BEFORE THE MEDICAL BOARD OF CALIFORNIA

DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA

In the Matter of the Accusation ) Against: )

) )

Hardeep Singh Ahluwalia, M.D ) )

Physician's and Surgeon's ) Certificate No. A 86707 )

) Respondent )

File No. 800-2016-020378

DECISION

The attached Stipulated Settlement and Disciplinary Order for Public Reprimand is hereby adopted as the Decision and Order of the Medical Board of California, Department of Consume.r Affairs, State of California.

This D.ecision shall become effective at 5:00 p.m. on November 9,

IT IS SO ORDERED October 10, 2018.

MEDICAL BOARD OF CALIFORNIA

/~~~-)id/ By: / '\. R-o"""n_a_l_d_,,,H_._L_e-+-.---:n-.-, _,_ ,__a-ir'---_ ---

Panel A

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XAVIER BECERRA Attorney General of California MARY CAIN-SIMON Supervising Deputy Attorney General JOSHUA M. TEMPLET Deputy Attorney General State Bar No. 267098

455 Golden Gate Avenue, Suite 11000 San Francisco, CA 94102-7004 Telephone: (415) 510-3533 Facsimile: (415) 703-5480

Attorneys for Complainant

BEFORE THE MEDICAL BOARD OF CALIFORNIA

DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA

In the Matter of the Accusation Against:

HARDEEP SINGH AHLUWALIA, M.D.

658 Fremont Avenue Los Altos, CA 94024

Physician's and Surgeon's Certificate No.A86707

Respondent.

Case No. 8002016020378

OAH No. 2018050627

STIPULATED SETTLEMENT AND DISCIPLINARY ORDER FOR PUBLIC REPRIMAND

20 IT IS HEREBY STIPULATED AND AGREED by and between the parties to the above-

21 entitled proceedings that the following matters are true:

22 PARTIES

23 1. Kimberly Kirchmeyer (Complainant) is the Executive Direct~r of the Medical Board

24 of California (Board). She brought this action solely in her official capacity and is represented in

25 this matter by Xavier Becerra, Attorney General of the State of California, via Joshua M.

26 .. Templet, Deputy Attorney General.

27 2. Respondent Hardeep Singh Ahluwalia, M.D. (Respondent) is represented in this

28 proceeding by attorney Bradford J. Hinshaw, 12901 Saratoga Ave., Saratoga, CA 95070-9988.

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STIPULATED SETTLEMENT (8002016020378)

1 3. On or about April 14, 2004, the Board issued Physician's and SurgeQn's Certificate . .

2 No. A 86707 to Respondent. The certificate was in full force and effect at all times relevant to the

3 charges brought in Accusation No. 8002016020378, and will expire on September 30, 2019,

4 unless renewed.

5 .JURISDICTION

6 4. Accusation No. 8002016020378 (Accusation) was filed before the Board, an~ is

7 currently pending against Respondent. The Accusation.and all other statutorily required

8 documents were properly served on Respondent on April 11, 2018. Respondent .timely filed his

9 Notice of Defense contesting the Accusation.

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A copy of the Accusation attached as Exhibit A and is incorporated herein.

ADVISEMENT AND WAIVERS

Respondent has carefully read, fully discussed with counsel, and understands the

13 charges and allegations in the Accusation. Respondent has also carefully read, fully discussed

14 with counsel, and understands the effects of this Stipulated Settlement and Disciplinary Order for

15 Public Reprimand.

16 7. Respondent is fully aware of his legal rights in this matter, including the right to a

17 hearing on the charges and allegations in the Accusation; the right to confront and cross-examine

18 the witnesses against him; the right to present evidence and to testify on his own behalf; the right

19 to the issuance of subpoenas to compel the attendance of witnesses and the production of

.20 documents; the right to reconsideration and court review of an adverse decision; and all other

21 rights accorded by the California Administrative Procedure Act and other applicable laws.

22 8. Respondent voluntarily, knowingly, and intelligently waives and gives up each and

23 every right set forth above.

24 CULPABILITY

25 9. Respondent understands and agrees that the charges and allegations in the

26 Accusation, if proven at a hearing, constitute cause for imposing discipline on his Physician's and

27 Surgeon's Certificate.

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STIPULATED SETTLEMENT (8002016020378)

. 1 10. For the purpose of resolving the Accusation without the expense and uncertainty of

2 further proceedings, Respondent agrees that, at a hearing, Complainant could establish a factual

3 basis for the charges in the Accusation and that Respondent hereby gives up his r~ght to contest

4 those charges.

5 11. Respondent agrees that his Physician's and Surgeon's Certificate is subject to

6 discipline and he agrees to be bound by the Board's imposition of discipline as set forth in the

· 7 Disciplinary Order below.

8 CONTINGENCY

9 12. This stipulation shall be subject to approval by the Board. Respondent understands

10 and agrees that counsel for Complainant and Board staff may communicate directly with the

11 Board regarding this stipulation and settlement; without notice to or participation by Respondent

12 or his counsel. By signing the stipulation, Respondent understands and agrees that he may not

13 withdraw his agreement or seek to rescind the stipulation prior to the time the Board considers

14 and acts upon it. If the Board fails to adopt this stipulation as its Decision and Order, the

15 Stipulated Settlement and Disciplinary Order for Public Reprimand shall be of no force or effect,

16 except for this paragraph, it shall be inadmissible in any legal action between the parties, and the

17 Board shall not be disqualified from further action by having considered this matter. .

18 13. The parties understand and agree that Portable Document Format (PDF) and facsimile

19 copies of this Stipulated Settlement and Disciplinary Order for Public Reprimand, including PDF

20 and facsimile signatures thereto, shall have the same force and effect as the originals.

21 14. In consideration of the foregoing admissions and stipulations, the parties agree that

22 the Board may, without further notice or formal proceeding, issue and enter the following

23 Disciplinary Order:

24 DISCIPLINARY ORDER

· 25 A. Pilblic Reprimand

26 · IT IS HEREBY ORDERED that Respondent Hardeep Singh Ahluwalia, M.D., as holder. of

27 Physician's and Surgeon's Certificate No. A 86707, shall be and hereby is publicly reprimanded

28 pursuant to Business and Professions Code section 2227. This Public Reprimand is issued as a

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STIPULATED SEITLEMENT (8002016020378)

1 result of the following conduct by Respondent as forth in the Accusation:

2 Respondent failed to document an indication for intervention on the patient's lower left leg, and he failed to document and archive pre-intervention, intermediate, and

3 post-intervention images detailing the position of the intervention devices and the effect of the devices on the patient's relevant blood vessels. In addition, Respondent

4 acknowledged failing to document and archive images of his peripheral artery interventions on other patients.

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6 B. MEDICAL RECORD KEEPING COURSE.

7 Within 60 calendar days of the effective date of this Decision, Respondent shall enroll in a

8 course in medical record keeping approved in advance by the Board or its designee. Respondent

9 shall provide the approved course provider with any information and documents that the approved

10 course provider may deem pertinent. Respondent shall participate in and successfully compiete

11 the classroom component of the course not later than six (6) months after Respondent's initial

12 enrollment. Respondent shall successfully complete any other component of the course within

13 one (1) year of enrollment. The medical record keeping course shall be at Respondent's expense

14 and shall be in addition to the Continuing Medical Education requirements for renewal of

15 licensure.

16 A medical record keeping course taken after the acts that gave rise to the charges in the

17 Accusation, but prior to the effective date of the Decision may, in the sole discretion of the Board

18 or its designee, be accepted towards the fulfillment of this condition if the course would have

19 been approved by the Board or its designee had the course been taken after the effective date of

20 this Decision.

21 Respondent shall submit a certification of successful completion to the Board or its

22 designee not later than 15 calendar days after successfully completing the course, or not later than

23 15 calendar days after the effective date of the Decision, whichever is later. Failure to enroll in, I

24 participate in, or successfully complete the course within the designated time period shall

25 constitute unprofessional conduct and grounds for further disciplinary action.

26 C. CLINICAL COMPETENCE ASSESSMENT PROGRAM.

27 Within 60 calendar days of the effective date of this Decision, Respondent shall enroll in a

28 clinical competence assessment program approved in advance by the Board or its designee.

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STIPULATED SETTLEMENT (8002016020378)

1 Respondent shall successfully complete the program not later than six (6) months after

2 Respondent's initial enr?llment unless the Board or its designee agrees in writing to an extension

3 of that time.

4 The program shall consist of a comprehensive assessment of Respondent's physical and . .

5 ·mental health and the six general domains. of clinical competence as defined by the Accreditation

6 . Council on Graduate Medical Education and American Board of Medical Specialties pertaining to

7 Respondent's current or intended area of practice. The program shall take into account data

8 obtained from the pre-assessment, self-report forms and interview, and the Decision(s),

9 Accusation(s), and any other information that the Board or its designee deems relevant. The.

10 program shall require Respondent's on-site participation for a minimum of three (3) and no more

11 than five (5) days as determined by the program for the assessment and clinical education

12 evaluation. Respondent shall pay all expenses associated with the clinical competence assessment

13 program.

14 At the end of the evaluation, the program will submit a report to the Board or its designee

15 that unequivocally states whether Respondent has demonstrated the ability to practice safely and

16 independently. Based on Respondent's performance on the clinical competence assessment, the

17 program will advise the Board or its designee of its recommendation( s) for the scope and length·

18 of any additional educational or clinical training, evaluation or treatment for any medical

19 condition or psychological condition, or anything else affecting Respondent's practice of

20 medicine. Respondent shall comply with the program's recommendations.

21 Determination as to whether Respondent successfully completed the clinical competence

22 assessment program is solely within the program's jurisdiction.

23 If Respondent fails to enroll in, participate in, or successfully complete the 'clinical

24 competence assessment program within the designated time period, Respondent shall receive a

25 notification from the Board or its designee to cease the practice of medicine within three (3)

26 calendar days after being so notified. Respondent shall not resume the practice of medicine until

27 enrollment or participation in the outstanding portions of the clinical competence assessment

28 program _have been completed. Failure to enroll in, participate in, or successfully complete the

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STIPULATED SETTLEMENT (8002016020378)

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program within the designated time period shall constitute unprofessional conduct and grounds

for further disciplinary action.

ACCEPTANCE

I have carefully read the above Stipulated Settlement and Disciplinary Order for Public

Reprimand and have fully discussed it with my attorney, Bradford J. Hinshaw. I unde~stand the

stipulation and the effect it will.have on my Physician's and Surgeon's Certificate. I enter into this

Stipulated Settlement and Disciplinary Order for Public Reprimand voluntarily, knowingly, ~d

intelligently, and agree to be bound by the Decision and Order of the Medical Board of

California. ~~. · . DATED: g: .. ~[ --l8° . . . . .

~~UWALIA,M.D. · Respondent

I have read and ;fully discussed with Respondent Hardeep Singh Ahluwalia, M.D. the terms

and ·conditions and other matters contained in the above Stipulated Settlement and Disciplinary

Order for Public Reprimand. I approve its form and content..

DATED: B-?1-f& ~ BRADFORDiHAW Attorney for Respondent

ENDORSEMENT

The foregoing Stipulated Settlement and Disciplinarr Order for Public Reprhnand is hereby

respectfully submitted for consideration by the Medical Board of California.

Dated: o/ s1/JJ1 r Respectfully submitted,

XAVIER BECERRA Attorney General of California MARY CAIN-S1MON Supervi · Deputy Attorney General

27 SF2018400i48

Jos AM. TEMPLET Deputy Attorney General Attorneys for Complainant

13232217 28

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STil>ULATED SETILEMENT (800~016020378)

Exhibit A

Accusation No. 8002016020378 ·

1 XAVIER BECERRA Attorney General of California MARY CAIN-SIMON Supervising Deputy Attorney General JOSHUA M. TEMPLET Deputy Attorney General State Bar No. 267098

455 Golden Gate Ayenue, Suite 11000 San Francisco, CA 94102-7004 Telephone:. ( 415)510-3533 Facsimile: (415) 703-5480 E-mail: J oshua.Tempfot@doj.ca.gov

Attorneys for Complain(l.nt

FILED STATE OF CALIFORNIA

MEDICAL BOARD OF CALIFORNIA ~~n' I It 20...!l.. BY . 11 /J ANALYST

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9 BEFORE 1 THE

MEDICAL BOARD OF CALIFORNIA DEPARTMENTOFCONSUMERAFFAIRS

.. STATE OF CALIFORNIA 10

11 II-~~~~~~~~~~~~~~~--.

12 In the Matter of the Accusation Against:

13 Hardeep Singh Ahluwalia, M.D. 658 Fremont Avenue

14 Los Altos, CA 94024

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Physkian's and Surgeon's Certificate No. A 86707,

Respondent. II-~~~~~~~~~~~~~~~-'

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19 Complainant alleges:

Case No. 8002016020378

ACCUSATION

20 PAR.TIES

21 1. Kimberly Kircbmeyer (Complainant) brings this Accusation solely in he~ official

22 capacity. as the Executive Director of the Medical Board of California, Department of Corisumer

23 Affairs (Board).

24 2. On April 14, 2004, the Board issued Physician's and Surgeon's Certificate Number

25 A 86707 to Hardeep Singh Ahluwalia, M.D. (Respondent). The certificate was in full force and

26 effect at all times relevant to the charges brought herein and will expire on September 30, 2019,

27 unless renewed.

28 Ill.

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(HARDEEP SINGH AHLUWALIA, M.D.) ACCUSATION NO. 8002016020378

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.JURISDICTION

This Accusation is brought before the Board, under the authority of the following

3 , laws. All section references are to the Business a~d Professions Code unless otherwise indicated.

4 4. . Section 2004 provides that the Board shall have the responsibility for the enforcement

5 of the discipJinary and criminal provisions of the Medical Practice Act.

6, 5. Section 2227 of the Code authorizes the Board to take action against a licensee who

, 7 has been found guilty under the Medical Practice Act by revoking his or het lieense, ~uspending

8 the license for a period not to exce.ed one year, placing the license on probation and requiring

9 payment of costs of probation monitoring, or taking such other.action as the Board deems proper.

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6. Section 223,4 of the Code states; in relevant part: ,

The board shall take action against any licensee who is charged with unprofessional conduct. In addition to other provisions of this article, unprofessional coriduct includes, but is not limited to, the following: ·

(a) Violating or attempting to violate, directly or indirectly, assisting in.or abetting the violation of, or conspiring to violate any provision of this chapter.

(b) Gross negligence.

(c) Repeated negligent acts. To be repeated, there mus.t be tWo or more negligent acts or omissions. An initial negligent act or omission followed by a separate and distinct. departure from the applicable .standard of care shall constitute repeated negligent acts.

(1) An initial negligent diagnosis followed by an act or omission medically appropriate for that negligent diagnosis of the patient shall constitute a single negligent act.

(2) When the standard of care requires a change in the diagnosis, act, or omission, that constitutes ,the negligent act described in paragraph (1), including, . but not limited to, a reevaluation of the diagnosis or a change.in treatment, and the licensee's conduct departs from the applicable standard of care, each departure constitutes a separate and distinct breach of the standard of care.

(d) Incompetence.

7. Section 2266 of the Code states: "The failure of a physician and surgeon to maintain

26 adequate and accurate records relating to the provision of services to their patients constitutes

. 27 unprofessional conduct."

28 Ill

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(HARDEEP SINGH AHLUWALIA, M.D.) ACCUSATION NO. 8002016020378

1

2 8.

FACTS

Patient P-11 had a major stroke in 2012, leaving her with a disabling left foot drop .

3 requiring a foot orthotic. The patient has since had residual weakness in her lower left leg and has

4 required a cane to. walk.

5 Artery Bypass by Previous Pl,tysician

9. In or about November 2014, when she was 74 ypars of age, the patient sustained a 7 fifth metatarsal fracture in her left foot, which likely further impaired her ability to walk. Due to

s concerns about the slowly healing fracture, the patient visited a physician2 for an evaluation on_

9 March 18, 2015. The physician calculated the patient's ankle-arm indices, presumably to evaluate

10 whether she had impaired ~irculation to her left leg from peripheral artery disease. The physician

n documented that the patient had a left ankle-arm index of0.36 and a right ankle"".arm index of

12 0.98. A normal ankle-arm index is 1.0-1.1. An index ofless than 0.40 is consistent with critical

13 limb ischemia, a severe form of peripheral artery disecise.

14 10. Indications for angiographic or surgical intervention to treat peripheral artery disease

15 include (1) tissue loss in the leg or foot; (2) rest pain in the leg or foot; and .(3) lifestyle-limiting

· 16 vascular claudication (pain upon exertion relieved by rest), each in conjunction with a low ankle-

17 arm index. In addition to the patient's low ankle-arm index, the physician documented that the

18 patient had borderline pain in h·er left foot, her sens~tion. of which was likely limited due to her

19 past stroke and the cortfoundjng presence of her foot fracture. The physician also noted that he

20 would expect someone with the patient's low ankle-arm index to haye significant claudication but

21 suggested that her limited ability to walk may have masked this. The. physician further

22 document.ed that he was concerned that the poor perfusion3 in her left leg was impeding the

23 healing of her foot fracture. Based on these findings, on May 18,2015, the physician performed a

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1 The patient is designated in this document as Patient P-l to protect her privacy. Respondent knows the names of the patient and can confirm her identity through discovery.

. 2 This physician treated P-1 before she began seeing Respondentlater this year. 3 Perfusion; in this case, refers to the delivery of blood through the circulatory system's

network of blood vessels. · ·

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(HARDEEP SINGH AHLUWALIA, M.D.) ACCUSATION NO. 8002016020378

1 · left femoral to above-the-1,mee popliteal artery bypass to improve circulation in her lower leftleg.

2 The patient's June 1, 2015 follow-up visit with the physician was unremarkable.

3 Angiographic Intervention by Respondent

4 ll. In June 2015, the patient fractured her left hip, which filrther limited·her ability to

5 walk. Soon thereafter, the patient moved to a new location to be closer to her family. The patient

6 then saw a new physician, Respondent, foi; a follow-up visit for her artery bypass. The patient's

7. initial consultation with Respondent was on June 29, 2015. She complained of pain in her left leg

8 when walking,. and she did not feel that the bypass surgery Jiad ~een successful.

9 12. On July 20, 2015, Respondent perform.ed an ultrasound on the patient's lower left

10 extremity. Respondent did not qocument or archive any of the ultrasound images. According to

11 the vascular technologist worksheet, the lower left leg artery bypass appeared to be patent with

12 reasonable.flow velocities. However, the flow through the bypass was monophasic, an abnormai

13 sign. Respondent.did not document the patient's ankle-arm indices to assess the degree of

14 perfusion to the lower left leg~

15 · 13, With.out documenting an indication for angiographic intervention, on August 17,

16 2015, Respondent performed a lower left leg angiogram on the patient. The angiogram showed

17 that the left femoral to popliteal artery bypass was open and unobstructed, with areas of stenosis.

18 Without documenting ail indication for further intervention, Respondent opted to treat the native

19 vasculature using a combin<1;tion of atherectomy, balloon angfoplasty, and stenting. Respondent

20 documented that the procedures improved perlusion to the lower left leg, but he did not docum.ent

21 any nost-intervention images confirming this.

22 14. Respondent's September 21, 2015 follow-up clinic note suggests that the indication

23 for the lower left leg angiogram and inte1ventions that he performed on August 17, 2015 was

24 vascular claudication. In his note, Respondent states that the intervention improved upon the

25 patient's claudication symptoms in her lower left leg. However, vascular cla1:J.dication was not an

26 appropriate indication for intervention for this patient. The patient had difficulty walking and paj.n

27 in her left leg for reasons independent of any potential vascular claudication, including a

28 dysfunctional lower left extreinity from a disabling stroke that required her to use a cane, a left

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(HARDEEP SINGH AHLUWALIA, M.D.) ACCUSATION NO, 8002016020378

1 foot fracture, potential incisional pain from her previous bypass surger~, and a recent left hip

2. fracture. Respondent neither confirmed that the patient's complaint was caused by her vasculature

3 nor ruled out these other conditions. Even if Respondent had confirmed that the patient's

4 vasculature was indeed a source of her pain and difficulty walking, it is not clearwhat benefit

5 intervention could have achieved given this patient's other limiting and painful conditions.

6 15. If Respondent was planning to .intervene based on the indication from the May 18,

7 2015 bypass performed by the patient's previous physician, then Respondent should have first

8 evaluated the healing of the patient's foot fracture. There is no documentation that he did this~

9 Nor did Respondent document any other indication for his intervention, such as rest pain or tissue

10 loss in the patient's left foot.

11 CAUSE FOR DISCIPLINE

1:2 (Repeated Negligence, Incompetence, Failure to Maintain Adequate Records)

13 16; Respondent is guilty of unprofessional conduct and subject to disciplinary action

14 against his license under section 2234, subdiv~sion (c) (repeated negligence), subdivision (d)

15 (incompetence), and section 2266 (inadequate records) of the Code, in that, he committed

16 repeated negligence, demonstrated a lack of knowledge, and failed to maintain. adequate records

17 in the practic~ of medicine by engaging in the conduct described above, including but not limited

18 to:

19 A. ' Respondent failed to document the patient's ankle-arm indices, which are used

20 to assess the degree of perfusion in a lower extremity.

21 B. Respondent failed to document and archive any images showing the pre-

22 intervention status of the patient's bypass.

23 C. Respondent failed to document an indication for intervention on the patient's

24 lower left leg.

25 D. The presumed indication for Respondent's intervention, suggested py the

26 patient's chief complaint and Respondent's post".'procedme records, was vascular claudication,

27 · which was not an appropriate indication for intervention on this patient.

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(HARDEEP SINGH AHLUWALIA, M.D.) ACCUSATION NO. 8002016020378

l E. Respondent failed to document and archive pre-intervention, intermediate, and

2 post-intervention images detailing the position of the intervention devices and the effect of the

3 · devices on the patient's relevant blood vessels. Respondent did not document or archive any

4 images of his intervention, apart from a single image of an inflated balloon in a lower extremity.

5 F. In the general course. of Respondent's practice, Respondent has acknowledged

6 f~iling to document and archive images of other peripheral artery interventions that he has

7 · performed in his office setting.

8 PRAYER

9 . WHEREFORE, Complainant requests that a hearing be held on the matters herein alleged,

10 and that following the hearing, the Medical Board of California issue a decision:

11 1. Revoking or suspending Physician's and Surgeon's Certificate Number

12 A 86707, issued _to Respondent;

13 2. Revoking, suspending or denying approval of Respondent's authority to

14 supervise physician assistants and advanced practice nurses;

15 3. Ordering Respondent, if placed on probation, to pay the Board the costs of •

16 _probation monitorivg; and

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4. Taking such other and further action as deemed ne~ssary and proper.

19 DATED: ~=A~p~r=i=l-=-1=1~·--=2_0_1_8~-

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23 SF201$400148

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Executive D ctor Medical .Board of California Department of Consumer Affairs State of California Complainant

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(HARDEEP SINGH AHLUWALIA, M.D.) ACCUSATION NO. 8002016020378