Doctors Name: Marlen Luna
License Number: 117215
License Status:
Current - (Dues Paid)
Accusation Filed
City of Record: Los Angeles
Region: Los Angeles
License issued on: 06/08/2011
Licensing Boards: Medical
Specialties :
General/Family Practice
Gender: Female
Accusations and Infractions or Causes for Discipline:
Failure To Maintain Adequate Records
Repeated Negligent Acts
Date of Last MBC Action: 01/25/2019
Repeat Offender:
No
Ongoing Discipline:
No
Out of State Discipline:
No
No Medical Board Activity:
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Medical Board Documents, News Articles, Court Documents, Etc.
| Accusation 1/03/2018 | |
| +Decision 1/25/2019 | |
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Additional Information (Medical School, Dated Actions, Excerpts from Disciplinary Actions, Notes) AMERICAN UNIVERSITY OF THE CARIBBEAN SCHOOL OF MEDICINE#ETHN
- 1/25/2019—PUBLIC REPRIMAND.
- 1/03/2018—ACCUSATION FILED.
Excerpt from Accusation dated 1/03/2018:
FIRST CAUSE FOR DISCIPLINE
(Repeated Negligent Acts)
7. Respondent is subject to disciplinary action under Code section 2234, subdivision (c), in that she committed repeated negligent acts in her care and treatment of Patient A. The circumstances are as follows.
8. Patient A was a 27-year-old-female and a member of Southern California Permanente Medical Group (Kaiser). She presented to Dr. A.B. on March 29, 2014, complaining of nausea, vomiting and yellowing of her eyes for the past 2 -7 days. Dr. A.B. assessed Patient A for hepatitis and ordered laboratory studies, including an Alanine Aminotransferase (ALT), Total Bilirubin4 and viral hepatitis panel. He did not document a scleral exam, however.
9. On March 31, 2014, Respondent reviewed the result of Patient A's laboratory tests and noted that several tests results were elevated. Specifically, ALT was 1400 (normal <54), Total Bilirubin was 10.2 (normal <1.0), Direct Bilbirubin [sic] was 5.7 (normal <0.2-1.2), and the hepatitis test were all non-reactive, which is normal. Respondent had her nurse call Patient A to advise her to go to the emergency department if she developed any pain, fever or chills. Her differential diagnosis on that date included: sepsis, gall bladder issues, or liver issues. Respondent ordered an abdominal ultrasound for Patient A to be done that day.
10. Patient A presented to Respondent in her clinic on April 1, 2014. Respondent noted that the patient's sclera were icteric and she had dark urine since March 27, 2014. Repeat laboratory studies remained elevated: ALT (now 1386), Alkaline Phosphatase now 164 (normal <125), Total Bilirubin (now 17.8), Direct Bilirubin (now 9.4), and Aspartate Aminotransferase (AST) now 1326 (normal <30). The results of the abdominal ultrasound were of a non-specific coarsened liver. Respondent noted that Patient A had no pain and no symptoms of sepsis. Respondent's plan was to continue the sepsis work-up and arrange a specialty referral pending the results. She advised the patient to return "as but, if her symptoms did not improve or worsened, she should return to the office. Respondent failed to advise Patient A that she should seek care at the emergency department, or note that she had done so.
11. Patient A returned to see Respondent on April 3, 2014. Respondent noted that Patient A had worsening jaundice, with worsening Total Bilirubin/Direct Bilirubin. The patient had a referral to the Liver Specialist scheduled for April 7, 2014. Laboratory tests were to be redrawn. Respondent noted that she expected the results to be elevated as the patient was more fatigued and nauseous and had a new complaint of right upper quadrant abdominal pain. She explained the etiologies to the patient and suggested she might need a liver transplant. It is noted that Patient A was receptive to the information. The laboratory results were elevated: ALT was 1186, Alkaline Phosphatase was 193, Total Bilirubin was 20.8, and AST was 1144. Art EKG was performed and was abnormal, suggestive of anterior ischemia. A transthoracic echocardiogram and cardiology referral were made. In her letter to the Board, Respondent states that she directed Patient A to go directly to the emergency department as her liver was dying. This directive is not noted in the patient's medical record and Patient A did not proceed directly to the emergency department.
12. On April 7, 2014, Dr. J.T. referred Patient A to the emergency department at Kaiser. He noted that the patient had significant hepatitis. He arranged for numerous tests and alerted the emergency department about her case. Ultimately, Patient A was admitted to the intensive care unit. She was transferred to UCLA Medical Center for a liver transplant on April 8, 2014. Patient A died on April 12, 2014.
Standard of Care
13. The standard of care when evaluating acute hepatitis includes evaluation of organ function to include AST, ALT, Alkaline Phosphatase, gamma-glutamyl transpeptidase, Total and Direct Bilirubin, albumin and INR levels. Etiology of hepatitis should be investigated and using viral hepatitis panel and liver ultrasound. A physical examination ofthe skin, abdomen and neurologic system should be completed.
14. The standard of care in sepsis evaluation and treatment is early goal directed therapy within six of recognition. This requires immediate admission to an acute care setting, such as an emergency department or intensive care unit. A serum lactate level should also be obtained.
15. Respondent's treatment of Patient A as set forth above includes the following acts and/or omissions which constitute departures from the standard of practice:
A. The failure to order an INR level, which may have demonstrated a coagulopathy, further quantifying the extent of liver injury;
B. The failure to appreciate the urgency of Patient A's compromising situation and arrange for an emergency GI evaluation;
C. The failure to recognize the signs and symptoms of sepsis; and
D. The failure to admit the patient for immediate treatment.
16. Respondent's acts and/or omissions as set forth in paragraphs 7 through 14, above, whether proven jointly, or in any combination thereof, constitute repeated negligent acts pursuant to section 2234, subdivision (c), of the Code. Therefore, cause for discipline exists.
SECOND CAUSE FOR DISCIPLINE
(Failure to Maintain Adequate and Accurate Records)
17. By reason of the matters alleged in paragraphs 7 through 11, inclusive, above, Respondent is subject to disciplinary action under section 2266 of the Code in that she failed to properly maintain adequate and accurate medical records documenting her care of Patient A.
Excerpt from Decision dated 1/25/2019:
DISCIPLINARY ORDER
IT IS HEREBY ORDERED that Physician's and Surgeon's Certificate No. A 117215 issued to Respondent Marlen Luna, M.D. is publicly reprimanded pursuant to Business and Professions Code section 2227. This public reprimand is issued in connection with Respondent's actions as set forth in Accusation No 800-2016-021838.
#PATIENTDEATH
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