additional Requested Medications:” was "Soma.“ (Exhibit 20, p. 22.)
(5). For patient ST, the Metropolitan medication form was dated "3/21/14” and purportedly signed on “3/21/14” with what appears to be Respondent’s signature.
Handwritten check marks were made next to Naproxen 550 mg. and Omeprazole. Also, handwritten under “Additional Requested Medications:” was “Soma.” (Exhibit 20, p. 36.)
25( a). During his testimony (beginning on day three) at the administrative hearing, Respondent produced Comprehensive Neurological Examination Reports for all five patients at issue, documenting that he conducted physical examinations and made diagnostic findings which warranted the prescription of medications (see Finding 25( c), below). The typewritten reports are the only copies of patient records he maintains; the remainder ofthe patients’ records, including forwarded copies of his reports, are maintained by Metropolitan.
25(b ). The records produced by Respondent indicated that he saw patient PM on 3/17/14; patient SC on 3/21/14; patient SL on 3/21/14; patient RM on 3/14/14; and patient ST on 3/21/14. This corresponds with the examination dates set forth in the Metropolitan medication forms for the patients.
25( c). According to the examination reports for all five patients, the “Medical [prescription] recommendations” which Respondent made for the patients all included virtually identical medications as follows: Motrin (either 600 or 800 mg.); either Zantac 150 mg. or Prilosec 10 mg.; and “Flexerill [sic]” 10 mg. None of these is a scheduled controlled substance.
26(a). During his testimony at the administrative hearing, Respondent also produced a blank Metropolitan medication form (Respondent’s amended form) which he insisted was the form he asked Metropolitan to use following the issuance of the ISO. Respondent’s amended form was virtually identical to the Metropolitan medication forms, except that it added the typewritten medication “Flexeril (Cyclobenzaprine )” under the formerly blank category “Muscle Relaxant Medication.”
26(b). Respondent’s amended form was not the form contained in the patient records obtained from Metropolitan, and Respondent had no credible explanation of why his amended form was not utilized. The totality of the evidence indicated that Respondent’s amended form was created for presentation at the hearing after the ISO violation allegations were raised.
27(a). Respondent denied prescribing Carisoprodol/Soma to any of the five patients and at any time after the ISO prohibition. He denied writing “Soma” on any prescription form after the ISO or putting his check mark next to Soma on any form. Respondent insisted that he prescribed Flexeril instead of Soma, but did not explain how he prescribed the Flexeril or other medications for the five patients, since no prescriptions on his prescription pad appear to have been issued and it appeared that he had signed the Metropolitan medication forms, which did not have Flexerillisted or handwritten on them.
27(b ). During his testimony at the administrative hearing, Respondent was asked about the Metropolitan medication forms for each of the five patients. His testimony was as follows:
(1). When shown the Metropolitan medication form for patient PM, Respondent testified that he was “not sure” it was his handwriting, but “maybe” it was, because “they do a lot of alterations at that clinic.” He acknowledged that the form included what appeared to be his signed name on bottom.
(2). When shown the Metropolitan medication form for patient SC, Respondent testified that he “did not consciously write or prescribe Soma.” When asked if the handwritten “Soma” was his handwriting, Respondent answered, “I don’t think so.”
(3). When shown the Metropolitan medication form for patient SL and asked if the handwritten “Soma” was his handwriting, Respondent answered that it “could be,” but “that it does not matter because it is not checked.” He explained that there was no check mark next to the handwritten Soma, and that it needed to be checked “to be valid.” He verified that it was his signature at the bottom of the form, but that he did not pre-sign the document.
(4). When shown the Metropolitan medication form for patient RM, Respondent testified that he did not write a prescription for Soma on that date. However, when asked if the handwritten “Soma” was his handwriting, Respondent answered that he was “not sure," but that, "even if it is mine, it is not checked.” He acknowledged that the form included what appeared to be his signed name on bottom.
(5). When shown the Metropolitan medication form for patient ST, Respondent testified that he did not prescribe Soma for that patient. He also stated that he was “not sure" if he wrote "Soma,” but that his check marks are different from those on the form, so he was "sure that they forged it.“ He acknowledged that the form included what appeared to be his signed name on bottom.
27( c). Respondent testified that the medication forms list common medications and that "you just check the ones you give the patient and sign.” However, when Respondent was asked to clarify the process for completion of the Metropolitan medication forms for prescribing medications, his answer was convoluted and confusing. He stated that the Metropolitan management completes the form and they will bring the form back to him and he gives it back regarding “the ones he agrees” on. According to Respondent, he does not fill out and sign the form, but he will sign it if they bring it to him when they disagree with what he prescribes, and then he “signs and checks.”
27( d). Although Respondent admitted that using the check-marked forms can be problematic because “anything could happen,” he stated that he did “not have much choice because [he does] not run the system for them.” Respondent asserted that he initially had problems with checking the medication form, and had complained to Metropolitan that "anyone could check [the forms],“ but in his six to seven years with Metropolitan, he saw no reason to discontinue the practice, "even though it is risky.” When asked to clarify what he meant when he stated that Metropolitan does “a lot of alterations to prescriptions,”
Respondent explained that “they do their own thing” and he goes there only one to two times per month, so he is “not there to see.” He also noted that “the clinics have pharmacists that they are glued to,” who “have deals with” the clinics, and that the pharmacists will “give you what they think they have,” and “impose what they want with the patients.” Respondent further noted that “most of the time they don’t tell you, they just go ahead with it, or someone in office will tell [the pharmacy] ‘okay’ because I am not there.” Despite his reservations, Respondent found the process to be “reliable,” and he still works for Metropolitan. However, he pointed out that since the post-ISO problems were brought to his attention, he has "stopped prescribing" at Metropolitan, so “they will probably fire me.”
27 (e). Respondent’s testimony about his post-ISO prescribing practices, and specifically his prescribing for patients PM, SC, SL, RM and ST was unclear, evasive and lacked credibility. Respondent was unable or unwilling to verify his signature on all five patients’ Metropolitan medication forms, and he never clarified the process for how he actually prescribed the medications he purportedly recommended in his consultation reports.
No prescriptions on his prescription pad appear to have been issued and the Metropolitan medication forms did not have Flexeril listed or handwritten on them. The totality of the evidence (including Respondent’s established practice of checking pre-listed medications in lieu of using of prescription pads, with the understanding that Metropolitan does “a lot of alterations” to the check forms, along with Respondent’s inability to deny the authenticity of his handwriting on the Metropolitan medication forms, and his certainty that “they forged" one of the forms) established that Respondent either knowingly prescribed Soma or, by allowing this lack of control over his prescriptions, authorized the prescribing of Soma under his medical license and DEA permit.
28(a). Complainant established by clear and convicting evidence that Respondent prescribed and/or facilitated the prescribing of Carisoprodol/Soma, a Schedule IV controlled substance, under his medical license and DEA permit.
28(b ). This constituted a violation of the ISO restriction, which prohibited Respondent from issuing prescriptions for any substance listed on Schedules II, III, IV or V.6
UNITED STATES DISTRICT COURT FOR THE CENTRAL DISTRICT OF CALIFORNIA ISSUED AN ORDER IN CASE NO. 12-01170(B)-MWF-6, THE UNITED STATES OF AMERICA VS. UCHE CHUKWUDI. DR. CHUKWUDI IS PROHIBITED FROM SEEING, TREATING OR PRESCRIBING OR ORDERING SERVICES OR ITEMS FOR MEDICARE PATIENTS AND PROHIBITED FROM PRESCRIBING CONTROLLED SUBSTANCES, INCLUDING HYDROCODONE (VICODIN) AND CODEINE FOR ANY PATIENTS.—7/29/2014
OIG Fugitive: Uche Chukwudi
(Office of Inspector General—US Dept of Health & Human Services)
On December 19, 2013, Dr. Uche Chukwudi was indicted on charges of health care fraud and conspiracy to commit health care fraud. Investigators believe that Dr. Chukwudi was involved in a scheme to fraudulently bill Medicare approximately $7.3 million for durable medical equipment (DME) that was never provided and was medically unnecessary.
Co-conspirator Adeline Ekwebelem owned Adelco Medical Distributors, a DME supplier in Gardena, California. According to the indictment, Ekwebelem paid marketers to solicit Medicare beneficiaries and offer them free DME, such as power wheelchairs, hospital beds, and orthotics, that they did not need. In return for the free products, the beneficiaries agreed to visit certain physicians, including Dr. Chukwudi, who would then use their beneficiary information to create false patient files and false statements in “face-to-face examination” forms. Dr. Chukwudi and other physicians then wrote prescriptions for the DME to be filled at Adelco.
Dr. Chukwudi referred more than 200 Medicare beneficiaries to Adelco for expensive, medically unnecessary DME, which enabled Ekwebelem to falsely bill Medicare for approximately $1.18 million. Dr. Chukwudi allegedly received cash kickbacks in return for writing the fraudulent prescriptions.
Ekwebelem was convicted on charges of conspiracy to commit health care fraud, health care fraud, and paying kickbacks for the recruitment of Medicare beneficiaries. Dr. Charles Okoye, a physician who referred more than 200 beneficiaries to Adelco, pleaded guilty to conspiracy to commit health care fraud. Both are awaiting sentencing. Patient recruiters Cindy Santana, Maritza Hernandez, and Romie Tucker, Jr., each pleaded guilty to illegal remunerations for health care referrals. Hernandez received 9 months in jail, while Santana and Tucker are awaiting sentencing.
Dr. Chukwudi fled the United States prior to his trial in September 2014. His whereabouts are currently unknown, and he remains a fugitive at-large.
CALIFORNIA—A Hawthorne woman responsible for more than $7 million in fraudulent Medicare billings, mostly for expensive power wheelchairs, was found guilty Friday of 16 federal charges stemming from the health-care fraud scheme.
Adeline Ekwebelem, 51, was convicted following a seven-day trial before U.S. District Judge Michael W. Fitzgerald, who set a Dec. 15 sentencing hearing in federal court.
Ekwebelem was found guilty of conspiracy to commit health-care fraud, a dozen counts of health-care fraud and three counts of paying illegal kickbacks for health-care referrals, according to the U.S. Attorney’s Office.
She is the fifth person convicted in relation to the scheme run out of her Gardena-based Adelco Medical Distributors Inc.
Evidence presented during the trial showed that Adelco billed Medicare for medically unnecessary equipment for beneficiaries who were often recruited off the street.
Ekwebelem paid illegal kickbacks to people known as marketers to recruit those beneficiaries. She also paid kickbacks to a handful of complicit doctors in exchange for fraudulent prescriptions for the wheelchairs.
Those doctors included Dr. Charles Okoye, who pleaded guilty last month, and Dr. Uche Chukwudi, who fled after being indicted and is a fugitive, prosecutors said.
Three of Adelco’s marketers — Romie Tucker, Cindy Santana and Maritza Hernandez — have also pleaded guilty to receiving kickbacks from Ekwebelem.
Ekwebelem submitted more than $7 million in fraudulent claims to Medicare and received nearly $3.5 million for those claims. (LINK) — 9/19/2014
(Iowa Board of Medicine Press Release) Brian J. Hansen, D.O., a 39-year-old Iowa-licensed physician who practices family medicine in Hampton, Iowa, had his Iowa medical license suspended by the Board on September 25, 2012. The Board filed a Statement of Charges and an Emergency Adjudicative Order alleging that Dr. Hansen engaged in a pattern of sexual misconduct and/or unprofessional conduct in the practice of medicine. The Board alleged that Dr. Hansen engaged in a pattern of inappropriate sexual conduct, including nonconsensual sexual contact, with at least six female patients and/or co- workers in Hampton, Iowa, between 2008 and May 2012. Under the terms of the Emergency Adjudicative Order, Dr. Hansen’s Iowa medical license is suspended until this matter is resolved. A hearing is scheduled on October 10-11, 2012.
(Iowa Board of Medicine Legal Document) The Board alleged that Respondent engaged in a pattern of sexual misconduct in violation of the laws and rules governing the practice of medicine in Iowa including the following:
A. Female #1: Respondent worked with Female# 1 and provided medical care to her between May 2009 and May 2012:
1) Respondent made improper sexual comments, sent inappropriate sexual emails, and made inappropriate sexual telephone calls, to Female #1.
2) On several occasions, Respondent masturbated in the presence of Female # 1 in his office while pornography was playing on his office computer.
3) On several occasions in 2011-2012, Respondent pressured Female # 1 to engage in sex acts with him, and physically threatened her on one occasion.
4) Respondent threatened to have Female # 1 fired.
B. Female #2: Respondent worked with Female #2 between July 20 10 and May 2012:
1) Respondent made improper sexual comments, sent inappropriate sexual emails, and made other inappropriate sexual overtures, to Female #2.
2) Respondent initiated inappropriate sexual contact with Female #2 while working together in the hospital in December 2011 and January 2012.
C. Female #3: Respondent worked with Female #3 between February 2007 and May 2012:
1) Respondent made improper sexual comments, sent inappropriate sexual emails, and made other inappropriate sexual overtures, to Female #3.
2) On multiple occasions, Respondent masturbated in the presence of Female #3 in his office while pornography was playing on his office computer.
3) On occasions while he was providing medical care to her, Respondent kissed Female #3, touched her inappropriately and engaged in nonconsensual sexual conduct toward her.
D. Female #4: Respondent worked with and provided medical care to Female #4 between April 2007 and May 2012:
1) Respondent made improper sexual comments, inappropriate sexual telephone calls, and other inappropriate sexual overtures, to Female #4.
2) Respondent engaged in nonconsensual sexual conduct with Female #4.
E. Female #5: Respondent worked with Female #5 and provided medical care to her between August 2010 and March 2012:
1) Respondent made improper sexual comments, inappropriate sexual telephone calls, and other inappropriate sexual overtures, to Female #5.
2) Respondent viewed pornography on his office computer in the presence of Female #5 on multiple occasions.
3) On one occasion while working with Female #5, Respondent asked her to engage in inappropriate sexual conduct.
F. Female #6: Respondent worked with, and provided medical care to, Female #6 between November 2006 and May 2012:
1) Respondent made improper sexual comments, sent inappropriate sexual emails, and other inappropriate sexual overtures, to Female #6.
2) On one occasion while providing medical care to Female #6,
Mercy doctor no longer employed at Franklin General
IOWA—
Officials at Mercy Medical Center-North Iowa confirmed Monday that Dr. Brian Hansen, a family physician employed at Franklin General Hospital, was no longer a member of the Franklin General staff as of Friday.
Further details were unavailable from the hospital.
“Because this is a personnel issue, we, per our policy, cannot comment,” Mercy officials said in a prepared statement. “Franklin General Hospital is committed to excellent patient care and has ensured that patient care continues uninterrupted and unaffected by any staff changes.”
A native of Hampton, Hansen earned his associate degree at North Iowa Area Community College, bachelor’s degree at Buena Vista University and medical degree at Des Moines University, from which he graduated in May 2003 with a doctor of osteopathic medicine degree.
He entered the Mercy Family Medicine Residency Program in July 2003 and began practicing at Franklin General Hospital in 2006. (LINK) — 6/04/2012
Hampton doctor’s license hearing continued
IOWA—A hearing scheduled Oct. 10-11 for Hampton family practice physician Dr. Brian Hansen has been continued, a spokesman for the Iowa Board of Medicine said Tuesday.
The continuance was granted at Hansen’s request. A new hearing date has not been set.
Hansen’s license to practice medicine was temporarily suspended in September based on allegations of sexual misconduct by six women with whom he was working.
A native of Hampton, Hansen received a doctor of osteopathic degree from Des Moines University in May 2003.
Prior to June 2012, he had been practicing medicine at Franklin General Hospital. Hansen was later named executive medical director at ABCM Corp. in Hampton and was practicing emergency medicine in Webster City, Charles City and Fairfield. (LINK) — 10/16/2012
Hampton doctor pleads guilty to felony sexual exploitation
IOWA—In front of six of his victims, Dr. Brian Hansen pleaded guilty in Franklin County District Court in Hampton to one count of sexual exploitation by a counselor or therapist, a Class D felony.
The plea was part of an agreement with the Iowa Attorney General’s Office that included no jail time but 15 years of court supervision.
“He is a predator and knew exactly what he was doing,” said a victim in court Thursday. She was referred to as A.S. in court documents.
The victims, all current or former employees of Franklin General Hospital, told tales of broken marriages, losing custody of their children, suicide attempts, health problems and losing jobs as a result of the abuse.
The crimes occurred between 2006 and 2012.
Hansen was charged Wednesday by Assistant Iowa Attorney General Susan Krisko with two counts of third-degree sexual abuse and six counts of sexual exploitation by a counselor or therapist.
The state agreed to dismiss both counts of sexual abuse and five of the six counts of sexual exploitation. Six of the seven women were listed as victims on the remaining count of sexual exploitation.
Hansen was sentenced by District Judge Colleen Weiland to five years in prison which was suspended, five years probation and a $7,500 fine.
He also received a special sentence requiring him to remain under court supervision for 10 years once his probation is completed.
Hansen must also register as a convicted sex offender and participate in the sex offender program through the Iowa Department of Corrections.
A no-contact order was issued including all seven victims.
The state has 30 days to submit requests for restitution.
Prior to June 2012, Hansen was practicing medicine at Franklin General Hospital in Hampton. The hospital is a member of the Mercy Health Network-North Iowa.
Hansen’s license to practice medicine was temporarily suspended in September 2012 based on the allegations of sexual misconduct by six women with whom he was working.
Since then Hansen was working as executive medical director at ABCM Corp., based in Hampton, which owns numerous rehabilitation centers, long-term care facilities and independent and assisted living communities in Iowa.
CEO Richard Allbee said Thursday that Hansen has been suspended from his duties and more action will be considered once his sentencing documentation and status as a sex offender are registered with the state.
The women victims were co-workers and patients of Hansen. In statements to the court, they told similar tales of friendship and trust which were broken when he coerced them to engage in sexual contact.
With her hands shaking, a victim identified as S.L. said Hansen sent her flirtatious emails.
One day he called her to his office and showed her a pornographic movie, asking her if that was something she might be interested in doing.
Another time, in an examination room at the hospital, she found Hansen exposed with his pants down.
He asked her if she’d like to “come over and touch that.”
The woman said she never told anyone what was going on because she didn’t think she would be believed.
“I’m not from Hampton. I wasn’t born and raised here,” S.L. said. “He’s a Hansen. He’s from Hampton.”
Victim J.K. called Hansen “a monster.”
One day she was taking a document to Hansen’s office and found him in a darkened room, masturbating behind his desk while a pornographic movie played on his computer.
“I wondered, how did I get into this situation and how do I get out of it?”J.K. said. “I knew if I told anybody about this you would have me fired.”
Victim K.V. told of a pattern of emails leading to sexual overtures.
“You were relentless,” K.V. said.
She thought that if she gave in,“the nightmare would stop.”
“You had amazing gifts as a physician. But you abused it and you abused us.”
Victim N.W. was hospitalized after a suicide attempt. Her husband left her and she lost custody of her children.
Hansen addressed the court before sentencing was pronounced.
“I always told my children that the choices they make will affect the rest of their lives. But I didn’t heed my own advice,” Hansen said, adding that what he did was very wrong.
“It’s time to put an end to it and move on with life. To the people in this room, I am sorry.”
Hansen’s wife, Jennifer, and two of his three children were in the courtroom for the hearing Thursday. Many in the packed courtroom were wearing small ribbons on their clothing as a show of support for Hansen. (LINK) — 5/30/2013
Former Hampton doctor jailed after violating probation
IOWA—A former Hampton physician was sentenced to seven days in jail in April for violating his probation on a charge of sexual exploitation by a counselor or therapist.
Brian Hansen, 41, was found in contempt of court by District Judge Colleen Weiland in April in Franklin County District Court.
Hansen admitted to entering a Hampton convenience store on Saturday, Nov. 30, to buy a cup of coffee, knowing that a victim referred to in court as J.K. was already inside the store.
As part of his probation, Hansen is prohibited from contacting victims or their families and must remain a minimum of 50 feet away from his victims.
Hansen was originally charged with two counts of sexual abuse and six counts of sexual exploitation by a counselor or therapist on May 29, 2013. He pleaded guilty to one count of sexual exploitation by a counselor or therapist, a class D felony, on May 30, 2013.
Hansen admitted having sexual contact with co-workers and patients at Franklin General Hospital in Hampton between 2006 and 2012.
He was sentenced to five years in prison suspended, five years probation and a $7,500 fine.
As a condition of his sentence on the original conviction, Hansen must also register as a convicted sex offender and participate in the sex offender program through the Iowa Department of Corrections.
Hansen voluntarily surrendered his Iowa medical license on Oct. 25, 2013, and agreed to pay a $10,000 civil penalty. (LINK) — 12/30/2013
Convictions with multiple victims are listed once with each victim’s information.
The link(s) below display the current Iowa Code, which may not be the Code in existence at the time of conviction. For archived versions of Iowa Code, please click here.
CALIFORNIA—The California Medical Board found 10 causes for discipline
1. Gross Negligence 2. Repeated Negligent Acts 3. Incompetence 4. Prescribing without an appropriate examination and medical indication 5. Excessive prescribing 6. Prescribing for himself 7. Violation of Federal or State drug statutes 8. Commission of acts involving dishonesty or corruption 9. Failure to maintain adequate and accurate medical record 10. General unprofessional conduct
Respondent is subject to disciplinary action under sections 2227 and 2234, as defined by section 2234, subdivision (b), of the Code, in that respondent committed gross negligence in his care and treatment of patient P.A., as more particularly alleged hereinafter:
A. On or about May 22, 2008, respondent commenced prescribing controlled substances and dangerous drugs for patient P.A. On this same date, respondent prescribed Alprazolam 1 mg3 for patient P.A. On or about September 11, 2008, October 2, 2008 and October 23, 2008, respondent prescribed 30 tablets of Provigil 200 mg 4 for P.A. However, beginning on or about November 11, 2008, respondent commenced prescribing 60 tablets of Provigil for patient P.A., and he prescribed 60 tablets of Provigil for patient P.A on or about December 6, 2008, and December 19, 2008. Thereafter, respondent regularly prescribed 60 tablets of Provigil and Nuvigil 5 for patient P.A. until about August 22, 2010. These prescriptions were filled by respondent at various pharmacies in San Diego including BioScrip Phannacy (BioScrip). Respondent prescribed these drugs for patient P.A. without ever creating a medical record for patient P.A., and without documentation of a physician/patient relationship with patient P.A. Moreover, respondent failed to create or generate any chart note for patient P.A. during this period.
B. According to the Controlled Substances Utilization and Review Evaluations (CURES) report, between about January 14, 2009 and December 20, 2009, respondent wrote approximately 34 separate prescriptions each for 60 tablets of Provigil 200 mg for patient P.A. Thus in 2009, respondent prescribed approximately 2040 tablets of Provigil 200 mg for patient P.A. All these prescriptions were filled by respondent at various pharmacies in San Diego. During 2010, respondent commenced prescribing Nuvigil 250 mg for patient P.A. in addition to the Provigil medications. During 2010, respondent wrote 14 prescriptions each for 60 tablets of Nuvigil 250 mg for patient P.A. This was in addition to the 24 separate prescriptions each for 60 tablets of Provigil 200 mg respondent wrote for patient P.A. during 2010. Thus in 2010, respondent prescribed a combined total ofapproximate1y 2280 tablets ofProvigil and Nuvigil for patient P.A. Between about January 10,2011 and May 2, 2011, respondent wrote nine (9) prescriptions for a total of approximately 240 tablets of Nuvigil 250 mg for patient P.A. In addition, during this period, respondent wrote three (3) prescriptions of Alprazolam 0.25 mg for patient P .A. All these prescriptions were filled by respondent at various pharmacies in San Diego.
C. Between about 2008 and 2011, respondent repeatedly prescribed large amount of Provigil and Nuvigil for patient P.A. without creating a medical record for patient P.A. and without establishing and documenting a physician/patient relationship with patient P.A. Moreover, respondent prescribed these drugs for patient P .A. without creating or generating any chart note, without ever documenting a patient complaint, without ever performing and/or documenting a physical examination, and without ever arriving at and/or documenting a diagnosis or treatment plan. Further, respondent prescribed these drugs for patient P .A. without ever obtaining and/or documenting patient P.A.’s informed consent, and without ever documenting a discussion of how patient P.A. was functioning on the drugs.
D. On or about June 6, 2010, respondent was arrested by officers of the San Diego Police Department for domestic violence. Respondent was alleged to have hit patient P.A. According to the police report, patient P .A. reported that he had an argument and altercation with respondent, in part, because he wanted respondent to stop “ordering” prescription drugs in his name. Patient P.A. also reported that he was studying to become a nurse and was afraid that "a pharmacy profile" showing the medications respondent was prescribing in his name would negatively impact his ability to obtain a license as a nurse.7
E. On or about August 8, 2010, patient P.A. spoke to the Pharmacy Manager at BioScrip about the Provigil prescriptions respondent was writing for patient P.A. Patient P.A. told the pharmacy manager that he had no knowledge of the prescriptions for Provigil respondent was writing in his name, that the prescriptions were fraudulent, and that he never received or used any of the Pro vigil medications. On or about September 24, 2010, P.A. signed a letter confirming he did not receive or use the Provigil medications. However, during his interview with the Medical Board’s senior investigator on or about January 17, 2012, patient P.A. told the investigator that the Provigil and Nuvigil medications respondent prescribed in his name were for his (P.A.’s) use.
F. Beginning in about May 16, 2009, respondent commenced prescribing Provigil 200 mg for himself. According to the CURES Report, between May 16, 2009 and December 21, 2009, respondent prescribed 60 tablets of Pro vigil 200 mg for himself nearly every 10 days. Respondent filled these prescriptions at various pharmacies in San Diego. During this period, respondent prescribed a total of approximately 840 tablets of Provigil for himself. Between about January 21, 2010 and June 5, 2010, respondent prescribed a total of approximately 420 tablets of Provigil 200 mg for himself, and between about May 25, 2011 and December 3, 2011, respondent prescribed a total of approximately 490 tablets ofNuvigil for himself.
16. Respondent committed gross negligence in his care and treatment of patient P.A. which included, but was not limited to, the following:
A. During the period of2008 to 2011, respondent prescribed large amounts of Provigil and Nuvigil to patient P.A. without creating a medical record for patient P.A.
B. During the period of2008 to 2011, respondent prescribed large amounts of Provigil and Nuvigil for patient P.A. without establishing and documenting a physician/patient relationship with patient P.A.
C. During the period of 2008 to 2011, respondent prescribed large amounts of Pro vigil and Nuvigil for patient P.A. without creating or generating any chart note, without ever documenting a patient complaint, without ever performing and/or documenting a physical examination, and without ever arriving at and/or documenting a diagnosis or treatment plan for patient P.A.
D. During the period of 2008 to 2011, respondent prescribed large amounts of Pro vigil and Nuvigil for patient P.A. without ever obtaining and/or documenting patient P.A. ’s informed consent, and without ever documenting a discussion of how patient P.A. was functioning on these controlled substances and dangerous drugs.
DISCIPLINARY ACTIONS—Record clear as of 12/30/2014
FLORIDA—Robert Kemp Crockett III, a doctor at Miami Children’s Hospital, has been charged with indecent liberties with a child in Brunswick County.
Robert Kemp Crockett III, 62, is charged with indecent liberties with a child, second-degree sexual offense and statutory rape.
Crockett, 62, turned himself in at the Brunswick County jail last week after a warrant was issued for his arrest. A pediatric emergency medicine specialist, he was released on $50,000 bail.
Crockett of Coral Gables, Fla., holds medical licenses in Florida and North Carolina and is a graduate of the Bowman Gray School of Medicine at Wake Forest University. A hospital spokeswoman said Crockett has been on leave from the hospital for several months and “his employment is suspended while the investigation is under way.”
Chief Ken Bellamy of the Ocean Isle Beach Police Department said the complaint originated when the victim’s family contacted Florida authorities, who asked Ocean Isle Beach Police to investigate.
The warrant references events on July 30 and 31. Bellamy said Crockett was in the area on vacation and that the incident with the 15-year-old boy was not prearranged.
Felony charges against Crockett include indecent liberties with a child, second-degree sexual offense and statutory rape.
MEDICAL BOARD RECORD—137798 LICENSE STATUS/DISCIPLINARY ACTIONS—License revoked
Temporary surrender of the physician’s New York State medical license issued pursuant to New York State Public Health Law Section 230.13. Later the physician’s New York State medical license was revoked on December 21, 2016.
License revocation. Both parties may request a review of the Hearing Committee’s Determination and Order. Misconduct Description:The Hearing Committee sustained the charges finding the physician guilty of having committed professional misconduct by having been convicted in Monroe County Supreme Court of New York State of Tampering with Physical Evidence, and having been convicted in Monroe County State of New York of Driving While Ability Impaired by Drugs.
NEW YORK—There are new charges against a local doctor already involved in a case involving the body of a missing man.
News10NBC has learned Dr. William Lewek is now charged with driving under the influence of drugs. He was arrested Saturday after being pulled over on 590 near Empire Boulevard in Irondequoit.
Lewek is already charged with drug possession and tampering with evidence. Police say they found the body of Matthew Straton in his backyard in the Park Avenue neighborhood earlier this year.
Irondequoit Police Sergeant Alan Laird said, “On Saturday evening at about 5:30 p.m., an officer was northbound on Route 590 in Irondequoit and noticed a vehicle driving erratically. The vehicle was stopped and the driver was identified as William Lewek. Mr. Lewek was asked to perform some field sobriety tests. Based on his performance on the field sobriety test, the officer felt there was more than just alcohol involved at which point a drug recognition expert was brought in and it was determined that Mr. Lewek was under the influence of not only alcohol but drugs.”
Straton’s mother, Kym, says Lewek’s latest arrest doesn’t surprise her. “It doesn’t surprise me. Nothing that he does surprises me. It just goes to show that he has no regard for the law or for anybody else. I mean, he could have hurt somebody else out there while he was out there driving.”
Matthew Straton went missing last October and three months later, police found his body in Lewek’s backyard.
Straton said, “He makes me sick. The sight of him makes me sick. I need this to be over with. The one thing that gets me through this past year is knowing that I have to fight for Matt. I’m Matt’s voice right now.”
Lewek’s trial is scheduled for February. If he is found guilty, he could face less than 10 years in prison. (LINK) — 12/29/2014
Psychiatrist Arraigned On Charges Related To Rowley St. Body
Rochester Police have once again shut down Rowley Street as they continue to scour the house and backyard of Dr. William Lewek.
The Monroe County Medical Examiner’s office confirmed Thursday evening that remains found in the backyard of Lewek’s home were those of 31-year-old missing man Matthew Straton. Police were led to the residence Wednesday after they received a tip. William Lewek, 62, pleaded not guilty Friday to charges of evidence tampering and cocaine possession in Rochester City Court. According to court documents, investigators found 17 bags of crack cocaine inside the Rowley Street home. He also had an office inside the home where he worked as a psychiatrist specializing in drug addiction.
Court documents allege that Lewek dragged Straton’s body out of a third floor bedroom on October 29th between 2 a.m. and 3 a.m. He covered it with grass, dirt and a patio chair. During that time the Straton family canvassed the area and put up flyers. The family says Straton had a history of addiction to pain medication, but they did not know Dr. Lewek.
“Matt’s had his problems with addiction and I have never heard if this man before. We are all baffled that it has come out this way. If he is a psychiatrist or a drug addiction helper why did he have cocaine? Did he feed mad? I am lost for words right now. A lot if unanswered questions, lots of unanswered questions still,” his mother Kym said.
“It has been [an] absolutely unbelievably thorough investigation. They have taken their time and have methodically tried to go through the evidence. The house is very large and we just a lot of things to go through and obviously I have seen you all report on the outside and you know that’s difficult when you’re when you’re becoming remains and you’re looking for physical evidence involving interior and exterior of the house,” Assistant District Attorney Kelly Wolford said.
Dr. Lewek is being held on $500,000 bail. The District Attorney’s office wanted bail set at $1 million because Lewek travels, speaks several languages and has a past DUI conviction in Arizona. (LINK) — 1/17/2014
Imprisoned psychiatrist loses medical license
A Rochester psychiatrist who pleaded guilty to hiding a body in the yard of his Rowley Street home had his medical license revoked by the state Department of Health.
The action against William Lewek took effect Dec. 21, according to the Health Department. Lewek is serving up to four years at Fishkill Correctional Facility in Beacon, Dutchess County.
In February 2015, Lewek admitted to the felony charge of tampering with physical evidence. The psychiatrist had been accused of burying the body of 32-year-old Matthew Straton beneath lawn debris and a patio chair.
Straton had been reported missing in October 2013, and a flier drawing attention to his disappearance was posted on a utility pole across the street from Lewek’s house in the Park Avenue neighborhood. The body was found in January 2014.
The cause of Straton’s death was never announced. Lewek allegedly told police that Straton had died of a drug overdose, and Lewek tried to conceal the body in his yard. Lewek and Straton had a personal relationship, said attorney Matthew Parrinello.
Lewek also was accused of possessing crack cocaine.
In December 2014, Lewek was charged after a traffic stop in Irondequoit with driving while ability impaired.
The state Health Department charged Lewek with professional misconduct based on his felony guilty plea in the Straton case and the misdemeanor driving charge. Lewek had temporarily surrendered his medical license on May 14, 2014, according to an emailed response from the state Department of Health to questions about the procedure in revoking a doctor’s license.
At the Nov. 17 hearing on the status of his license, Lewek testified by phone.
“He’s disappointed in the decision,” said Parrinello, who represented Lewek at the hearing. “A decision to appeal has not yet been made.”
The Board for Professional Medical Conduct disciplines physicians who are found guilty of misconduct, according to a statement from the health department. Based on the misconduct, the board imposes actions that it believes protects the public. The board considered sanctions ranging from a fine, censure and reprimand, up to revocation. Parrinello said that given Lewek’s felony plea, they were not surprised at the revocation. Parrinello said he was not sure about Lewek’s plans to practice upon his release, “but you don’t want that option taken away from you.”
Lewek, who was licensed to practice in 1979, is 64 years old.
Parrinello said Lewek told the hearing committee that he panicked and that he regrets the decision he made about Straton’s body.
According to the hearing report posted on the Health Department web site, “Particularly troublesome to the Hearing Committee was (Lewek’s) conduct in how he handled the unfortunate events that led to the felony charge, including not seeking medical assistance after discovering the body … and failing to report the incident for at least two months amid providing psychological care and treatment to patients within his home.”
The committee said that while Lewek had an “intense fixation” on the care he provided, he also had “boundary problems” and merged “his patients’ psychiatric issues and conditions with that of his own” and said Lewek was willing to exploit patients for his own benefit.
The report also addressed the charge against Lewek of driving while impaired. Some references to Lewek’s use of medications were redacted, but the document did contain the fact that Lewek is receiving treatment while in prison. The report noted that while professionals do receive treatment and continue to help others, (Lewek’s) “needs are compelling and will outlast his jail term.”
The committee noted that Lewek did not take steps on his own prior to being imprisoned and that his “markedly impaired judgment” put patients at risk and “as such, his license to practice … must be revoked.”
According to a statement from the health department, the doctor or the state can appeal the decision of a hearing committee to the administrative review board. A physician whose license has been revoked may petition to the Board of Regents for restoration, no sooner than three years after the revocation of the physician’s license. (LINK) — 12/29/2016
This profile is being updated on the Medical Board website and will be available on 1/17/2015
MASSACHUSETTS—It was a Perry Mason moment updated for the Internet age.
As Ivy League-educated pediatrician Robert P. Lindeman sat on the stand in Suffolk Superior Court this month, defending himself in a malpractice suit involving the death of a 12-year-old patient, the opposing counsel startled him with a question.
Was Lindeman Flea?
Flea, jurors in the case didn’t know, was the screen name for a blogger who had written often and at length about a trial remarkably similar to the one that was going on in the courtroom that day.
In his blog, Flea had ridiculed the plaintiff’s case and the plaintiff’s lawyer. He had revealed the defense strategy. He had accused members of the jury of dozing.
With the jury looking on in puzzlement, Lindeman admitted that he was, in fact, Flea.
The next morning, on May 15, he agreed to pay what members of Boston’s tight-knit legal community describe as a substantial settlement – case closed.
The case is a startling illustration of how blogging, already implicated in destroying friendships and ruining job prospects, could interfere in other important arenas. Lawyers in Massachusetts and elsewhere, some of whom downloaded Flea’s observations and posted them on their websites, said the case has also prompted them to warn clients that blogs can come back to haunt them.
Still, Andrew C. Meyer Jr., a well known Boston personal injury lawyer who followed the case, said he had never heard of a defendant blogging during a trial.
“Most of us investigate whatever prior writings our clients might have had, so they are not exposed to their inconsistencies in their testimony,” said Meyer, who has begun warning clients against the practice. “But it’s impossible to do if you don’t know that your client is blogging under an assumed name.”
Neither Lindeman nor his lawyer, Paul R. Greenberg, would comment. Vinroy Binns, the father of Jaymes Binns, of Dorchester, who died of complications from diabetes in 2002, also declined to comment.
Elizabeth N. Mulvey, the lawyer who represented Vinroy and Deborah Binns and unmasked Lindeman as Flea, said she laughed when she read a posting at the start of the trial in which Lindeman nicknamed her Carissa Lunt, noticed that she bit her fingernails and mused, “Wonder if she’s a pillow biter, too?”
But she was appalled that readers in the blogosphere who knew little or nothing about the case rallied to his defense.
The wrongful death suit alleged that Lindeman, who works at Natick Pediatrics, failed to diagnose that Jaymes Binns had diabetes on March 11, 2002, Mulvey said in a court document. Less than six weeks later, the boy died of diabetic ketoacidosis, said Mulvey, who described the condition as “diabetes gone haywire.”
Lindeman, a graduate of Yale University and Columbia University’s College of Physicians and Surgeons, is board-certified in general pediatrics and pediatric pulmonary medicine, according to the Natick Pediatrics website.
In recent years, he has shared his medical views on local television news programs, on the “Manic Mommies” podcast produced by two Ashland mothers, and in magazines.
He is also the author of drfleablog, in which he calls himself Flea and identifies himself only as a pediatrician in the Northeast. A flea, he told the Globe this year, is what surgeons called pediatricians in training. The Globe’s medical blog, White Coat Notes, has occasionally included links to Lindeman’s blog, which he has recently taken down.
Mulvey, who said she only learned of the blog a couple weeks before the trial, said after reading scores of back postings that it was controversial yet intellectually stimulating.
Over the past year, Lindeman increasingly used it to rail against the malpractice suit.
In April, before the trial began, he wrote about meeting with an expert on juries who advised him how to act when he was cross- examined. Flea was instructed to angle his chair slightly toward the jury, keep his hands folded in his lap, and face the jury when answering questions, slowly. “Answers should be kept to no more than three sentences,” he wrote.
The consultant told him juries in medical malpractice cases base verdicts almost entirely on their view of a doctor’s character.
“We’ve said it before, and we’ll say it again: If the basis of this case is that Flea is an arrogant, uncaring jerk who maliciously neglected a patient, resulting in his death, the plaintiff will not win,period,” Flea wrote. “As much of a cocky bastard that Flea may appear in the blogosphere, the readers who have a personal acquaintance with the real 3-D doctor understand how such an approach cannot succeed.”
Shortly before the end of his second day on the witness stand, while focusing on Lindeman’s views of a pediatric textbook, Mulvey asked him whether he had a medical blog, she recalled. He said he did. Then she asked him if he was Flea. He said he was.
The exchange may have been lost on jurors, but Meyer said Mulvey had telegraphed that she was ready to share Lindeman’s blog – containing his unvarnished views of lawyers, jurors, and the legal process – with the jury.
The next day, the case was settled. (LINK) — 5/31/2007
Commonwealth Suspends Medical License of Popular Pediatrician
MASSACHUSETTS—The state suspended the license to practice medicine for a popular Framingham pediatrician.
The Massachusetts Board of Registration in Medicine summarily suspended the medical license of Dr. Robert P. Lindeman, finding ”he is an immediate and serious threat to the public health, safety, and welfare.”
The Board alleges Dr. Lindeman “failed to meet the standard of care when treating four patients, issued prescriptions to several individuals not in the usual course of his medical practice, and failed to properly maintain several medical records,” according to a release.
He was ordered to immediately stop practicing medicine on Dec. 17.
Dr. Lindeman has the right to appeal the suspension to the Division of Administrative Law Appeals within seven days of Dec. 17.
Patients of Dr. Linderman began receiving letters Christmas week, that he could not practice medicine but the letter did not state the reasons why.
Dr. Linderman has owned and operated a private pediatrics practice - Natick Pediatrics - since 2002.
According to court documents, Dr. Lindeman had a patient who died, in 2002.
In 2007, he was involved in a civil trial in Suffolk County Coutry involving a wrongful death suit that alleged Dr. Lindeman failed to diagnose that Jaymes Binns, 12, had diabetes in March of 2002, according to court documents. Six weeks later, the Dorchester boy died of diabetic ketoacidosis, according to court records.
The civil case against Dr. Lindeman was settled privately in May 2007. No public details are available.
The suspension of his license has nothing to do with that 2002 death. Details on Dr. Lindeman’s “failure to meet the standard of care for four patients” were not available, when this report was published.
Lindeman, who lives in Brookline, is board-certified in general pediatrics. His now Framingham-based practice focuses on childhood and adolescent health care, with a specialty in diseases of the lung, such as asthma and chronic cough.
He earned his undergraduate degree at Yale University.Dr. Lindeman graduated from Columbia University College of Physicians and Surgeons in 1994 and has been licensed to practice medicine in Massachusetts since 1999.
He completed his medical training at Children’s Hospital in Boston, and was associated with a general pediatrics practice on the South Shore before being recruited by Metro West Medical Center, to establish a pediatrics and pediatric pulmonary practice in Natick, according to his profile on Natick Pediatrics. The practice is now located in the Lincoln Medical Building in Framingham.
He is certified by the American Board of Pediatrics. (LINK) — 12/29/2014
DISCIPLINARY ACTIONS—License renewed & current; Misdemeanor conviction; Probation; Limits on Practice
PLED GUILTY TO ONE COUNT OF VIOLATING DOUGLAS COUNTY CODE SECTION 9.454.351. (POSSESSION OF A DRUG WHICH MAY NOT BE INTRODUCED INTO INTERSTATE COMMERCE). ORDERED TO PAY FINE IN THE AMOUNT OF $1,137.00. — 9/20/2013
FIVE YEARS PROBATION WITH VARIOUS TERMS AND CONDITIONS. RESTRICTIONS: SHALL NOT RECOMMEND MARIJUANA TO ANY PATIENT FOR ANY MEDICAL PURPOSE, OR EVALUATE ANY PATIENT FOR THE PURPOSE OF MAKING A MEDICAL MARIJUANA RECOMMENDATION AND PROHIBITED FROM SUPERVISING PHYSICIAN ASSISTANTS.—9/05/2014
CALIFORNIA—A Yuba City doctor was placed on five years’ probation on Friday by the state Medical Board following a misdemeanor drug conviction in Nevada.
The discipline was imposed on Dr. Shahzad Naseem, a board certified pediatric infectious disease specialist.
Naseem was employed by Ampla Health in Yuba City but left in late 2013, according to a company spokeswoman.
Naseem’s Irvine lawyer, Courtney Pilchman, was not available for comment on Friday.
The state Medical Board filed an accusation against Naseem last year, recounting his March 2012 arrest in Stateline, Nev., when he attempted to enter Club Vex nightclub.
Security personnel at the club patted down Naseem, finding cocaine and marijuana, the accusation said.
Following his arrest, Douglas County sheriff’s deputies also found pills.
“I don’t understand the big deal,” Naseem is alleged to have told the officers. “I am not a drug dealer. It is a small amount. (It’s) just for personal use. There is nothing wrong with it.”
In September 2012, Naseem pleaded guilty to a misdemeanor drug charge and paid a fine, the accusation said.
California authorities learned of the conviction from the Douglas County District Attorney’s Office. Naseem had failed to inform the Medical Board, the accusation said.
While on probation, Naseem is barred from using controlled substances and alcohol. He also is subject to biological fluid testing by the board. He also can’t recommend marijuana for medical purposes. (LINK) — 9/06/2014
MEDICAL BOARD RECORD—C 23681 DISCIPLINARY ACTIONS—License renewed & current; Limits on practice; Hospital discipline; Probation
TERMINATION OR REVOCATION OF STAFF PRIVILEGES, Enloe Medical Center, Chico, CA — 8/26/2002
EFFECTIVE 10/14/08 FIVE YEARS PROBATION WITH VARIOUS TERMS AND CONDITIONS. EFFECTIVE 09/05/14 NEW DECISION EXTENDS PROBATION FOR FIVE YEARS WITH VARIOUS TERMS AND CONDITIONS. RESTRICTIONS: MAY ONLY PERFORM SURGERIES IN AN ACCREDITED HOSPITAL, HOSPITAL-RUN OUTPATIENT SURGERY CENTER OR AN ACCREDITED OUTPATIENT SURGERY CENTER NOT OWNED BY DR. MORGAN, PROHIBITED FROM ENGAGING IN THE SOLO PRACTICE OF MEDICINE, SUPERVISING PHYSICIAN ASSISTANTS AND DURING THE FIRST YEAR OF PROBATION, HE SHALL HAVE AN ONSITE SURGICAL PROCTOR PRESENT FOR ALL SURGICAL PROCEDURES THAT HE PERFORMS. — 9/05/2014
Chico doctor faces new accusation by state Medical Board
CALIFORNIA—Claiming his practice is unsafe, the state Medical Board wants to revoke or suspend a Chico physician’s medical license.
In 2008, the board put the license of plastic surgeon Loren Morgan on probation. An accusation had been filed against him in 2002 and amended in 2004 and 2005. The accusation alleged the doctor acted inappropriately in relation to six patients.
Now, in a new accusation, the board contends that the probation should be revoked and that Morgan should face discipline again. The accusation alleges he has been unprofessional and negligent, and that he suffers from illness that can affect his practice of medicine.
Morgan, in a phone interview, said the board is wrong and that he will fight the charges.
His trouble with the board started when he became the object of “a sham peer review,” he said.
He had criticized the previous administration of Enloe Medical Center, he said, and as a result, charges were made against him. His privileges to practice at Enloe were taken away. That drew the attention of the Medical Board, which then acted against him, also, he said.
The more recent accusation, filed on Dec. 29, has four “causes of discipline.”
The first of these concerns an incident in January of 2012, in which Morgan allegedly interfered with an ambulance crew’s efforts to care for one of his surgery patients. The patient was at her Chico home, suffering from surgical complications.
According to the accusation, Morgan tried to prevent paramedics from assessing the patient’s condition. It said the doctor insisted the patient be taken to Oroville Hospital, where he had privileges, instead of to Enloe, where paramedics wanted to go because it was much closer.
According to the complaint, the ambulance crew said the patient’s condition was “critical,” but Morgan told this newspaper, “she wasn’t in bad straits.”
The doctor denied that he interfered with the crew and said, “the only thing I did was to say, ‘Is there a way you could take her to Oroville?’”
In the second cause, the board states Morgan’s facility at 18 Williamsburg Lane is unsafe because certain conditions make it potentially unsanitary for surgery and because the one registered nurse, Morgan’s wife, is not a certified registered nurse anesthetist.
The accusation states that during a state Department of Public Health inspection in 2011, a patient at Morgan’s facility was given a type of anesthesia that “falls beyond the scope of practice for a registered nurse.”
Rebutting the charges, Morgan said his office passed a recent inspection by the Joint Commission on Accreditation of Health Care Organizations and that his patients haven’t had problems with infections.
His wife operates entirely within her scope of practice, he said. “If we do a big case, we have an anesthetist come in.”
The third cause states that Morgan did not keep adequate records of his care of patients.
The fourth cause concerns Morgan’s health. Because of the terms of his probation, Morgan underwent two neuropsychological evaluations. Both examiners concluded he was suffering from impairments which affect his competence.
Asked about the tests, Morgan told this newspaper, “we have done an independent exam. The Medical Board wasn’t really forthright in what they said.”
Morgan, who got his medical license in 1961, said he would have fought the charges that, beginning in 2002, led to his probation, but he couldn’t afford a lawyer. This time he has an attorney and will pursue the case, he said. (LINK) — 1/22/2013
Chico plastic surgeon disciplined by state for multiple reasons
A Chico plastic surgeon has been disciplined by the state Medical Board after being accused of unprofessional conduct, negligence and incompetence.
Dr. Loren R. Morgan had his medical license revoked by the board. However, the revocation was stayed, and Morgan is being allowed to practice, under certain conditions, during a five-year probation period.
A mitigating circumstance in the case was that Morgan had been licensed for 46 years without ever having been the subject of disciplinary action.
Medical Board documents state Morgan’s privileges to work at Enloe Medical Center were taken away in 2002. A spokeswoman for Enloe said he currently is not a member of the medical staff at the Chico hospital.
Board documents cite five cases involved in Morgan’s discipline.
In 1999, the documents state, Morgan kissed a young woman on the cheek during an appointment and told her, “we love you.” At another appointment, when the same woman was reclining in a chair and had her eyes closed because of the bright light shining in her eyes, Morgan kissed her on the mouth, the documents said.
In another 1999 case, the documents cite, Morgan was preparing an anesthetized female patient for jaw surgery when he lowered her gown, exposing her breasts and remarked how big they were. During the operation, he left her breasts exposed, the documents said.
Following a surgery performed in 1998, a patient began waking up while Morgan was talking to another doctor over the intercom, according to the documents.
He allegedly hit the patient on the forehead with the bottom of his fist and told him to “shut up.”
In a case from 1998, the documents said, Morgan was treating a child who was fussing about having an injection in his foot. The doctor threatened the boy with a spanking “longer and harder” than he’d ever been spanked before, the documents stated.
And in a case from 2000, Morgan was accused of performing hand surgery that was unnecessary and of not properly following up on the patient.
The last case, from 2002, involved surgery Morgan performed to remove fat from an obese woman. The documents claimed it was unprofessional to do surgery on such a high-risk patient, that Morgan did two procedures and only had consent for one, and that his decision to use certain drugs to treat post-operative bleeding represented incompetence and negligence.
The 64-year-old woman died just more than a month after surgery, the documents cited, noting her death was caused by blood clots resulting from her surgery.
As conditions of his probation, the board ordered Morgan to have a chaperone present when he treats female patients, to take certain training courses and undergo evaluations, and to meet other requirements.
On Friday, the Enterprise-Record left a message for Morgan at his office, offering him the opportunity to comment. He hadn’t called the newspaper by Monday afternoon. (LINK) — 1/27/2009
Obituary
L. RICHARD MORGAN, 80— Long time Chico resident L. Richard Morgan died Thursday April 21, 2016 Dr. Morgan was born Oct. 8, 1935 in Karval, CO.
Dr. Morgan attended the University of Colorado, Boulder for both undergraduate and medical school. Dr. Morgan did his Internship and General Surgery Residency at Letterman Army Medical Center in San Francisco, CA. He left there to serve in a special trauma unit assigned to Vietnam. His wartime service led him to a Plastic Surgery residency in at Barnes Memorial Hospital in St. Louis, MO.
From there Dr. Morgan became the Chief of Plastic Surgery at Valley Forge Medical Center. Moving west Dr. Morgan returned to his home state of Colorado to become Chief of Plastic Surgery at Fitzsimmons Army Medical Center in Aurora, CO. Completing his western travels Dr. Morgan retired from active duty (while remaining a reserve officer) and started private practice in Chico, CA in 1974.
Dr. Morgan was Board certified in General, Plastic, and Reconstructive Surgery. He chose to specialize in hand and Maxiliofaclal surgery stemming from the work he did reconstructing U.S. Soldiers in Vietnam. Dr. Morgan went on to serve wounded U.S. military from Bosnia, Desert Storm I, and Special Forces units from around the world. He was an Instructor in Advanced Trauma Life Support, Advanced Burn Life Support, Advanced Cardiac Life Support, and Combat Anesthesia. Dr. Morgan was a member of the American Society of Maxillofacial Surgeons, the American Association of Plastic Surgeons, and the Royal Society of Medicine. He was a fellow of the American College of Surgeons, the American Society of Plastic and Reconstructive Surgeons, and the American Cleft Palate Craniofacial Society.
Dr. Morgan was instrumental In starting and operating the burn unit at Chico Community Hospital that served burn patients across northern California until the hospitals closing. Before his 1997 retirement from the US Army Reserves, Dr. Morgan served as a special assistant to the US Army Surgeon General. Dr. Morgan retired as a Grade 06 Colonel. Over the course of his military career, Colonel Morgan was awarded the Army Commendation Medal with 2 Oak Leaf Clusters, the Meritorious Service Medal with 3 Oak Clusters, the Vietnam Service Medal with 2 Bronze Stars, the National Defense Service Medal, and the Army Reserve Component Achievement Medal.
Dr. Morgan retired from private practice in September of 2014. Richard is proceeded in death by his daughter Christina and is survived by Marilynn, his wife of 34 years, his daughter Bahra Flcher, son Sean (wife Amber), his son Peter, and eight grandchildren; Morgan Elizabeth, Philip, Max, Emily, Ashton, Jaxsann, Zachary, and Gracy.
Graveside services will be held at Glen Oaks Memorial Park, 1115 Midway, Chico on Friday, April 29, 2016 at 10:00 am. Published in Chico Enterprise-Record on Apr. 26, 2016
PLED NOLO CONTENDERE TO ONE COUNT OF VIOLATING VEHICLE CODE SECTION 23152(B)(BLOOD ALCOHOL .08% OR MORE). THREE YEARS PROBATION WITH TERMS AND CONDITIONS.—3/13/2012
FIVE YEARS PROBATION WITH VARIOUS TERMS AND CONDITIONS. DURING PROBATION, DR. GILL IS PROHIBITED FROM SUPERVISING PHYSICIAN ASSISTANTS.—8/27/2014
From the California Medical Board Decision:
November 4, 2004, “Wet Reckless” Conviction
On November 4, 2004, in the San Bernardino County Superior Court, case number TCH34406, respondent was convicted of one count of violating California Vehicle Code section 23103.5 (Wet Reckless), an alcohol-related misdemeanor.
As a result of the conviction, respondent was placed on summary probation for a period of three years on certain terms and conditions, including the requirement that he complete an “alcohol program.” Respondent successfully completed probation.
March 13, 2012, Driving Under the Influence of Alcohol (DUI) Conviction
On March 13, 2012, in the San Bernardino County Superior Court, case number TWV 1200218, respondent was convicted of one count of violating California Vehicle Code section 23152, subdivision (b), (driving with a blood alcohol level of 0.08% or more), a misdemeanor.
The facts and circumstances underlying respondent’s conviction are summarized as follows: On December 24, 2011, respondent was driving his silver BMW southbound on Milliken A venue, Rancho Cucamonga, California; respondent drove the BMW off the roadway and crashed into a utility pole; a San Bernardino County Sheriffs Deputy arrived at the scene and contacted respondent; the deputy administered a preliminary alcohol screening test to respondent; the test indicated that respondent’s blood alcohol content was 0.183%; respondent later plead guilty to DUI.
As a result of the 2012 conviction, respondent was placed on summary probation for a period of three years on certain terms and conditions.
Respondent is still on probation as a result of his 2012 conviction.
Respondent is in full compliance with the terms and conditions of his probation.
The Issue
Discipline is warranted based on respondent’s alcohol-related driving convictions; however, respondent used the instant proceedings to present evidence focused on the appropriate level of discipline.
Richard S. Sandor, M.D., a Diplomate of the American Board of Psychiatry and Neurology, authored an April3, 2014, letter concerning respondent. Dr. Sandor testified in conformity with the contents of his letter. His observations and opinions were as follows:
Dr. Gill has a second DUI in 2011 -his first was in 2004…I am Board-certified in Psychiatry and certified by the American Society of Addiction Medicine in Addiction Medicine. I also held a Certificate of Added Qualification in Addiction Psychiatry from 1993 to 2003. I have been in the field of Addiction Medicine for over 30 years, have been the medical director of several different programs, and was the president of California Society of Addiction Medicine from 1993-1995. I have taught and written extensively in the field. In addition, I have served as an evaluator for the Board of Registered Nursing and the California State Bar. I have appeared as an expert witness before several professional boards in over two dozen cases of individuals where there was a question of impairment due to substance abuse. I evaluated Dr. Gill in the same manner that I have evaluated other professionals about whom one of the licensing boards has concerns.
It goes without saying that Dr. Gill exercised exceedingly poor judgement [sic] by drinking and driving on two occasions. He acknowledges that and is remorseful. However, the issue at hand is whether he [is] safe to practice medicine. That, in tum, hinges on whether or not he is an alcoholic - whether he is likely to be taking care of patients while impaired by alcohol or drug use.
The DSM criteria for alcohol abuse specify the presence of ‘a maladaptive pattern of substance use’ -emphasis on the word ‘pattern.’ The criteria then cite a number of different examples of recurrent problems (social, health, employment, etc.) attributable to substance use and [sic] within the past 12 month time period. By these standards, two DUI’s over a seven year interval does not meet the criteria for the substance abuse diagnosis. Additionally, I feel that the circumstances of the second DUI are significant. Dr. Gill and his son had planned to stay overnight at the home of the people hosting the Christmas party they attended. That is, while Dr. Gill intended to drink alcohol at a celebration, he intended not to drive home while under the influence of alcohol. Unfortunately, his son argued with one of the guests, one thing led to another, and Dr. Gill and his son felt they had to leave - despite the fact that Dr. Gill had been drinking. On the way home, he and his son argued. His son struck him. Dr. Gill lost control of the car and hit a stationary object. The air bags deployed, and the car automatically called 911. Both paramedics and police arrived, Dr. Gill ‘blew’ a 0.20 BAL, and he was arrested.
It should be noted that on the occasion of both DUI’s, Dr. Gill was not on call. In his discussion with me, he was adamant that he had never been under the influence of alcohol while taking care of patients. He has never been the subject of any patient complaints reported to the Medical Board, and, when he was on hospital staff (by his choice, he no longer does inpatient work); he was never subject to any disciplinary actions affecting his privileges.
It should also be noted that Dr. Gill entered a drug and alcohol testing program conducted by Dr. Michael Sucher with the California Professionals Health Program on October 22, 2012. Dr. Gill provided me a record of all his test results and a letter from Dr. Sucher attesting to Dr. Gill’s compliance with all the regulations of that program. Except for the very first test, which tested positive for EtG (a metabolite indicating alcohol use within the past 96 hours), all his tests have been negative. As for the first one, Dr. Gill reported to me that he didn’t know he was ‘supposed to be completely abstinent.’ Since then, he has been. He denied having had any health, vocational, or relationship problems related to alcohol use. He also denied ever drinking alone or to rid himself of emotional distress. He has no history of psychiatric treatment and takes no medications - psychotropic or otherwise.
Again, to summarize, Dr. Gill does not meet the criteria for the diagnosis of alcohol abuse. He is guilty of having exercised very poor judgement [sic] by drinking and driving. He has met all the conditions consequent to his convictions, is remorseful, and has taken steps to assure the state that he is not a danger to the public.
I think it is also important to note that Dr. Gill practices internal medicine in an under-served area where the median income is quite low. A large proportion of his patients are covered under Medi-Cal. Not many doctors are eager to work with the population he takes care of, and, in my view, it would be [a] shame for the state to discipline him in a way that would make it impossible for him to continue his work. Obviously, we rely on the Medical Board to protect us from impaired and incompetent medical practitioners. That is not the case here, and it seems to me that it is not in the best interest of the patients he serves to remove him from practice. (Exh. C, italics in original)
In addition to reiterating the contents of his letter, Dr. Sandor testified that except for the two alcohol-related incidents that form the basis of this disciplinary action against respondent, “no other alcohol related problems were reported by anyone. [Respondent] did not disclose any other alcohol related problems.”
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