NATIONAL UNIVERSITY OF IRAN FACULTY OF MEDICINE—IRAN
- 1/07/2020—ACCUSATION FILED.
Excerpt from Accusation dated 1/07/2020:
FIRST CAUSE FOR DISCIPLINE
(Gross Negligence)
9. Respondent Kamran Matin, M.D. is subject to disciplinary action under section 2234, subdivision (b), in that he committed acts and omissions of gross negligence in his care and treatment of Patient A; The circumstances are as follows:
10. On or about August 22, 2014, Patient A, a then 77-year old female, presented to Southern California Permanente Medical Group (SCPMG or Kaiser) emergency department complaining of intense right-sided chest pain radiating into her mid-sternum, which she rated as an 8 out of 10, and was unable to catch her breath and sweating. She reported experiencing intermittent chest pain over the prior two weeks with shortness of breath upon regular activities, but her pain was now constant and crushing. Serial electrocardiograms2 (ECG or EKG) were concerning for dynamic changes and the Kaiser emergency room physician's impression was that the patient had unstable angina,3 an acute non-ST elevation myocardial infarction, and chest pain. The cardiologist at Kaiser determined the patient required a heart catheterization; however, their facility could not accommodate the patient for this procedure in a timely manner. As a result, she was transferred to Southern California Hospital - Culver City (SCHCC or Brotman) for further care and heart catheterization, which should be performed within seventy-two hours of patient presentation.
11. On or about August 23, 2014, at approximately 4:17 p.m., Patient A was admitted to the Intensive Care Unit (ICU) at SCHCC by admitting/attending physician, JN, and was seen by his Physician's Assistant (PA), and was subsequently placed in the Coronary Care Unit (CCU). Upon assessment, she was noted to be free of chest pain, but had diminished bilateral breathing sounds, and was on a heparin drip. The PA's assessment was NSTEMI with T-wave inversion. His plan was to follow the ECG results, and have the patient evaluated by a cardiologist for possible cardiac catheterization, among other things. At 7 p.m., Patient A's blood pressure was 116/61, with a heart rate of 72 beats per minute (bpm), and a respiratory rate of 18. At approximately 7:20 p.m., Respondent ordered a STAT ECG, which showed sinus rhythm with mild ST wave changes from V2 to V6; however, he did not physically see or examine the patient that day. At approximately 11 p.m., her blood pressure was low at 80/47, but subsequently returned to normal.
12. On or about August 24, 2014, at approximately 9:05 a.m., the PA ordered a STAT echocardiogram, which revealed that the left ventricular wall was normal, the left ventricular filling pattern was consistent with diastolic dysfunction, mild concentric hypertrophy, aortic valve calcification, mild mitral regurgitation, mild tricuspid regurgitation, and mildly increased pulmonary artery systolic pressure (PASP). Respondent did not physically see or examine the patient this day. At around 8 p.m. that evening, the patient's blood pressure was low at 94/32, and at 9 p.m., it was 96/47, but subsequently returned to normal.
13. On or about August 25, 2014, at approximately midnight, the patient's blood pressure was low at 108/43, and by 7 a.m., it was 100/39. At approximately 8:45 a.m., Respondent saw the patient for a cardiology consultation. At that time, her blood pressure was 125/49, and her heart rate was 77. Chest x-rays show no acute cardiovascular disease and an ECG showed sinus rhythm and rate with ST segment depression, incomplete right bundle branch block, and T-wave inversions, but no evidence of ST elevations. Respondent's assessment was NSTEMI, and he placed orders to start metoprolol, continue the heparin drip, aspirin and atorvastatin, and continue the benazepril. Respondent's plan was to perform a left heart catheterization and possible angioplasty and stent placement the next day once the patient was stable. He also wanted to obtain the patient's ECG results. According to Respondent, his hospital privileges allowed him to perform angiography/angiograms, but he did not have privileges to insert stents. Respondent subsequently placed a STAT order for Troponin, a 12-lead ECG, among other labs, and that that patient should have "nothing by mouth" (NPO) due to the scheduled heart catheterization later that day. Respondent, however, failed to document in the chart the reason for the change in his plans to perform the procedure, which was to be scheduled the following day, on August 26, 2014.
14. That day, on August 25, 2014, at approximately 4:20 p.m., Patient A was transported to the heart catheterization lab. While in the lab, Respondent stated he was informed by the lab personnel that hospital's new policy required that an interventional cardiologist be on the premises during the diagnostic catheterization, but one was not available at that time. Respondent, however, failed to document this conversation in the patient's chart, and failed to document with whom he spoke or the reasons why the catheterization was not performed at that time. At approximately 7:00 p.m., Patient A was returned to her room and the procedure was rescheduled for the next morning, August 26, 2014, at 8:00 a.m.
15. At approximately 9:00 p.m. that evening, an ECG noted sinus tachycardia changes and her blood pressure dropped to 78/46, and she had shallow breathing. According to the chart, at approximately 9:20 p.m., the nursing staff notified Respondent that the patient was complaining of intense chest pain, and that the ST segments were more depressed, and she had been hypotensive. Respondent ordered a STAT ECG, which was markedly ischemic, showing ST segment depression of up to 5 mm. According to Respondent, he did not hear back from the nursing staff regarding the ECG results nor the patient's condition; however, the chart reflects that Respondent was notified of the ECG results and that the patient's chest pain remained unchanged around 9:35 p.m. During his interview, Respondent stated that he did not call or follow-up regarding the ECG he had ordered because he presumed that everything was ok and that the attending physician, JN, probably dealt with the patient's condition. According to the chart, however, at approximately 9:47 p.m. Respondent ordered morphine, Plavix,27 and Troponin. At approximately 10:00 p.m., the patient's chest pain was an 8 out of 10, and sh~ was administered some medications.
16. On or about August 26, 2014, at approximately midnight, Patient A's chest pain was unchanged, but her blood pressure was low at 68/38, and she was vomiting. According to the chart, the nurse spoke with Respondent at that time and advised him of the patient's condition. At approximately 12:08 a.m., the chart reflects that Respondent placed an order for Levophed, Zofran, and sodium chloride. By 1:45 a.m., the patient's blood pressure had dropped to 68/26 and her heart rate was 119 bpm. At 2:30 a.m., the nurse recorded that the equipment could not pick up the patient's blood pressure. At approximately 2:45 a.m., the patient's blood pressure was 77/47, and her heart rate was 113 bpm. Fifteen minutes later, at approximately 3 a.m., her blood pressure was 32/14, and her respiratory rate was high at 32. At approximately 3:15 a.m., her blood pressure was 64/33 and her heart rate was 122 bpm. At 3:30 a.m., the patient's blood pressure was high at 132/93, and her heart rate was 115 bpm.
17. By 4:00 a.m., that morning Patient A's condition had changed. She was anxious, complaining of chest pain, and was still vomiting. She was noted to be in atrial fibrillation, with a bundle branch block noted along with widening of the QRS on ECG. Her blood pressure was 92/45, and her respiratory rate was 33. According to the chart, Respondent was paged at approximately 4:10 a.m. regarding the patient's condition, and the nurse noted that they were awaiting his call back. At 4:15 a.m., the patient's blood pressure could not be auscultated manually. By 4:45 a.m., her blood pressure was 76/41, and her heart rate was 126 bpm. Around 5 a.m., her blood pressure was 95/61, her heart rate was 125 bpm, and respiratory rate was 34. At 5:15 a.m., the patient's blood pressure was not detected and her heart rate was 132 bpm. According to the chart, at around 5:40 a.m., Respondent was notified that the patient was in Afib, that bundle branch block was noted with QRS widening and right axis deviation, and was very hypotensive. He ordered Amiodarone NS bolus. At approximately 5:45 a.m., the patient's blood pressure was 113/83 and her heart rate was 51 bpm. At approximately 5:58 a.m., Respondent was contacted again and informed that the patient was bradycardic. He stated he was on his way to the hospital. During that conversation, at approximately 6 a.m., a code blue was called and the patient reportedly had no vital signs. Cardiopulmonary resuscitation (CPR) was attempted by another physician, but unfortunately the patient expired at approximately 6:15 a.m. from cardiac arrest.
18. Respondent was grossly negligent in his care and treatment of Patient A when he failed to adequately follow up on the electrocardiogram ordered, failed to recognize re-infarction and cardiogenic shock, and failed to provide adequate treatment by performing a cardiac catheterization and a percutaneous coronary intervention (PCI), or to transfer the patient to a facility where the care could be timely provided.
SECOND CAUSE FOR DISCIPLINE
(Repeated Negligent Acts)
19. Respondent Kamran Matin, M.D. is subject to disciplinary action under section 2234, subdivision (c), in that he committed acts and omissions in his care and treatment of Patient A. The circumstances are as follows:
20. Paragraphs 10 through 17, above are incorporated by reference as if fully set forth herein.
21. Respondent's acts and omissions were repeatedly negligent when he:
A. Failed to adequately follow up on the electrocardiogram he ordered;
B. Failed to recognize re-infarction and cardiogenic shock; and
C. Failed to provide adequate treatment by performing cardiac catheterization and PCI or to transfer the patient to a facility where the care could be timely provided.
THIRD CAUSE FOR DISCIPLINE
(Failure to Maintain Adequate and Accurate Records)
22. espondent Kamran Matin, M.D. is subject to disciplinary action under section 2266, in that he failed to maintain adequate and accurate records in his care and treatment of Patient A. The circumstances are as follows:
23. Paragraphs 10 through 17, above are incorporated by reference as if fully set forth herein.
#PATIENTdeath |
