By Scott Glover, Lisa Girion. Video and photos by Liz O. Baylen

November 11, 2012

Prescription overdoses kill more people than heroin and cocaine.

An L.A. Times review of coroners’ records finds that drugs prescribed by a
small number of doctors caused or contributed to a disproportionate number of deaths.

Terry Smith collapsed face-down in a pool of his own vomit.

Lynn Blunt snored loudly as her lungs slowly filled with fluid.

Summer Ann Burdette was midway through a pear when she stopped breathing.

Larry Carmichael knocked over a lamp as he fell to the floor.

Jennifer Thurber was curled up in bed, pale and still, when her father found her.

Karl Finnila sat down on a curb to rest and never got up.

These six people died of drug overdoses within a span of 18 months. But according to coroners’ records, that was not all they had in common. Bottles of prescription medications found at the scene of each death bore the name of the same doctor: Van H. Vu.

After Finnila died, coroner’s investigators called Vu to learn about his patient’s medical history and why he had given him prescriptions for powerful medications, including the painkiller hydrocodone.

Investigators left half a dozen messages. Vu never called back, coroner’s records state.

Over the next four years, 10 more of his patients died of overdoses, the records show. In nine of those cases, painkillers Vu had prescribed for them were found at the scene.

Vu, a pain specialist in Huntington Beach, described himself as a conscientious, caring physician. He declined to comment on individual cases, citing confidentiality laws, but he said he treats many “very, very difficult patients” whose chronic pain is sometimes complicated by substance abuse and depression, anxiety or other mental illness.

“Every single day, I try to do the best I can for every single patient,” he said in an interview. “I can’t control what they do once they leave my office.”

Prescription drug overdoses now claim more lives than heroin and cocaine combined, fueling a doubling of drug-related deaths in the United States over the last decade.

Health and law enforcement officials seeking to curb the epidemic have focused on how OxyContin, Vicodin, Xanax and other potent pain and anxiety medications are obtained illegally, such as through pharmacy robberies or when teenagers raid their parents’ medicine cabinets. Authorities have failed to recognize how often people overdose on medications prescribed for them by their doctors.

A Los Angeles Times investigation has found that in nearly half of the accidental deaths from prescription drugs in four Southern California counties, the deceased had a doctor’s prescription for at least one drug that caused or contributed to the death.

Reporters identified a total of 3,733 deaths from prescription drugs from 2006 through 2011 in Los Angeles, Orange, Ventura and San Diego counties.

Dr. Van H. Vu said of his patients: “I can’t control what they do once they leave my office.” (Liz O. Baylen / Los Angeles Times)

An examination of coroners’ records found that:

• In 1,762 of those cases — 47% — drugs for which the deceased had a prescription were the sole cause or a contributing cause of death.
• A small cadre of doctors was associated with a disproportionate number of those fatal overdoses. Seventy-one — 0.1% of all practicing doctors in the four counties — wrote prescriptions for drugs that caused or contributed to 298 deaths. That is 17% of the total linked to doctors’ prescriptions.
• Each of those 71 physicians prescribed drugs to three or more patients who died.
• Four of the doctors — including Vu — had 10 or more patients who fatally overdosed.
• Vu had the highest total: 16.

Experts said the findings challenge the prevailing view of what is driving the surge in overdose deaths and should prompt closer scrutiny of doctors and their prescribing practices.

“The data you have is something that’s going to shock everybody,” said Dr. Jorge F. Carreon, a former member of the Medical Board of California.

Carreon, a South Gate physician whose term on the board ended in July, said he had long suspected that doctors’ prescriptions were contributing to the increase in overdoses. The Times’ analysis, he said, showed that it was “worse than what I thought.”

President Obama’s drug czar, R. Gil Kerlikowske, said of the findings: “Do I think this has the potential to change the game in the way it’s being looked at and being addressed, both at the state and federal level? Yes, I do.”

In its review of prescription drug fatalities, The Times examined cause-of-death findings, toxicology reports and other information in county coroners’ files, including lists of prescription medications found at death scenes. Those lists typically identify the prescribing doctor.

The deaths often stemmed from multiple drugs, sometimes prescribed by more than one physician. In some cases, the deceased mixed alcohol or illicit drugs with prescription medications.

Medical experts say that even one overdose death should prompt a doctor to conduct a thorough review of his or her prescribing.

“Personally, it would be a big, big deal,” said Dr. Peter Przekop, a pain and addiction specialist at the Betty Ford Center in Rancho Mirage and an assistant professor at Loma Linda University School of Medicine. “I would certainly want to stop using those medications until I knew what was going on.”

The 71 doctors with three or more fatal overdoses among their patients are primarily pain specialists, general practitioners and psychiatrists. Almost all work alone, without the peer scrutiny that is standard in hospitals, group practices and HMOs.

Four of them have been convicted of drug offenses in connection with their prescriptions. A fifth is awaiting trial on charges of second-degree murder in the overdose deaths of three patients.

The rest have never faced criminal prosecution over their practice of medicine, and most — including Vu — have spotless records with the Medical Board of California, which licenses and oversees physicians.

Dr. Lynn Webster, president-elect of the American Academy of Pain Medicine, said many physicians lack an appreciation of how easily patients with chronic pain can become addicted to their medications, and how dangerous those drugs can be.

“It leads them down a path that can be very harmful, and that’s what physicians have to watch for,” said Webster, who practices in Salt Lake City.

He said physicians who prescribe pain medications have a duty to screen patients for risk factors for addiction and then watch them closely to prevent abuse.

In interviews, several of the 71 Southern California doctors with multiple patient deaths described themselves as compassionate caregivers who try to ease the suffering of those in pain.

Vu and others said they follow recommended practices to deter drug abuse, including requiring patients to sign “pain management contracts” in which they agree to take their medications as directed and not obtain more from other doctors.

Some of the 71 doctors said overdose victims caused their own deaths by ignoring instructions on the safe use of medications. Some said family members of the deceased bore responsibility too for failing to intervene. Some also faulted health insurers, saying that reduced payments to physicians have made it difficult to spend the time to monitor patients adequately.

These doctors’ 298 patients who died of overdoses ranged in age from 21 to 79. The median age was 48.

Many had histories of mental illness or addiction, including previous overdoses or stints in drug treatment. Others did not start out as high-risk patients. They were middle-aged adults — teachers, nurses and police officers — with bad backs, injured knees and other non-life-threatening conditions.

Lynn Blunt was a 46-year-old mother of four who suffered from degenerative disc disease. Despite the pain, she was careful not to exceed the recommended dosage of her medications, said her husband, Lonnie. She wanted to remain alert enough to care for her two youngest children, girls ages 14 and 11, he said.

The condition eventually crippled Blunt, leaving her dependent on a cane and unable to continue working as a U.S. customs inspector. She saw a series of doctors, eventually ending up at Vu’s California Pain Center.

According to coroner’s records, Vu prescribed skin patches containing fentanyl, a pain reliever 100 times more powerful than morphine.

On Sept. 7, 2006, coroner’s records show, Blunt went to Vu’s clinic to receive an epidural injection of an unspecified medication for her pain. A day later, she was found dead in her family’s apartment in Downey.

Blunt overdosed on multiple drugs prescribed by Vu and two other doctors, coroner’s records show. High levels of fentanyl were found in her system.

Blunt had been looking forward to a planned trip to the East Coast to visit one of her two grown children, her husband said.

“We followed the prescriptions,” he said. “Something didn’t mix well.”

Vu, a native of Vietnam, was 11 when he and his family immigrated to the U.S. as refugees just before the fall of Saigon in 1975. They settled in Seattle.

As a high school student, he volunteered at a clinic for low-income families and was impressed, he said, by the selflessness of physicians serving “people who really needed help.”

He earned undergraduate and medical degrees from the University of Washington and served a residency in anesthesiology at USC. He is board-certified in that field and in pain medicine.

“I pretty much achieved the dream come true that America affords,” said Vu, 49, who lives with his wife and four children on Christiana Bay in Huntington Beach.

I am doing the best I can in this very difficult field …
But we have limits.”

— Dr. Van H. Vu

Vu said most of his patients are referred by other doctors, who turn to him as “a last resort” for those who have been battling pain for years. Many patients come to him already dependent on narcotics, he said.

Vu said he conducts routine urine tests to make sure they take their medications as prescribed and do not use illegal drugs. He said he regularly uses a state-run prescription monitoring program to see whether any of his patients are also obtaining drugs from other doctors.

“I am doing the best I can in this very difficult field,” he said. “I consider myself to be one of the best. But we have limits.”

He said any patient death from an overdose was unacceptable, but added that he has treated thousands of patients successfully with the same drugs.

“Are we willing to trade that?” he asked. “Are we willing to withhold pain medications from everyone?”

Vu said he was unaware of many of his patients’ deaths until Times reporters contacted him. He called the information “eye-opening.”

“I’m a physician,” Vu said. “I feel terrible when somebody loses their life. I’m the one who should be prolonging life, so I’m saddened by that.”

Asked whether he could have taken steps to prevent any of the deaths, Vu paused.

“No,” he said, finally. “I don’t think so.”

Larry Carmichael was a problem drinker who got sober through Alcoholics Anonymous. A doting single father, he coached his son’s T-ball team and passed on his love of surfing and fishing.

Carmichael worked as a carpet layer until a car accident left him with debilitating back pain, recalled his son, Dan. He went from one doctor to another in search of relief, and eventually became Vu’s patient.

By 2007, Carmichael “had a high tolerance and was known to take too many pills for his pain,” coroner’s records state. Renee Allen, Carmichael’s girlfriend, said she encouraged him to see if he could live without the medications, and to find another doctor.

“I’m not going to sit around and watch you die,” she recalled telling him.

But Carmichael kept taking pills. In the months before he died, Carmichael twice passed out, his son said.

“He needed real help,” Dan said.

On March 7, 2007, Carmichael filled prescriptions from Vu for half a dozen pain and anxiety medications, including morphine, according to coroner’s records.

After Carmichael failed to return phone calls for two days, Dan went to his father’s apartment in Lake Forest and found him dead. He was 51.

Dan grabbed his father’s prescription bottles and smashed them against a wall, sending pills flying around the room, according to a report by a coroner’s investigator.

The coroner concluded that Carmichael died of an accidental overdose of morphine.

For decades, prescriptions for narcotic painkillers were limited largely to cancer patients and others with terminal illnesses. The prevailing view was that the risk of addiction outweighed any benefit for the great majority of patients whose conditions were not life-threatening.

Today, narcotic painkillers are among the most popular prescription drugs in the U.S.

The seeds of this turnabout were planted in the late 1980s, when influential physicians argued in medical journals that it was inhumane to ignore suffering in non-cancer patients.

This new perspective coincided with efforts by drug makers to win approval for formulations of narcotics intended to ease moderate pain.

Pharmaceutical companies launched sales campaigns that downplayed the risks of addiction and overdoses and promoted the benefits of pain relief.

In 2001, Congress declared the start of the Decade of Pain Control and Research. Medical boards across the country encouraged physicians to assess and treat pain in all patients. In 2007, California lawmakers expanded the scope of pain relief, making it legal for doctors to prescribe narcotics to addicts, so long as the purpose was to treat pain and not simply feed a habit.

The use of painkillers quadrupled between 1999 and 2010. Doctors write about 300 million prescriptions a year for painkillers. That is enough for every adult American to be medicated around the clock for a month, according to the Centers for Disease Control and Prevention.

Hydrocodone became the most commonly prescribed drug in the U.S., eclipsing the leading antibiotics and cholesterol medications.

Older pain drugs — including morphine, codeine and Dilaudid — found new life outside hospital wards, while new ones such as fentanyl and Opana were brought to market. OxyContin, a chemical cousin of heroin, had sales of more than $1 billion within a few years of its introduction.

Narcotic pain relievers now cause or contribute to nearly 3 out of 4 prescription drug overdoses and about 15,500 deaths each year, according to the CDC. For every death, 32 people are treated in emergency rooms for nonfatal overdoses.

Although the death toll has received considerable attention, the medical board and law enforcement agencies in California have not mined coroners’ files, as The Times did, to identify doctors whose patients overdosed on drugs they prescribed.

Nor have officials tried to take advantage of detailed information that pharmacies provide to the state attorney general’s office, listing the kinds and quantities of drugs prescribed, by which doctors and for which patients.

Narcotic pain relievers now cause or contribute to nearly 3 out of 4 prescription drug overdoses and about 15,500 deaths each year

— Centers for Disease Control and Prevention

The Controlled Substances Utilization Review and Evaluation System was designed to help doctors learn whether any of their patients were seeking drugs from other physicians too.

The system could also be used to identify doctors who write large numbers of prescriptions for commonly abused drugs. The CDC has urged state authorities to use such programs to identify not only doctor-shopping patients but the physicians who cater to them. In California, authorities do neither.

Karl Finnila had a long record of drug arrests by the time he became Vu’s patient. He was bipolar, had attempted suicide and had overdosed several times, according to coroner’s records and his sister Sally, a tax accountant in Irvine.

Finnila, the oldest son of a Mattel Inc. executive, had been addicted to prescription drugs since he was a teenager, his sister said. He had been in and out of mental hospitals and was unable to hold a job.

He would lose touch with his family. But every so often, Sally would find him, take him to lunch and buy him a new pair of shoes and socks.

On June 29, 2007, Finnila was discharged from a hospital in Orange County, according to Carol Spetzman, a friend and caregiver. He had been treated there for a drug overdose, his sister said.

That same day, he filled prescriptions from Vu for hydrocodone and carisoprodol, a muscle relaxant, at a pharmacy down the hall from the doctor’s office, coroner’s records show.

Finnila then checked into a sober-living home in Westminster. After dinner, he went for a walk, sat down on a curb and died, coroner’s records state.

The cause was “combined effects” of hydrocodone, carisoprodol and seven other medications prescribed by Vu and other doctors. He was 43.

Jennifer Thurber had been coping with pain for much of her life by the time she came under Vu’s care.

Thurber’s childhood was marred by a painful stomach condition that caused severe indigestion. She had corrective surgery when she was 11, but a car accident seven years later brought the problem back.

She was prescribed various medications for the pain and eventually began abusing them, according to her father, Charles, an Orange County sheriff’s deputy.

Thurber obtained drugs through various doctors. On May 21, 2007, she filled prescriptions for morphine and methadone written by Vu.

Two days later, her father climbed the stairs of the family’s Fountain Valley home and pushed open the door of her bedroom to ask her to get ready for dinner.

He found his daughter in bed, pale and motionless. Blood trailed from her nose. He laid her on the floor and attempted CPR.

Thurber died of an overdose of multiple drugs prescribed by Vu and two other doctors, coroner’s records show.

Morphine and methadone were among the drugs. She was 22.

“That was my birthday,” her father recalled, his voice wavering. He said he blames himself for not seeing the signs of drug abuse sooner and for not paying closer attention to her doctors and what they were prescribing.

“At the time,” he said, “we thought they were trying to help her.”

Reckless prescribing, lost lives

The Medical Board of California is often slow to act when investigating doctors suspected of abusing their prescription pads – even when patients are dying.

Dr. Carlos Estiandan was up to no good, and the Medical Board of California was on to him.

By Lisa Girion and Scott Glover. Video and photos by Liz O. Baylen

December 9, 2012

He prescribed powerful painkillers to addicts who had no medical need for them, conducted sham examinations and appeared to be a key supplier for drug dealers, according to court records.

He wrote more prescriptions than the entire staffs of some hospitals and took in more than $1 million a year.

Worse, one of Estiandan’s patients had fatally overdosed on drugs he prescribed, a board investigator learned. The investigator said in her report that she confronted the doctor and told him the death was “the inevitable result” of giving narcotics to an addict.

Unknown to the investigator, two other Estiandan patients had suffered fatal overdoses. More deaths would follow.

By the time the medical board stopped Estiandan from prescribing, more than four years after it began investigating, eight of his patients had died of overdoses or related causes, according to coroners’ records.

It was not an isolated case of futility by California’s medical regulators. The board has repeatedly failed to protect patients from reckless prescribing by doctors, a Los Angeles Times investigation found.

It is board policy to give such cases a high priority. But The Times’ examination of board records and county coroners’ files from 2005 through 2011 found that:

“Material things are nothing now,” said Dr. Carlos Estiandan, who was released from prison in September, after serving roughly half of a five-year sentence. (Liz O. Baylen / Los Angeles Times)

• At least 30 patients in Southern California have died of drug overdoses or related causes while their doctors were under investigation for reckless prescribing. The board ultimately sanctioned all but one of those 12 doctors, and some were criminally charged — too late to prevent the deaths.
• The board seldom tries to suspend the prescribing privileges of doctors under investigation. The agency can petition a judge for an interim suspension order. It has obtained orders only rarely: 12 times in the last five years in cases of excessive prescribing, in a state with more than 100,000 practicing physicians.
• Even when the board sanctions doctors for abusing their prescribing powers, in most cases it allows them to continue practicing and prescribing. In 80% of the 190 cases of improper prescribing filed by the board since 2005, the offending physician was given a reprimand or placed on probation. In most of those cases, the doctor was allowed to continue writing prescriptions with few or no restrictions.
• Eight doctors disciplined for excessive prescribing later had patients die of overdoses or related causes. Prescriptions those doctors wrote caused or contributed to 19 deaths.

At the heart of these shortcomings is the board’s approach to oversight. It investigates when it receives a complaint of abuse or poor treatment of a specific patient or patients. It generally does not look for evidence of wider problems in a physician’s practice.

Bitter Pills

In rehab, Edward Shut fights his addiction to prescription drugs.

For example, in looking into cases of improper prescribing, investigators usually do not search county coroners’ files to determine whether — as in Estiandan’s case — a doctor’s patients are dying of drug overdoses.

Dr. Rick Chavez, a pain management physician in Redondo Beach, serves as an expert for the board in cases of reckless prescribing. He said overprescribing is a pervasive problem, and oversight is inadequate.

“We have doctors out there doing things that no one is monitoring,” he said. “It’s scary.”

The medical board’s president, Sharon Levine, a pediatrician who is an executive at Kaiser Permanente, declined to be interviewed, saying it would be “inappropriate” because disciplinary cases are ultimately decided by the board. Executive Director Linda Whitney declined to comment, and staff members said they are barred by policy from speaking with reporters.

Responding by email to written questions, board officials asserted that their “highest priority and primary mission is consumer protection.”

In response to The Times’ findings, they have asked the Legislature to require county coroners to report all prescription drug deaths to the board.

“If only one physician was found to be overprescribing,” the board said in its request to legislators, “this could save numerous lives.”

Estiandan, a diminutive man with a cheerful demeanor, had a thriving general practice. He sang tenor in his church choir, played golf once a week with his sons and took his wife ballroom dancing. He was a lieutenant colonel in the U.S. Air Force Reserve and led medical relief missions to the Philippines, where he grew up and attended medical school.

In October 2004, one of his employees reached out anonymously to authorities.

The man told Robin Hollis, a medical board investigator, that Estiandan, then 62, was taking in $3,000 in cash a day selling prescriptions. Drug-addicted patients, the employee said, crowded the lobby of the doctor’s clinic west of downtown Los Angeles, one of three he owned.

“Estiandan will give the patients anything they want,” he told Hollis, according to her report.

The U.S. Drug Enforcement Administration and the Los Angeles County Sheriff’s Department were also investigating Estiandan, and the agencies shared information.

Evidence accumulated quickly. Alleged drug dealers were arrested in Los Angeles carrying bottles of medications prescribed by Estiandan, court records show.

A Costco pharmacist reported that groups of men in their 20s and 30s were showing up at his counter with prescriptions from Estiandan for painkillers, tranquilizers and muscle relaxants — the makings of a drug cocktail that is popular with addicts.

The pharmacist, Edward Wong, told authorities he would call Estiandan to make sure the prescriptions were legitimate, and the doctor would instruct him to fill them. Eventually, Wong stopped calling and simply refused to fill the prescriptions.

In Albuquerque, DEA agents stopped a man who was carrying more than 1,800 pills and several bottles of narcotic cough syrup with a street value of up to $500 each. According to court records, the medication labels identified Estiandan as the prescriber.

In the summer of 2005, about 10 months into the investigation, Leo Martinez checked in at Estiandan’s clinic in Reseda. He paid a $120 fee for the office visit and waited a half-hour to see the doctor.

What happened next is detailed in court records.

Estiandan asked Martinez what was wrong.

“Nothing,” Martinez said. He explained that he wanted a refill for painkillers he had been prescribed by another doctor whose clinic had since closed.

Estiandan asked him why he was in pain: Had he fallen or been in an accident?

No, Martinez replied.

He asked Martinez again if he had hurt his back or been in an accident. This time, Estiandan nodded and raised his eyebrows.

Estiandan said the other doctor must have had a reason to prescribe painkillers.

Martinez said it was a long time ago and he couldn’t remember.

Estiandan told Martinez he couldn’t prescribe the drugs unless there was an indication Martinez was in pain.

Then he asked Martinez again if he had hurt his back or been in an accident. This time, Estiandan nodded and raised his eyebrows.

Reading the cue, Martinez said he hurt his back lifting weights.

Estiandan pulled out his prescription pad.

Martinez was an undercover sheriff’s narcotics investigator who had been secretly recording the conversation. He left Estiandan’s office with prescriptions for the painkiller Vicodin, the muscle relaxant Soma, the anti-anxiety drug Valium and a 16-ounce bottle of narcotic cough syrup.

The medical board and law enforcement agencies were not the only ones interested in Estiandan.

Medi-Cal agents suspected him of fraudulent billing and put him under surveillance. They followed him as he drove home to Northridge in a Lincoln Navigator or Lexus sedan, sometimes stopping at a hospital or to pick up takeout at a Filipino restaurant.

But amid this intense scrutiny of Estiandan’s life and medical practice, one thing appears to have escaped attention: what was happening to his patients.

One of them, Pamela Stone, suffered chronic pain from herniated disks. She also struggled with anxiety and had trouble sleeping.

Stone’s mother grew concerned when she didn’t hear from her daughter for a couple of days and asked the manager of the Reseda apartment building where Stone lived to check on her.

On Nov. 20, 2006, the manager opened the door to the apartment and found Stone’s lifeless body on her bed. There was a trace of dried white foam around her nose and mouth.

The coroner determined that Stone died of an accidental overdose of multiple drugs, including an anti-anxiety medication prescribed by Estiandan. She was 54.

Hollis continued with her investigation, unaware of the death.

Hollis is one of about 130 medical board investigators on the front lines of patient protection in California. They look into allegations of physician misconduct ranging from botched surgeries to sexual abuse of patients.

Their ranks have dwindled, even as the number of licensed physicians in the state has risen over the last decade, to 102,000.

There are about 30 fewer investigators today than in 2001. The board opened 1,577 investigations last year, a 40% decline from a decade ago, and investigations now take longer to complete: an average of 347 days, compared with 256 in 2001.

The agency is overseen by a 15-member board appointed by the governor and legislative leaders. By law, eight members must be doctors. The board is funded by physician licensing fees, a revenue stream that was supposed to be immune to California’s boom-and-bust budget cycles.

Members of the Medical Board of California meet in Torrance in May. (Liz O. Baylen / Los Angeles Times)

But Govs. Arnold Schwarzenegger and Jerry Brown used the board as a piggy bank, taking $15 million in licensing fees — the equivalent of a quarter of one year’s budget — to help fill holes in the state general fund.

Schwarzenegger ordered state employees to take three unpaid furlough days per month, hobbling the board’s enforcement efforts. Brown imposed hiring freezes. At one point, 1 in 4 investigator positions were vacant.

The board’s staff has warned for years that the cuts were crippling its ability to protect the public. Julianne D’Angelo Fellmeth, a public interest lawyer who has monitored the board for the state Legislature, said the situation is urgent.

“The medical board is regulating the most important profession in terms of irreparable harm,” Fellmeth said. “It should not be neutered.”

The board’s challenges go beyond the financial. Unlike medical regulators in other states, it cannot suspend a doctor’s license or prescribing privileges on its own, even to prevent imminent harm.

Instead, the board must petition a state administrative law judge for an interim suspension order. If it obtains an order, the board must file a complaint against the doctor within 15 days — a legal provision for which physician groups lobbied, Fellmeth said.

The 15-day rule means that “an investigation must be nearly complete” before the agency can seek a suspension, board spokeswoman Jennifer Simoes wrote in an email.

If a doctor has been criminally charged, the board can ask a Superior Court judge for a suspension. It has done so a handful of times in recent years in cases of excessive prescribing.

Board officials said they sometimes hold off on seeking suspensions until that point to avoid jeopardizing a criminal investigation.

Steve Opferman, a Los Angeles County sheriff’s deputy who runs a task force on healthcare fraud and took part in the Estiandan investigation, questioned that rationale. He said the board should move swiftly to shut down a doctor’s prescribing whenever lives are at stake — even if it could affect a criminal prosecution.

The danger in waiting, he said, is that “people are going to die.”

Andrew Corless began abusing drugs at the age of 15 and spent at least eight stints in drug treatment. On Aug. 11, 2006, he had a moment of resolve.

He called Estiandan’s office at 11:45 a.m. that day and left a message.

He was about to undergo drug detoxification, according to a handwritten note by a receptionist, and he asked that the doctor “please not see him anymore.”

Three hours later, Corless called back with a message “to disregard” the earlier call.

Leslie Greenberg lies in the grass at a park after leaving flowers at the nearby grave of her boyfriend Andrew Corless, who died in 2006 of prescription drug and alcohol intoxication. (Liz O. Baylen / Los Angeles Times)

Corless was in Estiandan’s office 10 days later, pleading for drugs, court records show. He was back again in December, this time after leaving rehab early.

On Dec. 13, 2006, Corless, 46, was found on the street in front of his house in Northridge, dead of an overdose. Two of the drugs found in his system — hydrocodone and alprazolam — had been prescribed for him by Estiandan.

A month later, authorities searched Estiandan’s offices and home. They found hundreds of partially completed prescription forms, some of them already signed, along with $12,300 in cash, court records show.

Looking at patients’ records, investigators saw that groups of people from as far as Bakersfield, the Antelope Valley, Victorville and San Bernardino would show up at Estiandan’s clinic near downtown Los Angeles on the same day, describe the same symptoms and leave with prescriptions for the same drugs.

Shortly after the raid, Estiandan was back at work — and writing prescriptions at a furious pace.

DEA agents consulted a database on prescriptions for controlled substances, written for patients paying in cash, to see where Estiandan stood. For March 2007, he ranked first in Southern California, Nevada and Hawaii, and fifth in the United States, according to court records.

For Joyce Saldivar, 55, he prescribed hydrocodone.

Saldivar had chronic back pain and was known to abuse her medications, according to coroner’s records. She died June 29, 2007. The cause was an overdose of multiple drugs, including hydrocodone.

Estiandan acknowledged that Corless was an alcoholic and an addict and had “begged” him for drugs, according to Hollis’ report.

By then, Hollis had learned about Corless’ death from his girlfriend, who complained to the medical board about Estiandan, court records show.

Hollis got Corless’ medical records and the autopsy report, and summoned Estiandan to an interview at a board office in Glendale on Sept. 12, 2007.

Estiandan acknowledged that Corless was an alcoholic and an addict and had “begged” him for drugs, according to Hollis’ report.

Hollis told Estiandan that she couldn’t understand how he could “continue to give pain medication to a person who is addicted,” according to her report. “I explained that now there was a patient death…. This was the inevitable result. It was just a matter of time.”

Hollis later obtained a report from an expert physician stating that Estiandan’s treatment of Corless included “extreme departures” from accepted standards and contributed to his death.

Another patient, Wilma Jones, 47, was found dead in an unfurnished one-room apartment in South Los Angeles on Feb. 14, 2008. She had contracted pneumonia, and various drugs had suppressed her breathing to the point of death, coroner’s records show.

One of the drugs was hydrocodone, which Estiandan had prescribed for her, records show.

Within a six-week span that summer, three more people died after taking medications prescribed by Estiandan. In all, seven of his patients had died since the medical board began investigating nearly four years earlier.

Estiandan, an early riser, was on the computer, tending to his stock portfolio on the morning of July 23, 2008, when a throng of DEA agents and sheriff’s deputies appeared at his doorstep.

The doctor was polite and cooperative as an officer handcuffed him and led him to a police car. He was charged with 13 felony counts of illegally prescribing controlled substances. He was not charged with any of his patients’ deaths.

Clint McKinney, center, hugs his mother and wife after scattering the ashes of his father, Bill, who died of cancer, and brother, Byron, who died of prescription drug-related causes. (Liz O. Baylen / Los Angeles Times)

Three weeks later, the medical board asked a Superior Court judge to suspend Estiandan’s license, saying it was “the surest way to protect the public” from a doctor who “supplied patients with drugs, not medical care.”

While the board waited for a ruling, Estiandan was free on bail and seeing patients.

Byron McKinney, a former pro wrestler, had been seeing Estiandan for eight years and had gotten hooked on the muscle relaxant carisoprodol, the anti-anxiety drug Xanax and a narcotic cough syrup, according to his brother, Clint.

McKinney, 33, died Nov. 18, 2008, of heart disease. The coroner said carisoprodol and hydrocodone were contributing factors. An empty bottle of hydrocodone cough syrup prescribed by Estiandan was found on a coffee table near McKinney’s body.

Clint McKinney told a coroner’s investigator that he and his brother “were able to regularly obtain prescription painkillers at free will via an unethical doctor who would write them five prescriptions for $120,” records show.

In February 2009, six months after the board went to court, a judge barred Estiandan from prescribing painkillers and other addictive drugs. He surrendered his medical license that September. The next year, he was tried and convicted on the criminal charges and sentenced to five years in prison.

He was released in September after serving about half his term. A few days later, he spoke with Times reporters in the spacious home where he now lives on a ridge of the Verdugo Mountains in Burbank.

He referred to his time in state prison as “my vacation” and described how he practiced guitar, tutored inmates, volunteered in the chapel and read the Bible.

By turns defensive and contrite, Estiandan complained of being unfairly targeted by prosecutors for simply doing his job.

He said he warned patients of the dangers of becoming addicted to prescription drugs, telling them: “Eventually you will lose control of yourself.”

He recalled that his wife, Gloria, a nurse, had warned that he was headed for trouble. She saw the disheveled people in his waiting room, Estiandan said, and told him: “Just let them go.”

Estiandan, now 70, said he was not motivated by greed and never intentionally harmed patients. But he said he realizes he used poor judgment in prescribing drugs.

“Instead of helping them, I might have harmed them,” he said of his patients. “I made a mistake.”

Rogue pharmacists feed addiction

Some provide massive amounts of painkillers and anti-anxiety drugs to addicts and dealers, according to state records, regulators and law enforcement officials.

BY SCOTT GLOVER, LISA GIRION AND HAILEY BRANSON-POTTS, LOS ANGELES TIMES

DEC. 19, 2012 6:19 PM PT

Joey Rovero’s quest for pills ended at Pacifica Pharmacy.

It was the same for Naythan Kenney,

Matt Stavron and Joseph Gomez.

All four were patients of a Rowland Heights

physician who was a prolific prescriber of narcotic

painkillers and other addictive drugs. To get their fix,

they needed more than a piece of paper.

They needed a pharmacist willing to dispense the drugs,

and at Pacifica they found one.

By Scott Glover, Lisa Girion and Hailey Branson-Potts

Video and photos by Liz O. Baylen

December 20, 2012

All four died of drug overdoses after filling prescriptions at the tiny pharmacy in Huntington Beach, court and coroners’ records show.

Pacifica’s owner, Thang Q. “Frank” Tran, sold pain medications in large quantities. Particularly popular with his customers were high-dose, 80-milligram tablets of OxyContin. Tran filled nearly twice as many of those prescriptions as did nearby Walgreens, CVS and Sav-On pharmacies combined, according to state records.

Many of his customers traveled long distances and paid cash. Rovero drove more than 350 miles from Arizona State University in Tempe to get his prescriptions in Rowland Heights and then 33 more miles to the pharmacy.

“I thought to myself, ‘Why in the world would these kids go that much farther out of their way?’ ” said April Rovero, whose son was 21 when he died. “Someone must have told them to go there.”

Pharmacists are supposed to be a last line of defense against misuse of prescription medications. By law, they are required to scrutinize prescriptions, size up customers and refuse to dispense a drug when they suspect the patient has no medical need for it.

Thang Q. Tran is appealing the revocation of his license. The state Board of Pharmacy found in April that he had improperly dispensed narcotics at Pacifica Pharmacy in Huntington Beach. (Liz O. Baylen / Los Angeles Times)

Voices

Bitter Pills

In rehab, Edward Shut fights his addiction to prescription drugs.

Some, however, provide massive amounts of painkillers and anti-anxiety drugs to addicts and dealers with no questions asked, according to state records, regulators and law enforcement officials.

Rogue pharmacists are key enablers of drug abuse and an important source of supply for the illegal market.

State officials who license and oversee pharmacies are overmatched by the scale of the problem.

Prescription drug abuse has increased sharply over the last decade, fueling a doubling of drug fatalities nationwide.

California’s 42,000 pharmacists filled 318 million prescriptions last year.

Those for OxyContin, Dilaudid and other potent painkillers have increased 52% over the last five years, according to a review of prescription data collected by the state. The total dosage dispensed by pharmacies has also grown: by nearly 50%, the data show.

The task of identifying careless or corrupt pharmacists and initiating disciplinary action falls to 37 investigators for the California Board of Pharmacy.

“We are struggling to keep up because there are more pharmacies, more licensees, more places to go,” said Virginia Herold, the agency’s executive director. “We work really hard. But there’s a limit to what we can do.”

The board has added investigators in recent years. Even so, “we do have some pharmacies that seem to be able to help deliver unconscionable quantities of drugs to patients,” Herold said.

It doesn’t help that illegal dispensing is a low priority for law enforcement agencies. Criminal prosecutions are rare and penalties typically light.

Rogue pharmacists have a symbiotic relationship with physicians who prescribe drugs for addicts. Neither can flourish without the other.

Their cooperation is usually unplanned. Through trial and error, addicts whose doctor writes prescriptions for narcotics will discover a pharmacist willing to dispense the drugs without the appropriate scrutiny. Then word gets around.

Both pharmacist and doctor can reap a windfall by writing and filling large numbers of prescriptions for cash.

High-volume dispensing of addictive drugs was par for the course at Burbank Medical Pharmacy, according to board records.

In a single day — Dec. 3, 2007 — the pharmacy filled 85 prescriptions for pain medications, according to a board accusation. None of the doctors who wrote the prescriptions were from the Burbank area, nor were any of the patients, the complaint states. Both are signs that a pharmacy is catering to addicts, according to regulators and law enforcement officials.

Burbank Medical also dispensed painkillers in volume to a drug dealer who claimed to be picking them up for patients too sick to do so, according to the board accusation and court files. The dealer was convicted in a prescription drug fraud scheme that prosecutors said generated millions of dollars.

Pharmacist Nancy Cha and the pharmacy are accused by the board of failing to ensure that the drugs they dispensed were for patients with legitimate need. They have not been implicated in the drug dealer’s fraud scheme.

The pharmacy also failed to account for 12,610 OxyContin tablets with a street value of more than $1 million, the board said.

Cha’s attorney, Richard Moss, said she was a well-meaning pharmacist who naively believed she was helping people in need.

“This was a real wake-up call,” Moss said of the board accusation. At a recent hearing on the case, Moss presented a defense that he said was largely “explanation and mitigation.”

The 13-member board will decide whether to revoke Cha’s license or take other disciplinary action.

In recent years, the board has taken disciplinary action only infrequently against pharmacists for filling customers’ prescriptions without ensuring that they were for legitimate medical needs.

Since 2006, five pharmacists have had their licenses revoked on those grounds, according to board records. Twelve others surrendered their licenses, and 22 were placed on probation. Over the same period, 23 California pharmacies have been sanctioned for similar offenses.

Derrick Jones, an agent for the U.S. Drug Enforcement Administration who oversees a prescription drug task force, said corrupt or inattentive pharmacists are a boon to addicts and dealers.

“If you’ve got a 22-year-old kid coming in with a prescription for enough Oxy to put a horse down, that’s got to raise some red flags with a good pharmacist,” Jones said.

“When those questions don’t get asked, that’s when the floodgates open. You’ll have people coming from L.A. all the way down to Orange County because they know they can get that prescription filled without any questions.”

Andrew Snay was adrift. The 22-year-old bounced from job to job. He worked at Home Depot, as a Kirby vacuum cleaner salesman and as a telemarketer.

The one constant in his life, his mother said, was his addiction to pills.

At one point, he used a shoulder injury as a pretext to obtain pain medications, his mother said. “He was just getting high,” she said.

If you’ve got a 22-year-old kid coming in with a prescription for enough Oxy to put a horse down, that’s got to raise some red flags with a good pharmacist.”

— Derrick Jones,
U.S. Drug Enforcement Administration

He went to great lengths to get pills — literally.

He would travel 40 miles from his home in Thousand Oaks to the office of Dr. Bernard Bass, a general practitioner in North Hollywood who treated people for chronic pain. Prescription in hand, he would go five more miles to Jay Scott Drugs in Burbank.

Bass would prescribe — and Jay Scott Drugs would dispense — the painkiller Norco, the anti-anxiety drug Xanax and a muscle relaxant called Soma, according to pharmacy board records. Together, they form a drug cocktail popular with addicts.

In a 14-month period, Snay filled 89 prescriptions at Jay Scott Drugs, according to a board accusation. Snay filled two of them — for hydrocodone and Xanax — two days before he died of an overdose on March 20, 2008, records show.

An empty bottle of painkillers with the pharmacy’s label was at his bedside.

Shortly after his death, Snay’s mother, Kim, confronted Albert Daher, the supervising pharmacist and owner of Jay Scott Drugs, according to her testimony at a pharmacy board hearing. She asked for a record of the drugs her son had purchased. Daher gave her a printout, then asked for it back moments later, she said.

She said she refused and walked out.

Scanning the document, Snay saw that her son was able to obtain 400 pills in one four-day period in 2007, the year before he died.

“I almost fainted,” she said.

Snay and three other people from Ventura County, ages 21, 25 and 31, died of overdoses in the span of a month in 2008 after filling prescriptions at Jay Scott Drugs, according to the board accusation.

Binders of evidence fill the prosecutors’ table at a hearing on Jay Scott Drugs (Liz O. Baylen / Los Angeles Times)

All four were patients of Bass, who pleaded guilty in May 2009 to illegally prescribing painkillers and other addictive drugs. Bass, 62, died of a heart attack a month later.

Over a 19-month period, Jay Scott Drugs filled an average of 68 prescriptions a day written by Bass for painkillers and other commonly abused drugs, the board said.

On a single day — Sept. 7, 2007 — 93 out of 132 prescriptions for controlled substances filled at the pharmacy were for patients of Bass.

In July of the same year, Jay Scott’s wholesaler alerted the pharmacy board that the drugstore was ordering more than 100,000 hydrocodone pills a month, records show. A board expert said at the hearing that 100,000 pills was a “huge amount” for a pharmacy of that size.

In all, the pharmacy dispensed $1.7 million worth of drugs prescribed by Bass, according to a board investigator’s report.

Jay Scott Drugs also catered to patients of Dr. Masoud Bamdad when others would not fill his prescriptions, according to board records and testimony.

Bamdad’s patients routinely drove from his office in San Fernando to Jay Scott Drugs, 11 miles away. The pharmacy filled 1,357 prescriptions for Bamdad’s patients over 18 months. Nearly three-fourths were for painkillers and other controlled substances.

Bamdad is serving a 25-year sentence in federal prison for selling prescriptions to addicts, one of whom died of an overdose at age 23 after filling a prescription for Xanax at Jay Scott Drugs.

The pharmacy board is seeking to revoke or suspend the licenses of Daher and two colleagues and the pharmacy’s operating permit.

In an interview, Daher denied any wrongdoing and said he and his colleagues are “extremely vigilant” in dispensing narcotics. He said he looked forward to mounting a defense against the board accusation when hearings in the case resume next summer.

Albert Daher, right, talks with attorney Daniel R. Friedenthal at his hearing before the state Board of Pharmacy in November. Daher, owner of Jay Scott Drugs, denies any wrongdoing. (Liz O. Baylen / Los Angeles Times)

“I want to clear my name,” he said.

Daher said he spoke to Bass after his patients began showing up at the pharmacy with prescriptions for narcotics. He said Bass seemed knowledgeable and compassionate and told him his patients, including the younger ones, suffered from pain and needed the medications.

Daher said that an investigator with the Medical Board of California, which licenses and oversees doctors, visited the pharmacy in July 2007 to obtain records on two of Bass’ patients. Daher said he asked whether he should stop filling Bass’ prescriptions. Daher said he asked the same question of pharmacy board officials when they visited for a routine inspection.

In neither case did the regulators inform him of the allegations against Bass or tell him to stop filling the doctor’s prescriptions, Daher said.

“They should have been more forthcoming,” he said.

The pharmacy board said it could not comment on a pending case. The medical board also declined to comment.

Daher said that as soon as he learned of overdose deaths among Bass’ patients, he stopped dispensing drugs to patients with chronic pain.

Regarding Bamdad, Daher said that by all indications the doctor was a responsible prescriber, and that he felt betrayed when he learned otherwise.

Brian Spahr, a financial planner in Huntington Beach, would occasionally look out the window of his office at the parking lot he shared with Pacifica Pharmacy. Young men would congregate there after walking out of the pharmacy. Some would leap into the air and exchange high-fives.

Once, Spahr saw Pacifica customers spread cash across the dashboard of a car. On another occasion, he saw “money and prescriptions changing hands,” he said.

Law enforcement officers escort Dr. Hsiu-Ying “Lisa” Tseng out of her Rowland Heights clinic in March 2012 (Liz O. Baylen / Los Angeles Times)

Spahr complained first to Huntington Beach police, then to the pharmacy board.

A board investigator ran Pacifica’s name through a state database and found that the pharmacy was filling an unusually high number of prescriptions for OxyContin and other potent drugs written by a Rowland Heights physician identified as “Dr. T,” according to an accusation filed by the board.

“Dr. T” is Lisa Tseng, who has since been charged with second-degree murder in the overdose deaths of three of her patients.

The investigator studied files on 18 of Tseng’s patients who filled prescriptions for 80-milligram doses of OxyContin at Pacifica Pharmacy. He found that 15 lived 35 miles or more from Tseng’s office in Rowland Heights, and 15 lived at least 20 miles from the pharmacy.

Brandon Barnes, of Laguna Niguel, described in court how he went to Tseng’s office with some friends in 2009 to get prescriptions for narcotics. Barnes, then 19, said he told Tseng his hand hurt from a skateboarding injury. But his real motive was to get high.

Testifying at Tseng’s preliminary hearing, Barnes said the doctor gave him prescriptions for Xanax, Soma and the narcotic painkiller Opana. He said one of his friends told him they would have to go to “a special kind of hole-in-the wall pharmacy” to get the prescriptions filled.

The pharmacy was Pacifica, and he and his friends paid for the drugs with $800 in cash, Barnes testified.

Lisa Gomez questioned how Pacifica could have filled Tseng’s prescription for her son, Joseph. He went on painkillers after surgery to remove a cyst from his tailbone, and he became addicted, she said. Once an avid snowboarder and rugby player, he became red-eyed and listless under the influence of pills.

“I’m sure when he got these prescriptions filled, he wasn’t looking good,” Gomez said in an interview. “It’s a pretty distinct look.”

Joseph Gomez went to Pacifica on Aug. 26, 2009, to fill a prescription for Xanax and Soma, coroner records show. He fatally overdosed two days later on a combination of drugs, including the active ingredient in Xanax, the records show. He was 26.

At a board hearing earlier this year, pharmacist Thang Tran repeatedly invoked his 5th Amendment right against self-incrimination.

The board found “clear and convincing evidence” that Tran had dispensed narcotics improperly and revoked his license and Pacifica’s permit in April. He has filed an appeal in Superior Court.

A sign on the door of Pacifica’s shuttered storefront on Beach Boulevard directs customers to a pharmacy called TLC Xpress in neighboring Fountain Valley.

When reporters visited the pharmacy last week, Tran was behind the counter. When they asked to speak to him, he ducked into a back room and refused to come out.

KAMALA HARRIS HASA POWERFUL TOOLFOR IDENTIFYING RECKLESS DOCTORS,BUT SHE DOESN’T USE IT.

As California’s attorney general, Harris controls a database

that tracks prescriptions for painkillers and other commonly abused drugs

from doctors’ offices to pharmacy counters

and into patients’ hands.

The system, known as CURES, was created so physicians and pharmacists could check to see whether patients were obtaining drugs from multiple providers.

Law enforcement officials and medical regulators could mine the data for a different purpose: To draw a bead on rogue doctors.

But they don’t, and that has allowed corrupt or negligent physicians to prescribe narcotics recklessly for years before authorities learned about their conduct through other means, a Times investigation found.

Prescription drug overdoses have increased sharply over the last decade, fueling a doubling of drug fatalities in the U.S. To help stem the loss of life, the federal Centers for Disease Control and Prevention recommends that states use prescription data to spot signs of irresponsible prescribing, and at least six states do.

California is not one of them.

By monitoring the flow of prescriptions, authorities can get an early jump on illegal or dangerous conduct by a doctor. Among the telltale signs: writing an inordinate number of prescriptions for addictive medications or for combinations of drugs popular among addicts.

Harris’ office keeps CURES off-limits to the public and the news media. But information from a commercial database containing the same kind of data illustrates how valuable CURES could be as an investigative tool.

Pills collected at death scenes await destruction in a coroner’s property room. Prescription overdoses have fueled a doubling of U.S. drug fatalities in the last decade. (Liz O. Baylen / Los Angeles Times)

Private firms purchase prescription data from pharmacies and sell it to drug companies for use in marketing their products. The Times obtained a list from such a database ranking the most prolific prescribers of narcotic painkillers in the Los Angeles area for June 2008.

Of the top 10 doctors on the list, six were eventually convicted of drug dealing or similar crimes or were sanctioned by medical regulators. One of them was a cocaine addict. Some had been prescribing narcotics in high volume for years before authorities caught up with them.

At least 20 of their patients died of overdoses or related causes after taking drugs they prescribed, according to coroners’ records.

Had officials been tracking the doctors’ prescriptions in CURES, some of those deaths might have been prevented.

Harris, a career prosecutor who was elected attorney general in 2010, declined repeated requests to be interviewed for this article.

Nathan Barankin, her chief of staff, said Harris wants to improve CURES so more doctors can use it to identify drug-seeking patients, and to help prosecutors pursue dealers and other drug offenders.

She has not proposed using CURES to detect signs of excessive prescribing.

Barankin said financial constraints limit the attorney general’s options. CURES is “on life support” because of state budget cuts and is barely able to fulfill its primary mission of helping doctors and pharmacists track patients’ use of medications, he said.

Even so, the database, as is, could be used to look for signs of improper prescribing. “It certainly has that capacity, as I understand it,” Barankin said.

He added, however, that if Harris did begin using CURES to monitor doctors, the state Department of Justice lacks the resources to follow up on leads.

“We don’t have the horses or the ability to do that kind of work,” he said.

The Medical Board of California, which licenses and oversees physicians, has appealed to the public to report instances of excessive prescribing, a step it took in response to recent Times articles on overdose deaths.

But the board does not use CURES to identify doctors whose prescribing poses a danger to patients.

“We don’t have the resources,” said executive director Linda K. Whitney.

Dr. Tyron Reece was one physician who would have tripped an alarm early on, if officials had been watching his prescriptions in CURES.

The Inglewood family practitioner ranked fourth among prescribers of oxycodone and hydrocodone in the Los Angeles area in June 2008, according to the commercial database. Reece’s customers paid for nearly all those prescriptions in cash, the data show.

The pharmacies that filled Reece’s prescriptions were required by law to report them to CURES.

But Reece was not stopped until 2011, and then only because federal authorities investigating a drug smuggling ring stumbled upon evidence that implicated him. Dozens of prescription vials bearing the doctor’s name had been found in the trash at a suspect’s home.

Confronted by investigators, Reece admitted that he regularly sold prescriptions for cash to patients he had never examined. He pleaded guilty to drug dealing and is awaiting sentencing.

Nathan Kuemmerle, a West Hollywood psychiatrist, was busted in 2010 after narcotics detectives arrested a suspect for selling prescription pills on Craigslist. The suspect identified Kuemmerle as the source of the drugs, court records show.

During their investigation, detectives requested a CURES report on Kuemmerle in 2009 and found that he was the No. 2 prescriber of narcotic painkillers in California and the No. 1 prescriber of the highest-dose form of the stimulant Adderall, according to court records.

Kuemmerle prescribed nearly four times as many of the Adderall pills as the next doctor on the list, the CURES report showed. A medical expert said Kuemmerle wrote an average of 15 prescriptions per day for controlled substances over a four-year period, a “remarkably high” figure, court records show.

Kuemmerle pleaded guilty in 2011 to drug dealing and was sentenced to three years’ probation.

Investigators expressed amazement that Kuemmerle was able to get away with such high-volume prescribing while his prescriptions were being reported to CURES. The failure to use the database to look for signs of improper prescribing closes off a valuable source of leads, they say.

“If a doctor is prescribing in a way that could be considered unreasonable, there is nothing from CURES to say, ‘This might be a problem,'” said Redondo Beach Police Det. Robert Carlborg, who worked on the case. “If there had been, Kuemmerle would have been caught way sooner.”

On a warm October afternoon in 2003, Carmen Pack was taking her children to buy Slurpees in the Bay Area suburb of Danville.

Troy, 10, was on his scooter. Alana, 7, was riding her bike.

Heading toward them in a gold Mercedes was Jimena Barreto, a nanny for wealthy families in the area. She had been drinking and popping pills.

The Mercedes careened across two lanes of traffic. Alana was killed instantly. Troy died a few hours later.

Evidence emerged that Barreto was a “doctor shopper” who had obtained prescriptions for painkillers from half a dozen physicians at the same hospital. When the doctors testified at Barreto’s trial, each said they didn’t know about the others’ prescriptions.

That exposed a problem that Bob Pack, the children’s father, set out to remedy.

Pack, a technology entrepreneur, learned that California pharmacists were required to submit detailed data to the state on the controlled substances they dispensed. The information includes the name of the patient and the prescribing physician, as well as the drug and dosage.

The information is stored in the Controlled Substance Utilization Review and Evaluation System — CURES. The system has been in operation in various forms since 1939.

When Pack began studying CURES, doctors or pharmacists who suspected a patient of abusing drugs could call or fax requests to review the patient’s history of filling prescriptions for narcotics. But it could take weeks before they received the desired information.

Pack devised a plan for real-time access to the database. He and some Silicon Valley friends helped design an Internet portal that would allow medical professionals to review a patient’s history of medication use while considering whether to prescribe or dispense new drugs.

State officials embraced the idea.

Pack also pitched a separate component that would automatically alert state officials to doctors with suspicious prescribing patterns. In a recent interview, he called it a “built-in red flag system” that would deliver reports weekly or monthly.

Pack said he discussed the idea with then-Atty. Gen. Jerry Brown in 2007 and met regularly with state officials about the project for a couple of years.

At one meeting, in a demonstration of the database’s potential, staff members presented Brown with a list of the 10 most prolific prescribers of narcotics in the state.

“Jerry Brown and his team were really into that,” Pack recalled.

Brown announced the start of real-time access to CURES at a news conference in September 2009. Pack was at Brown’s side as he touted the “high-tech monitoring system” that would “enable doctors and law enforcement to identify and stop prescription-drug seekers from doctor-shopping and abusing prescription drugs.”

A federal agent removes a computer as evidence from a physician’s office. Data the state already collects could help authorities move sooner to stop reckless prescribers. (Liz O. Baylen / Los Angeles Times)

But the idea of using CURES to scrutinize doctors’ prescribing was no longer part of the program. Pack attributed its disappearance to “a combination of apathy and a lack of funding.”

Brown did not respond to requests for comment.

Pack, in an email, said “the idea was always there and still is, but the AG’s office just needs to set it as a priority.”

After Brown became governor in 2011, he eliminated the Bureau of Narcotics Enforcement, the unit that operated CURES, as part of his response to the state’s financial crisis.

CURES is now run by a single full-time employee in the attorney general’s office. A private company under contract with the state collects electronic reports on prescriptions from pharmacies and enters them into the database.

The effort is funded with about $400,000 in fees collected annually from the medical board and other professional licensing agencies.

Of more than 212,000 physicians, pharmacists and other professionals eligible for online access to CURES, fewer than 10% have signed up. The attorney general’s office says the database could not handle the demand if every eligible prescriber signed up for online access.

Earlier this month, when one Los Angeles doctor sent an email to the attorney general’s office seeking help accessing CURES to monitor his patients’ drug use, he received an automated response:

“Unfortunately, due to budget restrictions, there is no staff to accept or respond to your communication.”

Medical experts say improving such databases should be a priority because they can play a crucial role in reducing prescription drug deaths.

“This is life and death … if you can do it for a $100 credit card purchase, why can’t you do it for prescriptions?”

— Dr. Allen Frances
Duke University School of Medicine

Prescription monitoring systems are most effective when they focus on doctors rather than on patients, said Len Paulozzi, a public health physician at the Centers for Disease Control and Prevention who specializes in prescription drug abuse.

Paulozzi said CURES could be used for more than generating lists of top prescribers. Officials could, for example, search for instances of patients driving long distances to see a particular doctor, he said. They could also look for physicians who prescribe high dosages of commonly abused drugs.

“Whether you are talking about firemen, policemen or doctors, somebody needs to be looking at what they are doing,” he said in an interview. “I don’t see anything wrong with that.”

Dr. Allen Frances, a professor emeritus of psychiatry at the Duke University School of Medicine and an authority on misuse of prescription drugs, said credit card companies monitor customers’ purchases more closely than most states monitor prescribing of addictive medications.

“This is life and death,” Frances said. “If you can do it for a $100 credit card purchase, why can’t you do it for prescriptions?”

In New York, Massachusetts, Ohio, Kentucky, New Jersey and Wyoming, information from prescription databases that suggests improper prescribing is sent to law enforcement agencies, medical licensing boards or both. West Virginia is developing a program to analyze prescription data to flag problem doctors. South Dakota plans to create a similar program.

Paul Phinney, president of the California Medical Assn., an advocacy and lobbying group for doctors, expressed reservations about this approach, saying that CURES should not become a “big brother” that could make “physicians think twice about prescribing appropriate pain medication.”

\

But Ronald Wender, former president of the state medical board, said physicians who are prescribing appropriately would have nothing to fear from such scrutiny.

“If you are an oncologist and you are taking care of people in cancer pain, that’s one thing,” said Wender, an anesthesiologist who oversees a large pain-management practice in Los Angeles. “But if you are a general practitioner and writing loads of opioid prescriptions, then something is wrong.”

State officials said it would cost about $2.8 million to make CURES more accessible and easier to use, and $1.6 million more per year to keep it running.

State Sen. Mark DeSaulnier (D-Concord), a longtime supporter of CURES whose father struggled with substance abuse, said he would propose legislation in January to finance such an upgrade, and would like to see the system used to track doctors as well as patients.

“People are suffering and dying from overprescribing right now,” DeSaulnier said. “If there are outliers, people need to investigate that and ask questions.”

Times staff writer Hailey Branson-Potts contributed to this report.

The post <a href="https://www.latimes.com/science/la-me-prescription-deaths-20121111-html-htmlstory.html#footer-header">Dying for relief | A Times Investigation</a> appeared first on The Patient Safety League.

BY SOUMYA KARLAMANGLA

AUG. 12, 2019 3 AM PT

The Berkeley pediatrician was treating a teenager for anxiety and panic attacks. A few months into his therapy appointments, he began showing the boy pictures of men masturbating as well as other pornographic images, according to state documents.

During several appointments, the doctor instructed the boy to masturbate and watched as he did so. He later had the boy perform oral sex on him.

Late last year, the Medical Board of California stripped the doctor, Bayard Allmond, 84, of his license to practice.

Allmond is part of a growing wave of California doctors who have faced sexual misconduct allegations in the last two years.

Since fall of 2017, the number of complaints against physicians for sexual misconduct has risen 62%, a jump that coincides with the beginning of the #MeToo movement, according to a Times analysis of California medical board data.

During that same time, medical boards across the country also noticed a surge in sexual misconduct complaints, according to Joe Knickrehm, spokesman for the nonprofit Federation of State Medical Boards, though figures were not available.

Many experts link the increase to societal shifts spurred by the #MeToo movement, which encouraged victims to speak out, as well as noteworthy abuse cases involving medical professionals.

In 2018, Larry Nassar, a former USA Gymnastics doctor, was sentenced to 40 to 175 years in prison for molesting young athletes. The same year, hundreds of women came forward to accuse former longtime USC gynecologist George Tyndall of inappropriate behavior. In June, former UCLA gynecologist James Heaps was charged with sexual battery and exploitation during his treatment of two patients at a university facility.

As these stories permeate, patients have become more vocal in the doctor’s office, seeking to know what physicians are doing each step of an exam, doctors say. They are also more willing to speak up if something bothers them, empowered by these recent revelations, said Dr. Sheryl Ross, an OB-GYN in Santa Monica.

“It’s a look, it’s a touch, it’s having a man rub up against you with an erection — it’s subtle things that I think women didn’t always have an understanding that this is inappropriate,” Ross said. “The days of just sitting back and having the doctor tell you what to do are gone.”

The California medical board, which licenses more than 140,000 physicians, has the power to take away a doctor’s license if it decides that person has acted inappropriately and violated the terms of their license. Anyone can file a misconduct complaint with the board, which will then be investigated by staff.

During the fiscal year that ended in June, the California medical board received 11,406 complaints against physicians and surgeons, the most it has ever received. Complaints of sexual misconduct, though small in number, are among the fastest growing type of allegation.

In fiscal year 2017-18, 280 complaints were filed against physicians for sexual misconduct, compared with 173 the previous year. In the 2018-19 fiscal year, there were 279.

The Times obtained data on sexual misconduct through public records requests to the medical board, which does not typically publicize sexual misconduct complaint numbers and has not yet published any data from the 2018-19 fiscal year.

The misconduct by Allmond, the Berkeley physician, occurred in 2016, but it appears the patient did not report it to police or the medical board until late 2017. Last year, Allmond pleaded no contest to a felony count of sending harmful matter to a minor with sexual intent.

Neither Allmond nor his lawyer could be reached for comment.

Medical board spokesman Carlos Villatoro said the board hasn’t changed policies or tried to round up more complaints against physicians, for sexual misconduct or anything else. However, the board “takes allegations of sexual misconduct very seriously,” he said in an email.

Since mid-2017, 23 physicians in California have lost their medical licenses because of sexual misconduct.

Often, those cases result from an ongoing criminal case against a doctor.

In June, the medical board revoked the license of Lake County nephrologist Moutaz Almawaldi after he was convicted of sexual battery. Earlier this year, the board stripped San Francisco psychiatrist Billy Lockhart of his license after he was convicted of possessing child pornography and sentenced to prison.

But such cases are likely not driving the increase in complaints to the medical board, experts say. Instead, it’s probably patients reporting the kind of misconduct they may have overlooked otherwise.

A patient confronted with inappropriate behavior that is perhaps subtle, or could be interpreted in different ways, may be emboldened by a culture that is increasingly saying these things are not OK, said Dr. James Marroquin, a bioethicist in University of Texas at Austin’s Dell Medical School.

“Where in the past she just kind of blew it off, if you have more publicity about the stories from Harvey Weinstein and others … it might tip women to respond in a different way,” Marroquin said.

Marian Hollingsworth, a frequent critic of the board, agreed that Californians in particular may have recently learned about the medical board’s role in sanctioning doctors from following the cases against Tyndall and Heaps.

Yet Hollingsworth worries the increased complaints will not bring more actions against physicians. Just 4% of complaints turn into action against physicians, a figure that has dropped in recent years.

“The disciplines haven’t been proportional to the number of complaints,” Hollingsworth said.

Indeed, in both the 2016-17 and 2017-18 fiscal years, 21 doctors were disciplined for sexual misconduct. The figure dropped to 13 in the most recent fiscal year, according to medical board data.

A doctor whose license is revoked can apply for a new license in three years. Still, some physicians feel the board has overstepped.

The medical board revoked the license of Dr. Muhannad Hafi, who practiced in Santa Clara County, in December 2018 after two female patients accused him of sexual misconduct.

Hafi, however, maintains his innocence.

A criminal case involving the first patient, who accused him of touching her breasts and sticking an ungloved finger in her mouth, went to trial and Hafi was acquitted by a jury. Police did not file charges based on the second patient’s allegations that the doctor pressed his erect penis against her body.

In December, Hafi sued the medical board in San Francisco County Superior Court, arguing that taking away his license is “manifestly unjust and not supported by the weight of the evidence.” In June, a judge determined that the board had acted correctly and that the revocation will stand. Neither Hafi nor his attorney could be reached for comment.

Representatives from medical boards nationwide said in their annual survey last year that sexual harassment violations were among the most important topics to them, said Knickrehm, spokesman for the Federation of State Medical Boards.

In response, the agency launched a working group on sexual boundary violations last year. The group is studying state medical board policies and trends related to sexual misconduct by physicians and plans to share new recommendations in 2020, he said.

Richard Carpiano, a medical sociologist at UC Riverside, said that it’s vital the medical profession address its public reputation in the wake of these misconduct cases. Faith between the patient and the physician is uniquely important for the field, he said.

“For the medical profession, the trust between a patient and a doctor is the foundation,” he said.

The post Sexual misconduct allegations against California doctors rise sharply since #MeToo era began appeared first on The Patient Safety League.

BY HARRIET RYAN, 

MATT HAMILTON

DEC. 9, 2018 8 AM PT 

For the birth of their first child, social worker Diane Vidalakis and her husband chose one of Pasadena’s most prominent obstetricians, Dr. Patrick Sutton, vice chair of obstetrics and gynecology at Huntington Memorial Hospital.

Labor initially progressed smoothly, with the couple listening to music and watching “Dancing With the Stars” in the hospital maternity ward.

Sutton arrived for the delivery in what the Vidalakises would later testify was a frenzied state. He shouted that he had to do an emergency caesarean section and then backtracked, picked up a pair of scissors and made three progressively deeper incisions into the base of Vidalakis’ vagina, according to interviews, court records and a medical board complaint.

A minute later, she delivered a healthy daughter. Her own body, however, was grievously wounded. Vidalakis would never regain control of her bowels, and specialists who examined her would express shock that such extensive injuries resulted from a delivery at an American hospital by a licensed physician.

“I never challenged or questioned his authority,” Vidalakis said in an interview. Without admitting wrongdoing, Sutton settled a 2011 lawsuit she and her husband filed for $750,000.

What Vidalakis and many other women who sought care from Sutton did not know was that he had a long history of patient complaints about his conduct before, during and after labor.

A Times investigation identified more than 20 women who claim Sutton mistreated them during his medical care. Their allegations date to 1989, his first year at Huntington, and include unwanted sexual advances, medical incompetence, the maiming of women’s genitals and the preventable death of an infant. Sutton denied each allegation in an interview with The Times.

Top Huntington administrators were warned repeatedly about Sutton over the decades, according to interviews with current and former administrators and other hospital employees. One obstetrician at the hospital told The Times she complained to Huntington’s chief medical officer and its compliance department on several occasions about what she saw as his poor clinical judgment and misogynistic remarks.

“No matter what concerns I had, they would continue to do nothing,” said Dr. Shawanda Renee Obey.

Unease about Sutton was so widespread at Huntington that some nurses adopted a policy of misleading him about the progress of a woman’s labor to keep him out of the delivery room for as long as possible, according to interviews with more than half a dozen current and former nurses.

Hospital administrators continued backing Sutton, even allowing him for several years to lead internal investigations of other obstetricians. After The Times reported in October that he was facing a fifth accusation of sexual impropriety in court or by the medical board, the hospital announced he would have a chaperone when treating patients.

In early November, the newspaper presented Huntington with a detailed list of questions for this story.

A hospital spokeswoman subsequently said that Sutton was no longer working there, “effective immediately.” In an interview last month, Sutton said the hospital asked him to take a leave of absence or face suspension and he agreed to the leave.

Sutton said he was a good doctor and that the patients who complained represented only a tiny fraction of the thousands of women he cared for during his career. He maintained that the hospital never took any disciplinary action against him until this fall. He also noted that he had prevailed in the only two malpractice cases in his career that went to trial.

“I agree my record looked kind of crappy, and I wish it wasn’t, but that doesn’t mean I’m any risk to patients at all or that patients don’t want to keep seeing me,” Sutton said.

Dr. Lori Morgan, Huntington’s chief executive, declined to answer questions about Sutton, citing state law that makes internal discipline of physicians confidential. She said the hospital’s governing board is forming a committee to reexamine how it grants doctors privileges to practice.

The Times interviewed more than 60 people about Sutton’s practice, including patients, their spouses and family members, birth coaches, nurses, physicians, lawyers and other hospital employees. Many spoke on the condition of anonymity, with some citing potential professional repercussions.

::

The son of a doctor and a social worker, Sutton grew up in Pasadena less than a mile from Huntington. He graduated with honors from Caltech in 1976, and after medical school at the University of Michigan did residency training at California Hospital and L.A. County-USC Medical Center.

Entering private practice in 1989, he chose an office around the corner from Huntington. With its distinctive rose-colored facade, marble fountains and manicured grounds, the hospital has long embodied the aspirations of Pasadena, Southern California’s “city of millionaires.”

Its nationally ranked maternity ward, which welcomes more than 3,500 babies annually, is the heart of the hospital. Tall and strapping, with a bedside manner that could be tender and sweet, Sutton was beloved by many patients, who returned to him for the births of second and third children and recommended him to co-workers, friends and relatives.

“He has a lot of patience and would sit there to make sure all my questions were answered before he moved on,” one patient wrote in a 2011 Yelp review. “My birthing experience was wonderful!”

Others left his care feeling scared, angry and even traumatized. Some made their displeasure known to Sutton, the hospital or the medical board, but some said they shared their experience only with family and close friends.

Madelaine Hill was in the second category.

During a difficult 1989 pregnancy, the then-25-year-old commercial artist had to be hospitalized. Sutton had a “soothing” approach, Hill recalled, but the way he touched her was unsettling.

“He would play with my nipples, and a couple times, after he did the vaginal exam, he touched my clitoris,” Hill said. “It was scary.”

Her husband, from whom she is now separated, said she told him at the time about Sutton’s inappropriate touching.

Both said she didn’t switch doctors because they were embarrassed and fearful of losing the pregnancy. Sutton delivered their son by caesarean section in July 1989. After Sutton touched Hill’s clitoris at a postpartum visit, she decided to stop seeing him, she said.

She never filed a complaint with Huntington or the medical board. The Times learned about Hill from a friend whom she told in the late 1990s that Sutton had acted inappropriately.

Sutton said he had no memory of Hill, but denied her allegations: “I have never touched or said something to a patient for the purpose of sexual gratification.”

By the mid-1990s, Huntington was getting notice of dissatisfied patients in the form of malpractice lawsuits. During a 1991 hysterectomy, Sutton neglected to remove an ovary and a fallopian tube, according to a lawsuit against the physician and the hospital.

Patient Sandra Bueno, then 27, complained of pelvic pain in the months and years after the procedure, but Sutton told her the pain was “psychosomatic and/or psychogenic,” according to her lawsuit.

Sutton didn’t detect the cause of the problem — even after performing a second surgery to try to alleviate her pain, she alleged in court records. Another Huntington surgeon finally identified the issue in 1995 and removed the tube and ovary. Sutton denied liability but settled the case in 1997 for $90,000. A judge dismissed the claim against Huntington.

Sutton said in an interview that scar tissue made it difficult to discern Bueno’s ovary and that he “did everything adequately.” He said he settled only because “I felt bad for this lady having a second surgery.”

Later that year, allegations against Sutton once more landed the hospital in court. Ann Bussone, a 40-year-old Pasadena attorney, was rushed to Huntington 10 weeks shy of her due date. She was leaking fluid, and over the next two days at the hospital, the baby’s heart rate became increasingly abnormal, according to a court brief filed by her lawyer.

Bussone’s sister-in-law, an obstetrics nurse at another facility, came to Huntington and said Bussone needed a perinatology specialist and another ultrasound. Sutton dismissed the advice and left the hospital, Bussone’s trial brief alleged.

That night, the baby’s heartbeat could not be detected, and after an emergency caesarean, the infant girl died. Afterward, according to the brief, Bussone confronted Sutton about what she saw as his mishandling of the birth. He cried and apologized, telling her, “This case will change the way I practice medicine forever.”

In court filings, Sutton denied wrongdoing but settled the suit for $135,000. A judge dismissed Huntington as a defendant.

Sutton said in an interview that he thought his treatment of Bussone was “totally defendable” in court because of positive readings on a fetal heart monitor. But he said that after the death, he adopted a policy of always consulting with a perinatologist in such cases.

“It was a terrible outcome and I hated it,” he told The Times.

Childbirth instructor Kathy Killebrew, who has taught more than 5,000 women over her career, said she started hearing complaints about Sutton in the mid-1990s. A student named Consuelo “Connie” Gennaro pulled her aside after a 1998 class, she said.

Gennaro, then 37, was carrying what she and her husband considered a “miracle child,” conceived after 14 years of trying. At prenatal appointments, Sutton repeatedly asked questions about her sex life even after she made it clear she was not interested in discussing the topic, according to Gennaro and an accusation the medical board later filed against the obstetrician.

During an ultrasound, Gennaro expressed worry that her vaginal discharge might indicate a problem with the baby. Sutton responded by reaching his hand down her maternity pants and inserting two ungloved fingers into her vagina, according to medical board records and Gennaro.

“I felt this overwhelming shame and embarrassment,” she said.

After consulting with another doctor and Killebrew, Gennaro filed a medical board complaint.

A doula, or birth coach, whom Gennaro had hired to be with her during the delivery said she recommended also alerting Huntington.

“It was too stressful” for Gennaro, recalled the doula, Kimberly Francis. “So I decided because she [had] confided in me … to report it myself to Huntington.”

Francis said she does not recall the details of how she lodged a complaint with the hospital 20 years ago but that she remembered being summoned to a meeting at Huntington with half a dozen male physicians.

After she described Gennaro’s experience, one of the physicians told her that they were aware Sutton had a problem with his temper and “we are working on that with him now,” she said.

Francis’ mother and Killebrew said that she told them about the meeting at the time it occurred.

Sutton told The Times that his colleagues never informed him of such a meeting and that no one at Huntington had ever indicated they believed he had a temper problem. He disputed Gennaro’s account in an interview, saying he did nothing improper.

“I have never put a hand in a patient’s vagina without gloves,” he said.

The medical board investigating Gennaro’s complaint found it credible and rolled it into a larger 2002 accusation that also alleged misconduct in Sutton’s handling of Bussone’s birth as well as injuries sustained by another child.

After negotiations with Sutton’s lawyer, the board agreed to a settlement under which it dropped all the counts involving Gennaro and Bussone. Sutton admitted one charge of failing to maintain medical records for the injured child and was placed on probation for four years.

Other settlement terms indicated concerns that went beyond medical record-keeping. Sutton was ordered to take a course on professional boundaries and required to have a chaperone during breast and pelvic exams.

::

Sutton delivered Tawny Rusch’s first child, and there was no question she would return to him for her second, she said. But after that 2000 birth, her breast milk didn’t come in, and after leaving Huntington, the 32-year-old continued bleeding in volumes that shocked her.

“The clots were huge and I was saying, ‘I don’t remember this from the first one,’” she said. She provided medical records, correspondence and notes that support her account.

“For the next eight days, I kept calling his office,” she said. His staff told her repeatedly that the bleeding was normal, she recalled.

On the ninth day, she said, she hemorrhaged at a copy shop.

“It was like a bucket of blood,” Rusch said. “It was like from a horror movie.”

She drove to Sutton’s office and he performed an ultrasound, according to Rusch and the medical records. Part of her placenta was still in her body.

Placenta retained for even a few hours can cause dangerous hemorrhaging, according to medical experts. Rusch’s had been inside her for two weeks, according to her medical records. In Huntington’s operating room, Sutton performed emergency surgery to remove the fragment.

At follow-up visits, she said, she told him she still was unable to nurse her daughter and that her period had never returned.

Over the next three and half years, the normally upbeat and sunny Rusch became, in her words, “a bitch all the time.” She raged at her children for tiny missteps, and her mother, she said, “accused me of doing drugs because I was always sweaty and always frazzled and always yelling.”

Finally, in 2004, she agreed to see a doctor about her moods. He referred her to an endocrinologist, who said he suspected Sheehan’s syndrome, a rare condition brought on by severe blood loss after labor. The bleeding causes the pituitary gland to shut down, effectively launching a woman into menopause.

With hormone therapy, she said, her mood swings stabilized.

She had stopped seeing Sutton, but she thought often of the damage her condition caused to her children and marriage, she said. In 2006, Rusch mailed him a three-page letter describing her medical ordeal. She provided a copy to The Times.

“I do hope in the future that if a patient of yours complains [of] a lot of bleeding and has large clots postpartum … that perhaps you will listen,” the letter read. She said she received no response.

Sutton said he does not recall Rusch or receiving such a letter. Based on her account she gave The Times, he said, his actions were “pretty much appropriate care.”

“Unfortunately, she was unhappy. I’m sorry for that,” he said.

Lawsuits continued arriving at Huntington’s door. A Covina family sued Sutton and the hospital in 2003 after their son suffered severe brain damage during delivery. Both denied liability. The hospital settled the case for $1 million and Sutton for an additional $750,000.

Sutton said in an interview that a nurse was to blame in that case.

To the family of a child injured during a 2003 delivery, the hospital denied liability but paid $25,000 to settle the family’s lawsuit. Sutton, who insisted he had acted properly in that birth, took the matter to trial. A jury found in his favor that he was not negligent and awarded the family no money.

In 2005, two women filed a sexual battery lawsuit against Sutton, accusing him of lewd comments and improper touching during appointments at his office. He settled the case for an undisclosed sum. Records of the case were destroyed by the court two years ago, and it’s unclear how Sutton’s lawyer responded to the allegations.

The terms of the settlement barred Sutton and the women from publicly discussing the case. Huntington was not named in the suit, though the hospital’s policy requires doctors to disclose lawsuits against them in order to keep working there.

At the close of the litigation, a lawyer for the women contacted the medical board and was directed to a state investigator, Shellee Thorson, according to correspondence between the attorney and the investigator reviewed by The Times. At Thorson’s request, the women’s attorney forwarded a copy of one plaintiff’s deposition from the lawsuit to the board, according to a copy of the 2006 letter.

Sutton said in an interview that the board told him it had investigated and decided not to take action. Thorson, who still works for the medical board, declined to comment, and the board’s executive director, Kimberly Kirchmeyer, said confidentiality rules barred her from discussing Sutton.

Obstetrics is considered a high-risk specialty and practitioners are sued more often than most doctors. But by the early 2000s, the payouts for Sutton were high even among his peers, malpractice insurance experts told The Times. In the course of a 30-year career, a typical California obstetrician will have malpractice awards totaling about $450,000, according to an analysis provided to The Times by an insurer.

Court records show Sutton had paid more than double that and was less than 20 years into his career.

Sutton’s legal problems were known to some at Huntington, but colleagues continued to place confidence in him. Obstetricians there elected him vice chair in 2009, placing him in charge of the committee that evaluated complaints against doctors.

Dr. Ted Merchant said he spoke with Sutton about the lawsuits, but never doubted his fitness as a doctor. Both were part of a rotation in which they cared for each other’s patients.

“I thought he was very attentive to his patients and took good care of them,” said Merchant, who is now retired.

Others at Huntington had a different view. The Times interviewed nearly a dozen current and former employees, including administrators, physicians and nurses who worked alongside Sutton for decades. Many described him as a volatile presence on the maternity ward and said he had once been reported to administrators for throwing a surgical instrument at a nurse.

With laboring mothers, he appeared to be in a hurry, urging patients to begin pushing earlier than other obstetricians and giving episiotomies to women who did not need them, according to labor nurses as well as administrators who fielded complaints from them.

Six current and former nurses said Sutton often instructed them to turn off the epidural, the spinal anesthetic that relieves the pain of contractions, for the last stage of labor, saying it would allow women to push more effectively. Obstetricians sometimes adjust the epidural if a woman is having difficulty pushing, but Huntington nurses believed Sutton was doing it routinely and when it was not necessary, they told The Times. Some saw the practice as cruel, because it exposed patients to agonizing pain that they had explicitly asked to avoid, the hospital staffers said. When Sutton called to check on patients, some nurses said they took to misleading him about patients’ progress.

One nurse recalled that when she started at Huntington more than a decade ago, a senior colleague warned her: “He’s going to tell you to turn off the epidural, so consider the timing of your call [to summon him].”

In the delivery room, six nurses said, Sutton had a practice of placing his fingers in each side of the vagina and pulling the walls apart strenuously and for a prolonged period. In separate interviews, four nurses mimicked Sutton’s practice in an identical way: His face locked in a grimace, his arms shaking from exertion. Other Huntington obstetricians did not pull on women that way, the nurses said.

Experts told The Times that they were unfamiliar with it as a medical technique and said it posed a risk of tissue damage.

Some nurses used an internal website to complain about Sutton, employees said, but many felt it was futile to challenge a doctor.

Sutton told The Times that he did not rush deliveries. He said he was loud and animated during labor, shouting, grimacing and holding his breath, because he was trying to demonstrate to laboring mothers when and how to breathe and push.

He said he placed his hands inside women and pressed down with a lot of exertion to provide a target for pushing, but denied pulling the walls of their vagina apart. He said he turned the epidural off early only in cases where numbness was interfering with pushing.

“I never do it against a patient’s will,” he said.

He said a nurse accused him of throwing a surgical instrument, but that he threw it on a table and was not angry at the time. Huntington cleared him, he said. As when asked about other allegations against Sutton, the hospital declined to comment, citing confidentiality obligations.

In recent years, one of Sutton’s colleagues said she regularly complained about him to hospital administrators. Dr. Obey, who started in Huntington’s maternity ward in 2016, said she and Sutton worked together on about a dozen caesarean surgeries. She said he stretched and manipulated the uterus and tissue around it with his hands in a rough way she found medically inappropriate and potentially damaging to patients.

“I feel like he’s deliberately being destructive to their pelvic organs,” she said.

His frequent sexualized remarks about patients also bothered her, she said. Once when she asked that he not “be so rough on pelvic tissue” of a patient, she said, Sutton responded by laughing and saying it “makes for better sex and gives them more room.”

She said she complained to Huntington’s compliance office and maternity department administrators. On several occasions, she said, she took the matter directly to the hospital’s longtime chief medical officer, Dr. Paula Verrette.

“The only thing she would say is, ‘We are working on it,’” Obey said.

Verrette declined to comment and referred The Times to a hospital spokeswoman.

Several former employees told The Times that Verrette received complaints from multiple sources about Sutton. He said he suspected that some colleagues might have complained over the years, but that Verrette, with whom he spoke frequently, never confronted him with any complaints.

Chemin Perez was volunteering as a doula for low-income mothers in 2008 when she crossed paths with Sutton. She said her client brought copies of a written birth plan to Huntington stating she wanted to avoid an episiotomy.

The practice of routinely slicing the perineum to facilitate delivery was once very common, with some hospitals in the 1970s reporting episiotomy rates close to 90%, according to textbooks and published research. But in the 1980s, the field began moving away from the practice, hospital data collected by the federal government show. Research has indicated that cutting lacked a provable benefit and put women at greater risk for severe tears that lead to permanent incontinence and other problems, according to the American College of Obstetricians and Gynecologists (ACOG).

ACOG had advised against the routine use of episiotomies since 2006. One large-scale survey found the national episiotomy rate had declined to 8% last year, and patient safety groups have pushed for a further decline.

Perez said she tried to give a copy of her client’s birth plan to Sutton.

“He did not respond and the look he gave us was the roll of his eyes,” said Perez, who is now a midwife in Arcadia.

As the child was crowning without complication, Perez said, Sutton wordlessly cut the woman’s perineum.

“I feel like he did it as a punishment: I’m not going to do what you want to do, I’m going to do it my way,” she said.

Perez provided a copy of a Feb. 15, 2008, letter that she said she and the mother prepared at the doula’s home computer two weeks after the birth. It was addressed to Dr. Vance Polich, Huntington’s former chief medical officer, and copied to Sutton, a hospital spokeswoman and the medical board. Perez recalled that she and the mother hand-delivered the letter to the hospital.

“The doctor sliced me right down to my anus,” the letter read. “I don’t feel my wishes were respected at my son’s birth. … I hope something will be done to stop Dr. Sutton from performing unnecessary episiotomy’s (sic) in the future.”

Contacted by The Times, the woman said she suffered from “a lot of memory lapse” around the period of the birth. She said she recalled that Perez helped her during labor and that she visited the doula at her residence, but she did not remember preparing a complaint. The birth certificate confirmed Sutton delivered her child.

Polich said in an interview that he had retired two months before the date on the letter and never received it. Asked whether he got other complaints about Sutton, he said he needed to call Huntington’s lawyers and declined to comment further.

Sutton said he didn’t remember delivering the baby or receiving the letter, but he denied Perez’s account. He said he has adapted his practice as views of episiotomies have changed and estimated that his personal rate now stands at about 5% — the rate identified as optimal by patient safety advocates.

“If the person says don’t do an episiotomy, I won’t do one,” he said. “I never have done episiotomies to punish a patient, and although I may not agree with the birth plans, I always read them and don’t ever roll my eyes at them.”

Later in 2008, a patient in her 40s complained to the medical board that Sutton had discussed her sex life in terms fit for a pornographic movie, board records allege.

Sutton “told the patient she should feel free to fantasize about anything, ‘Whether you would like it from behind or the front, with another woman or another man, or anything you want,’” a board lawyer wrote in a filing accusing Sutton of sexual misconduct and other offenses.

The woman asked him to stop, but he pressed ahead while rubbing her legs, the board filing stated.

Once again, Sutton reached an agreement that allowed him to admit to a single records-keeping charge. Sutton told The Times that he did not make the comments the woman alleged and the patient’s chart reflected “a significant hearing problem.” He said he considered fighting the allegations, but believed he would be found culpable for failing to keep good records even if he was cleared of the other counts.

Under the deal he made in 2011 with the board, those counts were dropped. He was placed on a second probation term, told to take another class on professional boundaries and ordered to have a chaperone while examining patients. He also agreed to enter psychotherapy. Sutton said he participated in six months of group counseling.

Kirchmeyer, the medical board’s executive director, said the agency no longer allows doctors to settle cases by admitting only to record-keeping errors. She said that about six years ago, she decided the agreements were “not appropriate” because they obscured the severity of the alleged misconduct.

Sutton continued to practice at Huntington during this period. At the time, he served as department chair. Sutton said Huntington’s then-chief executive officer, Stephen Ralph, asked him to resign as chair out of the “best interest” of the hospital, and he did.

High school science teacher Brittany Coker had not previously met Sutton when he arrived in her Huntington delivery room in January 2010.

Coker had a written birth plan calling for him to avoid an episiotomy, and she reiterated to Sutton in person that she did not want to be cut, according to Coker and her doula. The nurse chimed in, telling him, “She doesn’t need one. She’s going to deliver without tearing,” Coker recalled in a recent interview.

Sutton then put a finger on each side of her vagina and ripped downward, tearing her perineum, Coker said. Her husband and doula, who were both present, confirmed her account.

“Well, there. Now she doesn’t need an episiotomy,” Coker recalled him saying.

Sutton delivered her son and stitched the tear. After he left, the nurse apologized to Coker, she said. When Sutton later returned to examine her, he said, “Wow, you must be in a lot of pain. You must wish you had listened to me and had the episiotomy,” she recalled.

Coker’s husband said he and his wife drew up a letter of complaint to Huntington, but in the exhaustion of new parenthood, they never got around to sending it.

Sutton said he did not remember Coker, but denied her account.

“I don’t ever intentionally tear a vagina,” he said.

Diane Vidalakis and her husband entered Huntington’s maternity ward eight months after the Cokers left. She brought a written birth plan calling for no episiotomy, if possible.

Vidalakis, then 39, had seen Sutton for gynecological services for a dozen years and said he seemed like a different person at the birth.

“Just busted through the door, crazy hair, just kinda shouting at everyone: Turn the music off! Get your feet into the stirrups!” she recalled.

Sutton told the couple there was an issue with the child’s heartbeat, and a medical board accusation would later describe “decelerations” in the heart rate. Sutton grabbed the side of Vidalakis’ vagina and pulled “like he was trying to rip her in half,” recalled her husband, John.

Sutton announced he was going to perform a caesarean and began assembling instruments, the Vidalakises said. Then he grabbed the scissors.

Sutton would later tell medical board investigators that he made a single cut. But John Vidalakis and the couple’s doula, both standing a foot or two away, said he cut three times in the same spot. “Episiotomy x3,” states the doula’s contemporaneous notes, summaries of which are contained in the medical board complaint filed by Vidalakis.

Sutton said nothing about the injury, even after Diane Vidalakis asked him, “Why are you stitching in my butt,” according to interviews with her and her husband, their depositions and the medical board complaint.

Discharged from the hospital, Diane found she had no control over her bowels and stool seemed to be coming from her vagina, she said. Sutton’s office staff told her it was normal, she said. At her one-month checkup, Sutton examined her and said the episiotomy was “well healed,” according to medical records submitted to the board.

With no improvement, she returned to Sutton’s office three months later. He told her the episiotomy had “failed” and suggested she get pregnant again and allow him to fix the problem with surgery after the second child’s birth, according to the couple’s sworn testimony in their lawsuit and their board complaint.

Instead, the Vidalakises consulted a series of specialists who told her that the wall between her anus and vagina was gone and her sphincter muscles severed. One surgeon said her injuries were something one might find in Rwanda, but rarely in the industrialized world, according to his 2012 deposition for her lawsuit.

“The reason I remember it is because I had not seen anything that drastic, you know, in America,” Beverly Hills colorectal surgeon Zuri Murrell said in the deposition.

At City of Hope, the Duarte cancer hospital, a surgeon who normally treats patients with colon cancer performed three operations on Vidalakis, according to the depositions of her and her husband and the accusation the medical board filed against Sutton. She remains incontinent.

Sutton disputed parts of the Vidalakises’ account in an interview. He said that Diane Vidalakis’ sphincter muscles were intact after delivery and that she had somehow severed them between her first and second postpartum examinations. He theorized that the injury might have occurred as a result of sex.

“But at no time did I miss a diagnosis,” he said, adding that his insurance carrier settled the case without his permission. “I planned to defend myself. I think I acted appropriately.”

Vidalakis’ husband, John, called Sutton’s explanation of her wounds “removed from reality.” The couple were not intimate for more than a year after their daughter’s birth because of the extent of her injuries, according to their medical board complaint.

The $750,000 settlement Sutton reached with the Vidalakises in 2012 required his malpractice insurers to drop him as a customer the next month, according to a copy reviewed by The Times. It was an unusual provision, but the Vidalakises said they wanted to make sure he did not harm other women. The couple said their attorneys believed Sutton was unlikely to find another insurer and would probably be forced out of business.

Three months after Vidalakis’ delivery at Huntington, Sutton used his fingers to rip the perineum of a laboring mother at what is now USC Verdugo Hills Hospital, according to the woman, her husband and her doula, who were all present.

The doula, Cindy Jaime, said that just before the December 2010 incident, Sutton was “noticeably irritated” by the woman’s repeated reminders that she didn’t want an episiotomy.

“I felt he was angry because they were questioning him,” Jaime said.

Sutton said he did not recall the patient, but reiterated that he had never intentionally torn a woman’s vagina.

After returning home from the birth, Jaime recounted the incident to her husband, Humberto, a veteran police detective. He said he was outraged and called the medical board in Sacramento. He said that at the time, he was acting as a concerned spouse and not a law enforcement officer.

A regional supervisor for the board told him that Thorson, the same investigator who had been sent the deposition five years earlier, already had an open file on Sutton and recommended he directly contact her, according to emails between Jaime, her husband, her clients and other doulas.

“The supervisor said to not even bother filing a complaint at this time as it will take too long to go through the channels of Sacramento,” Jaime told her clients in an email. Sharing the development with her doula friends, she wrote, “I am so hoping to get this doctor away from women and babies ASAP.”

Humberto Jaime said that when he phoned the investigator, he identified himself as a police detective so she would take his report seriously.

“I even remember telling the investigator that, in my opinion, it was not only neglectful, but was a crime,” said Humberto Jaime, adding that he told her, “I don’t want this to just slip through the cracks and not be investigated.”

Over the next two weeks, Cindy Jaime helped her clients prepare a written statement and collected information from her circle of doula friends. Emails to her husband indicate he gave Thorson the names of Coker, Killebrew and a former Huntington nurse who Jaime said could provide the names of “2-3 other victims.”

Those women said in interviews they were never contacted by Thorson or any other investigator. Sutton said the medical board did not contact him about their complaints. Thorson and the medical board declined to comment.

In 2013, Sutton and another obstetrician working at Verdugo Hills began a caesarean section before the anesthesia took effect, according to allegations in court records.

“I felt very sharp cutting pains, slicing through my abdomen,” patient Kelly Fudge said in a deposition. “I was unable to catch my breath enough to scream.”

In court filings, Sutton’s attorneys blamed the anesthesiologist. The case was settled on confidential terms. Sutton said he was not required to pay any money or admit to any missteps.

Years after the birth of his daughter, John Vidalakis called the number for Sutton’s office on a whim. Is he accepting new patients? Vidalakis asked.

Yes, a receptionist told him.

At the time the couple filed their lawsuit, Sutton was on board probation and an agency employee was supposed to be monitoring his practice. But it turned out the medical board had never launched an investigation into Diane Vidalakis’ injuries.

The probation officer asked about new malpractice claims at quarterly meetings with Sutton, and on at least two occasions, he referred to the Vidalakis suit, according to medical board records.

The notes of those meetings have since been destroyed, but the probation officer’s electronic summary of one conversation raises questions about whether Sutton presented the Vidalakis case accurately.

“A woman gave birth to a large baby over a year ago, and her husband is complaining that due to his wife having a large baby, that he feels Dr. Sutton may have not treated the vaginal tear correctly, or something to that effect,” the officer, Natalie Altamirano, wrote.

Altamirano didn’t refer it for further investigation. Now retired, she told The Times that Sutton misled her.

“I was not given all the facts of the severity of the case,” she wrote in an email. Had she understood “the egregious circumstances” alleged by the Vidalakises, she would have given it to a supervisor for possible investigation, she wrote.

Sutton testified in a hearing this summer that he gave her a full accounting of the lawsuit’s allegations.

The medical board did not begin investigating until 2016, when John Vidalakis learned Sutton was still practicing and filed a complaint. The board retained an obstetrics expert to evaluate the case and in 2017 moved to revoke or suspend Sutton’s license for, among other allegations, incompetence in how he responded to Vidalakis’ symptoms.

Sutton objected to the timing of the case. Under state law, the board must file disciplinary actions within three years of discovering alleged misconduct.

In a downtown L.A. hearing room in June, Sutton’s lawyer argued that when his client told the probation officer about the Vidalakises’ lawsuit in 2012, it constituted sufficient notification. The clock started ticking then, the lawyer said, and the case was now beyond the statute of limitations.

The administrative law judge sided with Sutton, and the case was dismissed this summer.

Eight years after Diane Vidalakis’ delivery at Huntington, the injury she says she sustained under Sutton’s care circumscribes her life. She cannot anticipate when she will need to use the bathroom. She had to give up her career as a social worker, and routine activities such as driving her kids to school or restaurant dinners are difficult or impossible. Her injury is something that is always on her mind.

“I just feel so damaged,” she said.

The medical board filed another accusation against Sutton in September, alleging that he made inappropriate sexual comments to a patient in 2016. He denies the claim.

No longer allowed to practice at Huntington, Sutton said he is pursuing positions at outpatient surgery centers.

The post More than 20 women accused a prominent Pasadena obstetrician of mistreating them. He denied claims and was able to continue practicing  appeared first on The Patient Safety League.

BY KIM CHRISTENSEN STAFF WRITER 

AUG. 1, 2021 5 AM PT

Wendy Knecht figures she’s been failed twice by doctors — once by the plastic surgeon she accused of botching her breast reconstruction, and again by the California physicians lobby fighting a proposed law that would force doctors to alert patients to potential conflicts of interests.

Knecht, a Studio City writer and healthcare advocate, was diagnosed in December 2014 with the BRCA2 gene mutation, which has been linked to an increased risk of breast and ovarian cancers.

The former Pan Am flight attendant, whose mother died of breast cancer, decided to reduce her risk by having a preventive double mastectomy.

The surgery left Knecht, now 65, with nerve damage and in chronic pain. It also led to a malpractice lawsuit, two complaints to the Medical Board of California and a push for legislation requiring doctors to tell patients if they have accepted payments from the makers of drugs and medical devices.

AB 1278 is working its way through the Legislature but was amended amid strong opposition from the California Medical Assn. so that it no longer requires doctors to inform patients about such payments.

“It’s really disheartening,” Knecht said. “When a physicians group is against patient care and transparency and informed consent, that’s upsetting.”

Anthony York, spokesman for the CMA, said the group is all for transparency but considered the disclosure requirements too burdensome. The association has said the disclosures would bury doctors in paperwork and could disrupt vital patient care.

“Disclosure itself is something CMA supports,” York said. “The concern we have is trying to protect the sanctity of the patient-physician visit.”

Orange County United Way is committed to improving the lives of everyone who lives here while empowering those who are most vulnerable.

Knecht’s ordeal began six years ago, when she had a bilateral mastectomy and breast reconstruction after being diagnosed with the mutant gene.

Dr. Max Lehfeldt, a prominent Pasadena plastic surgeon, performed the reconstruction in February 2015 using Seri Surgical Scaffold, a silk mesh support for soft tissue. In Knecht’s case it was supposed to bolster the temporary, saline-filled implants that replaced the breast tissue removed during her surgery.

Immediately after the operation, Knecht experienced excruciating pain, she said in her lawsuit and medical board complaints.

She later learned — from other doctors who performed corrective surgeries — that the mesh had failed to adhere to her chest wall and was not supporting the implants, which were larger and heavier than promised, according to her lawsuit and the medical board complaints.

She also discovered that at the time of her surgery, the Seri Surgical Scaffold, although cleared by the Food and Drug Administration for other uses, was not approved for breast reconstruction.

Knecht’s lawsuit contended that Lehfeldt’s pushing of the device and his failure to inform her of its “off-label” use was driven by his financial relationship with its maker, Allergan, which federal records show had paid him more than $400,000 over three years to research and promote it.

Had she known of that relationship before her surgery, she would have made different choices, Knecht said.

“He appears to have a vested interest in this product, which seems to have caused a conflict of interest,” she said in her first medical board complaint, in August 2016, which also accused Lehfeldt of withholding information about postoperative complications.

“By not acknowledging this product’s failure in my case, Dr. Lehfeldt has caused severe harm and has demonstrated a flagrant disregard for the standard of care and ethics,” she said in the complaint, a copy of which she provided to The Times.

Knecht’s lawsuit alleged that Lehfeldt had conducted a clinical trial of the device for Allergan and used the same technique in her surgery, making her an unwitting participant in an “experimental” procedure. Three months after her operation, the FDA issued Allergan a warning letter, telling it to stop marketing the scaffold for breast reconstruction because it was an unapproved use.

Lehfeldt did not respond to The Times’ requests for an interview. Court records show he denied the allegations in Knecht’s lawsuit, including that the off-label use of the Seri mesh was inappropriate. He also said there was “no evidence presented” that her surgery was experimental.

Lehfeldt and his insurance company ultimately settled Knecht’s lawsuit for $1 million, without admitting liability. Allergan also settled with Knecht for an undisclosed sum sealed by a confidentiality agreement.

In December 2016, the medical board closed its investigation of Lehfeldt without pursuing disciplinary action. The vast majority of complaints are resolved that way, according to a Times investigation that found a pattern of leniency in the board’s discipline of doctors accused of harming patients.

“I was never interviewed,” Knecht said. “One of the biggest problems with the medical board is that it is so one-sided toward doctors.”

During discovery for her lawsuit, Knecht’s attorneys obtained records that Lehfeldt had submitted to the board in response to her complaint.

They included a 10-page “summary of treatment” in which he said that he had explained all options to Knecht before her surgery and that she ultimately chose to use the Seri Surgical Scaffold over another device. He also said he disclosed his research and training affiliations with Allergan to her.

“I advised [her] that my recommendations are driven purely on what is best for the patient and their specific clinical circumstances,” he told the board, denying that he concealed any of his concerns or findings from her.

“Everything was clearly explained in the operative report and to WK post operatively,” he wrote, using Knecht’s initials.

Knecht and her husband, Dr. Kalman Edelman, a gastroenterologist who was with her at the consultation, “emphatically dispute” those assertions and others outlined in the summary, according to a second complaint she filed with the medical board in March 2018.

That complaint also alleged that Lehfeldt had altered Knecht’s medical records by adding a notation to falsely indicate he had fully informed her about the Seri mesh and alternative treatments before her surgery. Knecht had copies of her original records and spotted the discrepancy.

During a 2017 deposition in the malpractice lawsuit, Lehfeldt acknowledged adding the notation to her chart — 21 months after her surgery — but said his failure to flag it as new information, as required, was merely an oversight.

“I added an additional clarification to one of the consult sheets, given the discussion we’d had, and I failed to initial and date it,” he said.

After Knecht’s second complaint, the board reopened its investigation and is now pursuing disciplinary action against Lehfeldt. He is accused of repeated negligent acts in his care of three patients, including Knecht, according to a second amended accusation filed in February.

In Knecht’s case, the board’s accusation alleges he altered her records without noting that his changes were made nearly two years after her surgery.

“His failure to sign and date the entry constitutes a departure from the standard of care,” the accusation reads.

A spokesman for the medical board declined to comment.

Medical device manufacturers and drugmakers must report their payments to doctors, which are then posted on the federal government’s Open Payments website.

But physicians are not required to inform their patients of those relationships, which can create conflicts of interest.

Knecht said she considered that to be a huge hole in patient safety and sought out her elected representative to remedy it. After meeting with her, Assemblyman Adrin Nazarian (D-North Hollywood) introduced legislation to mandate those disclosures.

The bill as written would have required doctors to disclose in writing the names of all drug and device companies they received payments from. The disclosures were to be made during patients’ initial office visits and then once a year thereafter, and doctors also would be required to provide a written notice to patients about the Open Payments website. The medical board supported the proposal.

The California Medical Assn. opposed the bill, and in an email to members in May, the CMA’s political action committee sought donations to help kill it.

“This bill only adds to the litany of unnecessary burdens that divert physicians away from what they should be doing — providing care to their patients,” it said.

Patient advocates have long complained that their efforts to push legislators for meaningful change have been hamstrung by the politically potent doctors group, which has close ties to Gov. Gavin Newsom. A recent proposal to significantly increase medical license fees to beef up enforcement and another to shift the balance of the medical board from a physician majority to a public member majority were modified or cut from a pending Senate bill amid CMA lobbying.

Robert Fellmeth, executive director of the Center for Public Interest Law at the University of San Diego, which sponsored AB 1278, has called the CMA a “pernicious cartel” that consistently fights to starve the medical board of the funds it needs to investigate doctors.

Nazarian said the CMA opposition “was the main driving force” behind his decision to amend the bill so that it no longer requires doctors to tell their patients which companies, if any, are paying them. He said he chose to drop that provision because he feared trying to salvage it would doom the entire bill.

As it heads to a Senate Appropriations Committee hearing Aug. 16, the bill now only requires physicians to notify their patients of the existence of the Open Payments website and to post a notice about it in their offices.

Knecht said she is hopeful, but not optimistic, that the original provisions might be restored at the next step in the legislative process.

“The bad thing is the onus is still on the patient to find out about their doctors,” she said. “That’s kind of a tragedy.”

The post After her botched surgery, she pitched a medical disclosure bill. Doctors are fighting it appeared first on The Patient Safety League.

February 3, 2022

By Melody Gutierrez, Brittny Mejia, Jack Dolan

Tracy Dominguez has often thought about standing in the lobby of the Medical Board of California and shouting. Maybe then she would be heard, she said.

Since her pregnant 23-year-old daughter Demi died in 2019 while under the care of a Bakersfield doctor repeatedly reprimanded for negligence, according to state medical board records, Dominguez has fought to have her family’s heartbreak considered in disciplinary hearings by the Medical Board of California. Instead, she said state law reduced her daughter to being called “Patient 1″ in documentation given to the medical board members who discipline doctors. Her grandson Malakhi, delivered as Demi was dying, was described only as “a 4 lb 7 oz male infant” in the case against Dr. Arthur Park.

In December, the Medical Board allowed Park to avoid an administrative hearing and surrender his license with the ability to apply for reinstatement later. Park could not be reached for comment Thursday.

“This is a tragedy that no family should have to go through and then they make it so hard in the complaint process,” Dominguez said. “Our voices are not being heard.”

Senate Bill 920 by Sen. Melissa Hurtado (D-Sanger) would change that.

For nearly three decades, California law has forbidden the state’s medical board from considering victim statements in their decision-making. Instead, a person filing a complaint to the medical board can provide a statement to a deputy attorney general assigned to their case, but those words are not allowed to be shared with board members who ultimately determine what discipline, if any, is warranted.

“People feel they don’t have a voice in the disciplinary process and they want to be able to tell their side and be heard,” Hurtado said. “I don’t think they are expecting everything to change overnight, but it is something they desperately want.”

A doctor was charged with sexual assault. The Medical Board didn’t suspend his license

Medical board member Eserick “TJ” Watkins said the current process allows the board — composed of eight physicians and five public members — to ignore the harm patients say they faced. That’s a criticism shared by patient advocacy groups who have for decades accused the board of being too lenient on the doctors it regulates.

The Times’ own findings in July revealed the board had consistently allowed doctors accused of negligence to keep practicing and harming patients, at times leaving them dead, paralyzed, brain-damaged or missing limbs.

“Right now, doctors have way more rights. After a patient gives their initial statement, they might as well go away,” said Watkins, a vocal critic of the board he sits on as a public member. “We choose when to use the law. We settle nearly every case. There are very dangerous doctors walking the streets.”

Watkins said the board receives summaries of allegations from the state’s attorney general’s office in which much of the details of a patient’s allegations are removed. At the same time, Watkins said, the summaries provided to board members voting on a disciplinary action often rely heavily on the assessments of experts hired by a doctor who is being scrutinized.

“And then I get a page of the doctor’s accolades, where they went to school and such,” Watkins said. “The doctor is the only human in the conversation.”

With criticism of the Medical Board mounting, the agency sent legislative leaders an 11-page letter last month asking for reforms to help it discipline bad doctors, including lowering the evidentiary standard necessary for proving cases and increasing the wait time for physicians to petition to reinstate their revoked or surrendered licenses.

“These proposals were developed because we’re listening, we want to improve, these proposals will help us improve, and we need the Legislature’s help to improve,” Board President Kristina Lawson said in a recent interview, adding that she anticipates the agency will consider additional legislative proposals this month stemming from The Times’ reporting.

A Medical Board spokesman did not immediately respond to a request for comment on Hurtado’s bill, which is the second proposed reform of the agency to be introduced in the state Legislature so far this year.

Assemblywoman Akilah Weber (D-San Diego), who is an obstetrician, is author of Assembly Bill 1636 to require the Medical Board to permanently ban doctors convicted of sexually abusing patients.

That bill came after a Times investigation found that the board reinstated 10 physicians since 2013 who lost their licenses for sexual misconduct. In one case, Bakersfield internist Dr. Esmail Nadjmabadi sexually abused a woman and later reported her to immigration officials in an attempt to make her “unavailable” to investigators, Medical Board records said.

Five other female patients — including one in her mid-teens — told police and state regulators about similar sexual misconduct by Nadjmabadi. In 2009, he pleaded no contest to a criminal charge of sexual exploitation by a physician involving two or more women and the following year surrendered his medical license.

Five years later, he successfully petitioned the Medical Board to be reinstated, a surprise to the women whom he had been found to have abused.

“I read that article and my stomach turned. This is the sort of stuff you see in horror movies,” Weber said.

AB 1636 is backed by the California Medical Assn., the politically powerful doctors’ lobbying group that patient advocates have long accused of obstructing reform and shielding bad physicians from disciplinary action.

A spokeswoman for the doctor’s lobbying group declined to comment Thursday until the California Medical Assn. could review Hurtado’s bill to allow victims’ voices to be included in disciplinary proceedings.

“It will be interesting to see how it goes,” Hurtado said. “I don’t know why anyone would be against it.”

Patients who have been victimized by doctors said the bill is much needed.

Fabiana Ramirez Flores, who was sexually abused by Nadjmabadi, thanked Hurtado “on behalf of each victim,” for her interest in making changes.

Another woman, who asked The Times to identify her only by her initials, T.T., said the bill will help future victims, but that it comes too late for her. T.T. was a patient of Dr. Zachary Cosgrove when the two began dating. In 2006, he turned up drunk and shoeless at her door. After T.T. reported Cosgrove to the human resources department at the clinic where he worked, he showed up uninvited and demanded that she call the clinic back and say her complaint against him was untrue, according to Medical Board records.

When she refused, Cosgrove told T.T. — whom he knew was being treated for depression and an anxiety disorder — to kill herself because it would hurt less than what he was going to do to her, the board’s records show. Cosgrove lost his license, but was later reinstated without T.T. being able to weigh in.

Reached by phone Thursday, T.T. said she supported the proposed legislation.

“For future victims, this is going to help,” she said. “It’s a good thing. But for those of us already affected? What can we do?”

Marian Hollingsworth, co-founder of the advocacy group Patient Safety League, said she would be “thrilled” to see the law changed to require the board to consider victim statements.

It would give patients a voice, Hollingsworth said.

“You would get the chance to tell the doctor how they hurt you and your family, and to have that considered by the board, it’s a big thing,” she said.

The board’s failure to consider such statements while adjudicating cases “teaches the victims that they don’t matter, they don’t have a say, everything is about the doctor,” Hollingsworth said.

Brittny Mejia

Brittny Mejia is a Metro reporter who joined the Los Angeles Times in 2014. She writes narrative pieces with a strong emphasis on the Latino community and others that make up the diversity of L.A. and California. Mejia was a Pulitzer Prize finalist in 2021 in local reporting for her investigation with colleague Jack Dolan that exposed failures in Los Angeles County’s safety-net healthcare system.

The post Patients are barred from doctor disciplinary hearings in California. That could change appeared first on The Patient Safety League.

Jan. 25, 2022 5 AM PT

California’s system for getting bad doctors out of the profession is obviously not working.

If it were, we would not read that a Bakersfield doctor got his license back after pleading no contest to a criminal charge of sexual exploitation by a physician. Nor would a Victorville doctor who inappropriately touched two teenage patients during exams still be allowed to practice. Those examples were detailed in a Times investigation last month that found the Medical Board of California has since 2013 reinstated 10 physicians who lost their licenses for sexual misconduct.

A few months earlier, The Times reported that the medical board has consistently allowed doctors accused of negligence to keep practicing — leaving some patients dead, paralyzed, brain-damaged or missing limbs.

And a national ranking released last year by Public Citizen, a group that advocates for safe and affordable healthcare, shows that California does a poor job of seriously disciplining doctors, compared with most other states. It ranked California’s Medical Board 33rd in the nation, in large part because it gives many doctors a slap on the wrist instead of revoking their licenses in egregious cases.

Even the group that lobbies for doctors realizes that it’s time for a change. The California Medical Assn. — which has a track record of neutering proposals to reform how doctors are regulated — is putting its political muscle behind legislation to permanently ban doctors who are convicted of sexually abusing patients from practicing medicine in the state.

That’s one piece of the solution, and it deserves lawmakers’ support. But it should not be the only change legislators and Gov. Gavin Newsom make this year to ensure the safety of Californians seeking medical care.

They must also embrace more sweeping reforms that put patient safety at the center of how California regulates the medical profession. These should include giving non-doctors more say on the Medical Board of California, lowering the standard of evidence necessary to discipline doctors for misconduct and a robust examination of the fees doctors pay to determine if they are enough to effectively investigate complaints.

Consumer advocates are calling for such reforms, as is the Medical Board itself. The panel tasked with licensing and disciplining doctors is asking lawmakers to make these changes, arguing in a letter to legislative leaders that they’re necessary “to protect California consumers.”

So far, none of the board’s many proposals have been introduced in legislation this year.

The board has asked for similar changes in the past, but they’ve been scuttled or watered down. Last year, lawmakers defanged a bill reauthorizing the Medical Board by deleting a provision to add more non-doctors to the panel and reducing the increase in doctors’ licensing fees. The legislation requires reviewing the fee structure this year to determine if additional increases are necessary. That’s important, because the board needs sufficient funding to quickly investigate complaints.

But the Medical Board must not be the only source of potential solutions. An internal whistleblower has asked the state auditor to investigate the board’s inner workings. The auditor’s office does not disclose whether it launches an audit in response to a whistleblower, but we hope the auditor will take up this request and deliver results that can help inform the Legislature.

The doctors lobby is a major political force at the state Capitol. It gave $750,000 to the California Democratic Party last summer and routinely makes campaign donations to sitting lawmakers. The California Medical Assn. spent $200,000 last year to help elect Assembly member Akilah Weber (D-San Diego), an obstetrician/gynecologist who is carrying the bill to permanently revoke licenses from doctors who are convicted of sexual abuse in criminal court. It spent $765,000 on lobbying last year in Sacramento — more than Amazon, the pharmaceutical industry or the bankers association. Its chief executive and top lobbyist were among the guests atduring the first year of the pandemic. Spending power and personal connections have given the doctors group outsize influence.

Too often, California’s regulation of the medical profession comes down to a political negotiation between what the medical board wants and what the doctors lobby will tolerate, said Dr. Sidney Wolfe, founder and senior advisor of Public Citizen, who has studied medical boards across the nation.

“Something as important as this should not be resolved on political grounds. It should be resolved on the health and safety of the patients of California,” he said.

We agree. Lawmakers must remember as they do their jobs this year that a top priority should be patient safety.

The post Editorial: California must do more to get bad doctors out of the profession appeared first on The Patient Safety League.

By Jack Dolan, Brittny Mejia, Kim Christensen

Jan. 13, 2022 6:51 PM PT

Doctors who are convicted of sexually abusing patients would be permanently banned from practicing medicine in California under a bill introduced this week by state legislators.

The move comes a month after a Times investigation found that the Medical Board of California had reinstated 10 physicians since 2013 who lost their licenses for sexual misconduct. They included two doctors who abused teenage girls and one who beat two female patients when they reported him for sexually exploiting them.

“I read that article and my stomach turned. This is the sort of stuff you see in horror movies,” said the bill’s lead author, Assemblywoman Akilah Weber (D-San Diego), who is an obstetrician/gynecologist. “I was shocked. I was very concerned for patients and very concerned for the medical profession itself.”

The measure would be a major overhaul of current practice, which patients and healthcare advocates contend favors leniency for doctors and provides victims of sexual misconduct no voice in the disciplinary process.

The change would take the decision to reinstate such doctors out of the hands of the Medical Board and “make it very clear that this is something we will not tolerate in California,” Weber said.

Under the bill, any doctor who is criminally convicted for sexual misconduct with patients — as were several in The Times’ investigation — would lose their license and be prohibited from applying for reinstatement.

The bill faces little known opposition and is backed by the California Medical Assn., the politically powerful doctors’ lobbying group that patient advocates have long accused of obstructing reform and shielding bad physicians from disciplinary action.

In a statement Thursday, the CMA said the bill would ensure that “physicians who commit this egregious conduct are appropriately disciplined” and would protect “the integrity of the medical profession.”

Also on Thursday, Medical Board president Kristina Lawson said “we welcome and we’re grateful for the introduction of this bill,” adding that “the patient-doctor relationship is one that’s based on trust. Any doctor who breaches that trust through sexual misconduct or otherwise should not be able to continue practicing medicine in California.”

Assemblyman Al Muratsuchi (D-Rolling Hills Estates), a co-author, is a former prosecutor for the state attorney general’s office who worked on cases involving doctors accused of sexual misconduct. He condemned the “glaring loophole” in current state law that allows for reinstatement.

“There really is no excuse,” Muratsuchi said. “This bill is a long overdue, common sense proposal to protect patients from sexual misconduct.”

Currently, when a physician is charged with sexual misconduct, the medical board usually waits to act until the criminal case is resolved. Board lawyers have argued that attempting to revoke a doctor’s license while the case is still pending is difficult and could ultimately interfere with the prosecution.

If the doctor is found guilty, the board usually then revokes the license or allows the doctor to surrender it.

But even in those cases, under current law, the doctor is eligible to apply for reinstatement three years later.

The board has wide latitude when considering those applications, even in cases of severe misconduct such as physically assaulting patients, sexually abusing minors or lying to police.

The board reinstated Bakersfield internist Esmail Nadjmabadi in 2015, six years after he pleaded no contest to a criminal charge of sexually exploiting patients. Six women — including one in her mid-teens — had told authorities about their abuse at his hands.

He abused Fabiana Ramirez Flores on the pretext of screening her for colon cancer. She was an undocumented immigrant and, when she spoke up about the abuse, Nadjmabadi reported her to immigration officials in a bid to make her “unavailable” to investigators, according to Medical Board records.

He also persuaded a female staff member to lie to police about being in the room during one of the assaults, according to an accusation filed by the Medical Board.

“I don’t know how they can return a license to someone like that,” Ramirez said after learning of Nadjmabadi’s reinstatement from a Times reporter. “He was taking advantage of vulnerable women.”

Nadjmabadi declined to answer specific questions about the case, saying, “That’s ancient history; it’s over. I’ve moved on with my life. Life is good.”

The board also reinstated Dr. Zachary Cosgrove, 57, a Bakersfield family practitioner who had sex with three female patients, then turned violent when they reported him to authorities, according to the Medical Board accusation. He kicked and punched one, threw furniture at another and told the third, “You’d better just kill yourself. … That’s going to hurt less than what I’m going to do to you,” the accusation states. Cosgrove admitted to the allegations as part of his petition to be reinstated.

“He knew that I was vulnerable,” the woman, who asked to be identified only by her initials T.T., told a Times reporter in a recent interview. “He knew that I was depressed, and I was taking antidepressants, and he said for me to kill myself,” she recalled. “Who does that?”

Cosgrove surrendered his license in 2008 and the board turned down his initial request for reinstatement three years later. But they reinstated him in 2016 after he explained that his behavior had been driven by an addiction to methamphetamines that made him “hypersexual.”

In a brief interview, Cosgrove said he “absolutely” deserved to get his license back. “I went through a lot of rehabilitation,” he told a reporter. “I think second chances are a good thing.”

Nothing in current state law required the Medical Board to approve the applications for reinstatement from Nadjmabadi, Cosgrove and others.

In fact, administrative law judges who weighed the evidence in Cosgrove’s applications advised the board not to reinstate him. But the board, a majority of whose members are doctors, voted to overrule the judge the second time around.

Lawson has argued the board’s hands are tied in some cases by bad law and complicated regulations.

The bill comes on the heels of the board asking lawmakers last week for more modest reforms to help it discipline bad doctors, including lowering the standard of proof necessary to prove cases.

In an 11-page letter sent to Legislative leaders, board officials also called for increasing the waiting time for physicians to petition to reinstate their revoked licenses. They also asked that doctors’ licensing fees be increased, the board’s primary source of revenue.

Patients, consumer advocates and some legislators have long contended that the board too often sides with doctors in disciplinary cases and fails in its primary mission to protect the public.

“I think it’s a good start,” said state Sen. Melissa Hurtado (D-Sanger), another co-author of the bill. But it does nothing to address the problem of doctors who are so bad at their jobs that they repeatedly harm patients, with no effect on their licenses.

In July, The Times found that the board had consistently allowed doctors accused of negligence to keep practicing and harming patients, at times leaving them dead, paralyzed, brain-damaged or missing limbs.

“At what point does it become unsafe for doctors to continue practicing, that’s what I’m most concerned about,” Hurtado said.

Brittny Mejia

Brittny Mejia is a Metro reporter who joined the Los Angeles Times in 2014. She writes narrative pieces with a strong emphasis on the Latino community and others that make up the diversity of L.A. and California. Mejia was a Pulitzer Prize finalist in 2021 in local reporting for her investigation with colleague Jack Dolan that exposed failures in Los Angeles County’s safety-net healthcare system.

The post LAWMAKERS MOVE TO TIGHTEN RESTRICTIONS ON DOCTORS appeared first on The Patient Safety League.

January 8, 2022

(Associated Press)By Melody Gutierrez, Brittny Mejia, Jack Dolan, Kim Christensen

Jan. 7, 2022 6:51 PM PT

Long under fire from patients and consumer advocates, the Medical Board of California is asking lawmakers to pass several far-reaching reforms to help it discipline bad doctors, including lowering the standard of proof necessary to prove cases.

In an 11-page letter and memo sent to Legislative leaders this week, board officials also asked them to increase the waiting time for doctors to petition to reinstate their revoked licenses. The board also seeks a hike in licensing fees on doctors, its primary source of revenue.

“We hear from people every day about the impact that the board has on their lives,” President Kristina Lawson said in an interview Friday. “These proposals were developed because we’re listening, we want to improve, these proposals will help us improve, and we need the Legislature’s help to improve.”

Lawmakers said they welcomed the recommendations and would review them as they begin to introduce bills during the legislative session that began Monday.

Previous efforts to pass major reforms have been stymied by the California Medical Assn., the powerful doctors lobby, which worked to kill earlier licensing-fee increases and measures to beef up the board’s disciplinary powers. On Friday, without committing to specific proposals, association president Dr. Robert E. Wailes pledged to support reforms that protect the public.

“To protect patients and the sanctity of the physician-patient relationship, the Medical Board of California must have a strong and robust licensing and disciplinary process,” Wailes said. “We look forward to working with the board and the Legislature to make appropriate and necessary reforms that put the safety of patients first.”

That was welcome news to lawmakers who have pushed back against the doctors lobby.

“If the California Medical Assn. is ready to sit down and work toward comprehensive reform, I’m ready to do so, and I am ready to do so now,” said state Sen. Richard Roth (D-Riverside), chairman of the Business, Professions and Economic Development Committee, which oversees licensing boards. “But we can’t address these on a piecemeal basis, and that’s what has been forced on us in the past.”

Patients, consumer advocates and some legislators have long contended that the board goes easy on bad doctors and fails in its primary mission to protect the public.

A Times investigation last month found that since 2013, the board has reinstated 10 physicians who had lost their licenses for sexual misconduct. They included two doctors who abused teenage girls and one who beat two female patients when they reported him for sexually exploiting them.

In July, The Times found that the board had consistently allowed doctors accused of negligence to keep practicing and harming patients, at times leaving them dead, paralyzed, brain-damaged or missing limbs.

In previous interviews, Lawson has defended the panel as “dedicated and committed to protecting California consumers” while acknowledging that it has “room for improvement.” She said the board is bound by rules and regulations that complicate efforts to put bad doctors out of business.

The board’s recommendations include changing evidentiary standards to make it quicker, easier and less expensive to discipline doctors, according to the memo by Executive Director Bill Prasifka outlining the panel’s legislative requests for 2022.

Under current law, the board must show “clear and convincing proof to a reasonable certainty” that disciplinary actions such as public reprimands, probation, suspension or revocation are warranted.

That is a lower burden of proof than the “beyond a reasonable doubt” standard in criminal prosecutions. But it is a higher bar than the “preponderance of evidence” in civil litigation, which requires a greater than 50% probability that a claim is true.

Medical boards in 41 other states and U.S. territories apply the preponderance standard, according to the memo.

“As a result, California is out of step with most other jurisdictions, making it more difficult, time consuming, and expensive to prosecute instances of unprofessional conduct in this state,” it stated.

Lawson said the board “really spent some time thinking about whether it makes sense that we’re required to meet a higher burden of proof in California” than similar panels elsewhere.

“The board as a group concluded that we wanted to raise this as an issue, and we wanted to pursue parity with other boards across the country,” she said in the interview.

The board’s recommendations also would extend the waiting period for doctors to petition for the return of revoked licenses from the current three years to five — a move Lawson signaled in an earlier interview with The Times after it reported on questionable reinstatements.

“So while that isn’t an outright prohibition on reinstatement, it is an additional limitation on their right to petition,” she said in the earlier interview.

The board also has requested a new application fee from doctors seeking reinstatement, to cover the costs of the proceedings. In the last fiscal year, the board spent nearly $1 million on litigation and hearing expenses, with no mechanism to recover those costs, the memo said.

The board’s recommendations also would enhance reporting of physician misconduct. In addition to currently mandated reporting by healthcare facilities and educational institutions, the board is calling for medical groups, health insurance providers, temporary staffing agencies and others to report misconduct.

The board’s memo resurrected earlier requests to increase its funding and change its makeup of eight physician members and seven non-doctors known as “public members.” Reformers for years have demanded significant increases to medical license fees and a shift in the balance of the board to a majority of public members, in the hope of getting more patient-friendly decisions in disciplinary cases.
Such measures in the past have been quashed amid vehement opposition by the deep-pocketed doctors lobby.

Longstanding critics of the board greeted the new recommendations with both skepticism and cautious optimism.

“The Medical Board making these recommendations is one thing,” said former state Sen. Jerry Hill (D-San Mateo). “The Medical Board pursuing and advocating for these changes is another.”

During his time in the Legislature, Hill fought for three years to pass legislation requiring doctors who have been placed on probation for sexual misconduct and other violations to notify patients. Hill said the Medical Board was often as much of a hindrance as the physicians lobby.

“In many cases, we found the Medical Board was singing the same tune as the California Medical Assn.,” Hill said. “So, if the Medical Board is taking a strong position and communicating that clearly, that would be helpful.”

State Sen. Melissa Hurtado (D-Sanger) said she was surprised to receive the board’s legislative requests, which came as she plans to introduce her own reformbill in the coming weeks. Hurtado said the board’s recommendations show that the agency needs to be overhauled to meet its basic mission: ensuring patient safety.

“This is a great first step by the Medical Board, but there is so much work that needs to be done,” Hurtado said. “I appreciate their input, but I have my own, too. We have so many cases that have come out of the city of Bakersfield, which I represent, and this is something that is personal to me.”

Marian Hollingsworth, co-founder of the advocacy group Patient Safety League, said she was “kind of stunned” by the board’s recommendations. In the past, she said, board officials have told advocates it was up to them to ask for legislative reforms.

“I don’t know if it’s desperation or panic or realization that because of the L.A. Times articles, that they’re in a very bad place PR-wise,” she said. “Their reputation is really on the line.”

Hollingsworth said she is encouraged by the requested change to the evidentiary standard and hopes it could lead to “better patient protection.” She is not completely sold.

“I’ve learned not to get too excited, because I know that things can change,” she said. “It’ll be interesting to see what happens. I don’t think a lot of the legislators really know what goes on with the Medical Board that they are supposed to regulate.”

Brittny Mejia

Brittny Mejia is a Metro reporter who joined the Los Angeles Times in 2014. She writes narrative pieces with a strong emphasis on the Latino community and others that make up the diversity of L.A. and California. Mejia was a Pulitzer Prize finalist in 2021 in local reporting for her investigation with colleague Jack Dolan that exposed failures in Los Angeles County’s safety-net healthcare system.

The post State Medical Board seeks far-reaching reforms to discipline bad doctors appeared first on The Patient Safety League.

BY KIM CHRISTENSEN, JACK DOLAN, BRITTNY MEJIADEC. 30, 2021 5 AM PT

Two weeks before Christmas in 2019, an emergency room nurse at Cedars-Sinai Medical Center in Los Angeles joined one of her colleagues, Dr. Anshul Gandhi, for a drink after work.

She took the invitation as a friendly gesture and thought that “building bridges between doctors and nurses was good for morale,” according to a civil lawsuit she later filed against him.

But instead of sharing a little holiday cheer, Gandhi drugged her at a bar, followed her home and sexually assaulted her, the lawsuit alleges.

Three other women from Cedars came forward with similar allegations about the emergency room physician, eventually leading prosecutors to charge him with felony sexual battery of four women, according to court documents. Some of the original criminal charges against Gandhi have been dismissed or reduced. He now faces two felony counts of sexual battery. He has pleaded not guilty.ADVERTISING

After Gandhi, 35, was charged, lawyers for the Medical Board of California, which regulates doctors, called him an “extreme danger to the public” and could have moved to suspend his license. Instead, they convinced the judge to prohibit Gandhi from practicing as a condition of his bail. The board’s procedures to quickly suspend a medical license in such circumstances are too complex and expensive, they argued in one court filing.

But what at first seemed like a winning tactic for the Medical Board now appears to have unraveled after another judge recently agreed with Gandhi’s attorneys that it is the board’s job, not the court’s, to determine if doctors are qualified to see patients.

In November, the court lifted its restrictions and Gandhi became eligible to practice as he awaits trial. Any reference to the court order and criminal case stemming from the alleged sexual abuse has been scrubbed from his profile on the board’s website. His attorney said he is not currently seeing patients but is looking for work.

Gandhi’s case is the latest to raise serious questions about the panel’s ability to bar a doctor it determines is dangerous from seeing patients and highlights significant gaps in its oversight.

“The scary part is that there’s nothing on the Medical Board’s website about this doctor,” said Marian Hollingsworth, co-founder of the Patient Safety League, an advocacy group. “If the information isn’t there, [the board is] failing in their job to protect patients. That’s what bothers me.”

A Cedars-Sinai spokesperson declined to comment on pending litigation, but said Gandhi had previously provided services at the hospital as a contract physician and resigned in January 2020.

The Medical Board declined to comment on Gandhi’s case, as it does in all pending disciplinary actions, noting that complaints and investigations are confidential by law. A spokesperson for the board said it was required by law to remove references to the initial court order restricting his practice once the second judge lifted it.

Board officials could not point to anything in state law that prohibits them from informing patients of pending criminal charges against doctors. But Carlos Villatoro, another spokesperson for the board, maintained it can’t post such information unless it is mandated to do so, which would require changes to the Business and Professions Code.

The board has long battled allegations by patients, consumer advocates and others that it goes easy on bad doctors and fails to protect patients.

A Times investigation earlier this month found that since 2013 the board reinstated 10 physicians who had lost their licenses for sexual misconduct. They included two doctors who abused teenage girls and one who beat two female patients when they reported him for sexually exploiting them.

In July, The Times found the board had consistently allowed doctors accused of negligence to keep practicing and harming patients, leaving them dead, paralyzed, brain-damaged and missing limbs.

In previous interviews, board President Kristina Lawson has defended the panel as “dedicated and committed to protecting California consumers,” while acknowledging that it has “room for improvement.” But she also said the board is bound by rules and regulations that complicate putting bad doctors out of business.

“We have to operate within the confines of the law,” she said.

The emergency room nurse who sued Gandhi, identified in the lawsuit as Jane Doe, also filed a complaint with the Medical Board and reported the incident to Los Angeles police. Besides the sexual assault, the lawsuit also alleges Gandhi took a nude photo of her while she was passed out and posted it on social media. He has denied her allegations and the charge related to her has been dismissed from the criminal case. Her civil lawsuit is pending.

One of Gandhi’s subsequent accusers, another ER nurse, became acquainted with him on a hike and later accepted his invitation to have drinks at a bar and then go to his house to watch a movie in July 2018, according to a board investigator’s declaration in court records. She alleges Gandhi “slipped something into the drink” there and when she awoke he was on top of her, masturbating.

Another hospital employee told a Medical Board investigator that she was at a 2016 holiday party that Gandhi also attended. At some point she passed out and woke up at Gandhi’s home, pinned beneath him as he masturbated, according to thedeclaration submitted as part of bail proceedings.

Yet another co-worker alleged that he “jumped on top of her” and masturbated after they returned to his home to watch television following a “happy hour function after work” and drinks at a bar in 2016, the declaration states.

Reached by phone, Gandhi referred questions to his criminal defense attorney, Michael Kraut, who declined to comment.

Michael Khouri, Gandhi’s lawyer in the civil suit and Medical Board matters, said he could not comment on the specifics of the criminal case. But he said all of Gandhi’s sexual encounters were consensual, referring to his accusers as “so-called victims.”

“Of course, we contend they are not victims,” Khouri said. “Our contention is that he has no liability to the plaintiff in the civil case. I can say that we believe he is innocent of the charges in the criminal case.”

Khouri said that Gandhi’s accusers are lying, motivated by “money and the scorn of rejection” and that their claims of being drugged are “fantasy.”

Gandhi’s accusers in the criminal case are not identified by name.

Christopher Grivakes, the attorney for Jane Doe in the pending civil suit, called Khouri’s characterization of the women “offensive” and said his client is “a very credible witness.”

“It is horrible what happened to her,” he said. “The reason we have a jury system is for people to find out who is telling the truth. I am confident that when we get to a jury, Jane Doe will be believed.”

The Times has confirmed Jane Doe’s identity but does not routinely name alleged victims of sexual abuse.

Khouri said Gandhi has not resumed practice “but is able to, obviously, and is in the process of looking for a suitable position.”

After Gandhi was charged, lawyers for the Medical Board acknowledged in court papers it could have sought to prevent him from practicing through an interim suspension order or a temporary restraining order. But they argued that the court could move more quickly and efficiently.

“The public would be in immediate danger” if the judge did not act, the board’s lawyers wrote in August 2020 for the bail proceeding. The judge agreed and in September 2020 ordered Gandhi to stop practicing pending the outcome of the criminal case.

In its court filings, the board explained it was not privy to all the evidence it would need to prove an administrative disciplinary charge, and that to do so would require the state to “expend scarce public resources in two different forums” to achieve the same result of keeping Gandhi from treating patients.

Under current state regulations, if the board files an interim suspension order against a doctor who is charged criminally, it must offer the physician a timely hearing, which would almost certainly happen before the trial.

Some doctors simply accept the suspension to avoid testifying and the possibility of getting caught in a lie or otherwise incriminating themselves. But if the doctor insisted on a hearing, the board would need to present substantially the same evidence, and witnesses, involved in the criminal case.

And if it failed to prove the merits of a disciplinary action to an administrative law judge, that could jeopardize the criminal case because defense attorneys could argue that the issue had already been litigated, board lawyers said in court records.

Matthew Magner, a former Kern County deputy district attorney who prosecuted doctors, said the Medical Board appears to be “hamstrung by their own policies and procedures.”

Most prosecutors would welcome the chance to watch the doctor testify at a board hearing, Magner said, but they would be reluctant to allow their own witnesses to give statements. So most would prefer the judge to simply forbid the doctor from practicing as a condition of bail.

Securing the court-ordered restrictions achieved the board’s goal of putting Gandhi out of business and prompted the Texas Medical Board to suspend his license there.

That kept Gandhi from practicing for a little more than a year, until last month, when his lawyers convinced a different judge on the case to lift the previous order.

Gandhi’s lawyers contended that he was not a danger to the public and did not have access to controlled substances as an emergency room doctor. They also said that the Medical Board’s view “sensationalizes the facts of the case,” and that the accusations are not related to his practice of medicine.

“Accordingly, this case is not about Dr. Gandhi’s conduct as a physician but about alleged encounters that occurred outside the hospital setting,” they said in court papers.

Los Angeles County Superior Court Judge Deborah Brazil granted the defense motion to lift his medical restrictions on Nov. 19, court records show, and did not impose other conditions requested by the Medical Board and prosecutors, including that Gandhi have a chaperone when treating patients.

The state attorney general’s office, which represents the Medical Board in court, declined to comment.

It’s not unheard of for doctors’ licenses to remain valid even after they’ve been charged with serious crimes.

San Diego spinal surgeon Lokesh Tantuwaya’s license remained active for years after he was indicted in 2018 for allegedly accepting millions in bribes to perform surgeries at a hospital whose owner illegally overbilled insurers for the hardware inserted into patients’ backs. Several of Tantuwaya’s patients sued him for malpractice, including a woman who alleged her routine back surgery was botched so badly her leg had to be amputated.

Despite the federal indictment — and Tantuwaya’s long history of being put on probation by the Medical Board for previous cases, including domestic violence, gross negligence, and dishonesty — his license remained valid until a few months ago when he failed to pay the renewal fee.

He pleaded not guilty to the federal charges and is currently in jail awaiting trial.

In Gandhi’s case, nothing in the public record indicates that the Medical Board has taken further action since the restrictions were lifted.

A previous notice of the court order restricting his practice has disappeared from the board’s online license lookup, a valuable tool for patients seeking to vet doctors.

In emailed responses to The Times, a spokesperson for the board said state law mandates that a suspension order “must be deleted from the [doctor’s] profile if the restriction is lifted or if an administrative decision becomes effective” — even if that means leaving patients in the dark about pending criminal charges.

“For the Board to leave the suspension order on the website indefinitely, the Legislature would need to change the law mentioned above,” spokesperson Emmalee Ross said in the email.

The board also renewed Gandhi’s license for another two years on Nov. 12 through its online portal. He met all requirements and the board “does not have the authority to deny licensure based on unproven criminal or administrative court charges,” Ross said.

But she noted that the court’s restrictions were still in place at the time.

“At the point that Dr. Gandhi renewed, he was still subject to the court-ordered restriction and was not allowed to practice medicine in California,” she said.

Times staff writer Melody Gutierrez contributed to this report.

The post A doctor was charged with sexual assault. The Medical Board didn’t suspend his license appeared first on The Patient Safety League.

By Kim Christensen, Brittny Mejia, Jack DolanDec. 16, 2021 11:55 AM PT

Legislators, regulators and one of California’s most powerful healthcare lobbies are calling for drastic reforms in response to revelations that the state Medical Board gave licenses back to doctors who sexually abused patients.

The push for change at the Medical Board of California, which oversees the discipline of doctors in the state, followed a Los Angeles Times investigation that found since 2013 the panel reinstated 10 physicians who had lost their licenses for sexual misconduct. They included two doctors who abused teenaged girls and one who beat two female patients when they reported him for sexually exploiting them.

One of the doctors, a Bakersfield internist, reported his primary accuser — an undocumented immigrant from Mexico — to immigration officials in a bid to prevent her from testifying against him, according to the board’s records.

“That’s evil, pure evil,” said state Sen. Melissa Hurtado (D-Sanger), whose district includes Bakersfield. She noted that her own parents immigrated from Mexico. “The board is severely broken; it’s absolutely insane that you have someone who has committed these horrible acts on individuals and there’s no justice,” Hurtado said.

“We should abolish the board and start over,” she said. “I think it’s reasonable and people would be so happy with it.”

Robert E. Wailes, president of the powerful California Medical Assn., which patient advocates have long accused of obstructing reform and shielding bad doctors from disciplinary action, called the cases detailed in The Times’ report “abhorrent and intolerable.”

The physicians’ behavior should disqualify them for life, Wailes said.

The Times investigation detailed the cases of several doctors who were convicted of crimes stemming from their sexual misconduct.

“Each instance is a flagrant abandonment of what it means to be a doctor and constitutes heinous criminal behavior that should result in the permanent revocation of a license to practice medicine,” Wailes said. “Any physician who violates a patient’s trust and the sanctity of the physician-patient relationship in this way has no place in the medical profession.”

In sharp contrast to its earlier opposition to some disciplinary measures, Wailes pledged that the association, which lobbies for physicians, “will champion the necessary reforms to ensure California patients are protected from criminal sexual misconduct” by doctors.

Gov. Gavin Newsom, who appointed half of the board’s current members and is ultimately responsible for their performance, declined to comment for this story.

Erin Mellon, a spokeswoman for the governor, wrote via email: “Any claims of sexual assault, especially against minors, should be taken seriously.” She called on lawmakers to “hold people accountable” but did not specify how they should do that.

She also said the governor expects board members to “use their full authority” to hold doctors accountable but did not say whether he thinks they have done so in the cases cited by The Times.

Meanwhile, the doctors who admitted to having had sexual misconduct with teenagers — Esmail Nadjmabadi in Bakersfield and Hari M. Reddy of Victorville — have current licenses and have resumed practicing. Both have declined to answer specific questions about their cases, with Nadjamabadi saying, “That’s ancient history; it’s over. I’ve moved on with my life.”

Also back practicing is Zachary Cosgrove, a Bakersfield family practitioner who had sex with three female patients, then turned violent when they reported him to authorities, according to Medical Board records. He kicked and punched one, threw furniture at another and told the third, “You’d better just kill yourself. … That’s going to hurt less than what I’m going to do to you,” according to the records.

Like the others, Cosgrove went to therapy and admitted to the allegations against him before successfully petitioning for reinstatement of his license. Cosgrove could not be reached for comment for this story. He previously told The Times he went through a lot of rehabilitation and “absolutely” deserved to get his license back.

Any sexual contact with patients violates a physician’s code of ethics as laid out by the American Medical Assn. and violates California law.

But a Times review of all petitions for reinstatement since 2013 found that doctors whose licenses were revoked or surrendered due to sexual misconduct succeeded in getting them back more than half of the time.

That’s a significantly higher rate than for doctors who lost their licenses for all other reasons, including fraud, drug abuse and gross negligence, according to the review.

In a recent interview, Board President Kristina Lawson said she was “unable to verify” The Times’ findings and refused to discuss the details of individual cases or explain why the board granted specific reinstatements, citing privacy laws.

She conceded that the board has “room for improvement.” She said it is bound by state regulations that prevent it from deeming some offenses — such as sexual misconduct with a minor — as reasons for permanent disqualification.

Lawson said she has directed the staff to look into notifying victims before reinstating doctors’ licenses and providing a venue for victims to be heard during the reinstatement process.

Former state Sen. Jerry Hill (D-San Mateo) said The Times’ findings were gut-wrenching – and indicative of deep flaws in the Medical Board’s oversight of doctors. Hill spent three years trying to pass legislation requiring doctors on probation for certain violations, including sexual misconduct, to notify patients of their status.

Hill, whose Patient’s Right to Know Act became law in 2019, has long contended the Medical Board protects doctors at the expense of patient safety, in large part because of pressure from the physicians’ lobby.

“It’s just incredible. It’s just shocking,” Hill said of The Times’ report. “As I see it, the medical board clearly has failed the people of California in so many ways. They should be replaced by people who represent the people of California, not the California Medical Assn. and the bad doctors of California.”

Hill said he was especially troubled by The Times’ finding that the Medical Board reinstates a larger percentage of doctors whose licenses are revoked for sexual misconduct than for other violations.

“What I see is that a value has been established by the medical board that it’s OK, or less significant, to sexually abuse someone and scar them for life than perhaps to scar them by a knife in a faulty surgery,” he said. “It’s outrageous.”

Hill also said that the board’s three-year waiting period for doctors to apply for reinstatement after their licenses have been revoked is not long enough for those who have sexually abused patients.

“That is way shorter than it should be under any circumstances,” he said.

Most the board’s 15 members — eight are doctors — have been reluctant to speak publicly.

Eserick “TJ” Watkins, who was appointed two years ago by the Senate Rules Committee, is the exception. He has become a hero to patients rights advocates.

In an interview Wednesday, Watkins said he will focus his efforts in the coming year on ensuring patients who were harmed by their physicians have a voice in the disciplinary process.

None of the victims of the doctors who committed sexual misconduct were invited to speak at the reinstatement hearings. Those interviewed by The Times didn’t know their abusers had gotten their licenses back until Times reporters told them.

The victims are the “obvious voice missing in the room when we deliberate in private,” Watkins said, adding that “they are nobody” in the eyes of some fellow board members.

He called the reinstatements “sickening” and questioned whether his colleagues would have voted the same way if the women had been called to testify, if they had been sitting there in the room.

“We’re not protecting the public at all,” Watkins said. “If you can’t stand up in the face of sexual misconduct, then when are you going to stand up?”

Brittny Mejia

Brittny Mejia is a Metro reporter who joined the Los Angeles Times in 2014. She writes narrative pieces with a strong emphasis on the Latino community and others that make up the diversity of L.A. and California. Mejia was a Pulitzer Prize finalist in 2021 in local reporting for her investigation with colleague Jack Dolan that exposed failures in Los Angeles County’s safety-net healthcare system.

The post Times’ sex abuse investigation triggers calls for reform of state Medical Board appeared first on The Patient Safety League.