Doctor's Name

NEW YORK MEDICAL COLLEGE

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• 8/22/2017—SURRENDER OF CALIFORNIA MEDICAL LICENSE, EFFECTIVE 12/31/2017.
  • 3/10/2017—FIRST AMENDED ACCUSATION FILED.
  • 5/20/2016—ACCUSATION/PETITION TO REVOKE FOR GROSS NEGLIGENCE, REPEATED NEGLIGENT ACTS, PRESCRIBING WITHOUT AN APPROPRIATE PRIOR EXAMINATION, FAILURE TO MAINTAIN ADEQUATE AND ACCURATE MEDICAL RECORDS, AND UNPROFESSIONAL CONDUCT.
• 5/30/2004—PROBATION COMPLETED. LICENSE FULLY RESTORED FOLLOWING PROBATION. 
• 4/27/2000—4 YEARS PROBATION WITH TERMS AND CONDITIONS, EFFECTIVE 5/30/2000. 
  • 3/17/1999—ACCUSATION FILED.
• 12/10/1988—PRIOR PROBATION COMPLETED. 
• 1/04/1984—5 YEARS PROBATION FOR GROSS NEGLIGENCE/INCOMPETENCE. 
  • 7/11/1983—FIRST AMENDED ACCUSATION FILED.
  • 7/26/1982—ACCUSATION FILED.

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Youtube video showing Dr. Santella wielding a knife at a religious minister outside his clinic.

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Excerpt from Accusation dated 7/17/2017:

FIRST CAUSE FOR DISCIPLINE
(Gross Negligence)

10. Respondent has subjected his Physician's and Surgeon's Certificate No. 023945 to disciplinary action under sections 2227 and 2234, as defined in section 2234, subdivision (b), of the Code, in that Respondent committed gross negligence in his care and treatment of patients J.R., K.J., R.G., E.H., C.T., V.A., and T.D., as more particularly alleged hereinafter:

Patient J.R.

(a) In or around 1991, Respondent began treating patient J.R. and continued seeing her as a primary care physician for more than twenty (20) years. 

(b) Respondent treated patient J.R. for multiple conditions including, chronic pain, myasthenia gravis, anemia and tachycardia.

(c) Respondent routinely gave patient J.R. injections of Demerol and fentanyl at office visits, but he did not document in patient J.R.'s progress notes any reasons and/or treatment plan for administering these injections of controlled substances to her.

(d) Dosage amounts and lot numbers for controlled substances administered and/or dispensed to patient J.R. are frequently missing from the progress notes. Respondent documented in the progress notes that he had administered the "standard dose" of controlled substances to patient J.R. rather than specify an amount given. However, in many of the progress notes it is unclear whether Respondent actually administered an injection to patient J.R. during these visits.

(e) Respondent rarely documented any history or physical examination findings in patient J.R.'s progress notes.

(f) Despite being a patient of Respondent's for over twenty (20) years, patient J.R.'s medical records do not contain a clear medical indication documented by Respondent (or the use of controlled substances to treat patient J.R.'s pain.

(g) Despite being a patient of Respondent's for over twenty (20) years, patient J.R.'s medical records contain only one (1) pain assessment progress note documenting some assessment of the course of treatment she was receiving from Respondent.

(h) In a progress note dated April 13, 2012, it is documented that patient J.R. had chronic anemia. Laboratory tests conducted at or around the time of this progress note indicated a drop in her hemoglobin level to 7.0, which was lower than the last tested level of 11.7. Significantly, Respondent did not take any action after laboratory tests showed a drop in her hemoglobin level.

(i) Respondent committed gross negligence in his care and treatment of patient J.R. which included, but was not limited to, the following:

(1) Respondent failed to maintain adequate and accurate records including, but not limited to, failing to document whether controlled substances had been administered and/or dispensed to patient J.R.; failing to document the reasons why controlled substances had been administered and/or dispensed to patient J.R.; failing to document what were the dosages of the controlled substances administered and/or dispensed to patient J.R.; and rarely documenting any history or physical examination findings, treatment plan and/or periodic review during patient J.R.'s course of treatment; and

(2) Respondent failed to act on a significantly abnormal blood test result in light of patient J.R.'s diagnosed chronic anemia.

Patient K.J.

(j) In or around 2005, Respondent began treating patient K.J. and continued seeing her as a primary care physician for approximately nine (9) years. 

(k) Respondent treated patient K.J. for multiple conditions including, lower back pain, arthritic pain in feet and knees, depression and chronic obstructive pulmonary disease.

(l) Respondent also treated patient K.J. for uncontrolled hypertension. Patient K.J.'s blood pressure measured at numerous visits was out of control, with systolic ranging between 185 to 196 and diastolic ranging between 110 to 132. There were multiple follow up visits with Respondent where patient K.J.'s blood pressure was not recorded in the progress note. Significantly, Respondent did not take any action to look for secondary causes of patient K.J.'s hypertension; nor did he refer patient K.J. to a specialist for assistance with management of her uncontrolled hypertension.

(m) To treat patient K.J.'s pain, Respondent initially prescribed her Vicodin; which was then escalated to Vicodin ES and later morphine plus Vicodin ES. In or around 2012, Respondent began prescribing patient K.J. Dilaudid; which was later changed to and varied between oxycodone, Percocet and Norco. Significantly, Patient K.J.'s "overuse of pain medications" was noted in a progress note, but Respondent never referred her to a pain management specialist for further evaluation.

(n) Respondent routinely gave patient K.J. injections of Demerol and fentanyl at office visits, but he did not document in patient K.J.'s progress notes any reasons and/or treatment plan for administering these injections of controlled substances to her.

(o) Dosage amounts and lot numbers for controlled substances administered and/or dispensed to patient K.J. are frequently missing from the progress notes. Respondent documented in the progress notes that he had administered the standard dose" of controlled substances to patient K.J. rather than specify an amount given. However, in many of the progress notes it is unclear whether Respondent actually administered an injection to patient K.J. during these visits.

(p) Respondent rarely documented any history or physical examination findings in patient K.J.'s progress notes.

(q) Despite being a patient of Respondent's for approximately nine (9) years, patient K.J.'s medical records do not contain a clear medical indication documented by Respondent for the use of controlled substances to treat patient K.J.'s pain.

(r) Despite being a patient of Respondent's for approximately nine (9) years, patient K.J.'s medical records contain only one (1) pain assessment progress note documenting some assessment of the course of treatment she was receiving from Respondent.

(s) Respondent committed gross negligence in his care and treatment of patient K.J. which included, but was not limited to, the following:

(1) Respondent failed to maintain adequate and accurate records including, but not limited to, failing to document whether controlled substances had been administered and/or dispensed to patient K.J.; failing to document what were the dosages of the controlled substances administered and/or dispensed to patient K.J.; failing to document the reasons why controlled substances had been prescribed to patient K.J.; and rarely documenting any history or physical examination findings, treatment plan and/or periodic review during patient K.J.'s course of treatment.

Patient R.G.

(t) In or around 1995, Respondent began treating patient R.G. and continued seeing him as a primary care physician for approximately nineteen (19) years.

(u) Respondent treated patient R.G. for multiple conditions including, obesity, diabetes, hepatitis C and peripheral artery disease.

(v) Respondent prescribed monthly Percocet refills for patient R.G. due to chronic pain and surgeries. Despite several long gaps between patient visits, Respondent routinely refilled patient R.G.'s monthly Percocet prescription without seeing him. Moreover, Respondent never documented where patient R.G. had been even though he refilled the Percocet prescriptions without seeing Respondent for long periods of time.

(w) In or around October 2013, Respondent increased patient R.G.'s prescription quantity of Percocet from one (100) hundred tablets to one hundred fifty (150) tablets but did not document the reason or reasons for increasing the quantity of tablets.

(x) Respondent rarely documented any history or physical examination findings in patient R.G.'s progress notes.

(y) Despite being a patient of Respondent's for approximately nineteen (19) years, patient R.G.'s medical records do not contain a clear medical indication documented by Respondent for the use of controlled substances to treat patient R.G.'s pain.

(z) Despite being a patient of Respondent's for approximately nineteen (19) years, patient R.G.'s medical records contain only one (1) pain assessment progress note documenting some assessment of the course of treatment he was receiving from Respondent.

(aa) Respondent committed gross negligence in his care and treatment of patient R.G. which included, but was not limited to, the following:

(1) Respondent failed to maintain adequate and accurate records including, but not limited to, failing to document whether controlled substances had been administered and/or dispensed to patient R.G.; failing to document the reasons why controlled substances had been prescribed to patient R.G.; failing to document why the dosages of controlled substances prescribed to patient R.G. were adjusted; and rarely documenting any history or physical examination findings, treatment plan and/or periodic review during patient R.G.'s course of treatment.

Patient E.H.

(bb) In or around 2004, Respondent began treating patient E.H. and continued seeing her as a primary care physician for approximately ten (10) years.

(cc) Respondent treated patient E.H. for multiple conditions including, knee pain, lumbar degenerative disc disease and depression.

(dd) Respondent regularly prescribed Percocet on a monthly basis to patient E.H. due to chronic pain.

(ee) In or around November 2012, Respondent increased patient E.H.'s prescription quantity of Percocet from one (100) hundred tablets to one hundred fifty (150) tablets, but did not document the reason or reasons for increasing the quantity of tablets.

(ff) Respondent rarely documented any history or physical examination findings in patient E.H.'s progress notes.

(gg) Despite being a patient of Respondent's for approximately ten (10) years, patient E.H.'s medical records do not contain a clear medical indication documented by Respondent for the use of controlled substances to treat patient E.H. 's pain.

(hh) Despite being a patient of Respondent's for approximately ten (10) years, patient E.H.'s medical records contain only one (1) pain assessment progress note documenting some assessment of the course of treatment she was receiving from Respondent.

(ii) Respondent committed gross negligence in his care and treatment of patient E.H. which included, but was not limited to, the following:

(1) Respondent failed to maintain adequate and accurate records including, but not limited to, failing to document whether controlled substances had been administered and/or dispensed to patient E.H.; failing to document the reasons why controlled substances had been prescribed to patient E.H.; failing to document why the dosages of controlled substances prescribed to patient E.H. were adjusted; and rarely documenting any history or physical examination findings, treatment plan and/or periodic review during patient E.H.'s course of treatment.

Patient C.T.

(jj) In or around 2005, Respondent began treating patient C.T. and continued seeing him as a primary care physician for approximately nine (9) years. Patient C.T.'s progress notes and medical records prior to 2010 were accidentally destroyed by Respondent's office.

(kk) Respondent treated patient C.T. for multiple conditions including, obesity, diabetes mellitus and pain management. Respondent had suffered a crush injury which resulted in a leg amputation and had left him confined to a wheel chair [sic].

(ll) In or around February 2010, Respondent was prescribing Percocet 5-325 mg tablets to patient C.T. for pain management. However, according to prescription records, the Percocet dosage was later increased to 10-325 mg tablets, but with no corresponding documentation in patient C.T.' s progress notes explaining the reason or reasons for increasing the dosage.

(mm) In or around August 2012, Respondent prescribed OxyContin 14 20 mg tablets to patient C.T. In or around April 2013, Respondent increased patient C.T.'s OxyContin dosage to 40 mg tablets, but with no corresponding documentation in the progress notes explaining the reason or reasons for increasing the dosage. In or around May 2013, according to prescription records Respondent increased patient C.T.'s OxyContin dosage to 80 mg tablets, and again, there is no corresponding documentation in the progress notes explaining the reason or reasons for increasing the dosage. Significantly, in light of factors indicating that patient C.T.'s pain was not being adequately treated with escalating dosages of OxyContin, Respondent never referred him to a pain management specialist for further evaluation.

(nn) In or around June 2014, Respondent was still prescribing both Percocet 5-325 mg tablets and OxyContin 80 mg tablets to patient C.T.

(oo) Despite being a patient of Respondent's for approximately nine (9) years, patient C.T.'s medical records do not contain a clear medical indication documented by Respondent for the use of controlled substances.

(pp) Despite being a patient of Respondent's for approximately nine (9) years, patient C.T.'s medical records contain only one (1) pain assessment progress note documenting some assessment of the course of treatment he was receiving from Respondent.

(qq) Regarding Respondent's care and treatment of patient C.T.'s diabetes mellitus, in April 2011, and June 2011, two (2) laboratory tests were performed, which looked at his hemoglobin and creatinine levels and a lipid panel was performed. These tests performed in 2011 are the last laboratory tests found in patient C.T.'s medical records, even though he continued to see Respondent for another three (3) years. Nor does there appear to be any documentation in his medical records of an ophthalmology evaluation to screen for diabetic retinal disease.

(rr) Respondent rarely documented any history or physical examination findings in patient C.T.'s progress notes.

(ss) Respondent committed gross negligence in his care and treatment of patient C.T. which included, but was not limited to, the following:

(1) Respondent failed to maintain adequate and accurate records including, but not limited to, failing to document whether controlled substances had been administered and/or dispensed to patient C.T.; failing to document the reasons why controlled substances had been prescribed to patient C.T.; failing to document why the dosages of controlled substances prescribed to patient C.T. were adjusted; and rarely documenting any history or physical examination findings, treatment plan and/or periodic review during patient C.T.'s course of treatment.

Patient V.A.

(tt) On or about December 6, 2012, Respondent performed surgery on patient V.A. to remove a ruptured ovarian cyst.

(uu) On or about December 11, 2012, Respondent saw patient V.A. for a post-operative office visit. Patient V.A. complained of pain and Respondent prescribed her Demerol, a controlled pain medication. Respondent failed to perform an adequate medical history and physical examination, as well as document informed consent prior to issuing a controlled prescription for opioids. Three (3) days later, Respondent prescribed the patient a second controlled pain medication, Roxicodone, due to her complaints of persistent pain. Again, Respondent failed to obtain a history, perform a physical exam, and document informed consent before issuing this controlled prescription for opioids.

(vv) On or about January 12, 2014, Respondent charted a follow-up visit with patient V.A. and documented that her pain medication, Demerol, was not working. Respondent refilled the patient's Roxicodone prescription and added naproxen and MS Contin. Again, Respondent failed to obtain a history, perform a physical exam, and document informed consent before issuing this controlled prescription for opioids.

(ww) In or around January 2013, patient V.A., who was admitted into a hospital for unspecified care, provided a polysubstance abuse history to the medical provider which had included, opioids, methamphetamine, and marijuana.

(xx) In or around February 2013, Respondent, with full knowledge of patient V.A.'s polysubstance abuse history, refilled her prescription for Roxicodone and also started her on Butrans, an opioid delivered via transdermal patch. Again, Respondent failed to obtain a history, perform a physical exam, and document informed consent before issuing this controlled prescription for opioids.

(yy) Respondent maintained patient V.A. on controlled pain medications for over the next two (2) years, up to in or around April 2015. During this period of time, Respondent never obtained a history, performed a physical exam, and/or documented informed consent before issuing these controlled prescriptions for opioids. During this same period of time, Respondent, despite the lack of improvement in this patient's pain, never documented a review of the course of pain treatment and/or considered changes in therapy other than to increase the quantity of pain medications already prescribed to the patient. Lastly, during this same period of time, Respondent never referred patient V.A. to a pain management specialist, ordered a drug screen, and/or ran a Controlled Substance Utilization Review and Evaluation System (CURES) report to determine if she was using or abusing her controlled prescriptions.

(zz) On or about April 20, 2017, Respondent was interviewed at the California Medical Board's San Diego District Office, with his attorney present, regarding the care and treatment he had provided to patient V.A. During the subject interview, Respondent was asked about the patient's persistent pain and why he had continued to prescribe her opioids, to which he replied "[I]n desperation I would refill her medications somehow just to get rid of her."

(aaa) Respondent committed gross negligence in his care and treatment of patient V.A. which included, but was not limited to, the following:

(1) Respondent failed to perform periodic review of patient V.A.'s pain and treatment status; and

(2) Respondent, with full knowledge of patient V.A.'s polysubstance abuse history, increased the prescription quantity and number of different controlled prescriptions issued to her.

Patient T.D.

(bbb) On or about September 14, 2015, Respondent performed a second trimester abortion on patient T.D. The procedure was performed at an abortion clinic, Family Planning Associates (FPA), where Respondent had worked performing abortions. Regarding the procedure, FPA's post-operative note indicated that all "products of conception" had been observed and accounted for, and that the patient had tolerated the procedure well. However, during the procedure itself, the patient had suffered significant blood loss of approximately 2000 ml and had to be treated with a medication combination of tocolytics to stop the hemorrhaging. In fact, Respondent documented that the patient had suffered significant hemorrhaging during the procedure. However, despite a loss of approximately 2000 ml of blood during the surgical abortion, Respondent believed patient T.D. was stable enough to be moved into a recovery room at FPA. Initially, the patient's condition was documented as stable. However, Respondent was soon notified that excessive bleeding had begun and the patient was then returned to an operating room at FPA and a Foley catheter balloon was used to tamponade the uterine cavity.

(ccc) Patient T.D.'s family called 911 and an ambulance arrived to transfer her from FPA to Scripps La Jolla Hospital (Scripps) emergency room. Patient T.D. arrived at Scripps in hemorrhagic shock. She was later stabilized and then taken to an operating room where she underwent a supercervical hysterectomy and left salpingo-oopherectomy for uterine perforation, and injury to the left uterine vessels and the left adnexal vessels in the retroperitoneal space. Significantly, a pathology report later documented that "products of conception" were still in patient T.D.'s uterus.

(ddd) Dr. A.S. was the physician who had handled patient T.D.'s case when she first arrived to the Emergency Room at Scripps. Dr. A.S. later informed Medical Board investigators that Respondent had never contacted him to provide any information about patient T.D.'s abortion procedure and/or the complications she had experienced during and after the procedure at FPA. In fact, Respondent failed to document that he had ever contacted Dr. A.S. to follow up on his patient's condition following her transfer in an ambulance under emergent conditions.

(eee) On or about January 21, 2016, Respondent saw patient T.D. at his office. She was complaining of "pain" and "hot flashes." Respondent, without performing a medical examination and/or obtaining and documenting informed consent, prescribed patient T.D. one hundred forty (140) tablets of narcotics and ninety (90) tablets of Lexapro. On or about the following day, Respondent mailed a letter to patient T.D. indicating that he was refusing to care for her in the future, and that she needed to see the surgeon who did her hysterectomy for ongoing care.

(fff) Respondent committed gross negligence in his care and treatment of patient T.D. which included, but was not limited to, the following:

(I) Respondent failed to recognize and react to the severity of patient T.D.'s emergent condition;

(2) Respondent failed to seek tertiary care for patient T.D. in a timely manner given her emergent condition;

(3) Respondent failed to adequately and correctly document the procedure and related events that transpired on or about September 14, 2015; and

(4) Respondent failed to communicate with patient T.D. the details of her procedure and the serious complications that occurred afterwards; rather, he just prescribed her controlled pain medications, without performing a medical examination and/or obtaining informed consent, and simply discharged her from his practice.

SECOND CAUSE FOR DISCIPLINE
(Repeated Negligent Acts)

11. Respondent has further subjected his Physician's and Surgeon's Certificate No. 023945 to disciplinary action under sections 2227 and 2234, as defined in section 2234, subdivision (c), of the Code, in that Respondent committed repeated negligent acts in his care and treatment of patients J.R., K.J., R.G., E.H., C.T., V.A., and T.D., as more particularly alleged hereinafter:

Patient J.R.

(a) Paragraphs 1O(a) through 1O(i), above, are incorporated by reference and realleged as if fully set forth herein.

(b) Respondent committed repeated negligent acts in his care and treatment of patient J.R., which included, but was not limited to, the following:

(1) Respondent failed to properly document a satisfactory history and physical examination including, failing to clearly document a recognized medical indication for the use of controlled substances in treating patient J.R.'s chronic pain;

(2) Respondent failed to properly document a treatment plan including, failing to develop and record a treatment plan for the use of controlled substances in treating patient J.R.'s chronic pain;

(3) Respondent used a "standard dose" of medications when treating patient J.R.'s chronic pain with controlled substances rather than individualizing pharmacological therapy to meet her medical needs; and

(4) Respondent failed to perform periodic review of patient J.R.'s pain and treatment status.

Patient K.J.

(c) Paragraphs 10(j) through 10(s), above, are incorporated by reference and realleged as if fully set forth herein.

(d) Respondent committed repeated negligent acts in his care and treatment of patient K.J., which included, but was not limited to, the following:

(1) Respondent failed to properly document a satisfactory history and physical examination including, failing to clearly document a recognized medical indication for the use of controlled substances in treating patient K.J.'s chronic pain;

(2) Respondent failed to properly document a treatment plan including, failing to develop and record a treatment plan for the use of controlled substances in treating patient K.J.'s chronic pain;

(3) Respondent used a "standard dose" of medications when treating patient K.J.'s chronic pain with controlled substances rather than individualizing pharmacological therapy to meet her medical needs;

(4) Respondent failed to perform periodic review of patient K.J.'s pain and treatment status;

(5) Respondent failed to adjust Patient K.J.'s medications and/or make a referral to a pain management specialist in light of the concern over her "overuse of pain medications"; and

(6) Respondent failed to adequately work up and manage patient K.J.'s severe hypertension.

Patient R.G.

(e) Paragraphs 10(t) through 10(aa), above, are incorporated by reference and realleged as if fully set forth herein.

(f) Respondent committed repeated negligent acts in his care and treatment of patient R.G., which included, but was not limited to, the following:

(1) Respondent failed to properly document a satisfactory history and physical examination including, failing to clearly document a recognized medical indication for the use of controlled substances in treating patient R.G.'s chronic pain;

(2) Respondent failed to properly document a treatment plan including, failing to develop and record a treatment plan for the use of controlled substances in treating patient R.G.'s chronic pain;

(3) Respondent failed to perform periodic review of patient R.G.'s pain and treatment status.

Patient E.H.

(g) Paragraphs 10(bb) through 10(ii), above, are incorporated by reference and realleged as if fully set forth herein.

(h) Respondent committed repeated negligent acts in his care and treatment of patient E.H., which included, but was not limited to, the following:

(1) Respondent failed to properly document a satisfactory history and physical examination including, failing to clearly document a recognized medical indication for the use of controlled substances in treating patient E.H.'s chronic pain;

(2) Respondent failed to properly document a treatment plan including, failing to develop and record a treatment plan for the use of controlled substances in treating patient E.H.'s chronic pain; and

(3) Respondent failed to perform periodic review of patient E.H.'s pain and treatment status.

Patient C.T.

(i) Paragraphs 10(jj) through 10(ss), above, are incorporated by reference and realleged as if fully set forth herein.

(j) Respondent committed repeated negligent acts in his care and treatment of patient C.T., which included, but was not limited to, the following:

(1) Respondent failed to properly document a satisfactory history and physical examination including, failing to clearly document a recognized medical indication for the use of controlled substances in treating patient C.T.'s chronic pain;

(2) Respondent failed to properly document a treatment plan including, failing to develop and record a treatment plan for the use of controlled substances in treating patient C.T.'s chronic pain;

(3) Respondent failed to perform periodic review of patient C.T.'s pain and treatment status;

(4)  Respondent failed to make a referral to a pain management specialist; and

(5)  Respondent failed to adequately monitor patient C.T.'s diabetes mellitus.

Patient V.A.

(k) Paragraphs 1O(tt) through 1O(aaa), above, are incorporated by reference and realleged as if fully set forth herein. 

(I) Respondent committed repeated negligent acts in his care and treatment of patient V.A., which included, but was not limited to, the following:

(1) Respondent failed to perform periodic review of patient V.A.'s pain and treatment status;

(2) Respondent, with full knowledge of patient V.A.'s polysubstance abuse history, increased the prescription quantity and number of different controlled prescriptions issued to her;

(3) Respondent failed to obtain a substance abuse history before prescribing controlled medications to patient V.A.;

(4)  Respondent failed to obtain and document informed consent; and

(5)  Respondent failed to refer patient V.A., with her complex pain issues outside of Respondent's scope of practice, to a pain management specialist.

Patient T.D.

(m) Paragraphs 10(bbb) through 10(fff), above, are incorporated by reference and realleged as if fully set forth herein.

(n) Respondent committed repeated negligent acts in his care and treatment of patient T.D., which included, but was not limited to, the following:

(1) Respondent failed to recognize and react to the severity of patient T.D.'s emergent condition;

(2) Respondent failed to seek tertiary care for patient T.D. in a timely manner given her emergent condition;

(3) Respondent failed to adequately and correctly document the procedure and related events that transpired on or about September 14, 2015; and

(4) Respondent failed to communicate with patient T.D. the details of her procedure and the serious complications that occurred afterwards; rather, he just prescribed her controlled pain medications, without performing a medical examination and/or obtaining informed consent, and simply discharged her from his practice.

THIRD CAUSE FOR DISCIPLINE
(Prescribing Without an Appropriate Prior Examination)

12. Respondent has further subjected his Physician's and Surgeon's Certificate No. G23945 to disciplinary action under sections 2227 and 2234, as defined in sections 2242 and 4022, of the Code, in that Respondent prescribed, dispensed, or furnished dangerous drugs to patients J.R., K.J., R.G., E.H., C.T., V.A., and T.D., without an appropriate prior examination and a medical indication, as more particularly alleged hereinafter:

13. Paragraphs 10 and 11, above, are hereby incorporated by reference and realleged as if fully set forth herein.

FOURTH CAUSE FOR DISCIPLINE
(Failure to Maintain Adequate and Accurate Medical Records)

14. Respondent has further subjected his Physician's and Surgeon's Certificate No. G23945 to disciplinary action under sections 2227 and 2234, as defined in section 2266, of the Code, in that Respondent failed to maintain adequate and accurate records in c0nnection with his care and treatment of patients J.R., K.J., R.G., E.H., C.T., V.A., and T.D., as more particularly alleged hereinafter:

15. Paragraphs 10 and 11, above, are hereby incorporated by reference and realleged as if fully set forth herein.

FIFTH CAUSE FOR DISCIPLINE
(Unprofessional Conduct)

16. Respondent has further subjected his Physician's and Surgeon's Certificate No. G23945 to disciplinary action under sections 2227 and 2234 of the Code, in that Respondent has engaged in conduct which breaches the rules or ethical code of the medical profession, or conduct which is unbecoming to a member in good standing of the medical profession, and which demonstrates an unfitness to practice medicine, as more particularly alleged hereinafter:

17. Paragraphs 10, 11, 12, 13, 14 and 15, above, are hereby incorporated by reference and realleged as if fully set forth herein.

18. On or about June 11, 2016, an incident was captured on video 19 involving Respondent and another individual (M.Z.) in front of a clinic, wherein Respondent engaged in outrageous conduct and made physically threatening gestures towards M.Z. The clinic, Family Planning Associates, is an abortion clinic located in San Diego where Respondent was working on that date. M.Z. was present outside of the clinic that day to read from the Bible and essentially protest abortion. The video showed Respondent exiting the clinic's front entrance with a large pair of scissors in his hand and walking directly over to M.Z., who was standing approximately ten to twelve (10 to 12) feet away from the clinic's front entrance with his back towards the second floor railing. Respondent quickly approached M.Z. after M.Z. had stated that he needed to repent for "murdering babies." Respondent aggressively pressed his face to within inches of M.Z.'s face and angrily replied "Why?" During the exchange, Respondent obnoxiously exhaled several times directly into M.Z.'s face while speaking in a guttural tone of voice. When asked if he did that to babies, Respondent replied in a guttural tone "Yeah, I love it!" At one point, Respondent raised the large pair of scissors still in his hands to chest level and aggressively leaned his body forward causing physical contact with M.Z., who then turned away and took a step back towards the railing to avoid Respondent. Respondent still holding the scissors only inches away from M.Z., continued making guttural sounds and aggressively exhaling right into M.Z.'s face. When told about all of the babies that he had "killed" Respondent continued to repeat "I love it, I love it!" in a guttural tone of voice; remarkably, he said this and still continued his outrageous conduct even as patients, including a young child, are seen entering the clinic's front entrance.

DISCIPLINARY CONSIDERATIONS

19. To determine the degree of discipline, if any, to be imposed on Respondent, Complainant alleges that on or about May 30, 2000, in a prior disciplinary action entitled In the Matter of the Accusation Against Robert John Santella, MD., Case No. 10-1996-61463, the Medical Board of California (Board) issued a decision revoking Respondent's Physician's and Surgeon's Certificate No. G23945, staying that revocation, and placing Respondent on probation for four (4) years on various terms and conditions. The Board imposed discipline on Respondent in this matter based on findings that Respondent admitted he failed to maintain adequate records as alleged in paragraph eight (8) of the Accusation. That decision is now final and is incorporated by reference as if fully set forth herein.

20. To determine the degree of discipline, if any, to be imposed on Respondent, Complainant alleges that on or about December 10, 1983, in a prior disciplinary action entitled In the Matter of the Accusation Against Robert Santella, MD., Case No. 07-1981-702851, the Board of Medical Quality Assurance of California (Board) issued a decision revoking Respondent's Physician's and Surgeon's Certificate No. 023945, staying that revocation, and placing Respondent on probation for five (5) years on various terms and conditions. The Board imposed discipline on Respondent in this matter based on findings that Respondent had committed acts of gross negligence and/or incompetence. That decision is now final and is incorporated by reference as if fully set forth herein.

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Excerpt from Accusation dated 3/17/1999:

FIRST CAUSE FOR DISCIPLINE
(Incompetence)

5. Respondent Robert John Santella, M.D., is subject to disciplinary action on account of the following:

PATIENT ELLA M.

A. Patient Ella M. (hereinafter "Ella"), a then 46 year old Gravida 1, Para 1 female, first presented to on November 4, 1994. She had dysfunctional bleeding and a left adnexal mass that respondent continued to observe until he performed surgery on March 30, 1995.

B. On March 30, 1995, without first investigating the possibility of an intrauterine malignancy, respondent performed a vaginal hysterectomy without laparoscopic assistance.

C. During the surgery, he discovered that the adnexal lesion was markedly adherent to the pelvic area and the omentum. Accordingly, the lesion was extremely difficult to remove.

D. Portions of respondent's chart notes for Ella have diagrams drawn over them, making the notes difficult to read and making it difficult to discern the goals of the diagnostic evaluation or treatment plan.

PATIENT JACKIE W.

E. Patient Jackie W. (hereinafter "Jackie"), a then 30 year old Gravida 5, Para 3 female with a history of long standing pelvic inflammatory disease and multiple surgeries, first presented to respondent on January 6, 1994 with complaints of irregular bleeding and pelvic pain. On January 12, 1994, respondent performed a diagnostic laparoscopy and the endocervical portion of a D&C, during which he noted and drained multi-cystic ovaries. The D&C was reported as revealing severe dysplasia even though a pap smear two days earlier was negative. Further, respondent failed to perform a cone biopsy or loop excision to determine the appropriate method of treatment. And, in fact, final pathology did not confirm the presence of endocervical dysplasia.

F. On February 9, 1994, Jackie was admitted to the hospital for a total vaginal hysterectomy for severe endocervical dysplasia and chronic pelvic pain. A right ovarian cystectomy was performed during the surgery.

G. Respondent went on to perform a right laparoscopic oophorectomy in August 1994, followed by a left salpingo-oophorectomy and appendectomy in June 1995.

H. Portions of respondent's chart notes for Jackie have diagrams drawn over them, making the notes difficult to read and making it difficult to discern the goals of the diagnostic evaluation or treatment plan.

PATIENT THREE

I. Patient Three, a then 60 year old female, first presented to respondent on July 31, 1995, for a preoperative evaluation of a suspected ovarian malignancy.

J. On August 7, 1995, respondent performed a total abdominal hysterectomy and bilateral salpingo- oophorectomy with pelvic washings. An ovarian tumor showing no surface irregularities was removed without rupture. Intraoperative frozen section diagnosis was reported as mucinous ovarian neoplasm with some features suggesting possible borderline tumor. Respondent did not perform a lymph node biopsy or omentectomy.

K. Portions of respondent's chart notes for Patient Three have diagrams drawn over them, making the notes difficult to read and making it difficult to discern the goals of the diagnostic evaluation or treatment plan.

6. Respondent Robert John Santella, M.D., is subject to disciplinary action in that he was incompetent, in violation 19 of Code section 2234 (d), in connection with his care and treatment of Ella, Jackie and Patient Three, in that:

A. Complainant realleges paragraph 5 above and incorporates it by reference herein.23

B. Respondent performed a vaginal rather than abdominal hysterectomy on Ella.

 

C. Respondent failed to perform a cone biopsy or loop excision to evaluate Jackie's reported endocervical dysplasia prior to her hysterectomy.

D. Respondent failed to refer Jackie for psychiatric evaluation in the midst of her multiple gynecological surgeries.

E. Respondent frequently drew anatomic diagrams over his clinical notes regarding Ella, Jackie and Patient Three, making those notes difficult to read and making it difficult to discern the goals of his diagnostic evaluation and his treatment plan.

SECOND CAUSE FOR DISCIPLINE
(Repeated Negligent Acts)

7. Respondent Robert John Santella, M.D., is further subject to disciplinary action in that he committed repeated negligent acts, in violation of Code section 2234 (c), in connection with his care and treatment of Ella, Jackie and Patient Three, in that:

A. Complainant realleges paragraphs 5 and 6 above and incorporates them herein by reference.

B. Respondent failed to rule out endometrial malignancy with a screening endometrial biopsy prior to performing a vaginal hysterectomy for abnormal bleeding on Ella.

C. Respondent performed a vaginal rather than abdominal hysterectomy on Ella.

D. Respondent failed to perform a cone biopsy or loop excision to evaluate Jackie's reported endocervical dysplasia prior to her hysterectomy.

E. Respondent failed to refer Jackie for psychiatric evaluation in the midst of her multiple gynecological surgeries.

F. Respondent failed to obtain a confirmatory omental biopsy or perform a partial omentectomy in connection with his evaluation of Patient Three.

G. Respondent frequently drew anatomic diagrams over his clinical notes regarding Ella, Jackie and Patient Three, making those notes difficult to read and making it d~fficult to discern the goals of his diagnostic evaluation and his treatment plan.

THIRD CAUSE FOR DISCIPLINE
(Failure to Maintain Adequate and Accurate Records)

8. Respondent Robert John Santella, M.D., is further subject to disciplinary action for unprofessional conduct in that 16 he failed to maintain adequate and accurate records, in violation 17 of Code section 2266, as more specifically set forth in paragraphs 5, 6 and 7 above, which are incorporated herein by reference.

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Excerpt from Accusation dated 7/11/1983:

RANDA P. MATTER

23. At all times herein mentioned Randa P. was pregnant and was a patient of and under the care of respondent.

24. On or about August 27, 1981, Randa P. was admitted to El Cajon Valley Hospital by respondent where she delivered, at term, a stillborn female infant.

25. Respondent's management and treatment of patient Randa P. is incompetence in violation of section 2234(d) by reason of the following:

A. Respondent failed to recognize the potential danger of hypertension and headache manifested by the patient during the last weeks of pregnancy.

B. Respondent failed to consider that the patient's bleeding on August 26, 1981, might be due to placental separation.

C. Respondent failed to assess the fetal condition during the critical period of hypertension.

D. Respondent failed to take and record the fetal heart rate between August 17, 1981, and August 26, 1981.

E. Respondent failed to perform any test of the fetal condition.

F. Respondent failed to hospitalize the patient to properly evaluate preeclampsia or to evaluate the possibility of placental separation.