BEFORE THE MEDICAL BOARD OF CALIFORNIA

DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA

In the Matter of the Accusation ) Against: )

) )

DAVID JUAN, M.D. ) )

Physician's and Surgeon's ) Certificate No. G78505 )

) Respondent )

Case No. 13-2012-226731

DECISION

The attached Stipulated Surrender of License and Order is hereby adopted as the Decision and Order of the Medical Board of California, Department of Consumer Affairs, State of California.

This Decision shall become effective at 5:00 p.m. on September 9, 2015

IT IS SO ORDERED September 2, 2015

MEDICAL BOARD OF CALIFORNIA

1 KAMALA D. HARRIS Attorney General of California

2 JOSE R. GUERRERO Supervising Deputy Attorney General

3 EMILY L. BRINKMAN Deputy Attorney General

4 State Bar No. 219400 455 Golden Gate Avenue, Suite 11000

5 San Francisco, CA 94102-7004 Telephone: (415) 703-5742

6 Facsimile: (415) 703-5843 E-mail: Emily.Brinkman@doj.ca.gov

7 Attorneys for Complainant

8 BEFORE THE MEDICAL BOARD OF CALIFORNIA

9 DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA

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11 In the Matter of the Accusation Against:

12 DAVID JUAN, M.D.

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669 Winggate Drive Sunnyvale, CA 94087

Physician's and Surgeon's Certificate No. G78505

Respondent.

Case No. 13-2012-226731

STIPULATED SURRENDER OF LICENSE AND ORDER

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

19 entitled proceedings that the following matters are true:

20 PARTIES

21 1. Kimberly Kirchmeyer (Complainant) is the Executive Director of the Medical Board

22 of California. She brought this action solely in her official capacity and is represented in this

23 matter by Kamala D. Harris, Attorney General of the State of California, by Emily L. Brinkman,

24 Deputy Attorney General.

25 2. David Juan, M.D. (Respondent) is represented in this proceeding by attorney Joseph

26 S. Picchi, Esq., whose address is: Galloway, Lucchese, Everson & Picchi, 1676 Nmih California

27 Blvd., Suite 500, Walnut Creek, CA 94596-4183.

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1 3. On or about March 16, 1994, the Medical Board of California issued Physician's and

2 Surgeon's Certificate No. G78505 to David Juan, M.D. (Respondent). The Physician's and

3 Surgeon's Certificate expired on February 28, 2014, and has not been renewed.

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JURISDICTION

4. Accusation No. 13-2012-226731 was filed before the Medical Board of California

(Board), Department of Consumer Affairs, and is currently pending against Respondent. The

Accusation and all other statutorily required documents were properly served on Respondent on

March 27, 2015. Respondent timely filed his Notice of Defense contesting the Accusation. A

copy of Accusation No. 13-2012-226731 is attached as Exhibit A and incorporated by reference.

ADVISEMENT AND WAIVERS

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

charges and allegations in Accusation No. 13-2012-226731. Respondent also has carefully read,

fully discussed with counsel, and understands the effects of this Stipulated Surrender of License

and Order.

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

hearing on the charges and allegations in the Accusation; the right to be represented by counsel, at

his own expense; the right to confront and cross-examine the witnesses against him; the right to

present evidence and to testify on his own behalf; the right to the issuance of subpoenas to compel

the attendance of witnesses and the production of documents; the right to reconsideration and

court review of an adverse decision; and all other rights accorded by the California

Administrative Procedure Act and other applicable laws.

7. Respondent voluntarily, knowingly, and intelligently waives and gives up each and

every right set forth above.

CULP ABILITY

8. Respondent admits the truth of each and every charge and allegation in Accusation

26 No. 13-2012-226731, with the exception that when he was sentenced by the Santa Clara Superior

27 Court he was ordered to serve 90 days of home confinement and not 90 days in county jail as

28 referenced in the Accusation. Respondent agrees that cause exists for discipline and hereby

2

Stinulated Surrender of License (Case No. 13-2012-226731)

1 surrenders his Physician's and Surgeon's Certificate No. G78505 for the Board's formal

2 acceptance.

3 9. Respondent understands that by signing this stipulation he enables the Board to issue

4 an order accepting the surrender of his Physician's and Surgeon's Certificate without further

5 process.

6 RESERVATION

7 10. The admissions made by Respondent herein are only for the purposes of this

8 proceeding, or any other proceedings in which the Medical Board of California or other

9 professional licensing agency is involved, and shall not be admissible in any other criminal or

1 O civil proceeding.

11 CONTINGENCY

12 11. This stipulation shall be subject to approval by the Medical Board of California.

13 Respondent understands and agrees that counsel for Complainant and the staff of the Medical

14 Board of California may communicate directly with the Board regarding this stipulation and

15 surrender, without notice to or participation by Respondent or his counsel. By signing the

16 stipulation, Respondent understands and agrees that he may not withdraw his agreement or seek

17 to rescind the stipulation prior to the time the Board considers and acts upon it. If the Board fails

18 to adopt this stipulation as its Decision and Order, the Stipulated Surrender and Disciplinary

19 Order shall be of no force or effect, except for this paragraph, it shall be inadmissible in any legal

20 action between the parties, and the Board shall not be disqualified from further action by having

21 considered this matter.

22 12. The parties understand and agree that Portable Document Format (PDF) and facsimile

23 copies of this Stipulated Surrender of License and Order, including Portable Document Format

24 (PDF) and facsimile signatures thereto, shall have the same force and effect as the originals.

25 13. In consideration of the foregoing admissions and stipulations, the parties agree that

26 the Board may, without further notice or formal proceeding, issue and enter the following Order:

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Stioulated Surrender of License (Case No. 13-2012-226731)

1 ORDER

2 IT IS HEREBY ORDERED that Physician's and Surgeon's Certificate No. G78505, issued

3 to Respondent David Juan, M.D., is surrendered and accepted by the Medical Board of California.

4 1. The surrender of Respondent's Physician's and Surgeon's Certificate and the

5 acceptance of the surrendered license by the Board shall constitute the imposition of discipline

6 against Respondent. This stipulation constitutes a record of the discipline and shall become a part

7 of Respondent's license history with the Medical Board of California.

8 2. Respondent shall lose all rights and privileges as a Physician and Surgeon in

9 California as of the effective date of the Board's Decision and Order.

10 3. Respondent shall cause to be delivered to the Board his pocket license and, if one was

11 issued, his wall certificate on or before the effective date of the Decision and Order.

12 4. If Respondent ever files an application for licensure or a petition for reinstatement in

13 the State of California, the Board shall treat it as a petition for reinstatement. Respondent must

14 comply with all the laws, regulations and procedures for reinstatement of a revoked license in

15 effect at the time the petition is filed, and all of the charges and allegations contained in

16 Accusation No. 13-2012-226731 shall be deemed to be true, correct and admitted by Respondent

1 7 when the Board determines whether to grant or deny the petition.

18 5. If Respondent should ever apply or reapply for a new license or certification, or

19 petition for reinstatement of a license, by any other health care licensing agency in the State of

20 California, all of the charges and allegations contained in Accusation No. 13-2012-226731 shall

21 be deemed to be true, correct, and admitted by Respondent for the purpose of any Statement of

22 Issues or any other proceeding seeking to deny or restrict licensure.

23 ACCEPTANCE

24 I have carefully read the above Stipulated Surrender of License and Order and have fully

25 discussed it with my attorney, Joseph S. Picchi, Esq. I understand the stipulation and the effect it

26 will have on my Physician's and Surgeon's Certificate. I enter into this Stipulated Surrender of

27 License and Order voluntarily, knowingly, and intelligently, and agree to be bound by the

28 Decision and Order of the Medical Board of California.

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Stipulated Surrender of License (Case No. 13-2012-226731)

2 DATED: -~ -/-;l-~--j-~--1----·-----··-

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4 I have read and fully discussed with Respondent David Juan. M.D. the terms and conditions

5 and other matters contained in this Stipulated Surrender of License and Order. I approve its form

6 and content.

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DAlTJlc ·~ {:;/ ~~· - J{~:PII S. PI CCI ll, ESQ.

/Attorney fr)r Re~pondcnt JO

11 ENDQRSEMENT

12 The foregoing Stipulated Surrender of License and Order is hereby respectfully submitted

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Cor consideration by the Medical Board of California of the Depart men! ol'Comumer A!fairs.

Respect Cully submitted,

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19 EMILY .

20 Dcput ttorncy General 11 ttorne) ·sj(Jr Comp/ a i nant

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5 . ------------+ Stipulated Surrender of Liecn~e (Case No. 13-2012-226731)

Exhibit A

Accusation No. 13-2012-226731

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K1\!'v1ALA D. HARRlS

Attorney General of California JOSE R .. GUl:'.RRERO Supervising Deputy Attorney General EM!LY L BHJNKMAN FILED Deputy Attorney General State Bar No. 219400

455 Golden Gate Avenue, Suite 11000 San Francisco, CA 94102-7004 Telephone: (415) 703-5742

fiTATE OF CAJ.JFORNIA ME~!CAL B~ ~IFORNIA ~E~T · ,;( l 20 .J.S-

.. / J+£. - ANALYST Facsimile: ( 415) 703-5483 E-mail: Emily.Brinkmant@doj.ca.gov

AUomeJ'sfor Complainant

BEFORE THE MEDICAL BOARD OF CALlFORNIA

DEPARTMENT OF CONSUMER AFFAIRS STA TE OF CALIFORNIA

In the Matter of the Accusation J\gainst:

DA \'ID JC . M.D,

669 Winggate Drive Sunnyvale. 94087

Physician's and Surgeon's Certificate No. G78SOS

Case No. 13-201:2-226731

IACCGSATlON

I Respondent. I

Complainant alicges:

PARTIES

1. Kimberly Kirchmeyer (Complainant) brings this Accusation solely in her official

capacity as the Executive Director of the Medical Board of California, Department of Consumer

Affairs.

.., On or about March 16, 1994, the Medical Board of California issued Physician's and

Surgeon's Certificate Number 078505 to David Juan, M.D. (Respondent). The Physician's and

Surgeon's Certificate expired on February 28, 2014, and has not been renev,,.ed .

Accusation

JURISDICTION

2 3. This I\ccusation is brought before the Medical Board of California (Board), 1

3 Department of Consumer Affairs, under the authority of the following hnvs. All section

4 references are to the Business and Professions Code unless otherwise indicated.

5 4. Section 2227 of the Code provides that a licensee \Vho is found guilty under the

6 Medical Practice Act may have his or her Hcense revoked, suspended for a period not to exceed

7 one yeaL placed on probation and required to pay the costs of probation monitoring, or such other

8 action taken in relation to discipline as the Division deems proper.

9 5. Section 2234 of the Code, states in relevant part:

JO "'fhc board shall take action against any licensee vvho is charged with unprofessional

1 l conduct. ln addition to other provisions of this ru1icle, unprofessional conduct includes, but is 1101

12 limited to. the follmving:

13 "(b) Gross negligence.

14 "(c) Repeated negligent acts. To be repeated, there must be nvo or more negligent acts or

15 omissions. l\n initial negligent act or omission foI1ovved by a separate departure from

j 6 the applicable standard of care shall constitute repeated negligent acts.

17 "(l) /\n initial negligent diagnosis followed by an act or medically appropriate

18 for that negligent diagnosis of the patient shall constitute a single negligent act.

19 "(2) When the standard of care requires a change in the diagnosis, act, or omission that

20 constitutes the negligent act described in paragraph (1 ), including, but not limited to, a

21 reevaluation of the diagnosis or a change in treatment, and the licensee's conduct departs from the

22 applicable standard of care, each departure constitutes a separate and distinct breach of the

23 standard of care.

24 "(d) Incompetence.

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term ··Board" means the Medical Board of California. ''Division Medical Quality" or '·Division" shall also be deemed to refer to the Board (Bus. & Prof. Code section 2002).

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commission of any act involving dishonesly or con-uption which is substantially

related to the qualifications, functions, or duties of a physician and surgeon .

"(f) /my action or conduct \;"hich would have warranted the denial of a certificate.''

6. Section 2236 of the Code states in relevant part:

The conviction of any offense substantially related to the functions, or

duties of a physician and surgeon constitutes unprofessional conduct within the meaning of this

chapter [Chapter 5, the Medical Practice Act]. The record of conviction shall he conclusive

evidence only of the fact that the conviction occurred.

"(cl) A. plea or verdict of guilty or a conviction after a plea of no lo contendere is deemed lO

be a conviction within the meaning of this section and Si:ction 2236. 1. The rc1.:ord conviction

shall be conclusive evidence of the fact that the conviction occurred."

7. Section 22?7 the Code states:

'·(a) The conviction of a charge of violating any federal statutes or regulations or any statute

or regulation of this state. regulating dangerous drugs or controlled substances, constitutes

unprofessional conduct. The record of the conviction is such

unprofessional conduct A plea or verdict of guilty or a conviction following a plea of no lo

is deerned to be a conviction wilhin the meaning of

''(b) Discipline may be ordered in accordance \\'ith Section 2227 or the Division of

Licensing may order the denial of the license when the time for appeal has elapsed, or the

judgment of conviction has been affirmed on appeal, or when an order granting probation is made

suspending the imposition of sentence, irrespective of a subsequent order under the provisions of

Section 1203 .4 of the Penal Code allowing such person to withdravv his or her plea of guilty and

to enter a plea of not guilty, or setting aside the verdict of guilty, or dismissing the accusation,

complaint, information, or indictment"

8. Section 2238 of the Code states:

''A violation of any fcdcrai statute or federal regulation or of the statutes or regulations

of this state regulating dangerous drugs or controlled substances constitutes unprofessional

conduct.'"

3 Accusation

9. Section 224 l of the Code stales in relevant pan:

') A physician and surgeon may prescribe, dispense. or administer prescription drugs or

3 prescription controlled substances to an addict for purposes of maintenance on, or detoxification

4 from, prescription drugs or controlled substances only as set forth in subdivision (c) or in Sections

5 I 11215, l 1217, 11217.5, l 1218, 11219, and 11220 ofihc Health ancl Nothing in this

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subdivision shall authorize a physician and surgeon to prescribe, dispense, or administer

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dangerous drugs or controlled substances to a person he or she knovvs or reasonably believes is

using or will use the drugs or substances for a nonmcdical purpose.,.

J 0. Section 2242 of the Code states in relevant part:

"(a) Prescribing, dispensing, or furnishing dangerous drugs as defined in Section

1 l \\'ithout an appropriate prior examination and a medical indication, constitutes unprofessional

12 conduct." I

13 I 11. Section 2266 of lhe Code provides that the failure to maintain adequate and accurate

14 Ii !I records relating to the provision of services to patients constitutes unprofessional conduct.

15 12. Section T' of the Code states in relevant part:

16 Repeated acts of clearly excessive prescrihing. furnishing. dispensing. or administering

7 drugs or treatment. repeated acts of clearly excessive use diagnostic procedures. or repeated

18 acts of clearly excessive use of diagnostic or treatment facilities as determined by the standard of

19 the community of licensees is tmprofessional conduct for a physician and surgeon. dentist,

20 podiatrist, psychologist, physical therapist, chiropractor. optometrist, speech-language pathol<)gist,

21 or audiologist.

'l ") L.~ "(c) A practitioner who has a medical basis for prescribing. furnishing, dispensing, or

23 administering dangerous dmgs or prescription controlled substances shall not be subject to

24 disciplinary action or prosecution under this section.

25 I, "(d) No physician and surgeon shall be subject to disciplinary action pursuant to this section

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for treating intractable pain in compliance with Section 2241.5."

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Accusation

13. Health and Safety Code section 11153 states in relevant

A prescription for a comrolled substance shall only issued a legitimate medical

3 purpose by an individual practitioner acting in the usual course of his or her professional practice.

4 'I11e responsibility for the proper prescribing and dispensing of controlled substances is upon the

5 prescribing practitioner, but a corresponding responsibility rests the pharmacist fills the

6 prescription. Except as authorized by this division, the follmving arc not legal prescriptions: (l)

7 an order purporting to be a prescription which is issued not in the usual course professional

8 treatment or in iegitimate and authorized research: or (2) an order for an addict or habitual use of

9 controlled substances, \Vhich is issued not in the course of professional treatment or as part of an

1 O authorized narcotic treatrnent program, frir the purpose of providing the user with controlled

l l substances, sufficient to keep him or her comfortable nmintaining customary use.''

14. Health and Safety Code section 11154 states in relevant part:

13 Except tl'ie regular practice of his or her profession, no person knowingly

14 prescribe, administer. dispense. or furnish a controlled substance to or for any person or animal

\Vhich is not under his or her treatment for a pathology or condition to a

16 controlled substance, except as provided in this division."

1 '7 I 15. and Safc:y Code section 11156 states:

18 "(a) Except as provided in Section 2241 of the Business and Profession no person

19 shall prescribe for, or administer, or dispense a controlled substance to, an addict or to any person

20 representing himself or herself as such, except as pcm1itted by this division.

21 ·'(b)( 1) For purposes of this section, "addict'" means a person whose actions are

22 characterized by craving in combination \Mith one or more of the following:

"(A) Impaired control over drug use.

24 ''(B) Compulsive use.

"(C) Continued use despite harm.

26 ''(2) 1\otv.:ithstanding paragraph (1 l, a person whose drug-seeking is primarily due

to the inadequate control of pain is not an addict within the meaning of this section."

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Accusation

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RELEVANT DRUG INFORMATION

16. AdderaH is the trade name for a combination of amphetamine and

dextroamphetaminc. It is a dangerous drug as defined in section 4022 and is a Schedule II

controlled substance as defined in Health and Safety Code section 11055, subsection (d).

Adderall is indicated for the treatment of Attention Deficit Disorder \Vi th !Iyperactivity(/\ DJ l D)

and narcolepsy. Caution should be used ·when prescribing Adderall and doses should start at the

smallest possible amount. Amphetamines have been extensively abused and continued use can

result in tolerance. extreme psychological dependence, and severe social disability.

17. Ambien is the trade name for zolpidem tartratc. It is a non-bcnzodiazepine hypnotic

and a central nervous system depressant (CNS). It is a dangerous drug as defined by section 4022

and a Schedule IV controlled subsu.mce as defined by Health and Safety Code section 11057,

subsection Arnhier: is indicated for the shon-term treatment insomnia. Any combination

other CNS depressants can increase the effect of Ambien. Because of the risk habituation

and dependence doctors should carefully monitor patients with a history of addiction or drug

18. Buprcnorphine, also known as Subutex. is used to treat opioid dependenee

(including heroin and narcotic painkillers). 11 is a dangerous drug as defined in section and

is a Schedule III controlled substance as defined in Heahh and Safety Code section 11056. It is in

a class of medications called opioid antagonists. This medication, along with Suboxone, prevents

withdrmval symptoms.

19. Carisoprodol, also known by the trade name Soma, is a muscle-relaxant and

sedative. 1t is a dangerous drug as defined in section 4022 and is a Schedule IV controlled

substance as defined by Health and Safety Code section l l 057. It can be habit frmning and its

side effects may impair thinking or reaction time; it can increase dizziness and drmvsincss. Since

the effects carisoprodol and alcohol or carisoprodol and other CNS depressants or psychotropic

drugs may be addictive. doctors should use appropriate caution \Vith patients who take more than

one of these agents simultaneously.

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Al:cusation

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20. Clonazepam is the generic name for Klonopin. a bcnzodiazepine anticonvulsant. h is

a dangerous drug as defined by section 4022 and a Schedule IV controlled substance as defined in

Health and Safety Code section 11057. subsection (d). Clonazepam produces CNS depression

and should be used \Vith caution \·Vith other CNS depressant drugs. It can produce psychological

and physical ckpcrn.lence and abrupt discontinuation can produce withdrawal symptoms similar to

alcohol vvithdrmva!.

21. Dilaudid is a trade name for hydromorphone hydrochloride. It is a dangerous drug as

defined in section 4022 and a Schedule II controlled substance as defined by Health and Safety

Code section 11055. subsection (b). Psychological and physical dependence. as well as tolerance,

may develop \Vith repeated use; therefore, doctors should only prescrihe and administer it \Vith

caution. Side effects indude dnnvsiness. mental clouding, respiratory and vomiting.

Fentanyl transdermal s~·stem. which goes the name

opioid pain reliever. It is a dangerous drug as defined in section 4022 and a Schedule II

controlled substance as defined by Health and Safety Code section 11055, subsection ( c ).

lS a rnedication and is indicated for treatment chronic

cannot be managed by lesser means and requires continuous opioid administration. Fentanyl

presems u of serious or life-thremening i1ypoventila1icm.

23. Gabapentin. also knmvn by the trade name Neurontin, is an antiepileptic and is

indicated as adjunctive therapy in the treatment of partial seizures in adults with epilepsy. It is a

dangerous drug within the meaning of section 4022.

24. Hydrocodone l'l'ith acetaminophen is also k.11mvn as Norco. Norco is administered I I

with ten milligrams (mg) of hydrocodonc and 325 mg of acetaminophen (APAP). It is a schedule I U controlled substance and narcotic as defined bv Health and Safotv Code section 11055, . ~ ~

subdivision It is also a dangerous drug as defined by section 4022. Repeated administration

hydrocodone over a course of several weeks may result in psychological and physical

dependence.

25. Lorazepam, also knmvn by the trade name Ati van, is for anxiety sedation

28 and the management of anxie1y disorder for the short-term relief symptoms. It is a dangerous

Accusation

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drug as defined bv 4022 and is a Schedule IV controlled substance as defined bv Health and ...._. ~ .,

Safety Code section l J 057. subsection (d). !t is not recommended for patients with primary

depressive disorders. Abrupl discontinuation of lorazepam can produce withdrawal symptoms,

including seizures.

26. l\'lcthadonc hydrochloride is a synthetic narcotic pain reliever that produces effects

similar to those of morphine. h is a dangerous drug as defined in section 4022 and a Schedule JI

controlled substance as defined by Health and Safety Code section 11055, subsection (c).

Methadone can produce drug dependence of the morphine type and, therefore, has the potential

for abuse. Psychological and physical dependence can develop \Vith repeated administration, and

doctors should prescribe and administer it ·with the same degree caution as with morphine.

27. l\forphinc sulfate is used for patients who require opioid pain relief for moderate to

severe Jt is a dangerous drug as defined by scctin1: 4022 and is a Schedule ll controlled

substance as defined hy Health and Safety Code section i 1055, subdivision ). l\·forphinc can

produce drug dependence and has the potential for abuse. Tolerance and physical and

dependence can develop v .. ith repeated use. or reduction in the

dose after prolonged use can n::sult in withdnnval symptoms,

Oxycodonc 'lVith acctaminO[lhcn, also krnnvn the trade name IS Ll

scmisynthctic narcotic analgesic \Vith multiple actions qualitmively similar to those morphine.

It is a dangerous drug as defined in section 4022 and is a Schedule II controlled substance as

defined by Health and Safety Code section 11055. subsection (b). Oxycodone can produce drug

dependence of the morphine type and, therefore. has the potential for abuse. It is a short acting

22 1 opioid and intended for immediate relief of pain.

23 29. OxyContin is a trade name for oxycodone hydrochloride controlled-release tablets.

24 Oxycontin is a dangerous drug as defined in section 4022 and a Schedule II controlled substance

and narcotic as defined by Health and Safety Code section 11055, suhdivision (b). Respiratory

26 depression is chief hazard from all opioid agonisl preparations, OxyContin should be used

\Vith caution and started in a reduced dosage in patients who are concun-ently receiving

28 depressants. It is a long acting opioid and intended for pain relief over a period.

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Accusation

30. Ritalin. a trade name for methylphenidate hydrochloride, is a mild CNS stimulant

indicated for the treatment of AD.HD. It is a dangerous drug as defined in section 4022 of the

Code and a Schedule II controlled substance as defined in Health and Safety Code section 11055.

4 subdivision (d). This medication should be given cautiously to patients \Vitb a history of drug

5 dependence or akoholism. Chronic use can lead to increased tolerance psychological

6 dependence.

7 31. Xanax is a trade name for alprazolam and is used for the management of anxiety

8 disorders or for the short-tenn relief anxiety symptoms. !t is a dangerous drug as defined in

9 section 40:22 and a Schedule IV controlled substance and narcotic as defined hy Health and Safety

l O Code section 11057. subdivision (d). Xanax has CNS depressant effects and patients should be

I l cautioned about the simultaneous ingestion of alcohol and other depressant drugs YVhile

12 using Xanax. Doctors sho:Jld carefully rnoniwr patients \\'ith or abuse histories

1 -, ~j when pn.:sc;-ihing Xanax because of their predisposition to habituation and dependence.

FIRST CAUSE FOR DISCIPLINE

15 nprofessional Conduct: Gross Negligence and/or Acts

16 1ncompetence: and/or Excessive Prescribing Based on the Provided to Patient CV)2

17 or abou: March 2 7. l ::::. Respondent began

J 8 rnale. CV completed a patient information fonn, a two page pre-printed medical history fonn., a

19 t\vo page ·'Review of Systems" fonn, a "Depression Anxiety and Stress Scale (DASS}" evaluation

20 form, a "Consent & Agreement for Opioid Maintenance Therapy for Malignant & Non-Malignant

21 Pain," and a notice of possible urine testing. The medical history fonn allmved the patient to

22 check a box for "yes" or "no" to various medical conditions. CV checked "yes'· to having a

23 history of migraines, back pain, asthma, eczema, and chicken pox. He '>Vrote that he was taking

24 AJlegra. and vitamins B and C. I k also checked boxes that he rarely used alcohol and never used '-" , .

25 tobacco or drugs. On the Revie"v of Systems form, CV checked "yes'' to tbe following medical

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2 Patient initials are used to protect the patient's privacy. Respondent may learn the names of the patients through the discovery process.

9

Accusation

change of sleeping pattern. allergies, abnorrnal sleep panerns, anxiety, shortness breath.

2 coughing, 1.vheczing, yellO\V or green phlegm, pain. and tiredness.

" J 33. The progress note (titled "Examination Form") for this first visit indicates that CV

4 had a "torn bicep tendon'' and low back pain. The note indicated that Respondent pcrfrmned a

5 limited physical examination, but much of the information is not legible and is replete

6 medical abbreviations. The diagnosis is listed as: right shoulder pain, depression/stress, knv back

7 pain, and sciatica. Respondent did not revie\v or order any imagining studies, previous

8 I medical records, or speak with prior treatment providers to confirm this diagnosis. Respondent II

9 I fl

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prescribed 30 mil Ji grams (mg) of Oxycodone ( 180 pills for 30 days), t\vo mg of Xanax ( 90 pills

for 30 days), and 300 mg of gabapcntin (200 pills frn 30 days). Respondent instructed on If

l l I!

II exercises for his back and shoulder pain. I

12 I i During Respondent's imcrview on . 2013 investigators for Health

'" 1 ~' II 11

Quality Investigation t 'nit (HQfU) for the Bo;ird, Respondem admitted that the DA.SS score

14 H n indicated CV was extremely and severely depressed. Despite this assessment, Respondent did not

15 into 's mental health history or refer him to another

16 treatment. Respondent stated that he regularly prescribes Xanax for depression to his patients.

17 Respondent also admitted that he did not to about \vhether had substance

18 use/abuse history.

19 35. On or about April 24, 2012, CV returned to Respondent's office for a follow-up

20 appointment. CV completed the "Progress Note Pain Assessment and Documentation Tool

. 21 (PADT)" form. CV indicated he was taking three pills of Xanax and six pills of Oxycodone per

22 day, his pain level \vas bet\veen four and seven, the pain medication \Vas sufficient to deal \Vith

}"' __ , his pain, and generally he \vas better. Respondent's progress note for the visit indicates that he

pcrfonncd a limited range of motion evalua1ion. Respondent added 350 mg of Soma (90 pills for

25 30 days) \Vtthout indicating the reason for the medication. He also refilled the same medications

26 at the same dose and ins1ruc1ion from the previous visit

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10

Accusation

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36. Respondent cominued to see CV for fo11cnv-up appointments cm May 22. 12.' June

19, 2012. and July 17. 1012. At each of these visits, Respondent continued to refill the

medications at the same dose despite failing to conduct a physical examination or periodic

rcvievis of the patient's opioid use or effectiveness of the mcdications.4

37. Respondent conducted a urine screen of CV on June l 2012. The test showed that

CV was using the medications that Respondent prescribed.

38. The records indicate that on June 19, 2012, Respondent referred to another doctor

for Cognitive Behavioral Therapy. CV's medical records also contain a Controlled Substance

Utilization Review & Evaluation System (ClJRFS) repon showing that CV was also prescribed

/unbicn, dona~-:;cpam. and Addcra!l from another doctor "vhilc receiving mr:dications from

Respondent There is nothing in the medical records indicating that Respondent discussed \vith

CV the risks hen di ts of using all of these controlled substances at same ti1ne.

or about August 14. 2012, CV returned for a follow-up visit. indicated his

pain level \Vas bctvveen five and six and that 75 percent of his \Vas controlled the

medications. that he \Vas not sleeping \'>"dL Respondent not a physical

examination during this visit. Respondent refilled the Xanax and the but reduced the

oxycodone from six to two piils per day pills ). Respondent

18 added 60 mg of morphine sulfate (60 pills for 30 days). There is no notation in the progress note

19 why Respondent added morphine sulfate. This \:vas the last medical appointment.

20 40. CV' s medical records contain copies of the prescriptions Respondent \Vrote at each

21 visit. On the prescription copies from August 14, 2012 there are nvo handwritten notes. The first

22 note indicated that paramedics \Vere called because "CV was unresponsive" for approximately

five minutes and that CV refused to go to the hospital. The second handv.,;ritten note is dated

14 August 27. 11 states lhat "father called & said his son is in rehab & doesn't want us to prescribe

25 narcotics 10 his son anymore.''

26 3 or 11vlav :21. Re·~nondent ordered an

27 lumbar spine. The imagi'ng reports indic-ate there was mild to inodcrate L5-S l and LA-LS.

4 Respondent discontinued gabapcntin at the May 22. 2012 appointment.

11

Accusation

41. medical record also contains a typed note dated August l 4. 12 from

Respondent's medical assistant about CV losing consciousness in the waiting room. Respondent

made no medical notation about this incident in the medical record.

4 42. On or about November 29, 2012, Respondent completed a Confidential Morbidity

5 Report 1o Santa Clara Cou:1ty Public Health Administration. On the Respondent stated

6 that CV lost consciousness on August 14, 2012 in his office. Respondent checked the ''yes" box

7 that it is likely that additional lapses in consciousness would occur, that CV not be permitted to

8 drive, and that Department of Motor Vehicles should evaluate CV.

9 43. On or about March 20, 2013, CV met with an HQIU investigator to discuss the care

10 provided by Respondent. CV indicated that he got Respondent" s name from a friend who said

11 Rcsponcknt would easily prescribe controlled substances. At the first appointment reported

l:.; shoulder pain, but Respondent also diagnosed him as having back pain, despite not

14 complaining any back injury or pain. CV also told Respondent he had trouble sleeping. The

l 5 appointment took bcnvcen six to ten mimncs. and follo\:v-up appointments were to

16 minutes. CV admitted to initially only using 15 to 20 percent of the medication prescribed by

17 Respondent and solci the rest of the medications. \Vi thin one month treatment. he \Vas :

18 addicted to all of the medications and \vas using 40 percent of the medications. CV reported that

J 9 at his 1ast office visit with Respondent, it had been three days since he had taken any medication

20 and had never discussed withdrawal or the risks of suddenly stopping his medications with

21 Respondent. CV stated he had a seizure in Respondent's office after his last appointment with

22 Respondent.

44. CV told the HQIU investigalor that since he began seeing Respondent he has been

24 mTested three times for driving under the influence. He reported that he "blacked out" on Xanax

25 prescribed to him b:y Respondent. CV eventually entered an in~paticnt rehabilitation program.

26 Since completing rehabilitation, he has remained sober and began professional golf again.

4 'i Respondent is guilty of unprofessional conduct and subject to disciplinary action

28 under sections 2234 [unprofessional conduct I. and/or 2234(b) [gross negligence]. and/or 2234(

12

Accusation

f repeated ncgligcm acts], and/or 2234\d) [incompetence/lack kno-vvledge], including but not

limited to the following:

a) Respondent failed to reviev,: prior medical records to confirm cv·s diagnosis and

medical issues:

Respondent failed to discuss the patient's prior use op!ciids or bcnzodiazcpincs,

including his failure to ask CV any questions about his substance use/abuse history;

c) Respondent failed to conduct a thorough and complete initial physical examination,

and his diagnosis of lmv back pain, shoulder pain, and sciatica \Vere \Neakly supported

in the medical record:

d) Respondent faiicd to justify the medical necessity for the high doses of opioid

medications prescribed, including his failure to justii)' the medical necessity adding

morphine su!Cate:

e) Respondent failed lO conduct periodic- reviews of CV's treatment plan, and whether

the patient \Vas responding or not to the medications,

46, Respondent is also guilty of unprofessional ect to disciplinary action

under sections 2242 lfumishing drugs without examination l and/or 725 [excessive prescribingl in

that he inappropriately and excessively prescribed high of controlled subswnces to CV in

the absence of an appropriate prior medical examination or medical indication.

SECOND CAUSE FOR DISCIPLINE

(Unprofessional Conduct: Gross Negligence and/or Repeated Negligent Acts and/or

Incompetence: and/or Excessive Prescribing and/or lnadequatc Medical Record Keeping

Based on the Care Provided to Patient MA)

4 7. On or about January 31, 2012, Respondent began treating patient :tv1A, a 24-year old

male. At this initial visit MA completed a patient registration form, a DASS evaluation fom1, a

1wo page ''Review of Systems" fom1, a one page history form. and signed the ''Consent &

/\greement for Opioid Maintenance Therapy for \vfalignant & Non-lvialignant Pain" fonn. On the

one page history form, .VlA wrote that his chief complaint was ''hand\vrist pain.'' that same

form. l'v1A also checked ".yes" next to the following medical history questions: chicken pox.

13

Accusation

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migraines, and back pain.

48. In the progress note for this first visit, Respondent indicated he conducted a limited

physical examination; however. much ofihc note is not legible and is full of medical

abbreviations. Respondent noted that MA complained of anxiety since he was 15, he smoked

marijuana, had used a frimily member's Xanax, and suffered from tunnel syndrome v.,ith l 0

out of 10 pain. A nerve conduction report \Vas attached to this progress note indicating MA had

bilateral carpel tunnel of moderate severity. Respondent diagnosed MA with carpel tunnel

syndrome, depression, stress. and anxiety. At this first visit, Respondent prescrihed 10 mg of

methadone (90 pills for 30 days) and two mg of Xanax (90 pills for 30 days). Respondent did not

discuss MA ·s substance :.tsciabuse history with him despite MA 's admission that he used

controlled substances not prescribed to him a1ong \Vith marijuana.

49. Respondent comimk'd to sec Ml\ on February :::1.?L,, l 27. 2012. and April

24. 20 l 2.' The patient completed the two page PADT form at each these follow-up visits.

Respondent continued MA on the same medications. By ApriL lVLA reported his pain le·vcl at

three to four out of l 0. Despite the patient's report decreased pain. wrote

less effective." Respondent did not conduct any physical examination MA during these visits.

50. On or abom l\fay MA completed PADT indicated that · pain

\Vas between six to eight but that 60% of it was controlled with medications. The progress note

indicated that MA had left hand surgery three weeks ago. Respondent added 30 rng of oxycodone

(150 pills for 30 days) and reissued the methadone and Xanax prescriplions.6 The PADT form

indicates that the oxycodone was added "due 10 surgery & inadequate pain control."

51. On or about June 6, 2012, 1v1A's mother called Respondent's office to complain about

the amount of medication Respondent prescribed to MA, that her son was a fonner heroin addict

and had been to a detox program, and that he had overdosed. Respondent's partner, Dr. Jack

Kundin agreed to take over the care of MA.

.· l'vl/\ was also seeing a hand specialist for upcoming surgery. 6 MA also received 5!325 mg of Norco (20 pills) from his hand surgeon on April 30, 2012

and again on September 13, 2012.

14

Accusation

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52. ln J'v1A's medical record there is a fax from \Val greens Pharmacy dated M.ay 1 2012.

At the bottom ponion of the page is a handwritten note dated June 6. 20 l 2. The note says.

"Heroin addict slurred speech blood in stool detox program'· and the name MA 'smother.

During Respondent's Board interview. he indicated this was his note documenting the call with

'.vlA. smother. lle just happened to 1.vrite this note on whatever page he m medical

chart. Be also stated that he told the mother to take MA to the emergency room.

53. On or about June 19, 2012, Dr. Kundin completed a progress note for a foUmv-up

appointment with MA that indicated the treatment plan was to reduce the methadone and Xanax

lo one pill per day. Dr. Kunclin did not \\Tile any prescriptions for MA during this visit.

54. or about June 21. 2012, Respondent refilled al 1 three 's prescriptions (JO

mg Methadone for 60 pills, two mg of Xanax for 60 pills, mg of oxycodonc for 110

pills). Respondent \'-'TOte these prescriptions despite Dr. Kundin taking over the care 1\1A and

the treatment plan to reduce :he medications. Rcsponden1 did not \Vrite a corresponding progress

note for prescriptions.

55. Respondent is guilty of unprofessional conduct subject 10

under sections 2234 [unprofessional conductl, and/or 2234(b) [gross negligencel, and/or 2234(c)

l d ,. ~ ' ..,,, .., 1 'd ~· '1 ' l' repeater ncgugcnt acts j, anw or ..::...::.Y-rl, ·) [ mcompetencci 1acK o including, not

limited to the follmving:

Respondent failed to conduct and document an adequate initial history and physical,

including a substance use and history;

b) Respondent failed to conduct periodic rcvic\vs of the patient's use:: of the controlled

substances, including side e.ffccts and the possibility that MA was abusing the

medications.

c) Respondent failed to conduct a physical examination at follow-up appointments;

7 MA 's medical record indicates that Dr. Kundin had fi:Jllovv-up appointments with tv1A on the following dates: July 17, 2012 (the methadone and Xanax continued at the same dosage, while

increased lo 1 pills): August 13, 1 to pills Xanax and methadone s1aycd the same); September 11, 20 2 ( oxycodom; and Xanax decreased to 45 pills and methadone was decreased to 30 pills): and Septemher 25, 2 (methadone increased to 60 pills, Xanax increased to 90 pills. and oxycodone increased to 70 pills).

15

Accusation

Respondent faiied 10 seek outside assistance or recommend that seek help for

possible substance abuse issues.

56. Respondent failed to maintain adequate and accurate medical records in connection

4 \Vi th his care of Patient MA in violation of section 2266. Specifically, Respondent failed to

5 document a thorough medical history and examination at the initial appointment. Respondent

6 also failed to adequately document physical evaluations at follow-up appointments, including the

7 diagnosed condition Respondent \Vas treating.

8 57. Respondent is also guilty of unprofessional conduct and subject to disciplinary action

9 under sections 2242 [furnishing drugs without examination] and/or 725 I excessive prescribing] in

10

11

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that inappropri::.itciy and excessivdy prescribed high doses of controlled substances lo MA in

the absew:c of an appropriate prior medical examination or medical indication.

THIRD C.:\lJSF FOR DISCIPLINE

(Unprofessional Conduct: Gross Negligence and/or Repealed Negligent Acts and/or

Incompetence; and/or Excessive Prescribing and/or Inadequate Medical Record Keeping

Based on Care Provided to TB)

i 6 58. On or about June 7. 20 l 2, Respondent began 1rcating patient TR a 22-year o1d male.

17 TB a patient Rcgisu-mion form, a t\vo page "Revic\'>' Systems" form. a tYvo page

18 history form, a DASS form, a "Consent & Agreement for Opioid :tv1aintenance Therapy for

19 Malignant and Non-Malignant Pain'' form, and a notice about random urine screens. On the

20 history page, TB indicated his chief complaint was "major pain after car accident." He also

21 checked several "yes" boxes related to prior medical conditions, including suffering from

12 migraines and back pain. The medical records contain MRI reports from January 28, 2012 for

TB's left knee. The report indicated that TB suffered from a complete tear of the posterior

24 crnciate ligament large joint effusion caused by recent injury, a mild sprain, and suspected

25 mcniscocapsular separation. Respondent did not discuss TB's substance use/abuse history v.,.rith

26 him.

Respondent noted on the progress note for this first visit that had been in a car

28 accident that TB suffered from a torn knee /\CL in his left knee. neck sprain. and "low back

16 ___ , _____ _ Accusation

pain.'' Respondent conducted a limited physical examination. but the note is only partialiy legible

I and is full medical abbreviations. Respondent prescribed 300 mg of Neuromin (200 pilis for

~

_) days). 300 mg of Soma (90 pills for 30 days), two mg of Xanax pills for 30 days), and 30

4 mg of oxyc:odone (300 pills for 30 days).

5 or about July 6, 2012, TB returned to Respondent's office a

6 appointment. The progress note indicated he was there for a prescription refill and "needs

7 surgery." ·rhe remaining handwTiting (five lines) on the note is partially legible. Prescriptions

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were refilled at the same dosage and quantity as the prior report; however. the prescription form

checked Dr. Jack Kundin's name as the prescriber.

61 . On or about .l uly 18, 2012, TB returned to Respondent's office rcq ucsting medication

1 l refills because he \Vas in a car accident and lost his medications in the ulovc box. Respondent '-' .

12 noted i)crfonninQ a limiied nbvsic;1l examination. ·rhcrc arc ~ . . numbers next tP the \'arious

13 areas where Respondent appeared to use a pain scale to document s · levels. Respondent

14 refilled all the same prescriptions at the same dose, but reduced amount of pills given

Vi ( oxycodonc, reduced to l GO pills: Xanax. to 48 pills: Soma. reduced to pills: and

16 Ncurnntin. reduced to 32 pills). There was no discussion with TB about potential concerns \;i,rith

i7 ii 1·

early or medication requests.

' 18 I

I 61 On or about August 3. 2012, TB saw Respondent for a follov,:-up. TB completed the

19

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PADT fonn indicating that his pain was between a four and five and his pain was 75% controlled.

TB also checked "yes" in the box about \vhct11er the current medications \Vere enough to "make a

21 real difference in your life.'" Respondent documented a limited physical examination. Despite

22 TB's reports that his pain \Vas controlled, Respondent added 60 mg of morphine sulfate (60 pills

13 for 30 days). Respondent also refilled the oxycodonc { 180 pills for 30 days): Xanax (90 pills for

24 30 clays); Soma (90 pills for 30 days): and Neurontin (30 pills for 30 days '>vith five refills). There

" ~ .LJ vvas no notation in the: medical record why morphine: sulfate was added.

63. Respondent continued to see TB on August 31, 12 and 28, 2012. TB

27 completed the PADT form for these visits, indicating that his pain was hctvvcen a two to a four.

28

'7 j {

/\ccusation

/\teach Respondent documented performing a limited physicai exam. He refilled all the

2 same prescriptions at the smne dose and quantity vv·ith the exception Neurontin.

3 64. On or about October 31, 2012. TB went to Respondent requesting a refill of his

4 medications because he "ran out three davs ago." The record notes that Dr. \Vhhc in Chico ., 4,,. '

5 Califurnia was pn.::scribing medications to TB. Respondent con<luctcd a limited

6 movement examination and appeared to use a pain scak 10 document TB' s pain levels. TB

7 indicated his pain was any\vhere between a five to a seven. Respondent vvrotc prescriptions for

8 the sarnc medications previousiy prescribed.

9 65. There is an undated letter in TB's medical file indicaling that Respondent would no

1 O longer sec patients after October 31, 2012.

J 1 66. ·ih:re is a fax note to Respondent from a Walgrcens pharmacist on October 3 l, 20 l 2

12 to confirm Responden: · s prcscrip:ion for morphine sti!ratc \Vrittcn on October 31. J 2. Also. on

l3 this fax is a handwnncn note from Respondent dated t\ovember 27, 12 that the last morphine

14 sulfate prescription he prescribed was on September 28, 2012 and the pharmacy should report the

15 incident to the police. There is no explanation ·why Respondent \\Tote this note earlier

16 prescription for morphine sulfate dated October 3 L 2012, which was documented in TB's chart.

17 Un or about April 15, 2013, an HQIU investigator met with w care and

18 treatment by Respondent. During tf)c interview, TB indicated that he \Vas not addicted to

19 controlled substances or street drugs before he began seeing Respondent. At the initial visit TB

20 indicated that Respondent conducted a physical examination of him, prescribed various

21 medications, and had him sign several documents. TB stated he received paperwork on the

22 various medications prescribed but he did not actually talk to Respondent about the risks and

23 benefits of using these medications. TB also stated that Respondent never told him how addictive

24 the medications \vere. There \Vas never any discussion about the possibility of tapering the

medications or hov,· he \vcmld be weaned off of the medications \vhcn he no longer needed pain

26 rnanagement. TB said he \Vas fully addicted to the medications \Vi thin to six months of first

using them. that he suffered withdrmval symptoms if he did not take all the medication

28 prescribed by Respondent, and his grades at college decreased dramatically. Eventually, TB

J 8

Accusation

dropped out college. At the time of the inlerviev./, TB had been off all controlled substances

' for three months.

3 68. Respondent is guilty of unprofessional conduct and subject to disciplinary action

4 under sections :2234 [unprofessional conduct], and/or 2234(b) !gross negligcnccj, and/or 2234(c)

) [repeated negligent actsj, and/or 2234(d) [incompetence/lack of knovvledgej, but not

6 limited to the following:

7 a) At the initial visit, Respondent failed to conduct an adequate initial history,

8 evaluation, and examination, including whether TB had any prior substance use/abuse

9 history. Respondent also failed to discuss any prior treatments and the success or

10 fail urc of those treatments, and \vha1 1)rior medications he tried nreviouslv. i • ,

11 Respondent also failed to revic\v any prior medical records to confin11 TB 's

12

cumrnHed substance prescriptions and what the treatment plan and objectives vvere.

14 At subsequent medical appointments. Respondent failed to conduct periodic revievvs

15 medical basis for the controlled and the current

16 treatment plan on TB 's medical condition. Th1s includes Respondent's failure to

17 discuss a second car accident vvith and needed refills.

18 69. Respondent failed to maintain adequate and accurate medical records in connection

19 with his care of Patient TB in violation of section 2266. Specifically, the medical records lack a

20 diagnosis. clear treatment objectives, and the medical justification for the controlled substances.

21 70. Respondent is also guilty of unprofessional conduct and subject to disciplinary action

22 under sections 2242 [furnishing drugs without examination] and/or 725 [excessive prescribing] in

that he inappropriately and excessively prescribed high doses of controlled substances to TR in

24 the absence of an appropriate prior medical examination or medical indication.

\\ \ \•,

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J\c\.:usation

FOURTH CAt:sE FOR nISClPL!NE

') (Lnprofessional Conduct: Crross Negligence and/or Repeated Negligent Acts and/or

,., -~ lncompetence: and/or Excessive Prescribing and/or inadequate Medical Record Keeping

4 Based on the Care Provided to TS)

5 71. Respondent treated TS, a 23-year-old male, on three occasions, August 3, 12,

6 August 10. 2012, and September 13. 2012. TS completed a patient Registration form, a two page

7 "'Review of Systems" form. a two page history form, a three page DASS form, a "Consent &

8 Agreement for Opioid fvfaintcnance Therapy for Malignant and Non-Malignant Pain" form. and a

9 notice about random urine screens. On the history page. TS indicated his chief complaint was

10 ""ADD/anxiety." He also checked "yes'' to the boxes related to back pain and asthma. TS also

1 1 checked multi pk boxes on the "Reviev,' of Systems" form indicating multiple current medical

11 problems ( fotigue, lethargy. change of sleeping patterns. allergies, depression. . headaches,

l 3 chest pain, coughing, wheezing, pain, stiffness, swelling: ioints. and excessi vc svv'CatinuJ ~ . ~·

14 Respondent did not discuss substance useiabuse history or previous treatments \Vith

15 TS.

16 72. At the first appointment on or about August 3, ::w 1 Respondent conducted a limited

17 physical examination: i10wever, \he document is not legible and contains mostly medical

18 abbrevia1ions. The note also indicated that TS stated he suffered from Attention Deficit Disorder

19 (ADD) since childhood and was getting Ritalin from another doctor but his last dose was one

20 week ago. Respondent diagnosed TS ·with ADD/ADHD, depression, anxiety, and stress without

21 rcvie,ving any additional medical records from other providers or performing any testing.

22 Respondent prescribed two mg of Xanax (90 pills for 30 days) and 20 mg of Ritalin (90 pills for

')" .:._} 30 days).

24 73. On or about August 10, 2012, TS returned to Respondent's ofiice claiming that his

25 girlfriend ''flushed'' his medications and he needed a refill. Respondent did nol conduct a

" ( ,.:..,) ,I

physical examination and he refilled the Ritalin and Xanax (63 pills of each).

27 II ii

28 i\ I,

7 4, On or about September 13. 2012. Respondent smv TS the last time. During that

appointment, the progress note indicated that he \Vas i11iurcd at a skate park approximately three

I 20 i ..

[ Accusation

\Veeks prior. The note also indicated that his anxiety \Vas under control. Respondent refilled the

Xanax at the same dose and quamit;,· and added two mg of Dilaudid ( 48 pills). progress note

3 does not indicate why he prescribed the Dilaudid.

4 75. The Controlled Substance Utilization Review and Evaluation System (CURES)

5 indicate t11at betvn:cn February 28, 2010 to February 201 received the

6 foUowing medications from other providers: Subutex, Ritalin, buprenorphine, fentanyl, and

7 Dilaudid.

8 76. There is an undated letter in TB's medical file that Respondent vvou!d no longer see

9 patients after October 31, 2012.

Hl 77. I\.cspondent is guilty of unprofessional conduct and subject to disciplinary action

J l under sections 2234 [ unprofi.:ssional conduct], and/or 2234(b) [gross negligcnccJ, and/or 2234(c)

lrc11Jcated 11:.:vJi 2en1 actsr,,, and/or 2234( d J fincomi)ctencc 1lack

~ """"'" ._ . ' . :, t includ · not

limited w flJllowing:

a) Respondent failed to discuss \vith TS his prior psychiatric history and treatment. He

also failed to discuss any substance use/abuse history 'IVith TS. Respondent failed to

review any prior medical records or conduct testing to detennine or confirm a medical

17 diagnosis. Respondent failed to provide a rncdical · pn:scribing

18 controlled substances.

19 b) Respondent failed to coordinate care with TS's additional Ritalin prescriber.

20 c) Rcsponde11t failed to document any of TS' s injuries that prompted Respondent to

21 prescribe pain relievers.

22 78. Respondent failed to maintain adequate and accurate medical records in connection

23 \Vi th his care of Patient TS in violation of section 2266. Specifically, Respondent did not

24 document conducting an adequate initial examination and history and he failed to indicate a

25 diagnosis/treatment plan for the subsequent two medical visits.

16 79. Respondent is also gu11ty of unprofessional conduct and subject to disciplinary action

27 under sectirins 2242 [furnishing drugs without examination! an di or 725 [excessive prescribing] in

28

21

Accusation

that he inappropriately and excessively prescribed high doses of controlled substances to m

2 the absence ::m appropriate prior medical examination or medical indication.

FIFTH CAUSE FOR DISCIPLINE

4 (Criminal Conviction)

5 80. Respomknt is subject to disciplinary action under sections 2234, 123 and ll1

6 that J{.espondcnt was convicted of a crime. The circumstances arc as follows:

7 81. The Santa Clara County District Attorney's Office fi1ed a felony criminal complaint

8 against Respondent in People v. David Juan, Case No.Cl 37035B in the Santa Clara Superior

9 Court Respondent was charged with three counts of prescribing controlled substances to a

l O person \Vithout a legitimate medical purpose in violation of Health and Safc~ty Code section

11 1l153(a). The complaint is based on the care Respondent provided to CV, lv!A, and TB.

!2 82. On or about Scpt<.::mbcr 19. 20 l 4, Respondent no contest to felony

13 counts as churgect The Santa Clara County Superior Court sentenced Respondent to formal

14 probation for years, ordered him 1.0 serve 90 days in county jail. complete 200 hours of

comrmmity service. and ri.ot 10 prnctice medicine on standard

16 tcnns, conditions. and fines were also ordered.

17 PRAYER

18 WHEREFORE, Complainam requests that a hearing be he1d on the n:1atters herein alleged,

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

20 Revoking or suspending Physician's and Surgeon's Certificate Number G78505,

11 issued to David Juan, M.D.;

22 Revoking. suspending or denying approval of David Juan, M.D.1s authority to

supervise physician assistaI1ts, pursuant to section 3527 of the Code:

'.24 3. Ordering David Juan, M.D. to pay the Medical Board of California the costs of

25 probation monitoring, if placed on probation;

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J Accusation I

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4. Taking such other and further action as deemed necessary and proper.

DATED: MarciL27_,,_ :>fl l 5

SF20144l0623 l l 747558.doc

, Executive Director Medical Board of California Department of Consumer Affairs State of California Complainant

Accusation