UNIVERSITY OF CALIFORNIA, LOS ANGELES SCHOOL OF MEDICINE
- 8/02/2019—PUBLIC REPRIMAND.
- 6/04/2019—SECOND AMENDED ACCUSATION FILED.
- 2/06/2019—FIRST AMENDED ACCUSATION.
- 5/14/2018—ACCUSATION FILED.
- 12/07/2016—CHARGED WITH THE UNLAWFUL PRACTICE OF MEDICINE (SEE ARTICLE).
- 2/25/2010—PUBLIC REPRIMAND. STIPULATED DECISION. NO ADMISSIONS BUT CHARGED WITH GROSS NEGLIGENCE AND REPEATED NEGLIGENCE IN THE CARE AND TREATMENT OF 1 PATIENT, AND FAILURE TO MAINTAIN ADEQUATE AND ACCURATE MEDICAL RECORDS IN THE CARE, TREATMENT AND MANAGEMENT OF 3 PATIENTS. PHYSICIAN MUST COMPLETE A CLINICAL TRAINING PROGRAM AND MEDICAL RECORD KEEPING COURSE. EFFECTIVE 3/29/2010.
- 4/02/2009—ACCUSATION FILED.
Excerpt from Accusation dated 2/25/2010:
FIRST CAUSE FOR DISCIPLINE
(Gross Negligence)
7. Respondent is subject to disciplinary action under sections 2227 and 2234, as defined by section 2234, subdivision (b), of the Code, in that respondent was grossly negligent in his care, treatment and management of patient D.H., as more particularly alleged hereinafter:
A. Patient D.H., then a 59 year old female, began treating with respondent at SCPMG Medical Clinic as early as May, 2004, for multiple medical complaints including hypertension.
B. On or about September 21, 2006, patient D.H. presented to respondent for treatment of her hypertension and depression. However, her blood pressure was 76/44 and she was in atrial flutter. Respondent assessed the patient's blood pressure as stable and no further investigation or action was taken.
C. On or about September 26, 2006, patient D.H. arrived late in the clinic's parking lot for her 2:30 p.m. scheduled appointment with respondent. She called the nurses' clinic for help because she was too weak and unable to ambulate without assistance. At approximately 3: 15 p.m., staff from the nurse's clinic went to the parking lot and assisted patient D.H. who was hypotensive with a blood pressure of 96/35, pulse of 138, and oxygen saturation (02Sat) of 94%. She was assisted to the nurse's clinic, placed in a procedure room, and vital signs rechecked. Her blood pressure was 96/35, pulse of 138, and oxygen saturation of 95%. Patient D.H. was on warfarin for atrial fibrillation.
D. The nursing staff in the nurses' clinic called respondent and informed him that patient D.H. had come to the clinic with a one week history of nausea and diarrhea, and asked him to see the patient. Respondent, who was in the medical clinic, came to the nurses' clinic to see patient D.H. Respondent did not ask if the patient's vital signs had been taken, did not ask that the vital signs be taken, and did not take the vital signs himself. Respondent looked at patient D.H. and did a visual examination, and concluded that diarrhea was her problem and that she needed intravenous (IV) fluids.
E. Respondent ordered IV Dextrose 5% with Sodium Chloride and IV phenergan but changed the phenergan to an oral dose because the nurse informed him that the patient had driven herself to the clinic. At approximately 5:05 p.m., patient D.H.'s blood pressure was 93/35 and her pulse was 124. The blood pressure was rechecked and recorded at 90/26. Respondent was made aware of the patient's blood pressure readings. Respondent instructed the nurse to ambulate the patient and recheck her blood pressure. The patient was ambulated and her blood pressure was rechecked and recorded at 144/40. Respondent instructed the nurse to discontinue the IV and discharge​ the patient home.
F. At approximately 5:25 p.m., patient D.H.'s blood pressure was 144/40 and her pulse was 133, however, the nurse noted that the patient was still feeling weak. Respondent had left the building, and the nurse asked another physician in the clinic to evaluate the patient. Patient D.H. was subsequently transported by ambulance to the emergency room at P. Hospital.
G. Patient D.H. was seen at P. Hospital emergency room at approximately 7:10 p.m. She received one liter of IV fluids with sodium chloride. A CT scan of her abdomen and pelvis revealed an 8 cm abscess in the left abdominal wall. She was treated with antibiotics and transferred to K. Hospital.
H. At K. Hospital, patient D.H. underwent a CT guided drainage of the abdominal abscess and she was hospitalized for approximately one week.
I. Approximately one week after patient D.H. was seen by respondent in the nurses' clinic on or about September 26, 2006, a nurse working with respondent brought him a progress sheet that had been filled out by the nurse at the time of the September 26 clinic visit. The physician section on the progress sheet was blank. Respondent became upset that he had not seen the note before and refused to sign the progress note.
8. Respondent committed gross negligence in his care and treatment of patient D.H. which included, but was not limited to, the following:
(a) On or about September 26, 2006, respondent failed to examine patient D.H. before discharging her and before he left the building for the day.
SECOND CAUSE FOR DISCIPLINE
(Repeated Negligent Acts)
9. Respondent has further subjected his Physician's and Surgeon's Certificate No. G63835 to disciplinary action under sections 2227 and 2234 as defined by section 2234 subdivision (c), of the Code in that he committed repeated negligent acts in his care and treatment of patient D.H., as more particularly alleged hereinafter:
10. Paragraphs 7 and 8, above, are hereby incorporated by reference and re-alleged as if fully set forth herein.
(a) On or about September 21, 2006. respondent failed to evaluate the patient more thoroughly and address the issue of her low blood pressure;
(b) On or about September 26, 2006, respondent failed to perform an abdominal examination on the patient; and
(c) On or about September 26, 2006, respondent failed to check the patient's vital signs before ordering IV hydration.
THIRD CAUSE FOR DISCIPLINE
(Failure to Maintain Adequate and Accurate Medical Records)
11. Respondent is further subject to disciplinary action under sections 2227 and 2234, as defined by section 2266 of the Code, in that he failed to keep adequate and accurate records of his care, treatment and management of patient D.H. and other patients, as more particularly alleged hereinafter:
12. Paragraphs 7 and 8, above, are hereby incorporated by reference and re-alleged as if fully set forth herein.
Medical Record No. 9428563
A. The patient, then a 43-year old female with Type I diabetes, was seen by respondent for the first time on or about August 14, 2006. When respondent was interviewed by the Medical Board, on or about March 14, 2008, his chart note was illegible so he had to read his notes out loud.
B. The patient was on 4 units of insulin two times a day and respondent discontinued the morning dose. At this visit, respondent did not record how long the patient had insulin dependent diabetes. Similarly, on the patient's second visit to respondent, on or about August 22, 2006, respondent did not document how long the patient had insulin dependent diabetes.
Medical Record No. 7521581
C. The patient, then a 56-year old male, was first seen by respondent on or about August 2, 2006, for mild anemia, anxiety, fatigue, allergic rhinitis and a back problem. At his interview with the Medical Board, on or about March 14, 2008, respondent tried to read his notes but he could not decipher some of the words.
Medical Record No. 6994970
D. The patient, then an 84-old female, was seen by respondent approximately 30 times, from in or about August, 2002, through October, 2006, for hypertension, hyperglycemia, and other medical conditions. During his interview with the Medical Board, on or about March 14, 2008, his chart notes were illegible so he had to read his notes out loud.
E. During his care of the patient, respondent made adjustments to the patient's medications, however, it was difficult for respondent to determine from his notes when he changed the patient's medications, whether he increased or decreased the dosage, and which medications the patient was taking in previous visits that she was still taking at the subsequent visits.
​Excerpt from Accusation dated 5/14/2018: [See amended accusation for changes.]
FIRST CAUSE FOR DISCIPLINE
(Aiding and Abetting Unlicensed Practice of Medicine)
14. Respondent has subjected his Physician's and Surgeon's Certificate No. 063835 to disciplinary action under sections 2227, 2264, and 2234, subdivision (a), as defined by section 2052, subdivision (b), of the Code, in that he aided and abetted the unlicensed practice of medicine, as more particularly alleged hereinafter:
15. On or about October 1, 2004, S.K, a California licensed Chiropractor, formed a professional corporation named, "First Health Medical Center of Fresno, Inc.," (FHMC). The primary place of business for FHMC was 7161 N. Howard Street, Suite 100, Fresno, CA, 93720.
16. On or about March 1, 2007, FHMC began to transact business under the fictitious business names of, "Mystique Medical Spa and Wellness Center of Fresno Inc.," "Mystique Medical Spa," and "Mystique Medical." (Mystique.) The primary place of business for Mystique was 7161 N. Howard Street, Fresno, CA, 93720. Mystique has never been incorporated with the California Secretary of State.
17. On or about August 4, 2009, at the Annual Meeting of the Board of Directors of FHMC, there was an agreement to add 20% to the cost of staff products regarding Mystique.
18. On or about September 15, 2012, at the Annual Meeting of the Board of Directors of FHMC, Respondent was named as the permanent Medical Director of FHMC.
19. On or about March 12, 2014, an undercover investigator for the Division of Investigations, M.P. (Investigator M.P.), attended a prescheduled appointment at Mystique, and was seen by Jaclynne Burris, R.N. (Nurse Burris) for a Botox consultation. Investigator M.P. was never seen by a physician, physician assistant, or nurse practitioner. During the appointment, Nurse Burris completed the entire evaluation, and recommended a specific number of Botox injections in specific locations of investigator M.P.'s face. Nurse Burris negotiated a price per unit for the Botox. Nurse Burris further informed Investigator M.P. that Mystique performs Botox on a walk-in basis, and that Investigator M.P. would not need to see a doctor first.
20. On or about September 15, 2014, an undercover investigator for the Division of Investigations, R.H. (Investigator R.H.)) called Mystique to schedule a Botox consultation. Investigator R.H. spoke with Ms. K, who identified herself as the manager. During that phone call, Ms. K identified Respondent as the medical director of Mystique, and claimed he was present every hour. She further informed Investigator R.H. that Respondent also worked at FHMC, which she explained was linked to Mystique.
21. On or about September 16, 2014, Investigator R.H. attended a prescheduled appointment at Mystique, and was seen by Crystal Bartolome, R.N. (Nurse Bartolome) for a Botox consultation. Investigator R.H. was never seen by a physician, physician assistant, or nurse practitioner. During the appointment, Nurse Bartolome completed the entire evaluation, and recommended a specific number of Botox injections in specific locations of Investigator R.H.'s face. Nurse Bartolome provided a price per unit for the Botox. Nurse Burris further informed Investigator R.H that she could perform the Botox that day, and that she would not need to see anyone else first.
22. On or about September 19, 2014, an undercover investigator for the Division of Investigations, M.T. (Investigator M.T.), attended a prescheduled appointment at Mystique, and was seen by Elsa Ortiz, R.N. (Nurse Ortiz) for a Botox consultation. Investigator M.T. was never seen by a physician, physician assistant, or nurse practitioner. During the appointment, Nurse Ortiz completed the entire evaluation, and recommended a specific number of Botox injections. Nurse Ortiz provided a price per unit for the Botox. Nurse Ortiz further informed Investigator M.T. that she could perform the Botox that day. Investigator M.T. inquired about a product for eyelashes, and Nurse Ortiz recommended Latisse. After filling out a form, Investigator M.T. then purchased a box of Latisse for $194.80.
23. On or about November 14, 2014, an undercover investigator for the Division of Investigations, R.C. (Investigator R.C.), attended a prescheduled appointment at Mystique, and was seen by Nurse Ortiz for a Botox consultation. Investigator R.C. was never seen by a physician, physician assistant, or nurse practitioner. During the appointment, Nurse Ortiz completed the entire evaluation, and recommended a specific number of Botox injections. Nurse Ortiz provided a price per unit for the Botox. Investigator R.C. did not receive any Botox that day, but the medical record for the visit indicates that she received 58 units of Botox.
24. On or about November 14, 2014, investigators from the Division of Investigation served a search warrant on Mystique. During the execution of the search warrant, patient records and personnel documents were reviewed, witnesses were interviewed, and various pieces of evidence were booked.
25. On or about November 14, 2014, Ms. K was interviewed by an investigator from the Division of investigations. During that interview, Ms. K explained that Mystique is owned by FHMC. She further explained that Respondent is made aware of any patients with contra-indications for medication provided at Mystique.
26. On or about July 18, 2016, the Fresno County District Attorney filed a Felony Complaint against Respondent in the matter of The People of the State of California v. Elsa Flores Ortiz, Mark Lawrence Nazarian, Jaclynne Theresa Burris, Crystal Ines Bartolome, County of Fresno Superior Court Case No. F16904472. Count thirteen of the complaint charged Respondent with Aiding and Abetting the Practice of Medicine without Certification between on or about March 1, 2013, through October 31, 2014, in violation of Business and Professions Code section 2052(b), a felony.
27. PATIENT A: On or about September 14, 2011, through on or about November 12, 2014, Patient A received multiple treatments from nurses at Mystique, including but not limited to Botox injections. Patient A was never seen by a physician, physician assistant, or nurse practitioner at any of these appointments, with the exception of November 5, 2013, when Nurse Practitioner S.T. completed a "Skin Care Standing Order," authorizing continued treatment. Patient A's chart contains no record of a physical examination being conducted on that date, or any date thereafter.
28. PATIENT B: On or about April 11, 2014, through on or about September 19, 2014, Patient B received multiple laser hair removal treatments from nurses at Mystique. Patient B was never seen by a physician, physician assistant, or nurse practitioner at any of these appointments prior to receiving treatment.
SECOND CAUSE FOR DISCIPLINE
(Gross Negligence)
29. Respondent has further subjected his Physician's and Surgeon's Certificate No. G63835 to disciplinary action under sections 2227 and 2234, as defined by section 2234, subdivision (b), of the Code, in that respondent committed gross negligence in his care and treatment of patients A and B, as more particularly alleged hereinafter:
(a) Paragraphs 14 through 28, above, are incorporated by reference and realleged as if fully set forth herein.
(b) Respondent committed gross negligence in his care and treatment of patient A by allowing a registered nurse to evaluate and treat the patient without a prior consultation with the supervising physician, physician assistant, or nurse practitioner; and
(c) Respondent committed gross negligence in his care and treatment of patient B by allowing a registered nurse to evaluate and treat the patient without a prior consultation with the supervising physician, physician assistant, or nurse practitioner.
THIRD CAUSE FOR DISCIPLINE
(Repeated Negligent Acts)
30. Respondent has further subjected his Physician's and Surgeon's Certificate No. G63835 to disciplinary action under sections 2227 and 2234, as defined by section 2234, subdivision (c), of the Code, in that he committed repeated negligent acts in his care and treatment of patients A and B, as more particularly alleged in paragraphs 14 through 29, above, which are hereby incorporated by reference and re-alleged as if fully set forth herein·
FOURTH CAUSE FOR DISCIPLINE
(Furnishing Dangerous Drugs Without Exam)
31. Respondent has further subjected his Physician's and Surgeon's Certificate No. G63835 to disciplinary action under sections 2227 and 2234, as defined by section 2242, of the Code, in that he prescribed, dispensed, or furnished dangerous drugs without an appropriate prior examination and medical indication as more particularly alleged in paragraphs 14 through 30 above, which are hereby incorporated by reference and realleged as if fully set forth herein.
DISCIPLINARY CONSIDERATIONS
32. To determine the degree of discipline, if any, to be imposed on Respondent Mark Lawrence Nazarian, M.D., Complainant alleges that on or about March 29, 2010, in a prior disciplinary action entitled, In the Matter of the Accusation Against Mark Lawrence Nazarian, MD., before the Medical Board of California, Case No. 10-2007-181465, Respondent's license was publicly reprimanded in connection with his care and treatment of one patient, as set forth in Accusation No. 10-2007-181465. That decision is now final and is incorporated by reference as if fully set forth herein.
#FARCE—The number of causes of discipline in the second accusation have been whittled own from 4 in the original accusation to 1 in the second amended accusation. |
