UNIVERSITY OF CALIFORNIA, SAN DIEGO SCHOOL OF MEDICINE
Cross-Reference: See documents for Dr. Egisto Salerno. Dr. Grisolia testified on his behalf.
- 12/10/2014—PROBATION COMPLETED.
- 12/10/2007—SEVEN YEARS PROBATION WITH TERMS AND CONDITIONS.
- 9/11/2007—SECOND AMENDED ACCUSATION FILED.
- 1/31/2007—FIRST AMENDED ACCUSATION FILED.
- 1/06/2006—ACCUSATION FILED.
Excerpt from Accusation dated 9/11/2007:
FIRST CAUSE FOR DISCIPLINARY ACTION
(Gross Negligence)
12. Respondent has subjected his Physician's and Surgeon's Certificate No. G 42884 to disciplinary action under sections 2227 and 2234 as defined by 2234, subdivision (b) of the Code, in that he was grossly negligent in the medical care he rendered to patients L.G., LG., W.W., D.D., J.L. and A.S. The circumstances are as follows:
Patient. L.G.
A. Patient L.G. was respondent's spouse. She died on October 23, 2003, at the age of 52, at the home she shared with respondent. An autopsy determined the cause of death to be accidental due to intoxication from morphine, Vicodin, Celexa, Benadryl, and Restoril. The coroner concluded L.G.'s death was attributed to the combined effect of multiple sedative prescription medications. Toxicological studies revealed that the levels of some of the drugs found in L.G.'s system were above the usual therapeutic range.
B. Respondent and L.G. were married in or about 1990. Prior to their marriage, and dating back to at least 1987, L.G. had been diagnosed with a variety of medical conditions that included syncopal episodes and drop attacks for which she had been taking Dilantin, an anticonvulsant medication. She also had been diagnosed with migraine headaches and complex partial seizures, both also controlled with Dilantin. These conditions, including a post-traumatic headache disorder, dated back to a minor head injury in or about 1987. In addition to these conditions, L.G. had been diagnosed with difficulty in sleeping, arthritis, anxiety disorder, chronic allergies, and possible depression.
C. Respondent, a neurologist by specialty, participated in L.G.'s medical care prior to and following their marriage, including prescribing medications for her various medical conditions. In addition to respondent, L.G. also received medical care from several other physicians as well from 1987 through 2003.
D. Respondent's medical records for L.G. were virtually non-existent and consist of only five pages of notes, dated between April 9, 1987 through October 20, 2003, three days before L.G.'s death. There are no notes consistent with an initial evaluation of L.G., either dictated or handwritten. There are gaps in the evaluations that do exist between May 21, 1987, to September 20, 1988, and from November 3, 1988, to May 2, 1989, with a final note on June 5, 1999. Thereafter, there are no more notes until the two final notes shortly before the patient's death, one dated March 8, 2003, and the other dated October 20, 2003. Respondent's brief medical records that do exist for L.G. indicate that respondent assumed the primary responsibility for L.G.'s medical care in or about May 1998, based on a chart notation that L.G., then respondent's wife, trusted respondent to take care of her and that she did not want to see any other physician.
E. Respondent's chart note for L.G., dated March 8, 2003, states that L.G.'s headaches and seizures were well controlled.
F. Respondent's chart note for LG., dated October 20, 2003, three days before her death, is quite extensive and appears to be the longest note in respondent's chart with respect to the care he provided to L.G. In this note, respondent indicated that L.G. had a single seizure, typical epileptic drop with postictal confusion witnessed by him. L.G. had not been taking Neurontin for two days and had sleep loss from her trip back home. She had the onset of right hip pain four days prior to the note, and she was given morphine sulfate 30 mg. every four hours from an old prescription that respondent had at his home. Also, respondent gave L.G. Prednisone. On the evening prior to L.G.'s death, respondent admitted giving L.G. Benadryl, Restoril, and morphine sulfate.
G. Respondent prescribed many medications to L.G. during the years he treated her. Specifically, between July 13, 2001, and October 20, 2003, respondent prescribed multiple prescriptions for Vicodin, as well as prescriptions for Restoril, Prempro, Xenical, Beconase, Celexa, Indocin, Fioricet, Diflucan, Advair, chromalin sodium, Retin-4 Motrin, Compazine, Septra, Azmacort, clindamycin, and Alupent. In addition, at various other times, respondent also prescribed to L.G. Benadryl, morphine sulfate, Valium, hydrocodone, Esgic, Effexor, and Neurontin. In addition, L.G. was also receiving Lorazepam and morphine prescribed by other doctors as well.
Patient I.G.
H. On or about July 7, 1999, patient I.G., then 49 years old, made a visit to respondent's clinic with complaints of neck pain radiating to both extremities and cramping in both hands. As medical history, patient I.G. stated that he suffered a ruptured disc from an automobile accident in 1996, that a cervical MRI was performed at the San Diego V A Hospital and that he was taking 4-10 tablets of Percocet a day. Respondent examined the patient. His impression included cervical strain and bilateral carpal tunnel syndrome. He ordered a cervical MRI and prescribed 60 tablets of Percocet and Prednisone for the patient. On or about July 13, 1999, patient I.G. made a return visit during which respondent reviewed the MRI films and prescribed 200 tablets of Percodan 2 for the patient.
I. Beginning in August 1999 and continuing until about September 2001, patient I.G. made nearly monthly visits to respondent's clinic. With some exceptions, respondent prescribed 200 tablets of Percocet 5 mg. for patient LG. on each visit)/ On most of these visits, respondent noted the patient's complaint as "increased neck pain" or "no change." During this period, patient I.G. was also receiving treatment and other medications from the Pain Clinic at the San Diego VA Hospital. Beginning in October 2001, patient LG.'s visits changed to every other month. Between about October 1, 2001 and about January 23, 2002, respondent prescribed 400 tablets of Percocet 5 mg. every other month for patient LG. However, beginning with the visit on or about March 18, 2002, respondent increased the dosage to 600 tablets of Percocet 5 mg. every other month. Respondent continued to prescribe 600 tablets of Percocet 5 mg. every other month until patient I.G.'s final visit on or about August 3, 2005. Despite the large amount of controlled substances prescribed, there is no documentation of ongoing physical examination of patient LG. during the period of treatment, and there is no documentation of an established treatment plan of treatment of the patient's cervical and neck pain. Moreover, respondent failed to obtain and note patient LG.'s informed consent for the prolonged treatment with narcotics, failed to discuss and/or note he discussed other pain treatment modalities with the patient, and failed to conduct periodic reviews to determine the effectiveness of large amounts of controlled substances he was prescribing for the patient.
Patient W.W.
J. On or about November 16, 1993,2 patient W.W., a 45-year-old male, made a visit to respondent's clinic with a complaint of low back pain. As medical history, the patient W.W. stated he underwent a lumbar laminectomy at the UCSD Medical Center in about 1991, and was again hospitalized at the San Diego VA hospital in October 1993. Patient W.W. also stated that he abused street drugs for 15 years but stopped in about 1991, and that he was on Motrin 75 mg. daily. Respondent examined the patient. His impression was "arachnoiditis." Respondent wrote a prescription for several medications including 30 tablets of Tylenol #4 for the patient. On patient W.W.'s next visit, respondent noted the patient's pain was unchanged and he prescribed 50 tablets of Tylenol #4 for the patient. On or about January 3, 1994, respondent was informed that a pharmacy had denied patient W.W.'s request for 60 tablets of Tylenol #4.
K. On or about March 27, 1995, the patient W.W. presented with lower back pain radiating to both lower extremities. On this visit, the patient specifically requested the drug Doriden. Respondent prescribed 30 tablets of Doriden to the patient on this visit. Thereafter, patient W.W. made monthly visits during 1995. On all of these visits, respondent wrote prescriptions for Dilaudid and Valium!Q/ for the patient. On the visit of about November 8, 1995, respondent noted patient W.W. had forged a prescription to obtain Tylenol #3 at UCSD. Patient W.W. made nearly monthly visits during 1996, 1997 and 1998. On most of these visits, respondent noted the patient's back pain was worsening. On most visits he prescribed 200 tablets of Dilaudid, 100 tablets of Tylenol #4 and 100 tablets of Valium for the patient. On or about April 2, 1998, respondent noted patient W.W.'s house had burned down. On or about May 12, 1998, patient W.W. reported he was assaulted by "gang members" and suffered a "minor traumatic brain injury." On the visit on or about August 3, 1998, patient W.W. reported that someone attempted to obtain drugs from a pharmacy by impersonating the patient. On the visit on or about September 2, 1998, respondent commenced prescribing Methadone 80 mg. instead of the Dilaudid drug. Thereafter and continuing through about December 1999, respondent monthly prescription for patient W.W. included Methadone, Tylenol #4 and Valium.
L. Patient W.W. made monthly visits from January 2000 to November 2000. During this period, respondent continued to prescribe 250 tablets of Methadone 10 mg., 100 tablets of Valium and 100 tablets of Tylenol #4 on each visit for treatment of patient W.W's back pain. During this period, patient W.W. was also been treated at the San Diego VA Hospital where he was diagnosed with Post Traumatic Stress Syndrome. On or about April 4, 2001, patient W.W. checked himself to the ER at Scripps Mercy Hospital complaining he was being poisoned at the hotel in which he resided.
M. Patient W.W. resumed his visits to respondent's clinic on or about August 20, 2003, when he complained of"left upper extremity swelling." On this visit, respondent noted patient W.W. "went to Mercy Hospital" and "was followed (sic) by San Diego VA Hospital" and "was on Methadone 10 mg. up to 20 per day." Respondent wrote a prescription for medications that included 600 tablets of Morphine Sulphate (MS) 30 mg., 100 tablets of Valium 10 mg. On patient W.W.'s follow-up visit on or about September 22, 2003, respondent prescribed 600 tablets of long acting Morphine Sulphate (MSIR) 30 mg. and 600 tablets of Methadone 10 mg. for the patient. Respondent repeated this prescription on the patient's visits on October 20, 2003, December 2, 2003, and December 23, 2003. There is no notation of the medical justification for the morphine sulphate medications.
N. Patient W.W. continued his monthly visits throughout 2004, and from January 2005 until the final visit on or about September 13, 2005. On most visits, respondent noted "low back pain" or "increased back pain" as the patient's complaint. On nearly all visits, respondent prescribed 600 tablets of MS 30 mg., 600 tablets of Methadone 10 mg. and 100 tablets of Valium 5 mg. for patient W.W. On or about March 18, 2004, respondent noted he had received a telephone call from a police officer stating patient W.W. was "delusional, confused and paranoid." On the visit on or about June 21, 2005, respondent noted patient W.W. underwent a psychological evaluation at UCSD. His impression on this visit was patient W.W. suffered a "paranoid reaction."
O. Respondent prescribed large amounts of controlled substances to patient W.W. over a prolonged period without performing and documenting adequate ongoing physical examinations and without establishing and documenting a treatment plan for the patient's lower back pain. Respondent also failed to obtain and note the patient W.W.'s informed consent for the prolonged treatment with narcotics, failed to discuss and/or note he discussed other pain treatment modalities with the patient. Respondent also failed to conduct periodic reviews to determine the effectiveness of large amounts of controlled substances he was prescribing for patient W.W. In spite of the clear signs of addiction, respondent failed to take and note steps he took to determine whether patient W.W. was addicted to pain medication, and failed to obtain a pain specialist or an addictionologist consult for the patient at any time during the period of treatment.
Patient J.L.
P. On or about August 11, 1994, at the request of her attorney, patient J.L., then 39 years old, consulted with respondent for a "neurologic disability" evaluation in connection with a breast implant litigation. Patient J.L. reported, among other things, that she underwent a cervical laminectomy procedure in 1983 and a bilateral silicone breast implantation in 1987, and that in 1991, she began to suffer pain in her shoulders and neck, left arm tingling and numbness, memory loss, chronic fatigue and depression. Patient J.L. denied taking any medications for her medical problems, denied smoking or drinking and denied using recreational drugs. After evaluating the patient, respondent reported his impressions and diagnosis in a Neurologic Comprehensive Evaluation report addressed to the patient's attorney. His impressions and diagnosis included "Atypical Neurologic Disease Syndrome," polyneuropathy, arthralgias, myalgias, sustained balance disturbance and progressive memory loss. Respondent concluded patient J.L. was unable to perform any vocational or avocational activities and has been disabled since 1992.
Q. On or about August 31, 1994, patient J.L. returned to respondent's clinic complaining of increased neck pain. Respondent prescribed Prednisone 20 mg. Patient J.L. made a return visit in which she reported the Prednisone medication caused anxiety, sweatiness and tachycardia. Respondent prescribed Klonopin for the patient. On the visit on or about November 7, 1994, respondent noted patient J.L could not afford Klonopin. On this date, respondent prescribed Ativan, Valium and 10 refills of Vicodin. Thereafter, the patient J.L. made roughly monthly visits through 1996 during which the patient received prescriptions for Vicodin and Valium. On most visits, respondent noted patient J.L. complained of pain in the neck, headaches and auditory and visual hallucinations. In 1995, in the course of its disability evaluation, the Department of Social Services (DDS) found that patient J.L. suffered from both depressive and anxiety disorders. In March 1996, DDS noted patient J.L. carried a diagnosis of personality disorder and active alcohol abuse. On patient J.L. 's visit on or about April 19, 1996, respondent noted the patient was drinking beer to relieve the pain. In 1997, patient J.L. made approximately 16 visits, and in 1998, she made approximately 18 visits. Respondent prescribed Vicodin and Valium for the patient on nearly every visit, and on some visits, respondent added prescriptions for Zoloft, Klonopin, Ritalin and Zyprexa. On patient J.L.'s visit on or about February 12, 1997, respondent noted the patient requested more Vicodin which was denied. On the visit on or about October 23, 1998, respondent noted patient J.L. was using marijuana. In November 1998, respondent began prescribing Fentanyl for patient J.L. Patient J.L. was admitted to the hospital on numerous occasions during 1996 through 1998.
R. Patient J.L. made approximately 22 office visits during 1999. On most of the visits, respondent continued to prescribe Vicodin, Valium, Trazadone, Ritalin, Fentanyl and Klonopin for the patient. In February, April, June and October, patient J.L. was hospitalized for visual and auditory hallucinations and for exacerbation of her dymelination autoimmune disorder. Patient J.L. was noted to have a history of schizophrenia and schizoaffective disorder during these hospitalizations. Beginning in December 1999, respondent commenced prescribing Oxycontin for the patient. There is no notation that patient J.L. complained of pain on any of the visits in 1999.
S. Patient J.L. made approximately 27 office visits during 2000. Respondent prescribed Oxycontin (160 mg. per day), Valium, Klonopin for the patient throughout the year. With the exception of 5 visits (visits on March 20 and 29, June 14, August 7 and November 1) there is no notation patient J.L. complained of pain during these visits. On the visit on or about April 10, 2000, respondent noted patient J.L. was "hearing increased voices" telling her to "kill herself." On or about May 9, 2000, respondent noted that patient J.L. had checked herself into the detox facility at Charter Hospital for Valium detoxification. At the hospital, patient J.L. admitted she had been obtaining Valium from Mexico. On the visit on or about August 7, 2000, respondent noted patient J.L. "threw out" her Oxycontin medication, and on the December 29, 2000, visit, respondent noted patient J.L. "threw away" all her prescription drugs upon observing her brother use IV drugs.
T. Patient J.L. made approximately 30 office visits during 2001. Respondent prescribed Oxycontin, Klonopin and Valium for the patient during this period. On or about April 4, 2001, patient J.L. reported her Oxycontin medication was seized by a US Border Patrol agent as she crossed the border. In May of 2001, respondent increased the Oxycontin dosage to 240 mg. a day. On or about June 18, 2001, respondent noted patient J.L. fell and hit her head while riding her bicycle. On or about August 8, 2001, respondent noted patient J.L. fell in a river. On or about August 30, 2001 patient J.L. reported that her friend had been "pressuring" her for prescription drugs and that some of the patient's drugs were missing. On or about September 12, 2001, respondent noted patient J.L. crashed her bike.
U. Patient J.L. made approximately 28 office visits in 2002. Respondent prescribed Oxycontin 240 mg. per day for the patient on nearly every visit. He also continued the prescriptions for Valium and Klonopin. On or about June 25, 2002, respondent's staff noted patient J.L. called the office claiming she lost two days of medications. This same day, another physician called the respondent's office and instructed respondent's staff that patient J.L. should not be prescribed any medication because her "story was unbelievable." On or about November 11, 2002, respondent noted he prescribed Klonopin for patient J.L. so the patient would no longer use marijuana, and on December 9, respondent noted patient J.L. was "staying away from marijuana."
V. Patient J.L. made approximately 30 office visits in 2003. Respondent prescribed Oxycontin 240 mg. per day for the patient on nearly every visit. Respondent also continued the prescription for Klonopin, and on some occasions, added Prednisone. On the visit on or about February 24, 2003, patient J.L. reported her friend had stolen her medication. Respondent wrote another prescription for Oxycontin on this visit. On or about March 24, 2003, patient J.L. called respondent's staff requesting more medication because she spilled water on her medications. On the April 23 visit, patient J.L. reported that her friend had stolen and used "a lot" of the patient's medication. On or about May 12, 2003, patient J.L. called respondent's office requesting an early refill of her Klonopin medication claiming the Klonopin had been "washed" away. Respondent ordered a refill of the Klonopin medication. On the visit on or about May 20, 2003, patient J.L. again reported she "lost" her Klonopin. On or about June 23, 2003, patient J.L. called respondent's office requesting an early refill claiming she "accidentally" took double the prescribed dosage. On the visit on or about September 22, 2003, respondent prescribed 50 tablets of Percocet for patient J.L. in addition to the Oxycontin medication. On the visit on or about November 11, 2003, respondent noted that patient J.L. was "desperate," "confused" and "psychotic" and that he instructed the patient to "slow down on Oxycontin."
W. Patient J.L. made approximately 25 office visits in 2004. Patient J.L.'s complaints were related to her psychiatric problems on most of these visits. Respondent prescribed Oxycontin for patient J.L. on nearly every visit. He also prescribed Klonopin, Ambien Seroquel, Stratera and Neurontin for the patient during the year. On the visit on or about January 20, 2004, respondent noted patient J.L. had "increasing psychosis and paranoia." On the visit on or about March 11, 2004, patient J.L. reported she fell and hit her head and neck. On the visit on or about April 20, 2004, respondent noted patient J.L. was using less marijuana. On or about July 30, 2004, patient J.L. called respondent's staff claiming she "lost" all her medications. On the visit on or about August 3, 2004, respondent increased the Oxycontin dosage to 480 mg. per day, and on the visit on or about August 13, 2004, he increased the Oxycontin dosage to 640 mg. per day. Thereafter, respondent prescribed 640 mg. per day for patient J.L. on each visit. On the visit on or about November 17, 2004, respondent noted patient J.L. stated she was "disintegrating and falling apart." On the visit on or about December 15, 2004, patient J.L. reported she fell on her head five days before the visit.
X. Patient J.L. made approximately 19 visits in 2005, and made her final visit on or about September 23, 2005. Patient J.L. 's complaints on most visits related to her psychiatric problems. Respondent prescribed Oxycontin 640 mg. per day for patient J.L. on each visit. He also continued to prescribe Klonopin, Percocet, Xanax and other drugs for the patient during the year. On the visit on or about January 11, 2005, patient J.L. reported she "threw away" her Klonopin medication. On or about March 30, 2005, patient J.L. reported all her medications had been destroyed in a "wash." On the visit on or about May 12, 2005, respondent noted patient J.L. was "holding marijuana." In or about July or August 2005 patient J.L. called respondent's staff requesting refill of her Klonopin prescription 12 days earlier than ordered. On or about September 9, 2005, respondent's staff noted patient J.L. reported her house had been broken into and her medication had been stolen.
Y. Respondent prescribed large amounts of controlled substances to patient J.L. over a prolonged period without performing and documenting adequate ongoing physical examinations, and without establishing and documenting a treatment plan for the patient's pain. Respondent also failed to obtain and note patient J.L.'s informed consent for the prolonged treatment with narcotics, failed to discuss and/or note he discussed other pain treatment modalities with the patient. Respondent also failed to conduct periodic reviews to determine the effectiveness of large amounts of controlled substance she was prescribing for patient J.L. Inspite of the clear signs of addiction, respondent failed to take any steps to determine whether patient J.L. was addicted to pain medication and failed to obtain a pain specialist or addictionologist consultation for the patient. Further, in spite of the clear evidence patient J.L. was obtaining other prescription drugs and marijuana from other sources, respondent failed take and note steps he took to determine the patient was not abusing prescription medications and "street" drugs.
Patient D.D.
Z. On or about December 11, 1995, patient D.D., then 40 years old, consulted with respondent. Patient D.D. complained of excruciating pain in the back and legs and a headache. She stated the pain was controlled by large amounts Vicodin and Valium. On or about May 17, 1995, patient D.D. made a follow-up visit at which time respondent reviewed the patient's medical records including an MRI, and formulated the impression of cervical multiple sclerotic lesion. Thereafter, patient D.D. made regular office visits during 1996 through 1999. Respondent's standard prescriptions for the patient during this period included Oxycontin, Vicodin and Valium. The initial dosage of the Oxycontin was 80 mg. per day. This was increased to 160 mg. per day in 1997, and to 240 mg. per day in 1998, and to 480 mg. per day by 1999. Respondent also increased the dosages for the Valium and Vicodin for patient D.D. during this period. During this period, patient D.D. declined to follow respondent's suggestion that she undergo a procedure for the placement of an opiate pump.
AA. Patient D.D. made regular office visits between January 2000 and September 2005. During 2000, patient D.D. made approximately eight visits during which respondent continued to prescribe 480 mg. Oxycontin per day, along with 200 tablets of Extra Strength Vicodin (Vicodin ES) and 120 tablets of Valium per month. Patient D.D. made monthly visits during 2001. On the January 2001 visit, respondent increased the dosage of the Oxycontin to 600 mg. per day. However, on the following visit on or about February 26, 2001, respondent replaced the Oxycontin with Morphine Sulphate Controlled Release Cantin (MS Contin) 150 mg. per day, and this dosage was increased to 210 mg. per day. In addition, respondent prescribed 100 tablets of Vicodin ES and 180 tablets of Valium 10 mg. per month for the patient. Patient D.D. made approximately seven visits in 2002, approximately seven visits in 2003, approximately six visits in 2004 and five visits in 2005. During this period respondent increased the patient's MS Cantin to 480 mg. per day in addition to the Vicodin and Valium prescriptions.
BB. Respondent prescribed large amounts of controlled substances to patient D.D. over a prolonged period without performing and documenting adequate ongoing physical examinations, and without establishing and documenting a treatment plan for the patient's pain. Respondent also failed to obtain and note patient D.D.'s informed consent for the prolonged treatment with narcotics, failed to discuss and/or note he discussed other pain treatment modalities with the patient. Respondent also failed to conduct periodic reviews to determine the effectiveness of large amounts of controlled substances he was prescribing for patient D.D.
Patient A.S.
CC. On or about December 12, 2002, patient A.S., then 38 years old, consulted with respondent for evaluation of the patient's chronic headaches. As history, the patient stated her headaches started at age five and had worsened over time, and were occurring almost daily. Patient A.S. reported that she had been followed by several physicians, that multiple CT scans of the head had been normal, that in the past she had been treated with several different medications including Inderol, Neurontin and Depakote, and that her current medications included Wellbutrin, Zoloft and Ultram. On this visit, respondent performed a neurologic examination. His impression was "migrainous headaches disorder."
DD. Beginning in January 2003, patient A.S. commenced office visits for treatment. On or about January 6, 2003, patient A.S. made an office visit complaining of"increased headache postpartum." Respondent prescribed one month supply of Tofranil, 30 tablets of Fioricet (with no refills) and 30 tablets of Vicodin (with no refills) for the patient. Patient A.S.'s next contact with respondent's office was on July 16, 2003, when she called respondent's staff requesting early refill of her Vicodin medication. On the visit on or about August 5, 2003, respondent noted the Tofranil and Cardizem medications did not result in an improvement of the headaches. Respondent also noted patient A.S. was obtaining medications such as Wellbutrin and Lortab from other sources. On this visit, respondent prescribed Fioricet, Vicodin and Sansert for patient A.S., and noted he explained the benefits and risks associated with the Sansert medication to the patient. Patient A.S. made visits in October, November and December 2003, during which respondent wrote prescriptions Lortab, Norco, Xanax and Zonergram for the patient. On the visit on or about October 14, 2003, Patient A.S. reported she was unable to obtain the Sansert medication but was taking the drug Ativan. Respondent failed to inquire how the patient obtained the Ativan medication. On the visit on or about December 17, 2003, respondent noted patient AS would have to undergo Zonergram detoxification.
EE. Patient A.S. made approximately nine office visits during 2004. During this period, respondent prescribed Norco, Xanax and Prednisone for the patient's headaches on nearly every visit. On the visit on or about February 17, 2004, respondent noted patient A.S. would have to undergo Norco detoxification. On or about July 24, 2004, respondent's staff noted that a Wal-Mart Pharmacy had denied patient AS.'s request for a refill of her Norco medication. On or about July 28, 2004, patient A.S. attempted to obtain a refill of her Norco prescription by use of an "old prescription." On the visit on or about November 8, 2004, respondent noted patient A.S. might have to undergo detoxification in the following spring.
FF. The patient made approximately three visits in 2005. Respondent added Percocet to the patient's medication during this period. On the visit on or about February 7, 2005, respondent noted he would "hold detox until things blow up." On the visit on or about April 4, 2005, respondent admonished patient A.S. for overusing the Percocet medication. On or about May 6, 2005, respondent's staff noted patient A.S. had attempted to obtain Norco from the Wal-Mart pharmacy through forgery. On or about May 6, 2005, a Sav-On Pharmacy notified respondent that patient A.S. had obtained a refill for Norco without authorization. On patient AS.'s final visit on or about May 23, 2005, respondent noted the patient was obtaining prescriptions from different sources.
GG. Respondent prescribed large amounts of controlled substances to patient A.S. over a prolonged period without performing and documenting adequate ongoing physical examinations and without obtaining a definitive diagnosis of the patient's pain. Respondent also failed to establish and document a treatment plan for patient A.S.'s pain, failed to obtain and note patient A.S.'s informed consent for the prolonged treatment with narcotics, and failed to discuss and/or note he discussed other pain treatment modalities with the patient. Respondent also failed to conduct periodic reviews to determine the effectiveness of large amounts of controlled substances he was prescribing for patient A.S. In spite of the clear signs of addiction, respondent failed to take any steps to determine whether patient A.S. was addicted to pain medication, failed to obtain a pain specialist or addictionologist consultation for the patient, and failed to refer the patient to a detox program. Further, in spite of the clear evidence patient A.S. was obtaining other prescription drugs from other sources, respondent failed take and note steps he took to determine whether patient A.S. was not abusing prescription medications drugs.[sic]
13. Respondent committed gross negligence in his care and treatment of patients L.G., I.G., W.W., J.L., D.D. and A.S. which included, but was not limited to, the following:
Patient L.G.
A. Paragraphs 12(A) through 12(G) are hereby incorporated by reference as if fully set forth herein.
B. Between on or about March 26, 1987 through on or about October 23, 2003, respondent treated L.G. for chronic headaches and epilepsy and failed to obtain and record a full history and physical examination, as well as record any physical findings during his follow-ups until 1989, with no further visits recorded until on or about March 8 and October 20, 2003.
C. Between on or about March 26, 1987 and on or about October 23, 2003, respondent issued to L.G. in excess of 90 prescriptions for dangerous drugs and/or controlled substances and/or failed to conduct and record a prior good faith examination on each occasion.
D. Between on or about March 26, 1987 and on or about October 23, 2003, respondent treated L.G. for chronic recurrent headaches and epilepsy and failed to maintain adequate medical records for her.
E. Between on or about March 26, 1987 and on or about October 23, 2003, respondent treated L.G. for documented chronic pain and repeatedly failed to abide with the guidelines established by the Intractable Pain Act, as specified in Business and Professions Code section 2241.5.
Patient I.G.
F. Paragraphs 12(H) through 12(I) are hereby incorporated by reference as though fully set forth.
G. Respondent failed to perform and note periodic reviews of his treatment of the patient to determine the effectiveness and appropriateness of the large amount of controlled substances he prescribed for the patient.
H. Respondent treated this patient with controlled substances over a prolonged period without establishing and documenting a treatment plan for the patient's cervical and neck pain.
I. Respondent treated this patient with controlled substances over a prolonged period without performing and documenting ongoing adequate physical examinations.
J. Respondent failed to obtain and document the patient's informed consent for treatment with narcotics over a prolonged period, and failed to discuss and/or note he discussed other treatment modalities with the patient.
K. Respondent treated this patient for documented chronic pain and repeatedly failed to abide with the guidelines established by the Intractable Pain Act, as specified in Business and Professions Code section 2241.5.
Patient W.W.
L. Paragraphs 12(J) through 12(0) are hereby incorporated by reference as if fully set forth herein.
M. Respondent failed to perform and note periodic reviews of his treatment of the patient to determine the effectiveness and appropriateness of the large amount of controlled substances he prescribed for the patient.
N. Respondent failed refer this patient for treatment-by a pain management specialist or an addictionologist at any time during the period of treatment.
O. Respondent treated this patient with controlled substances over a prolonged period without performing and documenting ongoing adequate physical examinations.
P. Respondent failed to obtain and document the patient's informed consent for treatment with narcotics over a prolonged period, and failed to discuss and/or note he discussed other treatment modalities with the patient.
Q. Respondent treated this patient for documented chronic pain and repeatedly failed to abide with the guidelines established by the Intractable Pain Act, as specified in Business and Professions Code section 2241.5.
Patient J.L.
R. Paragraphs 12(P) through 12(Y) are hereby incorporated by reference as if fully set forth herein.
S. Respondent failed to perform and note periodic reviews of his treatment of the patient to determine the effectiveness of the large amount of controlled substances he prescribed for the patient.
T. Respondent failed refer this patient for treatment by a pain management specialist or an addictionologist at any time during the period of treatment.
U. Respondent treated this patient with controlled. substances over a prolonged period without performing and documenting ongoing adequate physical examinations.
V. Respondent failed to obtain and document the patient's informed consent for treatment with narcotics over a prolonged period, and failed to discuss and/or note he discussed other treatment modalities with the patient.
W. During the period of treatment, respondent failed to take and note steps he took to determine whether the patient was abusing prescription medications and "street" drugs despite the clear evidence the patient was obtaining other prescription drugs and marijuana from other sources.
X. Respondent treated this patient for documented chronic pain and repeatedly failed to abide with the guidelines established by the Intractable Pain Act, as specified in Business and Professions Code section 2241.5.
Patient D.D.
Y. Paragraphs 12(Z) through 12(BB) are hereby incorporated by reference as if fully set forth herein.
Z. Respondent failed to perform and note periodic reviews of his treatment of the patient to determine the effectiveness and appropriateness of the large amount of controlled substances he prescribed for the patient.
AA. Respondent treated this patient with controlled substances over a prolonged period without performing and documenting ongoing adequate physical examinations.
BB. Respondent failed to obtain and document the patient's informed consent for treatment with narcotics over a prolonged period, and failed to discuss and/or note he discussed other treatment modalities with the patient.
CC. Respondent treated this patient for documented chronic pain and repeatedly failed to abide with the guidelines established by the Intractable Pain Act, as specified in Business and Professions Code section 2241.5.
Patient A.S.
DD. Paragraphs 12(CC) through 12(GG) are hereby incorporated by reference as if fully set forth herein.
EE. Respondent failed to perform and note periodic reviews of his treatment of the patient to determine the effectiveness and appropriateness of the large amount of controlled substances he prescribed for the patient.
FF. Respondent failed [sic] refer this patient for treatment by a pain management specialist or an appropriate specialist any time during the period of treatment.
GG. Respondent treated this patient with controlled substances over a prolonged period without performing and documenting ongoing adequate physical examinations.
HH. Respondent failed to obtain and document the patient's informed consent for treatment with narcotics over a prolonged period, and failed to discuss and/or note he discussed other treatment modalities with the patient.
II. During the period of treatment, respondent failed to take and note steps he took to determine whether the patient was abusing prescription medications and "street" drugs despite the clear evidence the patient was obtaining other prescription drugs from other sources.
JJ. Respondent treated this patient for documented chronic pain and repeatedly failed to abide with the guidelines established by the Intractable Pain Act, as specified in Business and Professions Code section 2241.5.
SECOND CAUSE FOR DISCIPLINE
(Repeated Negligent Acts)
14. Respondent has further subjected his Physician's and Surgeon's Certificate No. G 42884 to disciplinary action under sections 2227 and 2234, as defined by section 2234, subdivision (c) of the Code, in that he engaged in for repeated negligent acts in his care and treatment of patients L.G., I.G., W.W., J.L., D.D. and A.S. as more particularly alleged in paragraphs 12 and 13, above, and which are hereby incorporated by reference as if fully set forth.
THIRD CAUSE FOR DISCIPLINE
(Prescribing Without Good Faith Prior Examination)
15. Respondent has further subjected his Physician's and Surgeon's Certificate No. G 42884 to disciplinary action under sections 2227 and 2234, as defined by section 2242 of the Code, in that he repeatedly prescribed both dangerous drugs and controlled substances to patients L.G., I.G., W.W., J.L., D.D. and A.S. without a documentation of medical indication and without conducting and documenting a good faith prior medical examination, as more particularly alleged in paragraphs 12 and 13, above, and which are hereby incorporated by reference as if fully set forth.
FOURTH CAUSE FOR DISCIPLINE
(Failure to Maintain Adequate and Accurate Medical Records)
16. Respondent has further subjected his Physician's and Surgeon's Certificate No. G 42884 to disciplinary action under sections 2227 and 2234, as defined by section 2266 of the Code, in that he failed to maintain adequate and accurate medical records for patients L.G., LG., W.W., J.L., D.D. and A.S. as more particularly alleged in paragraphs 12 and 13, above, and Which are hereby incorporated by reference as if fully set forth.
FIFTH CAUSE FOR DISCIPLINE
(Violation of State or Federal Drug Statutes)
17. Respondent has further subjected his Physician's and Surgeon's Certificate No. G 42884 to disciplinary action under sections 2227 and 2234, as defined by section 2238 of the Code, in that he has violated state or federal drug statutes in the manner in which he prescribed both dangerous drugs and controlled substances to patients L.G., l.G., W.W., J.L., D.D. and A.S. as more particularly alleged in paragraphs 12 and 13, above, and which in their entirety are hereby incorporated by reference as if fully set forth.
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