Doctors Name: Austin Merritt Kooba
License Number: 71262
License Status:
Revoked
City of Record: Santa Rosa
Region: Northern
License issued on: 04/07/2000
Licensing Boards: Medical
Specialties :
OBGYN
Gender: Male
Accusations and Infractions or Causes for Discipline:
Unprofessional Conduct
Gross Negligence
Incompetence
Sexual Misconduct
Date of Last MBC Action: 12/07/2016
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 12/07/2016 | |
| +Decision 1/09/2018 | |
| Article: Medical Board of California revokes license of Healdsburg OB/GYN for sexuxal misconduct 2/21/2018 | |
| Article: Kaiser doctor loses license for affair with patient 2/22/2018 | |
| Article: Healdsburg doctor's license revoked 2018-02-28 | |
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Additional Information (Medical School, Dated Actions, Excerpts from Disciplinary Actions, Notes)UNIVERSITY OF COLORADO SCHOOL OF MEDICINE
2/16/2018—CALIFORNIA MEDICAL LICENSE REVOKED.
12/07/2016—ACCUSATION FILED.
Excerpt from Accusation dated 12/07/2016:
FIRST CAUSE FOR DISCIPLINE
(Unprofessional Conduct: gross negligence; and/or repeated negligent acts; and/or
incompetence in the care of Patient A)
9. Respondent is subject to disciplinary action for unprofessional conduct [2234], and/or gross negligence [2234(b)], and/or repeated negligent acts [2234(c)], and/or incompetence [2234(d)] based on the care provided and the sexual relationship he engaged in with Patient A. The circumstances are as follows:
10. Respondent is 52 years old and: practices as an obstetrician/gynecologist at Kaiser Permanente- Santa Rosa (Kaiser) and is board certified by the American Board of Obstetrics and Gynecology. He began acting as Patient A's obstetrician/gynecologist (Ob/Gyn) on January 24, 2002. Respondent served as Patient A's obstetrician for three of her pregnancies and delivered two of her babies. Patient A's last in person office visit with Respondent was on September 12, 2012.
11. Over the years, Patient A and Respondent became friendly and the patient sought his advice regarding nursing school and her subsequent nursing employment.
12. Patient A began working as a nurse at Kaiser Permanente - Santa Rosa in approximately December of2010. She worked nights in the postpartum department. She worked nights in the post at that time, Respondent was the Director of Labor and Delivery for Kaiser - Santa Rosa. After four months, Patient A moved to nights in the Labor and Delivery Unit and then eventually switched to day shifts. Respondent continued to act as Patient A's obstetrician/gynecologist while she also worked as a nurse alongside Respondent. Respondent was very flirtatious with Patient A when they worked together, including requesting that she specifically assist him with deliveries, commenting on her looks, touching her arms, and rubbing his body against her in the operating room.
13. In April of 2012 Patient A's infant son died unexpectedly.
14. Following the death of her son, Patient A did not want to return to work in the Labor and Delivery Unit. She expressed her concerns to Respondent and he indicated he would help her with the paperwork to stay off of work because he did not want her to quit working in Labor and Delivery. Respondent also offered to provide her counseling sessions. Although Respondent told Patient A that he had a background in psychiatry, in reality he has a master's degree in behavioral studies and no training in providing psychiatry or counseling.
15. From April 24, 2012 through December 2012, Respondent provided Patient A with "Bereavement Counseling." According to Patient A she saw him approximately twenty times for counseling sessions but Respondent did not document all of the appointments. The Patient would schedule "Bereavement Counseling" sessions with Respondent through his staff, 12 of which were documented visits. The documented visits would generally last thirty minutes to an hour. The remaining sessions, which took place after Patient A's work shift, were arranged directly between Respondent and Patient A via text message or phone. Patient A would go to Respondent's office during his "administrative" time and she would spend several hours with Respondent during these counseling sessions. None of the "Bereavement Counseling" was paid through insurance or from Patient A.
16. Respondent completed progress notes for 12 "Bereavement Counseling" sessions and listed various diagnoses for Patient A such as "Stress," "Bereavement Counseling," or "Bereavement Counseling: Uncomplicated." The progress notes contain very little information and are maintained in the SOAP note format.. Most of the progress notes indicate that Respondent and Patient A "reflected on issues from last appointment."
17. On or about April 24, 2012, Respondent documented in the first progress note that he was providing a "Consultation" for Patient A and he diagnosed her with "acute stress disorder" following the death of a child. He also documented that Patient A was not able to return to work. Respondent informed Patient A that he had to "fight" with her supervisors to get her time off of work and a modified schedule approved.
18. On or about May 16, 2012, Respondent listed the diagnosis as "Stress" following the patient's complaints of difficulty sleeping. He also noted that she needed more time off of work and was unable to get an appointment for the psychiatry department until June, but "wants to talk to me [Respondent] sooner."
19. On or about May 30, 2012, Patient A was seen by a Licensed Clinical Social Worker (LCSW) during a telephone triage screening for anxiety and trauma following her son's death. That same day, a psychologist conducted an urgent psychological intake of Patient A. The following day, another psychologist saw Patient A and provided urgent care follow-up.
20. On/or about June 5, 2012, Patient A attended the first official group sessions titled "Anxiety Introduction Group" with a licensed psychologist.
21. On or about June 7, 2012, Patient A first saw a psychologist for a "Bereavement Counseling" follow-up appointment. Shortly thereafter, she saw a psychiatrist for her adult psychiatry intake appointment. The psychiatrist also wrote a memo requesting that Patient A be permitted to contiμue on modified work duties by not having direct patient care.
22. Later on June 7, 2012, at approximately 1:30 p.m., Respondent saw Patient A for "Bereavement Counseling: uncomplicated" and he prescribed Patient A 10 milligrams (mg) of Ambien (15 pills, with no refills). Under the progress note portion, Respondent wrote "Continued discussion of bereavement of son, and how other events in her past have influenced these feelings. Improving. Still not ready to return to work with direct patient care. Will have on modified for another two weeks. F/u [follow-up] in one week."
23. After the first three mental health sessions with Kaiser staff, Patient A was still thinking about leaving the labor and delivery unit because of her anxiety associated with her deceased son. Respondent recommended Patient A discontinue her therapy with the mental health services and instead to rely on the "Bereavement Counseling" that he was providing.
24. On or about June 12, 2012, Patient A attended the second "Anxiety Introduction" group session. She never returned for the last two group sessions.
25. On or about June 28, 2012, Patient A cancelled her psychology appointment. Patient A did not return to Kaiser Permanente's mental health services, and instead received "counseling" from Respondent.
26. While Respondent was providing "Bereavement Counseling" to Patient A he also wrote three internal memo's [sic] verifying her visits with the Ob/Gyn department in order to allow her to stay on modified work. Patient A had no actual care or appointments in the Ob/Gyn department during the time Respondent was providing "Bereavement Counseling."
27. Starting in about the fourth therapy session, Respondent began asking Patient A about her sexual history and sex life with her husband. During one of the sessions, the patient disclosed that she was molested as a child. Respondent also discussed his sex life with his wife during the sessions. The patient was uncomfortable with the sexual nature of the discussions and would often end their sessions early and leave Respondent's office.
28. At one of the last therapy sessions, Patient A was recalling an upsetting situation and Respondent reached out and touched her upper thigh in what she perceived to be a sexual nature. He then tried to kiss her. The patient pulled away and then left the office.
29. On or about September 12, 2012, at the last documented "Bereavement Counseling" appointment, Respondent again prescribed Patient A 10 mg of Ambien (15 pills, with no refills). No other notes were completed for the session.
30. Respondent and Patient A continued to see each other for "Bereavement Counseling" through December 2012 and they continued to work together. Respondent remained overly friendly and flirtatious with Patient A. Between April 19, 2012 through June 12, 2014, the cell phone records between Respondent and Patient A show hundreds of text messages and phone calls with each other. Many calls were placed during non-business hours.
31. On or about June 15, 2013, Respondent prescribed Patient A 10 mg of Ambien (15 pills, with no refills). According to the Department of Justice Controlled Substance Utilization Review and Evaluation System, this prescription had a new number from the prescriptions Respondent wrote for Patient A in July 2012 and September 2012. There was no documentation in Patient A's medical record regarding this prescription.
32. In early October 2013, Patient A attended a work conference out of town. During the second night of the conference, Patient A was sitting in the lounge area of the hotel with two other Kaiser nurses and Respondent discussing rumors about possible budget cuts. Respondent and one of the nurses got into a heated discussion about which department should lose staff. Eventually the two nurses left. Patient A and Respondent were then joined by two other Kaiser nurses, a husband and wife. Shortly thereafter, Patient A became uncomfortable with the conversation and said she was going back to her room. Respondent said he would walk her to her room. On the way to the room, Respondent pulled Patient A into the stairwell and insisted that she go to his room with him, which she agreed to.
33. Once in Respondent's room, the two talked for awhile. Respondent told Patient A that from the first time he saw her in an exam room he was attracted to her. He even remembered the examination room number where he first saw her. At this point they began kissing. Respondent tried to remove her shirt, but Patient A was uncomfortable with that. Respondent told her she was beautiful and "he had seen it all before." The patient felt a strong emotional bond with Respondent, and eventually she let him undress her. He then got undressed. Patient A was not r~ady to have sexual intercourse but remembered a time when Respondent told her during "Bereavement Counseling" that his wife refused to perform oral sex on him. Patient A then performed oral sex on Respondent. After she performed oral sex, Respondent told Patient A that he could no longer be her doctor.
34. Afterwards, she remained in his room and they continued to talk throughout the night, including about their spouses and families. Respondent relayed that he and his wife planned on getting divorced when their youngest child graduated high school. While they talked they also continued to kiss, but did not have sexual intercourse. Patient A returned to her room at 6 a.m., which she was sharing with one of the other nurses.
35. When Patient A returned to work that following Monday she immediately changed her Ob/Gyn doctor. On or about October 28, 2013, another doctor at Kaiser officially became Patient A's selected Ob/Gyn doctor.
36. The relationship between Patient A and Respondent escalated quickly after this point. Within the next two to three weeks they drove out to Bodega Bay and had sexual intercourse for the first time in a car. Patient A would go to Respondent's office when she got off of work around 3:30 p.m., while he was still working, and they would have sex in his office. They would also meet in the clinic when it was closed during Respondent's night call shifts and have sex. They had sex in respondent's office two to three times per week, including when he was on duty and was required to report for patient care.
37. Respondent admitted to engaging in a sexual relationship with Patient A.
38. On or about Friday February 21, 2014, Patient A took a home pregnancy test, which was positive. She then called Respondent at work to tell him. Patient A told Respondent that she was going to the emergency room because she was having severe uterine pain and needed to have her intrauterine device (IUD) removed, which upset Respondent. Respondent told her not to go to the Kaiser emergency room because people would find out about their relationship and he would lose his medical license. This was the first time Respondent mentioned his medical license to Patient A during their relationship. Respondent then instructed Patient A how to remove the IUD herself, which she did.
39. According to Patient A's medical records, she emailed her gynecologist at approximately 1:42 p.m. and requested a quantitative blood HCG test. Patient A had two different blood draws done between February 21 and 23, 2014 to determine her HCG levels. Both showed that she was pregnant, but the second HCG level was lower than the first, indicating she was miscarrying.
40. Respondent then left work early and picked up Patient A to talk. Respondent brought up abortion, which upset Patient A because she had told him in the past that she would never have an abortion. Despite the patient's belief on abortion, an appointment was made at the Planned Parenthood in Clearlake, Lake County, approximately one hour from their location. Respondent continued to tell Patient A that a baby would destroy both of their families and they would both lose their jobs and he again said he would lose his medical license.
41. Patient A went into the Planned Parenthood Clinic for an intake appointment. The pregnancy test was positive; however, Patient A was not far enough along in the pregnancy for anything to appear in the ultrasound nor was there a heartbeat yet. The records reflected the Patient A reported using an IUD for contraception. Options for termination were given to Patient A but she did not schedule a procedure. Respondent was very angry that she did not have the abortion.
42. Respondent then drove them to the Kaiser clinic, which was closed. Patient A walked over to the hospital and went to the lab for another quantitative HCG test. Back in the clinic, Respondent performed an ultrasound and noted that there was thickening of Patient A's uterus lining, but Respondent did not document this in her medical record. Respondent continued to press the patient about having an abortion, telling her things like "it's just a few cells," that it was "not a viable pregnancy" because of the IUD, and that he could prescribe her medication to terminate the pregnancy.
43. Later on February 21, 2014, Respondent then drove them to a local Walgreens, which is not a pharmacy approved by Kaiser's insurance. Respondent wrote Patient A, a prescription for 200 micrograms of misoprostol (30 pills); however, he backdated it for January 5, 2014. Patient A filled eight pills because insurance would not cover the medication and she had to pay cash for it. Respondent was upset and told her she needed to fill all 30 pills so she then returned and had the pharmacy fill the remaining 22 pills. They picked up the remaining 22 pills through the pharmacy drive-thru window a short time later.
44. During Respondent's interview with an investigator on behalf of the Medical Board he stated that the Patient came to him in early January 2014 and requested the prescription for menstrual cramps. He did not document the misoprostol prescription in the patient's medical file; nor did he conduct an examination of the patient before prescribing the medication. Moreover, during the interview, Respondent claimed he was unaware that misoprostol can induce labor/cause a miscarriage.
45. Patient A continued to talk to Respondent about not wanting to take the medication but she knew he would not let her go home until she did. Eventually Respondent put four of the pills in her mouth and kissed her. He thanked her for protecting their families and stated that she was a good mother. Respondent finally took Patient A home around 1:30 a.m. and he slept in his car in her driveway.
46. On Saturday, the following day, Patient A still had not started bleeding so Respondent advised her to take four more pills vaginally.
47. On Sunday, she still had not started bleeding so she took another four pills orally. Later in the day, Patient A met Respondent and they went for a walk. While they were walking she began bleeding. The bleeding lasted several weeks and eventually Patient A developed a uterine infection. Respondent brought her over antibiotics in an unlabeled pill bottle. He did not tell her what kind of antibiotics he was giving her or where he obtained the medication. Respondent did not document providing antibiotics to Patient A in her medical record.
48. On or about February 27, 2014, Patient A had a third HCG blood test which showed she was no longer pregnant.
49. The following weekend Respondent and Patient A had a pre-planned vacation to the same hotel where they first began their relationship back in October 2013. Respondent admitted that he panicked when Patient A told him she was pregnant and that he would spend the rest of his life making it up to her. Respondent thought it would be healing for her if they had a baby together once they got married. Patient A realized that things had changed in their relationship and she was no longer happy seeing Respondent. She began a cycle where she would try to break up with Respondent every few days but Respondent would always say that he would not be able to work with her if they no longer dated. Patient A felt that Respondent would try to have her terminated from Kaiser if she broke off their relationship with him.
50. On or about March 3, 2014, Patient A had a new IUD inserted at Kaiser. According to the medical records, Patient A indicated that her prior IUD came out prior to her pregnancy or at the time of the miscarriage in February.
51. On or about May 11, 2014, Mother's Day, Patient A began to have trouble sleeping and suffering from panic attacks. She wanted to leave Labor and Delivery because she started seeing pregnant patients with due dates in November, which is when she would have been due. Respondent refused to talk about the pregnancy. Around that time, Respondent's wife discovered text messages between Respondent and Patient A.
52. On or about June 5, 2014, Patient A finally ended the relationship with Respondent. She told Respondent to take whatever time he needed to figure out things with his wife and children. During this conversation, Respondent made some comment about Human Resources wanting to meet with her.
53. On or about June 6, 2014, Patient A's nursing supervisor contacted her to bring her union representative with her for a meeting with Human Resources.
54. On or about June 10, 2014, Patient A reported the relationship with Respondent to a physician at Kaiser who was providing her treatment for anxiety and insomnia.
55. On or about June 12, 2014, Patient A filed a complaint with Kaiser Permanente's corporate office as a patient against Respondent.
56. Respondent is guilty of unprofessional conduct and subject to disciplinary action under sections 2234 [unprofessional conduct], and/or 2234(b) [gross negligence], and/or 2234(c) [repeated negligent acts], and/or 2234(d) [incompetence] including, but not limited to the following:
a. Respondent engaged in a sexual relationship with Patient A who was under his care and treatment for "Bereavement Counseling" and to whom he prescribed controlled substances.
b. Respondent terminated Patient A as a patient in order to engage in a sexual relationship with the patient.
c. Respondent continued to provide medical care to Patient A after the professional relationship formally ended by prescribing misoprostol and antibiotics to Patient A.
d. Respondent prescribed misoprostol, including predating the prescription, to Patient A in order to induce an abortion.
e. Respondent provided "Bereavement Counseling" to Patient A, a service that was outside the scope of his knowledge and practice as an obstetrician/gynecologist. He further discouraged Patient A from obtaining mental health counseling from qualified personnel, and urged her to continue treatment with him.
f. Respondent's statement that he had no knowledge about misoprostol's alternate uses for obstetrics and gynecology indicates incompetence.
SECOND CAUSE FOR DISCIPLINE
(Sexual Misconduct/Sexual Exploitation)
57. The allegations of Paragraphs 9 through 56, above, are herein incorporated by reference as if fully set forth below.
58. Respondent is subject to disciplinary action for sexual misconduct [726] and/or sexual exploitation [729] based on the sexual relationship he had with Patient A.
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