Doctor's Name

UNIVERSITY OF THE EAST, RAMON MAGSAYSAY MEMORIAL MEDICAL CENTER

---

---

• 9/14/2018—THREE YEARS PROBATION WITH VARIOUS TERMS AND CONDITIONS. DURING PROBATION, DR. GANDINGCO IS PROHIBITED FROM SUPERVISING PHYSICIAN ASSISTANTS AND ADVANCED PRACTICE NURSES. THIS RESTRICTION SHALL NOT APPLY WHEN SUPERVISING ADVANCED PRACTICE NURSES WHILE EMPLOYED WITH THE PERMANENTE MEDICAL GROUP AND/OR KAISER HOSPITALS IN THE HOSPITAL AND CLINICAL SETTINGS.
• 7/21/2017—ACCUSATION FILED.

---

---

Excerpt from Accusation dated 7/21/2017:

FIRST CAUSE FOR DISCIPLINE
(Repeated Negligent Acts)

6. Respondent Winnie Joyce Gandingco, M.D. is subject to disciplinary action under section 2234 subdivision (c) of the Code in that she committed repeated negligent acts in the care and treatment of patients S.M. and G.N. The circumstances are as follows:

Patient S.M.

7. The Medical Board of California received a Report of Settlement filed by the Kaiser Foundation Health Plan, Inc. notifying that it had paid a settlement on behalf of Respondent to patient S.M. for failure to diagnose a pulmonary embolism.

8. Patient S.M. was a 25-year-old female patient with a history of panic attacks, obesity and low back pain who saw Respondent on January 28, 2013 complaining ofdepression and pain in her chest. Respondent diagnosed her with major depression and costochondritis1 and prescribed Wellbutrin and Tylenol. Instructions were given asking the patient to follow up in the event of worsening or new symptoms. Respondent should have performed a CT Angiogram of patient S.M.'s chest due to the probability of pulmonary embolism. Respondent failed to perform a CT Angiogram which would have allowed her to clinically diagnose patient S.M. with bilateral pulmonary emboli.

9. The documentation on the January 28, 2013, visit has no details about patient S.M.'s report of chest pain and whether or not she had shortness of breath, dizziness, weakness, cough or swelling. The eight-point review of systems noted "negative" for all symptoms including the cardiovascular and respiratory systems. This review did not match the rest of patient S.M.'s history. The physical exam reports that patient S.M. was alert, oriented, and in no distress. This does not match the interview in which the patient was described as tearful and upset. It is crucial to describe the emotional state of a patient presenting with depression or anxiety. The physical examination should include affect, mood, grooming, level of attention, eye contact, speech quality, the presence of injuries, as well as ability to answer questions. The review of symptoms should list specifically the symptoms which were inquired about, not just general categories.

10. The following day, on January 29, 2013, Patient S.M. sent Respondent an email describing a bad reaction to the Wellbutrin. Specifically, the patient reported symptoms of "anxiety, nausea and delirium" and requested a prescription for Zoloft. Respondent granted the new prescription as requested.

11. Six days after the initial visit, on February 3, 2013, patient S.M. suffered cardiac arrest caused by bilateral pulmonary emboli. Patient S.M had severe, permanent anoxic brain damage as a result of the pulmonary emboli.

12. On February 11, 2013, a MRI of patient S.M.'s brain showed diffuse hypoxic injury. On March 15, 2013, patient S.M. was discharged home.

13. Respondent committed acts of repeated negligence in her care and treatment of patient S.M., which included, but was not limited to, the following:

(a) Respondent's failure to diagnose pulmonary embolism represents a departure from the standard of care;

(b) Respondent's failure to adequately and accurately document medical records represents a departure from the standard ofcare;

Patient G.N

14. Respondent treated patient G.N., a 52-year-old man with chronic conditions including obesity, diabetes mellitus, hypertension, hypertriglyceridemia, diabetic retinopathy, sleep apnea and tobacco abuse for three (3) years.

15. On April 7, 2014, patient G.N. presented for an office visit complaining of cough, tremor, numbness on his left side and a lump on his right hand. In the history of presenting complaints, patient G.N. mentions a wrist lump, two episodes of left sided numbness and weakness lasting seconds, which spontaneously resolved in the last couple of weeks. The review of patient G.N's systems was entirely negative. Patient G.N's physical exam was recorded as entirely normal. Auscultation of patient G.N.'s carotid arteries was not performed. In the assessment, Respondent listed diabetic retinopathy, diabetes, hypertension, hypertriglyceridemia, obstructive sleep apnea, obesity and discussed smoking cessation. Respondent charted patient G.N. was not ready to quit smoking and that he suffered a transient ischemic attack. For the transient ischemic attack, Respondent recommended patient G.N. continue taking aspirin, statin, and blood pressure medication. Respondent also advised patient G.N. to seek emergency care in the event he developed more symptoms. Respondent failed to diagnose patient G.N.'s carotid artery stenosis.

16. In treating patient G.N. for suspected transient ischemic attack, Respondent should have ruled out acute brain injury, and identified potential causes ofthe symptoms as quickly as possible. Respondent did not initiate a diagnostic evaluation of patient G.N.'s carotid arteries to rule out carotid artery stenosis.

17. On April 27, 2014, patient G.N. suffered an acute stroke secondary to a total, right sided carotid artery occlusion. Patient G.N. underwent tissue plasminogen treatment and aggressive medical management. Patient G.N. also had inpatient rehabilitation. Patient G.N. has permanent, disabling neurological damage from the stroke, left sided hemiparesis and speech impairment. Patient G.N.'s stroke could have been avoided if Respondent had initiated a diagnostic evaluation of patient G.N.'s carotid arteries at the April 7, 2014 visit.

18. Respondent was negligent in his care and treatment of patient G.N., which included, but was not limited to, Respondent's failure to order a carotid ultrasound after a suspected transient ischemic attack.

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

19. Respondent is subjet to disciplinary action under section 2266 of the Code in that he failed to maintain adequate and accurate medical records in the care and treatment of patien S.M. The circumstances are as follows:

20. Paragraphs 7 through 12 above, are repeated here as if fully set forth.