XAVIER BECERRA MEDICAL BO;~?;~ ~LIFORNIA SACRAMENTO JONES … Darren... · 2 E. A. JONES III...

1 XAVIER BECERRA Attorney General of California

2 E. A. JONES III Supervising Deputy Attorney General

3 CLAUDIA RAMIREZ Deputy Attorney General

4 State Bar No. 205340 California Department of Justice

5 300 South Spring Street, Suite 1702 Los Angeles, California 900 13

6 Telephone: (213) 897-5678 Facsimile: (213) 897-9395

7 Attorneys for Complainant

FILED STATE OF CALIFORNIA

MEDICAL BO;~?;~ ~LIFORNIA SACRAMENTO q 20 j_J BY}) . R 1 e,. ,fxrtl5 ANALYST

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MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS

STATE OF CALIFORNIA

In the Matter of the Accusation Against:

DARREN LYLE BERGEY, M.D. 900 East Washington Street, Suite 300 Colton, California 92324

Physician's and Surgeon's Certificate No. A 72267,

Case No. 800-2014-006206

ACCUSATION

Respondent.

Complainant alleges:

PARTIES

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

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

21 Affairs ("Board").

22 2. On or about June 29, 2000, the Medical Board issued Physician's and Surgeon's

23 Certificate Number A 72267 to Darren Lyle Bergey, M.D. ("Respondent"). That Certificate was

24 in full force and effect at all times relevant to the charges brought herein and will expire on

25 October 31, 2017, unless renewed.

26 JURISDICTION

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

28 laws. All section references are to the Business and Professions Code ("Code"). unless otherwise

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(DARREN LYLE BERGEY, M.D.) ACCUSATION NO. 800-2014-006206

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indicated.

4. Section 2227 of the Code provides that a licensee who is found guilty under the

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

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

action taken in relation to discipline as the Board deems proper.

5. Section 2234 of the Code states:

"The board shall take action against any licensee who is charged with unprofessional

conduct. In addition to other provisions of this article, unprofessional conduct 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 must 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.

"(e) The commission of any act involving dishonesty or corruption which is substantially

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

"(f) Any action or conduct which would have warranted the denial of a certificate.

"(g) The practice of medicine from this state into another state ·or country without meeting

the legal requirements of that state or country for the practice of medicine. Section 2314 shall not

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1 apply to this subdivision. This subdivision shall become operative upon the implementation of

2 the proposed registration program described in Section 2052.5.

3 "(h) The repeated failure by a certificate holder, in the absence of good cause, to attend and

4 participate in an interview by the board. This subdivision shall only apply to a certificate holder

5 who is the subject of an investigation by the board."

6 6. Section 2242 of the Code states:

7 "(a) Prescribing, dispensing, or furnishing dangerous drugs as defined in Section 4022

8 without an appropriate prior examination and a medical indication, constitutes unprofessional

9 conduct.

10 "(b) No licensee shall be found to have committed unprofessional conduct within the

11 meaning of this section if, at the time the drugs were prescribed, dispensed, or furnished, any of

12 the following applies:

13 "(1) The licensee was a designated physician and surgeon or podiatrist serving in the

14 absence ofthe patient's physician and surgeon or podiatrist, as the case may be, and ifthe drugs

15 were prescribed, dispensed, or furnished only as necessary to maintain the patient until the return

16 of his or her practitioner, but in any case no longer than 72 hours.

17 "(2) The licensee transmitted the order for the drugs to a registered nurse or to a licensed

18 vocational nurse in an inpatient facility, and ifboth of the following conditions exist:

19 "(A) The practitioner had consulted with the registered nurse or licensed vocational nurse

20 who had reviewed the patient's records.

21 "(B) The practitioner was designated as the practitioner to serve in the absence of the

22 patient's physician and surgeon or podiatrist, as the case may be.

23 "(3) The licensee was a designated practitioner serving in the absence of the patient's

24 physician and surgeon or podiatrist, as the case may be, and was in possession of or had utilized

25 the patient's records and ordered the renewal of a medically indicated prescription for an amount

26 not exceeding the original prescription in strength or amount or for more than one refill.

27 "(4) The licensee was acting in accordance with Section 120582 of the Health and Safety

28 Code."

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1 7. Section 725 ofthe Code states:

2 "(a) Repeated acts of clearly excessive prescribing, furnishing, dispensing, or administering

3 of drugs or treatment, repeated acts of clearly excessive use of diagnostic procedures, or repeated

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

5 the community of licensees is unprofessional conduct for a physician and surgeon, dentist,

6 podiatrist, psychologist, physical therapist, chiropractor, optometrist, speech-language pathologist,

7 or audiologist.

8 "(b) Any person who engages in repeated acts of clearly excessive prescribing or

9 administering of drugs or treatment is guilty of a misdemeanor and shall be punished by a fine of

10 not less than one hundred dollars ($1 00) nor more than six hundred dollars ($600), or by

11 imprisonment for a term of not less than 60 days nor more than 180 days, or by both that fine and

12 imprisonment.

13 "(c) A practitioner who has a medical basis for prescribing, furnishing, dispensing, or

14 administering dangerous drugs or prescription controlled substances shall not be subject to

15 disciplinary action or prosecution under this section.

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

17 for treating intractable pain in compliance with Section 2241.5."


19 "The failure of a physician and surgeon to maintain adequate and accurate records relating

20 to the provision of services to their patients constitutes unprofessional conduct."


22 "(a) Notwithstanding any other law, a physician assistant may perform those medical

23 services as set forth by the regulations adopted under this chapter when the services are rendered

24 under the supervision of a licensed physician and surgeon who is not subject to a disciplinary

25 condition imposed by the Medical Board of California prohibiting that supervision or prohibiting

26 the employment of a physician assistant. The medical record, for each episode of care for a

27 patient, shall id,entify the physician and surgeon who is responsible for the supervision of the

28 physician assistant.

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1 (b)(1) Notwithstanding any other law, a physician assistant performing medical services

2 under the supervision of a physician and surgeon may assist a doctor of podiatric medicine who is

3 a partner, shareholder, or employee in the same medical group as the supervising physician and

4 surgeon. A physician assistant who assists a doctor of podiatric medicine pursuant to this

5 subdivision shall do so only according to patient-specific orders from the supervising physician

6 and surgeon.

7 (2) The supervising physician and surgeon shall be physically available to the physician

8 assistant for consultation when that assistance is rendered. A physician assistant assisting a

9 doctor of podiatric medicine shall be limited to performing those duties included within the scope

10 of practice of a doctor of podiatric medicine.

11 ( c )(1) A physician assistant and his or her supervising physician and surgeon shall establish

12 written guidelines for the adequate supervision of the physician assistant. This requirement may

13 be satisfied by the supervising physician and surgeon adopting protocols for some or all of the

14 tasks performed by the physician assistant. The protocols adopted pursuant to this subdivision

15 shall comply with the following requirements:

16 (A) A protocol governing diagnosis and management shall, at a minimum, include the

17 presence or absence of symptoms, signs, and other data necessary to establish a diagnosis or

18 assessment, any appropriate tests or studies to order, drugs to recommend to the patient, and

19 education to be provided to the patient.

20 (B) A protocol governing procedures shall set forth the information to be provided to the

21 patient, the nature of the consent to be obtained from the patient, the preparation and technique of

22 the procedure, and the follow up care.

23 (C) Protocols shall be developed by the supervising physician and surgeon or adopted from,

24 or referenced to, texts or other sources.

25 (D) Protocols shall be signed and dated by the supervising physician and surgeon and the

26 physician assistant.

27 (2)(A) The supervising physician and surgeon shall use one or more of the following

28 mechanisms to ensure adequate supervision of the physician assistant functioning under the

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1 protocols:

2 (i) The supervising physician and surgeon shall review, countersign, and date a sample

3 consisting of, at a minimum, 5 percent of the medical records of patients treated by the physician

4 assistant functioning under the protocols within 30 days of the date of treatment by the physician

5 assistant.

6 (ii) The supervising physician and surgeon and physician assistant shall conduct a medical

7 records review meeting at least once a month during at least 10 months of the year. During any

8 month in which a medical records review meeting occurs, the supervising physician and surgeon

9 and physician assistant shall review an aggregate of at least 10 medical records of patients treated

10 by the physician assistant functioning under protocols. Documentation of medical records

11 reviewed during the month shall be jointly signed and dated by the supervising physician and

12 surgeon and the physician assistant.

13 (iii) The supervising physician and surgeon shall review a sample of at least 10 medical

14 records per month, at least 10 months during the year, using a combination of the countersignature

15 mechanism described in clause (i) and the medical records review meeting mechanism described

16 in clause (ii). During each month for which a sample is reviewed, at least one of the medical

17 records in the sample shall be reviewed using the mechanism described in clause (i) and at least

18 one of the medical records in the sample shall be reviewed using the mechanism described in

19 clause (ii).

20 (B) In complying with subparagraph (A), the supervising physician and surgeon shall select

21 for review those cases that by diagnosis, problem, treatment, or procedure represent, in his or her

22 judgment, the most significant risk to the patient.

23 (3) Notwithstanding any other law, the Medical Board of California or the board may

24 establish other alternative mechanisms for the adequate supervision ofthe physician assistant.

25 (d) No medical services may be performed under this chapter in any ofthe following areas:

26 (1) The determination of the refractive states of the human eye, or the fitting or adaptation

27 of lenses or frames for the aid thereof.

28 (2) The prescribing or directing the use of, or using, any optical device in connection with

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1 ocular exercises, visual training, or orthoptics.

2 (3) The prescribing of contact lenses for, or the fitting or adaptation of contact lenses to, the

3 humaneye.

4 ( 4) The practice of dentistry or dental hygiene or the work of a dental auxiliary as defined in

5 Chapter 4 (commencing with Section 1600).

6 (e) This section shall not be construed in a manner that shall preclude the performance of

7 routine visual screening as defined in Section 3501.

8 (f) Compliance by a physician assistant and supervising physician and surgeon with this

9 section sha,ll be deemed compliance with Section 1399.546 of Title 16 of the California Code of

10 Regulations."

11 10. Section 3502.1 ofthe Code states:

12 "(a) In addition to the services authorized in the regulations adopted by the Medical Board

13 of California, and except as prohibited by Section 3502, while under the supervision of a licensed

14 physician and surgeon or physicians and surgeons authorized by law to supervise a physician

15 assistant, a physician assistant may admJnister or provide medication to a patient, or transmit

16 orally, or in writing on a patient's record or in a drug order, an order to a person who may lawfully

17 furnish the medication or medical device pursuant to subdivisions (c) and (d).

18 (1) A supervising physician and surgeon who delegates authority to issue a drug order to a

19 physician assistant may limit this authority by specifying the manner in which the physician

20 assistant may issue delegated prescriptions.

21 (2) Each supervising physician and surgeon who delegates the authority to issue a drug

22 order to a physician assistant shall first prepare and adopt, or adopt, a written, practice specific,

23 formulary and protocols that specify all criteria for the use of a particular drug or device, and any

24 contraindications for the selection. Protocols for Schedule II controlled substances shall address

25 the diagnosis of illness, injury, or condition for which the Schedule II controlled substance is

26 being administered, provided, or issued. The drugs listed in the protocols shall constitute the

27 formulary and shall include only drugs that are appropriate for use in the tYpe of practice engaged

28 in by the supervising physician and surgeon. When issuing a drug order, the physician assistant is

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1 acting on behalf of and as an agent for a supervising physician and surgeon.

2 (b) "Drug order," for purposes ofthis section, means an order for medication that is

3 dispensed to or for a patient, issued and signed by a physician assistant acting as an individual

4 practitioner within the meaning of Section 1306.02 of Title 21 ofthe Code ofFederal

5 Regulations. Notwithstanding any other provision oflaw, (1) a drug order issued pursuant to this

6 section shall be treated in the same manner as a prescription or order of the supervising physician,

. 7 (2) all references to "prescription" in this code and the Health and Safety Code shall include drug

8 orders issued by physician assistants pursuant to authority granted by their supervising physicians

9 and surgeons, and (3) the signature of a physician assistant on a drug order shall be deemed to be

10 the signature of a prescriber for purposes of this code and the Health and Safety Code.

11 (c) A drug order for any patient cared for by the physician assistant that is issued by the

12 physician assistant shall either be based on the protocols described in subdivision (a) or shall be

13 approved by the supervising physician and surgeon before it is filled or carried out.

14 (1) A physician assistant shall not administer or provide a drug or issue a drug order for a

15 drug other than for a drug listed in the formulary without advance approval from a supervising

16 physician and surgeon for the particular patient. At the direction and under the supervision of a

17 physician and surgeon, a physician assistant may hand to a patient of the supervising physician

18 and surgeon a properly labeled prescription drug prepackaged by a physician and surgeon,

19 manufacturer as defined in the Pharmacy Law, or a pharmacist.

20 (2) A physician assistant shall not administer, provide, or issue a drug order to a patient for

21 Schedule II through Schedule V controlled substances without advance approval by a supervising

22 physician and surgeon for that particular patient unless the physician assistant has completed an .

23 education course that covers controlled substances and that meets standards, including

24 pharmacological content, approved by the board. The education course shall be provided either

25 by an accredited continuing education provider or by an approved physician assistant training

26 program. If the physician assistant will administer, provide, or issue a drug order for Schedule II

27 controlled substances, the course shall contain a minimum of three hours exclusively on Schedule

28 II controlled substances. Completion of the requirements set forth in this paragraph shall be

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.(DARREN LYLE BERGEY, M.D.) ACCUSATION NO. 800-2014-006206

1 verified and documented in the manner established by the board prior to the physician assistant's

2 use of a registration number issued by the United States Drug Enforcement Administration to the

3 physician assistant ~o administer, provide, or issue a drug order to a patient for a controlled

4 substance without advance approval by a supervising physician and surgeon for that particular

5 patient.

6 (3) Any drug order issued by a physician assistant shall be subject to a reasonable

7 quantitative limitation consistent with customary medical practice in the supervising physician

8 and surgeon's practice.

9 (d) A written drug order issued pursuant to subdivision (a), except a written drug order in a

10 patient's medical record in a health facility or medical practice, shall contain the printed name,

11 address, and telephone number of the supervising physician and surgeon, the printed or stamped

12 name and license number of the physician assistant, and the signature ofthe physician assistant.

13 Further, a written drug order for a controlled substance, except a written drug order in a patient's

14 medical record in a health facility or a medical practice, shall include the federal controlled

15 substances registration number of the physician assistant and shall otherwise comply with Section

16 11162.1 ofthe Health and Safety Code. Except as otherwise required for written drug orders for

17 controlled substances under Section 11162.1 ofthe Health and Safety Code, the requirements of

18 · this subdivision may be met through stamping or otherwise imprinting on the supervising

19 physician and surgeon's prescripti.on blank to show the name, license number, and if applicable,

20 the federal controlled substances registration number of the physician assistant, and shall be

21 signed by the physician assistant. When using a drug order, the physician assistant is acting on

22 behalf of and as the agent of a supervising physician and surgeon.

23 (e) The supervising physician and surgeon shall use either of the following mechanisms to

24 ensure adequate supervision of the administration, provision, or issuance by a physician assistant

25 of a drug order to a patient for Schedule II controlled substances:

26 (1) The medical record of any patient cared for by a physician assistant for whom the

27 physician assistant's Schedule II drug order has been issued or carried out shall be reviewed,

28 countersigned, and dated by a supervising physician and surgeon within seven days.

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(2) If the physician assistant has documentation evidencing the successful completion of an

education course that covers controlled substances, and that controlled substance education course

(A) meets the standards, including pharmacological content, established in Sections 1399.610 and

1399.612 of Title 16 of the California Code ofRegulations, and (B) is provided either by an

accredited continuing education provider or by an approved physician assistant training program,

the supervising physician and surgeon shall review, countersign, and date, within seven days, a

sample consisting of the medical records of at least 20 percent of the patients cared for by the

physician assistant for whom the physician assistant's Schedule II drug order has been issued or

carried out. Completion of the requirements set forth in this paragraph shall be verified and

documented in the manner established in Section 1399.612 ofTitle 16 ofthe California Code of

Regulations. Physician assistants who have a certificate of completion of the course described in

paragraph (2) of subdivision (c) shall be deemed to have met the education course requirement of

this subdivision.

(f) All physician assistants who are authorized by their supervising physicians to issue drug

orders for controlled substances shall register with the United States Drug Enforcement

Administration (DEA).

(g) The board shall consult with the Medical Board of California and report during its

sunset review required by Article 7.5 (commencing with Section 9147.7) of Chapter 1.5 of Part 1

of Division 2 of Title 2 of the Government Code the impacts of exempting Schedule III and

Schedule IV drug orders from the requirement for a physician and surgeon to review and

countersign the affected medical record of a patient."

11. California Code of Regulations, title 16, section 1399.545, states:

"(a) A supervising physician shall be available in person or by electronic communication at

all times when the physician assistant is caring for patients.

(b) A supervising physician shall delegate to a physician assistant only those tasks and

procedures consistent with the supervising physician's specialty or usual and customary practice

and with the patient's health and condition.

(c) A supervising physician shall observe or review evidence of the physician assistant's

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1 performance of all tasks and procedures to be delegated to the physician assistant until assured of

2 competency.

3 (d) The physician assistant and the supervising physician shall establish in writing transport

4 and back-up procedures for the immediate care of patients who are in need of emergency care

5 beyond the physician assistant's scope of practice for such times when a supervising physician is

6 not on the premises.

7 (e) A physician assistant and his or her supervising physician shall establish in writing

8 guidelines for the adequate supervision of the physician assistant which shall include one or more

9 ofthe following mechanisms:

10 (1) Examination ofthe patient by a supervising physician the same day as care is given by

11 the physician assistant;

12 (2) Countersignature and dating of all medical records written by the physician assistant

13 within thirty (30) days that the care was given by the physician assistant;

14 (3) The supervising physician may adopt protocols to govern the performance of a physician

15 assistant for some or all tasks. The minimum content for a protocol governing diagnosis and

16 management as referred to in this section shall include the presence or absence of symptoms,

17 signs, and other data necessary to establish a diagnosis or assessment, any appropriate tests or

18 studies to order, drugs to recommend to the patient, and education to be given the patient. For

19 protocols governing procedures, the protocol shall state the information to be given the patient,

20 the nature of the consent to be obtained from the patient, the preparation and technique of the

21 procedure, and the follow-up care. Protocols shall be developed by the physiCian, adopted from,

22 or referenced to, texts or other sources. Protocols shall be signed and dated by the supervising

23 physician and the physician assistant. The supervising physician shall review, countersign, and

24 date a minimum of 5% sample of medical records of patients treated by the physician assistant

25 functioning under these protocols within thirty (30) days. The physician shall select for review

26 those cases which by diagnosis, problem, treatment or procedure represent, in his or her judgment,

27 the most significant risk to the patient;

28 (4) Other mechanisms approved in advance by the board.

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1 (f) The supervising physician has continuing responsibility to follow the progress of the

2 patient and to make sure that the physician assistant does not function autonomously. The

3 supervising physician shall be responsible for ·all medical services provided by a physician

4 assistant under his or her supervision."

5 FIRST CAUSE FOR DISCIPLINE

6 (Gross Negligence-Patients R.S.R., S.S., J.B., and M.A.)

7 12. Respondent Darren Lyle Bergey, M.D. is subject to disciplinary action under section

8 2234, subdivision (b), of the Code in that Respondent was grossly negligent in the care and

9 treatment ofpatients R.S.R., S.S., J.B., and M.A. 1 The circumstances are as follows:

10 13. At all relevant times, Respondent, physician assistant J.L., and physician assistant

11 M.L. jointly provided care and treatment to R.S.R., S.S., J.B., M.A., T.W., and F.H, including but

12 not limited to, prescribing medications to them.2 Respondent supervised J.L. and M.L. As the

13 supervising physician, Respondent is responsible for all medical services and medications

14 provided by a physician assistant under his supervision.

15 Patient R.S.R.

16 14. On or about June 17, 2010, R.S.R., a forty-three-year-old male, fell 54 feet from a

17 ladder onto his back and sustained a fractured cervical spine. On October 15, 2010, Respondent

18 first treated R.S.R. The patient was on one medication, Tramadol. Respondent evaluated and

19 diagnosed him with cervical compression fracture and lumbar sprain, which are both nonsurgical.

20 conditions. He recommended conservative treatment. There was no radiculopathy.

21 15. On November 24, 2010, Respondent evaluated R.S.R., did not note anything new, and

22 referred him for physical therapy. Based on the initial assessment that R.S.R. was non-surgical (a

23 medical treatment that does not involve cutting open the body), Respondent could have

24 transitioned him to a home program or primary care follow up. Instead, Respondent followed him

25 with no treatment plan with an endpoint, just treatment.

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1 The initials of the patients' names are used to protect their right of privacy. 2 The departures with respect to patients T.W. and F.H. are addressed in the second

through fifth causes for discipline.

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1 16. On December 22, 2010, and January 28, 2011, Respondent prescribed 60 tablets of

2 Anaprox 550 mg, 30. capsules ofRestoril30 mg, 60 capsules ofPrilosec 20 mg, and Medrox 120

3 gm.3

4 17. On March 2, 2011, Respondent prescribed 90 tablets ofUltram 50 mg.

5 18. On April2011, Dr.I.L., an outside consultant, reported that he did not find anything

6 surgical with R.S.R. He noted no numbness or tingling in the arms and no deficits. He noted

7 "cervical pain" as the diagnosis. He further noted C5-6 disk protrusion but no neurological

8 impingement.

9 19. However, Respondent referred R.S.R. to Dr. J.K. who three days later on April15,

10 2011, in a "Pain Management Consultation" said there was numbness and tingling in the left arm

11 with C5-6 sensory change, but no motor or reflex changes. Dr. J.1K. did not describe the symptom

12 distribution, which makes his report incomplete. Dr. J.K. only reviewed Respondent's records.

13 Dr. J.K. 's cursory description of symptoms, however, was used to justify the epidurals

14 Respondent ordered. Respondent did not acknowledge the inconsistencies between the two

15 ·outside reports from Dr.I.L. and Dr. J.K., and did not have a planned endpoint for narcotic

16 prescriptions.

17 20. On May 26, 2011, Respondent prescribed 60 capsules ofPrilosec 20 mg and 90

18 tablets of Ultram 50 mg.

19 21. On June 17, 2011, Respondent prescribed 60 capsules ofPrilosec 20 mg.

20 22. On August 26, 2011, Respondent deemed the original single cervical diagnosis of

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3 Naproxen (Anaprox and Naprosyn), Motrin (Ibuprofen), Celebrex (Celecoxib), Voltaren (diclofenac), and Nabumetone (Relafen) are nonsteroidal anti-inflammatory drugs. Prilosec (Omeprazole) and Protonix (Pantoprazole) are proton pump inhibitors that decrease the amount of acid produced in the stomach. Medrox ointment is a topical pain reliever. They are dangerous drugs as defined in Business and Professions Code section 4022.

Benzodiazepines are a class of drugs that produce CNS depression and are most commonly used to treat insomnia and anxiety. They are a type of medication known as tranquilizers. Examples ofbenzodiazepines include alprazolam (e.g., Xanax), lorazepam (e.g., Ativan), clonazapem (e.g., Klonopin), diazepam (e.g., Valium), temazepam (e.g., Restoril), clorazepate (Tranxene), nordazepam (e.g., Nordaz), and oxazepam (e.g., Serax). They are classified as Schedule IV controlled substances as defined by section 1308.14(c) ofTitle 21 ofthe Code ofFederal Regulations and Health and Safety Code section 11057, subdivision (d). They are dangerous drugs as defined in Business and Professions Code section 4022.

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1 compression fracture healed. But he provided three new diagnoses without explanation as to what

2 had changed. The three new diagnoses were cervical radiculopathy, C5-6 disk herniation, and

3 C3-4 foramina! narrowing.

4 23. On September 28, 2011, R.S.R. had a C5-6 fusion where a healed fracture and no new

5 findings were reported. Since the preoperative visit was on September 21, 2011, more than a year

6 after the June 17, 2010, incident, presumably in the interim, R.S.R. may have developed some

7 radicular symptoms. However, a focal finding was not in the patient's medical record. In fact, a

8 physical examination was not reported at that time. In addition, there were no true and

9 reproducible objective findings in the medical record.

10 24. On October 12, 2011, R.S.R. had a postoperative visit. He seemed to be doing well.

11 He had no radicular symptoms. The physical exam was cursory and only addressed the wound. It

12 is assumed there were no other findings, only some low grade pain. R.S.R. should have been out

13 of the practice within a few months based upon this surgical result regardless of the merits of the

14 surgery. However, R.S.R. would not be discharged and instead was shifted to physician assistant

15 J.L. for years of pain management despite successful surgery. There ~as no treatment plan with

16 an endpoint, just treatment.

17 25. On November 11, 2011, December 21, 2011, February 1, 2012, and March 9, 2012,

18 Respondent prescribed 120 tablets ofVicodin 5-500 mg, 30 tablets ofXanax 0.5 mg, and 60

19 capsules ofPrilosec 20 mg.4

20 26. On December 21, 2011, R.S.R. was on multiple drugs as a drug screening on this date

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showed acetaminophen, Lorazepam, hydrocodone, hydromorphone, amitriptyline, and

nortriptyline in R. S .R.' s system. 5 This drug treatment regimen would go on for several years.

4 Hydrocodone/Acetaminophen (Norco, Lortab, Vicodin) is an opioid pain medication. It is a Schedule II controlled substance as defined by section 1308.12, subdivision (b )(1 )(vi) of Title 21 of the Code of Federal Regulations and Health and Safety Code section 11055, subdivision (b )(1 )(I). It is a dangerous drug as defined in Business and Professions Code section 4022.

5 Amitriptyline (Elavil) and Nortriptyline (Pamelor ~nd Aventyl HCI) are tricyclic antidepressants. Tricyclic antidepressants are a class of drugs that are traditionally used to treat depression; however, they may also be used in the treatment of other mood disorders, to relieve chronic nerve-related pain, to reduce bed-wetting, to manage obsessive compulsive behaviors, and to prevent migraines. They are dangerous drugs as defined in Business and Professions Code

(continued ... )

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1 27. On May 16, 2012, and August 1, 2012, Respondent prescribed 120 tab~ets·ofNorco

2 10-325 mg, 30 tablets ofXanax 0.5 mg, 60 tablets of Anaprox 550 mg, and 60 capsules of

3 Prilosec 20 mg.

4 28. On June 20, 2012, Respondent prescribed 120 tablets ofNorco 10-325 mg, 30 tablets

5 ofXanax 0.5 mg, 60 tablets of Anaprox 550 mg, 60 capsules ofPrilosec 20 mg, and 10 capsules

6 ofPamelor 10 mg (2 refills).

7 29. On September 5, 2012, Respondent prescribed 30 tablets ofXanax 0.5 mg, 60

8 capsules ofPrilosec 20 mg, and 90 tablets ofTylenol3 (APAP/Codeine) 300-30 mg.6

9 30. On October 5, 2012, Dr. J.K. did an initial "Pain Management Consultation" that was

10 incomplete. He left out symptoms and a neurological exam, but agreed with Respondent's I

11 referral request for lumbar facet blocks. Dr. J.K. only reviewed Respondent's records.

12 31. On December 21; 2012, Respondent reported "no focal neurologic findings were

13 identified." He recommended pain management, which is arbitrary in light of the very good

14 exam and surgical result. Instead, Respondent continued to prescribe drugs for years without a

15 single reassessment of the diagnosis or need for Norco, much less five drugs. R.S.R. should have

16 been discharged with the excellent exam reported by Respondent, but instead R.S.R. was

17 continued indefinitely in the practice and now on five drugs.

18 32. On December 21, 2012, Respondent prescribed 120 tablets ofNorco 10-325 mg, 30

19 tablets ofXanax 0.5 mg, 60 tablets of Anaprox 550 mg, and 60 capsules ofPrilosec 20 mg.

20 33. A March 1, 2013, progress note is a typical note indicating the patient had ongoing

21

22

23

24

25

26

27

28

complaints of the neck, low back, and into the extremities, but did not have focal findings or any

( ... continued) section 4022.

Hydromorphone (Dilaudid) is an opioid pain medication. It is a Schedule II controlled substance as defined by section 1308.12, subdivision (b)(l)(vii) ofTitle 21 ofthe Code ofFederal Regulations and Health and Safety Code section 11055, subdivision (b )(1 )(J). It is a dangerous drug as defined in Business and Professions Code section 4022.

6 Tylenol with Codeine #3 is acetaminophen and codeine. Codeine is an opioid pain medication. Acetaminophen is a less potent pain reliever that increases the effects of codeine. Acetaminophen and codeine is a combination medicine used to relieve moderate .to severe pain. It is a Schedule III controlled substance as defined by 1308.13(e)(1) of Title 21 of the Code of Federal Regulations and Health and Safety Code section 11056, subdivisions (e)(l) and (e)(2). It is a dangerous drug as defined in Business and Professions Code section 4022.

15


1 complication from the surgical intervention now two years after the surgery.

2 34. On March 1, 2013, April 5, 2013, June 19, 2013, and September 4, 2013, Respondent

3 prescribed 90 tablets ofNorco 10-325 mg, 30 tablets ofXanax 0.5 mg, 60 tablets of Anaprox 550

4 mg, and 60 capsules of Prilosec 20 mg.

5 35. On July 31, 2013, October of2013, November 13, 2013, December 17, 2013,

6 February 3, 2014, April 9, 2014, and June 9, 2014, Respondent prescribed 90 tablets ofNorco 10-

7 325 mg; 30 tablets ofXanax 0.5 mg, 60 tablets of Anaprox 550 mg, and 60 tablets ofProtonix 20

8 mg.

9 36. Electrodiagnostic testing on or about August 27, 2013, showed no evidence of

10 cervical radiculopathy in the upper extremities. Therefore, there was no basis for narcotics.

11 37. · On October 16, 2013, R.S.R. was still receiving treatment from Respondent. Since

12 the electrodiagnostic testing, Respondent dropped the radiculopathy diagnosis. However, there is

13 no discussion in the medical record of whether the extremity symptoms should now be

14 questioned. R.S.R. had neck and back symptoms and two more new symptoms-hands and knees.

15 These symptoms do not justify narcotics or even specialty care, but it continued. A workup or

16 reassessment would be in order for these new joint symptoms and hand complaints, but no

17 reassessment for diagnosis or need for narcotics was found in R.S.R. 's medical records.

18 38. By December 2, 2013, R.S.R.'s symptoms became so widespread as to lack any

19 credibility. Respondent noted "numerous complaints of headaches, problems with his eyes, pain

20 in his anterior chest and shoulder." Respondent also noted throbbing in R.S.R.'s arms and painful

21 jaw. He continued prescribing drugs to R.S.R.

22 39. On June 20, 2014, the four-year anniversary of the patient's incident, R.S.R. had

23 complaints concerning all four extremities. He was on five drugs including Xanax, Pamelor,

24 Prisolec, Naprosyn, and Norco. Ifvalid, this suggests a neurological disease process. If not, it is

25 drug-seeking behavior. Respondent should have perforrp.ed a workup or reassessment for these

26 new symptoms, but none was found in R.S.R. 's medical records. Instead, R.S.R. was seen for a

27 six-month follow up for drugs, which was an ongoing plan. R.S.R. pointed out that the drugs

28 were not as effective as before. There still was no reassessment of the treatment plan.

16


1 40. On July 11, 2014, August 13, 2014, September 11, 2014, and October 15, 2014,

2 Respondent prescribed 90 tablets ofNorco 10-325 mg, 60 tablets of Anaprox 550 mg, and 60

3 tablets ofProtonix 20 mg.

4 41. On July 23, 2014, and August 15, 2014, Respondent prescribed 30 tablets ofXanax

5 0.5 mg.

6 42. A September 16, 2014, cervical magnetic resonance imaging ("MRI") scan showed a

7 solid fusion and no other specific abnormalities that would be expected to be a source of-

8 discomfort.

9 43. On December 15, 2014, and January 21, 2015, Respondent prescribed 90 tablets of

10 Norco 10-325 mg and 30 tablets ofXanax 0.5 mg.

11 44. R.S.R. became pe~anent and stationary in January 2015.

12 45. Respondent engaged in an extreme departure from the standard of care with respect to

13 R.S.R.'s care and treatment when he issued years of prescriptions with no significant changes

14 from year to year, prescribed multiple drugs, renewed prescriptions without any corroborating

15 findings, failed to address inconsistent and changing complaints, made no effort to reduce or

16 eliminate prescription drugs, and had no treatment plan with objectives and an endpoint.

17 Patient S.S.

18 46. On January 8, 2010, S.S., a fifty-nine-year-old female, tripped when her shoe became

19 caught on a broken tile. She did not fall. S.S. was able to break her fall with her forearms against

20 a copier machine, but felt her whole body j~rk. She had back, right hip, and right knee pain.

21 4 7. Respondent first saw her on October 22, 2010, for an orthopedic .surgical

22 consultation. He assessed her with right hip degenerative disease, L3-4 moderate stenosis, and

23 right L4 radicrilopathy, with hip flexor weakness and radiculopathy; He prescribed her Celebrex

24 200 mg and Norco extra strength.

25 48. On January 19, 2011, Respondent prescribed 90 tablets ofVicodin 7.5/750 mg (3

26 refills).

27 49. On April4, 2011, Respondent prescribed 90 tablets ofNorco 10-325 mg, 120 tablets

28 ofMotrin 800 mg, and 60 tablets ofPrilosec 20 mg.

17


1 50. On April27, 2011, Dr. T.D., a joint replacement specialist evaluated S.S. He

2 diagnosed her with possible labral tear of the right hip versus arthritis and multiple lumbar disk \

3 degenerative arthritis. An x-ray dated April27, 2011, showed early degenerative arthritis in the

4 right hip, On or about September22, 2011, S.S. underwent right hip surgery with Dr. T.D.

5 51. Respondent continued to follow S.S. for chronic low back pain. Despite the consult

6 with Dr. T.D. and an MRI showing more left-sided fmdings, Respondent did not modify S.S.'s

7 drug program and did not reassess her diagnosis or treatment plan. He continued to prescribe her

8 medications, including Norco, Ibuprofen, and Prilosec.

9 52. On July 20, 2011, October 9, 2011, and December 7, 2011, Respondent prescribed 90

10 tablets ofNorco 10-325 mg, 90 tablets ofMotrin 800 mg, and 60 tablets ofPrilosec 20 mg.

11 53. On August 24, 2011, and November 9, 2011, Respondent prescribed 90 tablets of

12 Norco 10-325 mg and 90 tablets ofMotrin 800 mg.

13 54. On January 6, 2012, Dr. J.K. provided a "Pain Management Consultation" that merely

14 recommended the procedure Respondent requested, namely a lumbar epidural injection. Dr. J.K.

15 only reviewed Respondent's records. Dr. J.K. noted diabetes, which is a common source of

16 musculoskeletal complaint, but it was not addressed by Respondent.

17 55. On January 12, 2012, in a written report, Respondent addressed an outside consult by

18 Dr. P .S., who noted there was no surgical low back or hip problem. Respondent disagreed with

19 ·Dr. P.S .. 's hip assessment, but acknowledged the hip is better. In contrast, he did not acknowledge

20 Dr. P.S.'s spine opinion. Respondent ordered an epidural and more narcotics, as ifhe ignored the

21 spine discussion. Those omissions are critical as it is Respondent's unsupported spine diagnosis

22 that served as the basis for years of additional narcotics.

23 56. . On January 6, 2012, February 29, 2012, March 28, 2012, May 23, 2012, October 4,

24 2012, November 16, 2012, December 14, 2012, Respondent prescribed 90 tablets ofNorco 10-

25 325 mg, 90 tablets ofMotrin 800 mg, and 60 tablets ofPrilosec 20 mg.

26 57. On Feblllary 1, 2012, April25, 2012, July 20, 2012, September 19, 2012, Respondent

27 prescribed 90 tablets ofNorco 10-325 mg and 90 tablets ofMotrin 800 mg.

28 58. On June 22, 2012, Respondent prescribed 90 tablets ofNorco 10-325 mg, 90 tablets of

18


1 Motrin 800 mg, and 90 tablets ofPrilosec 20 mg.

2 59. On August 17, 2012, Respondent prescribed 90 tablets ofNorco 10-325 mg and 90

3 tablets ofPrilosec 20 mg.

4 60. On November 16, 2012, a drug screen was administered and was positive for opiates,

5 oxycodone, and tricyclic antidepressants.7 S.S. was on narcotics two and one half years after the

6 January 8, 2010, incident and after two lumbar MRl scans (dated April2, 2012, and August 20,

7 2012) that discredit the right leg radiculopathy, as there are more findings on the left side that is

8 asymptomatic. Respondent never discussed this inconsistency. He also did not reassess the

9 treatment plan with specific goals or an endpoint. ·

10 61. S.S. was still on narcotics in 2013. On January 11, 2013, February 8, 2013, March 8,

11 2013, April 5, 2013, and May 3, 2013, May 31, 2013, June 28, 2013, Respondent prescribed 90

12 tablets ofNorco 10-325 mg, 90 tablets ofMotrin 800 mg, and 60 capsules ofPrilosec 20 mg.

13 62. On August 2, 2013, Respondent prescribed 60 tablets ofLyrica 75 mg (4 refills),

14 Voltaren 1% (4 refills), 90 tablets ofNorco 10-325 mg (4 refills).8

15 63. On August 27, 2013 and September 25, 2013, Respondent prescribed 180 tablets of

16 Norco 10-325 mg. On September 25, 2013, Respondent prescribed 180 tablets of

17 Hydrocodone/Acetaminophen 10-325 mg (3 refills). On October 9, 2013, Respondent prescribed

18 180 tablets ofOxycodone 10 mg. On November 13, 2013, Respondent prescribed 36 tablets of

19 Oxycodone 10 mg.

20 64. On March 8, 2013, S.S. complained of constant low back pain into both lower

21 extremities. She was on Motrin, Norco, Prilosec, and Lyrica. The physical examination showed

22 decreased sensation in multiple dermatomes, right L3, L4, and L5. Motor strength showed some

23 flexion weakness of the right hip; otherwise, it was intact. The assessment was now "severe"

24

25

26

27

28

7 Oxycodone (OxyContin) is an opioid pain medication. It is a Schedule II controlled substance as defined by section 1308.12, subdivision (b)(1)(xiii) ofTitle 21 ofthe Code of Federal Regulations and Health and Safety Code section 11055, subdivision (b)(l)(M). It is a dangerous drug as defined in Business and Professions Code section 4022.

8 Lyrica (Pregabalin) is an anti-epileptic drug, also called an anticonvulsant. It is a Schedule V controlled substance as defined by 1308.15(e)(4) ofTitle 21 ofthe Code ofFederal Regulations. It is a dangerous drug as defined in Business and Professions Code section 4022.

19


1 right L3-4 and moderate left-sided neural foramina! stenosis and central stenosis, degenerative

2 disk disease at L4-5 and 5 mm left paracentral extrusion at L5-S1 with degeneration of the

3 sacroiliac joints and the right hip. The plan was to continue medications.

4 65. On January 3, 2014, which is four years after S.S.'s slip without fall, physician

5 assistant J.L. noted that another doctor took her off narcotics. He puts her back on Norco without

6 explanation. Specifically, he prescribed Norco 10/325 mg for breakthrough pain. He did not

7 perform a physical examination. Respondent reviewed, signed, and dated the progress note.

8 66. On January 3, 2014, 10 Fentanyl patch 25 meg, 30 tablets ofNorco 10-325 mg (2

9 refills), and Voltaren Gel (3 boxes) (2 refills) were prescribed by Respondent. On February 4,

10 2014, Respondent prescribed 10 Fentanyl patch 25 mcg.9

11 67. On February 7, 2014, Respondent evaluated S.S. for a Permanent and Stationary

12 report. He believes she is on Fentanyl patches only. She tells him she wants to begin using

13 Norco, even though it was already prescribed. The right lower extremity neurological exam

14 normalized. Nevertheless, Respondent prescribed six Norco a day. Specifically, he prescribed

15 180 tablets ofNorco 10-325 mg (3 refills). He failed to justify the prescription. He also failed to

16 address this strong suggestion of drug-seeking behavior.

17 68. Respondent calls the lumbar disorder simple bulging disks from a July 27, 2010,

18 computerized tomography ("CT") scan, missing the interim MRI scans. However, later in the

19 report, those scans and other information that was inserted in prior reports is repeated here

20 without comment. Respondent also states the sensory exam is intact when there have been three

21 sensory dermatomes in the prior exams. None of these inconsistencies are acknowledged or

22 discussed as if the report was based on a cursory assessment. The record review was so poor that.

23 physician assistantJ.L. and Respondent had different understandings about the usage ofNorco

24 within a month of each other.

25

26

27

28

9 A Fentanyl Patch is a narcotic pain medicine. Fentanyl is used for managing severe chronic pain. Fentanyl is a Schedule II controlled substance as defined by section 1308.12, subdivision (c)(9) of Title 21 of the Code ofFederal Regulations and Health and Safety Code section 11055, subdivision (c)(8). It is a dangerous drug as defined in Business and Professions Code section 4022.

20


1 69. On May 30, 2014, S.S. was seen for follow up. She was having pain after lap band

2 surgery and continued to be treated conservatively. The sensory exam remained normal in the

3 lower extremities. She was post gastric banding (July 30, 2013); had degenerative low back

4 disease; had degenerative disease of the right hip and the sacroiliac joints; and was status post

5 right hip surgery (September 22, 2011). The plan was to continue S.S. on narcotics with no

6 endpoint. Respondent ordered 1 0 Fentanyl patch 25 meg.

7 70. On July 2, 2014 and July 30, 2014, Respondent prescribed 10 Fentanyl patch 25 meg.

8 71. Respondent treated S.S. until on or about November 4, 2014.


10 S.S.'s care and treatment when he issued years of prescriptions with no significant changes from

11 year to year, prescribed multiple drugs, renewed prescriptions without any corroborating findings,

12 failed to address inconsistent and changing complaints, made no effort to reduce or eliminate

13 prescription drugs, and had no treatment plan with objectives and an endpoint.

14 Patient J.B.

15 73. On July 7, 2011, J.B., a fifty-four-year-old male, was involved in a head-on collision

16 while employed as a driver. The collision resulted in two fatalities. On or about January 20,

17 2012, Respondent began treating J.B. At the time, J.B. was already on six medications including

18 Lexapro, Vicodin, Xanax, Fioricet, Temazepam, Tramadol, and Nabumetone. 10

19 74. On March 30, 2012, Dr. J.K. provided a "Pain Management Consultation." He only

20 reviewed Respondent's records. He provided an incomplete assessment, noting a decreased left

21 triceps reflex, but no motor or sensory testing. He recommended cervical epidural injections. He

22 did not discuss medications.

23 75. On May 31, 2012, Respondent prescribed 45 tablets ofXanax .5 mg.

24

25

26

27

28

10 Lexapro (Escitalopram) is an antidepressant. It is a dangerous drug as defined in Business and Professions Code section 4022.

Fiorcet contains a combination of acetaminophen, butalbital, and caffeine. It is used to treat tension headaches that are caused by muscle contractions. It is a dangerous drug as defined in Business and Professions Code section 4022.

Tramadol (Ultram) is a narcotic-like pain reliever. It is a Schedule IV controlled substance as defined by section 1308.14(b)(3) of Title 21 ofthe Code ofFederal Regulations. It is a dangerous drug as defined in Business and Professions Code section 4022.

21


1 76. On July 19, 2012, and August 22, 2012, Respondent prescribed 30 tablets of

2 Sumatriptan 50 mg.U

3 77. On August 3, 2012, Respondent prescribed 60 tablets of Anaprox DS 550 mg, 60

4 tablets ofPrilosec 20 mg, 30 capsules ofRestoril30 mg, 60 tablets ofUltram 50 mg, 120 tablets

5 ofVicodin 5-500 mg, and 30 tablets ofXanax .5 mg.

6 78. On September 15, 2012, October 4, 2012, November 14, 2012, January 23, 2013, and

7 · March 20, 2013, Respondent prescribed 60 tablets of Anaprox DS 550 mg, 90 tablets ofNorco

8 10-325 mg, 60 tablets ofPrilosec 20 mg, 30 capsules ofRestoril30 mg, 60 tab~ets ofUltram 50

9 mg, and 30 tablets ofXanax .5 mg. On November 14, 2012, Respondent also prescribed 30

10 tablets ofPhenergan 25 mg (one refill). On January 23, 2013, and March 20, 2013, Respondent

11 also prescribed 60 tablets of Zanaflex 4 mg. 12

12 79. Dr. D.K. provided second opinions on October 11, 2012, and November 8, 2012. In

13 his consult, he noted only neck and low back pain, but nothing radicular from the neck. However,

14 in the physical examination he noted a different exam, as now the biceps reflex changed and there

15 · was numbness in the left thumb, index, and long fingers dorsal and volar. He disputed the need

16 for the C7-T1level, but agreed with C5-7. T~at level was included in the surgery based on a

17 disco gram, but drugs were still required long after surgery.

18 80. On November 15, 2012, Dr. V.S., a psychiatrist saw J.B. Dr. V.S. found multiple

19 psychiatric conditions from the head-on collision. Dr. V.S. pointed out this was difficult to treat.

20 J.B. was on eight drugs including Norco. Dr. V.S. endorsed Respondent continuing to provide

21 psychotropic drugs along with psychotherapy. He recommended that a neurologist assess the

22 upper extremities.

23 81. On February 20,2013, Respondent prescribed 30 tablets ofZolpidem Tartrate CR

24

25

26

27

28

11 Sumatriptan (Imitrix 50) is a serotonin 5-HT1 receptor agonist. It is a medication used for the treatment of migraine and cluster headaches. It is a dangerous drug as defined in Business. and Professions Code section 4022.

12 Zanaflex (Tizanidine) is a short-acting muscle relaxer. Phenergan (Promethazine) is used to prevent and treat nausea and vomiting related to certain conditions-(such as before/after surgery, motion sickness). It is also used to treat allergy symptoms such as rash, itching, and runny nose. They are dangerous drugs as defined in Business and Professions Code section 4022.

22


1 12.5 mg. 13

2 82. On February 26, 2013, Dr. R.L. conducted electrodiagnostics. It was normal in the

3 upper and lower extremities.

4 83. On May 29,2013, June 21,2013, July 31,2013, August 30,2013, October 30,2013,

5 and November 27,2013, Respondent prescribed 90 tablets ofOxycontin 30 mg. On June 21,

6 2013, Respondent also prescribed 90 tablets Xanax 0.5 mg.

7 84. On May 1, 2013, Dr. D.K. again disputed the need for C7-T1 fusion.

8 85. On July 1, 2013, Dr.I.L. performed a neurology assessment for headaches. He noted

9 numbness in both hands' first three digits. He diagnosed J.B. with carpal tunnel syndrome,

10 clinically making it two consultants who disputed Respondent's planned three-level fusion.

11 86. Respondent did then recommend Discography with which Dr. D.K. agreed. Dr. D.K.

12 indicated the report was positive. The three level surgery was done in February of2014.

13 87. On September 25, 2013, Respondent prescribed 60 tablets of Anaprox DS 550 mg, 90

14 tablets ofNorco 10-325 mg, 60 tablets ofProtonix 20 mg, 30 capsules ofRestoril30 mg, 60

15 tablets ofUltram 50 mg, 30 tablets ofXanax .5 mg, and 60 tablets ofZanaflex 4 mg.

16 88. On October 4, 2013, J.B. underwent a left knee arthroscopy with partial

17 meniscectomy and chondroplasty.

18 89. A January 2014 progress note prepared by physician assistant J.L. shows that J.B. had

19

20

21

22

23

24

25

26

27

28

undergone postoperative therapy for the left knee pending psychological clearance for the C5-T1

anterior cervical discectomy and fusion. J.B. 's complaints were neck pain, low back pain, and left

knee pain. There was no indication of any radicular symptoms in the upper or lower extremities.

He was on nine drugs including OxyContin, Zanaflex, Norco, and Imitrex. The physical

examination was limited to the knees only. The diagnoses were left C6-7 radiculopathy, L3-L5

disk and facet changes, disk degeneration at C5-T1 with stenosis, and status post left knee surgery

on October 4, 2013. J.B. was temporarily disabled and he was to continue drugs and follow up.

13 Zolpidem (Ambien) is a sedative. It is a Schedule IV controlled substance as defined by section 1308.14(c)(54) of Title 21 ofthe Code ofFederal Regulations and Health and Safety Code section 11057, subdivision (c)(32). It is a dangerous drug as defined in Business and Professions Code section 4022.

23


1 90. On February 5, 2014, J.B. had a preoperative education visit with Respondent. They

2 went over the procedure in detail. There was no physical examination or symptoms listed.

3 91. On February 19, 2014, Respondent performed an anterior cervical discectomy and

4 fusion from C5-T1 on J.B. However, J.B. still had 8 out of 10 pain. One year after the surgery,

5 J.B. was still requiring pain management so the surgery benefit was questionable. There was no

6 discussion as to why he needed narcotics if the surgery was indicated and effective. There was no

7 reassessment for alternative explanations for the ongoing symptoms and multiple drug

8 requirements.

9 92. On February 21, 2014, Respondent prescribed 180 tablets ofOxycodone 10 mg.

10 93. On February 25, 2014, April2, 2014, May 14, 2014, June 13, 2014, July 3, 2014,

11 August 15,2014, and September 24,2014, Respondent prescribed 90 tablets ofOxycontin 30 mg.

12 94. On November 14, 2014, there was a conference with physician assistant M.L. and

13 Dr. M. who wanted J.B. weaned offofnarcotics. J.B. was not weaned.

14 95. On December 3, 2014, Respondent prescribed 60 tablets ofOxycontin 30 mg, 120

15 tablets ofNorco 10-325 mg, 60 tablets ofPantoprazole, 30 capsules ofDuloxetine 60 mg, 60

16 tablets ofTizanidine 4 mg, 90 tablets of Alprazolam 0.5 mg, and 30 capsules ofTemazepam 30

17 mg. 14

18 96. On January 15, 2015, Respondent prescribed 100 tablets ofNorco 10-325 mg.

19 97. On February 18, 2015, Respondent prescribed 100 tablets ofNorco 10-325 mg and 90

20 tablets of Zanaflex 4 mg.

21 98. One year postop on or about February 28, 2015, J.B. was undergoing pain

22 management for the lumbar and cervical medial branch block. There was decreased sensation of

23 the C4, 5, 6, 7, 8, and T1 dermatomes. The side was not specified. A motor power examination

24 showed decrease on both sides in shoulders, elbows, and wrists. Symmetrical reflexes were

25

26

27

28

14 Duloxetine (Cymbalta) is a selective serotonin and norepinephrine reuptake inhibitor antidepressant. It is used to treat major depressive disorder, general anxiety disorder, fibromyalgia (a chronic pain disorder), chronic muscle or joint pain (such as low back pain and osteoarthritis pain), and pain caused by nerve damage in adults with diabetes (diabetic neuropathy). It is a dangerous drug as defined in Business and Professions Code section 4022.

24


1 noted. He was totally disabled. There was no discussion about the high number of dermatomes

2 which is more suggestive of a neurological disease, not a disk issue. Moreover, this disappeared

3 five months later without explanation. This is more evidence of cursory engagement with the

4 medical evidence by Respondent where he also completely overlooks a surgical knee disorder.

5 99. On July 15, 2015, J.B. reported for a follow up evaluation. He did not have the

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

medial branch blocks. He had ongoing complaints of back pain and left knee pain. There is no

description of any radicular symptoms in his medical records. The physical examination showed

motor and sensory was intact. Respondent still recommended the medial branch blocks in the . I

area ofthe surgery from C6-T1 and renewal ofprescriptions without quantities. J.B. was still

totally disabled until August 26, 2015.

100. On August 19, 2015, it was noted J.B. had a fall because the left knee collapsed and

was now affecting the right knee. Therapy was prescribed.

101. On August 19, 2015, Respondent prescribed medications including 30 tablets of

Restori130 mg (2 refills), 100 tablets ofNorco 10-325 mg, 30 tablets ofXanax 0.5 mg, and 30

tablets of Cymbalta 60 mg.

102. On September 16, 2015, Respondent prescribed 30 tablets of Ambien 10 mg and 100

tablets ofNorco 10-325 mg.

103. On September 24, 2015, J.B. underwent facet block injections from C7-Tl.

104. On August 24, 2015, J.B. was still on Norco and seven other drugs when seen by Dr.

D.K. for a reevaluation. His neck pain did not change, but the neuro exam now was more ulnar

rather than median or cervical. Dr. D.K. chose not to discuss this new finding that supports the

neurologist who called this peripheral neuropathy not radiculopathy in the first place. He also

pointed out that a knee meniscal tear had been overlooked. That meniscal tear was never

addressed by Respondent and could be a significant source of pain.

105. On September 18, 2015, Dr. V.S. performed a psychiatric reevaluation. He withdrew

the endorsement for Respondent to provide psychiatric medications and stated that a psychiatrist

needed to. provide them based on disjointed treatment. J.B. had turned to alcohol and lost weight.

106. Respondent engaged in an extreme departure from the standard of care with respect to

25


1 J.B. 'scare and treatment when he issued years of prescriptions with no significant changes from

2 year to year, prescribed multiple drugs, changed findings suggesting a neuropathy (both median

3 and ulnar nerves clinically but overlooked by Respondent), made no effort to wean or change to

4 non-narcotic treatment even when recommended in November of2014, made inconsistent

5 findings, failed to address inconsistent and changing complaints, and had no treatment plan with

6 objectives and an endpoint.

7 Patient M.A.

8 107. On November 6, 2009, M.A., a fifty-two year-old female, was lifting beer boxes from

9 one pallet to another while working. Approximately two days later, she felt pain in her right

10 shoulder, upper arm, right hand, and neck. She reported this pain to her employer as an injury.

11 She left work with multiple symptoms in April of 2011 that she assumed were from the 2009

12 incident, but were probably diabetic peripheral neuropathy.

13 108. On or about August 13, 2010, Respondent first saw M.A. He evaluated her, identified

14 her as having right shoulder derangement, and recommended that she undergo injections of the

15 right shoulder. Respondent prescribed 120 tablets ofNorco 10-325 mg.

16 109. On May 6, 2011 and June 30,2011, Dr. M.D. and Dr. T.H., orthopedic surgeons,

17 evaluated M.A. and did not find anything wrong with her right shoulder. Neither found any

18 condition that would justify prescription medications. M.A. nevertheless was taking Norco four

19 times per day and Naprosyn.

20 110. On November 25, 2011, M.A. had a cervical MRI that was negative for an injury.

21 The electrodiagnostics show M.A. had severe carpal tunnel syndrome, which establishes that she

22 did not have an injury, but instead had peripheral neuropathy. It was likely related to diabetes

23 with her family history or other medical condition.

24 111. Instead of acknowledging M.A. did not have an industrial injury and referring M.A. to

25 her private medical doctor for evaluation and treatment, Respondent chose to disregard this

26 evidence and kept her in the industrial program in his office with narcotics when what she needed

27 was insulin. This is a departure from the standard of care.

28 112. On December 17, 2010, June 10, 2011, July 6, 2011, and August 17, 2011,

26


1 Respondent prescribed 120 tablets ofVicodin 5-500 mg, 60 capsules ofPrisolec 20 mg, 60 tablets

2 of Ailaprox 50 mg.

3 113. On January 19, 2011, Respondent prescribed 120 tablets ofNorco 10-325 mg, 60

4 capsule~ ofPrisolec 20 mg, 60 tablets of Anaprox 550 mg, and Medrox 60 gm.

5 114. On December 9, 2011, Respondent prescribed 120 tablets ofNorco 10-325 mg, 90

6 . tablets ofMotrin 800 mg, and 60 capsules ofPrisolec 20 mg.·

7 115. On January 9, 2012, Dr. K.D. conducted electrodiagnostics that showed evidence of

8 peripheral neuropathy, not a cervical or shoulder problem. Respondent missed those fmdings.

9 M.A. was taking Anaprox, migraine medication, Prilosec, and Vicodin. She now reported pain in

10 both shoulders and hands (right greater than left). The findings were abnormal for bilateral

11 median nerve sensory changes and were consistent with "severe bilateral carpal tunnel syndrome"

12 and "moderate right ulnar neuropathy at the wrist level consistent with Guyon's canal

13 entrapment." The electromyography was normal. Dr. K.D. recommended potential carpal tunnel

14 surgery.

15 116. On January 19, 2012, Respondent requested a medial branch block authorization for a

16 patient who had peripheral neuropathy. The blocks were done on April13, 2012.

17 117. On January 27, 2012, Respondent prescribed 90 tablets ofMotrin 800 mg and 60

18 capsules ofPrisolec 20 mg.

19 118. On February 22, 2012, Dr. V.A.; an orthopedic surgeon, evaluated M.A. and

20 diagnosed her with a wrist flexor tendonitis, but acknowledged carpal tunnel syndrome: on

21 electrodiagnostics. He did not find a significant shoulder disorder. He notes a family history of

22 diabetes. Dr. V.A. reported that M.A. was not on narcotics.

23 119. On March 2, 2012, Dr. J.K. performed a "Pain Management Consultation" for

24 Respondent. Dr. J.K. stated M.A. was on narcotics. He found a painful cervical motion and

25 shoulder and cervical diagnoses. He arranged cervical blocks. On March 2, 2012, Respondent

26 prescribed 120 tablets ofNorco 10-325 mg, 90 tablets ofMotrin 800 mg, and 60 capsules of

27 Prilosec 20 mg without explanation, justification, or acknowledgment that she was not on any

28 medications a week earlier.

27


1 120. On April4, 2012, May 9, 2012, and June 22, 2012, Respondent prescribed 120 tablets

2 ofNorco 10-325 mg, 90 tablets ofMotrin 800 mg, and 60 capsules ofPrilosec 20 mg.

3 121. On or about May 16, 2012, Dr. R.Z., an Agreed Medical Evaluator in orthopedic

4 surgery, evaluated M.A. and reported that she was having ongoing complaints, was disabled, and

5 in need of further right shoulder surgery.

6 122. On July 12, 2012, M.A. was evaluated by Dr. T.G, an orthopedic surgeon. He noted

7 only right shoulder pain and nothing cervical or neurologic. He noted the electrodiagnostics were

8 normal in 2010. This recent change and evidence of peripheral neuropathy, likely diabetic with

9 the family history, was new and can explain symptoms years later, but it was missed by

1 0 Respondent.

11 123. Dr. T.G. diagnosed a rotator cuff tear, which was not present in prior studies or

12 consults. He rec~mmended surgery, but noted he needed an MRl. His physical examination of

13 M.A. showed no neuro findings or true shoulder objectives. M.A. had the surgery on October 17,

14 2012. On November 15,2012, M.A. was only on Zofran for nausea and no narcotics were found

15 necessary by Dr. T.GY

16 124. On August 1, 2012 and September 5, 2012, Respondent prescribed 120 tablets of

17 Norco 10-325 mg, 90 tablets ofMotrin 800 mg, and 30 capsules ofRestoril30 mg.

18 125. On October 10, 2012, Respondent prescribed 120 tablets ofNorco 10-325 mg, 90

19 tablets ofMotrin 800 mg, and 30 tablets ofXanax 10 tng (5 refills).

20 126. On November 21, 2012, Respondent prescribed 120 tablets ofNorco 10-325 mg, 90

21 tablets ofMotrin 800 mg, and 60 tablets ofProtonix 20 mg.

22 127. On January 2, 2013, MA. complained of neck pain into the right shoulder even

23 though she just had shoulder surgery.

24 128. On January 2, 2013, and February 6, 2013, Respondent prescribed 120 tablets of

25 Norco 10-325 mg, 90 tablets ofMotrin 800 mg, 60 capsules ofPrilosec 20 mg, 10 tablets of

26

27

28

15 Zofran (Ondansetron) is a medication used to prevent nausea and vomiting caused by cancer chemotherapy, radiation therapy, or surgery. It is a dangerous drug as defined in Business and Professions Code section 4022.

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1 Zofran 8 mg.

2 129. On February 27, 2013, she underwent a manipulation of the shoulder.

3 130. On March 20, 2013, and May 3, 2013, Respondent prescribed 120 tablets ofNorco

4 10-325 mg, 90 tablets ofMotrin 800 mg, and 60 capsules ofPrilosec 20 mg.

5 131. On May 3, 2013, M.A. had a follow up with Respondent. Respondent missed a

6 Frozen Shoulder diagnosis, a known complication of diabetes, despite the electrodiagnostics and

7 family history. He diagnosed cervical strain and arthropathy along with right shoulder and right

8 hand issues. She was permanent and stationary (per the Agreed Medical Examiner), but

9 Respondent refilled her medications anyway.

10 132. On July 12, 2013, Respondent prescribed 120 tablets ofNorco 10-325 mg, 90 tablets ·

11 ofMotrin 800 mg, 60 tablets ofProtonix 20 mg, and 30 tablets ofXanax 10 mg (4 refills).

12 133. On September 6, 2013, Respondent prescribed 120 tablets ofNorco 10-325 mg, 90

13 tablets of Motrin 800 mg, and 60 tablets of Proto nix 20 mg.

14 134. On October 30, 2013, Respondent prescribed 120 tablets ofNorco 10-325 mg, 90

15 tablets ofMotrin 800 mg, 60 tablets ofProtonix 20 mg, and 30 tablets ofRestoril30 mg.

16 135. On December 6, 2013, per Respondent, M.A. was permanent and stationary and had

17 reached maximum medical improvement. But M.A. had ongoing pain and limitations despite the

18 shoulder surgery and manipulation. Respondent missed the electrodiagnostics suggesting

19 peripheral neuropathy. The physical exam showed decreased sensation in the right upper

20 extremity that was "non-dermatomal," which is not radiculopathy and is more evidence of

21 peripheral neuropathy and diabetes. But Respondent did not consider any other condition other

22 than M.A.'s November 6, 2009 injury. She was on Norco, Motrin, and Protonix.


24 M.A.'s care and treatment when he issued years of prescriptions with no significant changes from

25 year to year, prescribed multiple drugs, re-started her on prescriptions even when she had stopped,

26 and had no treatment plan with objectives and an endpoint. Respondent chose drugs rather than a

27 medical workup for M.A.'s changing complaints, including both shoulders and both hands

28 suggesting more than she was referred for. Respondent sent her to three surgeons before one

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1 would operate on the right shoulder and he still did not consider another source of pain. That

2 surgery was complicated by stiffness and residual pain and Respondent still chose to prescribe

3 drugs rather than get to the source.

4 137. In addition to the above-mentioned departures from the standard of care concerning

5 patient R.S.R., S.S., J.B., and M.A., Respondent also engaged in extreme departures from the

6 standard of care when he failed to monitor drug logs for medications dispensed from his office

7 and failed to set strict policy for monitoring dangerous drugs by at least two staff members to

8 address hundreds of pages of Controlled Substance Utilization Review and Evaluation System

9 ("CURES") activity. During all relevant times, Respondent was a direct dispenser of

10 medications, including controlled substances.

11 138. Respondent's acts and/or omissions as set forth in paragraphs 13 through 137,

12 inclusive above, whether proven individually, jointly, or in any combination thereof, constitute

13 grossly negligent acts pursuant to section 2234, subdivision (b), of the Code. Therefore, cause for

14 discipline exists.

15 SECOND CAUSE FOR DISCIPLINE

16 (Repeated Negligent Acts-Patients R.S.R., S.S., J.B., M.A., T.W., and F.H.)


18 2234, subdivision (c), in that Respondent engaged in repeated negligent acts in the care and

19 treatment of patients R.S.R., S.S., J.B., M.A., T.W., and F.H. The circumstances are as follows:

20 140. The facts and allegations in Paragraphs 13 through 137, above, are incorporated by

21 reference andre-alleged as if fully set forth herein.

22 Patient R.S.R.

23 141. Respondent engaged in a simple departure from the standard of care with respect to

24 R.S.R.'s care and treatment for failing to suspect drug-seeking behavior, for failing to conduct

25 comprehensive reassessments, and for failing to consider alternative medical explanations for the

26 widespread symptoms.

27 Patient S.S.


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1 S.S.'s care and treatment for failing to suspect drug-seeking behavior, for failing to conduct

2 comprehensive reassessments, and for failing to consider alternative medical explanations for the



5 S.S.'s care and treatment for poor record review, lack of thoughtful analysis, and overlooking

6 important medical evidence that Respondent and physician assistant J.L. wrote different narcotic

7 plans within a month of each other.


9 S.S.'s care and treatment for providing narcotics at the patient's request and restarting after

10 another physician had stopped them.

11 Patient J.B.


13 J.B.'s care and treatment for failing to suspect drug-seeking behavior with changing symptoms in

14 a psychiatric patient, for failing to conduct comprehensive reassessments despite ineffective

15 surgery and changing and diffuse symptoms that were answered with more pain management

16 rather than a medical workup, and for failing to consider alternative medical explanations for the



19 J.B.'s care and treatment for poor record review, lack of thoughtful analysis, and overlooking

20 important medical evidence that the knee meniscal tear was never acknowledged.

21 Patient M.A.

22 14 7. Respondent engaged in a simple departure from the standard of care with respect to

23 M.A.'s care and treatment for not suspecting drug-seeking behavior, failing to conduct

24 comprehensive reassessments despite abnormal in-house electrodiagnostics and two consecutive

25 orthopedic surgeons who did not find a significant shoulder disorder, and failing to consider

26 alternative medical explanations for the widespread symptoms when she was referred only for her

27 hand.


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1 M.A.'s care and treatment for poor record review, documentation, and thoughtful analysis that

2 Respondent missed his own in-house electrodiagnostics and seemed unaware that M.A. had been

3 off narcotics according to outside records.

4 Patient F .H.

5 149. On March 4, 2011, Respondent saw F.H., a thirty-four-year-old male nurse, for an

6 orthopedic surgical consultation. F.H. reported that, in June of2009, while working, he was

7 helping lift a patient and he began to experience pain in his right shoulder, elbow, and down to his

8 little finger. He further reported that in September of2009, he began to experience mid and low

9 back pain. F .H.'s complaint at the time of the evaluation was neck pain between the shoulder

10 blades, right shoulder pain down to the little finger, aching in the mid back, and low back pain

11 with burning on the left lower extremity from the buttock to the tailbone. He also had constant

12 pain in the left leg with burning and tingling sensation. Respondent diagnosed him with left leg

13 radiculopathy, right lateral epicondylitis, and history ofL5-S 1 fusion with removal of hardware.

14 He recommended further workup and conservative treatment.

15 150. On April 11, 2011, electrodiagnostics showed evidence of bilateral L5 radiculopathy

16 without evidence of peripheral nerve compression. However, the nerve conduction studies

17 showed that the peroneal nerve had prolongation of the distal motor latencies suggesting

18 peripheral neuropathy. There was no decrease in amplitude. The upper extremities revealed

19 evidence of a carpal tunnel syndrome mid bilaterally, but no cervical radiculopathy. Therefore,

20 the electrical studies suggested median nerves in the upper extremities and peroneal nerves in the

21 lower extremities, which could indicate a peripheral neuropathy - this was missed by Respondent

22 who only considered the injury and not medical conditions that can cause peripheral neuropathy.

23 151. On October 12, 2011, Respondent prescribed 120 tablets ofNorco 10-325 mg (3

24 refills), 60 tablets of Zanaflex 4 mg (3 refills), and 60 tablets of Anaprox 550 mg (3 refills).

25 152. On December 7, 2011, F .H. underwent an MRl of the thoracic spine showing no

26 specific abnormalities.

27 153. On January 4, 2012, Respondent evaluated F.H. The diagnosis was right lateral

28 epicondylitis, right cervical radiculopathy, history ofL5-S 1 fusion with hardware removal, and

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1 left leg radiculopathy. There was no discussion of the electrodiagnostic testing suggesting a

2 peripheral neuropathy involving the median nerves.

3 154. On January 4, 2012, Respondent prescribed 120 tablets ofNorco 10-325 mg (5

4 refills), 30 tablets ofProzac 40 mg (5 refills), 60 capsules ofPrilosec 20 mg (5 refills), 60 tablets

5 of Anaprox 550 mg (5 refills), and Tizandine 4 mg (5 refills). 16

6 155. On or about February 3, 2012, F.H. underwent aCT of the lumbar spine. The history

7 showed F.H. had an injury on October 5, 2010, with a prior lumbar surgery in 2003. The October

8 5, 2010, incident was a lifting injury. The study shows a disk spacer construct at L5-S1 with

9 bilateral vacuum disk phenomenon. There is no evidence for fusion at L4-5 or L5-S1 posterior

10 elements and, therefore, a pseudoarthrosis is present. There is also moderate to severe bilateral

11 neural foramina! narrowing at L5-S 1 due to a pars defect with a grade 1-2 7 mm anterolisthesis of

12 L5 and Sl.

13 156. On April17, 2012, Respondent drained a lumbar wound hematoma. He noted F.H.

14 had undergone an L4-5 transforaminallumbar inter body fusion with a drain placed, but F .H. did

15 have postoperative drainage. F .H. underwent an irrigation and debridement. There was no

16 evidence of infection.

17 157. On February 8, 2012, Respondent prescribed 30 tablets ofProzac 80 mg (5 refills).

18 158. In or around March of2012, Respondent performed back surgery on F.H.

19 159. On or about April15, 2012, Respondent prescribed 180 tablets ofDilaudid 8 mg and

20 10 tablets ofBactrim DS. 17

21 160. On May 23, 2012, Respondent prescribed 120 tablets ofNorco 10-325 mg, 140

22

23

24

25

26

27

28

tablets ofDilaudid 4 mg, and 60 tablets of Zanaflex 4 mg.

161. On June 27, 2012 and August 10, 2012, Respondent prescribed 120 tablets ofNorco

10-325 mg and 60 tablets of Zanaflex 4 mg.

16 Prozac (Fluoxetine) is a selective serotonin reuptake inhibitors antidepressant. It is a dangerous drug as defined in Business and Professions Code section 4022.

17 Bactrim DS (Sulfamethoxazole/Trimethoprim) is an antibiotic combination containing a sulfonamide antibiotic. It is used for treating infections caused by certain bacteria. It is also used to prevent certain infections. It is a dangerous drug as defined in Business and Professions Code section 4022.

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1 162. On August 31, 2012, Dr. D.F ., a psychiatrist, evaluated F .H. Dr. D.F. noted that F .H.

2 was under the care of Respondent once a month and was take taking Norco four times a day for

3 five months since his back surgery by Respondent. He noted that F .H. had been treated by

4 psychiatrists off and on since 2006 and three months earlier by Dr. N.L. with medication

5 (Cymbalta). Dr. D.F. concluded that F.H. needed future sessions and medications by a

6 psychiatrist.

7 163. On September 7, 2012, October 5, 2012, November 2, 2012, and November 21,

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

2012, Respondent prescribed 120 tablets ofNorco 10-325 mg and 60 tablets of Zanaflex 4 mg.

164. On November 10,2012, Respondent prescribed Lidoderm 5%, patch, (3 refills). 18

165. January 18, 2013, Respondent prescribed 90 tablets ofNorco 10-325 mg and 60

tablets of Zanaflex 4 mg.

166. On January 25, 2013, Respondent indicated continuing conservative treatment for the

·same diagnosis with renewal of medication. He prescribed Lidoderm 5%, patch, (3 refills). The

last time Respondent saw F.H. was in January of2013.

167. Respondent engaged in a simple departure from the standard of care with respect to

F .H.'s care and treatment for practicing psychiatry and failing to follow Dr. D .F.'s instruction that

prescriptions are to be ordered by a psychiatrist.

168. Respondent engaged in a simple departure from the standard of care with respect to

F.H.'s care and treatment for not considering alternative medical conditions or drug-seeking

behavior in light of positive electrodiagnostics.

Patient T.W.

169. On or about April16, 2013, Respondent saw T.W., a fifty-three-year-old female, for

an initial orthopedic evaluation. He noted that she had a two-year history of low back pain with

involvement of the right flank into the left buttock and right anterior thigh to the knee. She was

on Norco 10-325 mg tablets and Oxycodone Hcl30 mgtablets that had been prescribed by other

physicians. The clinical exam showed hypersensitivity in the right L4 dermatome. Respondent

18 Lidoderm is a local anesthetic (numbing medication). It is a dangerous drug as defined in Business and Professions Code section 4022.

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1 diagnosed her with right leg radiculopathy and right knee internal derangement.

2 170. That same day, Respondent prescribed her 150 tablets ofOxycodone 10 mg, 21

3 tablets of Methylprednisolone 4 mg, and 90 tablets of Oxycontin 10 mg. The prescriptions were

4 filled on April 17, 2013. 19

5 171. On May 21, 2013, physician assistant J.L. had an interaction with T.W. and two other

6 patients wherein he suspected drug-seeking behavior by all three of them. He contacted a

7 pharmacy that T. W. had referenced during their conversation. A CURES report was run on all

8 three patients. The report on T.W. showed that she had received multiple prescriptions from

9 multiple providers and was using multiple pharmacies. As a result, T.W. was discharged from the

10 practice.


12 T.W.'s care and treatment for not suspecting drug-seeking behavior and prescribing two narcotics

13 to a patient who was already on multiple narcotics from other providers. Respondent prescribed

14 the narcotics without reviewing a CURES report. He also prescribed the narcotics to T. W. during

15 the first office visit when the narcotics could have been prescribed during a follow up visit since

16 T.W. had already been prescribed medication and was under care elsewhere.

17 173. Respondent's acts and/or omissions as set forth in paragraphs 1~0 through 172,

18 inclusive above, whether proven individually, jointly, or in any combination thereof, constitute

19 repeated negligent acts pursuant to section 2234, subdivision (c), of the Code. Therefore, cause

20 for discipline exists.

21 THIRD CAUSE FOR DISCIPLINE

22 (Excessive Prescribing-Patients R.S.R., S.S., J.B., M.A., T.W., and F.H.)

23 174. Respondent Darren Lyle Bergey, M.D. is subject to disciplinary action for

24 unprofessional conduct under section 725 of the Code for repeated acts of clearly excessive

25 prescribing of controlled substances. The circumstances are as follows:

26

27

28

· 19 Methylprednisolone (Medrol) is a· steroid that prevents the release of substances in the body that cause inflammation. It is a dangerous drug as defined in Business and Professions Code section 4022.

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1 175. · The facts and allegations in Paragraphs 13 through 137 and Paragraphs 140 through

2 172, above, are incorporated by reference and re-alleged as if fully set forth herein.

3 176. Respondent's acts and/or omissions as set forth in paragraph 175, inclusive above,

4 whether proven individually, jointly, or in any combination thereof, constitute repeated acts of

5 clearly excessive prescribing pursuant to section 725 of the Code. Therefore, cause for discipline

6 exists.

7 FOURTH CAUSE FOR DISCIPLINE

8 (Prescribing Without Exam/Indication-Patients R.S.R., S.S., J.B., M.A., T.W., and F.H.)


10 2242, subdivision (a), of the Code for prescribing, dispensing, or furnishing dangerous drugs

11 without an appropriate prior examination and medical indication. The circumstances are as

12 follows:

13 178. The facts and allegations in Paragraphs 13 through 137 and Paragraphs 140 through


15 179. Respondent's acts and/or omissions as set forth in paragraph 178, inclusive above, I

16 whether proven individually, jointly, or in any combination thereof, constitute prescribing without

17 an appropriate prior examination and medical indication pursuant to section 2242, subdivision (a),

18 of the Code. Therefore, cause for discipline exists.

19 FIFTH CAUSE FOR DISCIPLINE

20 (Inadequate and Inaccurate Recordkeeping)


22 2266 of the Code in that Respondent failed to maintain adequate and accurate medical records.

23 The circumstances are as follows:

24 181. The facts and allegations in Paragraphs 13 through 13 7 and Paragraphs 140 through


26 182. Respondent's acts and/or omissions as set forth in paragraph 181, inclusive above,

27 whether proven individually, jointly, or in any combination thereof, constitute inadequate and

28 inaccurate record keeping pursuant to section 2266 of the Code. Therefore, cause for discipline

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1 exists.

2 SIXTH CAUSE FOR DISCIPLINE

3 (Unprofessional Conduct)

4 183. Respondent is subject to disciplinary action under section 2234 ofthe Code for

5 unprofessional conduct. The circumstances are as follows:

6 184. The facts and allegations in Paragraphs 12 through 182, above, are incorporated by

7 reference and re-alleged as if fully set forth herein.

g. 185. Respondent's acts and/or omissions as set forth in paragraph 184, inclusive above,

9 whether proven individually, jointly, or in any combination thereof, constitute unprofessional

10 conduct pursuant to section 2234 of the Code. Therefore, cause for discipline exists.

11 PRAYER

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

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

14 1. Revoking or suspending Physician's and Surgeon's Certificate Number A 72267,

15 issued to Respondent Darren Lyle Bergey, M.D.;

16 2. Revoking, suspending or denying approval of Respondent Darren Lyle Bergey,

17 M.D.'s authority to supervise physician assistants and advanced practice nurses;

18 3. Ordering Respondent Darren Lyle Bergey, M.D., if placed on probation, to pay the

19 Board the costs of probation monitoring; and

20

21

22

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

23 DATED: ____ J~un==e~1~9~,~2=0~1~7 __ __

24

25

26 LA2017505928

27 62429965

28

KIMBERLY KlRCJ{MEYER 7l Executive Director Medical Board. of California Department of Consumer Affairs State of California Complainant

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XAVIER BECERRA MEDICAL BO;~?;~ ~LIFORNIA SACRAMENTO JONES … Darren... · 2 E. A. JONES III...

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Transcript of XAVIER BECERRA MEDICAL BO;~?;~ ~LIFORNIA SACRAMENTO JONES … Darren... · 2 E. A. JONES III...